Exemplar 16.B - Congenital Heart Defects
The mother of a baby born with a congenital heart defect is upset, as no one else in the family has been born with this condition. To determine the cause of the defect, which question is appropriate for the nurse to ask the mother? A) "Did you consume any alcohol before you knew you were pregnant?" B) "Is there a history of diabetes in your family?" C) "Was the baby's father exposed to any toxins in the work environment?" D) "Do you have a history of hypertension?"
A) "Did you consume any alcohol before you knew you were pregnant?" Most congenital heart defects occur during the first 8 weeks of pregnancy and are a combination of environmental and genetic factors. Fetal exposure to alcohol is one of the greatest factors for the development of these defects. Asking the mother if she consumed alcohol before she was aware that she was pregnant is an appropriate question when determining the cause of the heart defect. A history of hypertension will not cause a fetus to develop a congenital heart defect. The father's exposure to toxins in the work environment is not known to cause congenital heart defects of children. Maternal diabetes can impair fetal heart development, but a family history of diabetes is not known to cause congenital heart defects.
The nurse is planning care for a pediatric client recovering from surgery to repair a congenital heart defect. Which intervention should the nurse include to support the client's fluid status? A) Encourage oral intake of fluids when permitted. B) Limit oral and intravenous intake of fluids. C) Continue normal saline administration even after oral intake is normal. D) Convert the intravenous line to a saline lock immediately after surgery.
A) Encourage oral intake of fluids when permitted. The child should be encouraged to begin oral fluids and nutrition when permitted. Although oral fluids are rarely limited, intake and output should be carefully assessed. Fluids and antibiotics should be provided as ordered until the child's oral intake is normal. Once normal, the line can be converted to a heparin or saline lock.
During what period of gestation do congenital heart defects usually develop? A) First 8 weeks of gestation B) Second trimester C) Third trimester D) Last 4 weeks of gestation
A) First 8 weeks of gestation Most congenital heart defects develop during the first 8 weeks of gestation. They are usually the result of combined genetic and environmental factors.
The nurse is caring for a premature infant diagnosed with patent ductus arteriosus (PDA). Which medication should the nurse anticipate administering to this client? A) Indomethacin B) Propranolol C) Antibiotics D) Prostaglandin E1
A) Indomethacin Intravenous indomethacin often stimulates the closure of the PDA in premature infants. Prophylactic antibiotics are used in some clients with a congenital heart defect, but this is not common for infants with PDA. Propranolol is used to treat tetralogy of Fallot. Prostaglandin E1 is used with some congenital heart defects to maintain a PDA, not help close the PDA.
The nurse is caring for an infant diagnosed with hypoplastic left heart syndrome. The client has recently been scheduled for surgery to repair the defect. Which procedure does the nurse anticipate needing to provide client teaching about to the client's family? A) Norwood procedure B) Jatene procedure C) Rastelli procedure D) Damus-Kaye-Stansel procedure
A) Norwood procedure Hypoplastic left heart syndrome is repaired using the Norwood, Glenn, and Fontan procedures, depending on the child's age. The Jatene procedure and the Damus-Kaye-Stansel procedure surgically repair the Transposition of Great Arteries (TGA). The Rastelli procedure is used to repair TGA with ventricular septal defect and pulmonary stenosis.
The nurse is assessing a toddler diagnosed with tetralogy of Fallot (TOF). Which clinical manifestations does the nurse anticipate during the physical assessment? Select all that apply. A) Palpable thrill in the pulmonic area B) Nail clubbing C) Cough D) Apneic periods E) Knee-chest position
A) Palpable thrill in the pulmonic area B) Nail clubbing E) Knee-chest position Manifestations of TOF include a palpable thrill in the pulmonic area, clubbing of the fingers due to reduce oxygenation, and the knee-chest position, which the child will perform to decrease the return of systemic venous blood to the heart. A cough and apneic periods are not manifestations of this congenital heart defect.
The nurse provides discharge instructions to the parents of a child recovering from surgery to repair a congenital heart defect. What statement indicates that teaching has been effective? A) "Our child should be restricted in play and activity for at least 6 months." B) "Our child will need to take antibiotics prior to having dental surgery." C) "Fluids should be restricted to maximize lung function." D) "Our child should not return to normal activities for at least 2 years."
B) "Our child will need to take antibiotics prior to having dental surgery." Since the child is at risk for infective endocarditis, prophylactic antibiotics are indicated for invasive procedures. The child should be encouraged to gradually return to normal activities, including play. The child's activity should not be restricted for 6 months to 2 years. The child should not restrict fluids.
