Congenital Heart defects practice questions

1. The nurse explains that a ventricular septal defect will allow: a. blood to shunt left to right, causing increased pulmonary flow and no cyanosis. b. blood to shunt right to left, causing decreased pulmonary flow and cyanosis. c. no shunting because of high pressure in the left ventricle. d. increased pressure in the left atrium, impeding circulation of oxygenated blood in the circulating volume.

ANS: A Pulmonary blood flow is increased when a ventricular septal defect exists. The blood shifts from left to right because of the higher pressure in the left ventricle. This particular shift does not cause cyanosis.

20. The nurse uses a diagram to illustrate what four structural heart anomalies that comprise tetralogy of Fallot? Select the four that apply. a. Hypertrophied right ventricle b. Patent ductus arteriosus c. Ventral septal defect d. Narrowing of pulmonary artery e. Dextroposition of aorta

ANS: A, B, D, E The four anomalies that comprise tetralogy of Fallot are hypertrophied right ventricle, patent ductus arteriosus, stenosis of pulmonary artery, and dextroposition of the aorta.

Why is maintenance of fluid and electrolyte balance more critical in infants than in adults? 1) Renal function is immature in infants. 2) Cellular metabolism is less stable than in adults. 3) The proportion of water in infants' bodies is less than that in adults. 4) The daily fluid requirement per unit of body weight is less than that in adults

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Which of the following represents an effective nursing intervention to reduce cardiac demands and decrease cardiac workload? Choose all that apply. 1) Clustering nursing care to provide for periods of uninterrupted rest. 2) Developing and implementing a developmentally appropriate plan of care as tolerated. 3) Feeding the infant over a longer period of time. 4) Allowing the infant to have his or her own way to avoid conflicts.

1 and 2

Match the medication with the purpose of administration. Match the number with the letters: 1. digoxin 2. furosemide 3. captopril 4. oxygen A. Reduces afterload. B. Decreases effects of hypoxia. C. Reduces preload. D. Improves myocardial contractility.

1. D 2. C 3. A 4. B

Healthy and normal coping mechanisms utilized by parents of children with congenital heart disease include what? Select all that apply. A. Initially denying seriousness of the child's condition. B. Exhibiting overly protective behaviors toward the child. C. Seeking detailed information about the defect. D. Requesting reassurance and support.

A, C and D

What is the most common early complication of cardiac catheterization? 1) Cardiac dysrhythmias 2) Infection 3) Fluid overload 4) Electrolyte imbalance

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18. The school nurse recommends a heart healthy diet that limits fats to no more than ____% of the total dietary intake. a. 10 b. 15 c. 20 d. 30

ANS: D

Deoxygenated blood flows from the right ventricle to the left ventricle. What defect does this most likely describe? 1) Tetralogy of Fallot 2) Coarctation of the aorta 3) Atrial septal defect 4) Ventricular septal defect

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Defects associated with tetralogy of Fallot include 1) severe coarctation of the aorta, severe aortic valve stenosis, and severe mitral valve stenosis. 2) ventricular septal defect, overriding aorta, pulmonic stenosis, and right ventricular hypertrophy. 3) tricuspid valve atresia, atrial septal defect, and hyposplastic right ventricle. 4) origin of the aorta from the right ventricle and of the pulmonary artery form the left ventricle.

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A newborn infant is diagnosed as having a patent ductus arteriosus. The knowledgeable pediatric nurse understands that this congenital heart defect involves: 1) narrowing of the aorta. 2) origination of the pulmonary artery from the left ventricle and origination of the aorta from the right ventricle. 3) persistence of the fetal opening between the pulmonary artery and the aorta. 4) obstruction of left ventricular outflow at the level of the aortic valve.

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2. The assessment that would lead the nurse to suspect that a newborn infant has a ventricular septal defect is: a. a loud, harsh murmur with a systolic tremor. b. cyanosis when crying. c. blood pressure higher in the arms than in the legs. d. a machinery-like murmur.

