Question 1

An infant with trisomy 21 has a complete AV canal defect. Which finding, associated with having both of these conditions, will the primary care pediatric nurse practitioner expect?

Accepted Answer

Oxygen desaturation is a common finding in infants with trisomy 21 and a complete AV canal defect. This is due to the fact that the AV canal defect allows blood to flow from the left ventricle to the right ventricle, which can lead to decreased oxygen saturation in the blood.

Question 2

A 12-year-old child whose weight and body mass index (BMI) are in the 75th percentile has a diastolic blood pressure that is between the 95th and 99th percentiles for age, sex, and height on three separate occasions. Which test will be prescribed for this child initially?

Accepted Answer

The child's elevated diastolic blood pressure suggests possible hypertension, which can be related to renal issues. Therefore, renal function tests are initially prescribed to assess kidney health and rule out secondary causes of hypertension.

Question 3

The primary care pediatric nurse practitioner (PNP) is performing a well child examination on a school-age child who had complete repair of a tetralogy of Fallot (TOF)defect in infancy. What is important in this child's health maintenance regime?

Accepted Answer

Cardiology clearance is important for this child to participate in sports and physical activity. Restriction of physical activity is not necessary unless there are specific complications or concerns. Sub-acute bacterial endocarditis prophylaxis is no longer recommended for TOF repair. Teaching about management of hypercyanotic episodes is not necessary in a child who has had complete repair of TOF.

Question 4

The primary care pediatric nurse practitioner (PNP) performs a well child examination on a 12-month-old child who had repair of a congenital heart defect at 8 months of age. The child has a normal exam. The parent reports that the child is not taking any medications. The nurse practitioner will contact the child's cardiologist to discuss whether the child needs which medication?

Accepted Answer

The American Heart Association recommends that children with a repaired congenital heart defect receive prophylactic antibiotics before certain dental and surgical procedures to prevent bacterial endocarditis. Amoxicillin is the antibiotic typically used for prophylaxis in children. The other medications listed are not indicated for prophylaxis in this population.

Question 5

The primary care pediatric nurse practitioner auscultates a new grade II vibratory, mid-systolic murmur at the mid sternal border in a 4-year-old child that is louder when the child is supine. What type of murmur is most likely?

Accepted Answer

The characteristics of the murmur described suggest that it is a Still's murmur. Still's murmurs are innocent murmurs commonly heard in children between 2-7 years old. They are usually heard best at the lower left sternal border, are mid-systolic, vibratory, and grade II or III in intensity. They are typically louder when the child is supine and quieter or absent in the standing or sitting position. They are benign and do not require further evaluation unless there are other signs or symptoms present.

Question 6

A 3-month-old infant who was previously healthy now has a persistent cough, bilateral lung crackles, and poor appetite. The primary care pediatric nurse practitioner auscultates a grade III/VI, low-pitched, holosystolic murmur over the left lower sternal border and palpates the liver at one centimeter below the ribs. What diagnosis is likely?

Accepted Answer

The symptoms described, including a persistent cough, poor appetite, and a grade III/VI, low-pitched, holosystolic murmur over the left lower sternal border, along with liver enlargement, are indicative of a ventricular septal defect (VSD). These symptoms suggest increased pulmonary blood flow and heart failure, which are common in significant VSDs.

Question 7

The primary care pediatric nurse practitioner (PNP) is examining a 2-week-old infant and auscultates a wide splitting of S during expiration. What condition may this finding represent?

Accepted Answer

Wide splitting of S during expiration is a characteristic finding in ASD. In ASD, there is a communication between the atria that allows blood to flow from the left atrium to the right atrium, causing a delay in the closure of the pulmonic valve during expiration, resulting in the wide splitting of S. COA, PDA, and VSD are not known to cause this finding.

Question 8

A 7-year-old child who has a history of a repaired congenital heart defect (CHD)has many dental caries along with gingival erythema and irritation and a temperature of 102.5°F. What will the primary care pediatric nurse practitioner do next?

Accepted Answer

The answer of A 7-year-old child who has a history...

Question 9

A 12-year-old child whose body mass index (BMI) is greater than the 95th percentile has a blood pressure at the 98th percentile for age, sex, and height. After lifestyle changes that include diet and exercise, the child's BMI drops to the 90th percentile, but the blood pressure remains the same. What is the primary care pediatric nurse practitioner's next step in treating this child?

