Congenital Heart Defect Practice Questions (Test #4, Fall 2020)

Patent ductus arteriosus causes what type of shunt? _____________________

Left to right. Blood flows from the higher-pressure aorta to the lower-pressure pulmonary artery, resulting in a left to right shunt. TEST-TAKING HINT: What is the CHD classification of PDA?

A newborn is diagnosed with a congenital heart defect (CHD). The test results reveal that the lumen of the duct between the aorta and pulmonary artery remains open. This defect is known as _____________________.

Patent ductus arteriosus (PDA). TEST-TAKING HINT: This is a defect with increased pulmonary fl ow. It should close in the fi rst few weeks of life.

Which statement by a parent of an infant with congestive heart failure (CHF) who is being sent home on digoxin (Lanoxin) indicates the need for further education? 1. "I will give the medication at regular 12-hour intervals." 2. "If he vomits, I will not give a make-up dose." 3. "If I miss a dose, I will not give an extra dose." 4. "I will mix the digoxin in some formula to make it taste better."

4 1. This is appropriate for digoxin (Lanoxin) administration. 2. This is appropriate for digoxin administration. 3. This is appropriate for digoxin administration. 4. If the medication is mixed in his formula, and he refuses to drink the entire amount, the dose will be inadequate. TEST-TAKING HINT: What if the child does not drink all the formula?

Indomethacin (Indocin) may be given to close which congenital heart defect (CHD) in newborns? _____________________

Patent ductus arteriosus (PDA). TEST-TAKING HINT: Prostaglandins allow the duct to remain open; thus, a prostaglandin inhibitor, such as indomethacin (Indocin) or ibuprofen (Motrin), can help close the duct

For the child with hypoplastic left heart syndrome, which drug may be given to allow the patent ductus arteriosus (PDA) to remain open until surgery? _____________________

Prostaglandin E. TEST-TAKING HINT: Prostaglandin E maintains ductal patency to promote blood fl ow until the Norwood procedure is begun. Consider the opposite of wanting to close the PDA.

Twelve hours after cardiac surgery, the nurse is assessing a 3-year-old who weighs 15 kg. The nurse should notify the surgeon about which of the following clinical findings? 1.A urine output of 60 mL in 4 hours. 2.Strong peripheral pulses in all four extremities. 3.Fluctuations of fluid in the collection chamber of the chest drainage system. 4.Alterations in levels of consciousness.

4 Clinical signs of low cardiac output and poor tissue perfusion include pale, cool extremities, cyanosis or mottled skin, delayed capillary refill, weak, thready pulses, oliguria, and alterations in level of consciousness. An adequate urine output for a child over 1 year should be 1 mL/kg/h. Therefore 60 mL/4 h is satisfactory. Strong peripheral pulses indicate adequate cardiac output. Drainage from the chest tube should show fluctuation in the drainage compartment of the chest drainage system. The fluid level normally fluctuates as proof that the apparatus is airtight. On about the 3rd postoperative day, the fluctuation ceases indicating the lungs have fully expanded.

Which of the following is the greatest priority for the therapeutic management of a child with congestive heart failure (CHF) caused by pulmonary stenosis? 1.Educating the family about the signs and symptoms of infection. 2.Administering enoxaparin (Lovenox) to improve left ventricular contractility. 3.Assessing heart rate and blood pressure every 2 hours. 4.Administrating furosemide (Lasix) to decrease systemic venous congestion.

4 Pulmonary stenosis can cause right-sided CHF, resulting in venous congestion. Removing accumulated fluid is a primary goal of treatment in right-sided CHF. Lasix is used to reduce venous congestion. It is important to educate the family about signs and symptoms of CHF but treating the client's CHF is the priority. Lovenox is an anticoagulant and will not help improve left ventricular contractility. It is important to assess vital signs frequently in the child with CHF but assessments do not treat the problem.

