NCLEX-RN Practice Questions (Cardiac)

Which type of Congenital Heart Defect has late cyanosis?

-Left-->Right shunts

Mixed disorders:

-Transposition of the great vessels (TGV) -Total anomalous pulmonary venous return (TAPVR) -Truncus arteriosus -Hypoplastic left heart syndrome (HLHS).

ECHO can be used to detect the pressure in the chambers of the heart and it's surrounding vessels. True or False

False *Cardiac Catheterization is used for pressure readings inside the heart.

Normal K+ levels are the same for newborns and older children/adults. True or False

False *Newborn K+ 3-6 mEq/L *Older: 3.5-5.0 mEq/L

How do you manage a newborn with "PINK" Tetralogy of Fallot?

*"PINK" tetralogy of Fallot refers to a tetralogy of Fallot in which the degree of right ventricular outflow obstruction is minimal, resulting no significant right to left shunt, and therefore no cyanosis

What are the types of Congenital Heart Defects that cause a Left-->Right shunt?

- Atrial Septal Defect (ASD) -Ventricular Septal Defect (VSD) -Atrioventricular Septal Defect (AVSD) aka Endocardial Cushion Defect (ECD) -Patent Ductus Arteriosus (PDA)

What are the right-to-left shunts/cyanotic heart defects?

*Tetralogy of Fallot *Transposition of great arteries *Truncus arteriosus *Tricuspid atresia *Total anomalous pulmonary venous connection (TAPVC)

What does the aortic valve develop from?

- 3 swelling of subendocardial mesenchyme -Cavitation of these swellings form the thin valve leaflets and sinuses

What makes a Left--> Right shunt clinically relevant?

- Adding blood to the right side of the heart creates a volume overload on pulmonary circulation *If uncorrected, can progress to pulmonary vessel thickening, pulmonary hypertension, and right heart hypertrophy (this could cause shift to R-->L shunt which could cause cyanosis)

What makes an obstructive defect clinically relevant?

- Depends on whether it is from L or R side of heart *Left heart obstruction: increase in pulmonary circulation pressure (pressure overload) --> pulmonary venous hypertension --> left heart failure- *Right heart obstruction: insufficient blood flow to lungs --> hypoxia --> cyanosis (if R-to-L shunt present) --> eventually R heart failure

How should an infant with a patent ductus arteriosus that develops heart failure be treated?

- PDA should be closed -Can be closed using medicine early after birth that promotes spontaneous involution (Indomethacin) -Surgically through incision in left chest, suture ligation of PDA -Also can use an obstructing coil or plug to close PDA

A complete operative repair of a Tetralogy of Fallot includes what?

- Patch closure of ventricular septal defect, so that blood in LV will flow into aorta -Relief of RV outflow tract obstruction (pulmonary trunk stenosis) w/ muscle resection, RVOT patch placement to increase diameter, or placement of RV to PA conduit

What are the outcomes of a patent ductus arteriosus?

- Pulmonary resistance drops -Pressure in aorta becomes significantly higher than pressure in pulmonary artery -Blood flows from aorta to pulmonary artery (L-->R shunt) via PDA- L-->R shunt sends extra already oxygenated blood back to lungs instead of out to body -Can lead to heart failure and poor growth

What is the general cause of Congenital Heart Defects?

-Abnormal morphological development of the heart and/or great vessels that results in altered hemodynamic function

What are common side effects of Prostaglandin E1 (PGE) to monitor for?

-Apnea -Fever -Hypotension (@ higher doses) -Increased secretions -Gastric outlet obstruction w/ chronic use

What should be done for a baby experiencing a hypercyanotic "tet" spell?

-Calm infant -Provide supplemental oxygen -Place in knee-to-chest position to increase systemic venous return to the heart and augment blood flow across RVOT resistance (SVR). *Medications: IM morphine sulfate, IV bolus of saline *Other medications: IV ketamine, IV phenylephrine, beta blockers

Which congenital heart defect is associated with Turner Syndrome (45, XO)?

-Coarctation of the Aorta

Obstructive disorders:

-Coarctation of the aorta -Aortic stenosis -Pulmonary stenosis

What are the four major complications of Ventricular Septal Defects (VSDs) that have significant shunts?

