Deck 25: Cardiovascular Alterations

Question 1

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

A) 4
B) 8
C) 12
D) 16

Answer 1

8

Question 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

Answer 2

to divert blood from the fetal lungs to the fetal aorta

Question 3

Cardiac abnormalities account for what percentage of all congenital malformations?

A) 5%
B) 10%
C) 20%
D) 25%

Answer 3

25%

Question 4

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

A) ear
B) fist
C) knee
D) elbow

Question 5

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

A) has a high concentration of hemoglobin
B) has a high-pressure vascular bed
C) carries deoxygenated blood
D) returns blood to the heart

Question 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

Question 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

Question 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

Question 9

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

A) peripheral cyanosis of the hands
B) perioral cyanosis
C) cyanosis of the lips or tongue
D) cyanosis of the feet

Question 10

Which of the following terms describes the nurse's 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
B) angle nails
C) notching
D) clubbing

Question 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

Question 12

Systolic murmurs are considered abnormal if they are:

A) grade I
B) grade II
C) grade III or greater
D) grade 0

Question 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

Question 14

Which of the following actions would the nurse take when finding an innocent murmur while listening to a child's heart?

A) Refer the child and mother to a cardiologist.
B) Advise the caregiver(s) to restrict the child's activity.
C) Teach the family that this murmur needs no intervention.
D) Get an order for oxygen, and administer it as soon as possible.

Question 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
B) congenital heart defects
C) maternal alcoholism
D) prematurity

Question 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 child's 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

Question 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.

Question 18

The nurse caring for a child who has had a heart catheterization is aware that the child's 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 physician's orders

Question 19

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

A) cardiomyopathy
B) endocarditis
C) congenital heart disease
D) myocarditis

Question 20

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

A) acquired heart disease
B) tetralogy of Fallot
C) aortic stenosis
D) congenital valve problems

Question 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.

Question 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
B) peripheral edema
C) greatly elevated blood pressure
D) diaphoresis during feeding

Question 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

Question 24

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

A) sitting
B) standing
C) lying flat
D) head slightly elevated

Question 25

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

A) furosemide (Lasix)
B) spironolactone (Aldactone)
C) bumetanide (Bumex)
D) chlorothiazide (Diuril)

Question 26

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

A) analgesics
B) antibiotics
C) inotropes
D) cortisone

Question 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
B) chloride levels
C) potassium levels
D) platelet

Question 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
B) drug incompatibility
C) digitalis toxicity
D) dehydration

Question 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.

Question 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.

Question 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
B) have a bowel movement
C) disengage and take a break
D) take a nap

Question 32

Which of the following heart defects increases pulmonary blood flow?

A) pulmonary stenosis
B) patent ductus arteriosus
C) pulmonary atresia
D) tetralogy of Fallot

Question 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
B) tetralogy of Fallot
C) patent ductus arteriosus (PDA)
D) transposition of the great arteries (TGA)

Question 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 child's 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.

Question 35

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

A) transposition of the great arteries
B) ventral septal defect
C) pulmonary atresia
D) atrial septal defect

Question 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

Question 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
B) 48 hours
C) 1 week
D) 2 to 3 weeks

Question 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
B) just below the left clavicle
C) at the fifth intercostal space
D) over the mitral valve

Question 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

Question 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 nurse's 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."

Question 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

Question 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
B) at 6 months to 1 year
C) before 2 years old
D) no earlier than age 3

Question 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

Question 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

Question 45

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

A) balloon valvuloplasty
B) valvular shunt
C) Jones procedure
D) valve replacement

Question 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

Question 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 newborn's 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

Question 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

Question 49

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

A) Fontan procedure
B) arterial switch
C) Norwood procedure
D) Glenn shunt

Question 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

Question 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 child's care." Which of the following interventions would be most helpful?

A) Tell the parents they don't 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 child's care?"
D) Tell the parents that their indifference is preventing full recovery of the child.

Question 52

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

A) in the early postoperative period
B) 3 days before discharge
C) 24 hours before discharge
D) day of discharge

Question 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
B) 4
C) 5
D) 6

Question 54

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

A) acute rheumatic fever
B) Kawasaki disease
C) a waterborne fluke
D) cholera

Question 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

Question 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

Question 57

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

A) Smith criteria
B) Jones criteria
C) Aims test
D) Rockwood test

Question 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

Question 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 pattern--for 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

Question 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

Question 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
B) the formation of aneurysms
C) hemorrhage
D) a hypertensive stroke

Question 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

Question 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
B) emboli
C) outgrowths
D) vegetations

Question 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

Question 65

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

Question 66

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
B) radial pulses
C) pulse oximetry
D) vital signs

Question 67

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
B) bounding upper-extremity pulses
C) diminished lower-extremity pulses
D) intermittent claudication