Chapter 33: Alterations of Cardiovascular Function in Children
MULTIPLE CHOICE
1. Most cardiovascular developments occur between which weeks of gestation?
a.
Fourth and seventh weeks c. Twelfth and fourteenth weeks
b.
Eighth and tenth weeks d. Fifteenth and seventeenth weeks
ANS: A
Cardiogenesis begins at approximately 3 weeksÕ gestation; however, most cardiovascular de-
velopment occurs between 4 and 7 weeksÕ gestation.
PTS: 1 REF: Page 1194
2. The function of the foramen ovale in a fetus allows what to occur?
a.
Right-to-left blood shunting c. Blood flow from the umbilical cord
b.
Left-to-right blood shunting d. Blood flow to the lungs
ANS: A
The nonfused septum secundum and ostium secundum result in the formation of a flapped ori-
fice known as the foramen ovale, which allows the right-to-left shunting necessary for fetal
circulation. The foramen ovale is not involved in the blood flow described by the other op-
tions.
PTS: 1 REF: Pages 1195-1196
3. At birth, which statement is true?
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: B
From the available options, the only change that takes place in the circulation at birth is the
shift of gas exchange from the placenta to the lungs.
PTS: 1 REF: Page 1197
4. When does systemic vascular resistance in infants begin to increase?
a.
One month before birth
b.
During the beginning stage of labor
c.
One hour after birth
d.
Once the placenta is removed from circulation
ANS: D
The 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 REF: Page 1197
5. Which event triggers congenital heart defects that cause acyanotic congestive heart failure?
, a.
Right-to-left shunts c. Obstructive lesions
b.
Left-to-right shunts d. Mixed lesions
ANS: B
Congenital heart defects that cause acyanotic congestive heart failure usually involve left-to-
right shunts (see Table 33-4). Acyanotic congestive heart failure does not involve any of the
other options.
PTS: 1 REF: Pages 1201-1202 | Table 33-4
6. Older children with an unrepaired cardiac septal defect experience cyanosis because of
which factor?
a.
Right-to-left shunts c. Obstructive lesions
b.
Left-to-right shunts d. Mixed lesions
ANS: A
Older 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. None of the other options accurately describe the process that results in cyanosis.
PTS: 1 REF: Page 1202
7. Which congenital heart defects occur in trisomy 13, trisomy 18, and Down syndrome?
a.
Coarctation of the aorta (COA) and pulmonary stenosis (PS)
b.
Tetralogy of Fallot and persistent truncus arteriosus
c.
Atrial septal defect (ASD) and dextrocardia
d.
Ventricular septal defect (VSD) and patent ductus arteriosus (PDA)
ANS: D
Congenital heart defects that are related to dysfunction of trisomy 13, trisomy 18, and
Down syndrome include VSD and PDA (see Table 33-2). The other defects are not
associated with dysfunction of trisomy 13, trisomy 18, and Down syndrome.
PTS: 1 REF: Page 1200 | Table 33-2
8. An infant has a continuous machine-type murmur best heard at the left upper sternal border
throughout systole and diastole, as well as a bounding pulse and a thrill on palpation.
These clinical findings are consistent with which congenital heart defect?
a.
Atrial septal defect (ASD) c. Patent ductus arteriosus (PDA)
b.
Ventricular septal defect (VSD) d. Atrioventricular canal (AVC) defect
ANS: C
If pulmonary vascular resistance has fallen, then infants with PDA will characteristically have
a continuous machine-type murmur best heard at the left upper sternal border throughout sys-
tole and diastole. If the PDA is significant, then the infant also will have bounding pulses, an
active precordium, a thrill on palpation, and signs and symptoms of pulmonary overcircula-
tion. The presentations of the other congenital heart defects are not consistent with the de-
scribed the symptoms.
PTS: 1 REF: Pages 1203-1204
MULTIPLE CHOICE
1. Most cardiovascular developments occur between which weeks of gestation?
a.
Fourth and seventh weeks c. Twelfth and fourteenth weeks
b.
Eighth and tenth weeks d. Fifteenth and seventeenth weeks
ANS: A
Cardiogenesis begins at approximately 3 weeksÕ gestation; however, most cardiovascular de-
velopment occurs between 4 and 7 weeksÕ gestation.
PTS: 1 REF: Page 1194
2. The function of the foramen ovale in a fetus allows what to occur?
a.
Right-to-left blood shunting c. Blood flow from the umbilical cord
b.
Left-to-right blood shunting d. Blood flow to the lungs
ANS: A
The nonfused septum secundum and ostium secundum result in the formation of a flapped ori-
fice known as the foramen ovale, which allows the right-to-left shunting necessary for fetal
circulation. The foramen ovale is not involved in the blood flow described by the other op-
tions.
PTS: 1 REF: Pages 1195-1196
3. At birth, which statement is true?
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: B
From the available options, the only change that takes place in the circulation at birth is the
shift of gas exchange from the placenta to the lungs.
PTS: 1 REF: Page 1197
4. When does systemic vascular resistance in infants begin to increase?
a.
One month before birth
b.
During the beginning stage of labor
c.
One hour after birth
d.
Once the placenta is removed from circulation
ANS: D
The 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 REF: Page 1197
5. Which event triggers congenital heart defects that cause acyanotic congestive heart failure?
, a.
Right-to-left shunts c. Obstructive lesions
b.
Left-to-right shunts d. Mixed lesions
ANS: B
Congenital heart defects that cause acyanotic congestive heart failure usually involve left-to-
right shunts (see Table 33-4). Acyanotic congestive heart failure does not involve any of the
other options.
PTS: 1 REF: Pages 1201-1202 | Table 33-4
6. Older children with an unrepaired cardiac septal defect experience cyanosis because of
which factor?
a.
Right-to-left shunts c. Obstructive lesions
b.
Left-to-right shunts d. Mixed lesions
ANS: A
Older 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. None of the other options accurately describe the process that results in cyanosis.
PTS: 1 REF: Page 1202
7. Which congenital heart defects occur in trisomy 13, trisomy 18, and Down syndrome?
a.
Coarctation of the aorta (COA) and pulmonary stenosis (PS)
b.
Tetralogy of Fallot and persistent truncus arteriosus
c.
Atrial septal defect (ASD) and dextrocardia
d.
Ventricular septal defect (VSD) and patent ductus arteriosus (PDA)
ANS: D
Congenital heart defects that are related to dysfunction of trisomy 13, trisomy 18, and
Down syndrome include VSD and PDA (see Table 33-2). The other defects are not
associated with dysfunction of trisomy 13, trisomy 18, and Down syndrome.
PTS: 1 REF: Page 1200 | Table 33-2
8. An infant has a continuous machine-type murmur best heard at the left upper sternal border
throughout systole and diastole, as well as a bounding pulse and a thrill on palpation.
These clinical findings are consistent with which congenital heart defect?
a.
Atrial septal defect (ASD) c. Patent ductus arteriosus (PDA)
b.
Ventricular septal defect (VSD) d. Atrioventricular canal (AVC) defect
ANS: C
If pulmonary vascular resistance has fallen, then infants with PDA will characteristically have
a continuous machine-type murmur best heard at the left upper sternal border throughout sys-
tole and diastole. If the PDA is significant, then the infant also will have bounding pulses, an
active precordium, a thrill on palpation, and signs and symptoms of pulmonary overcircula-
tion. The presentations of the other congenital heart defects are not consistent with the de-
scribed the symptoms.
PTS: 1 REF: Pages 1203-1204
