Cardiovascular - NCLEX-Style Questions

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

Which are the most serious complications for a child with Kawasaki disease (KD)? Select all that apply. 1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm. 4. Hypocoagulability. 5. Decreased sedimentation rate. 6. Hypoplastic left heart syndrome.

1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation.

Which physiological changes occur as a result of hypoxemia in congestive heart failure (CHF)? 1. Polycythemia and clubbing. 2. Anemia and barrel chest. 3. Increased white blood cells and low platelets. 4. Elevated erythrocyte sedimentation rate and peripheral edema.

1. Polycythemia and clubbing. The hypoxemia stimulates erythropoiesis, which causes polycythemia, in an attempt to increase oxygen by having more red blood cells carry oxygen. Clubbing of the fingers is a result of the polycythemia and hypoxemia.

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

1. Allow parents to hold and rock their child. 4. Make frequent position changes. 5. Feed the child when sucking the fists. 6. Change bed linens only when necessary. 7. Organize nursing activities. Rocking by the parents will comfort the infant and decrease demands. Frequent position changes will decrease the risk for infection by avoiding immobility with its potential for skin breakdown. An infant sucking the fists could indicate hunger. Change bed linens only when necessary to avoid disturbing the child. Organize nursing activities to avoid disturbing the child.

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

1. Feeding formula that is supplemented with additional calories. Formula can be supplemented with extra calories, either from a commercial supplement, such as Polycose, or from corn syrup. The infant would get too tired while feeding for 20 min, which increases cardiac demand. Limit breastfeeding to a half hour, or 15 minutes per side. Smaller feedings more often, such as every 2 to 3 hours, would decrease cardiac demand. Soft nipples that are easy for the infant to suck would make for less work getting nutrition.

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

1. Hypokalemia. The rubbing of the child ' s eyes may mean that she is seeing halos around the lights, indicating digoxin (Lanoxin) toxicity. The HR is slow for her age and also indicates digoxin toxicity. A decrease in serum potassium because of the furosemide (Lasix) can increase the risk for digoxin toxicity.

The nurse is caring for a child with Kawasaki disease (KD). A student nurse who is on the unit asks if there are medications to treat this disease. The nurse's response to the student nurse is: 1. Immunoglobulin G and aspirin. 2. Immunoglobulin G and ACE inhibitors. 3. Immunoglobulin E and heparin. 4. Immunoglobulin E and ibuprofen (Motrin).

1. Immunoglobulin G and aspirin.

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

1. Polycythemia. 2. Blood clots. 3. Cerebrovascular accident (CVA). 4. Developmental delays. 6. Brain damage. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke (CVA). Developmental delays can be caused by multiple hospitalizations and surgeries. The child usually catches up to the appropriate level. Hypoxia can increase the risk for bacterial endocarditis, not viral pericarditis. Brain damage can be caused by hypoxia, blood clots, and stroke (CVA). Hypoxic episodes cause acidosis, not alkalosis.

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

1. Ventricular septal defect (VSD). 2. Right ventricular hypertrophy. 4. Pulmonic stenosis (PS). 6. Overriding aorta.

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

2. "Your baby's defect is small and will likely close on its own by 1 year of age."

Treatment for congestive heart failure (CHF) in an infant began 3 days ago and has included digoxin (Lanoxin) and furosemide (Lasix). The child no longer has retractions, lungs are clear, and HR is 96 beats per minute while the child sleeps. The nurse is confident that the child has diuresed successfully and has good renal perfusion when the nurse notes the child's urine output is: 1. 0.5 cc/kg/hr. 2. 1 cc/kg/hr. 3. 30 cc/hr. 4. 1 oz/hr.

2. 1 cc/kg/hr.

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

2. Aortic stenosis (AS). AS can progress, and the child can develop exercise intolerance that can be better when resting.

