CCRN tricky practice questions
How do young children respond to decreased cardiac output? (cardiac 3)
A. SV and HR are increased
B. SV and HR are decreased
C. SV stays the same and HR is increased
D. SV is decreased and HR is increased - ANSC
The majority of cardiac arrests in kids are due to - ANSRespiratory failure
Adrenergic stimulation is one of the compensatory mechanisms used when cardiac output
fails. Which of the following is a result of adrenergic stimulation? (cardiac 6)
A. Longer diastolic period
B. Blockage of the release of norepinephrine and epinephrine
C. Increased myocardial oxygen consumption
D. Increased systemic blood flow - ANSC
Jose is a 19 m/o with congestive heart failure secondary to cardiomyopathy. Which of the
following manifestations would the nurse NOT expect to find? (cardiac 7)
A. Machine like murmur
B. Diaphoresis
C. S3 gallop
D. Pulmonary edema - ANSA
Diaphoresis is r/t adrenergic stimulation
S3 gallop and pulmonary edema are r/t fluid overload
Which of the following is NOT true r/t L sided heart failure? (cardiac 8)
A. PAP, PCWP and CVP are all decreased
B. During systole, the L ventricle does not completely empty
C. There is a back flow of blood from the left ventricle to the left atrium
D. There is decreased contractility - ANSA- they're all increased
What is the MOST common and what is the LEAST common type of cardiomyopathy in
children? - ANSMost- dilated
Least- restrictive
A child has been diagnosed with hypertrophic cardiomyopathy. Which of the following
describes this type of myopathy? (cardiac 10)
A. Fibrosis and scarring lead to poor contractile movement
B. It is congenital
C. It is a congestive cardiomyopathy
D. There is a decrease in size and capacity of the ventricles - ANSD. Hypertrophic is a
myopathy that leads to decreased ventricular space because the myocardial muscle is so large
Restrictive is congenital where there is poor contractile movement r/t fibrosis and scarring
Dilated is congestive because stasis of blood can occur in the chambers
What is NOT a goal for treatment for the cardiomyopathies? - ANSIncreasing preload
,What is the action of Milrinone? - ANSINCREASES intracellular calcium- increased
contractility
Causes vasodilation- decreases after load and PCWP
Which cardiomyopathy needs the most caution with inotropes? - ANSHypertrophic- too
much inotropes may burn out the heart muscle and lead to heart failure
Which of the following is TRUE concerning pressures in pulmonary edema? (cardiac 14)
A. Increase in both oncotic and pulmonary capillary pressure
B. Decrease in both
C. Increase in oncotic pressure and decrease in pcp
D. Decrease in oncotic pressure and an increase in pcp - ANSD.
Oncotic pressure is pressure in the vessels pulling water in... with decreased oncotic pressure
the vessels get leaky-
pulmonary edema is leaky
What is cor pulmonale - ANSR sided heart failure r/t increased pressures in the pulmonary
artery and right ventricle
4 parts of TOF - ANSVSD
Overriding aorta
Pulmonary stenosis
Right ventricular hypertrophy
Degree of pulmonary stenosis determines how bad TOF is
In a patient with TOF, what structural variance is present in a hyper cyanotic spell? (cardiac
16)
A. decrease in pulmonary blood flow
B. Increase in left to right shunting
C. Communication between the atria
D. Temporary cessation of shunting - ANSA.
What would be seen in compensated shock? (cardiac 19)
A. Hypotension
B. Cold clammy skin
C. Jaundice
D. Ecchymosis and petechiae - ANSB.
Hypotension is uncompensated and Ecchymosis and petechiae occur when the clotting
factors are alerted in uncompensated shock
Which of the following is NOT present in hypovolemic shock? (cardiac 21)
A decreased preload
B decreased afterload
C no change in contractility
D Decreased cardiac output - ANSB
What is the most common heart defect in children? - ANSVSD
,Alex is a 10 month old with AV canal. After surgical correction, Alex experiences a serious
complication where his blood pressure and heart rate drop and pulmonary artery pressure
increases. All of the following could be used to manage this complication EXCEPT (cardiac
23):
A. Administration of nitric oxide
B. Hyperventilation
C. Sedation and paralysis
D. Administration of a beta blocker - ANSD
This is pulmonary hypertensive crisis. A B and C are all interventions for that and Beta
Blockers can make it worse
During the first 2 weeks of life, which of the following can cause the ductus arteriosus to
reopen? (cardiac 24)
A. Alkalosis
B. Over oxygenation
C. PGE
D. Indomethacin - ANSC.
Acidosis and hypoxia can lead to a PDA
Mark is an infant with PDA. Which of the following manifestations would not be
anticipated? (cardiac 25)
A. Waterhammer pulse
B. Soft, quiet murmur
C. Low diastolic pressure
D. Signs of congestive heart failure - ANSB.
Machine- like murmur will be present. PDA can lead to congestive heart failure
Which lab test should be ordered prior to starting indomethacin? - ANSCBC
Platelets need to be adequate before starting indomethacin
which of the following vessels does a modified Blalock Taussing shunt connect? (cardiac 27)
A. The subclavian artery to the pulmonary artery
B. The superior vena cava and the pulmonary artery
C. The superior vena cava and the aorta
D. The subclavian artery and the superior vena cava - ANSA
What is one big side effect of Labetalol - ANSRespiratory failure. Should be used with
caution in kids with asthma, etc.
