PEDIA: CARDIOVASCULAR DISORDERS

Arrange these parts of the conduction system of the heart in the correct order as an action potential would pass through them. 1. AV node 2. Purkinje fibers 3. Atrioventricular bundle 4. R and L bundle of His 5. SA node

2 - 5 - 3 - 4 - 1

Select all the true statements about the aorta:

:"The ascending aorta branches off to supply the coronary arteries of the heart." "The aortic arch branches off to supply the head, neck, and upper extremities."

An infant has a large ventricular septal defect (VSD). The defect is located in the upper section of the ventricular septum and is near the tricuspid and aortic valve. Based on this description, what type of ventricular septal defect is this?

Membranous.

As noted in the previous question, a loud murmur was noted during assessment of a newborn with patent ductus arteriosus. As the nurse you know that what type of murmur is a hallmark sign of this condition?

Systolic and diastolic machinery - like murmur.

A newborn is diagnosed with truncus arteriosus. You're educating the parents about this heart defect. Which statement by the mother demonstrates she understood the education provided about this condition?

"My baby's heart shares one artery that connects the right and left ventricles."

A family member, who is caring for a 2-year-old with Tetralogy of Fallot, asks you why the child will periodically squat when playing with other children. Your response is:

"Squatting helps to increase systemic vascular resistance, which will decrease the right to left shunt that is occurring in the ventricles and this helps increase oxygen levels."

A two-month-old is showing signs and symptoms of heart failure. An echocardiogram is ordered. The test shows the infant has a ventricular septal defect (VSD). Which statement below best describes the blood flow in the heart due to this congenital heart defect?

"The blood in the heart is shunting from the left ventricle to the right ventricle, which is increasing pulmonary blood flow."

As the nurse you know which statements below are correct about the ductus arteriosus? Select all that apply:

"The ductus arteriosus is a structure that should be present in all babies in utero." "The ductus arteriosus normally closes about 3 days after birth or sooner."

Which of these statements regarding the conduction system of the heart is NOT correct? Select all that apply.

- The SA node is located on the upper wall of the left atrium. - The AV node conducts action potentials rapidly through it. - Action potentials are carried slowly through the atrioventricular bundle.

Which of the following would Nurse Tony suppose to regard as a cardinal manifestation or symptom of digoxin toxicity to his patient Clay diagnosed with heart failure?

-,Extreme bradycardia

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. 4. Developmental delays. 5. Viral pericarditis. 6. Brain damage. 7. Alkalosis.

1, 2, 3, 4, 6.

As the nurse you know that if a patient has a large ventricular septal defect and does not receive treatment, the patient may develop Eisenmenger Syndrome. This syndrome causes?

A REVERSAL OF BLOOD SHUNTING IN THE HEART FROM RIGHT TO LEFT AND WILL CAUSE CYANOSIS

It is considered as the bluntly rounded portion of the heart.

Apex

Bryce is a child diagnosed with coarctation of aorta. While assessing him, Nurse Zach would expect to find which of the following?

Absent or diminished femoral pulses. Absent or diminished femoral pulses is a classic characteristics of Coarctation of Aorta.

BP screenings to detect end-organ damage should be done routinely beginning at what age? 1. Birth. 2. 3 years. 3. 8 years. 4. 13 years.

Age 3 years is the recommended age to establish a baseline BP in a normal healthy child

After the birth of a newborn with severe coarctation of the aorta, the physician orders a prostaglandin infusion. As the nurse you know that this medication will have what type of therapeutic effects? Select all that apply:

Allow a connection between the aorta and pulmonary artery, Decrease the workload on the left ventricle,Increase blood flow to the lower extremities

You're caring for a newborn who has Tetralogy of Fallot with severe cyanosis. You anticipate the newborn will be started on ___________?

Alprostadil (Prostaglandin E)

A 5-year-old girl Hannah is recently diagnosed with Kawasaki disease. Apart from the identified symptoms of the disease, she may also likely develop which of the following?

Aneurysm formation Kawasaki disease is a rare childhood illness that affects the blood vessels. 20% to 25% of children can develop aneurysm formation if not intervened. Treatment depends on the degree of the disease, but is often immediate treatment with IV gamma globulin or aspirin. Corticosteroids can sometimes lessen impending complications. Children who experience the disease usually need lifelong follow-up appointments to keep an eye on heart health.

