CHA EXAM #3 UPDATED ACTUAL
Questions And CORRECT Answers
Overview of Congenital Heart Defects - CORRECT ANSWERS -infants and children, inadequate
cardiac output is most commonly caused by congenital heart defects (a shunt, obstruction, or combination
that puts excessive volume on the myocardium)
Assessment of Congenital Heart Defects - CORRECT ANSWERS *pulse oximetry within 24 hours
of birth prior to hospital discharge for cyanotic defects
-R wrist pre-ductal, either post-ductal, L wrist mixed
-tachy ardia, especially during rest and slight exertion (>160)
-tachypnea (>60), characteristic murmurs are present with defects
-profuse scalp diaphoresis, especially in infants
-fatigue and irritability
-sudden weight gain
**Most frequent parental complaint: difficulty feeding
(infant must be awakened to be fed; has weak suck, may turn blue while eating; takes overly long time to
feed, falls asleep during feeding without finishing)
-signs of decreased CO: decreased peripheral pulses, feeding difficulties, hypotension, irritability,
oliguria, pale, cool extremities, tachycardia, exercise intolerance
Congenital heart Defects - CORRECT ANSWERS -perform pulse oximetry testing as directed
looking for positive criteria, which would result in a retest or further testing
-pulse oximeter measured on R hand (preductal) and either foot (postductal) to look for deoxygenated
blood circulating to extremeties
-positive criteria resulting in retest or further diagnostic testing: any measurement <95%, a difference of
>3% between the preductal and postductal readings on 3 different readings, each 1 hour apart
,-monitor for respiratory distress (nasal flaring, use of accessory muscles, crackles)
-monitor strict I/O and notify HCP if decreased, weigh diapers as appropriate
-maintain strict fluid restrictions as ordered
-monitor daily weight for fluid retention; a weight gain of 0.5kg in 1 day is caused by fluid accumulation
-elevate head of bed in semi-fowlers
-maintain a neutral thermal environment to prevent cold stress in infants
-provide rest and decrease environmental stimuli; organize nursing activities to allow for uninterrupted
rest
-feed when hungry and soon after awakening; provide small, frequent feedings to conserve energy and O2
supplies (may increase caloric infant feeding, limit PO feedings to 20 minutes to avoid overtiring, may
need to supplement with gavage feeding)
*administer digoxin as prescribed (assess apical HR for 1 minute prior to administration, hold digoxin if
pulse is less than 100bpm in infants, be aware that infants rarely recieve more than 1 ml of dig in one
dose)
***if hyeprcyanotic spell occurs, place infant in knee-chest position and admin 100% by face mask**
Defects with Increased Pulmonary Blood Flow - CORRECT ANSWERS Pathophys:
-blood flows from high pressure left side to low pressure right side
-may be asymptomatic or have HF with signs of decreased CO
Common Types of Defects:
-atrial septal defects (ASD)
-ventricular septal defects (VSD)
-patent ductus arteriosus (PDA)
Obstructive Defects - CORRECT ANSWERS Pathophys:
-blood entering a portion of the heart meets an anatomic narrowing (stenosis), causing obstruction to
blood flow
,-may be asymptomatic or have HF with signs of decreased CO
Common Types of Defects:
-aortic stenosis
-coarctation of aorta (localized narrowing near ductus arteriosus)
-pulmonary stenosis
Cyanotic Lesions with decreased pulmonary blood flow - CORRECT ANSWERS Pathophys:
-decrease in blood flowing to the lungs
-left side of the heart has low O2 saturation
-pressure on right side heart exceeds pressure on left side of heart, allowing desaturated blood to SHUNT
right to left
*typically cyanosis and hypoxia with clubbing and poor growth
Common Types of Defects:
-TETRALOGY OF FALLOT
-4 defects: vsd, pulmonary stenosis, overriding aorta and right ventricular hypertrophy
cyanotic lesions with increased pulmonary blood flow - CORRECT ANSWERS Pathophys:
-fetal heart fails to develop separate pulmonary and systemic circulations or there is a reversal of
circulation causing desaturated blood in the systemic circulation
-causes increased cardiac workload, decreased cardiac output, and cyanosis
-severely cyanotic at birth with symptoms of HF and need intervention immediately
Common Types of Defects:
-transposition of the great arteries
, Congenital heart defects may be repaired by - CORRECT ANSWERS -cardiac catheterization,
balloon angioplasty
-valvuloplasty
-cardiac bypass
-palliative shunts
-transplantation
Cardiac Surgery post-op care, in addition to routine care (congenital heart defects) - CORRECT
ANSWERS -facilitate parent-child contact asap
home care instructions:
-omit outside play for several weeks
-avoid crowds for 2 weeks after discharge
-avoids activities in which the child could fall for 2-4 weeks, such as bike riding
-child may return to school in 3rd week after discharge with half days
-avoid immunizations, invasive procedures, and dental visits for 2 months
-advise parents importance of dental visit every 3 months after age 3 and to inform dentist of cardiac
problems so prophylactic antibiotics can be prescribed if needed
-advise patients to discipline the child normally
-instruct patients when to call MD: coughing, tachypnea, cyanosis, anorexia, pain, vomiting, diarrhea
Pain in MI - CORRECT ANSWERS -sudden onset
-substernal
-crushing
-tightness
-severe
-unrelieved by nitro
-may radiate to (back, neck, jaw, shoulder, arm)
