patho ch 25 questions

A 1-month-old infant was diagnosed with truncus arteriosus (TA) with a ventricular septal defect. This condition results in: a. hypertrophy of the aorta and major arteries. b. transposition of the aorta and the pulmonary trunk. c. the aorta returning blood to the right atrium. d. blood from both ventricles mixing in a common vessel.

ANS: D TA is failure of normal separation and division of the embryonic outflow track into a pulmonary artery and an aorta, resulting in a single vessel that exits the heart. It does not involve hypertrophy of the aorta. It does not involve transposition of the aorta. It does not involve the aorta returning blood to the right atrium. REF: p. 664

A newborn is suspected of having coarctation of the aorta. Which of the following assessments would aid in diagnosis? a. Cyanosis b. Bounding pedal pulses c. Cool arms d. Weak or absent femoral pulses

ANS: D The newborn will have weak or absent femoral pulses because blood flow is obstructed near the lower extremities, not bounding pedal pulses. Coarctation is not a cyanotic defect. The infant will have warm arms because blood flow is present in the upper extremities. REF: p. 656

What term is used to describe the patent opening between the aorta and pulmonary artery in a fetus? a. Foramen ovale b. Sinus venosus c. Ductus arteriosus d. Septal defect

ANS: C In the fetal circulation, the ductus arteriosus is an opening between the aorta and the pulmonary artery. The foramen ovale allows flow of blood between the left and right atrium. The sinus venosus is a type of atrial septal defect. The septal defect is an opening in the heart's septum. REF: p. 659

A newborn experiences frequent periods of cyanosis, usually occurring during crying or after feeding. Which cardiac diagnosis does this history support? a. Atrioventricular canal (AVC) defect b. Ventricular septal defect (VSD) c. Tetralogy of Fallot d. Atrial septal defect (ASD)

ANS: C Infants with tetralogy of Fallot experience cyanosis after crying or during feeding. Infants with AVC defect may experience cyanosis, but it is not related to feeding or crying. Infants do not experience cyanosis with either VSD or ASD. REF: p. 661

Intrauterine exposure to which factor could be responsible for a diagnosis of congenital heart disease? a. Diabetes b. Alcohol exposure c. Viral infection d. Dextroamphetamine

ANS: C One of the identified causes of cardiac defects is an intrauterine viral infection, especially rubella. Diabetes contributes to large babies. Alcohol exposure contributes to abnormalities such as facial changes while exposure to dextroamphetamines leads to other abnormalities. REF: p. 655

A 1-month-old infant visits his primary care provider for a well-baby check. Physical exam reveals decreased cardiac output, hypotension, tachycardia, and a loud murmur suggestive of aortic stenosis. Which condition would be expected with this diagnosis? a. Atrial dilation b. Ventricular hypertrophy c. Atrial rigidity d. Decreased contractility

ANS: B The infant with aortic stenosis will also be experiencing ventricular hypertrophy because of the resistance of blood flow from the left ventricle into the aorta. Aortic stenosis is not associated with either atrial dilation, rigidity, or decreased contractility. REF: p. 657

What is the most common type of congenital heart defect assessed for in infants? a. Atrial septal defect (ASD) b. Ventricular septal defect (VSD) c. Tetralogy of Fallot d. Atrioventricular canal defect

ANS: B The most common type of congenital heart defect is a VSD. REF: p. 660

When the pediatrician cardiologist discusses total anomalous pulmonary venous connection, which of the following statements BEST describes this condition? a. The foramen ovale closes after birth. b. Pulmonary venous return is introduced into the right atrium. c. Pulmonary venous return is introduced into the left atrium. d. The foramen ovale does not close.

ANS: B The pulmonary venous return is connected to the right side of the circulation, rather than to the left atrium. It does not include closure of the foramen ovale after birth. REF: p. 663

An 8-week-old infant presents to the pediatrician for a well-baby checkup. Physical exam reveals a murmur, and an echocardiogram confirms a ventricular septal defect. Which genetic disorder is likely to accompany this diagnosis? a. Huntington disease b. Color blindness c. Down syndrome d. Hemophilia

ANS: C Down syndrome is the genetic factor that would most likely accompany the diagnosis of a congenital heart defect. Neither Huntington disease, color blindness, nor hemophilia is a genetic disorder that would most likely accompany a diagnosis of congenital heart defect. REF: p. 655

A 5-year-old female is found to have hypertension during three separate visits to her primary care provider. The nurse would expect tests to suggest that the hypertension is secondary to: a. renal disease. b. brain tumor. c. hypocalcemia. d. hyponatremia.

ANS: A Hypertension in a 5-year-old is related to renal disease. Secondary hypertension in a 5-year-old is not usually related to a brain tumor, hypocalcemia, or hyponatremia. REF: p. 667

An 8-week-old infant's well-baby check reveals a murmur, and an echocardiogram shows a large ventricular septal defect. If left untreated, what condition could develop? a. Pulmonary hypertension b. Cyanosis c. Dysrhythmias d. Valve damage

ANS: A If the degree of shunting is significant and not corrected, the child is at risk for developing pulmonary hypertension. Cyanosis is not present at first if the shift is left to right. Dysrhythmias do not occur. The defect does not lead to valve damage. REF: p. 660

A 1-year-old female with a ventricular septal defect is experiencing left-sided heart failure. Which symptom will most likely occur? a. Failure to thrive b. Increased urinary output c. Jaundice d. Flat neck veins

ANS: A Left heart failure in infants is manifested as poor feeding and sucking, often leading to failure to thrive. None of the other symptoms is associated with left-sided failure. REF: pp. 665-666

