Perfusion EAQ's April 2019 #1
A 6-month-old infant has a congenital right-to-left shunt defect of the heart. What clinical findings are expected when the nurse completes a history and physical assessment and reviews the child's laboratory reports? Select all that apply. Orthopnea Tissue hypoxia Increased hematocrit Frequent respiratory infections Bounding pulses in upper extremities
B and C- When right-to-left shunting of blood occurs in a congenital heart defect, nonoxygenated blood is being circulated to the extremities, resulting in tissue hypoxia. With the hypoxic conditions in the capillaries, erythropoietin is released to signal increased production of red blood cells (RBCs). The increased production of RBCs results in an increased hematocrit. There is no orthopnea with right-to-left shunting. Respiratory infection is common in the setting of left-to-right shunt. There are no peripheral pulse changes with this type of cardiac shunt.
A nurse is assessing a newborn with suspected retention of a fetal structure that will result in a congenital heart defect. Which fetal structures should undergo change after birth? Select all that apply. Mitral valve Foramen ovale Pulmonary veins Ductus arteriosus Pulmonary arteries
B and D- If the foramen ovale fails to close, the infant will have an atrial septal defect. If the ductus arteriosus fails to close, the pressure in the lungs and heart will be abnormal, resulting in chronic heart disease. The mitral valve, pulmonary veins, and pulmonary arteries do not change after birth.
The mother of a boy with recently diagnosed hemophilia is pregnant with her second child. She asks the nurse what the chances are that her baby will also have hemophilia. How should the nurse respond? There is a 5% chance that the baby will be affected. There is a 25% chance that the baby will be affected. There is a 50% chance that the baby will be affected. There is a 75% chance that the baby will be affected.
B- Before the sex of the unborn child is known, the odds are 25%; 50% of pregnancies will result in boys, and each has a 50% chance of having hemophilia. Hemophilia is an X-linked recessive disorder. The mother is usually the carrier, and the father is unaffected. The laws of Mendelian genetics do not include a 5% probability of inheritance of hemophilia. A 50% or 75% chance is too high; there is only a 25% chance that the fetus will be affected.
An infant with congenital heart disease is to be discharged with prescriptions for digoxin and furosemide. The nurse discusses the danger signs of digoxin toxicity with the parents. What danger sign requires a call to the healthcare provider? Difficulty feeding with vomiting Cyanosis during periods of crying Daily naps lasting more than 3 hours A pulse rate faster than 100 beats/min
A- Vomiting and feeding issues are early signs of digoxin toxicity. Cyanosis is expected in a crying infant with heart disease because the energy expenditure exceeds the body's ability to meet the oxygen demand. Long naps are expected; infants routinely require several naps, and an infant with heart disease requires long rest periods. The pulse rate of an infant receiving digoxin should remain faster than 100 beats/min.
After a discussion with the primary healthcare provider, the parents of an infant with patent ductus arteriosus (PDA) ask the nurse to explain once again what PDA is. How should the nurse respond? The diameter of the aorta is enlarged. The wall between the right and left ventricles is open. It is a narrowing of the entrance to the pulmonary artery. It is a connection between the pulmonary artery and the aorta.
D- Before birth, oxygenated fetal blood is shunted directly into the systemic circulation by way of the ductus arteriosus, a connection between the pulmonary artery and the aorta. After birth, the increased oxygen tension causes a functional closure of the ductus arteriosus. Occasionally, particularly in preterm infants, this vessel remains open, a condition known as patent ductus arteriosus. Enlargement of the diameter of the aorta is not the problem in patent ductus arteriosus. A defective wall between the right and left ventricles is a description of ventricular septal defect. A narrowing of the entrance to the pulmonary artery is a description of pulmonic stenosis.
What common finding can the nurse identify in most children with symptomatic cardiac malformations? Mental retardation Inherited genetic disorders Delayed physical growth Clubbing of the fingertips
C- Children with cardiac malformations often require more energy to fulfill the activities of daily living; decreased oxygen utilization and increased energy output in the developing child result in a slow growth rate. Mental retardation is not a common finding in children with congenital heart disease. Cardiac anomalies are more often a result of prenatal, rather than genetic, factors. Clubbing is not characteristic of most children with cardiac anomalies, only of those with more severe hypoxia.