-Congenital heart failure secondary to large volume left --> right shunt -Pulmonary hypertension with eventual reversal of shunt to right --> left shut (Eisenmenger's syndrome) -Left ventricle dysfunction as a late consequence of chronic volume overload -Bacterial endocarditis

What makes a Right-->Left shunt clinically relevant?

-Cyanosis -Increase in amount of reduced (unoxygenated) hemoglobin in circulation (>1/3) -Deoxygenated blood gets into the systemic circulation *Ex: Tetralogy of Fallot, Pulmonary atresia, Tricuspid atresia, Pulmonary hypertension of the newborn (meconium aspiration syndrome), and Eisenmenger syndrome

What defect causes a dilatation of the right atrium (RA) and the right ventricle (RV)?

-Ebstein Anomaly of the Tricuspid Valve

What part of the fetus has the highest blood oxygen saturation? Adult?

-Fetus: umbilical vein (from placenta to fetus) -Adult: pulmonary vein (from lungs to RA)

What are the most common causes of Congenital Heart Defects?

-Genetic: trisomies (13, 15, 18, 21), Turner syndrome (45,XO), monegenic disorders -Environmental -Idiopathic (90%)

What are the characteristic clinical findings associated with a Patent Ductus Arteriosus?

-Harsh, continuous "machinery-like" murmur -Usually seen in isolation (90%) -Necessary for survival in AV or PV atresia, others

What medication can be used to close a Patent Ductus Arteriosus?

-INDOMETHACIN ex:Prostaglandin inhibitors (NAIDs) **When surgical ligation is not indicated**

What are the clinical features of Tetralogy of Fallot?

-Murmur present if significant pulmonary stenosis (left sternal boarder) *Most common Cyanotic heart defect *More common in males *Heart appears to be boot shaped *Increased tachypnea

Disorders with INCREASED pulmonary blood flow:

-Patent ductus arteriosus (PDA) -Atrial septal defect (ASD) -Ventricular septal defect (VSD)

What are "Tet spells"?

-Profound and progressive cyanosis -Disappearance of typical ejection fracture systolic murmur - indicates RVOT obstruction is so severe that there is no forward blood flow into pulmonary arteries or significant R to L shunting across VSD -Hyperpneic, irritable

Which type of Congenital Heart Defect has cyanosis?

-Right-->Left shunts

What determines the clinical outcome of Tetralogy of Fallot?

-Severity of pulmonary trunk stenosis determines degree of cyanosis

What is the most common right-to-left shunt / cyanotic heart defect?

-Tetralogy of Fallot

Disorders with DECREASED pulmonary blood flow:

-Tetralogy of Fallot -Tricuspid atresia

What is a Senning Procedure used to treat? What happens?

-Treatment for transposition of the great vessels (atrial switch) *Senning procedure is named after Ake Senning who inserted the first pacemaker

What are the complications of a Senning procedure for tx of transposition of the great vessels?

-Venous obstruction (systemic or pulmonary veins) -Arrhythmias (atrial or sinus node dysfunction -Systemic ventricle (RV) dysfunction

What is the most common major congenital heart defect?

-Ventricular Septal Defect (VSD) *25% of all congenital heart defects

When do most Congenital Heart Defects arise?

-Weeks 3-8 of embryogenesis

How can you delay the closure of the Patent Ductus Arteriosus?

-You can delay the closure of the Patent Ductus Arteriosus by continuously infusing Alprostadil (Prostaglandin E1) *It is used by slow injection into a vein to open the ductus arteriosus until surgery can be carried out

What are the most common types of Congenital Heart Defects?

1) Ventricular Septal Defect 2) Patent Ductus Arteriosus(these two make up 75% of CHD) 3) Atrial Septal Defect 4) Transposition of Great Vessels 5) Tetraology of Fallot(these five make up 95% of CHD)

Do not administer Digoxin (lanoxin) if heart rate is less than ____ in an infant (numeric response only)

100 bpm

Which of the following are correct statements regarding Digoxin (Lanoxin)? Check all that apply. A. Digoxin is the drug of choice to improve myocardial contractility B. Often prescribed to increase contractility and decrease afterload C. ALWAYS check dose with another Registered Nurse before administration D. Administration is normally IV for infants

A. Digoxin is the drug of choice to improve myocardial contractility B. Often prescribed to increase contractility and decrease afterload C. ALWAYS check dose with another Registered Nurse before administration **Direct to the side of the mouth and rinse with water.**

A patient diagnosed with heart failure has been prescribed digoxin (Lanoxin). Which of the following will the healthcare provider include when teaching the patient about this medication? Choose all answers that apply: A. "Call our office if you experience nausea or lack of appetite." B. "You should keep a record of your daily weights." C. "Report any visual changes to our office immediately." D. "Increase dietary sodium to maintain your fluid balance." E. "If your pulse is less than 60 beats per minute, do not take the medication." F. "If you miss a dose, you should double the dose next time."