A 16-year-old being treated for hypertension has laboratory values of hemoglobin B 16 g/dL, hematocrit level 43%, sodium 139 mEq/L, potassium 4.4 mEq/L, and total cholesterol of 220 mg/dL. Which drug does the nurse suspect the patient takes based on the total cholesterol? 1. Beta blockers. 2. Calcium channel blockers. 3. ACE inhibitors. 4. Diuretics.

Beta blockers are used with caution in patients with hyperlipidemia, hyperglycemia, and impotence.

A 10-year-old has undergone a cardiac catheterization. At the end of the procedure, the nurse should first assess: 1. Pain. 2. Pulses. 3. Hemoglobin and hematocrit levels. 4. Catheterization report.

Checking for pulses, especially in the canulated extremity, would assure perfusion to that extremity and is the priority post procedure.

As the nurse you know that some patients who have coarctation of the aorta will develop collateral circulation of the arteries due to the abnormality on the aorta. Which option below indicates a patient is experiencing collateral circulation?

Chest x-ray that demonstrates notching on the ribs

You're working in the NICU providing care to a neonate who has a large patent ductus arteriosus. Which finding during your head-to-toe assessment would require you to immediately notify the physician?

Crackles.

Prior to surgery for truncus arteriosus, what medications may be ordered to help with heart function and complications related to heart failure? Select all that apply:

DIGOXIN, ACE INHIBITORS, DIURETICS.

Which of the following genetic disorders increases a patient risk of developing truncus arteriosus?

DiGeorge syndrome

True or False: Atrial septal defects can lead to a decrease in lung blood flow.

FALSE.

A concerned mother brings her 3-month-old to the clinic. The mother states the infant seems to be small for its age. In addition, she states the infant fatigues very easily while feeding and rarely finishes a feeding. While collecting a thorough health history, what other signs and symptoms described by the mother may indicate the child has a congenital heart defect, such as a ventricular septal defect? Select all that apply:

FREQUENT TREATMENT FOR LUNG INFECTIONS, DIAPHORESIS WHEN NURSING, SWELLING IN THE HANDS AND FEET

A 3-day-old infant is diagnosed with truncus arteriosus. As the nurse, you know to monitor the infant for what complications? Select all that apply:

HEART FAILURE AND PULMONARY HYPERTENSION

A patient is diagnosed with a large atrial septal defect. You're providing information for the patient on the complications related to this condition. What topics will you include in the patient's education? Select all that apply:

HEART FAILURE, STROKE, PULMONARY HYPERTENSION

A 4-month-old is scheduled to take Digoxin for treatment of a ventricular septal defect. The patient's apical pulse is 89 beats per minute. As the nurse you will? Select all that apply:

HOLD THE DOSE, NOTIFY PHYSICIAN

A child diagnosed with congestive heart failure (CHF) is receiving maintenance doses of digoxin and furosemide. 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?

Hypokalemia. 2. Hypomagnesemia. 3. Hypocalcemia. 4. Hypophosphatemia. The rubbing of the child's eyes may mean that she is seeing halos around the lights, indicating digoxin toxicity. The HR is slow for her age and also indicates digoxin toxicity. A decrease in serum potassium because of the furosemide can increase the risk of digoxin toxicity.

A heart transplant may be indicated for a child with severe heart failure and: 1. Patent ductus arteriosus (PDA). 2. Ventricular septal defect (VSD). 3. Hypoplastic left heart syndrome. 4. Pulmonic stenosis (PS).

Hypoplastic left heart syndrome is treated by the Norwood procedure, or heart transplant.

The procedure that has to be performed in order to shift the high pressure from the right ventricle to the left ventricle in Transposition of the Great Arteries (TGA) is:

Jatene Procedure. The Jatene procedure, arterial switch operation or arterial switch, is an open heart surgical procedure used to correct dextro-transposition of the great arteries (d-TGA)

A child who has reddened eyes with no discharge; red, swollen, and peeling palms and soles of the feet; dry, cracked lips; and a "strawberry tongue" most likely has

Kawasaki disease or KD.

