CHAPTER 25: CARDIOVASCULAR ALTERATIONS My Nursing Test Banks

CHAPTER 25: CARDIOVASCULAR ALTERATIONS

MULTIPLE CHOICE

1.Cardiac development is fairly complete by how many weeks of gestation?

a.

4

c.

12

b.

8

d.

16

ANS: B

Feedback

A

Incorrect. Cardiac development is nearly complete by 8 weeks of gestation.

B

Correct. Cardiac development is nearly complete by 8 weeks of gestation.

C

Incorrect. Cardiac development is nearly complete by 8 weeks of gestation.

D

Incorrect. Cardiac development is nearly complete by 8 weeks of gestation.

PTS: 1 REF: p. 847 Anatomy and Physiology OBJ: Cognitive Level: Knowledge

2.What is the purpose of the ductus arteriosus while the fetus is developing in utero?

a.

to divert blood from the fetal lungs to the fetal aorta

b.

to circulate blood throughout the fetal body and back to the placenta

c.

to move blood between the various chambers of the fetal heart

d.

to direct blood immediately to the fetal liver

ANS: A

Feedback

A

Correct. The ductus arteriosus (a blood vessel connecting the aorta with the pulmonary artery) is used to divert blood from the fetal lungs to the fetal aorta as the lungs do not participate in gas exchange in utero. This structure usually closes after birth.

B

Incorrect. The ductus arteriosus does not circulate blood throughout the fetal body and back to the placenta. This is the role of the umbilical cord.

C

Incorrect. The ductus arteriosus does not move blood between the various chambers of the fetal heart.

D

Incorrect. The ductus arteriosus does not direct blood immediately to the fetal liver.

PTS:1REF:p. 861 Congestive Heart Failure

OBJ: Cognitive Level: Comprehension

3.Cardiac abnormalities account for what percentage of all congenital malformations?

a.

5%

c.

20%

b.

10%

d.

25%

ANS: D

Feedback

A

Incorrect. Cardiac abnormalities do not account for 5% of all congenital malformations.

B

Incorrect. Cardiac abnormalities do not account for 10% of all congenital malformations.

C

Incorrect. Cardiac abnormalities do not account for 20% of all congenital malformations.

D

Correct. Cardiac abnormalities account for 25% of all congenital malformations.

PTS: 1 REF: p. 847 Anatomy and Physiology OBJ: Cognitive Level: Knowledge

4.Heart size has a correlation that continues into adulthood. The heart is the size of the:

a.

ear

c.

knee

b.

fist

d.

elbow

ANS: B

Feedback

A

Incorrect. The heart is not the size of the ear.

B

Correct. Heart size corresponds with the size of the childs fist; this correlation continues into adulthood.

C

Incorrect. The heart is not the size of the knee.

D

Incorrect. The heart is not the size of the elbow.

PTS:1REF:p. 847 Anatomy and Physiology

OBJ: Cognitive Level: Comprehension

5.After birth the pulmonary artery is the only artery in the body that:

a.

has a high concentration of hemoglobin

c.

carries deoxygenated blood

b.

has a high-pressure vascular bed

d.

returns blood to the heart

ANS: C

Feedback

A

Incorrect. The pulmonary artery carries deoxygenated blood. Since most oxygen carried in the blood is bound to hemoglobin and the pulmonary artery carries deoxygenated blood, it does not have a high concentration of hemoglobin.

B

Incorrect. The pulmonary vascular bed is a low-pressure vascular bed.

C

Correct. After birth the pulmonary artery is the only artery in the body that carries deoxygenated blood. All other arteries including the aorta carry oxygenated blood.

D

Incorrect. The pulmonary artery carries blood from the right ventricle to the lungs for oxygenation. It does not return blood to the heart.

PTS:1REF:p. 847 Anatomy and Physiology

OBJ: Cognitive Level: Comprehension

6.Which of the following calculations determines cardiac output?

a.

heart rate times stroke volume

b.

systolic blood pressure minus the apical heart rate

c.

heart rate at exercise minus heart rate at rest

d.

apical heart rate minus rate of pedal pulse

ANS: A

Feedback

A

Correct. Cardiac output is calculated by multiplying the heart rate by the stroke volume (CO=HR X SV)

B

Incorrect. Cardiac output is not calculated by subtracting the apical heart rate from the systolic blood pressure.

C

Incorrect. Cardiac output is not calculated by subtracting the heart rate at rest from the heart rate at exercise.

D

Incorrect. Cardiac output is not calculated by subtracting the pedal pulse from the apical heart rate.

PTS:1REF:p. 848 Anatomy and Physiology

OBJ: Cognitive Level: Application

7.Which of the following factors determines stroke volume?

a.

size of the heart and size of the heart valves

b.

age of the person and the condition of the heart

c.

preload, afterload, and contractility

d.

blood pressure and hormonal influences

ANS: C

Feedback

A

Incorrect. The size of the heart and size of the heart valves are not factors in determining stroke volume.

B

Incorrect. The age of the person and the condition of the heart are not factors in determining stroke volume.

C

Correct. The determinants of stroke volume are preload, afterload, and contractility.

D

Incorrect. Blood pressure and hormonal influences are not factors in determining stroke volume.

PTS:1REF:p. 848 Anatomy and Physiology

OBJ: Cognitive Level: Comprehension

8.Which of the following indicates the flow of blood in the human body?

a.

flows from an area of lower pressure to an area of higher pressure

b.

takes the path of most resistance and flows from the area of highest pressure to an area of low pressure

c.

goes from higher to lower pressure and takes the path of most resistance

d.

flows from an area of high pressure to an area of low pressure and takes the path of least resistance

ANS: D

Feedback

A

Incorrect. Blood flows in the human body from an area of high pressure to an area of low pressure.

B

Incorrect. Blood flow will take the path of least resistance, not most resistance. It is correct that blood flows from the area of highest pressure to an area of low pressure.

C

Incorrect. Blood flow does go from higher to lower pressure, but it takes the path of least resistance.

D

Correct. Blood flows in the human body from an area of high pressure to an area of low pressure (flowing down hill) and takes the path of least resistance.

PTS:1REF:p. 848 Anatomy and Physiology

OBJ: Cognitive Level: Application

9.The nurse assessing an infant will be most concerned about which of the following findings?

a.

peripheral cyanosis of the hands

c.

cyanosis of the lips or tongue

b.

perioral cyanosis

d.

cyanosis of the feet

ANS: C

Feedback

A

Incorrect. Peripheral cyanosis of the hands is usually caused by instability of the peripheral circulation system typically seen in the young infant and is not a concern. This is called acrocyanosis.

B

Incorrect. The nurse will not be most concerned about perioral cyanosis (cyanosis of the skin around the lips).

C

Correct. The nurse will be most concerned about cyanosis of the lips or tongue. This finding may indicate a cardiovascular alteration. Cyanosis appears when hemoglobin, approximately 5g/dl of blood, circulates unbound to oxygen and the measured oxygen saturation drops below 85%.

D

Incorrect. Cyanosis of the feet is usually caused by instability of the peripheral circulation system typically seen in the young infant and is not a concern. This is called acrocyanosis.

PTS:1REF:p. 849 Anatomy and Physiology

OBJ: Cognitive Level: Application

10.Which of the following terms describes the nurses finding that the angle between the nail and the nail bed of a child has been lost and the fingertips are wider and rounder?

a.

moon nails

c.

notching

b.

angle nails

d.

clubbing

ANS: D

Feedback

A

Incorrect. This is not a description of moon nails.

B

Incorrect. This is not a description of angle nails.

C

Incorrect. This is not a description of notching.

D

Correct. Clubbing is a result of chronic cyanosis with the subsequent development of the loss of the angle between the nail and nailbed. The fingertips eventually become wider and rounder.

PTS: 1 REF: p. 850 Assessment of the Child with a Cardiovascular Alteration

OBJ: Cognitive Level: Comprehension

11.Systolic murmurs are heard best in which of the following locations?

a.

between the first and second heart sounds

b.

in the right chest at the fourth intercostal space

c.

at the sternal border

d.

at the base of the heart

ANS: A

Feedback

A

Correct. Systolic murmurs are heard best between the first and second heart sounds.