ANS: A A loud, harsh murmur combined with a systolic thrill is characteristic of a ventricular septal defect.

A nurse involved in preoperative teaching for a preschool child scheduled for cardiac surgery would be sure that preparation for surgery was: 1) detailed in nature so that the child knew everything there was to know about the surgery. 2) geared toward the child's parents since the child is too young to understand anything about the surgery. 3) developmentally appropriate to the child's stage of growth and development. 4) done several days before the actual operation so that the child had the opportunity to think of any questions or concerns.

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What is the main function that fetal heart structures such as the ductus arteriosus perform? 1) To prevent fluid overload in the fetus. 2) To shunt blood toward fetal lungs. 3) To provide oxygenated blood to the fetal brain. 4) To allow a way for wastes to be removed.

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Which drugs are most often given to children with congenital heart disease (CHD)to specifically decrease the workload of the heart? 1) Opioids 2) Nitroglycerine 3) Diuretics 4) Potassium supplements

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The nurse is assessing an infant who is admitted for congestive heart failure. Which sign would the nurse most likely find? 1) Pedal edema 2) Sudden weight loss 3) Unexplained bruising 4) Dyspnea

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9. The nurse is caring for a child with a diagnosis of Kawasaki disease. The child's parent asks the nurse, "How does Kawasaki disease affect my child's heart and blood vessels?" The nurse's response is based on the understanding that: a. inflammation weakens blood vessels, leading to aneurysm. b. increased lipid levels lead to the development of atherosclerosis. c. untreated disease causes mitral valve stenosis. d. altered blood flow increases cardiac workload with resulting heart failure.

ANS: A Inflammation of vessels weakens the walls of the vessels and often results in aneurysm.

4. When a father asks why his child with tetralogy of Fallot seems to favor a squatting position, the nurse would explain that squatting: a. increases the return of venous blood back to the heart. b. decreases arterial blood flow away from the heart. c. is a common resting position when a child is tachycardic. d. increases the workload of the heart.

ANS: A The squatting position allows the child to breathe more easily because systemic venous return is increased.

5. An infant is experiencing dyspnea related to patent ductus arteriosus (PDA). The nurse understands dyspnea occurs because blood is: a. circulated through the lungs again, causing pulmonary circulatory congestion. b. shunted past the pulmonary circulation, causing pulmonary hypoxia. c. shunted past cardiac arteries, causing myocardial hypoxia. d. circulated through the ductus from the pulmonary artery to the aorta, bypassing the left side of the heart.

ANS: A When PDA is present, oxygenated blood recycles through the lungs, overburdening the pulmonary circulation.

21. What assessment(s) in a child with tetralogy of Fallot would indicate the child is experiencing a paroxysmal hypercyanotic episode? Select all that apply. a. Spontaneous cyanosis b. Dyspnea c. Weakness d. Dry cough e. Syncope

ANS: A, B, C, E Indicators of a paroxysmal hypercyanotic episode or a "tet" episode are spontaneous cyanosis, dyspnea, weakness, and syncope.

19. How would the nurse caring for an infant with congestive heart failure (CHF) modify feeding techniques to adapt for the child's weakness and fatigue? Select all that apply. a. Feeding more frequently with smaller feedings b. Using a soft nipple with enlarged holes c. Holding and cuddling the child during feeding d. Substituting glucose water for formula e. Offering high-caloric formula

ANS: A, B, C, E Infants with CHF fatigue easily. Feeding can be given more frequently in smaller amounts through a soft large-holed nipple. Formulas with a denser caloric content can be offered. The child may be encouraged to nurse if he or she is held.

6. An appropriate nursing action related to the administration of digoxin (Lanoxin) to an infant would be: a. counting the apical rate for 30 seconds before administering the medication. b. withholding a dose if the apical heart rate is less than 100 beats/min. c. repeating a dose if the child vomits within 30 minutes of the previous dose. d. checking respiratory rate and blood pressure before each dose.

ANS: B As a rule, if the pulse rate of an infant is below 100 beats/min, the medication is withheld and the physician is notified.