You're caring for a 2-year-old patient who has a large atrial septal defect that needs repair. This defect is causing complications. These complications are arising from an abnormal shunting of blood throughout the heart. As the nurse, you know that a __________________ shunt is occurring in the heart due to the defect.

LEFT TO RIGHT.

After speaking with the mother of the infant in the previous question, who may have a ventricular septal defect, you auscultate heart sounds. If a ventricular septal defect was present, you may hear a harsh murmur that is _______________________.

LOCATED AT THE LOWER LEFT STERNAL BORDER AND STARTS AT S1 AND EXTENDS INTO S2

an echocardiogram shows that your patient has an atrial septal defect located at the bottom of the septum near the tricuspid and mitral valves. As the nurse you know this is what type of atrial septal defect (ASD)?

OSTIUM PRIMUM

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 or PDA.

Which of the following is most likely associated with a cerebrovascular accident (CVA) resulting from congenital heart disease?

Polycythemia The child with congenital heart disease develops polycythemia resulting from an inadequate mechanism to compensate for decreased oxygen saturation

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.

A toddler who has been hospitalized for vomiting due to gastroenteritis is sleeping and difficult to wake up. Assessment reveals vital signs of a regular HR of 220 beats per minute, respiratory rate of 30 per minute, BP of 84/52, and capillary refill of 3 seconds. Which dysrhythmia does the nurse suspect in this child? 1. Rapid pulmonary flutter. 2. Sinus bradycardia. 3. Rapid atrial fibrillation. 4. Supraventricular tachycardia.

SVT is often above 200 and a result of dehydration, which a vomiting child could have. The rapid rate causes a low CO, resulting in low BP and prolonged capillary refill.

You're providing discharge education to the parents of a child who just had surgery to repair coarctation of the aorta. What should the nurse include in the teaching about issues that can arise after surgery that must be closely monitored by a cardiologist? Select all that apply:

RESTENOSIS OF THE AORTA AND HYPERTENSION

A 10-year-old child is recovering from a severe sore throat. The parent states that the child complains of chest pain. The nurse observes that the child has swollen joints, nodules on the fingers, and a rash on the chest. The likely cause is

Rheumatic fever or RF. To make the diagnosis of RF, major and minor criteria are used. Major criteria include carditis, subcutaneous nodules, erythema marginatum, chorea, and arthritis. Minor criteria include fever and previous history of RF.

The ductus arteriosus is another fetal structure that is important in the intrauterine life. It functions to:

Shunts the combined cardiac output from the pulmonary artery to the systemic circulation In the developing fetus, the ductus arteriosus, also called the ductus Botalli, is a blood vessel connecting the pulmonary artery to the proximal descending aorta. It allows most of the blood from the right ventricle to bypass the fetus's fluid-filled non-functioning lungs.

While feeding a 3-month-old infant, who has Tetralogy of Fallot, you notice the infant's skin begins to have a bluish tint and the breathing rate has increased. Your immediate nursing action is to?

Stop feeding the infant and place the infant in the knee-to-chest position and administer oxygen.

You are assessing the heart sounds of a patient with a severe case of Tetralogy of Fallot. You would expect to hear a __________ murmur at the _______ of the sternal border?

Systolic; left

True or False: In a normal heart without any type of congenital heart defect, the pulmonary vein carries oxygenated blood away from the lungs to the left side of the heart.

TRUE

A child has a Glasgow Coma Scale of 3, HR of 88 beats per minute and regular, respiratory rate of 22, BP of 78/52, and blood sugar of 35 mg/dL. The nurse asks the caregiver about accidental ingestion of which drug? 1. Calcium channel blocker. 2. Beta blocker. 3. ACE inhibiter. 4. ARB.

The beta blocker not only affects the heart and lungs but also blocks the beta sites in the liver, reducing the amount of glycogen available for use, causing hypoglycemia. The lower HR and BP also suggest ingestion of a cardiac medication.

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.

The increase in the SVR would increase afterload and increase blood return to the pulmonary artery

During play, a toddler with a history of tetralogy of Fallot (TOF) might assume which position? 1. Sitting. 2. Supine. 3. Squatting. 4. Standing.

The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow

TRUE or FALSE: A small muscular ventricular septal defect has a high probability of self-closure, and these types of VSDs are found in the lower portion of the ventricular septum.