B

Incorrect. Systolic murmurs are not heard best in the right chest at the fourth intercostal space.

C

Incorrect. Systolic murmurs are not heard best at the sternal border.

D

Incorrect. Systolic murmurs are not heard best at the base of the heart. The second heart sound is heard best at the base of the heart.

PTS: 1 REF: p. 850 Assessment of the Child with a Cardiovascular Alteration

OBJ: Cognitive Level: Application

12.Systolic murmurs are considered abnormal if they are:

a.

grade I

c.

grade III or greater

b.

grade II

d.

grade 0

ANS: C

Feedback

A

Incorrect. A heart murmur of grade III or less is considered an innocent murmur and is not abnormal.

B

Incorrect. A heart murmur of grade III or less is considered an innocent murmur and is not abnormal

C

Correct. Systolic murmurs are considered abnormal if they are loud and grade III or greater. A grade III is loud but not accompanied by a thrill.

D

Incorrect. A systolic murmur is considered abnormal at grade III or greater. Murmurs are graded based on their intensity from grade I to grade VI, with VI being the most severe. There is not a grade 0.

PTS: 1 REF: p. 850 Assessment of the Child with a Cardiovascular Alteration

OBJ: Cognitive Level: Comprehension

13.Which of the following best describes the quality of an innocent murmur?

a.

bowing and hissing following the second heart sound

b.

soft, short, systolic, and vibratory

c.

high pitched, diastolic, and organic

d.

to and fro, continuous, musical

ANS: B

Feedback

A

Incorrect. Bowing and hissing following the second heart sound are not a description of an innocent murmur.

B

Correct. An innocent murmur is described as soft, short, systolic, and vibratory, indicating there is no structural or functional heart disease. Over 80% of children have innocent murmurs sometime during childhood, most commonly beginning at age 3 or 4 years. Innocent murmurs are accentuated in high output states, especially with fever and anemia.

C

Incorrect. High pitched, diastolic, and organic are not a description of an innocent murmur.

D

Incorrect. To and fro, continuous, musical are not a description of an innocent murmur.

PTS: 1 REF: p. 850 Assessment of the Child with a Cardiovascular Alteration

OBJ: Cognitive Level: Comprehension

14.Which of the following actions would the nurse take when finding an innocent murmur while listening to a childs heart?

a.

Refer the child and mother to a cardiologist.

b.

Advise the caregiver(s) to restrict the childs activity.

c.

Teach the family that this murmur needs no intervention.

d.

Get an order for oxygen, and administer it as soon as possible.

ANS: C

Feedback

A

Incorrect. The nurse would not refer the child and mother to a cardiologist.

B

Incorrect. The nurse would not advise the caregiver(s) to restrict the childs activity.

C

Correct. The nurse would teach the family that this murmur needs no intervention and is not pathological, indicating no structural or functional heart disease.

D

Incorrect. The nurse would not get an order for oxygen, and administer it as soon as possible.

PTS: 1 REF: p. 851 Assessment of the Child with a Cardiovascular Alteration

OBJ: Cognitive Level: Application

15.While assessing a child the nurse finds hepatomegaly. The nurse is aware that this condition is most associated with which of the following?

a.

congestive heart failure

c.

maternal alcoholism

b.

congenital heart defects

d.

prematurity

ANS: A

Feedback

A

Correct. Hepatomegaly is most often associated with congestive heart failure. Inadequate emptying of the heart caused by volume overload or poor contractility results in cardiac failure. This generates an increase in venous volume with a subsequent increase in venous congestion. Systemic venous congestion results in liver engorgement and hepatomegaly.

B

Incorrect. Hepatomegaly is not associated with congenital heart defects.

C

Incorrect. Hepatomegaly is not associated with maternal alcoholism.

D

Incorrect. Hepatomegaly is not associated with prematurity.

PTS: 1 REF: p. 851 Assessment of the Child with a Cardiovascular Alteration

OBJ: Cognitive Level: Comprehension

16.When assessing a child for any possible cardiac anomalies, the nurse takes the right arm blood pressure (BP) and the BP in one of the legs. She finds that the right arm BP is greater than that found in the childs leg. The nurse reacts to these findings in which of the following ways?

a.

charts the findings and realizes they are normal

b.

suspects the child may have coarctation of the aorta

c.

places the child in the Trendelenburg position

d.

notifies the physician and alerts the surgery team

ANS: B

Feedback

A

Incorrect. Theses findings are not normal.

B

Correct. A right arm BP greater than a leg BP is indicative of coarctation of the aorta. Normally lower extremity BP is equal to or greater than arm BP.

C

Incorrect. The definitive treatment for coarctation of the aorta is relief of the obstruction by either surgery or balloon dilation. Placing the child in the Trendelenburg position in an incorrect nursing action.

D

Incorrect. The nurse should notify the physician of the BP findings but would not alert the surgery team since this is not an emergency situation. Treatment of the symptomatic newborn depends on the severity of the coarctation, symptomatology, degree of congestive heart failure, and systemic circulation.

PTS: 1 REF: p. 851 Assessment of the Child with a Cardiovascular Alteration

OBJ: Cognitive Level: Application

17.The nurse is assigned to care for a child who is scheduled for a catheterization for balloon dilation of narrow heart valves. Which of the following is most important for the nurse to do?

a.

Listen to the parents or caregivers fears and concerns and allay fears.

b.

Make certain the child has had nothing to eat or drink for 12 or more hours preceding the surgery.

c.

Ask about any latex allergy the child might have, and notify surgery immediately if there is a latex allergy.

d.

Take a last-minute set of vital signs before the surgery stretcher and staff members come for the child.

ANS: C

Feedback

A

Incorrect. While listening to the parents or caregivers fears and concerns and allaying fears is important, it is not the most important nursing action prior to the catheterization.

B

Incorrect. The child should be NPO for 4 to 6 hours prior to the procedure, but this is not the most important consideration before the procedure.

C

Correct. It is most important for the nurse to ask about any latex allergy the child might have, and notify surgery immediately if such an allergy exists. Some catheters used in the catheterization laboratory have latex balloons. If the child has a latex allergy, use of such a balloon can precipitate a life threatening reaction.

D

Incorrect. Taking a last-minute set of vital signs before the surgery stretcher and staff members come for the child is not the most important nursing action prior to the cath.

PTS: 1 REF: p. 855 Assessment of the Child with a Cardiovascular Alteration

OBJ: Cognitive Level: Application

18.The nurse caring for a child who has had a heart catheterization is aware that the childs activity level is:

a.

unrestricted because this is a minor procedure

b.

restricted to being up and about with no exercise, lifting, or other activity, which would increase heart rate

c.

restricted to sitting in a chair for 4 hours after the procedure

d.

bed rest with the affected extremity straight for 4 to 8 hours, subject to hospital policy and physicians orders

ANS: D

Feedback

A

Incorrect. The childs activity level is restricted. This is not a minor procedure.

B

Incorrect. The childs activity level is not restricted to being up and about with no exercise, lifting, or other activity, which would increase heart rate.

C

Incorrect. The child is not restricted to sitting in a chair for 4 hours after the procedure.

D

Correct. After a heart catheterization the child should be kept in bed with the affected extremity straight for 4 to 8 hours, subject to hospital policy and physicians orders.

PTS: 1 REF: p. 855 Assessment of the Child with a Cardiovascular Alteration

OBJ: Cognitive Level: Application

19.Which of the following conditions is the most common cause of congestive heart failure in infants?

a.

cardiomyopathy

c.

congenital heart disease

b.

endocarditis

d.

myocarditis

ANS: C

Feedback

A

Incorrect. Cardiomyopathy is an acquired heart disease and is one of the most common causes of congestive heart failure in older children or adolescents.

B

Incorrect. Endocarditis is an acquired heart disease and is one of the most common causes of congestive heart failure in older children or adolescents.

C

Correct. Congenital heart disease is the most common cause of congestive heart failure in infants.

