Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 34: Alterations of Cardiovascular Function in ChildrenMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. Most cardiovascular developments occur between which weeks of gestation?a. Fourth and seventh weeksb. Eighth and tenth weeksc. Twelfth and fourteenth weeksd. Fifteenth and seventeenth weeksANS: ACardiogenesis begins at approximately 3 weeks’ gestation; however, most cardiovascular development occurs between 4 and 7 weeks’ gestation.PTS: 1 DIF: Cognitive Level: Remembering 2. The presence of the foramen ovale in a fetus allows what to occur?a. Right-to-left blood shuntingb. Left-to-right blood shuntingc. Blood flow from the umbilical cordd. Blood flow to the lungsANS: AThe nonfused septum secundum and ostium secundum result in the formation of a flapped orifice known as the foramen ovale, which allows the right-to-left shunting necessary for fetal circulation. The foramen ovale is not involved in left-to-right shunting, blood flow from the umbilical cord, or blood flow to the lungs.PTS: 1 DIF: Cognitive Level: Remembering 3. The student studying pathophysiology learns which fact about circulation at birth?a. Systemic resistance and pulmonary resistance fall.b. Gas exchange shifts from the placenta to the lung.c. Systemic resistance falls and pulmonary resistance rises.d. Systemic resistance and pulmonary resistance rise.ANS: BAt birth, gas exchange shifts from the placenta to the lungs. Systemic vascular resistance increases after birth and pulmonary resistance decreases.PTS: 1 DIF: Cognitive Level: Remembering 4. When does systemic vascular resistance in infants begin to increase?a. One month before birthb. During the beginning stage of laborc. One hour after birthd. Once the placenta is removed from circulationANS: DThe low-resistance placenta is removed from circulation, which causes an immediate increase in systemic vascular resistance to approximately twice of that before birth.PTS: 1 DIF: Cognitive Level: Remembering 5. Which event triggers congenital heart defects that cause acyanotic congestive heart failure?a. Right-to-left shuntsb. Left-to-right shuntsc. Obstructive lesionsd. Mixed lesionsANS: BCongenital heart defects that cause acyanotic congestive heart failure usually involve left-to-right shunts. Right-to-left shunting causes hypoxemia and cyanosis. Obstructive and mixed lesions vary in their presentation, but obstructive lesions do not have shunting.PTS: 1 DIF: Cognitive Level: Remembering 6. Older children with an unrepaired cardiac septal defect experience cyanosis because of which factor?a. Right-to-left shuntsb. Left-to-right shuntsc. Obstructive lesionsd. Mixed lesionsANS: AOlder children who have an unrepaired septal defect with a left-to-right shunt may become cyanotic because of pulmonary vascular changes secondary to increased pulmonary blood flow. Left-to-right shunts are usually acyanotic. Obstructive and mixed lesions vary in their presentation but obstructive lesions do not include shunting.PTS: 1 DIF: Cognitive Level: RememberingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 7. A baby has been born with Down syndrome. What congenital heart defect does the healthcare professional assess this baby for?a. Coarctation of the aorta (COA)b. Tetralogy of Fallotc. Atrial septal defect (ASD)d. Ventricular septal defect (VSD)ANS: DCongenital heart defects that are related to Down syndrome include VSD and ASVD. COA is associated with Turner syndrome. Tetralogy of Fallot does not have a strong association with chromosomal defects. An ASD is often seen in Cri du Chat syndrome, Turner syndrome, or Klinefelter variant syndrome.PTS: 1 DIF: Cognitive Level: Understanding 8. An infant has a continuous machine-type murmur best heard at the left upper sternal border throughout systole and diastole. The healthcare professional suspects a congenital heart disorder. What other assessment finding is inconsistent with the professional’s knowledge about this disorder?a. Bounding pulsesb. Active precordiumc. Thrill on palpationd. Signs of heart failureANS: CA machine-type murmur is a classic sign of a PDA. Other manifestations include bounding pulses, an active precordium, a thrill on chest palpation, and signs of pulmonary overcirculation.PTS: 1 DIF: Cognitive Level: Understanding 9. An infant has a crescendo-decrescendo systolic ejection murmur located between the second and third intercostal spaces along the left sternal border. The healthcare professional suspects an atrial septal defect (ASD). For what other manifestation does the healthcare professional assess to confirm the suspicion?a. Wide, fixed splitting of the second heart soundb. Loud, harsh holosystolic murmurc. Cyanosis with crying and feedingd. Rapid deterioration with acidosisANS: AA wide fixed splitting of the second heart sound is also characteristic of ASD, reflecting volume overload to the RV, causing prolonged ejection time and delay of pulmonic valve closure. A loud, harsh holosystolic murmur is consistent with a ventricular septal defect. Cyanosis with crying and feeding (exertion) are classic “tet spells” associated with Tetralogy of Fallot. Rapid deterioration with acidosis, hypotension, and shock can accompany coarctation of the aorta.PTS: 1 DIF: Cognitive Level: Understanding 10. An infant has a loud, harsh, holosystolic murmur and systolic thrill that can be detected at the left lower sternal border that radiates to the neck. These clinical findings are consistent with which congenital heart defect?a. Atrial septal defect (ASD)b. Ventricular septal defect (VSD)c. Patent ductus arteriosus (PDA)d. Atrioventricular canal (AVC) defectANS: BOn physical examination of a child with a VSD, a loud, harsh, holosystolic murmur and systolic thrill can be detected at the left lower sternal border. An ASD is accompanied by a crescendo-decrescendo systolic ejection murmur located between the second and third intercostal spaces along the left sternal border. The PDA would present with a machine-like murmur. Physical findings in an AVC defect are similar to those found in individuals with VSDs with the addition of a holosystolic murmur radiating to the back and apex, reflecting mitral regurgitation.PTS: 1 DIF: Cognitive Level: Remembering 11. Where can coarctation of the aorta (COA) be located?a. Exclusively on the aortic archb.
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