8. The comment made by a parent of a 1-month-old that would alert the nurse about the presence of a congenital heart defect is: a. "He is always hungry." b. "He tires out during feedings." c. "He is fussy for several hours every day." d. "He sleeps all the time."

ANS: B Fatigue during feeding or activity is common to most infants with congenital cardiac problems.

12. A child has an elevated antistreptolysin O (ASO) titer. Which combination of symptoms, in conjunction with this finding, would confirm a diagnosis of rheumatic fever? a. Subcutaneous nodules and fever b. Painful, tender joints and carditis c. Erythema marginatum and arthralgia d. Chorea and elevated sedimentation rate

ANS: B The presence of two major Jones' criteria would indicate a high probability of rheumatic fever.

7. A child develops carditis from rheumatic fever. The nurse knows that the areas of the heart affected by carditis are the: a. coronary arteries. b. heart muscle and the mitral valve. c. aortic and pulmonic valves. d. contractility of the ventricles.

ANS: B The tissues that cover the heart and heart valves are affected. The heart muscle may be involved and the mitral valve is frequently involved.

15. When the child with rheumatic fever begins involuntary, purposeless movements of her limbs, the nurse recognizes that this is an indication of: a. seizure activity. b. hypoxia. c. Sydenham's chorea. d. decreasing level of consciousness.

ANS: C As the effects of rheumatic fever affect the central nervous system, the child may develop Sydenham's chorea manifested by involuntary, purposeless movements of the limbs.

16. The nurse clarifies to the parents of a 4-year-old child recovering from rheumatic fever that the child will need to receive monthly injections of penicillin G for a minimum of _____ year(s). a. 1 b. 2 c. 5 d. 10

ANS: C Children who recover from rheumatic fever should have a chemoprophylaxis protocol of penicillin G injections (about 200,000 units per dose) for a minimum of 5 years or up to the age of 18 to prevent further bouts of rheumatic fever.

17. The nurse is aware that the characteristics of high-density lipoproteins (HDLs) are that they: a. have high amounts of triglycerides. b. have only small amounts of protein. c. have little cholesterol. d. aid in steroid production.

ANS: C HDLs have low amounts of triglycerides, large amounts of proteins, low amount of cholesterol, and are excreted via the liver. They have no role in the production of steroids.

14. The nurse is aware that the infant born with hypoplastic left heart syndrome must acquire his or her oxygenated blood through: a. the patent ductus arteriosus. b. a ventricular septal defect. c. the closure of the foramen ovale. d. an atrial septal defect.

ANS: D Because the right side of the heart must take over pumping blood to both the lungs and systemic circulation, the ductus arteriosus must remain open to shunt the oxygenated blood from the lungs.

11. The parent of a 1-year-old child with tetralogy of Fallot asks the nurse, "Why do my child's fingertips look like that?" The nurse bases a response on the understanding that clubbing occurs as a result of: a. untreated congestive heart failure. b. a left-to-right shunting of blood. c. decreased cardiac output. d. chronic hypoxia.

ANS: D Clubbing of the fingers develops in response to chronic hypoxia.

13. An infant with congestive heart failure is receiving digoxin (Lanoxin). The nurse recognizes a sign of digoxin toxicity, which is: a. restlessness. b. decreased respiratory rate. c. increased urinary output. d. vomiting.

ANS: D Symptoms of digoxin toxicity include: nausea, vomiting, anorexia, irregularity in pulse rate and rhythm, and a sudden change in pulse.