D

Incorrect. Myocarditis is an acquired heart disease and is one of the most common causes of congestive heart failure in older children or adolescents.

PTS: 1 REF: p. 855 Assessment of the Child with a Cardiovascular Alteration

OBJ: Cognitive Level: Comprehension

20.The most common cause of congestive heart failure (CHF) in older children is:

a.

acquired heart disease

c.

aortic stenosis

b.

tetralogy of Fallot

d.

congenital valve problems

ANS: A

Feedback

A

Correct. The most common cause of congestive heart failure (CHF) in older children is acquired heart disease.

B

Incorrect. Tetralogy of Fallot is not the most common cause of congestive heart failure (CHF) in older children.

C

Incorrect. Aortic stenosis is not the most common cause of congestive heart failure (CHF) in older children.

D

Incorrect. Congenital valve problems are not the most common cause of congestive heart failure (CHF) in older children.

PTS: 1 REF: p. 855 Assessment of the Child with a Cardiovascular Alteration

OBJ: Cognitive Level: Comprehension

21.The nurse is assessing an infant with congestive heart failure (CHF). The nurse hears rales and rhonchi, observes nasal flaring and restlessness, and finds that the oxygen saturation is falling. What does the nurse most suspect?

a.

The infant has been over-medicated or undermedicated.

b.

There is an increase in lung fluid or a congenital heart defect.

c.

The infant has experienced a spontaneous pneumothorax.

d.

There is an electrolyte imbalance and probably respiratory acidosis.

ANS: B

Feedback

A

Incorrect. Rales and rhonchi, nasal flaring, restlessness, and falling oxygen saturation do not indicate that the infant has been over-medicated or undermedicated.

B

Correct. Rales and rhonchi, nasal flaring, restlessness, and falling oxygen saturation indicate pulmonary congestion or a congenital heart defect. As pulmonary congestion worsens, there is leaking of fluid into the alveoli and interstitium of the lung leading to pulmonary edema.

C

Incorrect. Rales and rhonchi, nasal flaring, restlessness, and falling oxygen saturation do not indicate that the infant has experienced a spontaneous pneumothorax.

D

Incorrect. Rales and rhonchi, nasal flaring, restlessness, and falling oxygen saturation do not indicate that there is an electrolyte imbalance and probably respiratory acidosis.

PTS:1REF:p. 857 Congestive Heart Failure

OBJ: Cognitive Level: Application

22.The nurse is assessing an infant with congestive heart failure (CHF). Which of the following symptoms would the nurse most likely find in this infant?

a.

jugular vein distention

c.

greatly elevated blood pressure

b.

peripheral edema

d.

diaphoresis during feeding

ANS: D

Feedback

A

Incorrect. Jugular vein distention cannot be observed in infants with CHF because of their short necks.

B

Incorrect. Peripheral edema is a rare finding in infants with CHF, but when present, it is usually localized to the periorbital area.

C

Incorrect. The blood pressure is usually maintained in infants with CHF. Hypotension, rather than hypertension, is a late and ominous sign.

D

Correct. An infant with congestive heart failure exhibits diaphoresis during feeding caused by sympathetic stimulation.

PTS:1REF:p. 857 Congestive Heart Failure

OBJ: Cognitive Level: Application

23.Which of the following symptoms would the nurse most likely find in assessing a child with right ventricular failure?

a.

rales and rhonchi, falling oxygen saturation, and labored breathing

b.

falling blood pressure, falling pulse rate, and increased respirations

c.

diaphoresis, nausea and vomiting, and tingling in extremities

d.

hepatomegaly, jugular venous distention, and peripheral edema

ANS: D

Feedback

A

Incorrect. Rales and rhonchi, falling oxygen saturation, and labored breathing indicate pulmonary congestion.

B

Incorrect. Falling blood pressure, falling pulse rate, and increased respirations are not symptoms of right ventricular failure.

C

Incorrect. Diaphoresis, nausea and vomiting, and tingling in extremities are not symptoms of right ventricular failure.

D

Correct. Systemic venous congestion indicates right ventricular failure with symptoms of hepatomegaly, jugular venous distention, and peripheral edema.

PTS:1REF:p. 857 Congestive Heart Failure

OBJ: Cognitive Level: Comprehension

24.Which of the following positions is used to evaluate jugular vein distention in older children?

a.

sitting

c.

lying flat

b.

standing

d.

head slightly elevated

ANS: A

Feedback

A

Correct. In the older child jugular vein distention is evaluated when the child is sitting.

B

Incorrect. In the older child jugular vein distention is not evaluated when the child is standing.

C

Incorrect. Jugular vein distention is not evaluated when the child is lying flat.

D

Incorrect. Jugular vein distention is not evaluated with the childs head slightly elevated.

PTS:1REF:p. 857 Congestive Heart Failure

OBJ: Cognitive Level: Application

25.Which of the following medications is the primary diuretic used in children to treat volume overload?

a.

furosemide (Lasix)

c.

bumetanide (Bumex)

b.

spironolactone (Aldactone)

d.

chlorothiazide (Diuril)

ANS: A

Feedback

A

Correct. Furosemide (Lasix), a potent loop diuretic, is the primary diuretic used in children to treat volume overload.

B

Incorrect. Spironolactone (Aldactone), a potassium sparing diuretic, is a weak diuretic. It is not the primary diuretic used in children to treat volume overload. This class of diuretics may be given with loop diuretics or thiazides to decrease the potential for hypokalemia.

C

Incorrect. Although bumetanide (Bumex) is also a loop diuretic like Lasix, it is not the primary diuretic used in children to treat volume overload.

D

Incorrect. Chlorothiazide (Diuril) is not the primary diuretic used in children to treat volume overload. Thiazides act at the distal renal tubules and are loss potent than loop diuretics such as Lasix. They also cause the kidneys to waste potassium, placing the child at risk for hypokalemia.

PTS:1REF:p. 858 Congestive Heart Failure

OBJ: Cognitive Level: Comprehension

26.The three primary treatments for congestive heart failure are diuretics, afterload-reducing agents, and:

a.

analgesics

c.

inotropes

b.

antibiotics

d.

cortisone

ANS: C

Feedback

A

Incorrect. The three primary treatments for congestive heart failure are diuretics, afterload-reducing agents, but not analgesics.

B

Incorrect. The three primary treatments for congestive heart failure are diuretics, afterload-reducing agents, but not antibiotics.

C

Correct. The three primary treatments for congestive heart failure are diuretics, afterload-reducing agents, and inotropes.

D

Incorrect. The three primary treatments for congestive heart failure are diuretics, afterload-reducing agents, but not cortisone.

PTS: 1 REF: p. 858 Congestive Heart Failure OBJ: Cognitive Level: Knowledge

27.You are the nurse preparing to give a child a dose of digoxin. Before giving the digoxin, you would first check the apical pulse, and you would also be most interested in making sure which of the following levels were within normal?

a.

red blood cell count

c.

potassium levels

b.

chloride levels

d.

platelet

ANS: C

Feedback

A

Incorrect. Before giving digoxin, you would first check the apical pulse. However, the red blood cell count would not be relevant.

B

Incorrect. Before giving digoxin, you would first check the apical pulse. However, the chloride level would not be relevant.

C

Correct. Before giving digoxin, you would first check the apical pulse and serum potassium level which should be normal. Hypokalemia in combination with digoxin can result in ventricular arrhythmias and can enhance digoxin toxicity.

D

Incorrect. Before giving digoxin, you would first check the apical pulse. However, the platelet levels would not be relevant.

PTS:1REF:p. 858 Congestive Heart Failure

OBJ: Cognitive Level: Application

28.You are caring for a child who is on a diuretic and digoxin. Prior to giving the medications, you assess this child and find that the child has a bradycardia, has a ventricular arrhythmia, and is nauseated and wanting to vomit. What is the most likely explanation for these signs and symptoms?

a.

hyperkalemia

c.

digitalis toxicity

b.

drug incompatibility

d.

dehydration

ANS: C

Feedback

A

Incorrect. These signs and symptoms do not indicate hyperkalemia.

B

Incorrect. These signs and symptoms do not indicate an incompatibility between a diuretic and digoxin.