A. "Call our office if you experience nausea or lack of appetite." B. "You should keep a record of your daily weights." C. "Report any visual changes to our office immediately." E. "If your pulse is less than 60 beats per minute, do not take the medication." *The patient needs to know how to recognize signs and symptoms of digoxin toxicity. *Doubling the dose of digoxin is not safe because it has a narrow therapeutic index. *Increased dietary sodium adds to the circulatory volume and can increase the workload on the heart.

A child underwent cardiac surgery and the nurse must prepare his parents for discharge. Which discharge instruction is correct? A. "Call your doctor before your child has dental care." B. "Keep your child away from other children for 6 months." C. "if your child vomits his digoxin, he may need a second dose". D. "Encourage the child to participate in activities so he can develop normally."

A. "Call your doctor before your child has dental care." *Upon discharge, parents should be taught to call the physician before the child has dental care. The child may be at risk for bacterial endocarditis after surgery, and dental procedures are a common portal of entry for bacteria. The physician may order antibiotics before a dental procedure.

A nurse is caring for a nine year old experiencing tachycardia due to myocarditis. Digoxin (lanoxin) is prescribed. Before giving digoxin to this child, the nurse should assess: A. Apical pulse B. Urine output C. Radial pulse D. Blood pressure

A. Apical pulse *Digoxin slows the heart rate and strengthens contractions; it shouldn't be given if the heart rate is abnormally low with regard to the child's age. The most accurate measure of the child's heart rate is the apical (not radial) pulse. Urine output and blood pressure don't need to be assessed before digoxin administration.

A child is in the pediatric intensive care unit immediately after cardiac surgery. Which nursing action is most important? A. Assess the airway. B. Administer sedation C. Maintain semi-Fowler's position. D. Monitor oxygen saturation readings.

A. Assess the airway. *Child will return from surgery with ET tube and nurse should check for bilateral breath sounds to evaluate tube placement.

The healthcare provider is reviewing health data collected on a group of patients at risk for high-output heart failure. Which of the following problems increase a patient's risk for this disorder? Choose all answers that apply: A. Cirrhosis B. Chronic anemia C. Hyperthyroidism D. Pericarditis E. Aortic valve stenosis

A. Cirrhosis B. Chronic anemia C. Hyperthyroidism *Hyperthyroidism is associated with sympathetic nervous system and adrenal activation, resulting in an increased metabolic rate. *Decreased oxygen-carrying capacity of the blood causes the heart to work harder to deliver oxygen to the tissues. *Cirrhosis can cause fluid shifts, leading to decreased circulating volume, causing the heart to work harder to circulate blood around the body.

The nurse is aware that a common physiologic adaptation of children with tetralogy of Fallot is: A. Clubbing of fingers B. Slow, irregular respirations C. Subcutaneous hemorrhages D. Decreased red blood cell count

A. Clubbing of fingers *Hypoxia leads to poor peripheral circulation; clubbing occurs as a result of additional capillary development and tissue hypertrophy of the fingertips.

The healthcare provider is administering an angiotensin converting enzyme (ACE) inhibitor to a patient diagnosed with heart failure. Which of the following describe the ways in which the ACE inhibitor is therapeutic for the patient who has heart failure? Choose all answers that apply: A. Decreases cardiac workload B. Increases peripheral vascular resistance C. Decreases myocardial remodeling D. Decreases cardiac preload E. Increases myocardial contractility F. Decreases cardiac output

A. Decreases cardiac workload C. Decreases myocardial remodeling D. Decreases cardiac preload *Decreased pumping ability of the heart causes decreased renal perfusion. *Decreased renal perfusion causes sympathetic nervous system (SNS) activation and initiation of the renin-angiotensin-aldosterone system (RAAS). *RAAS and SNS activation cause increased peripheral vascular resistance, increased preload, and increased afterload. *Angiotensin II and aldosterone are implicated in remodeling of the myocardium, which results in impaired contractility.

