NR 602 MIDTERM EXAM, NR 602 -PRIMARY CARE
OF THE CHILDBEARING AND CHILDREARING
FAMILY, CHAMBERLAIN COLLEGE OF NURSING
(PEDIATRIC NURSING
CARE OF CHILD WITH
CARDIOVASCULAR DISORDERS)
A 9-month-aged child was diagnosed to have tetralogy of fallot
after series of examinations, intensive physical assessments
and history taking. The child is admitted to the hospital for the
scheduled heart surgery for its repair.
1. The caregiver reviews the Kid’s record and notes that the
child has clubbed fingers. The caregiver understands that the
clubbing is most likely caused by: a. Peripheral hypoxia
b. Delayed physical growth
c. Chronic hypertension n
d. Destruction of bone marrow
ANS: A
Tetralogy of Fallot is involves four anomalies: pulmonary
stenosis, VSD (usually large), dextroposition
(overriding) of the aorta, and hypertrophy of right ventricles.
Because of the pulmonary stenosis, pressure builds up in the
right side of the heart. Vital fluid then shunts from this area of
increased pressure into the left ventricle and the overriding
aorta. This shunting causes the mixture of oxygenated and
unoxygenated Vital fluid thus the child may exhibit cyanosis that
worsens with activity. Clubbing, a thickening and flattening of the
tips of the fingers and toes, is thought to occur because of a
,chronic tissue hypoxia and polycythemia. Options B, C and D do
not cause
clubbing.
Reference: A. Pillitteri. Maternal and Child Nursing. 5th Edition.
Page 1304.
2. Which of the following should the caregiver expect to include
in the plan of care of a child diagnosed with tetralogy of fallot
who has undergone corrective surgery? a. 2 to 3 g of sodium in
the diet each day
c. Visits limited to a selected few
b. Physical activity restrictions
d. Assignment to an isolation room
ANS: A
Because of the hemodynamic changes that occur with open
heart surgical repair, particularly with septal defects, transient
congestive heart failure may develop. Therefore, the Kid’s
sodium intake typically is restricted to 2 to 3 g/day. Activity
restrictions are inappropriate, typically, the child is encouraged
to walk in the halls of the unit. Visitors are not restricted unless
the pediatric unit has restrictive visiting policies. The child can
be placed in a room with other children who are not contagious.
After correction of the defect, the risk for infection in the child is
the same as that for any postoperative client.
Reference: A. Pillitteri. Maternal and Child Nursing. 5th Edition
Page 1305.
SITUATION: Congenital heart defect is the most common form
of cardiac disease in children.
3. When performing an infant’s admission examination, the
caregiver notes all the following abnormal findings. Which
one is the most common sign of heart disease that the
caregiver should assess? a. Diastolic murmur
b. Circumoral cyanosis
c. Hypertension
d. TachycardiaANS: D
,Major part of the infants with CHD have tachycardia or a heart
rate above 160 beats per minute. This is often the first sign of
CHD that the caregiver can assess. Circumoral cyanosis,
hypertension and diastolic murmur may or may not be present
depending on the type and severity of the defect.
4. Upon assessment, an infant with the coarctation
of the aorta would be expected to have: a. Edema
b. Absence of palpable femoral pulses
c. Strong pedal pulses
d. Shortness of breath
ANS: B
Coarctation of the aorta is the narrowing of the lumen of the
aorta due to a constricting band. It occurs most often in boys
than in girls and is the leading cause of congestive heart failure
in the few months of life. If the coarctation of the aorta is slight,
absence of palpable femoral pulses may be the only symptom.
5. Tetralogy of Fallot is a defect that results in Reduced
pulmonary Vital fluid flow because:
a. Deoxygenated Vital fluid is shunted from the right ventricle to the
left ventricle through and the overriding aorta
b. Deoxygenated Vital fluid is shunted from the right atrium to the left
atrium and increased pressure from aortic stenosis
c. Deoxygenated Vital fluid is forced into the left atrium through a
patent ductus arteriosus
d. Deoxygenated Vital fluid continuopunly scirculates from the right
ventricle to the lungs and back to the right ventricle
ANS: A
This is a description of the shunting involved in TOF that causes
the altered hemodynamics.
6. A child with Tetralogy of Fallot who has not had surgical
repair may assume a posturing position as a
compensatory mechanism. The position automatically
assumed by the child would be: a. prone
b. Kneeling
c. Supine
, d. Squatting
ANS: D
Squatting allows for improved venous return of the Vital fluid
flow from the lower extremities. This is a position that other
children rarely assume. Squatting gives the physiologic relief to
an overstressed heart by trapping Vital fluid in the lower
extremities. Unfortunately, this position can leave an insufficient
amount of total circulating Vital fluid for the body to oxygenate
and deliver to major body organs.
7. A neonate born 18 hours ago with myelomeningocele over
the lumbosacral region is scheduled for corrective surgery.
Preoperatively, what is the most important nursing goal? a.
Preventing infection
c. Providing adequate nutrition
b. Ensuring adequate hydration
d. Preventing
contracture deformity
ANS: A
RATIONALES: Preventing infection is the caregiver's primary
preoperative goal for a neonate with myelomeningocele.
Although the other options are relevant for this neonate, they're
secondary to preventing infection.
8. Wally is a 4-year-aged child scheduled for a cardiac
catheterization. Preoperative teaching should be:
a. Directed at his parents, because he is too young to
understand.
b. Detailed in regard to the actual procedures so he will know
what to expect.
c. Done several days before the procedure so that he will be
prepared.
d. Adapted to his level of development so that he can
understand.
