Review Practice Exercise 1

Congenital heart diseases: Obstructive disorders > Child Health

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Practice Exercise 1

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Total Questions : 4

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Question 1:

A client is diagnosed with coarctation of the aorta. Which finding should the nurse expect during an assessment?

A. Normal blood pressure B. Increased blood pressure in the upper extremities C. Decreased blood pressure in the upper extremities D. Decreased or absent pulses in the upper extremities

Answer and Explanation

Choice A:

A finding of normal blood pressure is highly unlikely in a symptomatic patient with this defect. The mechanical obstruction necessitates an increase in proximal pressure to maintain systemic perfusion. Blood pressure readings will typically reveal a significant discrepancy between limbs.

Choice B:

Significant narrowing distal to the left subclavian artery increases afterload on the left ventricle. This causes a compensatory rise in systolic blood pressure within the vessels originating proximal to the obstruction. Consequently, hypertension is observed in the arms.

Choice C:

Blood pressure is not decreased in the upper extremities because they receive blood from pre-coarctation vessels. Decreased pressure is instead localized to the lower extremities and the descending aorta. The upper body remains hyperperfused relative to the lower body.

Choice D:

Pulses in the upper extremities are typically bounding rather than decreased or absent. This is due to the high volume and pressure generated proximal to the aortic narrowing. Absent pulses are a hallmark of the femoral arteries in this specific clinical context.

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Question 2:

A nurse is caring for a child 24-hours post coarctation of the aorta repair. Which of the following is the priority nursing diagnoses at this point?

A. Risk for Infection B. Risk for Impaired Skin Integrity C. Impaired Tissue Perfusion D. Anxiety related to hospitalization

Answer and Explanation

Choice A:

While the risk of surgical site infection is a valid concern, it is not the most life-threatening priority within the first 24 hours. Infection typically manifests several days after a procedure and does not pose the same immediate threat as vascular compromise. Standard aseptic techniques and prophylactic antibiotics are used to manage this risk while the nurse focuses on hemodynamic stability.

Choice B:

Impaired skin integrity related to the surgical incision is an expected finding rather than a priority diagnosis in the acute phase. Although the nurse must monitor for wound dehiscence or hematoma, these issues are secondary to the primary goal of maintaining vital organ perfusion. Skin integrity is a lower-level need on Maslow's hierarchy compared to the physiological necessity of adequate blood circulation.

Choice C:

Maintaining systemic blood flow is the critical priority during the immediate post-operative period following an aortic reconstruction. The nurse must monitor for spinal cord ischemia, renal failure, and bowel ischemia that can occur due to altered hemodynamics or surgical manipulation. Ensuring adequate oxygen delivery to distal tissues prevents permanent organ damage and identifies potential complications like graft thrombosis or persistent narrowing.

Choice D:

Anxiety is a psychosocial diagnosis that, while important for holistic care, does not take precedence over hemodynamic monitoring. In the initial 24 hours, physiological stability is the focus to ensure patient survival and successful surgical outcomes. Psychosocial needs are addressed once the child is clinically stable and the immediate risks of the major vascular surgery have subsided.

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Question 3:

A nurse is caring for a child after surgical repair of coarctation of the aorta. Which assessments are priorities in the immediate postoperative period? Select all that apply

A. Blood pressure in the upper and lower extremities B. Femoral pulse quality C. Urine output D. Signs of infection at the incision site

Answer and Explanation

Choice A:

Comparing blood pressure in upper and lower extremities is the most direct way to evaluate the success of the surgical repair. The nurse expects to see a significant reduction or total resolution of the preoperative pressure gradient. Persistent or worsening discrepancies may indicate surgical failure or acute thrombosis at the repair site.

Choice B:

Assessment of femoral pulse quality provides an immediate bedside indicator of distal aortic patency. Strong, palpable pulses in the lower extremities signify that blood is successfully traversing the repaired segment of the aorta. Weak or absent pulses post-surgery are red-flag findings that necessitate urgent surgical re-evaluation.

Choice C:

Urine output is a critical indicator of kidney perfusion and overall cardiac output in the immediate recovery phase. Because the renal arteries are located distal to the coarctation, they are sensitive to hemodynamic changes following the removal of the obstruction. A drop in output below 1 ml/kg/hr may signal low cardiac output or renal vascular complications.

Choice D:

Monitoring for signs of infection at the incision site is a standard nursing intervention, but it is not a priority in the immediate (first 24 hours) postoperative period. Surgical site infections typically take days to manifest through erythema, warmth, or purulent drainage. Immediate concerns must focus on life-threatening hemodynamic instability rather than subacute inflammatory processes.

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Question 4:

A nurse is reviewing the history of a client with newly diagnosed coarctation of the aorta. Which historical findings support this diagnosis? Select all that apply

A. Frequent headaches B. Nosebleeds C. Bounding lower extremity pulses D. Cool upper extremities

Answer and Explanation

Choice A:

Frequent headaches result from chronic hypertension in the upper body. The vessels proximal to the aortic narrowing are exposed to elevated pressures. This cephalic congestion leads to persistent or recurrent cephalgia. This symptom reflects the vascular stress on the cerebral circulation.

Choice B:

Nosebleeds, or epistaxis, occur due to the fragility of the nasal mucosa vessels under high pressure. The upper body hyperperfusion caused by the obstruction increases the force against these small capillaries. It is a classic clinical manifestation of pre-stenotic hypertension.

Choice C:

Bounding lower extremity pulses are not found in this condition. The narrowing specifically reduces the pulse volume and pressure distal to the site of coarctation. Femoral pulses are typically described as weak, delayed, or entirely absent upon palpation.

Choice D:

Cool upper extremities are inconsistent with the pathophysiology of this defect. The upper body receives blood from the aorta before the point of constriction and is therefore warm and well-perfused. It is the lower extremities that typically feel cool to the touch.

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Practice Exercise 1

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