Which is the most appropriate goal for a child with an unrepaired atrial septal defect (ASD)?
The child will have decreased pulmonary vascular resistance.
The child will remain free from cyanotic episodes.
The child will develop atrial enlargement.
The child will maintain blood pressure above 120/80 mmHg.
The Correct Answer is A
Choice A rationale
The ultimate hemodynamic consequence of a left-to-right shunt through an unrepaired Atrial Septal Defect (ASD) is chronic volume overload in the pulmonary vasculature. The most appropriate long-term goal is to decrease pulmonary vascular resistance (PVR) to prevent the progression of pulmonary hypertension and eventual reversal of the shunt (Eisenmenger syndrome). Normal PVR is low, typically ∼ 0.5-1.5 Wood units.
Choice B rationale
An Atrial Septal Defect (ASD) results in a left-to-right shunt and is an acyanotic heart defect, meaning the child is not expected to have cyanotic episodes unless Eisenmenger syndrome (shunt reversal due to severe pulmonary hypertension) develops, which is a late-stage complication. Therefore, "remaining free from cyanotic episodes" is an expected baseline, not the most appropriate primary therapeutic goal.
Choice C rationale
Atrial enlargement, particularly of the right atrium, is a consequence of the chronic volume overload caused by the left-to-right shunting across the Atrial Septal Defect (ASD). It is an undesirable pathophysiological finding, not an appropriate goal of care. The goal is to prevent or minimize these structural changes by addressing the underlying shunt.
Choice D rationale
While maintaining normal blood pressure is a general health goal, the primary problem with an Atrial Septal Defect (ASD) is pulmonary volume overload and subsequent pulmonary hypertension, not systemic hypotension. The goal blood pressure for a child varies significantly by age and is not the most specific or critical hemodynamic parameter for this particular congenital heart defect.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Nasal flaring is a cardinal early sign of respiratory distress in infants and children, representing an involuntary attempt to decrease airway resistance. Flaring the nares widens the upper airway opening, allowing a greater volume of air to pass and maximizing gas exchange efficiency during inspiration.
Choice B rationale
Central cyanosis (bluish discoloration of the mucous membranes and torso) signifies inadequate oxygenation and is a late and ominous sign of severe hypoxemia. It indicates a substantial 5 g/dL or greater increase in deoxygenated hemoglobin, signaling decompensated respiratory failure.
Choice C rationale
Bradycardia (abnormally slow heart rate) in an infant is a late and critical sign of severe hypoxia and impending cardiorespiratory arrest. The heart slows as a compensatory response to profound oxygen deficit, indicating a failure of the body to maintain adequate oxygen delivery.
Choice D rationale
Hypotension (abnormally low blood pressure) is a very late and decompensated sign of shock, often due to severe prolonged hypoxemia and acidosis. The body's initial response to respiratory distress is typically to maintain or increase blood pressure, so a drop indicates circulatory collapse.
Correct Answer is D
Explanation
Choice A rationale
Hypotonic saline is not the fluid of choice for septic shock because it lowers serum osmolality and can shift fluid into the cells, worsening intravascular volume depletion and hypotension. A 20 mL/kg bolus is the correct volume, but the fluid type and 10 minutes duration are inappropriate for initial resuscitation.
Choice B rationale
The volume of 5 mL/kg is insufficient for the initial resuscitation of a child in septic shock, where the goal is rapid, aggressive replacement of intravascular volume lost due to capillary leak and vasodilation. A 20 mL/kgbolus is the standard. Ringer's lactate is an acceptable crystalloid, but the volume is wrong.
Choice C rationale
𝐃5𝐖 (5.
Choice D rationale
0.9% 𝐍𝐚𝐂𝐥 (𝐧𝐨𝐫𝐦𝐚𝐥 𝐬𝐚𝐥𝐢𝐧𝐞) is an isotonic crystalloid and is the preferred initial fluid choice to expand the intravascular volume rapidly without risk of electrolyte shift. The dose of 20 mL/kgis standard and must be administered rapidly, typically over 5-30 minutes, to correct hypovolemia and improve cardiac output.
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