The nurse explains to the parents of a 5-year-old with a VSD that a cardiac cath has been scheduled to: A. Identify the specific location of the defect B. Determine the degree of cardiomegaly present C. Confirm the presence of a pansystolic murmur D. Establish the presence of ventricular hypertrophy

A. Identify the specific location of the defect *A cardiac catheterization will identify the exact location of the VSD as well as assess pulmonary pressures.

A patient diagnosed with right ventricular failure presents to the clinic with bilateral pitting edema. Which of the following circulatory changes does the healthcare provider conclude are responsible for this patient's clinical presentation? Choose all answers that apply: A. Increased plasma hydrostatic pressure B. Decreased lymphatic return to the heart C. Decreased plasma colloidal pressure D. Increased right atrial pressure E. Venous valvular incompetence

A. Increased plasma hydrostatic pressure B. Decreased lymphatic return to the heart D. Increased right atrial pressure *Plasma proteins are responsible for the colloidal pressure in the circulatory system. *Impaired right ventricular pumping causes increased pressure in the venous system. *Increased right atrial pressure interferes with lymphatic return to the central circulation.

The healthcare provider is teaching a group of senior citizens about risk factors for heart failure. Which of these factors will the healthcare provider include in the teaching? Choose all answers that apply: A. Sleep apnea B. Increased high density lipoproteins (HDL) C. Hypertension D. History of preeclampsia E. Obesity F. High sodium intake

A. Sleep apnea C. Hypertension D. History of preeclampsia E. Obesity F. High sodium intake *A sustained increase in cardiac workload can cause heart failure. *Untreated hypertension increases peripheral vascular resistance and cardiac workload. *Women who were diagnosed with preeclampsia during pregnancy are at increased risk for developing hypertension later in life. *High sodium intake increases circulating volume and preload. *Sleep apnea is associated with diastolic dysfunction. Obesity increases cardiac workload.

A nurse is assessing a 5 year old with a history of heart failure. Which finding indicates that the child has adequate cardiac output? A. Urine output of 30 mL/h B. Heart rate of 120 beats/min C. Cap refill time of 10 to 15 sec D. Bilateral crackles heard on auscultation

A. Urine output of 30 mL/hr *The minimal hourly urine output should be at least 30 mL/hr for an adult or a child. The normal heart rate for a 5 yr old is 70 to 90 bpm. Adequate cap refill time is 3 to 5 seconds. Crackles are an abnormal finding and may indicate hypervolemia, or excess circulating fluid volume, and heart failure.

A nine year old received digoxin (Lanoxin) daily for the past 5 days of his hospitalization. Before giving him his dose this morning, the nurse performs a routine assessment. Which assessment finding indicates the need to hold the child's morning dose of digoxin? A. Vomiting B. Palpitations C. Increased heart rate D. Serum digoxin level of 1.2 ng/mL

A. Vomiting *Vomiting is a sign of digoxin toxicity. *Palpitations and increased heart rate indicate that digoxin is needed. *The serum level is within the normal range.

In the fetal heart, the Foramen Ovale allows blood to enter the Left _____ from the Right Atrium.

Atrium *The foramen ovale is a normal cardiac structure found in all newborns and can be best described as a "door" between the right and left atria.

When obtaining a health history of a patient admitted with a diagnosis of heart failure, which statement made by the patient supports the diagnosis of heart failure? A. "I get hot and break out in a sweat during the night." B. "I get out of breath when I go up a flight of stairs." C. "I sometimes feel pain in the middle of my chest during exercise." D. "I often feel pain in my lower legs when I take my walk."

B. "I get out of breath when I go up a flight of stairs." *Decreased pumping ability of the heart results in decreased cardiac output and pulmonary congestion, causing shortness of breath.

A patient diagnosed with mild heart failure is prescribed hydrochlorothiazide (Microzide). The healthcare provider should determine the teaching about the medication has been successful if the patient makes which of these statements? A. "I should not worry if I experience a dry cough when taking this medication." B. "It is important for me to change positions slowly because I might become dizzy." C. "This medication might cause me to have a decrease in my appetite." D. "I might experience swelling in my legs when taking this medication."

B. "It is important for me to change positions slowly because I might become dizzy." *Hydrochlorothiazide inhibits sodium reabsorption, causing sodium and water (along with potassium and hydrogen ions) to be excreted. The diuretic effect and decrease in fluid volume may cause orthostatic (postural) hypotension. Position changes should be made slowly to prevent falls.