A child has been diagnosed with hemophilia type A after experiencing excessive bleeding from a minor trauma. The parents ask how this could happen in addition to many other questions. Hemophilia A is linked to a deficiency in what? Factor II Factor III Factor IX Factor VIII
D- (8)
An infant who has a congenital heart defect with left-to-right shunting of blood is admitted to the pediatric unit. What early sign of heart failure should the nurse identify? Cyanosis Restlessness Decreased heart rate Increased respiratory rate
D- Because the lungs are stressed by pulmonary edema, a quicker respiratory rate is the first and most reliable indicator of early heart failure in infants. Cyanosis is a late sign of heart failure; with early failure there is still adequate perfusion of blood. Infants with early heart failure do not move about; they become fatigued quickly, especially when feeding, because of a decrease of oxygen to body cells. The heart rate of an infant in early heart failure increases, not decreases, in an attempt to increase oxygen to body cells.
A newborn is found to have Down syndrome. The nurse knows that Down syndrome is usually accompanied by several problems. Which assessment should the nurse perform during the physical examination? Reflex responses for hypotonicity Eye examination for congenital cataracts Sensory stimulation for muscle flaccidity Cardiac irregularities for congenital heart disease
D- Children with Down syndrome have a high incidence of congenital heart defects, indicated by altered heart sounds. Without treatment a heart defect may become life threatening. The other options are expected but are not life threatening.
A nurse who works in a fertility clinic is discussing the inheritance pattern of sickle cell disease with the parents of a school-aged child with the disease. The parents are planning to have a second child. What does the nurse know is the parental genotypic makeup? Father heterozygous (sickle trait), mother heterozygous (sickle trait) Mother homozygous (no sickle trait), father heterozygous (sickle trait) Father homozygous (no sickle trait), mother heterozygous (sickle trait) Mother homozygous (has sickle cell disease), father is homozygous (no sickle trait)
A- Sickle cell disease is an autosomal recessive disorder; each parent contributes one affected gene. All children with a mother who is homozygous (has sickle cell disease) and a father who is homozygous (no sickle trait) will have the sickle cell trait but not sickle cell disease. There is a 50% chance that a child with a homozygous mother/heterozygous father, homozygous father/heterozygous mother, or homozygous mother/homozygous father will have the sickle cell trait, not sickle cell disease.
What intervention is included in the nursing care plan for a 4-month-old infant with tetralogy of Fallot and heart failure? Providing small, frequent feedings Positioning the child flat on the back Encouraging nutritional fluids often Measuring the head circumference daily
A- Small, frequent feedings with adequate rest periods in between may improve the infant's intake at each feeding; infants with tetralogy of Fallot become extremely fatigued while suckling. Positioning the child with the head elevated, not flat on the back, facilitates respiration; an infant cardiac seat, similar to a car seat, helps maintain the child in the semi-Fowler position. As a means of reducing the cardiac workload, excessive fluids usually are not offered, and fluids may even be restricted. The head circumference is not an important assessment for infants with congenital heart disease; daily head measurements should be taken for infants with hydrocephaly.
An infant with a congenital heart defect is being given gavage feedings. The parents ask the nurse why this is necessary. What is the best response by the nurse? "It limits the chance of vomiting." "It allows the feeding to be administered rapidly." "The energy that would have been expended on suckling is conserved." "The quantity of nutritional liquid can be regulated better than it can with a bottle."
C- Gavage feeding is preferred for weak infants, those with respiratory distress or ineffective sucking-swallowing coordination, and those who are easily fatigued. It conserves energy and reduces the workload of the heart. Vomiting is not a reason to institute gavage feedings; however, vomiting may be lessened because the amount and rapidity of the feeding can be controlled. Feeding the infant quickly is not desirable; vomiting followed by aspiration may occur. The amount given can be regulated with oral formula feeding as well.