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

2. Apical pulse rate.

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

2. Coarctation of the aorta (COA). In the older child, COA causes dizziness, headache, fainting, elevated blood pressure, and bounding radial pulses.

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

2. Polycythemia. Polycythemia is the result of the body attempting to increase the oxygen supply in the presence of hypoxia by increasing the total number of red blood cells to carry the oxygen.

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.

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

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.

2. Reduce joint inflammation.

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 infl ammation."

3. "I know she will be irritable for 2 months after her symptoms started." Arthritis in KD is always temporary. Peeling palms and feet are painless and usually not itchy, so this medication would not be needed. Diphenhydramine (Benadryl) is an antihistamine used for itching and allergy symptoms. Children can be irritable for 2 months after the symptoms of the disease start. Acetaminophen (Tylenol) is never given in high doses due to liver failure, and it is not an anti inflammatory. Aspirin is given in high doses for KD.

Which statement by the mother of a child with rheumatic fever (RF) shows she has good understanding of the care of her child? Select all that apply. 1. "I will apply heat to his swollen joints to promote circulation." 2. "I will have him do gentle stretching exercises to prevent contractures." 3. "I will give him his ordered anti-inflammatory medication for pain and inflammation." 4. "I will apply cold packs to his swollen joints to reduce pain." 5. "I will take my child every month to the health-care provider's office for his penicillin shot."

3. "I will give him his ordered anti-inflammatory medication for pain and inflammation." 5. "I will take my child every month to the health-care provider's office for his penicillin shot."

Which statement by the mother of a child with rheumatic fever (RF) shows an understanding of prevention for her other children? 1. "Whenever one of them gets a sore throat, I will give that child an antibiotic." 2. "There is no treatment. It must run its course." 3. "If their culture is positive for group A Streptococcus , I will give them their antibiotic." 4. "If their culture is positive for Staphylococcus A, I will give them their antibiotic."

3. "If their culture is positive for group A Streptococcus , I will give them their antibiotic." RF is caused by a streptococcal infection, not by Staphylococcus.

Which assessments indicate that the parent of a 7-year-old is following the prescribed treatment for congestive heart failure (CHF)? Select all that apply. 1. HR of 56 beats per minute. 2. Elevated red blood cell count. 3. 50th percentile height and weight for age. 4. Urine output of 0.5 cc/kg/hr. 5. Playing basketball with other children his age.

3. 50th percentile height and weight for age. 5. Playing basketball with other children his age. HR of 56 beats per minute is likely the result of digoxin (Lanoxin) toxicity. Elevated count of red blood cells indicates polycythemia secondary to hypoxemia. The 50th percentile height and weight for age shows good growth, indicating good nutrition and perfusion. Urine output of 0.5 cc/kg/hr indicates that furosemide (Lasix) is not being given as ordered; the output is too low. Playing basketball with children his age indicates he is following the prescribed treatment and responding well to it.

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

3. Coarctation of the aorta (COA). With COA there is narrowing of the aorta, which increases pressure proximal the defect (upper extremities) and decreases pressure distal to the defect (lower extremities). There will be high BP and strong pulses in the upper extremities and lower-than-expected BP and weak pulses in the lower extremities.

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. Defects with increased pulmonary blood flow. 4. Defects with decreased pulmonary blood flow. 5. Mixed defects. 6. Obstructive defects.

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

4. "I will mix the digoxin in some formula to make it taste better."

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."

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

4. Hold the child in knee-chest position to decrease venous blood return.

The nurse is caring for a child who has undergone a cardiac catheterization. During recovery, the nurse notices the dressing is saturated with bright red blood. The nurse's first action is to: 1. Call the interventional cardiologist. 2. Notify the cardiac catheterization laboratory that the child will be returning. 3. Apply a bulky pressure dressing over the present dressing. 4. Apply direct pressure 1 inch above the puncture site.

