Nokea
A cardiac defect that allows blood to shunt from the (high pressure) left side of the heart to the (lower pressure) right side can result in which condition?
- A. Cyanosis
- B. Heart failure
- C. Decreased pulmonary blood flow
- D. Bounding pulses in upper extremities
Correct Answer: B
Rationale: Left-to-right shunting increases pulmonary blood flow, overloading the right heart and leading to heart failure. Cyanosis and decreased pulmonary flow occur with right-to-left shunts, and bounding pulses are specific to coarctation of the aorta.
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Decreasing the demands on the heart is a priority in care for the infant with heart failure (HF). In evaluating the infants status, which finding is indicative of achieving this goal?
- A. Irritability when awake
- B. Capillary refill of more than 5 seconds
- C. Appropriate weight gain for age 18
- D. Positioned in high Fowler position to maintain oxygen saturation at 90%
Correct Answer: C
Rationale: Appropriate weight gain indicates successful feeding and reduced caloric loss, reflecting decreased cardiac demand. Irritability and prolonged capillary refill suggest ongoing HF, and high Fowler positioning aids breathing but doesn?t confirm reduced cardiac strain.
After returning from cardiac catheterization, the nurse monitors the childs vital signs. The heart rate should be counted for how many seconds?
- A. 15
- B. 30
- C. 60
- D. 120
Correct Answer: C
Rationale: Counting the heart rate for 60 seconds ensures accurate detection of arrhythmias or bradycardia. Shorter durations (15 or 30 seconds) are insufficient, and 120 seconds is unnecessarily long for routine assessment.
The physician suggests that surgery be performed for patent ductus arteriosus (PDA) to prevent which complication?
- A. Hypoxemia
- B. Right-to-left shunt of blood
- C. Decreased workload on the left side of the heart
- D. Pulmonary vascular congestion
Correct Answer: D
Rationale: PDA causes left-to-right shunting from the aorta to the pulmonary artery, leading to pulmonary vascular congestion. Surgery prevents this complication. Hypoxemia is linked to mixed flow defects, the shunt is left-to-right, and PDA increases left heart workload.
A 3-month-old infant has a hypercyanotic spell. What should be the nurses first action?
- A. Assess for neurologic defects.
- B. Prepare the family for imminent death.
- C. Begin cardiopulmonary resuscitation.
- D. Place the child in the kneechest position.
Correct Answer: D
Rationale: Placing the infant in the knee-chest position increases systemic vascular resistance, reducing the hypercyanotic spell. Oxygen and morphine may follow, but this is the first action. Neurologic defects, CPR, or preparing for death are inappropriate initial responses.
What blood flow pattern occurs in a ventricular septal defect?
- A. Mixed blood flow
- B. Increased pulmonary blood flow
- C. Decreased pulmonary blood flow
- D. Obstruction to blood flow from ventricles
Correct Answer: B
Rationale: A ventricular septal defect allows blood to shunt from the high-pressure left ventricle to the lower-pressure right ventricle, increasing pulmonary blood flow. It?s a one-way shunt, not mixed flow, doesn?t obstruct ventricular outflow, and isn?t associated with decreased flow.