For what additional defect should the nurse assess an infant with exstrophy of the bladder? Imperforate anus Absence of one kidney Congenital heart disease Pubic bone malformation
D- The pubic bone and the bladder form during the same period of embryonic development. Imperforate anus, absence of a kidney, and congenital heart disease are not associated with exstrophy of the bladder.
During the initial assessment of a newborn the nurse suspects a congenital heart defect. Which clinical manifestations support this suspicion? Select all that apply. Nasal flaring Sternal retractions Grunting respirations Short periods of apnea Cyanotic hands and feet Heart rate of 160 beats/min
A B C- Nasal flaring occurs because of the stress of breathing; the flaring allows more air to enter the respiratory passages. Sternal retractions occur when accessory muscles of respiration contract during the stress of breathing. Grunting respirations occur as the glottis closes and reopens at the height of inhalation; this momentary closure of the glottis increases the time during which oxygen and carbon dioxide are exchanged in the alveoli. Newborns have irregular respirations with periods of apnea. Cyanosis of the hands and feet (acrocyanosis) is typical of all newborns at the time of birth. A heart rate of 160 beats/min is within the expected range of heart rates of healthy infants.
A pregnant client tells the nurse in the prenatal clinic that although she and her husband do not have the disease, she has a 1-year-old daughter with sickle cell anemia. She asks the nurse, "Will this baby also have sickle cell anemia?" How should the nurse respond? "The chance that another child will have sickle cell anemia is 25%." "Only one child in a family is affected, so the others probably will be all right." "The most likely conclusion is that your children will have sickle cell anemia." "If your partner has the sickle cell gene, 50% of your children will have sickle cell anemia."
A- According to the Mendelian laws of inheritance, the sickle cell gene is recessive. If neither parent has the disease, both of them have the sickle cell trait; there is therefore a 25% chance that a child will have sickle cell anemia, a 50% chance that a child will have the sickle cell trait, and a 25% chance that a child will be unaffected. Saying that only one child in a family is affected and that the others probably will be all right is too vague. Stating that the children will have sickle cell anemia is not an accurate answer. The client should be told the probability of a child's inheriting the disease, but 50% is too high.
A nurse concludes that the teaching about sickle cell anemia has been understood when an adolescent with the disorder makes which statement? "I'll start to have symptoms when I drink less fluid." "I'll start to have symptoms when I have fewer platelets." "I'll start to have symptoms when I decrease the iron in my diet." "I'll start to have symptoms when I have fewer white blood cells."
A- Dehydration precipitates sickling of red blood cells and therefore is a major causative factor for painful episodes associated with sickle cell anemia. An inadequate number of platelets (thrombocytes) is unrelated to painful episodes associated with sickle cell anemia. Iron intake is unrelated to the sickling phenomenon. An inadequate number of white blood cells is unrelated to painful episodes associated with sickle cell anemia.
The nurse assesses a newborn and observes central cyanosis. What type of congenital heart defect usually results in central cyanosis? Shunting of blood from right to left Shunting of blood from left to right Obstruction of blood flow from the left side of the heart Obstruction of blood flow between the left and right sides of the heart
A- Right-to-left shunting results in inadequate perfusion of blood; not enough blood flows to the lungs for oxygenation. Left-to-right shunting results in too much blood flowing to the lungs; blood is adequately perfused. Left-sided obstruction to the flow of blood results in decreased peripheral pulses, not cyanosis. Obstruction of blood flow between the left and right sides of the heart usually occurs with patent ductus arteriosus. There should be no shunting of blood between the right and left sides of the heart after the ductus arteriosus has closed. If the ductus remains open, the shunting is from left to right, and cyanosis is not a factor.
A pregnant client with sickle cell anemia visits the clinic each month for a routine examination. What additional assessment should be made during every visit? Select all that apply. Signs of hypothyroidism Evidence of urinary tract infection Symptoms of hypoglycemia Presence of hyperemesis gravidarum Evidence of carpal tunnel syndrome
B and D- Pregnant clients with sickle cell anemia are particularly vulnerable to infections, especially of the genitourinary tract; urine specimens should be examined frequently. A client with sickle cell anemia should always be monitored for hydration, so assessment for dehydration from vomiting caused by hyperemesis gravidarum is of high concern. Hypothyroidism affects 1 in 1500 women during pregnancy; women with sickle cell anemia are not at any higher risk for hypothyroidism than the general population. Women with sickle cell anemia are not at an increased risk for carpal tunnel syndrome during pregnancy.