4. Apply direct pressure 1 inch above the puncture site.

The nurse is caring for an infant suspected of having Tetralogy of Fallot (ToF) who is scheduled for a cardiac catheterization. Which information should the nurse provide to the infant's parents? A) "A cardiac catheterization allows for the visualization of blood flow through the heart." B) "Cardiac catheterization gives the healthcare provider an image of the heart." C) "A cardiac catheterization allows the healthcare provider to evaluate the electrical activity of the heart." D) "Cardiac catheterization is a noninvasive procedure which allows the healthcare provider to evaluate the cardiac structures."

A) "A cardiac catheterization allows for the visualization of blood flow through the heart." Rationale: Cardiac catheterization is an invasive procedure which allows for the direct visualization of blood flow through the heart. This is a diagnostic test which can diagnose ToF.

The parent of a child diagnosed with Tetralogy of Fallot (ToF) says to the nurse, "I notice that my child squats frequently." Which is the most appropriate response by the nurse? A) "Squatting improves the oxygenation in the blood." B) "Your child may be experiencing muscle weakness from the lack of oxygen." C) "Your child may be squatting because they do not sleep enough." D) "Squatting allows for your child to inhale oxygen easier."

A) "Squatting improves the oxygenation in the blood." Rationale: Squatting is a compensatory mechanism in response to decreased oxygenation. Squatting results in increased blood flow through the pulmonary artery to the lungs, allowing for more blood to become oxygenated.

The parent of a newborn diagnosed with tricuspid atresia asks the nurse, "How did my baby develop this condition?" Which is the best response by the nurse? A) "The development of the condition is not well understood." B) "The development of the condition is due to environmental factors." C) "Tricuspid atresia occurs when there is a maternal iron deficiency." D) "Tricuspid atresia occurs in families with a genetic predisposition for the condition."

A) "The development of the condition is not well understood." Rationale: Tricuspid atresia, also known as pulmonary atresia, is a term used to describe an underdeveloped or absent tricuspid valve. Tricuspid atresia is a congenital condition for which the cause is not well understood and is not as common as the other heart defects that obstruct or decrease pulmonary blood flow.

The nurse has provided education about the administration of prostaglandin to the parent of an infant diagnosed with Tetralogy of Fallot (ToF) who is experiencing cyanosis from a severe obstruction of the right ventricle. Which statement made by the parent indicates the teaching has been successful? A) "The medication will allow blood flow to the lungs while you are preparing my baby for surgery." B) "The medication will help improve the electrical conduction of my baby's heart." C) "The medication will prevent the right ventricle from collapsing before my baby is taken to surgery." D) "The medication will decrease the workload of the heart to prevent heart failure while my baby is waiting for surgery."

A) "The medication will allow blood flow to the lungs while you are preparing my baby for surgery." Rationale: Prostaglandin keeps the ductus arteriosus open until surgery can be performed, allowing blood to flow to the lungs.

The nurse is reviewing the additional heart defects that accompany tricuspid atresia. Which defect(s) should the nurse include? *Select all that apply.* A) Atrial septal defect (ASD) B) Patent foramen ovale (PFO) C) Pulmonary atresia D) Aortic stenosis E) Coarctation of the aorta (COA) F) Ventral septal defect (VSD)

A) Atrial septal defect (ASD) B) Patent foramen ovale (PFO) F) Ventral septal defect (VSD) Rationale: To maintain vital blood flow for clients with tricuspid atresia, an alternate route must be present for the blood to pass through the right and left sides of the heart. Additional defects that present with tricuspid atresia include atrial septal defect (ASD), patent foramen ovale (PFO), and a ventral septal defect (VSD). These defects provide a substitute route for the blood that would otherwise be trapped on the right side.