The nurse is caring for a family with an infant with severe tetralogy of​ Fallot, which is impacting the​ family's ability to function. Which is the best nursing diagnosis to address this​ concern? A. Caregiver Role Strain B. Activity Intolerance C. Family​ Processes, Interrupted D. ​Infection, Risk for

Family​ Processes, Interrupted Rationale: The​ family's inability to function is best represented as Family​ Processes, Interrupted. There is no evidence to support that the family is experiencing caregiver role​ strain, only that the family unit as a whole is suffering. ​Infection, Risk for and Activity Intolerance may be​ true, but are not relevant to the specific problem that this family is experiencing.​ (NANDA-I ©​ 2014)

The nurse is preparing to discharge an infant with hypoplastic left heart syndrome. Which information should the nurse provide to the​ family? A. Infective endocarditis prophylaxis protocols B. Management of supplemental oxygen therapy C. Community support and resources D. Proper administration of propranolol

Community support and resources Rationale: It is imperative for the family to be given information about community resources and support due to the difficult nature of this disease. Propranolol and infective endocarditis prophylaxis are not necessary for a child with hypoplastic left heart syndrome​ (HLHS). Supplemental oxygen therapy is contraindicated in a child with HLHS because it promotes blood flow to the​ lungs, which may decrease blood flow to the body and place excessive demands on the right ventricle.

The nursing assessment of a newborn reveals​ cyanosis, a continuous murmur over the pulmonic​ area, and a harsh systolic murmur in the tricuspid area. Which condition should the nurse​ suspect? A. Ventricular septal defect B. Pulmonary stenosis C. Pulmonary atresia D. Aortic stenosis

​Pulmonary atresia Rationale: Pulmonary atresia is the absence of a connection between the right ventricle and the pulmonary artery at the site of the pulmonary valve or in the main pulmonary artery. A patent ductus arteriosus​ (PDA) provides the only flow of blood to the pulmonary arteries. Pulmonary atresia can cause cyanosis right after​ birth, along with a continuous murmur over the pulmonic area and a harsh systolic murmur in the tricuspid area. Aortic stenosis is usually​ asymptomatic, unless there is severe and​ life-threatening stenosis. Pulmonary stenosis is usually​ asymptomatic, although it may cause dyspnea with exertion. A ventricular septal defect does not cause cyanosis at​ birth, though a systolic murmur is heard at the 3rd or 4th intercostal space.

Match the description of the stuctural defect to the correct specific cardiac defect nomenclature. Match the numbers with the letters: 1. ventricular septal defect 2. atrial septal defect 3. patent ductus arteriosis 4. coarctation of the aorta A. A constricture of the lumen of the aorta, usually at or near the ductus arteriosis. B. A hole in the septum between the right and left ventricles. C. A hole in the septum between the right and left atria. D. The failure to close of the normal fetal circulation conduit between the pulmonary artery and the aorta.

1. B 2. C 3. D 4. A

10. The nurse explained how to position an infant with tetralogy of Fallot if the infant suddenly becomes cyanotic. The nurse can determine the father understood the instructions when he states "If the baby turns blue, I will: a. hold him against my shoulder with his knees bent up toward his chest." b. lay him down on a firm surface with his head lower than the rest of his body." c. immediately put the baby upright in an infant seat." d. put the baby in supine position with his head elevated."

ANS: A In the event of a paroxysmal hypercyanotic or "tet" spell, the infant should be placed in a knee-chest position.

22. The nurse explains that which congenital cardiac defect(s) cause(s) increased pulmonary blood flow? Select all that apply. a. Atrial septal defects (ASDs) b. Tetralogy of Fallot c. Dextroposition of aorta d. Patent ductus arteriosus e. Ventricular septal defects (VSDs)

ANS: A, D, E The congenital heart defects that cause increased pulmonary blood flow are ASDs, VSDs, and patent ductus arteriosus.

3. The finding the nurse would expect when measuring blood pressure on all four extremities of a child with coarctation of the aorta is blood pressure that is: a. higher on the right side. b. higher on the left side. c. lower in the arms than in the legs. d. lower in the legs than in the arms.

ANS: D The characteristic symptoms of coarctation of the aorta are a marked difference in blood pressure and pulses between the upper and lower extremities. Pressure is increased proximal to the defect and decreased distal to the coarctation.