A client with angina pectoris is scheduled for a stress echocardiogram. What should the nurse tell the client that an echocardiogram is? A tool used solely to determine the cause of chest pain A noninvasive approach to assess cardiovascular status A modality of minimal value in planning treatment for angina An invasive test that measures the body's reaction to progressive increases in exertion
B- A stress echocardiogram is noninvasive and uses echoes from pulsed high-frequency sound waves to locate and study the movements and dimensions of cardiac structures; it assesses myocardial disease, valve function, congenital heart defects, blood flow abnormalities, and systemic and pulmonic hypertension. A stress echocardiogram assesses structural defects as well as blood flow abnormalities. A stress echocardiogram is valuable in diagnosing and indicating treatment for a variety of conditions involving the heart's structure and function. A stress echocardiogram is not an invasive examination.
What nursing care to prevent a crisis is the same for school-aged children with sickle cell anemia and celiac disease? Limiting activity Protecting the child from infection Documenting the color and consistency of stools Offering a low-carbohydrate, high-protein, low-fat diet
B- Children with both illnesses have inadequate resistance to infection. Sickling results from a low oxygen level; celiac crisis results from malnourishment and immunologic defects. Activity need not be limited in celiac disease; strenuous activity should be limited in sickle cell anemia. Documenting the color and consistency of stools is important for children with celiac disease; it is not necessary for children with sickle cell anemia. A low-carbohydrate, high-protein, low-fat diet is not particularly helpful for children with sickle cell anemia or celiac disease.
A child with a congenital heart defect has a cardiac catheterization. What is an essential element of nursing care after this procedure? Encouraging early ambulation Monitoring the extremity distal to the insertion site Restricting fluids until blood pressure and heart rate have stabilized Comparing blood pressure in the affected and unaffected extremities
B- Monitoring the extremity distal to the insertion site for changes in temperature and color should indicate the presence or absence of a clot; comparing pedal pulses of both extremities may reveal clot formation that disrupts circulation. The child is kept in bed at least 6 hours after the procedure. Fluids may be given as soon as tolerated. Pulses, not blood pressure, must be checked for quality and symmetry.
An infant is born with a life-threatening congenital heart defect and is admitted to the neonatal intensive care unit. What is the priority nursing intervention at this time? Having the hospital chaplain visit the parents Assisting the parents with the grieving process Obtaining a prescription for a sedative to ease the parents' anxiety Arranging for a social worker to talk to the parents about available resources
B- Parental grieving is expected and necessary whenever an infant is born with severe problems; the parents are grieving the loss of a "normal baby." The parents should make the decision to meet with the chaplain. Obtaining a prescription for a sedative to ease the parents' anxiety may delay processing information and impede the grieving process. Arranging for a social worker to talk to the parents about available resources may be needed later; right now it is too soon to determine the outcome.
A client with a history of a congenital heart defect is admitted to the birthing unit in early labor. Which position does the nurse encourage the client to assume? Supine Semi-Fowler Trendelenburg Left lateral recumbent
B- The head of the bed should be elevated 45 degrees; this is known as the semi-Fowler position and permits maximal chest expansion for ventilation. The laboring woman should not assume the supine position, because this would increase the risk of hypotension as a result of decreased venous return. The Trendelenburg position interferes with optimal cardiac function during labor and is contraindicated. Left lateral recumbent does not facilitate maximal chest expansion.
A 10-year-old child is found to have hemophilia. The nurse is explaining how hemophilia is inherited. What is the best explanation of the genetic factor that is involved? It follows the Mendelian law of inherited disorders. The mother is a carrier of the disorder but usually is not affected by it. It is an autosomal dominant disorder in which the woman carries the trait. A carrier may be male or female, but the disease occurs in the sex opposite that of the carrier.