Labetalol is a mixed alpha 1 and beta adrenergic blocker
The nurse is caring for Elise, a newborn with pulmonary stenosis. After undergoing a
valvuloplasty, the nurse notes that her murmur has changed from a pre-procedure systolic
murmur to a regurgitant murmur in the left lower sternal border. What should the nurse do?
(cardiac 37)
, A. Continue to monitor
B. Record the findings as normal
C. Immediately notify the cardiologist
D. Administer pain medications and sedation - ANSC.
This indicates injury to the tricuspid valve. Should be closely monitored for signs of
decreased CO
Pulmonary over circulation is LEAST likely to occur in which of the following
circumstances? (cardiac 39)
A. Norwood procedure
B. BT shunt
C. PA band
D. Atrial switch procedure - ANSD.
Atrial switch is most likely to lead to pulmonary hypertension
All other procedures carry increased risk for pulmonary over circulation
What is the most common cause of myocarditis in children? (cardiac 42) - ANSCoxsackie
virus
What are some side effects of Amiodarone? - ANSParoxysmal ventricular tachycardia
Heart block
Bradycardia
All of the following are expected manifestations of pericarditis EXCEPT (cardiac 45):
A. Grating scratching sound on auscultation
B. Muffled heart sounds
C. Inability to assume a position other than supine
D. Pluses paradoxus - ANSC.
They usually can not tolerate being flat and prefer to sit up
Patient with pericarditis is also usually on very strict bedrest and not encouraged to ambulate
What is one effect that oxygen administration will have on a duct? (cardiac 50) -
ANSOxygen will close the duct and patient will desat/look cyanotic when oxygen is applied
If the patient relies on the duct, prostaglandins should be applied to keep it open
Which of the following is TRUE concerning pulmonary capillary wedge pressure? (cardiac
53)
A. It is an estimate of right atrial pressure
B. It gives information regarding the severity of left ventricular failure as well as tricuspid
valve stenosis
C. The pressure is obtained after the balloon has deflated
D. Tachycardia can cause a falsely elevated pressure - ANSD.
PCWP is an estimate of left atrial pressure and provides information regarding left ventricular
failure. It gives information on the mitral valve and is obtained when the balloon is inflated
How do young children respond to decreased cardiac output? (cardiac 3)
A. SV and HR are increased
B. SV and HR are decreased
C. SV stays the same and HR is increased
D. SV is decreased and HR is increased - ANSC
The majority of cardiac arrests in kids are due to - ANSRespiratory failure
Adrenergic stimulation is one of the compensatory mechanisms used when cardiac output
fails. Which of the following is a result of adrenergic stimulation? (cardiac 6)
A. Longer diastolic period
B. Blockage of the release of norepinephrine and epinephrine
C. Increased myocardial oxygen consumption
D. Increased systemic blood flow - ANSC
Jose is a 19 m/o with congestive heart failure secondary to cardiomyopathy. Which of the
following manifestations would the nurse NOT expect to find? (cardiac 7)
A. Machine like murmur
B. Diaphoresis
C. S3 gallop
D. Pulmonary edema - ANSA
Diaphoresis is r/t adrenergic stimulation
S3 gallop and pulmonary edema are r/t fluid overload
Which of the following is NOT true r/t L sided heart failure? (cardiac 8)
A. PAP, PCWP and CVP are all decreased
B. During systole, the L ventricle does not completely empty
C. There is a back flow of blood from the left ventricle to the left atrium
D. There is decreased contractility - ANSA- they're all increased
What is the MOST common and what is the LEAST common type of cardiomyopathy in
children? - ANSMost- dilated
Least- restrictive
A child has been diagnosed with hypertrophic cardiomyopathy. Which of the following
describes this type of myopathy? (cardiac 10)
A. Fibrosis and scarring lead to poor contractile movement
B. It is congenital
C. It is a congestive cardiomyopathy
D. There is a decrease in size and capacity of the ventricles - ANSD. Hypertrophic is a
myopathy that leads to decreased ventricular space because the myocardial muscle is so large
Restrictive is congenital where there is poor contractile movement r/t fibrosis and scarring
Dilated is congestive because stasis of blood can occur in the chambers
What is NOT a goal for treatment for the cardiomyopathies? - ANSIncreasing preload
,What is the action of Milrinone? - ANSINCREASES intracellular calcium- increased
contractility
Causes vasodilation- decreases after load and PCWP
Which cardiomyopathy needs the most caution with inotropes? - ANSHypertrophic- too
much inotropes may burn out the heart muscle and lead to heart failure
Which of the following is TRUE concerning pressures in pulmonary edema? (cardiac 14)