A newborn is diagnosed with coarctation of the aorta. The infant is discharged with a prescription for digoxin (lanoxin) 0.05 mg PO every 12 hours. The bottle of digoxin is labeled 0.15 mg in 1/2 teaspoon, the nurse should teach the mother to administer the medication using a: A. Nipple B. Calibrated syringe C. Plastic measuring spoon D. Bottle with an ounce of water

B. Calibrated syringe *A calibrated syringe or dropper provides the most accurate measurement of the medication.

When palpating the brachial, radial, and femoral pulses of a neonate, the nurse notes a difference in pulse amplitude between the femoral and radial pulses bilaterally. This difference suggests: A. Patent ductus arteriosus B. Coarctation of the aorta C. Diminished cardiac output D. Left to right shunting in the heart.

B. Coarctation of the aorta *Femoral and radial pulses suggests a coarctation of the aorta (narrowing of the aorta below the left subclavian artery). *A patent ductus arteriousus is associated with a bounding pulse due to left-to-right shunting of blood in the heart. *A weak or thinner pulse indicates diminished cardiac output.

The laboratory results of a patient diagnosed with heart failure shows a serum digoxin (Lanoxin) level of 2.1 ng/mL. Which medication is appropriate to administer at this time? A. Furosemide (Lasix) B. Digoxin immune fab (DigiFab) C. An increased dose of digoxin (Lanoxin) D. Potassium chloride (K-tab)

B. Digoxin immune fab (DigiFab) *A therapeutic digoxin serum concentration for heart failure is 0.5 - 0.9 ng/mL. *A level of 2.1 ng/mL is considered toxic so the antidote, digoxin immune fab, is appropriate to administer at this time.

When caring for a 3-year-old with tetralogy of Fallot, the nurse expects to see fatigue and poor activity tolerance. This is caused by: A. Poor muscle tone B. Inadequate oxygenation of tissues. C. Restricted blood flow leaving the heart D. Inadequate intake of food.

B. Inadequate oxygenation of tissues *The child's fatigue results from left to right shunting that occurs with tetralogy of Fallot. This shunting causes poorly oxygenated blood to circulate through the body. *Poor muscle tone and inadequate food intake can result from this condition, but these are effects, not causes. *Restricted blood flow leaving the heart is associated with aortic stenosis.

The mother of a child with a congenital cardiac defect asks the nurse why her child squats after exertion. The nurse should reply that this position: A. Reduces muscle aches B. Increases cardiac efficiency C. Enhances the pull of gravity D. Decreases blood volume in the extremities

B. Increase cardiac efficiency *When the child squats, blood pools in the lower extremities because of flexion of the hips and knees; less blood returns to the hear, enabling the heart to beat more effectively.

An infant with tetralogy of Fallot becomes cyanotic and dyspneic after a crying episode. To relieve the cyanosis and dyspnea, the nurse should place the infant in the: A. Orthopneic position B. Knee-chest position C. Lateral Sims' position D. Semi-Fowler's position

B. Knee-Chest position *Flexing the hips and knees decreases venous return to the heart from the legs; when venous return to the heart is decreased, the cardiac workload is decreased.

A complete blood workup is ordered for a 5 month old with tetralogy of Fallot. Because of the infant's heart disease, the nurse would expect the report to show: A. Anemia B. Polycythemia C. Agranulocytosis D. Thrombocytopenia

B. Polycythemia *Mrs. Reklau emphasized this. The body responds to the chronic hypoxia caused by the heart defect by increasing the production of red blood cells in an attempt to increase the oxygen-carrying capacity of the blood.

A patient with a history of coronary artery disease is being treated for a myocardial infarction (MI). During treatment, acute mitral valve regurgitation occurs. What is the most likely cause of the acute mitral valve dysfunction? A. Infective endocarditis B. Rupture of the chordae tendinae C. Atherosclerosis D. Ventricular fibrillation

B. Rupture of the chordae tendinea *The mitral valve is composed of a fibrous ring (annulus) attached to the chordae tendineae, which are in turn attached to the papillary muscles that anchor the valve to the floor of the ventricle. During a myocardial infarction the papillary muscles may suffer ischemic damage, causing rupture of the chordae tendineae.