Accepted Answer

The child's persistently elevated blood pressure despite lifestyle modifications necessitates a referral to a specialist (nephrologist or cardiologist) for further evaluation and management. Medication such as an ACE inhibitor may be considered, but this should be initiated and monitored by a specialist. An echocardiogram may be ordered by the specialist, but it is not the first next step in management. Continued close monitoring of blood pressure is important, but referral to a specialist is necessary in this case.

Question 10

The primary care pediatric nurse practitioner (PNP) is performing a sports physical on an adolescent whose history reveals mild aortic stenosis (AS). What will the nurse practitioner recommend?

Accepted Answer

Evaluation by a cardiologist prior to participation is recommended for any adolescent with a history of aortic stenosis, even if it is mild. The cardiologist can assess the severity of the condition and determine whether any restrictions or precautions need to be taken during physical activity. Avoidance of all sports may not be necessary, but clearance for any sports is not appropriate without further evaluation. Low-intensity sports may also not be appropriate depending on the severity of the AS.

Question 11

During a well baby examination of a 6-week-old infant, the primary care pediatric nurse practitioner notes poor weight gain, acrocyanosis of the hands and feet, and a respiratory rate of 60 breaths per minute. Oxygen saturation on room air is 93%. The remainder of the exam is unremarkable. Which action is correct?

Accepted Answer

The findings of poor weight gain, acrocyanosis, tachypnea, and decreased oxygen saturation suggest the possibility of a congenital heart defect. Therefore, the infant should be referred to a pediatric cardiologist for further evaluation and management. A follow-up in 1 week or reassurance to parents is not appropriate in this case. Ordering a chest radiograph and an electrocardiogram may be helpful, but a referral to a specialist should be the first step.

Question 12

An adolescent female has a history of repaired tetralogy of Fallot (TOF). Which long-term complication is a concern for this patient?

Accepted Answer

The answer of An adolescent female has a history of...

Question 13

During a well child assessment, the primary care pediatric nurse practitioner (PNP) auscultates a harsh, blowing grade IV/VI murmur in a 6-month-old infant. What will the nurse practitioner do next?

Accepted Answer

A grade IV/VI murmur in a 6-month-old infant requires further evaluation by a pediatric cardiologist to identify the cause and determine the appropriate treatment plan. While obtaining a complete blood count, electrocardiogram, and chest radiograph may provide additional information, they are not the primary next step in the management of a potential cardiac condition.

Question 14

The primary care pediatric nurse practitioner provides primary care for a 4-month-old infant who has a ventricular septal defect (VSD). The infant has been breastfeeding well but in the past month has dropped from the 20th percentile to the 5th for weight. What will the nurse practitioner recommend?

Accepted Answer

Infants with VSD may have increased energy needs due to the increased work of breathing caused by the heart defect. Fortifying the breast milk with added calories is a recommended intervention before supplementing with formula. Solid foods are not recommended for infants under 6 months of age. Switching to formula is not necessary if the infant is still able to breastfeed. A 24 kcal/ounce formula, which is the same caloric density as fortified breast milk, may be considered if fortification alone is not enough to support weight gain.

Question 15

A 6-year-old child has a systolic blood pressure between the 95th and 99th percentile for age, sex, and height and a diastolic blood pressure between the 90th and the 95th percentile on three separate clinic visits. This child's blood pressure is placed in which classification?

Accepted Answer

This child's blood pressure falls into the category of stage 1 hypertension, as it is between the 95th and 99th percentile plus 5 mmHg for systolic or between the 90th and 95th percentile for diastolic on three separate occasions.

Question 16

During a routine well child exam on a 5-year-old child, the primary care pediatric nurse practitioner auscultates a grade II/VI, harsh, late systolic ejection murmur at the upper left sternal border that transmits to both lung fields. The child has normal growth and development. What will the nurse practitioner suspect?

Accepted Answer

The description of a harsh, late systolic ejection murmur at the upper left sternal border that transmits to both lung fields is characteristic of pulmonic stenosis. This condition involves narrowing at the pulmonary valve or just below it, causing obstruction of blood flow from the right ventricle to the pulmonary artery.

Question 17

A 5-year-old child has an elevated blood pressure during a well child exam. The primary care pediatric nurse practitioner notes mottling and pallor of the child's feet and lower legs and auscultates a systolic ejection murmur in the left infraclavicular region radiating to the child's back. The nurse practitioner will suspect which condition?