C

Correct. The most likely explanation for these signs and symptoms is digitalis toxicity.

D

Incorrect. These signs and symptoms do not indicate dehydration.

PTS:1REF:p. 858 Congestive Heart Failure

OBJ: Cognitive Level: Application

29.The nurse planning nutritional interventions for an infant with congestive heart failure who has a nursing diagnosis of Imbalanced nutrition: Less than body requirements related to poor caloric intake and increased metabolic demands as evidenced by poor weight gain and weight loss would most likely include in the nursing care plan which of the following interventions?

a.

Increase calorie density slowly by adding less water when mixing formula or powdered formula to expressed breast milk.

b.

Quickly increase the calorie density by adding less water when mixing formula or powdered formula to expressed breast milk.

c.

Administer bolus feedings via a nasogastric tube every 2 to 3 hours.

d.

Start rice cereal earlier than is normally recommended.

ANS: A

Feedback

A

Correct. The nursing care plan would most likely include interventions such as increasing calorie density slowly by adding less water when mixing formula or powdered formula to expressed breast milk.

B

Incorrect. The nursing care plan would not include quickly increasing the calorie density by adding less water when mixing formula or powdered formula to expressed breast milk. Increasing caloric density should be accomplished slowly over a number of days, as a sudden increase will increase the osmotic load in the gut, producing diarrhea.

C

Incorrect. The nursing care plan would not include administering bolus feedings via a nasogastric tube every 2 to 3 hours.

D

Incorrect. The nursing care plan would not include starting rice cereal earlier than is normally recommended.

PTS:1REF:p. 861 Congestive Heart Failure

OBJ: Cognitive Level: Application

30.Which of the following outcome goals would be best for an adolescent male who has a nursing diagnosis of Imbalanced nutrition: Less than body requirements related to poor caloric intake and increased metabolic demands as evidenced by poor weight gain and weight loss?

a.

The child will ingest the appropriate number of calories for his age (50 calories per kilogram per 24 hours).

b.

The child will take in three meals per day.

c.

There will be an improvement in appetite during the next 3 days.

d.

The dietary department will consult with the child and his family to ascertain likes and dislikes and will serve more likes.

ANS: A

Feedback

A

Correct. The outcome goal that would be best for this adolescent male is: The child will ingest the appropriate number of calories for his age (50 calories per kilogram per 24 hours). This is an appropriate goal for this nursing diagnosis since the problem is poor caloric intake.

B

Incorrect. The best outcome goal would not be that the child will take in three meals per day because there is no guarantee that the caloric intake will be increased.

C

Incorrect. The best outcome goal would not be that there will be an improvement in appetite during the next 3 days. Simply improving the childs appetite does not guarantee in increase in calories.

D

Incorrect. Although consultation with a dietician can assist in providing increased calories, this is not the best outcome goal. The child can be provided with more calorie dense foods, but he also must ingest them to prevent weight loss.

PTS:1REF:p. 861 Congestive Heart Failure

OBJ: Cognitive Level: Application

31.The nurse is feeding an infant who has congestive heart failure. The infant arches her back and averts her eyes from the nurse. The nurse is aware that the infant is giving cues indicating a need or want to:

a.

pass gas or be burped

c.

disengage and take a break

b.

have a bowel movement

d.

take a nap

ANS: C

Feedback

A

Incorrect. The infant is not giving cues indicating a need to pass gas or be burped.

B

Incorrect. The infant is not giving cues indicating a need to have a bowel movement.

C

Correct. The infant is giving cues indicating a need or want to disengage and take a break from feeding.

D

Incorrect. The infant is not giving cues indicating a need to take a nap.

PTS:1REF:p. 864 Congestive Heart Failure

OBJ: Cognitive Level: Application

32.Which of the following heart defects increases pulmonary blood flow?

a.

pulmonary stenosis

c.

pulmonary atresia

b.

patent ductus arteriosus

d.

tetralogy of Fallot

ANS: B

Feedback

A

Incorrect. Pulmonary stenosis decreases pulmonary blood flow by shunting unoxygenated blood from the right side of the heart to the left. There is a mixing of oxygenated and unoxygenated blood in the systemic circulation. These infants are hypoxic and cyanotic.

B

Correct. Patent ductus arteriosus increases pulmonary blood flow. Defects that increase pulmonary blood flow are caused by a shunting of the blood from the left side of the heart to the right side through an abnormal connection (left to right shunt). These infants exhibit clinical manifestations of congestive heart failure.

C

Incorrect. Pulmonary atresia decreases pulmonary blood flow, resulting in unoxygenated blood from the right side of the heart to the left. There is a mixing of oxygenated and unoxygenated blood in the systemic circulation. These infants are hypoxic and cyanotic.

D

Incorrect. Tetralogy of Fallot decreases pulmonary blood flow, resulting in unoxygenated blood from the right side of the heart to the left. There is a mixing of oxygenated and unoxygenated blood in the systemic circulation. These infants are hypoxic and cyanotic.

PTS:1REF:p. 864 Congestive Heart Failure

OBJ: Cognitive Level: Comprehension

33.The nurse is assessing a child and hears a widely split S2, which is not affected by the respiratory pattern. The physician verifies the finding and orders a chest X-ray, which shows an enlarged heart. An echocardiogram is ordered, which shows the defect. The finding by the nurse is a classic murmur found in which of the following cardiac defects?

a.

atrial septal defect

c.

patent ductus arteriosus (PDA)

b.

tetralogy of Fallot

d.

transposition of the great arteries (TGA)

ANS: A

Feedback

A

Correct. In atrial septal defect, the infant is generally asymptomatic. There is often a soft systolic murmur and more classically a widely split S2 unaffected by respiratory pattern. Chest X rays will usually demonstrate an increased heart size.

B

Incorrect. In tetralogy of Fallot there is a characteristic systolic murmur resulting from the right ventricular outflow tract obstruction and is generally moderate in severity.

C

Incorrect. The murmur of a PDA is often continuous, and a chest X ray is normal.

D

Incorrect. These findings are not indicative of TGA. TGA should be suspected in an otherwise healthy newborn with acute cyanosis that is not responsive to oxygen. Chest X ray may be within normal limits or show a mildly enlarged right heart.

PTS:1REF:p. 864 Congestive Heart Failure

OBJ: Cognitive Level: Application

34.If an atrial septal defect is detected early in life, it is usually not repaired until the preschool age period. Why is this defect not repaired sooner?

a.

The childs heart needs to strengthen and grow to survive the surgery.

b.

There is the possibility of a spontaneous closure in the first 2 years of life.

c.

Parental separation is traumatic for the child, potentially increasing the workload of the heart.

d.

This gives the parents time to adjust to the idea, and separation for the child is easier.

ANS: B

Feedback

A

Incorrect. This defect is usually not repaired until the preschool age period, but not because the childs heart needs to strengthen and grow to survive the surgery.

B

Correct. If an atrial septal defect is detected early in life, it is usually not repaired until the preschool age period because there is the possibility of a spontaneous closure in the first 2 years of life, and the child is usually asymptomatic.

C

Incorrect. This defect is usually not repaired until the preschool age period, but not because parental separation is traumatic for the child, potentially increasing the workload of the heart.

D

Incorrect. This defect is usually not repaired until the preschool age period, but not because this gives the parents time to adjust to the idea, and separation for the child is easier.

PTS:1REF:p. 864 Congestive Heart Failure

OBJ: Cognitive Level: Application

35.Which of the following is the most common congenital heart defect?

a.

transposition of the great arteries

c.

pulmonary atresia

b.

ventral septal defect

d.

atrial septal defect

ANS: B

Feedback

A

Incorrect. Transposition of the great arteries is not the most common congenital heart defect.

B

Correct. Ventral septal defect (VSD) is the most common congenital heart defect. Isolated VSDs and those VSDs associated with other congenital anomalies account for approximately 50% of infants with congenital heart disease.

C

Incorrect. Pulmonary atresia is not the most common congenital heart defect.

D

Incorrect. Atrial septal defect is not the most common congenital heart defect.