True.

A newborn has severe coarctation of the aorta. What signs and symptoms would you expect to find in this patient? Select all that apply:

Very strong bounding pulses in the upper extremities, Cool legs and feet, Absent/diminished femoral pulses

You're teaching a class to a group of parents about congenital heart defects. During the class discussion, you ask the group to describe the surgical repair for truncus arteriosus. Select all the TRUE statements by the group members about this surgical repair:

"During the surgery the pulmonary arteries are separated from the truncus arteriosus and connected to the right ventricle using a valved conduit." AND "Some patients may need another surgical repair later on because of narrowing of the conduit that may occur or they may outgrow it."

As the nurse you know which statements are TRUE about Tetralogy of Fallot? Select all that apply:

"Tetralogy of Fallot is a cyanotic heart defect." "In this condition, the heart has to work harder to pump blood to the lungs, which causes the right ventricle to work harder and enlarge." "Many patients with this condition will experience clubbing of the nails."

A newborn baby is born with transposition of the great arteries (TGA). You're explaining the condition to the parents. Which statement by the father demonstrates he understood the education provided about this condition?

"The aorta and pulmonary artery are switched, which causes the aorta to arise from the right ventricle and the pulmonary artery to arise from the left ventricle."

You're caring for a child with coarctation of the aorta and educating the parents about the child's condition. Which statement by the parents demonstrates they understood the pathophysiology of this defect?

"The narrowing of the aorta leads to a high blood pressure in the arteries that are found before the site of narrowing in the aorta."

You're caring for a 2-day-old infant with a large patent ductus arteriosus. The mother of the infant is anxious and asks you to explain her child's condition to her again. Which statement below BEST describes this condition?

"The vessel connecting the aorta and pulmonary artery has failed to close at birth, which is leading to a left-to-right shunt of blood."

You're performing a head-to-toe- assessment on a newborn with severe coarctation of the aorta. You note a systolic heart murmur. Where is this heart murmur best auscultated in a patient with this condition?

at the left interscapular area

As the registered nurse you are developing a plan of care for a patient with Tetralogy of Fallot. Select all the appropriate nursing diagnoses below that would be specific to this patient:

Risk for deficient fluid volume, Activity intolerance, Failure to thrive

Select all the signs and symptoms of how a newborn with transposition of the great arteries may present after birth:

CYANOSIS, LOW OXYGEN LEVELS, INCREASED RESPIRATORY RATE, INCREASED HEART RATE

A 1-day-old infant is ordered an echocardiogram due to abnormal signs and symptoms related to a congenital heart defect. The echo confirms that truncus arteriosus is present. What signs and symptoms may present in this congenital heart defect? Select all that apply:

CYANOSIS, POOR FEEDING, CLUBBING OF FINGERS

Family discharge teaching has been effective when the parent of a toddler diagnosed with Kawasaki disease (KD) states: 1. "The arthritis in her knees is permanent. She will need knee replacements." 2. "I will give her diphenhydramine (Benadryl) for her peeling palms and soles of her feet." 3. "I know she will be irritable for 2 months after her symptoms started." 4. "I will continue with high doses of Tylenol for her inflammation."

Children can be irritable for 2 months after the symptoms of the disease start.

An 18-month-old with a myelomeningocele is undergoing a cardiac catheterization. The mother expresses concern about the use of dye in the procedure. The child does not have any allergies. In addition to the concern for an iodine allergy, what other allergy should the nurse bring to the attention of the catheterization staff? 1. Soy. 2. Latex. 3. Penicillin. 4. Dairy.

Children with spina bifida (myelo - meningocele) often have a latex allergy. The catheter balloon is often made of latex, and all personnel caring for the patient should be made aware of the allergy.

Your newborn patient has a severe case of transposition of the great arteries. The baby does not have any other defects and is therefore experiencing severe cyanosis and needs medical intervention immediately. The newborn is started on prostaglandin E and is scheduled for a balloon atrial septostomy. Select the statement below that best describes this procedure:

During this procedure a hole in the atrial septum is enlarged, which will be temporary.

True or False: Atrial septal defects are characterized by a hole in the interatrial septum that allows blood to mix in the right and left atria, which are the lower chambers of the heart.