ANS: D
Preoperative teaching should always be directed at the Kid’s
stage of development. The caregivers also benefit from the
OF THE CHILDBEARING AND CHILDREARING
FAMILY, CHAMBERLAIN COLLEGE OF NURSING
(PEDIATRIC NURSING
CARE OF CHILD WITH
CARDIOVASCULAR DISORDERS)
A 9-month-aged child was diagnosed to have tetralogy of fallot
after series of examinations, intensive physical assessments
and history taking. The child is admitted to the hospital for the
scheduled heart surgery for its repair.
1. The caregiver reviews the Kid’s record and notes that the
child has clubbed fingers. The caregiver understands that the
clubbing is most likely caused by: a. Peripheral hypoxia
b. Delayed physical growth
c. Chronic hypertension n
d. Destruction of bone marrow
ANS: A
Tetralogy of Fallot is involves four anomalies: pulmonary
stenosis, VSD (usually large), dextroposition
(overriding) of the aorta, and hypertrophy of right ventricles.
Because of the pulmonary stenosis, pressure builds up in the
right side of the heart. Vital fluid then shunts from this area of
increased pressure into the left ventricle and the overriding
aorta. This shunting causes the mixture of oxygenated and
unoxygenated Vital fluid thus the child may exhibit cyanosis that
worsens with activity. Clubbing, a thickening and flattening of the
tips of the fingers and toes, is thought to occur because of a
,chronic tissue hypoxia and polycythemia. Options B, C and D do
not cause
clubbing.
Reference: A. Pillitteri. Maternal and Child Nursing. 5th Edition.
Page 1304.
2. Which of the following should the caregiver expect to include
in the plan of care of a child diagnosed with tetralogy of fallot
who has undergone corrective surgery? a. 2 to 3 g of sodium in
the diet each day
c. Visits limited to a selected few
b. Physical activity restrictions
d. Assignment to an isolation room
ANS: A
Because of the hemodynamic changes that occur with open
heart surgical repair, particularly with septal defects, transient
congestive heart failure may develop. Therefore, the Kid’s
sodium intake typically is restricted to 2 to 3 g/day. Activity
restrictions are inappropriate, typically, the child is encouraged
to walk in the halls of the unit. Visitors are not restricted unless
the pediatric unit has restrictive visiting policies. The child can
be placed in a room with other children who are not contagious.
After correction of the defect, the risk for infection in the child is
the same as that for any postoperative client.
Reference: A. Pillitteri. Maternal and Child Nursing. 5th Edition
Page 1305.
SITUATION: Congenital heart defect is the most common form
of cardiac disease in children.
3. When performing an infant’s admission examination, the
caregiver notes all the following abnormal findings. Which
one is the most common sign of heart disease that the
caregiver should assess? a. Diastolic murmur
b. Circumoral cyanosis
c. Hypertension
d. TachycardiaANS: D
,Major part of the infants with CHD have tachycardia or a heart
rate above 160 beats per minute. This is often the first sign of
CHD that the caregiver can assess. Circumoral cyanosis,
hypertension and diastolic murmur may or may not be present
depending on the type and severity of the defect.
4. Upon assessment, an infant with the coarctation
of the aorta would be expected to have: a. Edema
b. Absence of palpable femoral pulses
c. Strong pedal pulses
d. Shortness of breath
ANS: B
Coarctation of the aorta is the narrowing of the lumen of the
aorta due to a constricting band. It occurs most often in boys
than in girls and is the leading cause of congestive heart failure
in the few months of life. If the coarctation of the aorta is slight,
absence of palpable femoral pulses may be the only symptom.
5. Tetralogy of Fallot is a defect that results in Reduced
pulmonary Vital fluid flow because:
a. Deoxygenated Vital fluid is shunted from the right ventricle to the
left ventricle through and the overriding aorta
b. Deoxygenated Vital fluid is shunted from the right atrium to the left
atrium and increased pressure from aortic stenosis
c. Deoxygenated Vital fluid is forced into the left atrium through a
patent ductus arteriosus
d. Deoxygenated Vital fluid continuopunly scirculates from the right
ventricle to the lungs and back to the right ventricle
ANS: A
This is a description of the shunting involved in TOF that causes
the altered hemodynamics.
6. A child with Tetralogy of Fallot who has not had surgical
repair may assume a posturing position as a
compensatory mechanism. The position automatically
assumed by the child would be: a. prone
b. Kneeling
c. Supine
, d. Squatting
ANS: D
Squatting allows for improved venous return of the Vital fluid
flow from the lower extremities. This is a position that other
children rarely assume. Squatting gives the physiologic relief to
an overstressed heart by trapping Vital fluid in the lower
extremities. Unfortunately, this position can leave an insufficient
amount of total circulating Vital fluid for the body to oxygenate
and deliver to major body organs.
7. A neonate born 18 hours ago with myelomeningocele over
the lumbosacral region is scheduled for corrective surgery.
Preoperatively, what is the most important nursing goal? a.
Preventing infection
c. Providing adequate nutrition
b. Ensuring adequate hydration
d. Preventing
contracture deformity
ANS: A
RATIONALES: Preventing infection is the caregiver's primary
preoperative goal for a neonate with myelomeningocele.
Although the other options are relevant for this neonate, they're
secondary to preventing infection.
8. Wally is a 4-year-aged child scheduled for a cardiac
catheterization. Preoperative teaching should be:
a. Directed at his parents, because he is too young to
understand.
b. Detailed in regard to the actual procedures so he will know
what to expect.
c. Done several days before the procedure so that he will be
prepared.
d. Adapted to his level of development so that he can
understand.
ANS: D
Preoperative teaching should always be directed at the Kid’s
stage of development. The caregivers also benefit from the