PTS: 1 REF: p. 864 Congestive Heart Failure OBJ: Cognitive Level: Knowledge

36.The nurse is working with the parents of an infant who has a small ventricular septal defect. The mother asks if the child will have surgery and, if not, what will be done about this defect. The nurse knows and will share with the parents that small ventricular septal defects are usually treated by:

a.

immediate surgery

b.

surgery at age 3

c.

waiting to see if it closes spontaneously in the first 2 years of life

d.

inserting an umbrella device or coil by catheterization to close off the defect

ANS: C

Feedback

A

Incorrect. Small ventricular septal defects are not usually treated by immediate surgery.

B

Incorrect. Small ventricular septal defects are not usually treated by surgery at age 3.

C

Correct. Small ventricular septal defects are usually treated by waiting to see if they close spontaneously, as 75-80% of these defects will close spontaneously.

D

Incorrect. Small ventricular septal defects are usually not treated by inserting an umbrella device or coil by catheterization to close off the defect.

PTS:1REF:p. 866 Congenital Heart Defects

OBJ: Cognitive Level: Application

37.The ductus arteriosus in the full-term newborn begins to close within 12 hours after birth and will normally be closed within what time frame?

a.

24 hours

c.

1 week

b.

48 hours

d.

2 to 3 weeks

ANS: D

Feedback

A

Incorrect. The ductus arteriosus in the full-term newborn begins to close within 12 hours after birth but will not normally be closed within 24 hours.

B

Incorrect. The ductus arteriosus in the full-term newborn begins to close within 12 hours after birth but will not normally be closed within 48 hours.

C

Incorrect. The ductus arteriosus in the full-term newborn begins to close within 12 hours after birth but will not normally be closed within 1 week.

D

Correct. The ductus arteriosus in the full-term newborn begins to close within 12 hours after birth and will normally be closed within 2 to 3 weeks.

PTS:1REF:p. 867 Congenital Heart Defects

OBJ: Cognitive Level: Comprehension

38.When the nurse is listening to the chest of an infant who has a murmur associated with a patent ductus arteriosus (PDA), the murmur will best be heard in which of the following locations?

a.

at the apex of the heart

c.

at the fifth intercostal space

b.

just below the left clavicle

d.

over the mitral valve

ANS: B

Feedback

A

Incorrect. The murmur associated with a patent ductus arteriosus (PDA) will not best be heard at the apex of the heart.

B

Correct. The murmur associated with a patent ductus arteriosus (PDA) will best be heard just below the left clavicle.

C

Incorrect. The murmur associated with a patent ductus arteriosus (PDA) will not best be heard at the fifth intercostal space.

D

Incorrect. The murmur associated with a patent ductus arteriosus (PDA) will not best be heard over the mitral valve.

PTS:1REF:p. 867 Congenital Heart Defects

OBJ: Cognitive Level: Application

39.The nurse is caring for a premature infant who is receiving an infusion of a substance in an attempt to close a patent ductus arteriosus. The nurse will explain to the mother that this substance is:

a.

indomethacin, which inhibits the synthesis of prostaglandin, the substance that maintains the patency of the ductus arteriosus

b.

a hypertonic saline solution that will draw the ductus into closure

c.

a cardiac stimulant, which increases the firing in the Purkinje fibers, thus causing a greater force for closing the ductus arteriosus

d.

an estrogen product, which will build up the tissue in the ductus arteriosus and cause an eventual closure

ANS: A

Feedback

A

Correct. The nurse will explain to the mother that indomethacin inhibits the synthesis of prostaglandin, the substance that maintains the patency of the ductus arteriosus. The ductus arteriosus is a direct connection between the main pulmonary artery and the aorta. It is necessary in the fetus for survival. In the premature infant the PDA does not close based on developmental immaturity; however, it does close in the full term infant.

B

Incorrect. Indomethacin is not a hypertonic saline solution that will draw the ductus into closure.

C

Incorrect. Indomethacin is not a cardiac stimulant, which increases the firing in the Purkinje fibers, thus causing a greater force for closing the ductus arteriosus.

D

Incorrect. Indomethacin is not an estrogen product, which will build up the tissue in the ductus arteriosus and cause an eventual closure.

PTS:1REF:p. 867 Congenital Heart Defects

OBJ: Cognitive Level: Application

40.The nurse is working with an infant who has trisomy 21 and an atrioventricular septal defect (AVC). The father asks the nurse about the percentage of children with Down syndrome who have atrioventricular septal defects. Which of the following is the nurses best explanation?

a.

Atrioventricular septal defects are very rare in children with Down syndrome because they usually occur without any other congenital anomalies.

b.

About 50% of children with Down syndrome have some congenital heart defect, and many of these are associated with some degree of atrioventricular septal defect.

c.

Less than 3% of children with Down syndrome will have an associated heart defect.

d.

Approximately 90% of the children who are born with Down syndrome have atrioventricular septal defects.

ANS: B

Feedback

A

Incorrect. Fifty percent of children with Down syndrome have some form of congenital heart defect, many of which are atrioventricular septal defects. Therefore, AVCs are not rare in these children.

B

Correct. The nurses best explanation is that about 50% of children with Down syndrome have some congenital heart defect, and many of these are associated with some degree of atrioventricular septal defect.

C

Incorrect. About 50% of children with Down syndrome will have an associated heart defect, not less than 3%.

D

Incorrect. Approximately 50% of children with Down syndrome have some form of congenital heart defect, many of which are atrioventricular septal defects.

PTS:1REF:p. 868 Congenital Heart Defects

OBJ: Cognitive Level: Application

41.In addition to closing the atrial and septal defect, the goal of surgery for atrioventricular septal defect is to:

a.

close a patent ductus arteriosus, which accompanies the atrioventricular septal defect

b.

insert a coil or similar device to close off the defect

c.

construct new mitral and tricuspid valves from the common A-V valve

d.

close the communication between the pulmonary artery and the aorta

ANS: C

Feedback

A

Incorrect. In addition to closing the atrial and septal defect, the goal of surgery for atrioventricular septal defect is not to close a patent ductus arteriosus, which accompanies the atrioventricular septal defect.

B

Incorrect. In addition to closing the atrial and septal defect, the goal of surgery for atrioventricular septal defect is not to insert a coil or similar device to close off the defect.

C

Correct. In addition to closing the atrial and septal defect, the goal of surgery for atrioventricular septal defect is to construct new mitral and tricuspid valves from the common A-V valve. AVC is associated with a septal defect in the atrium and ventricle, and involvement of the A-V valves. When the heart is developing the atrial and ventricular septa are not fully completed, thus, causing the mitral and tricuspid valves to develop inappropriately.

D

Incorrect. In addition to closing the atrial and septal defect, the goal of surgery for atrioventricular septal defect is not to close the communication between the pulmonary artery and the aorta.

PTS:1REF:p. 868 Congenital Heart Defects

OBJ: Cognitive Level: Comprehension

42.The nurse is caring for a 2-week-old infant with a diagnosis of truncus arteriosus. The nurse is aware that surgical repair for truncus arteriosus is done at which of the following times?

a.

within the first 1-2 weeks of life

c.

before 2 years old

b.

at 6 months to 1 year

d.

no earlier than age 3

ANS: A

Feedback

A

Correct. Surgical repair for truncus arteriosus is done within the first 1-2 weeks of life. Without treatment, the natural history of this defect is poor. The mean age of death is 2.5 months.

B

Incorrect. Surgical repair for truncus arteriosus is not done at 6 months to 1 year. Surgery is recommended in the neonatal period.

C

Incorrect. Surgical repair for truncus arteriosus is not done before 2 years old. Surgery is recommended in the neonatal period.

D

Incorrect. Surgical repair for truncus arteriosus is not done later than 3 years. It is recommended in the neonatal period.

PTS:1REF:p. 869 Congenital Heart Defects

OBJ: Cognitive Level: Comprehension

43.Children with defects with decreased pulmonary blood flow frequently have which of the following symptoms?

a.

nausea, vomiting, and chest pain

b.

slowed shallow breathing, diaphoresis, and flushed face

c.

hypoxia, cyanosis, polycythemia, erythrocytosis

d.

no symptoms at rest and extreme exhaustion on activity

ANS: C

Feedback

A

Incorrect. Children with defects with decreased pulmonary blood flow do not frequently have nausea, vomiting, and chest pain.