Questions And CORRECT Answers
Overview of Congenital Heart Defects - CORRECT ANSWERS -infants and children, inadequate
cardiac output is most commonly caused by congenital heart defects (a shunt, obstruction, or combination
that puts excessive volume on the myocardium)
Assessment of Congenital Heart Defects - CORRECT ANSWERS *pulse oximetry within 24 hours
of birth prior to hospital discharge for cyanotic defects
-R wrist pre-ductal, either post-ductal, L wrist mixed
-tachy ardia, especially during rest and slight exertion (>160)
-tachypnea (>60), characteristic murmurs are present with defects
-profuse scalp diaphoresis, especially in infants
-fatigue and irritability
-sudden weight gain
**Most frequent parental complaint: difficulty feeding
(infant must be awakened to be fed; has weak suck, may turn blue while eating; takes overly long time to
feed, falls asleep during feeding without finishing)
-signs of decreased CO: decreased peripheral pulses, feeding difficulties, hypotension, irritability,
oliguria, pale, cool extremities, tachycardia, exercise intolerance
Congenital heart Defects - CORRECT ANSWERS -perform pulse oximetry testing as directed
looking for positive criteria, which would result in a retest or further testing
-pulse oximeter measured on R hand (preductal) and either foot (postductal) to look for deoxygenated
blood circulating to extremeties
-positive criteria resulting in retest or further diagnostic testing: any measurement <95%, a difference of
>3% between the preductal and postductal readings on 3 different readings, each 1 hour apart
,-monitor for respiratory distress (nasal flaring, use of accessory muscles, crackles)
-monitor strict I/O and notify HCP if decreased, weigh diapers as appropriate
-maintain strict fluid restrictions as ordered
-monitor daily weight for fluid retention; a weight gain of 0.5kg in 1 day is caused by fluid accumulation
-elevate head of bed in semi-fowlers
-maintain a neutral thermal environment to prevent cold stress in infants
-provide rest and decrease environmental stimuli; organize nursing activities to allow for uninterrupted
rest
-feed when hungry and soon after awakening; provide small, frequent feedings to conserve energy and O2
supplies (may increase caloric infant feeding, limit PO feedings to 20 minutes to avoid overtiring, may
need to supplement with gavage feeding)
*administer digoxin as prescribed (assess apical HR for 1 minute prior to administration, hold digoxin if
pulse is less than 100bpm in infants, be aware that infants rarely recieve more than 1 ml of dig in one
dose)
***if hyeprcyanotic spell occurs, place infant in knee-chest position and admin 100% by face mask**
Defects with Increased Pulmonary Blood Flow - CORRECT ANSWERS Pathophys:
-blood flows from high pressure left side to low pressure right side
-may be asymptomatic or have HF with signs of decreased CO
Common Types of Defects:
-atrial septal defects (ASD)
-ventricular septal defects (VSD)
-patent ductus arteriosus (PDA)
Obstructive Defects - CORRECT ANSWERS Pathophys:
-blood entering a portion of the heart meets an anatomic narrowing (stenosis), causing obstruction to
blood flow
,-may be asymptomatic or have HF with signs of decreased CO
Common Types of Defects:
-aortic stenosis
-coarctation of aorta (localized narrowing near ductus arteriosus)
-pulmonary stenosis
Cyanotic Lesions with decreased pulmonary blood flow - CORRECT ANSWERS Pathophys:
-decrease in blood flowing to the lungs
-left side of the heart has low O2 saturation
-pressure on right side heart exceeds pressure on left side of heart, allowing desaturated blood to SHUNT
right to left
*typically cyanosis and hypoxia with clubbing and poor growth
Common Types of Defects:
-TETRALOGY OF FALLOT
-4 defects: vsd, pulmonary stenosis, overriding aorta and right ventricular hypertrophy
cyanotic lesions with increased pulmonary blood flow - CORRECT ANSWERS Pathophys:
-fetal heart fails to develop separate pulmonary and systemic circulations or there is a reversal of
circulation causing desaturated blood in the systemic circulation
-causes increased cardiac workload, decreased cardiac output, and cyanosis
-severely cyanotic at birth with symptoms of HF and need intervention immediately
Common Types of Defects:
-transposition of the great arteries
, Congenital heart defects may be repaired by - CORRECT ANSWERS -cardiac catheterization,
balloon angioplasty
-valvuloplasty
-cardiac bypass
-palliative shunts
-transplantation
Cardiac Surgery post-op care, in addition to routine care (congenital heart defects) - CORRECT
ANSWERS -facilitate parent-child contact asap
home care instructions:
-omit outside play for several weeks
-avoid crowds for 2 weeks after discharge
-avoids activities in which the child could fall for 2-4 weeks, such as bike riding
-child may return to school in 3rd week after discharge with half days
-avoid immunizations, invasive procedures, and dental visits for 2 months
-advise parents importance of dental visit every 3 months after age 3 and to inform dentist of cardiac
problems so prophylactic antibiotics can be prescribed if needed
-advise patients to discipline the child normally
-instruct patients when to call MD: coughing, tachypnea, cyanosis, anorexia, pain, vomiting, diarrhea
Pain in MI - CORRECT ANSWERS -sudden onset
-substernal
-crushing
-tightness
-severe
-unrelieved by nitro
-may radiate to (back, neck, jaw, shoulder, arm)