A 6-month-old who has episodes of cyanosis after crying could have the congenital heart defect (CHD) of decreased pulmonary blood flow called _____________________.

Tetralogy of Fallot (TOF). "Tet" spells are characteristic of TOF. TEST-TAKING HINT: Know the congenital heart defect classifi cations.

The _____________________ serves as the septal opening between the atria of the fetal heart

Foramen ovale. TEST-TAKING HINT: The foramen ovale is the septal opening between the atria of the fetal heart. The test taker needs to know basic fetal circulation

The flow of blood through the heart with an atrial septal defect (ASD) is _____________________.

Left to right. The pressures in the left side of the heart are greater, causing the fl ow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood fl ow with the extra blood. TEST-TAKING HINT: What is the CHD classification of ASD?

A 3-month-old has been diagnosed with a ventricular septal defect (VSD). The flow of blood through the heart is _____________________.

Left to right. The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood. TEST-TAKING HINT: The test taker should know that the classification for this defect is left to right.

Tetralogy of Fallot (TOF) involves which defects? Select all that apply. 1. Ventricular septal defect (VSD). 2. Right ventricular hypertrophy. 3. Left ventricular hypertrophy. 4. Pulmonic stenosis (PS). 5. Pulmonic atresia. 6. Overriding aorta. 7. Patent ductus arteriosus (PDA).

1,2,4,6 1. TOF is a congenital defect with a ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 2. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 3. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 4. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 5. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta 6. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 7. PDA is not one of the defects in tetralogy of Fallot. TEST-TAKING HINT: Tetralogy of Fallot has four defects. Pulmonary stenosis causes decreased pulmonary fl ow.

Congenital heart defects (CHDs) are classified by which of the following? Select all that apply. 1. Cyanotic defect. 2. Acyanotic defect. 3. Defects with increased pulmonary blood flow. 4. Defects with decreased pulmonary blood fl ow. 5. Mixed defects. 6. Obstructive defects. 7. Pansystolic murmurs.

3,4,5,6, 1. Heart defects are no longer classified as cyanotic or acyanotic. 2. Heart defects are no longer classified as cyanotic or acyanotic. 3. Heart defects are now classified as defects with increased or decreased pulmonary blood fl ow, mixed, obstructive, or acquired. 4. Heart defects are now classified as defects with increased or decreased pulmonary blood fl ow, mixed, obstructive or acquired. 5. Heart defects are now classified as defects with increased or decreased pulmonary blood fl ow mixed, obstructive, or acquired. 6. Heart defects are now classified as defects with increased or decreased pulmonary blood fl ow, mixed, obstructive, or acquired. 7. A murmur may be heard with a CHD, but a murmur does not classify the defect. TEST-TAKING HINT: Know the new classifications, not the older ones.

During a well-child checkup for an infant with tetralogy of Fallot (TOF), the child develops severe respiratory distress and becomes cyanotic. The nurse's first action should be to: 1. Lay the child flat to promote hemostasis. 2. Lay the child flat with legs elevated to increase blood flow to the heart. 3. Sit the child on the parent's lap, with legs dangling, to promote venous pooling. 4. Hold the child in knee-chest position to decrease venous blood return

4 1. Laying the child fl at would increase preload, increasing blood to the heart, therefore making respiratory distress worse. 2. Laying the child fl at with legs elevated would increase preload, increasing blood to the heart, therefore making respiratory distress worse. 3. Sitting the child on the parent ' s lap with legs dangling might possibly help, but it would not be as effective as the knee-chest position in occluding the venous return. 4. The increase in the SVR would increase afterload and increase blood return to the pulmonary artery. TEST-TAKING HINT: The test taker should choose the response that decreases the preload in this patient

The nurse is caring for a 9-month-old who was born with a congenital heart defect (CHD). Assessment reveals a HR of 160, capillary refill of 4 seconds, bilateral crackles, and sweat on the scalp. These are signs of _____________________.

