Chapter 27 The Child with a Cardiovascular Disorder - Leifer Maternity and Pediatric Nursing

Chapter 27 The Child with a Cardiovascular Disorder - Leifer Maternity and Pediatric Nursing

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 626 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 626 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 witcoarctation 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 627 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 627 TOP: Congenital Heart Disease KEY: Nursing Process Step: Implementation