Accepted Answer

The mottling and pallor in the lower extremities combined with the systolic ejection murmur in the left infraclavicular region radiating to the back are suggestive of coarctation of the aorta. Coarctation of the aorta is a narrowing of the aorta usually at the site of the ductus arteriosus. This narrowing can reduce blood flow to the lower extremities, causing decreased perfusion and mottling. The systolic ejection murmur is caused by turbulent blood flow through the narrowed aorta. Aortic stenosis would present with a harsh systolic ejection murmur at the base of the heart, but would not typically cause mottling or pallor in the lower extremities. Patent ductus arteriosus would cause a continuous machinery-like murmur and would not typically present with mottling or pallor. Pulmonic stenosis would present with a systolic ejection murmur at the upper left sternal border, but would not typically cause mottling or pallor of the lower extremities.

Question 18

A 9-month-old infant has a grade III/VI, harsh, rumbling, continuous murmur in the left infraclavicular fossa and pulmonic area. A chest radiograph reveals cardiac enlargement. The primary care pediatric nurse practitioner will refer the infant to a pediatric cardiologist and prepare the parents for which intervention to repair this defect?

Accepted Answer

The description of a harsh, rumbling, continuous murmur in the left infraclavicular fossa and pulmonic area, along with cardiac enlargement in a 9-month-old infant, is suggestive of a patent ductus arteriosus (PDA). Coil insertion in the catheterization laboratory is a common intervention to repair this defect, as it is less invasive than open-heart surgery and can effectively close the PDA.

Question 19

A 12-month-old infant who had cardiopulmonary bypass with red blood cell (RBC) and plasma infusions during surgery at 8 months is seen for a well child examination. Which vaccine may be administered at this visit?

Accepted Answer

The infant had received a blood transfusion within the past 11 months, which could interfere with the effectiveness of live-attenuated vaccines such as MMR and Varivax. OPV is no longer recommended in the United States. PCV-13 is a conjugate vaccine and is safe to administer to infants who have received blood products recently.

Question 20

A 5-year-old child who had a repair for transposition of the great arteries shortly after birth is growing normally and has been asymptomatic since the surgery. The primary care nurse practitioner (PNP)notes mild shortness of breath with exertion and, upon questioning, learns that the child has recently reported dizziness. What will the nurse practitioner do?

Accepted Answer

The presence of mild shortness of breath and dizziness in a child who had a repair for transposition of the great arteries shortly after birth raises concern for potential cardiac complications. Referral to a cardiologist is necessary for further evaluation and management.

Quiz 38: Cardiovascular Disorders

An infant with trisomy 21 has a complete AV canal defect. Which finding, associated with having both of these conditions, will the primary care pediatric nurse practitioner expect?

A 12-year-old child whose weight and body mass index (BMI) are in the 75th percentile has a diastolic blood pressure that is between the 95th and 99th percentiles for age, sex, and height on three separate occasions. Which test will be prescribed for this child initially?

The primary care pediatric nurse practitioner (PNP) is performing a well child examination on a school-age child who had complete repair of a tetralogy of Fallot (TOF) defect in infancy. What is important in this child's health maintenance regime?

The primary care pediatric nurse practitioner auscultates a new grade II vibratory, mid-systolic murmur at the mid sternal border in a 4-year-old child that is louder when the child is supine. What type of murmur is most likely?

The primary care pediatric nurse practitioner (PNP) is examining a 2-week-old infant and auscultates a wide splitting of S during expiration. What condition may this finding represent?

A 7-year-old child who has a history of a repaired congenital heart defect (CHD) has many dental caries along with gingival erythema and irritation and a temperature of 102.5°F. What will the primary care pediatric nurse practitioner do next?

The primary care pediatric nurse practitioner (PNP) is performing a sports physical on an adolescent whose history reveals mild aortic stenosis (AS) . What will the nurse practitioner recommend?

An adolescent female has a history of repaired tetralogy of Fallot (TOF) . Which long-term complication is a concern for this patient?

During a well child assessment, the primary care pediatric nurse practitioner (PNP) auscultates a harsh, blowing grade IV/VI murmur in a 6-month-old infant. What will the nurse practitioner do next?

A 6-year-old child has a systolic blood pressure between the 95th and 99th percentile for age, sex, and height and a diastolic blood pressure between the 90th and the 95th percentile on three separate clinic visits. This child's blood pressure is placed in which classification?

A 12-month-old infant who had cardiopulmonary bypass with red blood cell (RBC) and plasma infusions during surgery at 8 months is seen for a well child examination. Which vaccine may be administered at this visit?