Congestive heart failure (CHF). TEST-TAKING HINT: All of these are signs of pump failure. The infant is likely to have diaphoresis only on the scalp. The signs are not unlike those of an adult with this condition.

As part of the preoperative teaching for the family of a child undergoing a tetralogy of Fallot repair, the nurse tells the family upon returning to the pediatric floor that the child may: 1.Be placed on a reduced sodium diet. 2.Have an activity restriction for several days. 3.Be assigned to an isolation room. 4.Have visits limited to a select few

1 Because of the hemodynamic changes that occur with open heart surgery repair, particularly with septal defects, transient congestive heart failure may develop. Therefore, the child's sodium intake typically is restricted to 2 to 3 g/day. Activity restrictions are inappropriate. Typically the child is encouraged to walk the halls and unit. Risk for infection after the repair is the same as any postoperative client, therefore isolation is not necessary. The child may be placed in a room with other children who are not contagious. Visitors are not restricted unless the pediatric unit has restrictive visiting policies

A child born with Down syndrome should be evaluated for which associated cardiac manifestation? 1. Congenital heart defect (CHD). 2. Systemic hypertension. 3. Hyperlipidemia. 4. Cardiomyopathy

1 1. CHD is found often in children with Down syndrome. 2. This is not associated with Down syndrome. 3. This is not associated with Down syndrome. 4. This is not associated with Down syndrome. TEST-TAKING HINT: A child with a genetic syndrome, such as Down, is likely to have other abnormalities

A nursing action that promotes ideal nutrition in an infant with congestive heart failure (CHF) is: 1. Feeding formula that is supplemented with additional calories. 2. Allowing the infant to nurse at each breast for 20 minutes. 3. Providing large feedings every 5 hours. 4. Using firm nipples with small openings to slow feedings.

1 1. Formula can be supplemented with extra calories, either from a commercial supplement, such as Polycose, or from corn syrup. Calories in formula could increase from 20 kcal/oz to 30 kcal/oz or more. 2. The infant would get too tired while feeding, which increases cardiac demand. Limit breastfeeding to a half hour, or 15 minutes per side. 3. Smaller feedings more often, such as every 2 to 3 hours, would decrease cardiac demand. 4. Soft nipples that are easy for the infant to suck would make for less work getting nutrition. TEST-TAKING HINT: Allow the child to get the most nutrition most effectively

What can an electrocardiogram (ECG) detect? Select all that apply. 1. Ischemia. 2. Injury. 3. Cardiac output (CO). 4. Dysrhythmias. 5. Systemic vascular resistance (SVR). 6. Occlusion pressure. 7. Conduction delay.

1, 2, 4, 7. 1. An electrocardiogram can indicate ischemia of the heart muscle. 2. An electrocardiogram can indicate injury to the heart muscle. 3. An electrocardiogram does not indicate CO. 4. An electrocardiogram can show dysrhythmias. 5. An electrocardiogram does not show SVR. 6. An electrocardiogram does not show occlusion pressures. 7. An electrocardiogram does show conduction delays. TEST-TAKING HINT: The electrocardiogram checks the electrical system of the heart, not the mechanical system. CO is mechanical; occlusion pressure does not have to do with the electrocardiogram; and SVR measures pressures in the peripheral system.

Which of the following are examples of acquired heart disease? Select all that apply. 1. Infective endocarditis. 2. Hypoplastic left heart syndrome. 3. Rheumatic fever (RF). 4. Cardiomyopathy. 5. Kawasaki disease (KD). 6. Transposition of the great vessels.

