Practice questions: Week 8

A family member, who is caring for a 2-year-old with Tetralogy of Fallot, asks you why the child will periodically squat when playing with other children. Your response is: A. "Squatting helps to increase systemic vascular resistance, which will decrease the right to left shunt that is occurring in the ventricles and this helps increase oxygen levels." B. "Squatting helps to decrease systemic vascular resistance, which will decrease the left to right shunt that is occurring in the ventricles and this helps increase oxygen levels." C. "Squatting helps to decrease systemic vascular resistance, which will increase the right to left shunt that is occurring in the ventricles and this helps increase oxygen levels." D. "Squatting helps to normalize systemic vascular resistance, which will increase the left to right shunt that is occurring in the ventricles and this helps increase oxygen levels."

A

After speaking with the mother of the infant in the previous question, who may have a ventricular septal defect, you auscultate heart sounds. If a ventricular septal defect was present, you may hear a harsh murmur that is _______________________. A. Located at the lower left sternal border and starts at S1 and extends into S2. B. Located at the upper left sternal border and is continuous during systole. C. Located at the lower left sternal border and is continuous machine-like. D. Located at the upper left sternal border and is only heard during diastole.

A

An echocardiogram shows that your patient has an atrial septal defect located at the bottom of the septum near the tricuspid and mitral valves. As the nurse you know this is what type of atrial septal defect (ASD)? A. Ostium Primum B. Ostium Secundum C. Sinus Venosus D. Coronary Sinus

A

As the nurse you know that some patients who have coarctation of the aorta will develop collateral circulation of the arteries due to the abnormality on the aorta. Which option below indicates a patient is experiencing collateral circulation? A. Chest x-ray that demonstrates notching on the ribs B. A harsh diastolic murmur on inspiration at the 2nd intercostal border C. Ejection fraction of 12% on an echocardiogram D. Chest x-ray that demonstrates cardiomegaly

A

Which complication should the nurse expect in a child with a congenital heart defect? A. Risk of respiratory infections B. Risk for bleeding tendencies C. Risk of dehydration D. Risk for seizures

A

You're providing an in-service to a group of new nurses who will be caring for patients who have Tetralogy of Fallot. Which statement below is INCORRECT concerning how the blood normally flows through the heart? A. Unoxygenated blood enters through the superior and inferior vena cava and travels to the left atrium. B. The pulmonic valve receives blood from the right ventricle and allows blood to flow to the lungs via the pulmonary artery. C. The left atrium allows blood to flow down through the bicuspid valve (mitral) into the left ventricle. D. Oxygenated blood leaves the left ventricle and flows up through the aortic valve and aorta to be pumped to the rest of the body.

A

After admitting a child with an atrial septal defect, you start developing a nursing care plan. What nursing diagnoses can you include in the patient's plan of care based on the complications that arise from this condition? Select all that apply. A. Activity Intolerance B. Risk for Infection C. Decrease Cardiac Output D. Excess Fluid Volume E. Risk for Aspiration

A, B, C, D

Which interventions should the nurse use when caring for a child with cyanotic heart disease? Select all that apply. A. Keep accurate input and output records B. Note a runny nose or cough C. Document changes in energy level D. Provide adequate rest time E. Weigh child daily

A, B, C, D, E

As the nurse you know which statements are TRUE about Tetralogy of Fallot? Select all that apply. A. "Tetralogy of Fallot is a cyanotic heart defect." B. "In this condition the heart has to work harder to pump blood to the lungs, which cause the right ventricle to work harder and enlarge." C. "Tetralogy of Fallot is treated with only palliative surgery." D. "Many patients with this condition will experience clubbing of the nails."

A, B, D

Which nursing interventions are appropriate when administering digoxin to a preschooler? Select all that apply. A. Encourage patient to eat bananas or oranges B. Check dosage calculation with another nurse C. Hold dose if apical pulse is less than 100 bpm. D. Hold dose if labs indicate hypocalcemia or hypercalcemia E. Check apical pulse for 30 seconds prior to administration

A, B, D

Check each of the clinical manifestations that might indicate the presence of a congenital heart defect in an infant or young child. Select all that apply. A. Growth retardation B. Difficulty feeding C. Bradycardia D. Dyspnea E. Weak cry

A, B, D, E

A newborn has severe coarctation of the aorta. What signs and symptoms would you expect to find in this patient? Select all that apply. A. Very strong bounding pulses in the upper extremities B. Cool legs and feet C. Machine-like murmur only on systole D. Tet spells with activity E. Severe cyanosis F. Absent/diminished femoral pulses

A, B, F

Which symptoms are found in a child with tetralogy of Fallot? Select all that apply. A. Cyanosis B. Average weight and height C. Dyspnea on exertion D. Clubbing of fingers E. O2 saturation of 89%

A, C, D

A 4-month-old is scheduled to take Digoxin for treatment of a ventricular septal defect. The patient's apical pulse is 89 beats per minute. As the nurse you will? Select all that apply. A. Hold the dose B. Recheck the pulse via the brachial artery C. Administer the dose as scheduled D. Notify the physician

A, D

Select all the true statements about the aorta: A. "The ascending aorta branches off to supply the coronary arteries of the heart." B. "It's the third largest artery in the body." C. "The aorta comes off the right ventricle and supplies oxygenated blood to the body." D. "The aortic arch branches off to supply the head, neck, and upper extremities."