False

TRUE or FALSE: The signs and symptoms of a ventricular septal defect are most commonly detected in a baby following birth.

False.

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.

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.

You're providing education to the parents of a child who has a patent ductus arteriosus. The parents want to know the complications of this condition. In your education, you will include which of the following complications of PDA? Select all that apply:

Heart Failure, Pulmonary hypertension, Recurrent lung infection, Endocarditis.

You're developing a care plan for an infant with truncus arteriosus. When analyzing the pathophysiology for this condition, what nursing diagnosis can be included in this patient's plan of care? Select all that apply:

IMBALANCE NUTRITION, ACTIVITY INTOLERANCE AND INEFFECTIVE BREATHING PATTERN.

Aspirin has been ordered for the child with rheumatic fever (RF) in order to: 1. Keep the patent ductus arteriosus (PDA) open. 2. Reduce joint inflammation. 3. Decrease swelling of strawberry tongue. 4. Treat ventricular hypertrophy of endocarditis.

Joint inflammation is experienced in RF; aspirin therapy helps with inflammation and pain.

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.

You're assessing the heart sounds of a child with an atrial septal defect. You note a heart murmur at the 2nd intercostal space at the left upper sternal border. Heart murmurs noted in patients with an atrial septal defect are called?

MIDSYSTOLIC MURMURS.

Which of the following instructions would Nurse Courtney include in a teaching plan that focuses on initial prevention for Sheri who is diagnosed with rheumatic fever?

Treating streptococcal throat infections with an antibiotic. Rheumatoid fever results from improperly treated group beta-hemolytic streptococcal infections, usually pharyngitis. Therefore, prompt treatment of streptococcal throat infections with an antibiotic is a key preventive measure.

You're providing an in-service to a group of new nurses who will be caring for patients who have Tetralogy of Fallot. Which statement below is INCORRECT concerning how the blood normally flows through the heart?

Unoxygenated blood enters through the superior and inferior vena cava and travels to the left atrium.

A newborn baby with transposition of the great arteries has an echocardiogram performed to detect if any other defects are present in the heart. As the nurse, you know that what other defects can most commonly occur with TGA? Select all that apply:

VENTRICULAR SEPTAL DEFECT, PATENT DUCTUS ARTERIOSUS, ATRIAL SEPTAL DEFECT

What other congenital heart defect is most commonly present in truncus arteriosus?

Ventricular septal defect

A 4-month-old is diagnosed with Tetralogy of Fallot. You're providing an illustration to the parent to help him understand the pathophysiology of this condition. What defects must be present in the illustration to help the parent understand their child's condition? Select all that apply:

Ventricular septal defect Right ventricular hypertrophy Displacement of the Aorta Pulmonic Stenosis

The Foley Family is caring for their youngest child, Justin, who is suffering from tetralogy of Fallot. Which of the following are defects associated with this congenital heart condition?

Ventricular septal defect, overriding aorta, pulmonic stenosis (PS), and right ventricular hypertrophy The defects associated with tetralogy of Fallot include ventricular septal defect, overriding aorta, pulmonic stenosis (PS), and right ventricular hypertrophy.

While assessing a newborn's heart sounds you note a loud murmur at the left upper sternal border. You report this to the physician who suspects the infant may have patent ductus arteriosus. The physician asks you to obtain a pulse pressure. If patent ductus arteriosus is present, the pulse pressure would be ___________.

Wide.

Clay is an 8-year-old boy diagnosed with heart failure. Which of the following shows that he is strictly following the directed therapeutic regimen?

- Normal weight for age. Adequate weight for height demonstrates adequate nutritional intake and lack of edema.

When creating a teaching program for the parents of Jessica who is diagnosed with pulmonic stenosis (PS), Nurse Alex would keep in mind that this disorder involves which of the following?

- Obstruction of blood flow from right ventricle. PS refers to an obstruction of blood flow from the right ventricle.

Mr. and Mrs. Baker's only daughter is diagnosed with heart failure. Which of the following interventions would be appropriate to promote optimal nutrition for the infant?

- Replacing regular nipples with easy-to-suck ones The nurse should replace regular nipples with easy-to-suck-ones because the infant may tire instantly with regular nipples and thus would not be able to suck sufficiently.

