Chapter 26: The Child with a Cardiovascular Disorder Nursing School Test Banks

Chapter 26: The Child with a Cardiovascular Disorder

MULTIPLE CHOICE

1. What does the nurse explain 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.

DIF: Cognitive Level: Comprehension REF: Page 608 OBJ: 4
TOP: Congenital Heart Disease KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. Which assessment would lead the nurse to suspect that a newborn infant has a ventricular septal defect?
a. A loud, harsh murmur with a systolic thrill
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.

DIF: Cognitive Level: Comprehension REF: Page 608 OBJ: 4
TOP: Congenital Heart Disease KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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

DIF: Cognitive Level: Comprehension REF: Page 609 OBJ: 4
TOP: Congenital Heart Disease KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. A father asks why his child with tetralogy of Fallot seems to favor a squatting position. What is the nurses best response?
a. Squatting increases the return of venous blood back to the heart.
b. Squatting decreases arterial blood flow away from the heart.
c. Squatting is a common resting position when a child is tachycardic.
d. Squatting increases the workload of the heart.
ANS: A
The squatting position allows the child to breathe more easily because systemic venous return is increased.

DIF: Cognitive Level: Comprehension REF: Page 609 OBJ: 4
TOP: Congenital Heart Disease KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. An infant is experiencing dyspnea related to patent ductus arteriosus (PDA). What does the nurse understand regarding why dyspnea occurs?
a. Blood is circulated through the lungs again, causing pulmonary circulatory congestion.
b. Blood is shunted past the pulmonary circulation, causing pulmonary hypoxia.
c. Blood is shunted past cardiac arteries, causing myocardial hypoxia.
d. Blood is 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.

DIF: Cognitive Level: Comprehension REF: Page 608-609
OBJ: 4 TOP: Congenital Heart Disease
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

6. Which is the most appropriate nursing action related to the administration of digoxin (Lanoxin) to an infant?
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.

DIF: Cognitive Level: Application REF: Page 612 OBJ: 5
TOP: Congestive Heart Failure KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

7. A child develops carditis from rheumatic fever. Which areas of the heart are affected by carditis?
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.

DIF: Cognitive Level: Knowledge REF: Page 614 OBJ: 6
TOP: Rheumatic Fever KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. Which comment made by a parent of a 1-month-old would alert the nurse about the presence of a congenital heart defect?
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.

DIF: Cognitive Level: Application REF: Page 611-612
OBJ: 3 TOP: Congenital Heart Disease
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

9. The nurse is caring for a child with a diagnosis of Kawasaki disease. The childs parent asks the nurse, How does Kawasaki disease affect my childs heart and blood vessels? On what understanding is the nurses response based?
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.

DIF: Cognitive Level: Comprehension REF: Page 617 OBJ: 12
TOP: Kawasaki Disease KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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

DIF: Cognitive Level: Application REF: Page 610, Figure 26-3
OBJ: 4 TOP: Tetralogy of Fallot
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

11. The parent of a 1-year-old child with tetralogy of Fallot asks the nurse, Why do my childs fingertips look like that? On what understanding does the nurse base a response?
a. Clubbing occurs as a result of untreated congestive heart failure.
b. Clubbing occurs as a result of a left-to-right shunting of blood.
c. Clubbing occurs as a result of decreased cardiac output.
d. Clubbing occurs as a result of chronic hypoxia.
ANS: D
Clubbing of the fingers develops in response to chronic hypoxia.

DIF: Cognitive Level: Comprehension REF: Page 609-610
OBJ: 4 TOP: Tetralogy of Fallot
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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.

DIF: Cognitive Level: Application REF: Page 614, Box 26-1
OBJ: 6 TOP: Rheumatic Fever
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

13. An infant with congestive heart failure is receiving digoxin (Lanoxin). What does the nurse recognize as a sign of digoxin toxicity?
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.

DIF: Cognitive Level: Comprehension REF: Page 612 OBJ: 5
TOP: Heart Failure KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

14. Through what does the infant born with hypoplastic left heart syndrome acquire oxygenated blood?
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.

DIF: Cognitive Level: Knowledge REF: Page 610 OBJ: 3
TOP: Hypoplastic Left Heart Syndrome KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

15. A child with rheumatic fever begins involuntary, purposeless movements of her limbs. What does the nurse recognize that this indicates?
a. Seizure activity
b. Hypoxia
c. Sydenhams chorea
d. Decreasing level of consciousness
ANS: C
As the effects of rheumatic fever affect the central nervous system, the child may develop Sydenhams chorea, manifested by involuntary, purposeless movements of the limbs.

DIF: Cognitive Level: Knowledge REF: Page 614 OBJ: 6
TOP: Sydenhams Chorea KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

16. How long should a 4-year-old child recovering from rheumatic fever need to receive monthly injections of penicillin G?
a. 1 year
b. 2 years
c. 5 years
d. 10 years
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.

DIF: Cognitive Level: Knowledge REF: Page 615 OBJ: 7
TOP: Prophylaxis for Rheumatic Fever KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

17. What is accurate about the characteristics of high-density lipoproteins (HDLs)?
a. They have high amounts of triglycerides.
b. They have only small amounts of protein.
c. They have little cholesterol.
d. They 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.

