A 3-month-old infant who was previously healthy now has a persistent cough, bilateral lung crackles, and poor appetite. 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?

Correct Answer: D

Rationale: In this scenario, the likely diagnosis for the 3-month-old infant presenting with a persistent cough, bilateral lung crackles, poor appetite, a grade III/VI holosystolic murmur over the left lower sternal border, and a palpable liver is a Ventricular Septal Defect (VSD). VSD is a common congenital heart defect that can present with symptoms such as poor feeding, failure to thrive, respiratory distress, and heart murmur. A) Atrial septal defect (ASD) is less likely in this case as the symptoms and physical exam findings are more indicative of a VSD. B) Coarctation of the aorta (COA) typically presents with hypertension in the upper extremities and weak pulses in the lower extremities, which are not evident in this case. C) Patent ductus arteriosus (PDA) would present with a continuous murmur, bounding pulses, and widened pulse pressure, which are not described in the scenario. Educationally, understanding the characteristic clinical manifestations and physical exam findings associated with different congenital heart defects is crucial for pediatric nurses to provide early detection and appropriate management. Recognizing the specific signs and symptoms can lead to timely interventions and improved outcomes for infants with congenital heart defects.

Correct Answer: C

Rationale: In this scenario, the correct initial test to prescribe for the 12-year-old child with elevated diastolic blood pressure is option C) urinalysis and electrolytes. Urinalysis and electrolytes are essential in assessing kidney function and detecting conditions such as hypertension-related renal disease, which could be contributing to the elevated blood pressure in the child. Hypertension in children can be secondary to underlying conditions, and assessing renal function is crucial in the evaluation process. Option A) complete blood count and option B) erythrocyte sedimentation rate are not the most appropriate initial tests in this case. While they provide valuable information, they are not as directly related to assessing the impact of elevated blood pressure on the kidneys in this context. Option D) renal function is a consideration in the evaluation of hypertension in children, but urinalysis and electrolytes would be the more appropriate initial test to assess renal function specifically in this case. Educationally, understanding the rationale behind choosing specific diagnostic tests based on the clinical scenario is crucial for healthcare providers working in pediatric cardiovascular nursing. It highlights the importance of targeted assessments and the need to consider the underlying mechanisms contributing to elevated blood pressure in children to provide optimal care and management.

Correct Answer: A

Rationale: The correct answer is A) Beta blockers. Beta blockers are often prescribed for patients with hypertension due to their ability to reduce heart rate and blood pressure by blocking the action of adrenaline. Elevated cholesterol levels are a common side effect of beta blockers, which can lead to an increase in total cholesterol levels as seen in this patient. This indicates that the patient is likely taking beta blockers. Option B) Calcium channel blockers work by relaxing blood vessels and reducing the heart's workload, but they are not typically associated with elevated cholesterol levels. Option C) ACE inhibitors work by dilating blood vessels to lower blood pressure and improve blood flow. They do not typically affect cholesterol levels. Option D) Diuretics help the body get rid of excess sodium and water to lower blood pressure. They are not known to cause elevated cholesterol levels. Understanding the relationship between medication classes and their potential side effects is crucial in pharmacology, especially in pediatric cardiovascular nursing. By recognizing the side effects of specific drugs, nurses can anticipate potential complications and provide appropriate patient education and monitoring.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Aortic stenosis (AS). Aortic stenosis is a condition where the aortic valve narrows, leading to reduced blood flow from the heart to the body. The symptoms described by the child - dizziness, chest pain, and difficulty counting out loud and jumping simultaneously - are indicative of decreased cardiac output and oxygen delivery due to the narrowed aortic valve. Option A) Ventricular septal defect (VSD) is unlikely as it typically presents with symptoms like a loud heart murmur, poor weight gain, and frequent respiratory infections, which are not consistent with the child's symptoms. Option C) Mitral valve prolapse does not typically cause dizziness or chest pain but may present with palpitations or fatigue. Option D) Tricuspid atresia usually presents early in life with symptoms related to cyanosis and poor oxygenation, which do not align with the child's current symptoms. Educationally, understanding pediatric cardiovascular conditions is crucial for nurses caring for children. By analyzing symptoms, nurses can make informed clinical decisions and provide appropriate care. This case highlights the importance of recognizing subtle signs and symptoms in children that could indicate underlying cardiac issues, emphasizing the need for thorough assessment and prompt referral for further evaluation and management.

Correct Answer: B

Rationale: In the context of pediatric cardiovascular nursing, the correct answer to the question regarding the use of aspirin in a child with rheumatic fever (RF) is option B: Reduce joint inflammation. Aspirin is prescribed for children with RF to help alleviate joint pain and inflammation, which are common symptoms of this condition. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can help reduce inflammation in the joints affected by RF, thus improving the child's comfort and mobility. Option A: Keeping the patent ductus arteriosus (PDA) open is not a correct rationale for prescribing aspirin in a child with RF. PDA closure is not a primary indication for aspirin therapy in this context. Option C: Decreasing swelling of strawberry tongue is also not a primary reason for using aspirin in RF. Strawberry tongue is a clinical sign of RF but is not directly treated with aspirin. Option D: Treating ventricular hypertrophy of endocarditis is not a correct rationale for administering aspirin in a child with RF. Ventricular hypertrophy is a cardiac complication that may occur in RF, but it is not a direct indication for aspirin therapy. Educationally, understanding the rationale behind prescribing medications in pediatric cardiovascular conditions like RF is crucial for nurses caring for these patients. By knowing the specific indications for medications like aspirin, nurses can provide safe and effective care to children with RF and help manage their symptoms appropriately.