1, 3, 4, 5. 1. Infective endocarditis is an example of an acquired heart problem. 2. Hypoplastic left heart syndrome is a CHD. 3. RF is an acquired heart problem. 4. Cardiomyopathy is an acquired heart problem. 5. KD is an acquired heart problem. 6. Transposition of the great vessels is a CHD. TEST-TAKING HINT: "Acquired" means occurring after birth and seen in an otherwise normal and healthy heart

Discharge teaching for a 3-month-old infant with a cardiac defect who is to receive digoxin (Lanoxin) should include which of the following? Select all that apply. 1.Give the medication at regular intervals. 2.Mix the medication with a small volume of breast milk or formula. 3.Repeat the dose one time if the child vomits immediately after administration. 4.Notify the primary care provider of poor feeding or vomiting. 5.Make up any missed doses as soon as realized. 6.Notify the primary care provider if more than two consecutive doses are missed.

1,4,6 To achieve optimal therapeutic levels, digoxin should be given at regular intervals without variation, usually every 12 hours. Vomiting and poor feeding are signs of toxicity. If more than two consecutive doses are missed, interventions may be needed to assure therapeutic drug levels. The medication should not be mixed with any other fluid as refusal may result in inaccurate intake of the medication. Taking make-up doses, or taking the medication at times other than scheduled, may adversely affect serum levels.

After surgery to correct a tetralogy of Fallot, the child's parents express concern to the nurse that their 4-year-old child wants to be held more frequently than usual. The nurse recommends: 1.Introducing a new skill. 2.Play therapy. 3.Encouraging the behavior. 4.Having the volunteer hold the child.

2 The child is exhibiting regression. During periods of stress, children frequently revert to behaviors that were comforting in earlier developmental stages; play therapy is one way to help the child cope with the stress. Teaching a new skill most likely would add more stress. Parents should be instructed to praise positive behaviors and ignore regressive behaviors rather than calling attention to them through encouragement or discouragement. Having someone else hold the child does not encourage coping with the stress or promoting appropriate development

An infant weighing 9 kg is in the pediatric intensive care unit following arterial switch surgery. In the past hour, the infant has had 16 mL of urine output. Which action should the nurse take? 1.Notify the primary health care provider immediately. 2.Record the urine output in the chart. 3.Administer a fluid bolus immediately. 4.Assess for other signs of hypervolemia.

2 Urine output for an infant weighing 9 kg should be 1 mL/kg/h. 16 mL of urine output is more than adequate for 1 hour so the nurse should record the output in the chart. There is no reason to notify the primary health care provider regarding adequate urine output. The infant has adequate output so there is no need for a fluid bolus. A fluid bolus could also cause the infant to become fluid overloaded, increasing the workload on the heart. There is no information in the question indicating that the child is hypervolemic.

A child diagnosed with congestive heart failure (CHF) is receiving maintenance doses of digoxin (Lanoxin) and furosemide (Lasix). She is rubbing her eyes when she is looking at the lights in the room, and her HR is 70 beats per minute. The nurse expects which laboratory finding? 1. Hypokalemia. 2. Hypomagnesemia. 3. Hypocalcemia. 4. Hypophosphatemia

1 1. The rubbing of the child's eyes may mean that she is seeing halos around the lights, indicating digoxin (Lanoxin) toxicity. The HR is slow for her age and also indicates digoxin toxicity. A decrease in serum potassium because of the furosemide (Lasix) can increase the risk for digoxin toxicity. 2. Hypomagnesemia does not affect digoxin and is not related to the child rubbing her eyes. 3. Hypocalcemia does not affect digoxin and is not related to the child rubbing her eyes. 4. Hypophosphatemia does not affect digoxin and is not related to the child rubbing her eyes. TEST-TAKING HINT: The test taker knows that furosemide (Lasix) causes the loss of potassium and can cause digoxin (Lanoxin) toxicity.

A child has been seen by the school nurse for dizziness since the start of the school term. It happens when standing in line for recess and homeroom. The child now reports that she would rather sit and watch her friends play hopscotch because she cannot count out loud and jump at the same time. When the nurse asks her if her chest ever hurts, she says yes. Based on this history, the nurse suspects that she has: 1. Ventricular septal defect (VSD). 2. Aortic stenosis (AS). 3. Mitral valve prolapse. 4. Tricuspid atresia.

