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Pediatric Cardiovascular System

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Question Answer
In a cyanotic heart defect, a structural defect leads to obstruction of the pulmonary blood flow. This _____ pressure on the right side of heart, causing blood to flow ______ to _______.
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Increases pressure on the right side of heart, causing blood to flow right to left
Examples of cyanotic congenital heart defects include:
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Tetrology of Fallot (TOF), Transposition of the Great Vessels or Arteries (TGA, Truncus Arteriosus and Hypoplastic Left Heart
Which heart defect? Increased pulmonary blood flow, Abnormal opening between atria, Blood flow left to right, May lead to HF.
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Atrial Septal Defect (ASD), acyanotic
T/F It is possible for an atrial septal defect to be asymptomatic.
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True
How is an ASD treated?
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Surgical patches, ASD closure devices, occluders
Which congenital heart defect? Increased pulmonary blood flow Abnormal opening between the ventricles Blood flow left to right Increased Peripheral Vascular Resistance and workload of right heart Heart failure f. Treatment: pulmonary banding, surgical repair, can close spontaneously
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Ventricular Septal Defect (VSD), acyanotic
How is a VSD typically treated?
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A Pulmonary artery band, patch, trial device closure
With ASD and VSD, most likely a ________ will be auscultated when listening to the cardiac sounds.
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A murmur
What infection are patients with VSD at increased risk for?
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Bacterial endocarditis, requiring prophylaxis prior to any procedure where an injury allows pathogens to enter the bloodstream (like dental work)
Which congenital heart defect? Increased pulmonary blood flow, left side has to work harder as well as the right. More resistance in the pulmonary arteries. Higher rate in preterm infants, Failure of ductus arteriosis to close, Blood shunts from aorta (high) to pulmonary aorta (low), May lead to HF
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Patent Ductus Arteriosus (PDA), acyanotic
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What are the signs and symptoms of patent ductus arteriosus?
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Murmur, widened pulse pressure, bounding pulses, may develop signs of congestive heart failure
How is patent ductus arteriosus treated?
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Indocin is used to keep the ductus arteriosus open, surgical ligation, coils or occluders are used to repair it.
What congenital heart defects require prophylaxis prior to any medical or dental treatment that may introduce blood into the blood stream and cause a bacterial endocarditis infection?
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VSD, PDA, AS
What congenital heart defect? Obstruction to blood flow, Narrowing near ductus arteriosis, in the aorta, Increased pressure proximal to defect, decreased pressure after defect, Disparity in pulses in arms and legs (increased blood flow to arms and head and decreased blood flow to the legs) BP will be high, May have epistaxis (nosebleeds from high pressure in their heads)
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Coarctation of the aorta, acyanotic
How is coarctation of the aorta treated?
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Grafts, patches, PTA. High risk for restenosis
What congenital heart defect? Obstruction to blood flow Narrowing at aorta Increased resistance to ejection of blood from ventricles, eventually to HF
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Aortic stenosis (acyanotic)
What are the signs and symptoms of aortic stenosis?
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Decreased pulses, hypotension, tachycardia, poor feeding, exercise intolerance, chest pain, dizziness
How is an aortic stenosis treated?
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Valve repair/ replacement, Norwood (severe), usually angioplasty (PTA)
A child with an atrioventricular canal defect turns mildly cyanotic when they cry. The mom asks why this happens. You explain...
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Crying causes pressure changes in the heart, resulting in a pulmonary artery spasm, decreasing blood flow to the lungs temporarily.
What congenital heart defect? Obstruction to blood flow, Narrowing at pulmonary artery, Increased workload right heart may lead to HF, If severe, increased pressure may reopen foramen ovale and lead to right to left shift, therefore can become cyanotic .
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Pulmonary Stenosis (acyanotic)
With ________, the child may have mild CHF, cyanosis, a murmur, or cardiomegaly.
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Pulmonary stenosis
  
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