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 D
Explanation
Choice A rationale
Weight gain of 1 kg suggests fluid retention, which is contrary to the expected diuretic effect of furosemide. Furosemide, a loop diuretic, acts by inhibiting the Na+-K+-2Cl- cotransporter in the thick ascending limb of the loop of Henle, increasing water and electrolyte excretion. A decrease in body weight due to diuresis is the primary indicator of effectiveness in reducing fluid overload associated with CHF.
Choice B rationale
Decreased urine output indicates a diminished response to the diuretic, suggesting ineffectiveness or potential complications like dehydration or pre-renal injury. Effective diuresis should significantly increase the urine output, facilitating the removal of excess interstitial and intravascular fluid volume to alleviate the symptoms of pulmonary and systemic congestion in CHF. Normal urine output for children is typically 1 to 2 mL/kg/hr.
Choice C rationale
Increased crackles, also known as rales, are adventitious lung sounds that signify the presence of fluid in the alveoli and small airways, characteristic of pulmonary edema in CHF. Furosemide aims to decrease this fluid, improving oxygenation and reducing the audible crackles, making an increase an indicator of worsening condition or ineffective treatment.
Choice D rationale
Decreased respiratory rate often accompanies improved oxygenation and reduced work of breathing, secondary to the resolution of pulmonary congestion and edema. Furosemide's action reduces the fluid burden on the lungs, lowering the hydrostatic pressure and facilitating gas exchange, which in turn reduces the tachypnea and respiratory distress common in pediatric CHF.
Correct Answer is B
Explanation
Choice A rationale
A mild headache is a very common and expected symptom following a concussion, resulting from the temporary biomechanical injury to brain tissue or surrounding structures. This symptom alone typically does not indicate an immediate neurological deterioration or an expanding intracranial lesion, provided it doesn't rapidly worsen in severity or become refractory to simple analgesics. Management generally involves rest and observation.
Choice B rationale
Vomiting, especially if persistent or projectile, suggests a significant increase in intracranial pressure (ICP) due to brain swelling or an intracranial hemorrhage. This pressure irritates the vomiting center in the medulla, a critical area of the brainstem. Given that normal ICP is 5-15 mmHg in adults and slightly lower in children, new or worsening emesis warrants prompt clinical and possibly neuroimaging reevaluation.
Choice C rationale
Alertness indicates an intact reticular activating system (RAS), which is crucial for consciousness. Maintaining an alert mental status is a positive sign that suggests the primary brain centers are functioning adequately and the ICP is not critically elevated. A decreased level of consciousness would be a much more concerning indicator of neurological decline.
Choice D rationale
A normal gait reflects proper coordination of motor, sensory, and cerebellar functions. Gross neurological integrity suggests that the cerebral and cerebellar pathways, which govern balance and movement, are not significantly compromised. An abnormal gait, like ataxia, would be a sign of focal neurological deficit or severe intracranial pressure.
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