Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A 6-month-old infant is diagnosed with a congenital heart defect that causes a left-to-right shunt, resulting in increased pulmonary blood flow. Which of the following defects is most likely?
A. Coarctation of the Aorta
Coarctation of the Aorta is incorrect because this defect causes obstruction of blood flow from the left ventricle to the aorta. It is a pressure load problem (left ventricular hypertension) rather than a left-to-right shunt, and it does not primarily increase pulmonary blood flow.
B. Tetralogy of Fallot
Tetralogy of Fallot is incorrect because this is a cyanotic defect characterized by right-to-left shunting due to pulmonary stenosis and a VSD. Pulmonary blood flow is often decreased rather than increased.
C. Transposition of the Great Arteries
Transposition of the Great Arteries is incorrect because this is a cyanotic defect in which the aorta arises from the right ventricle and the pulmonary artery from the left ventricle, resulting in parallel circulation. Pulmonary blood flow is not increased by a left-to-right shunt.
D. Ventricular Septal Defect (VSD)
Ventricular Septal Defect (VSD) is correct because it is a acyanotic defect that allows blood to flow from the left ventricle (higher pressure) to the right ventricle (lower pressure). This left-to-right shunt increases pulmonary blood flow, which can lead to symptoms such as tachypnea, poor weight gain, and frequent respiratory infections. VSDs are the most common congenital heart defect in infants.
This question is an excerpt from Nurse Dive's nursing test bank - Ati dmmsn 650 OB/Pediatrics Proctored Exams. Take the full exam now
Full Explanation
A. Coarctation of the Aorta is incorrect because this defect causes obstruction of blood flow from the left ventricle to the aorta. It is a pressure load problem (left ventricular hypertension) rather than a left-to-right shunt, and it does not primarily increase pulmonary blood flow.
B. Tetralogy of Fallot is incorrect because this is a cyanotic defect characterized by right-to-left shunting due to pulmonary stenosis and a VSD. Pulmonary blood flow is often decreased rather than increased.
C. Transposition of the Great Arteries is incorrect because this is a cyanotic defect in which the aorta arises from the right ventricle and the pulmonary artery from the left ventricle, resulting in parallel circulation. Pulmonary blood flow is not increased by a left-to-right shunt.
D. Ventricular Septal Defect (VSD) is correct because it is a acyanotic defect that allows blood to flow from the left ventricle (higher pressure) to the right ventricle (lower pressure). This left-to-right shunt increases pulmonary blood flow, which can lead to symptoms such as tachypnea, poor weight gain, and frequent respiratory infections. VSDs are the most common congenital heart defect in infants.
Similar Questions
A 7-year-old child is newly diagnosed with acute lymphoblastic leukemia (ALL). The nurse is preparing the family for the treatment plan. Which of the following nursing interventions is most important for the nurse to include in the plan of care for this child during the induction phase of chemotherapy?
A. Administering pain medications to relieve headache and muscle aches
Administering pain medications to relieve headache and muscle aches is important for comfort, but it is not the highest priority during the induction phase.
B. Monitoring for signs of infection due to neutropenia
Monitoring for signs of infection due to neutropenia is correct because induction chemotherapy causes profound bone marrow suppression, leading to neutropenia. Neutropenia significantly increases the risk of infection, which can become life-threatening. Early detection of fever, chills, or other infection signs is critical for timely intervention, making infection prevention and monitoring the top priority during this phase.
C. Recommending home-schooling to minimize exposure to other children
Recommending home-schooling to minimize exposure to other children is supportive and helpful for infection prevention but is secondary to direct monitoring and management of neutropenia.
D. Encouraging a high-protein diet to promote growth
Encouraging a high-protein diet to promote growth is beneficial for overall health and recovery but is not the primary concern during the induction phase, when preventing infection is life-saving.
Full Explanation
A. Administering pain medications to relieve headache and muscle aches is important for comfort, but it is not the highest priority during the induction phase.
B. Monitoring for signs of infection due to neutropenia is correct because induction chemotherapy causes profound bone marrow suppression, leading to neutropenia. Neutropenia significantly increases the risk of infection, which can become life-threatening. Early detection of fever, chills, or other infection signs is critical for timely intervention, making infection prevention and monitoring the top priority during this phase.
C. Recommending home-schooling to minimize exposure to other children is supportive and helpful for infection prevention but is secondary to direct monitoring and management of neutropenia.
D. Encouraging a high-protein diet to promote growth is beneficial for overall health and recovery but is not the primary concern during the induction phase, when preventing infection is life-saving.