DIF: Cognitive Level: Knowledge REF: Page 616 OBJ: 11
TOP: High-Density Lipoproteins KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

18. What should the school nurse recommend when encouraging a heart-healthy diet for a child with high cholesterol?
a. A fat intake reduction of 5-10% of total calories
b. A fat intake reduction of 10-15% of total calories
c. A fat intake reduction of 15-20% of total calories
d. A fat intake reduction of 25-35% of total calories
ANS: D
For a child with increased cholesterol a fat reduction of 25-35% of total calories with less than 75 saturated fat and less than 200 mg of cholesterol per day is advised.

DIF: Cognitive Level: Knowledge REF: Page 616 OBJ: 11
TOP: Heart-Healthy Diet KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

19. The nurse is planning a hypertension-prevention program. What should be the main focus of the nurse when presenting information?
a. Pharmacological treatment
b. Surgical interventions available
c. Patient education
d. Reduction of aerobic exercise
ANS: C
The main focus of a hypertension-prevention program is patient education.

DIF: Cognitive Level: Knowledge REF: Page 616 OBJ: 10
TOP: Hypertension Prevention KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

20. A pediatric patient is scheduled for a noninvasive procedure to determine if his heart is structurally normal and to localize a murmur. What diagnostic test does the nurse anticipate?
a. Barium swallow
b. Chest x-ray
c. Electrocardiogram
d. Echocardiogram
ANS: D
Echocardiography is a noninvasive procedure that localizes murmurs and determines if theheart is structurally normal.

DIF: Cognitive Level: Knowledge REF: Page 607, Table 26-7
OBJ: N/A TOP: Diagnostic Tests
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

MULTIPLE RESPONSE

21. How would the nurse caring for an infant with congestive heart failure (CHF) modify feeding techniques to adapt for the childs 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.

DIF: Cognitive Level: Application REF: Page 612 OBJ: 5
TOP: Feeding Infant with CHF KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

22. What are the four structural heart anomalies that make up the 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.

DIF: Cognitive Level: Knowledge REF: Page 609 OBJ: 4
TOP: Tetralogy of Fallot KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

23. 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.

DIF: Cognitive Level: Comprehension REF: Page 609 OBJ: 3
TOP: Tet Spells KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

24. 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.

DIF: Cognitive Level: Comprehension REF: Page 610 OBJ: 3
TOP: Congenital Heart Defects KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

25. A 16-year-old patient is diagnosed with primary hypertension. What risk factors does the nurse mention when providing education on this diagnosis to the patient and his family? (Select all that apply.)
a. Heredity
b. Stress
c. Congenital defect
d. Obesity
e. Poor diet
ANS: A, B, D, E
Primary, or essential, hypertension implies that no known underlying disease is present. Nevertheless, heredity, obesity, stress, and a poor diet and exercise pattern can contribute to any type of hypertension.

DIF: Cognitive Level: Comprehension REF: Page 607 OBJ: 9 | 10
TOP: Primary Hypertension KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

COMPLETION

26. The nurse takes into consideration that the most common congenital heart defect is the ____________ ____________ defect.

ANS:
ventricular septal

VSDs are the most common congenital heart defect.

DIF: Cognitive Level: Knowledge REF: Page 615 OBJ: 2
TOP: VSD KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

27. The nurse explains that the difference between the systolic blood pressure reading and the diastolic blood pressure reading is called the __________ ___________.

ANS:
pulse pressure

The pulse pressure is the difference between the diastolic pressure and the systolic pressure.

DIF: Cognitive Level: Knowledge REF: Page 608 OBJ: 3
TOP: Pulse Pressure KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

28. Because the diagnosis of rheumatic fever is difficult, an aid used to identify the presence of rheumatic fever is the _____________ _______________.

ANS:
Jones criteria

The Jones criteria identify a cluster of symptoms and divide them into major criteria and minor criteria. The formula for making the diagnosis of rheumatic fever is to identify two major criteria in the patient, or one major and two minor criteria.

DIF: Cognitive Level: Knowledge REF: Page 609 OBJ: 6
TOP: Jones Criteria KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

29. ________________________is designed to serve the metabolic needs during intrauterine life and also to permit safe transition to life outside the womb.

ANS:
Fetal circulation

Fetal circulation is designed to serve the metabolic needs during intrauterine life and also to permit safe transition to life outside the womb.

DIF: Cognitive Level: Knowledge REF: Page 614 OBJ: 2
TOP: Fetal Circulation KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

30. Systemic blood pressure increases with age and is correlated with _________ and _________throughout childhood and adolescence.

ANS:
height; weight

Systemic blood pressure increases with age and is correlated with height and weight throughout childhood and adolescence. Significant hypertension is considered when measurements are persistently at or above the 95th percentile for the patients age and sex.

DIF: Cognitive Level: Knowledge REF: Page 615 OBJ: 8
TOP: Hypertension KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Health Promotion/Disease Prevention

31. ________________ is a systemic disease involving the joints, heart, central nervous system (CNS), skin, and subcutaneous tissues. It belongs to a group of disorders known as collagen diseases.

ANS:
Rheumatic fever (RF)

Rheumatic fever (RF) is a systemic disease involving the joints, heart, central nervous system (CNS), skin, and subcutaneous tissues. It belongs to a group of disorders known as collagen diseases

DIF: Cognitive Level: Knowledge REF: Page 613 OBJ: 1
TOP: Rheumatic Fever KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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