The nurse is caring for a newborn who has become dyspneic. While auscultating the client's heart sounds, the nurse hears a murmur in the second left intercostal space. Which diagnostic test should the nurse prepare the client for? A) Echocardiogram B) Nuclear stress test C) Electroencephalogram (EEG) D) Computed tomography (CT) scan

A) Echocardiogram Rationale: Pulmonary stenosis can be diagnosed through physical examination and diagnostic testing. During the physical examination, the healthcare provider might note the presence of a murmur, which is a whooshing or swishing sound heard when auscultating the heart. This is a result of turbulent blood flow trying to make its way through the narrowed pulmonic valve. The healthcare provider may prescribe diagnostic tests like a chest x-ray, cardiac catheterization, electrocardiogram (ECG), echocardiogram, and magnetic resonance imaging (MRI) to definitively diagnose and determine the severity of the heart defect.

The nurse is creating a plan of care for the parent of a newborn diagnosed with pulmonary atresia. Which instruction should the nurse include in the teaching? A) Frequently reposition the infant B) Limit exposure of the infant to immediate family members C) Use a firm bottle nipple when feeding the infant D) Avoid giving the baby live attenuated vaccines

A) Frequently reposition the infant Rationale: The parent of a newborn with pulmonary atresia should be taught to reposition the infant frequently because this promotes pulmonary hygiene.

The parent of an infant asks the nurse, "What caused my newborn to develop pulmonary stenosis?" Which factor(s) should the nurse include in the response? *Select all that apply.* A) Genetics B) Environment C) Gender D) Maternal age E) Gestational age at birth

A) Genetics B) Environment Rationale: Little is known about what causes pulmonary stenosis; however, genetic and environmental factors may play a role in its development.

The nurse is caring for a newborn diagnosed with pulmonary stenosis and a ventral septal defect (VSD). While awaiting a surgical procedure to correct the VSD, the healthcare provider prescribes a medication to help keep the ductus arteriosus open to ensure adequate blood flow. Which classification of medication should the nurse anticipate administering? A) Prostaglandin B) Anticoagulant C) Positive inotrope D) Diuretic

A) Prostaglandin Rationale: When caring for a client with pulmonary stenosis, there are several treatments the nurse should be aware of. For clients that are symptomatic and do not have any additional defects, like an atrial septal defect (ASD) or a ventral septal defect (VSD), therapeutic treatment of pulmonary stenosis includes balloon dilation of the valve, which can be done during cardiac catheterization. These clients may also have a surgical valvotomy, in which surgical incisions are made into the narrowed leaflets of the valve, thus opening them up to allow adequate blood flow to return. Some clients will require surgery to completely replace that affected valve, which can be made of synthetic or biological material. Clients that do have additional heart defects are often prescribed medication therapy. Before surgical interventions are implemented, newborns with pulmonary stenosis may be given prostaglandins to keep the ductus arteriosus open to help maintain blood flow to the lungs despite the obstructive nature of pulmonary stenosis. Other medications that may be used in clients include positive inotropes, which helps to strengthen the heart's ability to pump effectively; warfarin, which prevents clot formation; diuretics, which rid the body of excess fluid; and antidysrhythmics, which treat and manage abnormal heart beats and rhythms.

The neonatal intensive care unit (NICU) nurse is reviewing the heart defects in which pulmonary blood flow is obstructed or decreased. Which heart defect(s) should the nurse include? *Select all that apply.* A) Pulmonary stenosis B) Tricuspid atresia C) Tetralogy of Fallot D) Mitral valve stenosis E) Aortic stenosis F) Hypoplastic left heart syndrome