The latest echocardiogram of a teen with hypoplastic left heart syndrome​ (HLHS), who has had several cardiac surgeries in the​ past, shows right ventricular failure. The nurse should anticipate preparing the client for which​ treatment? A. Heart transplant B. Activity limitations C. Fontan procedure D. Closure of patent ductus arteriosus​ (PDA)

Heart transplant Rationale: In​ HLHS, the left side of the heart does not form correctly during fetal​ growth, resulting in underdeveloped heart structures. Heart transplant may be needed once the remaining ventricle begins to fail. Activity limitations would already be place. Fontan procedure would have been performed between 18 months and 3 years of age. The Fontan procedure results in the flow of systemic venous blood to the lungs without passing through a ventricle. A PDA provides an open pathway for the blood to enter circulation from the right ventricle and is usually maintained by the administration of prostaglandin E1.

The nurse is helping a mom breastfeed a newborn who has a defect that decreases pulmonary flow. The nurse observes that the newborn has difficulty breathing and becomes cyanotic during the feeding. Which instruction should the nurse​ provide? A. Use a bottle with a larger nipple size B. Periodically stop the newborn from sucking C. Bottle feed with breast milk D. Administer formula using a bottle

Periodically stop the newborn from sucking Rationale: Defects that increase or decrease pulmonary blood flow cause a​ newborn's heart rate and metabolic rate to increase. Feeding can take​ energy, which results in diaphoresis during feeding. The infant may need to stop sucking periodically during feedings to breathe. These infants have a higher metabolic​ rate, and inadequate calories may be​ consumed, resulting in poor weight gain. Changing to a bottle or formula will not address the problem.

A teenager who has had multiple hospitalizations since childhood for a congenital heart disorder asks the nurse questions about the condition. How should the nurse​ respond? A. ​"I'll see if I can get your doctor to come visit you later today and answer your​ questions." B. ​"You'll need to ask your parents about any questions that you​ have." C. ​"I'll be happy to answer what I can. What are your​ questions?" D. ​"Why do you need to​ know? Your parents are making your medical decisions until you are an​ adult."

​"I'll be happy to answer what I can. What are your​ questions?" Rationale: The nurse should recognize that providing the teen with answers to questions can help to support improved coping and a desire for increased independence. The nurse can answer the​ teen's questions and should not make the teen consult the parents or doctor for information. The teen has a right to​ information, even if the parents are making medical decisions.

The nurse is teaching parents how to care for their infant who has a congenital heart defect. Which statement by the parents indicates effective​ teaching? A. ​"We will avoid live virus​ vaccinations." B. ​"We will report all episodes of vomiting or​ diarrhea." C. ​"We will feed the baby formula because that is​ safest." D. ​"We will avoid feeding our baby for too long at a​ time."

​"We will report all episodes of vomiting or​ diarrhea." Rationale: It is important for the parents to report all episodes of vomiting or diarrhea because of the danger of infection.​ Infections, especially​ respiratory, make hypoxemia worse in children with​ cyanosis, and fever increase metabolic rates and oxygen demands. It is safe for the infant to receive​ vaccinations, and the baby should get all vaccinations on schedule to prevent common childhood diseases. Most infants with congenital heart defects take a little longer to​ feed; the nurse should encourage the parents to also encourage feeding to promote growth. Breastfeeding is important because of the nutritional and immunological benefits for the baby.

The nurse is reviewing the health histories of pregnant women who will be admitted to the unit for delivery. A client with which condition will require a cesarean​ birth? A. Aortic stenosis B. Patent ductus arteriosus C. Atrial septal defect D. Ventricular septal defect

​Aortic stenosis Rationale: In most​ cases, a vaginal delivery is preferable to cesarean birth due to the elevated risk of wound​ infection, blood​ clots, and bleeding.​ Further, vaginal delivery is preferable to cesarean section for most clients with congenital heart disease because they will likely lose less blood with vaginal birth.​ However, aortic​ stenosis, dilated​ aorta, and pulmonary hypertension are contraindications for vaginal delivery and would require a cesarean birth. A woman with atrial septal​ defect, ventricular septal​ defect, or patent ductus arteriosus should be able to deliver vaginally.