B

Incorrect. Children with defects with decreased pulmonary blood flow do not frequently have slowed shallow breathing, diaphoresis, and flushed face.

C

Correct. Children with defects with decreased pulmonary blood flow frequently have symptoms of hypoxia, cyanosis, polycythemia, and erythrocytosis. In these defects, the amount of blood flow to the pulmonary system is decreased, resulting in shunting of unoxygenated blood from the right side of the heart to the left. There is a mixing of oxygenated and unoxygenated blood in the systemic circulation.

D

Incorrect. Children with defects with decreased pulmonary blood flow are hypoxemic. Therefore, they tire easily and suffer extreme exhaustion on activity.

PTS:1REF:p. 869 Congenital Heart Defects

OBJ: Cognitive Level: Comprehension

44.The nurse is working with an infant who has a diagnosis of severe valvular pulmonary stenosis (PS). Although infants who have mild PS are asymptomatic, this infant with severe PS will most likely demonstrate which of the following signs and symptoms on assessment?

a.

nasal flaring, substernal retraction, restlessness, and crying with a shrill distinctive cry

b.

increase in right ventricular pressure, no symptoms at rest, intolerance of activity, and cyanosis with activity

c.

cyanosis at rest and with activity, increase in left ventricular pressure, listlessness, and lethargy

d.

rapid shallow respirations, increase in heart rate, and decrease in blood pressure at rest or with activity

ANS: B

Feedback

A

Incorrect. This infant with severe PS will not most likely demonstrate nasal flaring, substernal retraction, restlessness, and crying with a shrill distinctive cry.

B

Correct. This infant with severe PS will most likely demonstrate increase in right ventricular pressure, no symptoms at rest, intolerance of activity, and cyanosis with activity.

C

Incorrect. This infant with severe PS will not most likely demonstrate cyanosis at rest and with activity, increase in left ventricular pressure, listlessness, and lethargy.

D

Incorrect. This infant with severe PS will not most likely demonstrate rapid shallow respirations, increase in heart rate, and decrease in blood pressure at rest or with activity.

PTS:1REF:p. 869 Congenital Heart Defects

OBJ: Cognitive Level: Comprehension

45.Which of the following is the treatment for moderate to severe valvular pulmonary stenosis?

a.

balloon valvuloplasty

c.

Jones procedure

b.

valvular shunt

d.

valve replacement

ANS: A

Feedback

A

Correct. The treatment for moderate to severe valvular pulmonary stenosis is a balloon valvuloplasty.

B

Incorrect. The treatment for moderate to severe valvular pulmonary stenosis is not valvular shunt.

C

Incorrect. The treatment for moderate to severe valvular pulmonary stenosis is not the Jones procedure.

D

Incorrect. The treatment for moderate to severe valvular pulmonary stenosis is not valve replacement.

PTS:1REF:p. 870 Congenital Heart Defects

OBJ: Cognitive Level: Comprehension

46.An infant with tetralogy of Fallot who has multiple hypercyanotic spells will likely have a procedure to ensure pulmonary blood flow until surgical repair is performed. Which of the following is this procedure?

a.

coil

b.

Fontan procedure

c.

Blalock-Taussig (BT) shunt or modified BT shunt

d.

Jones procedure

ANS: C

Feedback

A

Incorrect. An infant with tetralogy of Fallot who has multiple hypercyanotic spells will not have a coil procedure to ensure pulmonary blood flow until surgical repair is performed.

B

Incorrect. The Fontan procedure is the final palliative procedure for children with tricuspid atresia.

C

Correct. A Blalock-Taussig (BT) shunt or modified BT shunt is a palliative procedure to increase pulmonary blood flow and increase oxygen saturation. This procedure provides blood flow to the pulmonary arteries from the left or right subclavian artery.

D

Incorrect. An infant with tetralogy of Fallot who has multiple hypercyanotic spells will not have a Jones procedure to ensure pulmonary blood flow until surgical repair is performed.

PTS:1REF:p. 872 Congenital Heart Defects

OBJ: Cognitive Level: Comprehension

47.When a newborn has a transposition of the great arteries (TGA), the only chance for survival is:

a.

administration of continuous oxygen

b.

serial blood transfusions to exchange the blood and increase the amount of oxygen in the newborns blood

c.

administration of sufficient potassium

d.

an intra-atrial connection such as a patent ductus arteriosus that allows mixing of oxygenated and deoxygenated blood

ANS: D

Feedback

A

Incorrect. In TGA, unoxygenated blood enters the right atrium to the right ventricle, then flows out the aorta into the body. Oxygenated blood from the lungs enters the left atrium to the left ventricle and then flows out the pulmonary artery back to the lungs. Thus, there is parallel circulation with no oxygenated blood getting to the systemic circulation. Administration of continuous oxygen will not benefit the newborn.

B

Incorrect. Serial blood transfusions to exchange the blood and increase the amount of oxygen in the newborns blood will not help because the mixing of oxygenated and unoxygenated blood needs to occur via an intra-atrial connection.

C

Incorrect. Administration of sufficient potassium will have no impact on the newborns chance of survival.

D

Correct. When a newborn has a transposition of the great arteries (TGA), the only chance for survival is an intra-atrial connection such as a patent ductus arteriosus that allows mixing of oxygenated and deoxygenated blood.

PTS:1REF:p. 872 Congenital Heart Defects

OBJ: Cognitive Level: Application

48.When the nurse assesses a newborn that has transposition of the great arteries (TGA), the nurse will most likely find which of the following signs or symptoms?

a.

normal size and weight and healthy appearance except for acute cyanosis that will not respond to oxygen

b.

low birth weight, small-size infant with a weak cry, and lethargic appearance

c.

ruddy skin appearance of face and extremities

d.

pallor, low blood pressure, and weak rapid pulse rate

ANS: A

Feedback

A

Correct. A newborn with TGA will most likely be of normal size and weight and healthy appearance except for acute cyanosis that will not respond to oxygen.

B

Incorrect. A newborn with TGA will not have the following signs or symptoms: low birth weight, small-size infant with a weak cry, and lethargic appearance.

C

Incorrect. A newborn with TGA will not have the following signs or symptoms: ruddy skin appearance of face and extremities.

D

Incorrect. A newborn with TGA will not have the following signs or symptoms: pallor, low blood pressure, and weak rapid pulse rate.

PTS:1REF:p. 872 Congenital Heart Defects

OBJ: Cognitive Level: Comprehension

49.Which of the following is the treatment of choice for the neonate with transposition of the great arteries (TGA)?

a.

Fontan procedure

c.

Norwood procedure

b.

arterial switch

d.

Glenn shunt

ANS: B

Feedback

A

Incorrect. The Fontan procedure is the final palliative procedure for children with tricuspid atresia.

B

Correct. The treatment of choice for the neonate with transposition of the great arteries (TGA) is arterial switch. The aorta is resected from the aortic trunk and the pulmonary artery is resected from the pulmonary trunk. These vessels are then switched, resulting in anatomic correction.

C

Incorrect. The Norwood procedure is used for hypoplastic left heart syndrome.

D

Incorrect. The Glenn shunt is used in repair of tricuspid atresia.

PTS:1REF:p. 872 Congenital Heart Defects

OBJ: Cognitive Level: Application

50.The nurse takes the right arm and the right leg blood pressure with the correct size cuff and subtracts the leg systolic pressure from the arm systolic pressure. The nurse does this to figure out:

a.

the pressure gradient across a coarctation of the aorta

b.

the degree of functioning of the mitral valve

c.

if there is some obstruction such as a thrombus in the arterial system

d.

if there is an impairment in circulation between the arm and leg

ANS: A

Feedback

A

Correct. The nurse takes the right arm and the right leg blood pressure with the correct size cuff and subtracts the leg systolic pressure from the arm systolic pressure in order to determine the pressure gradient across a coarctation of the aorta.