A nurse is teaching the parents of a child with tetralogy of Fallot about hypercyanotic spells ("tet spells"). When a spell occurs, the parents should: A. Call the physician immediately call the physician immediately B. Use a calm, comforting approach C. Lay the child in the supine position D. Take the child to the nearest emergency dept.

B. Use a calm, comforting approach *Hypercyanotic spells ("tet spells"), in which a child has an extreme bluish discoloration of the skin and mucous membranes, are commonly seen in children with tetralogy of Fallot (a condition with four cardiac anomalies: VSD, pulmonic stenosis, an overriding aorta, and right ventricular hypertrophy). The parents should maintain a calm, comforting approach and place the child in the knee-chest position. It isn't necessary to call the physician, and the spells aren't considered a medical emergency unless profound hypoxia occurs.

Which medication is usually given to children diagnosed with Kawasaki disease? A. Acetaminophen (Tylenol) every 4 hours B. Amoxicillin (Amoxil) divided into three daily doses C. Aspirin daily D. Ibuprofen (Motrin) every 6 to 8 hours

C. Aspirin daily *For (red) kawasaki disease, aspirin is given initially in an anti-inflammatory dose to control fever and symptoms of inflammation. When fever has subsided, aspirin is continued at an antiplatelet dose. If the child develops coronary abnormalities, salicylate therapy is continued indefinitely. Acetaminophen and ibuprofen aren't used because they don't thin the blood. Amoxicillin is an antibiotic, and antibiotics aren't effective in treating kawasaki disease.

A 3 month old infant is admitted with a diagnosis of tetralogy of Fallot. Assessment reveals that the infant's weight is in the 5th percentile. The nurse is aware that the reason for this inadequate weight gain is: A. Cyanosis leading to cerebral changes B. Decreased arterial Po2 resulting in polycythemia C. Activity intolerance resulting in deficient caloric intake D. Pulmonary hypertension resulting in recurrent respiratory infections.

C. Activity intolerance resulting in deficient caloric intake *Because the infant tires so easily, sufficient calories cannot be infested to meet nutritional needs.

The healthcare provider is caring for a patient with a diagnosis of mitral stenosis. When auscultating the patient's chest, which type of heart sound should the healthcare provider expect to hear? A. Midsystolic murmur B. Pansystolic murmur C. Diastolic murmur D. Systolic ejection murmur

C. Diastolic murmur *The healthcare provider would expect to hear a diastolic murmur because the mitral valve is open during diastole.

When considering physiological changes common in geriatric patients, the healthcare provider understands that which of these factors may increase the risk of heart failure in older patients? A. Increased myocardial contractility B. Increased stroke volume C. Impaired diastolic filling D. Decreased sympathetic activity

C. Impaired diastolic filling *Impaired filling during diastole may result in diastolic heart failure.

A patient diagnosed with heart failure has a pulmonary artery catheter (PAC) in place. What information about the patient's hemodynamic functioning will the healthcare provider obtain from this monitoring device? A. Pulmonary valve function B. Stroke volume C. Left ventricular functioning D. Coronary artery patency

C. Left ventricular functioning *The PAC can measure left ventricular end-diastolic pressure, which is an indication of left ventricular functioning.

An appropriate nursing action to include in the care of an infant with congenital heart disease who has been admitted with heart failure is: A. Positioning flat on the back B. Encouraging nutritional fluids C. Offering small frequent feedings D. Measuring the head circumference

C. Offering small frequent feedings *Because these infants become extremely fatigued while sucking, small frequent feedings with adequate rest periods can improve their total intake.

An 8 year old is admitted with myocarditis and associated tachycardia, and is prescribed fuosemide (Lasix). Which lab value does the nurse need to closely monitor for this child? A. Calcium B. Glucose C. Potassium D. Sodium

C. Potassium

A 4-month old infant who has a congenital heart defect develops heart failure and is exhibiting marked dyspnea at rest . The nurse is aware this finding can be attributed to: A. Anemia B. Hypovolemia C. Pulmonary edema D. Metabolic acidosis

C. Pulmonary edema *The increased blood volume and pressure in the lungs resulting from left ventricular failure causes pulmonary edema; dyspnea, and early sign of failure, is probably caused by the decreased distensibility of the lungs.