2 1. Murmur and CHF are often found in infancy. 2. AS can progress, and the child can develop exercise intolerance that can be better when resting. 3. Mitral valve prolapse causes a murmur and palpitations, usually in adulthood. 4. Tricuspid atresia causes hypoxemia in infancy. TEST-TAKING HINT: What do "stenosis," "prolapse," and "atresia" mean, and what do those conditions cause?

When assessing a child after heart surgery to correct tetralogy of Fallot, which of the following should alert the nurse to suspect a low cardiac output? 1.Bounding pulses and mottled skin. 2.Altered level of consciousness and thready pulse. 3.Capillary refill of 2 seconds and blood pressure of 96/67 mm Hg. 4.Extremities warm to the touch and pale skin.

2 With a low cardiac output and subsequent poor tissue perfusion, signs and symptoms would include pale, cool extremities; cyanosis; weak, thready pulses; delayed capillary refill; and decrease in level of consciousness

A child diagnosed with tetralogy of Fallot becomes upset, crying and thrashing around when a blood specimen is obtained. The child's color becomes blue and the respiratory rate increases to 44 breaths/min. Which of the following actions should the nurse do first? 1.Obtain a prescription for sedation for the child. 2.Assess for an irregular heart rate and rhythm" 3.Explain to the child that it will only hurt for a short time. 4.Place the child in a knee-to-chest position.

4 The child is experiencing a tet or hypoxic episode. Therefore the nurse should place the child in a knee-to-chest position. Flexing the legs reduces venous flow of blood from the lower extremities and reduces the volume of blood being shunted through the interventricular septal defect and the overriding aorta in the child with tetralogy of Fallot. As a result, the blood then entering the systemic circulation has higher oxygen content, and dyspnea is reduced. Flexing the legs also increases vascular resistance and pressure in the left ventricle. An infant often assumes a knee-to-chest position in the crib, or the mother learns to put the infant over her shoulder while holding the child in a knee-to-chest position to relieve dyspnea. If this position is ineffective, then the child may need a sedative. Once the child is in the position, the nurse may assess for an irregular heart rate and rhythm. Explaining to the child that it will only hurt for a short time does nothing to alleviate the hypoxia

A child has had open heart surgery to repair a tetralogy of Fallot with a patch. The nurse should instruct the parents to: 1.Notify all health care providers before invasive procedures for the next 6 months. 2.Maintain adequate hydration of at least 10 glasses of water a day. 3.Provide for frequent rest periods and naps during the first 4 weeks. 4.Restrict the ingestion of bananas and citrus fruit.

1 Children who have undergone open heart surgery with a patch are at risk for infection, especially subacute bacterial endocarditis (SBE), for the first 6 months following surgery. The newest evidence-based guidelines suggest that once the patch has epithelialized, these precautions are no longer necessary. Therefore, parents are instructed about SBE precautions including the need to notify providers before invasive procedures so antibiotics can be prescribed for that time period. Having the child drink a very large amount of water may lead to fluid overload. Children gear their rest schedule to their activities making it unnecessary to schedule frequent rest periods. Bananas and citrus fruit are high in potassium, but there is no evidence provided that the child has an elevated serum potassium requiring restrictio

An 18-month-old with a congenital heart defect is to receive digoxin (Lanoxin) twice a day. The nurse should instruct the parents about which of the following? 1.Digoxin enables the heart to pump more effectively with a slower and more regular rhythm. 2.Signs of toxicity include loss of appetite, vomiting, increased pulse, and visual disturbances. 3.Digoxin is absorbed better if taken with meals. 4.If the child vomits within 15 minutes of administration, the dosage should be repeated

1 Digoxin's effect is to slow the rate of the electrical conduction through the heart and increase the strength of the heart's contraction. Signs of toxicity include anorexia and decreased heart rate. Digoxin should be taken 1 hour before meals or 2 hours after meals in order to obtain better absorption of the drug. If the child vomits within 15 minutes of administration, the dose should not be repeated because it is not known how much of the medication has been absorbed.

