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

Correct Answer: C

Rationale: In this scenario, the correct answer is C) MMR (Measles, Mumps, and Rubella) vaccine. The reason for this is that the MMR vaccine is a live attenuated vaccine, which means it contains weakened forms of the viruses. Since the infant had cardiopulmonary bypass with RBC and plasma infusions during surgery, it indicates potential immunosuppression. Live vaccines are generally contraindicated in immunocompromised individuals. However, the MMR vaccine is an exception as it can be safely administered to these individuals. Option A) Measles, Option B) Mumps, and Option D) Oral polio vaccine are incorrect choices in this case. The measles and mumps vaccines are also live vaccines and should be avoided in immunocompromised individuals. The oral polio vaccine is a live vaccine as well and should not be given to individuals with compromised immune systems. From an educational standpoint, it is crucial for healthcare providers to have a thorough understanding of vaccine administration guidelines, especially in vulnerable populations like pediatric patients with prior medical history. Understanding the principles of live attenuated vaccines and their appropriateness in specific clinical scenarios is essential to ensure patient safety and optimal health outcomes.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Coarctation of the aorta (COA). Coarctation of the aorta presents with elevated blood pressure in the upper extremities and decreased or weak pulses in the lower extremities due to a narrowing of the aorta. The mottling and pallor of the feet and lower legs are suggestive of decreased perfusion distal to the coarctation site. The systolic ejection murmur heard in the left infraclavicular region that radiates to the back is a classic finding in COA. Option A) Aortic stenosis (AS) typically presents with a systolic ejection murmur in the right upper sternal border and does not cause the characteristic blood pressure discrepancy seen in coarctation of the aorta. Option C) Patent ductus arteriosus (PDA) usually presents with a continuous machinery-like murmur and is not associated with the blood pressure findings described in the case. Option D) Pulmonic stenosis is characterized by a systolic ejection murmur best heard at the left upper sternal border and is not typically associated with the blood pressure differences seen in coarctation of the aorta. Educationally, understanding the characteristic clinical manifestations and auscultatory findings of cardiovascular disorders in pediatric patients is crucial for healthcare providers to accurately diagnose and manage these conditions. Recognizing the specific signs and symptoms aids in timely intervention and ensures optimal patient outcomes.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Admit to the hospital with a pediatric cardiology consult. Rationale: Admitting the child to the hospital with a pediatric cardiology consult is the most appropriate action because the child has a history of a repaired congenital heart defect (CHD) and is presenting with signs of systemic infection (temperature of 102.5°F) along with dental issues. Children with CHD are at increased risk for infective endocarditis, a serious infection of the heart valves. Dental procedures can introduce bacteria into the bloodstream, leading to infective endocarditis. Therefore, in a child with CHD, any signs of systemic infection, especially dental issues, should be promptly evaluated by a pediatric cardiologist to determine the need for prophylactic antibiotics and to ensure appropriate management to prevent complications like infective endocarditis. Why others are wrong: B) Obtaining blood cultures and a CBC and consulting a pediatric cardiologist is not the most immediate action needed in this case. While obtaining blood cultures and a CBC can provide important diagnostic information, the priority is to address the acute situation and consult the pediatric cardiologist for further management. C) Referring the child to a pediatric dental surgeon immediately does not address the underlying cardiac concerns in this child with a history of CHD. The primary focus should be on evaluating the systemic infection and potential risk of infective endocarditis. D) Starting prophylactic antibiotics such as penicillin twice daily for 2 weeks without a proper evaluation and guidance from a pediatric cardiologist can be inappropriate and may not address the specific needs of this child with a repaired CHD and signs of systemic infection. Educational context: This scenario highlights the importance of understanding the implications of congenital heart defects in pediatric patients and the potential risks associated with dental issues and systemic infections. It underscores the critical role of the healthcare provider, especially in primary care settings, in recognizing red flags, taking prompt action, and involving appropriate specialists for comprehensive care and management of pediatric patients with complex medical histories.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Hypokalemia. When a child is on digoxin and furosemide for CHF, these medications can lead to potassium loss through various mechanisms, including increased urinary excretion. Hypokalemia can manifest as visual disturbances like blurred or yellow vision and can cause cardiac arrhythmias, which can be exacerbated by digoxin. Option B) Hypomagnesemia is incorrect because although loop diuretics like furosemide can cause magnesium loss, it is less common than potassium loss in this context. Option C) Hypocalcemia is incorrect as these medications primarily affect potassium and magnesium levels. Option D) Hypophosphatemia is also incorrect as it is not typically associated with the use of digoxin and furosemide. Educationally, it is crucial for nurses caring for pediatric patients with CHF to understand the potential side effects of medications used in their treatment. Recognizing the signs and symptoms of electrolyte imbalances, like hypokalemia in this case, is essential for prompt intervention to prevent complications such as cardiac arrhythmias. Regular monitoring of electrolyte levels is vital in children on these medications to ensure their safety and optimal outcomes.

Correct Answer: A

Rationale: In pediatric nursing, when managing an infant with congestive heart failure (CHF), it is crucial to promote ideal nutrition to support growth and development while managing the condition. The correct answer, option A, of feeding formula that is supplemented with additional calories is the most appropriate nursing action for several reasons. Infants with CHF often have increased caloric needs due to their higher energy expenditure from the increased work of breathing and poor weight gain. Supplementing the formula with additional calories helps meet these increased energy demands and supports optimal growth. It also ensures that the infant receives adequate nutrition despite potential feeding difficulties or fatigue associated with CHF. Option B, allowing the infant to nurse at each breast for 20 minutes, may not be feasible or effective in all cases. Infants with CHF may tire easily during feedings and may not have the energy to nurse effectively for an extended period. Large feedings every 5 hours (option C) may overwhelm the infant's compromised cardiovascular system and lead to fluid overload, exacerbating CHF symptoms. Using firm nipples with small openings to slow feedings (option D) may be appropriate for some feeding issues but does not address the increased caloric needs of infants with CHF. Slowing feedings may not be the primary concern in this scenario compared to ensuring adequate caloric intake. In an educational context, understanding the specific nutritional needs of infants with CHF is essential for pediatric nurses to provide safe and effective care. By selecting the correct option and supplementing the formula with additional calories, nurses can help support the infant's nutritional status and overall well-being while managing their cardiac condition.