A. Increase in both oncotic and pulmonary capillary pressure
B. Decrease in both
C. Increase in oncotic pressure and decrease in pcp
D. Decrease in oncotic pressure and an increase in pcp - ANSD.
Oncotic pressure is pressure in the vessels pulling water in... with decreased oncotic pressure
the vessels get leaky-
pulmonary edema is leaky
What is cor pulmonale - ANSR sided heart failure r/t increased pressures in the pulmonary
artery and right ventricle
4 parts of TOF - ANSVSD
Overriding aorta
Pulmonary stenosis
Right ventricular hypertrophy
Degree of pulmonary stenosis determines how bad TOF is
In a patient with TOF, what structural variance is present in a hyper cyanotic spell? (cardiac
16)
A. decrease in pulmonary blood flow
B. Increase in left to right shunting
C. Communication between the atria
D. Temporary cessation of shunting - ANSA.
What would be seen in compensated shock? (cardiac 19)
A. Hypotension
B. Cold clammy skin
C. Jaundice
D. Ecchymosis and petechiae - ANSB.
Hypotension is uncompensated and Ecchymosis and petechiae occur when the clotting
factors are alerted in uncompensated shock
Which of the following is NOT present in hypovolemic shock? (cardiac 21)
A decreased preload
B decreased afterload
C no change in contractility
D Decreased cardiac output - ANSB
What is the most common heart defect in children? - ANSVSD
,Alex is a 10 month old with AV canal. After surgical correction, Alex experiences a serious
complication where his blood pressure and heart rate drop and pulmonary artery pressure
increases. All of the following could be used to manage this complication EXCEPT (cardiac
23):
A. Administration of nitric oxide
B. Hyperventilation
C. Sedation and paralysis
D. Administration of a beta blocker - ANSD
This is pulmonary hypertensive crisis. A B and C are all interventions for that and Beta
Blockers can make it worse
During the first 2 weeks of life, which of the following can cause the ductus arteriosus to
reopen? (cardiac 24)
A. Alkalosis
B. Over oxygenation
C. PGE
D. Indomethacin - ANSC.
Acidosis and hypoxia can lead to a PDA
Mark is an infant with PDA. Which of the following manifestations would not be
anticipated? (cardiac 25)
A. Waterhammer pulse
B. Soft, quiet murmur
C. Low diastolic pressure
D. Signs of congestive heart failure - ANSB.
Machine- like murmur will be present. PDA can lead to congestive heart failure
Which lab test should be ordered prior to starting indomethacin? - ANSCBC
Platelets need to be adequate before starting indomethacin
which of the following vessels does a modified Blalock Taussing shunt connect? (cardiac 27)
A. The subclavian artery to the pulmonary artery
B. The superior vena cava and the pulmonary artery
C. The superior vena cava and the aorta
D. The subclavian artery and the superior vena cava - ANSA
What is one big side effect of Labetalol - ANSRespiratory failure. Should be used with
caution in kids with asthma, etc.
Labetalol is a mixed alpha 1 and beta adrenergic blocker
The nurse is caring for Elise, a newborn with pulmonary stenosis. After undergoing a
valvuloplasty, the nurse notes that her murmur has changed from a pre-procedure systolic
murmur to a regurgitant murmur in the left lower sternal border. What should the nurse do?
(cardiac 37)
, A. Continue to monitor
B. Record the findings as normal
C. Immediately notify the cardiologist
D. Administer pain medications and sedation - ANSC.
This indicates injury to the tricuspid valve. Should be closely monitored for signs of
decreased CO
Pulmonary over circulation is LEAST likely to occur in which of the following
circumstances? (cardiac 39)
A. Norwood procedure
B. BT shunt
C. PA band
D. Atrial switch procedure - ANSD.
Atrial switch is most likely to lead to pulmonary hypertension
All other procedures carry increased risk for pulmonary over circulation
What is the most common cause of myocarditis in children? (cardiac 42) - ANSCoxsackie
virus
What are some side effects of Amiodarone? - ANSParoxysmal ventricular tachycardia
Heart block
Bradycardia
All of the following are expected manifestations of pericarditis EXCEPT (cardiac 45):
A. Grating scratching sound on auscultation
B. Muffled heart sounds
C. Inability to assume a position other than supine
D. Pluses paradoxus - ANSC.
They usually can not tolerate being flat and prefer to sit up
Patient with pericarditis is also usually on very strict bedrest and not encouraged to ambulate
What is one effect that oxygen administration will have on a duct? (cardiac 50) -
ANSOxygen will close the duct and patient will desat/look cyanotic when oxygen is applied
If the patient relies on the duct, prostaglandins should be applied to keep it open
Which of the following is TRUE concerning pulmonary capillary wedge pressure? (cardiac
53)
A. It is an estimate of right atrial pressure
B. It gives information regarding the severity of left ventricular failure as well as tricuspid
valve stenosis
C. The pressure is obtained after the balloon has deflated
D. Tachycardia can cause a falsely elevated pressure - ANSD.
PCWP is an estimate of left atrial pressure and provides information regarding left ventricular
failure. It gives information on the mitral valve and is obtained when the balloon is inflated