A patient is diagnosed with heart failure and is prescribed digoxin (Lanoxin) and furosemide (Lasix). Before administering the furosemide to the patient, which laboratory result should the healthcare provider to review? A. Serum sodium B. Serum troponin C. Serum potassium D. Blood urea nitrogen (BUN)

C. Serum potassium *Furosemide may cause hypokalemia, which increases the risk of digoxin toxicity.

A nurse is teaching the mother of an infant who will take digoxin (Lanoxin) at home to treat a chronic tachyarrhythmia. Which signs of digoxin toxicity should the mother be taught? A. Blurred vision B. Heart rate of 180 beats/minute C. Vomiting two or more feedings D. Bulging of the anterior fontanel

C. Vomiting two or more feedings *signs of digoxin toxicity include nausea, vomiting, blurred vision, and yellow-green visual spots, but the mother will only be able to assess objective symptoms such as vomiting. Digoxin causes a decreased heart rate, which can progress to complete heart block if toxicity occurs (digoxin toxicity doesn't lead to tachycardia). Bulging of the anterior fontanel is a sign of increased intracranial pressure.

A one month old infant is admitted for confirmation of the diagnosis of ventricular septal defect. During the initial admission assessment, the nurse would expect to find: A. Bradycardia at rest B. Bounding peripheral pulses C. An activity related cyanosis D. A murmur at the left sternal border.

D. A murmur at the left sternal boarder *This murmur is the most characteristic finding in children with VSD

A nurse is carting for a child who recently underwent a cardiac catheterization to diagnose a congenital heart defect. Which finding indicates the need for immediate action? A. Increased Pulse B. Decreased urine output C. Increased temperature D. Bleeding from the catheter site.

D. Bleeding from the catheter site *Bleeding from the catheter site may become life threatening and demands immediate action. Immediately apply pressure to the site. An increased pulse indicates pain and the need for medication, which the nurse should give if other signs of pain are present, but it isn't an emergency intervention. Because a child must remain flat after a cardiac cath, a decrease in urine output may occur, but it doesn't require immediate action unless urine output is absent. An increased body temperature after cardiac catheterization is not abnormal.

Which nursing intervention best helps decrease anxiety for the parents of a child scheduled for cardiac surgery? A. Tell the parents not to worry, because the physician performs this procedure all the time. B. Obtain an order for anti-anxiety medication for the parents, if requested. C. Teach the parents and the child about the surgery 1 month before the procedure D. Explain the steps that will occur before and after surgery. The parents need something tangible to focus on.

D. Explain the steps that will occur before and after surgery. The parents need something tangible to focus on.

A child is suspected of having Kawasaki disease. Which finding is significant? A. Extreme lethargy B. Increased appetite C. Respiratory congestion D. Fever for at least 5 days

D. Fever for at least 5 days *Kawasaki disease is a type of vasculitis affecting small to medium sized vessels. It primarily affects the lymph nodes but may progress to the coronary arteries. A child with Kawasaki disease has a fever for at least five days along with an erythematous rash, red tongue, and red, cracked dry lips. Irritability, not lethargy is seen in Kawasaki disease, along with decreased appetite and edema of the hands and feet. Respiratory congestion isn't a common symptom.

A patient is being assessed for possible heart failure. Which of these laboratory results will provide support this diagnosis? A. Decreased serum sodium B. Increased creatine kinase C. Decreased C-reactive protein D. Increased brain natriuretic peptide (BNP)

D. Increase brain natriuretic peptide (BNP) *Increased fluid volume causes an increased stretch of the myocardium, causing the cells to release BNP. BNP is a peptide that opposes the actions of the renin-angiotensin system.

When assessing a patient with chronic heart failure, the healthcare provider would expect to identify which of these clinical manifestations? A. Expiratory wheezing B. Asymmetrical chest expansion C. Subcutaneous crepitus D. Inspiratory crackles

D. Inspiratory crackles *When there is decreased pumping ability of the heart fluid backs up into the pulmonary system. Inspiratory crackles are caused when air collides with fluid in the lungs.

A patient has been admitted to the cardiac unit with a diagnosis of right ventricular failure. Which of the following assessment findings would the healthcare provider expect to observe? is most likely to be observed by the healthcare provider? A. Fatigue and hemoptysis B. Bradycardia and circumoral cyanosis C. Dyspnea and pulmonary crackles D. Peripheral edema and jugular vein distension

D. Peripheral edema and jugular vein distention *The right ventricle receives blood from the right atrium. If right ventricular pumping is impaired, blood will back up through the right atrium and into the venous system.