A, D

Which complications are probable complications of congenital heart anomalies? Select all that apply. A. Congestive heart failure B. Subcutaneous nodules C. Rheumatic arthritis D. Cerebral thrombosis E. Subacute bacterial endocarditis

A, D, E

A newborn baby, who is diagnosed with transposition of the great arteries, is ordered by the physician to be started on an infusion of prostaglandin E (Alprostadil). The purpose of this medication is to: A. Prevent the closure of the foramen ovale. B. Allow a continued connection between the aorta and pulmonary artery via the ductus arteriosus. C. Prevent the closure of the ductus venosus. D. Increase the blood flow to the pulmonary vein, which will increase oxygen levels.

B

Select the structure below that allows blood to flow from the right to left atrium in utero and that should close after birth: A. Ductus Arteriosus B. Formen Ovale C. Ductus Venosus D. Ligamentum teres

B

You are assessing the heart sounds of a patient with a severe case of Tetralogy of Fallot. You would expect to hear a __________ murmur at the _______ of the sternal border? A. diastolic; right B. systolic; left C. diastolic; left D. systolic; right

B

You're caring for a child with coarctation of the aorta and educating the parents about the child's condition. Which statement by the parents demonstrates they understood the pathophysiology of this defect? A. "This condition can lead to right-sided heart failure." B. "The narrowing of the aorta leads to a high blood pressure in the arteries that are found before the site of narrowing in the aorta." C. "The dilation of the aorta leads to a decrease blood pressure in the arteries that are found after the site of dilation." D. "The upper and lower extremities will experience a decrease in blood flow due to the defect in the aorta."

B

You're performing a head-to-toe- assessment on a newborn with severe coarctation of the aorta. You note a systolic heart murmur. Where is this heart murmur best auscultated in a patient with this condition? A. at the 4th intercostal space left to the sternal border B. at the left interscapular area C. at the 2nd intercostal space right to the sternal border D. at the mid-subclavicular line right of the sternal border

B

A patient is diagnosed with a large atrial septal defect. You're providing information for the patient on the complications related to this condition. What topics will you include in the patient's education? Select all that apply. A. Tet spells B. Heart failure C. Stroke D. Pulmonary Hypertension E. Rheumatic Fever

B, C, D

After the birth of a newborn with severe coarctation of the aorta, the physician orders a prostaglandin infusion. As the nurse you know that this medication will have what type of therapeutic effects? Select all that apply. A. Prevent the foramen ovale from closing B. Allow a connection between the aorta and pulmonary artery C. Decrease the workload on the left ventricle D. Increase blood flow to the lower extremities

B, C, D

Check each of the clinical manifestations that might indicate the presence of a congenital heart defect in an infant or young child. Select all that apply. A. Bradypnea B. Decreased exercise tolerance C. Cyanosis D. Dry, hot skin E. Frequent respiratory infections

B, C, E

Select all the signs and symptoms of how a newborn with transposition of the great arteries may present after birth: A. Machinery-like heart murmur B. Cyanosis C. Low oxygen levels D. Bounding pulses in the upper extremities E. Increased respiratory rate F. Increased heart rate G. Knee-to-chest position

B, C, E, F

A newborn baby with transposition of the great arteries has an echocardiogram performed to detect if any other defects are present in the heart. As the nurse, you know that what other defects can most commonly occur with TGA? Select all that apply. A. Complete atrioventricular canal defect B. Ventricular septal defect C. Patent ductus arteriosus D. Tricuspid atresia E. Tetralogy of fallot F. Atrial septal defect

B, C, F

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

B, D

A concerned mother brings her 3-month-old to the clinic. The mother states the infant seems to be small for its age. In addition, she states the infant fatigues very easily while feeding and rarely finishes a feeding. While collecting a thorough health history, what other signs and symptoms described by the mother may indicate the child has a congenital heart defect, such as a ventricular septal defect? Select all that apply. A. Diarrhea B. Frequent treatment for lung infections C. Excessive wet diapers D. Diaphoresis when nursing E. Swelling in the hands and feet

B, D, E

A 4-month-old is diagnosed with Tetralogy of Fallot. You're providing an illustration to the parent to help him understand the pathophysiology of this condition. What defects must be present in the illustration to help the parent understand their child's condition? Select all that apply. A. Aortic stenosis B. Ventricular septal defect C. Coarctation of aorta D. Right ventricular hypertrophy E. Displacement of the aorta F. Pulmonic stenosis G. Patent ductus arteriosus

B, D, E, F

A two-month-old is showing signs and symptoms of heart failure. An echocardiogram is ordered. The test shows the infant has a ventricular septal defect (VSD). Which statement below best describes the blood flow in the heart due to this congenital heart defect? A. "The blood in the heart is shunting from the right ventricle to the left ventricle, which is increasing pulmonary blood flow." B. "The blood in the heart is shunting from the left ventricle to the right ventricle, which is decreasing pulmonary blood flow." C. "The blood in the heart is shunting from the left ventricle to the right ventricle, which is increasing pulmonary blood flow." D. "The blood in the heart is bypassing the left ventricle and is being shunted to the right ventricle, which is decreasing lung blood flow."