A) Pulmonary stenosis B) Tricuspid atresia C) Tetralogy of Fallot Rationale: The heart can be divided into right and left sides. The right side of the heart is responsible for pumping poorly oxygenated blood to the lungs, and the left side of the heart is responsible for pumping highly oxygenated blood out to the entire body. Some conditions can affect the right side of the heart's ability to pump effectively. These heart defects obstruct or decrease pulmonary blood flow, which ultimately leads to inadequately oxygenated blood. These types of heart defects are primarily congenital, which means they were present at birth. Such defects include pulmonary stenosis, tetralogy of Fallot (ToF), and tricuspid atresia. Pulmonary stenosis is a condition that can affect the right side of the heart's ability to pump effectively. This heart defect obstructs or decreases pulmonary blood flow, which ultimately leads to inadequately oxygenated blood. ToF is a condition that can affect the right side of the heart's ability to pump effectively. This heart defect obstructs or decreases pulmonary blood flow, which ultimately leads to inadequately oxygenated blood. Tricuspid atresia is a condition that can affect the right side of the heart's ability to pump effectively. This heart defect obstructs or decreases pulmonary blood flow, which ultimately leads to inadequately oxygenated blood.

The nurse is closely monitoring the intake and output of an infant with heart failure who is receiving diuretic therapy. The nurse would use which *most appropriate* method to assess the urine output? A) Weighing diapers B) Inserting a urinary catheter C) Comparing intake with output D) Measuring the amount of water added to formula

A) Weighing diapers Rationale: Although urinary catheter drainage is the most accurate in determining output, it is not the most appropriate method in an infant and places the infant at risk for infections.

The nurse has provided caregiver education about Kawasaki disease prior to client discharge from the hospital. Which statement made by the caregiver indicates further teaching is required? A) "The child will not be able to play contact sports while receiving therapy." B) "I will call my doctor if the child's fever gets above 101.4˚F (38.5˚C)." C) "The child is unable to receive live vaccines for up to a year after treatment." D) "I will avoid giving the child ibuprofen while he is receiving treatment."

B) "I will call my doctor if the child's fever gets above 101.4˚F (38.5˚C)." Rationale: Caregivers should be advised to notify the healthcare provider immediately of a fever of 100.4˚F or 38˚C or above, as this could indicate an infection.

The nurse explained the pathophysiology of Kawasaki disease to a nursing student. Which statement made by the student indicates they understood the teaching? A) "The immune cells are destroyed, becoming ineffective in protecting the arterial layers from invading pathogens." B) "Immune cells start attacking the endothelial lining of medium-sized blood vessels." C) "The immune system is unable to protect the arterial and venous system from pathogens that destroy the layers of the vessels. D) "The phagocytes are unable to release cytokines to alert the T and B cells to attack the pathogen."

B) "Immune cells start attacking the endothelial lining of medium-sized blood vessels." Rationale: For reasons unknown, immune cells like neutrophils and macrophages start attacking the endothelial lining of medium-sized blood vessels, most commonly the coronary arteries of the heart.

The parent of a 4-year-old client newly diagnosed with Kawasaki disease asks the nurse for information about the condition. Which statement should the nurse include in the parental teaching? A) "Kawasaki disease is a condition that is associated with acute inflammation of the lung tissue." B) "Kawasaki disease is a condition associated with acute inflammation of the medium-sized arteries." C) "Kawasaki disease is a condition associated with acute inflammation of meninges in the brain." D) "Kawasaki disease is a condition associated with acute inflammation of the venous system."

B) "Kawasaki disease is a condition associated with acute inflammation of the medium-sized arteries." Rationale: Kawasaki disease is a condition associated with acute inflammation of medium-sized arteries, and it is typically seen in children between the ages of 6 months and 5 years.

The parent of a newborn, newly diagnosed with pulmonary stenosis, states to the nurse, "I am not sure what pulmonary stenosis is." Which is the best response by the nurse? A) "Pulmonary stenosis is a narrowing of the valve that controls the blood flow from the left ventricle into the arterial system." B) "Pulmonary stenosis is a narrowing of the valve that controls the blood flow to the lungs." C) "Pulmonary stenosis is a narrowing of the valve that controls the blood flow from the right atrium to the right ventricle." D) "Pulmonary stenosis is a narrowing of the valve that controls the blood flow returning to the heart."