Appropriate intervention is vital for many children with heart disease in order to go on to live active, full lives. Which of the following outlines an effective nursing intervention to decrease cardiac demands and minimize cardiac workload?

- Scheduling care to provide for uninterrupted rest procedures. Organizing nursing care to provide for uninterrupted periods of sleep reduces cardiac demand.

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 flow. 5. Mixed defects. 6. Obstructive defects. 7. Pansystolic murmurs.

3. Heart defects are now classified as defects with increased or decreased pulmonary blood flow. 4. Heart defects are now classified as defects with increased or decreased pulmonary blood flow. 5. Heart defects are now classified as defects with increased or decreased pulmonary blood flow. 6. Heart defects are now classified as defects with increased or decreased pulmonary blood flow.

A child has been diagnosed with valvular disease following rheumatic fever (RF). During patient teaching, the nurse discusses the child's long-term prophylactic therapy with antibiotics for dental procedures, surgery, and childbirth. The parents indicate they understand when they say: 1. "She will need to take the antibiotics until she is 18 years old." 2. "She will need to take the antibiotics for 5 years after the last attack." 3. "She will need to take the antibiotics for 10 years after the last attack." 4. "She will need to take the antibiotics for the rest of her life."

4. "She will need to take the antibiotics for the rest of her life." Valvular involvement indicates significant damage, so antibiotics would be taken for the rest of her life.

You're working on a unit that provides specialized cardiac care to the pediatric population. Which patient below would be the best candidate for Indomethacin from the treatment of patent ductus arteriosus?

A premature infant.

After admitting a child with an atrial septal defect, you start developing a nursing care plan. What nursing diagnoses can you include in the patient's plan of care based on the complications that arise from this condition? Select all that apply:

ACTIVITY INTOLERANCE, RISK FOR INFECTIONS, DECREASE CARDIAC OUTPUT, EXCESS FLUID VOLUME

A newborn is taking Digoxin prior to surgical repair of a truncus arteriosus. You're assessing morning labs and the patient's Digoxin level is 1.8 ng/mL. The next dose of Digoxin is due at 1000. As the nurse you will? Select all that apply:

ADMINISTER AS ORDERED AND CHECK APICAL PULSE PRIOR TO ADMINISTRATION OF THE SCHEDULE DOSE OF 1000.

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.

AS can progress, and the child can develop exercise intolerance that can be better when resting

A newborn baby, who is diagnosed with transposition of the great arteries, is ordered by the physician to be started on an infusion of prostaglandin E (alprostadil). The purpose of this medication is to:

Allow a continued connection between the aorta and pulmonary artery via the ductus arteriosus.

You're educating the parents of a patient with transposition of the great arteries about the treatment options. Which treatment option below provides a permanent solution and is performed within the first few weeks of life?

Arterial switch procedure

Exposure to which illness should be a cause to discontinue therapy and substitute dipyri- damole (Persantine) in a child receiving aspirin therapy for Kawasaki disease (KD)? 1. Chickenpox or influenza. 2. E. coli or staphylococcus. 3. Mumps or streptococcus A. 4. Streptococcus A or staphylococcus.

Both chickenpox and influenza are viral in nature, so consider stopping the aspirin because of

An ACE inhibitor is ordered by the physician for an infant with truncus arteriosus. This medication will decrease afterload and help with the management of heart failure. Which medication below is an ACE inhibitor?

CATROPRIL

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.

CHD is found often in children with Down syndrome

Which of the following disorders leads to cyanosis from deoxygenated blood entering the systemic arterial circulation?

Tetralogy of Fallot Tetralogy of Fallot consists of four major anomalies: ventricular septal defect, right ventricular hypertrophy, pulmonic stenosis (PS), aorta overriding the ventricular septal defect. PS impedes the flow of blood to the lungs, causing increased pressure in the right ventricle, forcing deoxygenated blood through the septal defect the left ventricle. As a result of this decreased pulmonary flow, deoxygenated blood is shunted into the systemic circulation. The increased workload on the right ventricle causes hypertrophy. The overriding aorta receives blood from both the right and left ventricles. This is the definition of defect with decreased pulmonary blood flow where unoxygenated blood is shunted into the systemic circulation.

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 or TOF.