NURS 2356 ACTUAL LATEST EXAM 2024/2025 QUESTIONS
AND VERIFIED CORRECT ANSWERS/ ALREADY GRADED
A++
What are four acyanotic or left to right shunt defects? - ANSWER Atrial
Septal Defect (ASD), Ventricular Septal Defect (VSD), Patent Ductus
Arteriosus (PDA), and Coarctation of the Aorta (COA)
What is an Atrial Septal Defect, which direction is blood shunted, and what
gender is affected and has this defect repaired the most? - ANSWER It's
an abnormal opening between the right and left atrium, oxygenated blood is
shunted back into the right atrium. Females get this defect most commonly
What is the most common type of Atrial Septal Defect (ASD) - ANSWER
Incompetent Foramen Ovale
What are some s/s that might be indicative of an Atrial Septal Defect (ASD)
- ANSWER Poor feeding, dyspnea, failure to thrive, characteristic murmur,
paradoxical embolism which can result in CVA
What are the treatment options for the repair of an Atrial Septal Defect
(ASD) - ANSWER Treat symptoms with Digoxin and Diuretics and surgery
if present in a female due to high risk of clot formation or for a moderate-
large defect in males
What is a Ventricular Septal Defect (VSD), is it common or uncommon, and
which direction is blood shunted? - ANSWER It's the most common
congenital heart defect and it's an opening between the right and the left
ventricle and oxygenated blood is shunted from the left ventricle back into
the right
What is Eisenmenger Syndrome? - ANSWER reversal of a ventricular
septal defect's left to right shunt due to increased pulmonary pressure
leading to a right to left or cyanotic shunt
Clinical manifestations of Eisenmenger's Syndrome - ANSWER
Polycythemia and clubbing of fingers and toes
,What are some clinical manifestations of a Ventricular Septal Defect (VSD)
- ANSWER Failure to Thrive (FTT), murmur and palpable thrill
Based on Ventricular Septal Defects (VSD) clinical manifestations what
would be important in it's treatment plan - ANSWER increased calories via
24-27 cal formula, MCT oil and Polycose added to diet, and giving the child
30 min to feed and if not consuming enough NTG for Gavage feeds.
What is the treatment for Ventricular Septal Defects (VSD) - ANSWER
Antibiotic prophylaxis for all VSD, complete repair before 1 years old
When does the Ductus Arteriosus normally close - ANSWER between birth
and three months however most close between 10-18 hours after birth
What happens if the Ductus Arteriosus remains open? - ANSWER Creates
a Patent Ductus Arteriosus (PDA) which results in a left to right shunt due
to blood being shunted from the aorta back into the pulmonary trunk
What are the clinical manifestations of Patent Ductus Arteriosus (PDA) -
ANSWER low birth weight or premature birth, continuous machinery-like
murmur, widened pulse pressure and bounding pulses
What are children with Patent Ductus Arteriosus (PDA) or Ventricular
Septal Defects (VSD) at risk for? - ANSWER bacterial endocarditis and
pulmonary vascular obstructive disease
What medication is used to treat a Patent Ductus Ateriosus (PDA) -
ANSWER Indomethacin (prostaglandin inhibitor) to close the PDA which is
an alternative to surgery
What is the surgical correction of a Patent Ductus Arteriosus (PDA) and it's
purpose - ANSWER Ligation: requires thoracotomy and chest tube (pain
management and now at risk for pleural effusion and pneumonia); purpose:
prevents return of oxygenated blood into the lungs and decreases the risk
of the child developing CHF
What is Coarctation of the Aorta (COA)? - ANSWER narrowing of the aorta
leading to increased BP in the upper extremities and lower BP in the lower
extremities
,What are some clinical manifestations of an Coarctation of the Aorta
(COA)? - ANSWER Weak or absent posterior tibial, femoral, and pedal
pulses, pale, cool extremities
What could the bounding upper extremity pulses lead to in Coarctation of
the Aorta (COA) - ANSWER HA, epistaxis, aortic aneurysm or CVA
What is the management of Coarctation of the Aorta? - ANSWER
Prostaglandins may be used to keep PDA open until child goes to surgery,
Diuretics, Digoxin, Hydralazine, Lidocaine
What medications are used in the postoperative management of
Coarctation of the Aorta - ANSWER Captopril (ACE inhibitor), hydrazinem,
and/or Propranolol (beta blocker)
If a patient has coarctation of the aorta where must you take BP's? -
ANSWER In all four extremities
What is the accepted surgical correction of coarctation of the aorta? -
ANSWER under interventional cardiac catheterization balloon dilation with
stent placement is widely accepted
If a child has the subclavian flap procedure done to correct coarctation of
the aorta what can't you do postoperatively and why? - ANSWER There will
be no palpable pulse in the left arm therefore you must not take BP's in the
left arm
What is post-coarctectomy syndrome? - ANSWER aka Mesenteric Arteritis
which is restenosis of the aorta after surgical correction of coarctation
What is the therapeutic management of Post-coarctectomy syndrome
(Mesenteric Arteritis)? - ANSWER 24-48 hr NPO with NGT gastric
decompression to prevent NEC and replace output with saline to prevent
hyponatremia, tight BP control to prevent rupture of sutures
What are the clinical manifestations of post-coarctectomy syndrome
(mesenteric arteritis) - ANSWER abdominal pain, ileus and vomiting,
progression to intestinal wall hemorrhage perforation
, What's the treatment for Post-coarcectomy syndrome (Mesenteric
Arteritis)? - ANSWER Balloon dilation
How long does a child need to be NPO before a cardiac cath? - ANSWER
4-6 hr
What should be checked before a cardiac cath - ANSWER baseline distal
pulses and VS
Can Digoxin be mixed in with formula - ANSWER No.