B

Incorrect. The nurse does not do these calculations with blood pressure to determine the degree of functioning of the mitral valve.

C

Incorrect. The nurse does not do these calculations with blood pressure to determine if there is some obstruction such as a thrombus in the arterial system.

D

Incorrect. The nurse does not do these calculations with blood pressure to determine if there is an impairment in circulation between the arm and leg.

PTS:1REF:p. 874 Congenital Heart Defects

OBJ: Cognitive Level: Application

51.The nurse is caring for a child after heart surgery. One nursing diagnosis is Ineffective family coping related to illness and hospitalization as evidenced by verbalization of guilt by parents and lack of involvement in the childs care. Which of the following interventions would be most helpful?

a.

Tell the parents they dont need to feel guilty, and ask them to help with care.

b.

Explain all lines, tubes, and procedures; answer all questions; involve social workers and clergy; encourage verbalization; and listen to concerns.

c.

Ask the parents: Why do you think you feel so guilty and not feel comfortable helping with the childs care?

d.

Tell the parents that their indifference is preventing full recovery of the child.

ANS: B

Feedback

A

Incorrect. This does not address the parents guilt.

B

Correct. The most helpful interventions would be to explain all lines, tubes, and procedures; answer all questions; involve social workers and clergy; encourage verbalization; and listen to concerns.

C

Incorrect. Asking anyone why they have specific feelings usually puts them on the defensive. This question may block future communication between the nurse and parents.

D

Incorrect. This is not a helpful intervention and does not address their feelings of guilt.

PTS:1REF:p. 879 Congenital Heart Defects

OBJ: Cognitive Level: Application

52.Following congenital heart surgery, the nurse who is preparing caregivers for their childs discharge will begin teaching at which of the following time periods?

a.

in the early postoperative period

c.

24 hours before discharge

b.

3 days before discharge

d.

day of discharge

ANS: A

Feedback

A

Correct. The nurse will begin discharge teaching in the early postoperative period.

B

Incorrect. Three days before discharge is not an adequate amount of time to teach everything the caregivers need to know.

C

Incorrect. Twenty-four hours before discharge is not an adequate amount of time to teach everything the caregivers need to know.

D

Incorrect. The day of discharge is not an adequate amount of time to teach everything the caregivers need to know.

PTS:1REF:p. 882 Congenital Heart Defects

OBJ: Cognitive Level: Application

53.The nurse who is providing discharge teaching will advise parents that children usually can return to school within approximately 2 weeks, but the child should be excused from physical education classes for how many weeks?

a.

3

c.

5

b.

4

d.

6

ANS: D

Feedback

A

Incorrect. The child should be excused from physical education classes during the 6 weeks following surgery.

B

Incorrect. The child should be excused from physical education classes during the 6 weeks following surgery.

C

Incorrect. The child should be excused from physical education classes during the 6 weeks following surgery.

D

Correct. The child should be excused from physical education classes during the 6 weeks following surgery. Rough play and strenuous activities are avoided until 6 weeks following discharge.

PTS:1REF:p. 882 Congenital Heart Defects

OBJ: Cognitive Level: Application

54.Which of the following conditions is the leading cause of acquired heart disease in children in developing countries?

a.

acute rheumatic fever

c.

a waterborne fluke

b.

Kawasaki disease

d.

cholera

ANS: A

Feedback

A

Correct. The leading cause of acquired heart disease in children in developing countries is acute rheumatic fever (ARF).With the advent of penicillin, the incidence of ARF has decreased substantially in the United States.

B

Incorrect. The leading cause of acquired heart disease in children in developing countries is not Kawasaki disease.

C

Incorrect. The leading cause of acquired heart disease in children in developing countries is not a waterborne fluke.

D

Incorrect. The leading cause of acquired heart disease in children in developing countries is not cholera.

PTS: 1 REF: p. 882 Congenital Heart Defects OBJ: Cognitive Level: Knowledge

55.Acute rheumatic fever follows which of the following health problems?

a.

chickenpox

b.

an untreated or partially treated staphylococcal skin lesion or infection

c.

an untreated or partially treated group A streptococcal pharyngitis

d.

rubella

ANS: C

Feedback

A

Incorrect. Acute rheumatic fever does not follow chickenpox.

B

Incorrect. Acute rheumatic fever does not follow an untreated or partially treated staphylococcal skin lesion or infection.

C

Correct. Acute rheumatic fever follows an untreated or partially treated group A streptococcal pharyngitis. Although group A streptococci can produce infection in any body tissue, rheumatic fever will only follow a throat infection. It has never been identified subsequent to a group A streptoccoci skin infection (impetigo).

D

Incorrect. Acute rheumatic fever does not follow rubella.

PTS:1REF:p. 882 Congenital Heart Defects

OBJ: Cognitive Level: Comprehension

56.Following the acute inflammatory phase of rheumatic fever, which of the following cardiac pathologies is evident?

a.

enlargement of the heart

b.

inflammation of the pleura

c.

changes in the firing from the Purkinje fibers with irregular beats

d.

valvulitis with the most affected valve being the mitral valve

ANS: D

Feedback

A

Incorrect. Following the acute inflammatory phase of rheumatic fever, the most significant cardiac pathophysiological phenomena is not enlargement of the heart.

B

Incorrect. Following the acute inflammatory phase of rheumatic fever, the most significant cardiac pathophysiological phenomena is not inflammation of the pleura.

C

Incorrect. Following the acute inflammatory phase of rheumatic fever, the most significant cardiac pathophysiological phenomena is not changes in the firing from the Purkinje fibers with irregular beats.

D

Correct. Following the acute inflammatory phase of rheumatic fever, the most significant cardiac pathophysiological phenomena is valvulitis with the most affected valve being the mitral valve. Valvulitis is responsible for mitral valve deformity that results in mitral regurgitation.

PTS:1REF:p. 883 Acquired Heart Disease

OBJ: Cognitive Level: Comprehension

57.The criteria for diagnosis of acute rheumatic fever are known as:

a.

Smith criteria

c.

Aims test

b.

Jones criteria

d.

Rockwood test

ANS: B

Feedback

A

Incorrect. The criteria for diagnosis of acute rheumatic fever are not known as Smith criteria.

B

Correct. The criteria for diagnosis of acute rheumatic fever are known as Jones criteria.

C

Incorrect. The criteria for diagnosis of acute rheumatic fever are not known as the Aims test.

D

Incorrect. The criteria for diagnosis of acute rheumatic fever are not known as the Rockwood test.

PTS: 1 REF: p. 884 Acquired Heart Disease OBJ: Cognitive Level: Knowledge

58.What are the three organ systems primarily affected by acute rheumatic fever?

a.

heart, gastrointestinal, and joints

b.

central nervous system, endocrine, and heart

c.

heart, central nervous system, and joints

d.

integumentary, genitourinary, and heart

ANS: C

Feedback

A

Incorrect. The three organ systems primarily affected by acute rheumatic fever are not the heart, gastrointestinal, and joints.

B

Incorrect. The three organ systems primarily affected by acute rheumatic fever are not the central nervous system, endocrine, and heart.

C

Correct. The three organ systems primarily affected by acute rheumatic fever are the heart, central nervous system, and joints.

D

Incorrect. The three organ systems primarily affected by acute rheumatic fever are not the integumentary, genitourinary, and heart.

PTS:1REF:p. 883 Acquired Heart Disease

OBJ: Cognitive Level: Comprehension

59.Which of the following is the most characteristic finding of Kawasaki disease (KD) upon assessment?

a.

hands and feet that are tensely edematous and very erythematous with desquamation beginning by day 10

b.

hives that come and go and do not follow the usual patternfor example, half the lip or one eyebrow

c.

projectile vomiting when the child is not held upright during feedings

d.

tendency to squat quite frequently and for the lips to turn blue

ANS: A

Feedback

A

Correct. The most characteristic finding of KD are changes in the hands and feet that are tensely edematous and very erythematous with desquamation beginning by day 10. This starts just under the finger and toenails and progresses to involve the palms and soles, with skin peeling in sheets.