B) "Pulmonary stenosis is a narrowing of the valve that controls the blood flow to the lungs." Rationale: Pulmonary stenosis occurs when there is a narrowing of the pulmonic valve. This narrowing obstructs normal blood flow through the pulmonary artery, resulting in less blood flow to the lungs.

The nurse has provided home care instructions to the parents of a child who sis being discharged after cardiac surgery. Which statement made by the parents indicates a *need for further instructions?* A) "A balance of rest and activity is important." B) "We can apply lotion or powder to the incision id it is itchy." C) "Activities in which our child could fall need to be avoided for 2-4 weeks." D) "Large crowds of people need to be avoided for at least 2 weeks after surgery."

B) "We can apply lotion or powder to the incision id it is itchy." Rationale: Lotions and powders can irritate the surrounding skin, which could lead to skin breakdown and subsequent infection of the incision site.

The nurse is preparing to review the risk factors for Kawasaki disease with the parent of a child recently diagnosed with the condition. Which risk factors(s) should the nurse include in their teaching? *Select all that apply.* A) Maternal history of diabetes mellitus B) Asian ancestry C) Assigned male at birth D) Below five years of age E) Premature birth F) Maternal infection during pregnancy

B) Asian ancestry C) Assigned male at birth D) Below five years of age Rationale: The exact cause of Kawasaki disease remains unknown, but some sources suggest that it might be triggered by an infection or autoimmune process. *The most important risk factors associated with Kawasaki disease include being below 5 years of age, being assigned male at birth, and having Asian or Pacific Islander ancestry.*

The nurse is educating a nursing student about Tetralogy of Fallot (ToF). Which cardiac defect(s) should the nurse include in the teaching? *Select all that apply.* A) Patent ductus arteriosus (PDA) B) Atrial septal defect (ASD) C) Ventral septal defect (VSD) D) Right-ventricular hypertrophy E) Left-ventricular hypertrophy F) Pulmonary stenosis

B) Atrial septal defect (ASD) C) Ventral septal defect (VSD) D) Right-ventricular hypertrophy F) Pulmonary stenosis Rationale: Tetralogy of Fallot (ToF) consists of four different defects. These defects include pulmonary stenosis, right-ventricular hypertrophy, ventral septal defect (VSD), and an overriding aorta, which happens when the aorta is displaced and blood from both sides of the heart is able to flow through it. In some clients, a fifth defect, atrial septal defect (ASD) may be present. Since all of these factors can lead to right-to-left shunting of blood ToF can also be classified as a cyanotic heart condition.

A newborn diagnosed with transposition of the great arteries experiences a hypercyanotic spell while crying. Which *priority* action should the nurse take? A) Administer morphine 25 mcg/kg B) Place the infant in a knee-chest position C) Administer blow by oxygen D) Notify the healthcare provider

B) Place the infant in a knee-chest position Rationale: The nurse should place the infant in a knee-chest position because this increases systemic venous return, and increases systemic vascular resistance, improving blood flow to the lungs.

A nursing student caring for an infant diagnosed with Tetralogy of Fallot (ToF) with right-to-left shunting asks the nurse, "What is a hypercyanotic spell?" Which is the *best* response by the nurse? A) "A hypercyanotic spell is when there is an increase in the heart's demand for oxygen." B) "A hypercyanotic spell refers to repeated episodes of peripheral cyanosis." C) "A hypercyanotic spell is when the body's need for oxygen exceeds what is available in the blood supply." D) "A hypercyanotic spell is an episode of central cyanosis that lasts longer than 10 minutes."

C) "A hypercyanotic spell is when the body's need for oxygen exceeds what is available in the blood supply." Rationale: When right-to-left shunting of blood occurs in clients with Tetralogy of Fallot (ToF), the body's demand for oxygen exceeds what is available in the blood supply since less blood reaches the lungs. When this occurs, infants and children can experience hypercyanotic spells, called "blue spells" or "tet spells." These spells can be particularly worrisome to parents, guardians, or caregivers of the child during this time because they can become extremely cyanotic and appear to be starving for air. In more severe cases, the child may pass out, lose consciousness, or even experience convulsions. Episodes like this can last anywhere from a few minutes to a few hours.