A 40-year-old pregnant woman is concerned about the health of her unborn child. She has phenylketonuria (PKU) and recently had a viral infection. If the child is born with a congenital heart defect, which of the following is the most likely based on the mother's history? (select all that apply) a. Coarctation of the aorta b. Pulmonic stenosis c. Ventricular septal defect d. Patent ductus arteriosus e. Tetralogy of Fallot

ANS: A, D Coarctation of the aorta and patent ductus arteriosus are the disorders found in infants of mothers with PKU and a history of viral infections during pregnancy. REF: p. 656, Table 25-1

A newborn child is diagnosed with trisomy 18. Which of the following congenital heart defects should the nurse assess for in the infant? (select all that apply) a. Patent ductus b. Coarctation of the aorta c. Atrioventricular canal defect d. Ventricular septal defect e. Pulmonary stenosis

ANS: A, D, E The infant with trisomy 18 could present with a ventricular septal defect, a patent ductus, or pulmonary stenosis. REF: p. 656, Table 25-2

A 22-year-old pregnant woman presents to her OB/GYN for a prenatal checkup. The fetal heartbeat sounds irregular, and a fetal echocardiogram reveals an atrioventricular canal (AVC) defect. This defect is the result of: a. failure of the ductus arteriosus to close. b. incomple fusion of the endocardial cushions. c. a patent foramen ovale. d. a right-to-left shunt.

ANS: B AVC defect is the result of incomplete fusion of endocardial cushions. A patent ductus is the failure of the ductus arteriosus to close. The infant will not experience a patent foramen ovale. Flow is generally left to right, not right to left. REF: p. 660

An infant undergoes an echocardiogram for a suspected heart defect. Tests reveal an opening in the middle of the atrial septum. What term would the nurse use to describe this defect? a. Ostium primum b. Ostium secundum c. Sinus venosus d. Eisenmenger syndrome

ANS: B An opening in the middle of the atrial septum is referred to as an ostium secundum ASD. An ostium primum ASD is an opening low in the atrial septum and may be associated with abnormalities of the mitral valve. A sinus venosus ASD is an opening usually high in the atrial wall and may be associated with partial anomalous pulmonary venous connection. Eisenmenger syndrome is a condition in which shunting of blood is reversed because of high pulmonary pressure and resistance. REF: p. 659

Coarctation of the aorta is the local narrowing of the aorta near the: a. aortic valve. b. ductus arteriosus. c. diaphragm. d. bifurcation into the common iliac arteries.

ANS: B Coarctation of the aorta is narrowing of the aorta near the ductus arteriosus, not near the aortic valve, the diaphragm, or the bifurcation site. REF: p. 656

A newborn is severely cyanotic. An echocardiogram reveals transposition of the great arteries. What is the characteristic defect associated with this condition? a. The pulmonary artery leaving the right ventricle b. The aorta leaving the right ventricle c. Ventricular septal defect (VSD) d. Atrial septal defect (ASD)

ANS: B In transposition of the great arteries, the pulmonary artery leaves the left ventricle and the aorta exits from the right ventricle. The pulmonary artery normally leaves the right ventricle. Neither VSD nor ASD is associated with transposition of the great arteries. REF: p. 663

A newborn child is diagnosed with tetralogy of Fallot. What symptoms would the nurse expect to observe in the child? a. High-pitched cry and dyspnea b. Cyanosis and hypoxia c. Leg pain and twitching d. Epistaxis and anemia

ANS: B The child will experience cyanosis and hypoxia. This type of shunt decreases flow through the pulmonary system, causing less than normal oxygen delivery to the tissues and resultant cyanosis. It will not cause a high-pitched cry. It will not cause leg pain; leg pain occurs in coarctation of the aorta. Epistaxis is associated with coarctation of the aorta. REF: p. 661

A 2-week-old infant who presents with poor feeding, fatigue, dyspnea, and a murmur is diagnosed with a patent ductus arteriosus (PDA). This condition results in a(n): a. decreased pulmonary blood flow. b. right-to-left shunt. c. left-to-right shunt. d. increased systemic blood flow.

ANS: C PDA is failure of the fetal ductus arteriosus to close. The continued patency of this vessel allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, causing a left-to-right shunt. It does not cause decreased pulmonary blood flow. It could decrease systemic blood flow, not increase it. REF: p. 659

A newborn develops a murmur and cyanosis shortly after birth. A diagnosis of pulmonic stenosis (PS) is made after an echocardiogram revealed narrowing of the pulmonary: a. tree. b. artery. c. valve. d. vein.

ANS: C PS is a narrowing or stricture of the pulmonary valve causing resistance to blood flow from the right ventricle to the pulmonary artery. PS is not associated with an abnormality of the pulmonary tree, the pulmonary artery, or the vein. REF: pp. 658-659

A newborn child has a murmur and is cyanotic. An echocardiogram reveals that the tricuspid valve failed to develop and so no blood flows between the right atrium and ventricle. This condition is described with the term tricuspid: a. regurgitation. b. stenosis. c. atresia. d. transposition.

ANS: C Tricuspid atresia is failure of the tricuspid valve to develop; consequently, there is no communication from the right atrium to the right ventricle. In regurgitation, blood moves backward, but is not obstructed. In stenosis, blood flow is narrowed, but not totally obstructed. In transposition, the two great vessels are on opposite sides. REF: p. 662

A 3-year-old male is diagnosed with Kawasaki disease. What is the most likely cause of Kawasaki disease? a. A genetic defect causing left heart failure b. Autoimmune injury to the lymphatic vessels c. Infectious pericarditis d. Inflammation of the small capillaries, arteries, and veins

ANS: D Kawasaki disease is related to inflammation of small capillaries. Kawasaki disease is not a result of a genetic defect, an autoimmune disease, or infectious pericarditis. REF: p. 666