A newborn recently diagnosed with coarctation of the aorta is admitted to the neonatal intensive care unit. Which clinical manifestation in the client should the nurse​ monitor? A. Warm extremities B. Increased urinary output C. Loud murmur D. Delayed capillary refill

​Delayed capillary refill Rationale: Coarctation of the aorta is a defect that limits cardiac output. The nurse should monitor the infant for clinical manifestations of decreased cardiac​ output, which include delayed capillary​ refill, but do not include a loud​ murmur, increased urinary​ output, or warm extremities.

The nurse is assessing a toddler with uncorrected cyanotic heart disease. Which question to the parent is most​ appropriate? A. How is your​ child's appetite? B. Does your child often​ squat? C. When did your child start​ walking? D. Does your child sleep on her​ tummy?

​Does your child often​ squat? Rationale: Toddlers with uncorrected or partially corrected cyanotic heart disease often squat to reduce dyspnea. The kneedash-chest position reduces cardiac output by decreasing venous return from the lower extremities and by increasing systemic vascular resistance.

A teen with a cardiac defect reports feeling tired after physical education class. Which diagnostic test should the nurse anticipate the healthcare provider will​ order? A. Magnetic resonance imaging B. Exercise testing C. Echocardiogram D. Chest​ x-ray

​Exercise testing Rationale: Exercise testing can be used to evaluate controlled increases in activity and is best performed on a teen or adolescent. Chest​ x-ray and magnetic resonance imaging can only give a visual picture of how the heart is functioning. Echocardiography uses sound waves to create a moving picture of the heart and does not evaluate activity tolerance.

The nurse is assessing a newborn. Which finding is often the first indication of a congenital heart​ defect? A. Heart murmur B. Chest pain C. Syncope D. Exercise intolerance

​Heart murmur Rationale: The presence of a heart murmur is often the first indication of a congenital heart defect. A murmur indicates blood is flowing with​ higher-than-normal pressure to get through a narrowed valve or​ vessel, or is flowing through a shunt. Some infants and​ children, such as those with a small atrial septal defect​ (ASD), may be asymptomatic except for a heart murmur. Older children may have additional​ symptoms, such as exercise​ intolerance, chest​ pain, dysrhythmias, and syncope.

The nurse is caring for an infant with ventricular septal defect​ (VSD) with a very small opening. Which treatment does the nurse anticipate the child will​ require? A. Surgery to patch the hole B. Oral propranolol C. Monitor with periodic echocardiograms D. Administration of prostaglandin E1

​Monitor with periodic echocardiograms Rationale: Most small VSDs close spontaneously within the first 6 months of life. Treatment is​ conservative, such as watching and​ waiting, when there are no other complications present. Patching is not necessary with a small defect. Propranolol is not administered for​ VSD, but to manage a hypercyanotic episode. Prostaglandin E1 is used to maintain an open patent ductus arteriosus to encourage oxygenation in an infant.

The nurse is preparing to discuss a congenital heart defect that increases pulmonary blood flow. Which condition should the nurse​ include? A. Aortic stenosis B. Patent ductus arteriosus C. Pulmonary stenosis D. Tetralogy of Fallot

​Patent ductus arteriosus Rationale: Patent ductus arteriosus is a congenital heart defect that increases pulmonary blood flow because it increases blood flow between the left and right sides of the heart. Aortic stenosis obstructs systemic blood flow. Tetralogy of Fallot and pulmonary stenosis are conditions that decrease pulmonary blood flow.

The nurse is teaching the parents of a newborn about cardiac defects associated with tetralogy of Fallot. Which information should the nurse​ include? (Select all that​ apply.) A. Right ventricular hypertrophy B. Ventricular septal defect C. Pulmonary atresia D. Pulmonary stenosis E. Overriding aorta

​Right ventricular hypertrophy Ventricular septal defect Pulmonary stenosis Overriding aorta Rationale: Tetralogy of Fallot is a group of four defects including pulmonary​ stenosis, right ventricular​ hypertrophy, ventricular septal​ defect, and overriding aorta.​ Sometimes, there is a fifth​ defect, an open foramen ovale. Pulmonary atresia is not associated with tetralogy of Fallot.