The clinic nurse reviews the record of a child just seen by the pediatrician and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder? A) Pallor B) Hyperactivity C) Activity intolerance D) Gastrointestinal disturbances

C) Activity intolerance Rationale: A child with aortic stenosis shows signs of activity intolerance, chest pain, and dizziness when standing for long periods. Pallor may be noted, but is not specific to this type of disorder alone.

On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease? A) Cracked lips B) Normal appearance C) Conjunctival hyperemia D) Desquamation of the skin

C) Conjunctival hyperemia Rationale: In the acute stage, the child has a fever, conjunctival hyperemia, red throat, swollen hands, rash, and enlargement of the cervical lymph nodes.

The labor and delivery room nurse is preparing for the birth of an infant prenatally diagnosed with tricuspid atresia. Which sign(s) and symptom(s) should the nurse expect the infant to present with immediately following delivery? *Select all that apply.* A) Displaced point of maximal impulse (PMI). B) Clubbing of fingers C) Dyspnea D) Central cyanosis E) Tachycardia F) Heart murmur

C) Dyspnea D) Central cyanosis E) Tachycardia F) Heart murmur Rationale: Cyanosis, tachycardia, heart murmurs, and dyspnea are the most common early manifestations of tricuspid atresia, which are often noted at birth. Older children with tricuspid atresia can exhibit signs of chronic hypoxemia, like clubbing of fingers and toes, as a result of long-term desaturated blood circulating in the body.

The nurse reviews the medication administration record of a 5-year-old child newly diagnosed with Kawasaki disease. Which prescription(s) should the nurse anticipate administering to prevent thrombosis? *Select all that apply.* A) Multivitamin 1 tablet PO daily B) Amoxicillin 250 mg PO twice daily C) Intravenous immunoglobulin (IVIG) 2 gm/kg/dose x1 D) Aspirin 400 mg PO every six hours E) Albuterol 0.083% solution inhalation three times daily

C) Intravenous immunoglobulin (IVIG) 2 gm/kg/dose x1 D) Aspirin 400 mg PO every six hours Rationale: Treatment for Kawasaki disease includes supportive care and minimization of the risk of the coronary aneurysm. Clients should receive intravenous immunoglobulin, as well as high-dose aspirin, to prevent thrombosis. Normally, aspirin should be avoided in children because it can cause Reye syndrome, which is a condition characterized by liver failure and rapidly progressive encephalopathy; however, with Kawasaki disease, aspirin is permitted because its anti-thrombotic effects outweigh the risk of Reye syndrome.

The labor and delivery nurse is preparing for the birth of an infant who has confirmed Tetralogy of Fallot (ToF) with right to left shunting. Which assessment finding(s) should the nurse anticipate? *Select all that apply.* A) S3 gallop B) Pericardial friction rub C) Loud and harsh heart murmur D) Acyanosis E) Acrocyanosis F) Central cyanosis

C) Loud and harsh heart murmur F) Central cyanosis Rationale: Symptoms of Tetralogy of Fallot (ToF) can vary broadly in different clients, some with mild symptoms, while others can have a much more severe experience. The wide difference in symptoms is directly related to how much blood gets oxygenated. These symptoms of ToF can be present at birth and the infant may appear cyanotic, like in right to left shunting scenarios. In other cases, cyanosis may be less acute initially but can progress over the first 12 months of life, specifically as the pulmonary stenosis defect worsens. Another common initial finding in infants with ToF is a characteristic heart murmur that is loud and harsh.