What must you watch for after a cardiac cath - ANSWER arrhythmia's,
hemorrhage, distal pulses, increase fluids to get rid of dye (u/o), bleeding at
the site
If a child develops a fever within hours of a cardiac cath, what does this
imply, when would you be worried about a fever? - ANSWER Fever within
24 hours of the cardiac cath could be an inflammatory process, however, if
a fever develops 2-3 days later it could indicate an infectious process
What are the two main Cyanotic Heart Defects (aka right to left shunts) we
talk about - ANSWER Transposition of the Great Vessels and Tetrology of
Fallot
What are the four defects associated with the Tetrology of Fallor -
ANSWER VSD, overriding of the aorta, pulmonary stenosis, and right
ventricular hypertrophy
What are the manifestations of the Tetrology of Fallot - ANSWER Cyanotic
at birth or cyanosis that progresses in the first year as pulmonic stenosis
worsens, murmur due to the VSD, squatting, "Tet" or hyper cyanotic or blue
spells!
What is an effective way to manage "Tet," hyper cyanotic, or blue spells -
ANSWER squatting and knee to chest position
What are children with Tet spells at risk for? - ANSWER seizures and CVA
What dietary modifications must be made for a child with Tetrology of
Fallot? - ANSWER Increased cal (24-27 cal), MCT oil, and Polycose
AND VERIFIED CORRECT ANSWERS/ ALREADY GRADED
A++
What are four acyanotic or left to right shunt defects? - ANSWER Atrial
Septal Defect (ASD), Ventricular Septal Defect (VSD), Patent Ductus
Arteriosus (PDA), and Coarctation of the Aorta (COA)
What is an Atrial Septal Defect, which direction is blood shunted, and what
gender is affected and has this defect repaired the most? - ANSWER It's
an abnormal opening between the right and left atrium, oxygenated blood is
shunted back into the right atrium. Females get this defect most commonly
What is the most common type of Atrial Septal Defect (ASD) - ANSWER
Incompetent Foramen Ovale
What are some s/s that might be indicative of an Atrial Septal Defect (ASD)
- ANSWER Poor feeding, dyspnea, failure to thrive, characteristic murmur,
paradoxical embolism which can result in CVA
What are the treatment options for the repair of an Atrial Septal Defect
(ASD) - ANSWER Treat symptoms with Digoxin and Diuretics and surgery
if present in a female due to high risk of clot formation or for a moderate-
large defect in males
What is a Ventricular Septal Defect (VSD), is it common or uncommon, and
which direction is blood shunted? - ANSWER It's the most common
congenital heart defect and it's an opening between the right and the left
ventricle and oxygenated blood is shunted from the left ventricle back into
the right
What is Eisenmenger Syndrome? - ANSWER reversal of a ventricular
septal defect's left to right shunt due to increased pulmonary pressure
leading to a right to left or cyanotic shunt
Clinical manifestations of Eisenmenger's Syndrome - ANSWER
Polycythemia and clubbing of fingers and toes
,What are some clinical manifestations of a Ventricular Septal Defect (VSD)
- ANSWER Failure to Thrive (FTT), murmur and palpable thrill
Based on Ventricular Septal Defects (VSD) clinical manifestations what
would be important in it's treatment plan - ANSWER increased calories via
24-27 cal formula, MCT oil and Polycose added to diet, and giving the child
30 min to feed and if not consuming enough NTG for Gavage feeds.