The nurse is caring for an older adult client with a history of congenital heart disease. Which factor should the nurse consider when caring for this​ client? A. The client only needs a cardiovascular assessment when symptomatic. B. Mortality rates are the same for adults of all ages. C. The risk for developing cardiovascular disease is higher. D. Risk management for an older adult client with a congenital heart defect is not important.

​The risk for developing cardiovascular disease is higher. Rationale: An older adult client with a history of congenital heart disease is more likely to develop cardiovascular disease and also has a higher mortality rate. The client should see a cardiologist​ regularly, not just when symptomatic. Risk management and preventive care are necessary for anyone with a congenital heart​ defect, regardless of age.

The nurse is teaching women about vaccinations they should have before becoming pregnant. Which should the nurse include that will minimize the risk of having a child with a congenital heart​ disorder? A. Haemophilus influenza type B B. Rubella C. Influenza D. Polio

​rubella Rationale: Rubella vaccinations should be current before a woman becomes pregnant. A woman who contracts rubella during pregnancy is putting her infant at risk for a congenital heart disorder​ (CHD). Polio,​ influenza, and haemophilus influenza type B​ (HIB) during pregnancy are not associated with a CHD.

Which assessment finding should the nurse expect for a toddler experiencing​ hypercyanosis? A. Calm nature B. Bradycardia C. Increased PaO2 D. Squatting

​squatting Rationale: When infants and children with cyanosis rise in the​ morning, they may experience an abrupt decrease in systemic resistance and pulmonary blood flow. Toddlers with uncorrected cyanotic heart disease often squat to relieve dyspnea. This physiologic change can trigger a hypercyanotic episode when combined with the sudden increase in CO2 and venous return associated with​ crying, feeding,​ exercise, and straining with defecation. The partial pressure of oxygen ​(PO2​) is​ lowered, and the partial pressure of carbon dioxide ​(PCO2​) rises. Hypoxemia becomes progressively worse as the respiratory center in the brain​ overreacts, increasing the respiratory effort. Signs include increased rate and depth of​ respirations; increased heart​ rate; increased​ cyanosis, pallor, and poor tissue​ perfusion; diaphoresis; irritability and​ crying; and seizures and loss of consciousness.

The nurse is preparing to administer prostaglandin E1 to an infant with transposition of the great arteries. How should the nurse explain the purpose of this medication to the​ parents? A. ​"Prostaglandin E1 is used to lessen the effects of​ apnea." B. ​"Prostaglandin E1 is used to help improve systemic​ vasodilatation." C. ​"Prostaglandin E1 is used to help the baby get more oxygenated​ blood." D. ​"Prostaglandin E1 is used to repair the ductus​ arteriosus."

​​"Prostaglandin E1 is used to help the baby get more oxygenated​ blood." Rationale: For some cardiac​ defects, when the ductus arteriosus​ closes, cyanosis gets worse because there is no mixing of the blood from the right and left sides of the heart. One treatment is the administration of prostaglandin E1 ​ (PGE1​). This maintains the patency of the ductus​ arteriosus, helping the infant stay partially oxygenated until definitive repair can be done. Prostaglandin E1 is not used to treat apnea or systemic vasodilatation. These conditions are potential side effects from the use of prostaglandin E1. Prostaglandin E1 cannot repair the ductus arteriosus

Parents who just had a baby with transposition of the great arteries ask the nurse when the corrective surgery needs to be scheduled. How should the nurse​ reply? A. ​"When you are​ ready." B. ​"Sometime this​ week." C. ​"This afternoon." D. ​"Within the first year of​ life."

​​"Sometime this​ week. Rationale: Surgical repair of a transposition of the great arteries is usually performed during the first week of life. It does not need to be done urgently or emergently that​ afternoon, and it is not appropriate for the nurse to tell the parents that the surgery can happen when they are ready for it. Survival without surgery is​ impossible, so it should be scheduled soon and not within the first year.