The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure (HF). The nurse would assess for which *early* sign of HF? A) Pallor B) Cough C) Tachycardia D) Slow and shallow breathing

C) Tachycardia

A child with rheumatic fever will be arriving in the nursing unit for admission. On admission assessment, the nurse should ask the parents which question to elicit assessment information specific to the development of rheumatic fever? A) "Has the child complained of back pain?" B) "Has the child complained of headaches?" C) "Has the child had any nausea or vomiting?" D) "Did the child have a sore throat or fever within the last 2 months?"

D) "Did the child have a sore throat or fever within the last 2 months?"

The nurse provides home care instructions for the parents of a child with heart failure regarding the procedure for administration of Digoxin. Which statement made by the parent indicates the *need for further instruction?* A) "I will not mix the medication with food." B) "If more than one dose is missed, I will call the pediatrician." C) "I will take my child's pulse before administering the medication." D) "If my child vomits after medication administration, I will repeat the dose."

D) "If my child vomits after medication administration, I will repeat the dose." Rationale: If the child vomits after Digoxin is administered, they are not to repeat the dose.

The parent of a newborn newly diagnosed with Tetralogy of Fallot (ToF) asks the nurse, "What caused my baby to get this defect?" Which is the best response by the nurse? A) "The cause of ToF is unknown but is thought to be linked to maternal use of nicotine." B) "The cause of ToF is unknown, but a maternal folic acid deficiency is thought to play a role in the development of the condition." C) "The cause of ToF is unknown, but is linked with excessive maternal alcohol consumption during conception." D) "The cause of ToF is unknown, but it is thought to be associated with genetic factors."

D) "The cause of ToF is unknown, but it is thought to be associated with genetic factors."

The nurse receives the laboratory results for a child with a suspected diagnosis of rheumatic fever, knowing that which laboratory study would assist in confirming the diagnosis? A) Immunoglobulin B) Red blood cell count C) White blood cell count D) Anti-streptolysin O titer

D) Anti-streptolysin O titer

A pediatrician has prescribed oxygen as needed for an infant with heart failure. Which situation would likely increase the oxygen demand, requiring the nurse to administer oxygen to the infant? A) During sleep B) When changing the infant's diapers C) When a parent is holding the infant D) When drawing blood for electrolyte level testing

D) When drawing blood for electrolyte level testing

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

Foramen ovale.

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 (KD).

Patent ductus arteriosus causes what type of shunt? _____________________

Left --> Right Blood flows from the higher-pressure aorta to the lower-pressure pulmonary

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

Left --> 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.

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

Patent ductus arteriosus (PDA).

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

Prostaglandin

The nurse summarizes the signs and symptoms of Kawasaki disease for a nursing student. Which information should the nurse include in the statement? *Complete the following sentences by filling in the blanks with a word or phrase in the parenthesis following each blank.* The most important clinical manifestations of Kawasaki disease can be remembered with the mnemonic CRASH and burn. "C" stands for _____________*(cellular hyperplasia, conjunctival hyperemia, corneal inflammation)* associated with photophobia, "R" for rash, described as _____________*(plaques and scales, polymorphous exanthem, diffuse excoriations)*; while "A" stands for Adenopathy, more specifically lymphadenopathy of cervical lymph nodes, "S" is for _______________ *(stomatitis, strawberry tongue, sores)* that can be associated with dry and cracking lips and "H" is for ________________ *(hand, head, heart)* and ______________ *(eye, foot, vessel)* changes, which include edema, erythema, as well as desquamation of the skin on tips of fingers and toes; and finally, burn refers to fever.

The most important clinical manifestations of Kawasaki disease can be remembered with the mnemonic CRASH and burn. "C" stands for *conjunctival hyperemia* associated with photophobia, "R" for rash, described as *polymorphous exanthem*; while "A" stands for Adenopathy, more specifically lymphadenopathy of cervical lymph nodes, "S" is for *strawberry tongue* that can be associated with dry and cracking lips and "H" is for *hand* and *foot* changes, which include edema, erythema, as well as desquamation of the skin on tips of fingers and toes; and finally, burn refers to fever.