Which of the following characteristics of the pediatric respiratory system makes infants and young children more susceptible to respiratory distress compared to adults?
A. Smaller airway diameter and immature respiratory muscles
Smaller airway diameter and immature respiratory muscles is correct because infants and young children have narrower airways, making them more prone to obstruction from edema, mucus, or inflammation. Additionally, their respiratory muscles, including the intercostals, are underdeveloped, so they rely heavily on diaphragmatic breathing. These factors increase the risk of respiratory distress during illness or airway compromise.
B. More developed diaphragm and increased lung compliance
More developed diaphragm and increased lung compliance is incorrect because infants have a less developed diaphragm and less compliant chest wall, not more. This makes breathing less efficient and increases susceptibility to fatigue and distress.
C. Larger airway diameter and more developed lung volume
Larger airway diameter and more developed lung volume is incorrect because infants have smaller airway diameter and smaller lung volumes compared to adults, which contributes to rapid desaturation during respiratory compromise.
D. Larger alveolar surface area and stronger respiratory muscles
Larger alveolar surface area and stronger respiratory muscles is incorrect because infants have fewer alveoli and weaker respiratory muscles, which limits gas exchange and makes them more vulnerable to hypoxia.
Full Explanation
A. Smaller airway diameter and immature respiratory muscles is correct because infants and young children have narrower airways, making them more prone to obstruction from edema, mucus, or inflammation. Additionally, their respiratory muscles, including the intercostals, are underdeveloped, so they rely heavily on diaphragmatic breathing. These factors increase the risk of respiratory distress during illness or airway compromise.
B. More developed diaphragm and increased lung compliance is incorrect because infants have a less developed diaphragm and less compliant chest wall, not more. This makes breathing less efficient and increases susceptibility to fatigue and distress.
C. Larger airway diameter and more developed lung volume is incorrect because infants have smaller airway diameter and smaller lung volumes compared to adults, which contributes to rapid desaturation during respiratory compromise.
D. Larger alveolar surface area and stronger respiratory muscles is incorrect because infants have fewer alveoli and weaker respiratory muscles, which limits gas exchange and makes them more vulnerable to hypoxia.
A 6-month-old infant diagnosed with gastroesophageal reflux disease (GERD) presents with poor weight gain, frequent regurgitation, and occasional respiratory distress. The nurse must prioritize interventions to manage GERD effectively. Which nursing action is most appropriate to include in the care plan?
A. Instruct parents to feed the infant large volumes less frequently to reduce reflux episodes.
Instruct parents to feed the infant large volumes less frequently is incorrect because large feedings increase gastric distention and can worsen reflux. Small, frequent feedings are preferred.
B. Advise parents to allow the infant to sleep on their stomach to reduce reflux symptoms during sleep.
Advise parents to allow the infant to sleep on their stomach is incorrect because placing infants on their stomach increases the risk of sudden infant death syndrome (SIDS) and is not recommended. Infants should be placed on their back for sleep.
C. Recommend thickening all infant feedings with cereals to improve satiety and reduce vomiting
Recommend thickening all infant feedings with cereals is partially correct for some infants, but thickening should be guided by a healthcare provider, as it is not appropriate for all infants and can pose risks if done incorrectly.
D. Educate parents to position the infant at a 30-degree angle for 30 minutes after feeding and avoid propping bottles during feedings.
Educate parents to position the infant at a 30-degree angle for 30 minutes after feeding and avoid propping bottles during feedings is correct because upright positioning after feedings uses gravity to reduce reflux and prevents aspiration. Avoiding bottle propping reduces the risk of choking, overfeeding, and increased reflux episodes.
Full Explanation
A. Instruct parents to feed the infant large volumes less frequently is incorrect because large feedings increase gastric distention and can worsen reflux. Small, frequent feedings are preferred.
B. Advise parents to allow the infant to sleep on their stomach is incorrect because placing infants on their stomach increases the risk of sudden infant death syndrome (SIDS) and is not recommended. Infants should be placed on their back for sleep.
C. Recommend thickening all infant feedings with cereals is partially correct for some infants, but thickening should be guided by a healthcare provider, as it is not appropriate for all infants and can pose risks if done incorrectly.
D. Educate parents to position the infant at a 30-degree angle for 30 minutes after feeding and avoid propping bottles during feedings is correct because upright positioning after feedings uses gravity to reduce reflux and prevents aspiration. Avoiding bottle propping reduces the risk of choking, overfeeding, and increased reflux episodes.