Hypoxic spells in the infant with a congenital heart defect (CHD) can cause which of the following? Select all that apply. 1. Polycythemia. 2. Blood clots. 3. Cerebrovascular accident (CVA). 4. Developmental delays. 5. Viral pericarditis. 6. Brain damage. 7. Alkalosis.

1, 2, 3, 4, 6 1. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke (CVA). 2. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke (CVA). 3. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke (CVA). 4. Developmental delays can be caused by multiple hospitalizations and surgeries. The child usually catches up to the appropriate level. 5. Hypoxia can increase the risk for bacterial endocarditis, not viral pericarditis. 6. Brain damage can be caused by hypoxia, blood clots, and stroke (CVA). 7. Hypoxic episodes cause acidosis, not alkalosis. TEST-TAKING HINT: Hypoxic episodes in a child with CHD ("tet spells") can cause polycythemia and strokes (CVAs).

Which interventions decrease cardiac demands in an infant with congestive heart failure (CHF)? Select all that apply. 1. Allow parents to hold and rock their child. 2. Feed only when the infant is crying. 3. Keep the child uncovered to promote low body temperature. 4. Make frequent position changes. 5. Feed the child when sucking the fists. 6. Change bed linens only when necessary. 7. Organize nursing activities.

1, 4, 5, 6, 7. 1. Rocking by the parents will comfort the infant and decrease demands. 2. The infant would not be fed when crying because crying increases cardiac demands. The infant might choke if the nipple is placed in the mouth and the child inhales when trying to swallow. 3. Keep the child normothermic to reduce metabolic demands. 4. Frequent position changes will decrease the risk for infection by avoiding immobility with its potential for skin breakdown. 5. An infant sucking the fists could indicate hunger. 6. Change bed linens only when necessary to avoid disturbing the child. 7. Organize nursing activities to avoid disturbing the child. TEST-TAKING HINT: Do all that can be done to decrease demands on the child.

While assessing a newborn with respiratory distress, the nurse auscultates a machine-like heart murmur. Other findings are a wide pulse pressure, periods of apnea, increased Pa CO2, and decreased PO2. The nurse suspects that the newborn has: 1. Pulmonary hypertension. 2. Patent ductus arteriosus (PDA). 3. Ventricular septal defect (VSD). 4. Bronchopulmonary dysplasia.

2 1. Pulmonary hypertension is a pulmonary condition, which does not create a heart murmur. 2. The main identifier in the stem is the machine-like murmur, which is the hallmark of a PDA. 3. A VSD does not produce a machine-like murmur. 4. Bronchopulmonary dysplasia is a pulmonary condition, which does not create a heart murmur. TEST-TAKING HINT: The test taker needs to know common murmur sounds.

While looking through the chart of an infant with a congenital heart defect (CHD) of decreased pulmonary blood flow, the nurse would expect which laboratory finding? 1. Decreased platelet count. 2. Polycythemia. 3. Decreased ferritin level. 4. Shift to the left

2 1. The nurse should expect a normal platelet count in an infant with a CHD of decreased pulmonary blood fl ow. 2. Polycythemia is the result of the body attempting to increase the oxygen supply in the presence of hypoxia by increasing the total number of red blood cells to carry the oxygen. 3. Ferritin measures the amount of iron stored in the body and is not affected by decreased pulmonary blood fl ow. 4. "Shift to the left" refers to an increase in the number of immature white blood cells. TEST-TAKING HINT: The test taker needs to know what laboratory values hypoxia can affec

What should the nurse assess prior to administering digoxin (Lanoxin)? 1. Sclera. 2. Apical pulse rate. 3. Cough. 4. Liver function test.