Which best describes how congenital defects are categorized? A) By the severity of defect B) By the pathophysiology and hemodynamics of defect C) By the location of defect D) By the infant's age when the defect was diagnosed
B) By the pathophysiology and hemodynamics of defect Congenital heart defects are categorized by their pathophysiology and hemodynamics. They are not categorized by the severity of the defect, location of the defect, or the infant's age when the defect is diagnosed.
The nurse is caring for an adult client who was diagnosed with a congenital heart defect as a child, which was later repaired with surgery. Which common complication of a heart defect should the nurse monitor that the client may still be at risk for? A) Deep vein thrombosis B) Endocarditis C) Atherosclerosis D) Shock
B) Endocarditis Common complications of congenital heart defects that develop during adulthood include dysrhythmias, endocarditis, stroke, heart failure, pulmonary hypertension, and heart valve problems. Congenital heart defects do not normally cause deep vein thrombosis, atherosclerosis, or shock.
A baby will be having surgery to correct a congenital heart defect. On which topic should the parents be instructed regarding the care of the child before surgery? A) Restricting immunizations until after the surgery B) Preventing exposure to infection C) Implementing no particular precautions D) Restricting fluids for a week before the surgery
B) Preventing exposure to infection Preoperative care of a baby having surgery to correct a congenital heart defect should include prevention from infection with good hand washing. There are precautions that the parents should take to ensure the child is in optimal health prior to the surgery. Immunizations should be continued. The parents may be instructed to withhold food and fluids several hours before the surgery. Fluids would not be restricted for a week before surgery.
The nurse is analyzing data collected after assessing a child with a congenital heart defect that decreases pulmonary blood flow. Which nursing diagnosis would be applicable for this client? A) Acute Pain B) Ineffective Breathing Pattern C) Decreased Cardiac Output D) Excess Fluid Volume
C) Decreased Cardiac Output Nursing diagnoses for clients with congenital heart defects that decrease pulmonary blood flow include Decreased Cardiac Output, Risk for Infection, Caregiver Role Strain, and Activity Intolerance. Acute Pain and Ineffective Breathing Pattern are appropriate nursing diagnoses for a child following cardiac surgery. Excess Fluid Volume is a nursing diagnosis seen in the care of a client with a congenital heart defect that increases pulmonary blood flow.
The nurse is caring for a child who has just been diagnosed with an atrial septal defect (ASD). Which manifestations would the nurse expect upon assessment? Select all that apply. A) Pulmonary artery hypotension B) Midsystolic murmur at lower right sternal border C) Mitral valve regurgitation with cleft on mitral valve D) S1 heart tone may be split due to forceful left ventricular contraction E) Congestive heart failure
C) Mitral valve regurgitation with cleft on mitral valve E) Congestive heart failure ASD occurs when there is an opening in the atrial septum, permitting left-to-right shunting of blood. Midsystolic murmur may be auscultated at the lower left sternal border due to increased blood flow across the tricuspid valve. Mitral valve regurgitation may occur with a cleft on the mitral valve. S1 heart tones may be split due to forceful right ventricular contraction. Finally, pulmonary artery hypertension and congestive heart failure may occur.
The nurse is providing teaching to the parents of a child born with tetralogy of Fallot (TOF). Which statement should the nurse include in her teaching regarding this defect? A) "Increased pulmonary blood flow causes symptoms with this disease." B) "This disease consists of pulmonic stenosis, left ventricular hypertrophy, ventricular septal defect, and an overriding aorta." C) "Your child has a decreased amount of red blood cells because of this disease." D) "This disease consists of pulmonic stenosis, right ventricular hypertrophy, ventricular septal defect, and an overriding aorta."
D) "This disease consists of pulmonic stenosis, right ventricular hypertrophy, ventricular septal defect, and an overriding aorta." TOF consists of four defects—pulmonic stenosis, right ventricular hypertrophy, ventricular septal defect, and an overriding aorta. This disease is also characterized by decreased pulmonary blood flow and polycythemia (increased red blood cells due to hypoxia).
The nurse is caring for a pregnant woman with congenital heart disease. The woman asks if she will be able to have a vaginal delivery. Which answer by the nurse is correct? A) A Cesarean section is preferred because you will lose less blood than with a vaginal birth. B) A Cesarean section is preferred because there is a lower risk of infection than with a vaginal birth. C) A vaginal birth is preferred over a Cesarean section for women who have aortic stenosis. D) A vaginal birth is preferred because there is a lower risk of thrombophlebitis than with a Cesarean section.
D) A vaginal birth is preferred because there is a lower risk of thrombophlebitis than with a Cesarean section. Vaginal delivery is preferable to Cesarean section for most clients with congenital heart defects because they will likely lose less blood with vaginal birth. Risk of wound infection and thrombophlebitis are also concerns with Cesarean birth. Dilated aorta, pulmonary hypertension, and aortic stenosis are contraindications for vaginal delivery.