B- The hemophilia gene is carried on the X chromosome but is recessive. Therefore, the female is the carrier (an unaffected XO and an affected XH). If the male receives the affected XH (XHYO), he will have the disorder. Hemophilia is carried by the female; the Mendelian laws of inheritance are not sex specific. Hemophilia is a sex-linked recessive disorder. Only females carry the trait; usually males are affected.
Heart failure develops in a 4-month-old infant with a congenital heart defect, and the infant exhibits marked dyspnea at rest. What should the nurse immediately assess the infant for? Hypovolemia Bilateral crackles A decreased red blood cell count Decreased pH and carbon dioxide values
B- The increased blood volume and pressure in the lungs from impaired myocardial function results in pulmonary edema, which causes dyspnea; it is a sign of heart failure. Oxygenation is a priority concern that should be addressed immediately. Polycythemia, not anemia, is more common, because red blood cell production is increased to counteract hypoxia. Hypervolemia, not hypovolemia, is related to heart failure and pulmonary edema. Respiratory, not metabolic, acidosis can develop because of pulmonary insufficiency resulting in retention of carbon dioxide. THIS IS AN A-B-C QUESTION
The mother of an infant with a congenital heart defect who was admitted to the pediatric unit with heart failure asks why her baby must be weighed each morning. The nurse explains that the baby's treatment is based on changes in the daily weight. What complication can be prevented if treatment is successful? Renal failure Fluid retention Digitalis toxicity Protein malnutrition
B= Fluid retention is reflected by an excessive weight gain in a short period of time; inadequate cardiac output decreases blood flow to the kidneys, which leads to increased intracellular fluid and hypervolemia. Daily weights are appropriate if renal disease or hypovolemia is present; however, other assessments such as hourly urine output, blood urea nitrogen, and creatinine values provide a more accurate assessment of kidney function. Weight is helpful in determining medication dosages, but daily weights are not used to diagnose digitalis toxicity. Weight gain or loss resulting from nutritional intake is gradual and will not vary on a day-to-day basis.
A 5-week-old infant is admitted to the hospital with a tentative diagnosis of a congenital heart defect. The infant tires easily and has difficulty breathing and feeding. In what position should the nurse place this infant? Supine, with the knees flexed Orthopneic, with pillows for support Side-lying, with the upper body elevated Prone, with the head supported by pillows
C- In the side-lying position with the head and chest elevated, gravity promotes respiratory excursion; alternating side-lying positions allows pulmonary drainage and expansion. Placing the infant in an infant seat helps maintain these positions. The supine position causes the abdominal viscera to put pressure on the diaphragm, thereby impeding lung expansion. The orthopneic position is difficult to maintain in a 5-week-old infant; in addition, this position will not promote rest. The prone position will make it difficult for the lungs to expand, causing difficulty breathing.
A client with a long history of cardiovascular problems, including angina and hypertension, is scheduled to have a cardiac catheterization. During preprocedure teaching, what does the nurse explains to the client is the major purpose for catheterization? To obtain the pressures in the heart chambers To determine the existence of congenital heart disease To visualize the disease process in the coronary arteries To measure the oxygen content of various heart chambers
C- VISUALIZE. Angina usually is caused by narrowing of the coronary arteries; the lumen of the arteries can be assessed by cardiac catheterization. Although pressures can be obtained, they are not the priority for this client; this assessment is appropriate for those with valvular disease. Determining the existence of congenital heart disease is appropriate for infants and young adults with cardiac birth defects. Measuring the oxygen content of various heart chambers is appropriate for infants and young children with suspected septal defects.
A young child from a developing country is admitted to the pediatric unit for surgery to correct a congenital heart defect. The mother asks the nurse why her child squats after exertion. The nurse responds, in language that the mother understands, that this position does what? Decreases the number of muscle aches Improves walking capacity and hip mobility Reduces how hard the heart must work Helps more blood return to the heart
C- When the child squats, blood pools in the lower extremities because of hip and knee flexion which causes less blood to return to the heart and reduces how hard the heart must work (cardiac workload). For this young child, squatting after exertion does not reduce muscle aches, it is unrelated to walking capacity and hip mobility, and it decreases (not increases) blood return to the heart.