2 1. The sclera has nothing to do with CHF. 2. The apical pulse rate is assessed because digoxin (Lanoxin) decreases the HR; if the HR is <60, digoxin should not be administered. 3. Cough would not be assessed before administration. It is more commonly seen in patients who have been prescribed ACE inhibitors. 4. Liver function tests are not assessed before digoxin (Lanoxin) is administered. Digoxin can lower HR and cause dysrhythmias. TEST-TAKING HINT: The test taker should know that the sclera and liver function tests have nothing to do with digoxin (Lanoxin). Cough could be associated with ACE inhibitors.

The parents of a 3-month-old ask why their baby will not have an operation to correct a ventricular septal defect (VSD). The nurse's best response is: 1. "It is always helpful to get a second opinion about any serious condition like this." 2. "Your baby's defect is small and will likely close on its own by 1 year of age." 3. "It is common for health-care providers to wait until an infant develops respiratory distress before they do the surgery." 4. "With a small defect like this, they wait until the child is 10 years old to do the surgery."

2 1. This is not a collegial response, and the nurse should explain to the parents why an operation is not necessary now. 2. Usually a VSD will close on its own within the first year of life. 3. It is not common for health-care providers to wait until respiratory distress develops because that puts the infant at greater risk for complications. The defect is small and will likely close on its own. 4. Small defects usually close on their own within the first year. TEST-TAKING HINT: Know the various treatments depending on size of the defect. VSD is the most common CHD.

The school nurse has been following a child who comes to the office frequently for vague complaints of dizziness and headache. Today, she is brought in after fainting in the cafeteria following a nosebleed. Her BP is 122/85, and her radial pulses are bounding. The nurse suspects she has: 1. Transposition of the great vessels. 2. Coarctation of the aorta (COA). 3. Aortic stenosis (AS). 4. Pulmonic stenosis (PS)

2 1. Transposition of the great vessels does not cause these symptoms. 2. In the older child, COA causes dizziness, headache, fainting, elevated blood pressure, and bounding radial pulses. 3. AS does not cause these symptoms. 4. PS does not cause these symptoms. TEST-TAKING HINT: The test taker should recognize that the child's BP is elevated and her pulses are bounding, which are symptoms of COA.

The Norwood procedure is used to correct: 1. Transposition of the great vessels. 2. Hypoplastic left heart syndrome. 3. Tetralogy of Fallot (TOF). 4. Patent ductus arteriosus (PDA).

2 1. Transposition of the great vessels requires different surgical procedures. 2. The Norwood procedure is specific to hypoplastic left heart syndrome. 3. TOF requires different surgical procedures. 4. PDA requires different surgical procedures. TEST-TAKING HINT: Review surgical treatment of CHD.

The mother of a child hospitalized with tetralogy of Fallot tells the nurse that the child's 3-year-old sibling has become quiet and shy and demonstrates more than a usual amount of genital curiosity since this child's hospitalization. The nurse should tell the mother: 1."This behavior is very typical for a 3-year-old." 2."This may be how your child expresses feeling a need for attention." 3."This may be an indication that your child may have been sexually abused." 4."This may be a sign of depression in your child."

2 According to Erikson, the central psychosocial task of a preschooler is to develop a sense of industry versus guilt. Any environmental situation may affect the child. In this situation the sibling is probably feeling less attention from the mother and trying to resolve the conflict in an inappropriate way. Three-year-olds are usually active and outgoing. These behaviors represent a change. Data are not sufficient to suggest the child has been exposed to a sexual experience. Symptoms of depression would include withdrawal and fatigue.

In which congenital heart defect (CHD) would the nurse need to take upper and lower extremity BPs? 1. Transposition of the great vessels. 2. Aortic stenosis (AS). 3. Coarctation of the aorta (COA). 4. Tetralogy of Fallot (TOF).