What is the treatment for Ventricular Septal Defects (VSD) - ANSWER
Antibiotic prophylaxis for all VSD, complete repair before 1 years old
When does the Ductus Arteriosus normally close - ANSWER between birth
and three months however most close between 10-18 hours after birth
What happens if the Ductus Arteriosus remains open? - ANSWER Creates
a Patent Ductus Arteriosus (PDA) which results in a left to right shunt due
to blood being shunted from the aorta back into the pulmonary trunk
What are the clinical manifestations of Patent Ductus Arteriosus (PDA) -
ANSWER low birth weight or premature birth, continuous machinery-like
murmur, widened pulse pressure and bounding pulses
What are children with Patent Ductus Arteriosus (PDA) or Ventricular
Septal Defects (VSD) at risk for? - ANSWER bacterial endocarditis and
pulmonary vascular obstructive disease
What medication is used to treat a Patent Ductus Ateriosus (PDA) -
ANSWER Indomethacin (prostaglandin inhibitor) to close the PDA which is
an alternative to surgery
What is the surgical correction of a Patent Ductus Arteriosus (PDA) and it's
purpose - ANSWER Ligation: requires thoracotomy and chest tube (pain
management and now at risk for pleural effusion and pneumonia); purpose:
prevents return of oxygenated blood into the lungs and decreases the risk
of the child developing CHF
What is Coarctation of the Aorta (COA)? - ANSWER narrowing of the aorta
leading to increased BP in the upper extremities and lower BP in the lower
extremities
,What are some clinical manifestations of an Coarctation of the Aorta
(COA)? - ANSWER Weak or absent posterior tibial, femoral, and pedal
pulses, pale, cool extremities
What could the bounding upper extremity pulses lead to in Coarctation of
the Aorta (COA) - ANSWER HA, epistaxis, aortic aneurysm or CVA
What is the management of Coarctation of the Aorta? - ANSWER
Prostaglandins may be used to keep PDA open until child goes to surgery,
Diuretics, Digoxin, Hydralazine, Lidocaine
What medications are used in the postoperative management of
Coarctation of the Aorta - ANSWER Captopril (ACE inhibitor), hydrazinem,
and/or Propranolol (beta blocker)
If a patient has coarctation of the aorta where must you take BP's? -
ANSWER In all four extremities
What is the accepted surgical correction of coarctation of the aorta? -
ANSWER under interventional cardiac catheterization balloon dilation with
stent placement is widely accepted
If a child has the subclavian flap procedure done to correct coarctation of
the aorta what can't you do postoperatively and why? - ANSWER There will
be no palpable pulse in the left arm therefore you must not take BP's in the
left arm
What is post-coarctectomy syndrome? - ANSWER aka Mesenteric Arteritis
which is restenosis of the aorta after surgical correction of coarctation
What is the therapeutic management of Post-coarctectomy syndrome
(Mesenteric Arteritis)? - ANSWER 24-48 hr NPO with NGT gastric
decompression to prevent NEC and replace output with saline to prevent
hyponatremia, tight BP control to prevent rupture of sutures
What are the clinical manifestations of post-coarctectomy syndrome
(mesenteric arteritis) - ANSWER abdominal pain, ileus and vomiting,
progression to intestinal wall hemorrhage perforation
, What's the treatment for Post-coarcectomy syndrome (Mesenteric
Arteritis)? - ANSWER Balloon dilation
How long does a child need to be NPO before a cardiac cath? - ANSWER
4-6 hr
What should be checked before a cardiac cath - ANSWER baseline distal
pulses and VS
Can Digoxin be mixed in with formula - ANSWER No.
What must you watch for after a cardiac cath - ANSWER arrhythmia's,
hemorrhage, distal pulses, increase fluids to get rid of dye (u/o), bleeding at
the site
If a child develops a fever within hours of a cardiac cath, what does this
imply, when would you be worried about a fever? - ANSWER Fever within
24 hours of the cardiac cath could be an inflammatory process, however, if
a fever develops 2-3 days later it could indicate an infectious process
What are the two main Cyanotic Heart Defects (aka right to left shunts) we
talk about - ANSWER Transposition of the Great Vessels and Tetrology of
Fallot
What are the four defects associated with the Tetrology of Fallor -
ANSWER VSD, overriding of the aorta, pulmonary stenosis, and right
ventricular hypertrophy
What are the manifestations of the Tetrology of Fallot - ANSWER Cyanotic
at birth or cyanosis that progresses in the first year as pulmonic stenosis
worsens, murmur due to the VSD, squatting, "Tet" or hyper cyanotic or blue
spells!
What is an effective way to manage "Tet," hyper cyanotic, or blue spells -
ANSWER squatting and knee to chest position
What are children with Tet spells at risk for? - ANSWER seizures and CVA
What dietary modifications must be made for a child with Tetrology of
Fallot? - ANSWER Increased cal (24-27 cal), MCT oil, and Polycose