A patient who has a history of pulmonary valve stenosis tells the healthcare provider, "I don't have a lot of energy anymore, and both of my feet get swollen in the late afternoon." Which of these problems does the healthcare provider conclude is the likely cause of these clinical findings? A. Acute pericarditis B. Deep vein thrombosis (DVT) C. Peripheral artery disease D. Right ventricular failure

D. Right ventricular failure *A sign of right ventricular failure is peripheral edema.

What congenital heart defect causes cyanosis in children? A. Atrial septal defect B. Coarctation of the aorta C. Ventricular septal defect D. Transposition of the great vessels

D. Transportation of the great vessels *With transposition of the great vessels, the pulmonary artery is attached to the left ventricle and the aorta is attached to the right ventricle. The child is cyanotic because blood reaches the tissues from the right ventricle before being oxygenated by the lungs. *In atrial septal defect and ventricular septal defect, blood is shunted from the left side of the heart to the right side through patent openings. Because the blood travels from left to right, it's oxygenated and doesn't produce cyanosis. *Coarctation of the aorta is a narrowing of the aorta that decreases the circulation of oxygenated blood to the body. With this condition, the child won't be cyanotic unless cardiac output drops.

What is Atrioventricular Septal Defect/Endocardial Cushion Defect associated with?

Down Syndrome Trisomy 21 (40%) with complete AVSD

What are the two types of Transposition of the Great Vessels? How do they differ in outcomes?

Intact Ventricular Septum (85%): unstable needs prompt surgical interventions b/c relying on patent ductus arteriosus (PDA) to get oxygenated blood to systemic circulation (not sufficient) With Ventricular Septal Defect: stable (allows mixing of blood)

What is the direction of blood through a Patent Ductus Arteriosus?

Normal Left --> Right shunt *Can switch to Right --> Left shunt if there is severe pulmonary hypertension.

Mrs. Reklau's notes state: DO NOT give more than ____ mL (0.05 mg) in one dose to an infant

One mL

Where do Ventricular Septal Defects occur?

Opening between Left Ventricle and Right Ventricle *90% at septum (membranous portion) - Also can be in the muscular portion (50% close spontaneously)

What is the clinical presentation of an adult with Coarctation of the Aorta?

Postductal narrowing of aorta not accompanied by patent ductus arteriosus (PDA) *Symptoms depend on degree of narrowing *ex: rib notching (x-ray), HTN (hypertension), upper--> lower

When is maintaining the patency of the Patent Ductus Arteriosus important?

Provides blood flow to the lungs when there is severe obstruction to pulmonary blood flow: -severe pulmonary stenosis or atresia -right heart hypoplasia -tricuspid stenosis or atresia Provides blood flow to the body when there is severe obstruction to aortic blood flow: -severe aortic stenosis -left heart hypoplasia -coarctation of aorta

Digoxin should not be administered to a child (1 year and older) with a heart rate of less than 70. True or False

True

Digoxin should not be administered to an adult with a heart rate less than 60 bpm. True or False

True

Marfan syndrome is a congenital defect sometimes associated with CHD. Affected persons have valvular problems, increased dilitation of the Aorta, are tall and lean in stature with a "wingspan" that exceeds their height. Abe Lincoln was thought to have Marfan syndrome. True or False

True

Per our notes: Breathing stimulates the closure of the Ductus arteriosis. True or False

True

Per our notes: The clamping of the umbilical cord closes the Foramen Ovale. True or False

True

In the developing fetus, the ductus arteriosus (DA), is a shunt connecting the pulmonary artery to the aortic arch. True or False

True *It allows most of the blood from the right ventricle to bypass the fetus' fluid-filled lungs, protecting the lungs from being overworked and allowing the right ventricle to strengthen.

Child's chest should be assessed for thrills or abnormal pulsations during the physical exam. True or False

True *A thrill is a continual rhythmic vibration.

Serum Digoxin levels are 0.8-2.9 ug/L. True or False

True *Nursing responsibility includes but not limited to knowing serum digoxin levels.

At about 21 days of gestation the fetal heart begins beating and circulating blood. True or False

True

Decreased urinary output (fewer wet diapers or less frequent toileting) may be a sign of worsening heart failure. True or False

True