C

An 8-month-old is receiving digoxin. The nurse should notify the care provider and hold the dose if the heart rate is less than how many beats per minute? A. 70 B. 80 C. 90 D. 100

C

Which symptom is found with coarctation of the aorta? A. Hypotension in upper extremities B. Bounding pulses in lower extremities C. Hypotension in lower extremities D. Circumoral pallor and cyanosis

C

While feeding a 3-month-old infant, who has Tetralogy of Fallot, you notice the infant's skin begins to have a bluish tint and the breathing rate has increased. Your immediate nursing action is to? A. Continue feeding the infant and place the infant on oxygen. B. Stop feeding the infant and provide suction. C. Stop feeding the infant and place the infant in the knee-to-chest position and administer oxygen. D. Assess the infant's heart rate and rhythm.

C

You're educating the parents of a patient with transposition of the great arteries about the treatment options. Which treatment option below provides a permanent solution and is performed within the first few weeks of life? A. Prostaglandin E infusion B. Balloon atrial septostomy C. Arterial switch procedure D. Complete repair with a patch

C

Your newborn patient has a severe case of transposition of the great arteries. The baby does not have any other defects and is therefore experiencing severe cyanosis and needs medical intervention immediately. The newborn is started on prostaglandin E and is scheduled for a balloon atrial septostomy. Select the statement below that best describes this procedure: A. During this procedure the pulmonary artery and aorta are switched along with their coronary arteries. B. This procedure will enlarge a hole in the ventricular septum and provide permanent treatment for this condition. C. During this procedure a hole in the atrial septum is enlarged, which will be temporary. D. The procedure will switch the pulmonary vein and aorta long with their coronary arteries, which will be permanent.

C

As the registered nurse you are developing a plan of care for a patient with Tetralogy of Fallot. Select all the appropriate nursing diagnoses below that would be specific to this patient. A. Risk for deficient fluid volume B. Ineffective airway clearance C. Activity Intolerance D. Failure to thrive E. Risk for impaired liver function

C, D

A newborn baby is born with transposition of the great arteries (TGA). You're explaining the condition to the parents. Which statement by the father demonstrates he understood the education provided about this condition? A. "The pulmonary vein and artery are switched, which causes the pulmonary vein to deliver unoxygenated blood to the systemic circulation while the pulmonary artery delivers oxygenated blood back to the lungs." B. "The aorta and pulmonary vein are switched, which causes the aorta to arise from the right ventricle and the pulmonary vein to arise from the left ventricle." C. "The aorta and pulmonary artery are switched, which causes the aorta to arise from the left ventricle and the pulmonary artery to arise from the right ventricle." D. "The aorta and pulmonary artery are switched, which causes the aorta to arise from the right ventricle and the pulmonary artery to arise from the left ventricle."

D

An infant has a large ventricular septal defect (VSD). The defect is located in the upper section of the ventricular septum and is near the tricuspid and aortic valve. Based on this description, what type of ventricular septal defect is this? A. Outlet (conal or subarterial) B. Muscular C. Inlet (atrioventricular) D. Membranous

D

As the nurse you know that if a patient has a large ventricular septal defect and does not receive treatment, the patient may develop Eisenmenger Syndrome. This syndrome causes? A. A reversal of blood shunting in the heart from right to left and will cause pulmonary hypertension. B. A reversal of blood shunting in the heart from left to right and will cause cyanosis. C. A reversal of blood shunting in the heart from left to right and will cause pulmonary hypertension. D. A reversal of blood shunting in the heart from right to left and will cause cyanosis.

D

When teaching parents about home care of their child before corrective cardiac surgery which intervention is of primary importance? A. The parents should be extremely concerned about continuing cyanosis. B. Importance of reducing caloric intake to decrease cardiac demands. C. Importance of relaxing discipline and limit setting to prevent crying. D. Desirability of promoting normality within the limits of the child's condition.

D

Which nursing interventions should be included for the child with congestive heart failure? A. At least 1500 ml of fluids daily B. Monitor respirations during periods of activity C. Give 4 large feedings daily to conserve energy D. Organize activities to allow for adequate rest

D

You're assessing the heart sounds of a child with an atrial septal defect. You note a heart murmur at the 2nd intercostal space at the left upper sternal border. Heart murmurs noted in patients with an atrial septal defect are called? A. Holosystolic murmurs B. Diastolic murmurs C. Early systolic murmurs D. Midsystolic murmurs

D

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

D

You're caring for a newborn who has Tetralogy of Fallot with severe cyanosis. You anticipate the newborn will be started on ___________? A: Indomethacin B. Diclofenac C. Celecoxib D. Alprostadil

D

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

False, they increase blood flow to the lungs

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

False, upper chambers of the heart

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

False; VSD signs and symptoms most likely start to present around 1-3 months after birth

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

True

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

True