B

Incorrect. Hives that come and go and do not follow the usual patternfor example, half the lip or one eyebroware not characteristic findings of KD.

C

Incorrect. Projectile vomiting when the child is not held upright during feedings is not a characteristic finding of KD, but of pyloric stenosis (a gastrointestinal alteration)

D

Incorrect. The tendency to squat quite frequently and for the lips to turn blue is characteristic of Tetralogy of Fallot, a congenital cardiac anomaly.

PTS:1REF:p. 885 Acquired Heart Disease

OBJ: Cognitive Level: Comprehension

60.Which of the following best describes the pathophysiology of Kawasaki disease?

a.

multisystem vasculitis that tends to affect the coronary arteries

b.

poor circulation due to faulty valves that primarily affect the extremities

c.

hypertrophy of the heart causing arrhythmias

d.

electrolyte imbalance causing faulty firing of the heart

ANS: A

Feedback

A

Correct. Multisystem vasculitis that tends to affect the coronary arteries best describes the pathophysiology of KD.

B

Incorrect. Poor circulation due to faulty valves that primarily affects the extremities does not best describe the pathophysiology of KD.

C

Incorrect. Hypertrophy of the heart causing arrhythmias does not best describe the pathophysiology of KD.

D

Incorrect. Electrolyte imbalance causing faulty firing of the heart does not best describe the pathophysiology of KD.

PTS:1REF:p. 885 Acquired Heart Disease

OBJ: Cognitive Level: Comprehension

61.The nurse working with a child who has Kawasaki disease knows that between days 10 and 40 of the disease there is most often a danger of which of the following problems occurring?

a.

a grand mal seizure

c.

hemorrhage

b.

the formation of aneurysms

d.

a hypertensive stroke

ANS: B

Feedback

A

Incorrect. A grand mal seizure is not most often a danger between days 10 and 40 of the disease.

B

Correct. Between days 10 and 40 of KD there is most often a danger of the formation of aneurysms. There is a decrease in the inflammatory process during this time. However, because of earlier pathophysiological processes, vessels have undergone destructive changes. Coronary artery aneurysms are the most common types.

C

Incorrect. Hemorrhage is not most often a danger between days 10 and 40 of the disease.

D

Incorrect. A hypertensive stroke is not most often a danger between days 10 and 40 of the disease.

PTS:1REF:p. 885 Acquired Heart Disease

OBJ: Cognitive Level: Application

62.Which of the following are the main therapeutic interventions for Kawasaki disease in the first 10 days of the disease?

a.

antibiotics and Tylenol

b.

blood transfusions and a cortisone product

c.

diuretics and administration of packed cells

d.

intravenous immune globulin and aspirin

ANS: D

Feedback

A

Incorrect. The etiology of KD remains unconfirmed; therefore, antibiotics are not the mainstay of therapy in the first 10 days. Tylenol is an antipyretic and analgesic medication but has no anti-inflammatory effects.

B

Incorrect. Blood transfusions and a cortisone product are not the mainstay of therapy for KD in the first 10 days. Methylprednisolone has been used in select clients who are refractory to multiple doses of IVIG in combination with aspirin.

C

Incorrect. Diuretics and administration of packed cells are not the mainstay of therapy for KD in the first 10 days.

D

Correct. Intravenous immune globulin (IVIG) and aspirin are the main therapeutic interventions for KD in the first 10 days of the disease. IVIG usually results in rapid resolution of congestive heart failure, defervescence of fever, and normalization of sedimentation rate. IVIG reduces the incidence of coronary artery aneurysms. Aspirin is given to control the high remittent fever (101-105 F) and for inflammation.

PTS:1REF:p. 886 Acquired Heart Disease

OBJ: Cognitive Level: Application

63.When a person has infective endocarditis (IE), the infective organisms enter the blood and lodge and grow on the endocardium, forming what is generally referred to as:

a.

thrombi

c.

outgrowths

b.

emboli

d.

vegetations

ANS: D

Feedback

A

Incorrect. In the person with IE the infective organisms enter the blood and lodge and grow on the endocardium. They do not form thrombi.

B

Incorrect. In the person with IE the infective organisms enter the blood and lodge and grow on the endocardium. They do not form emboli.

C

Incorrect. In the person with IE the infective organisms enter the blood and lodge and grow on the endocardium. They do not form outgrowths.

D

Correct. When a person has infective endocarditis, the infective organisms enter the blood and lodge and grow on the endocardium, forming what is generally referred to as vegetations. Vegetations, or abnormal growths, contribute to the inflammation of the heart valves and lining of the heart and can break off and embolize to other parts of the body.

PTS:1REF:p. 888 Acquired Heart Disease

OBJ: Cognitive Level: Comprehension

64.A nurse is working with children and adolescents who have a known heart problem. The nurse is aware that when a child undergoes a procedure, the prevention of infectious endocarditis will involve which of the following interventions as a prophylaxis?

a.

gamma globulin 10 cubic centimeters in each of two deep muscle sites at least 24 hours before the procedure

b.

antibiotics, with the most frequent being penicillin or clindamycin for those with penicillin allergies

c.

intravenous glucose solution

d.

aspirin or Coumadin

ANS: B

Feedback

A

Incorrect. Gamma globulin 10 cc. in each of two deep muscle sites at least 24 hours before the procedure is not the recommended intervention as a prophylaxis.

B

Correct. The American Heart Association has set forth guidelines for antibiotic prophylaxis for prevention of infectious endocarditis in children with congenital heart disease prior to procedures associated with endocarditis. Antibiotics, with the most frequent being penicillin or clindamycin for those with penicillin allergies is the recommended prophylaxis.

C

Incorrect. Intravenous glucose solution is not the recommended intervention as a prophylaxis.

D

Incorrect. Aspirin or Coumadin are not the recommended interventions as prophylaxis.

PTS:1REF:p. 888 Acquired Heart Disease

OBJ: Cognitive Level: Application

COMPLETION

1.A pediatric client is to receive furosemide (Lasix) 2 milligrams (mg) per kilogram (kg) every 6 hours. The clients weight is 55 pounds. The nurse administers ____________________ mg of Lasix every 6 hours.

ANS:

50

fifty

Because the client is 55 pounds, the client weighs 25 kg. 25 kg 2 mg indicates the client should receive 50 mg of Lasix every 6 hours.

PTS:1REF:p. 859 Congestive Heart Failure

OBJ: Cognitive Level: Application

MULTIPLE RESPONSE

1.A nurse is performing the preprocedure assessment for a pediatric client planned for cardiac catheterization. Which of the following assessments would provide an essential baseline for comparison following the procedure? Select all that apply.

a.

pedal pulses

c.

pulse oximetry

b.

radial pulses

d.

vital signs

ANS: A, C, D

Feedback

Correct

Prior to the cardiac catheterization, the nurse should assess the pedal pulse distal to the catheterization site.

Oxygen saturation via pulse oximetry must be evaluated prior to beginning the procedure. This assessment will provide the baseline for comparison following the catheterization.

Vital signs must be evaluated prior to beginning the procedure. This assessment will provide the baseline for comparison following the catheterization.

Incorrect

The assessment of the radial pulses prior to the procedure would not be necessary.

PTS: 1 REF: p. 854 Assessment of the Child with a Cardiovascular Alteration

OBJ: Cognitive Level: Application

2.A pediatric client has a presumed diagnosis of coarctation of the aorta. The nurse is aware that which of the following symptoms are considered to be the classic clinical presentation(s) for the diagnosis? Select all that apply.

a.

upper-extremity hypertension

c.

diminished lower-extremity pulses

b.

bounding upper-extremity pulses

d.

intermittent claudication

ANS: A, C

Feedback

Correct

Coarctation of the aorta is associated with upper-extremity hypertension.

Coarctation of the aorta is associated with diminished lower-extremity pulses.

Incorrect

Bounding upper-extremity pulses are not associated with coarctation of the aorta. Intermittent claudication is not associated with coarctation of the aorta

PTS: 1 REF: p. 855 Assessment of the Child with a Cardiovascular Alteration

OBJ: Cognitive Level: Application

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