3 1. BPs would not need to be taken in both the upper and lower extremities in transposition of the great vessels. The aorta and pulmonary arteries are in opposite positions, which does not change the BP readings. 2. AS is a narrowing of the aortic valve, which does not affect the BP in the extremities. 3. With COA there is narrowing of the aorta, which increases pressure proximal to the defect (upper extremities) and decreases pressure distal to the defect (lower extremities). There will be high BP and strong pulses in the upper extremities and lower-than-expected BP and weak pulses in the lower extremities. 4. TOF is a congenital cardiac problem with four defects that do not affect the BP in the extremities. TEST-TAKING HINT: The test taker must know the anatomy of the cardiac defects and what assessments are to be made in each one

A nurse is caring for a child with congenital heart disease who is being treated with digoxin (Lanoxin). Which is included in the family's discharge teaching? 1. Make sure the medication is taken with food. 2. Repeat the dose if the child vomits. 3. Take the child's pulse prior to administration. 4. Weigh the child daily.

3 1. Digoxin (Lanoxin) should not be taken with food. Administer the medication 1 hour before or 2 hours after a meal. 2. The dose should not be repeated if the child vomits. 3. The child's pulse should be monitored before each dose. The dose should be withheld according to the health-care provider's parameters. 4. Checking weight is not related to the medication. TEST-TAKING HINT: Know the principles of giving digoxin (Lanoxin). Knowing that the drug is given to decrease the heart rate and increase cardiac output should be a key to the answer involving checking pulse.

Which plan would be appropriate in helping to control congestive heart failure (CHF) in an infant? 1. Promoting fluid restriction. 2. Feeding a low-salt formula. 3. Feeding in semi-Fowler position. 4. Encouraging breast milk.

3 1. The nurse would not need to restrict fluids, as the child likely would not be getting overloaded with oral fluids. 2. The infant likely will have sodium depletion because of the chronic diuretic use; the infant needs a normal source of sodium, so low-sodium formula would not be used. 3. The infant has a great deal of difficulty feeding with CHF, so even getting the maintenance fluids is a challenge. The infant is fed in the more upright position so that fluid in the lungs can go to the base of the lungs, allowing better expansion. 4. Breast milk has slightly less sodium than does formula, and the child needs a normal source of sodium because of the diuretic. TEST-TAKING HINT: Infants are not able to concentrate urine well and may have sodium depletion, so they need a normal source of sodium.

On examination, a nurse hears a murmur at the left sternal border (LSB) in a child with diarrhea and fever. The parent asks why the health-care provider never said anything about the murmur. The nurse explains: 1. "The health-care provider is not a cardiologist." 2. "Murmurs are difficult to detect, especially in children." 3. "The fever increased the intensity of the murmur." 4. "We need to refer the child to an interventional cardiologist."

3 1. This is not a collegial response. 2. The increased CO of the fever increases the intensity of the murmur, making it easier to hear. 3. The increased CO of the fever increases the intensity of the murmur, making it easier to hear. 4. This child does not need to see an interventional cardiologist. The murmur needs to be diagnosed first, and then a treatment plan would be developed. TEST-TAKING HINT: Consider the pathophysiology of fever.

When teaching a preschool-age child how to perform coughing and deep-breathing exercises before corrective surgery for tetralogy of Fallot, which of the following teaching and learning principles should the nurse address first? 1.Organizing information to be taught in a logical sequence. 2.Arranging to use actual equipment for demonstrations. 3.Building the teaching on the child's current level of knowledge. 4.Presenting the information in order from simplest to most complex.

3 Before developing any teaching program for a child, the nurse's first step is to assess the child to determine what is already known. Most older preschool children have some understanding of a condition present since birth. However, the child's interest will soon be lost if familiar material is repeated too often. The nurse can then organize the information in a sequence, because there are several steps to be demonstrated. These exercises do not require the use of equipment. The nurse should judge the amount and complexity of the information to be provided, based on the child's current knowledge and response to teaching.