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?

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) 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.

Correct Answer: D

Rationale: In this scenario, the correct action for the nurse to take is option D, which is to hold the child in the knee-chest position to decrease venous blood return. This position helps to improve systemic vascular resistance and decrease the right-to-left shunt in tetralogy of Fallot (TOF), thereby increasing pulmonary blood flow and oxygenation. Option A (lay the child flat to promote hemostasis) is incorrect because laying the child flat may exacerbate the cyanosis and compromise respiratory function further. Option B (lay the child flat with legs elevated to increase blood flow to the heart) is also incorrect as it can worsen the cyanosis by increasing the right-to-left shunt in TOF. Option C (sit the child on the parent's lap, with legs dangling, to promote venous pooling) is incorrect as it does not address the immediate need to improve oxygenation in a cyanotic infant with TOF. Educationally, understanding the appropriate positioning for a child with cyanotic spells due to TOF is crucial for pediatric nurses. The knee-chest position is a simple yet effective intervention that can be life-saving in this situation. It is essential for nurses to be able to quickly recognize and respond to respiratory distress and cyanosis in pediatric patients with congenital heart defects to optimize outcomes and provide safe, evidence-based care.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) The fever increased the intensity of the murmur. This is the right choice because fever can lead to increased flow through the heart, which can intensify existing murmurs. This phenomenon is known as the "Fever Murmur." It is important to recognize this as a temporary condition that does not necessarily indicate a serious underlying cardiac issue. Option A, stating that the pediatrician is not a cardiologist, is incorrect because pediatricians are trained to recognize common heart conditions in children and would typically investigate further if a murmur is detected. Option B, claiming that murmurs are difficult to detect, especially in children, is also incorrect. While it can be more challenging to detect murmurs in children due to their smaller size and faster heart rates, healthcare professionals are trained to listen carefully and differentiate between normal and abnormal heart sounds. Option D, suggesting referral to an interventional cardiologist, is premature at this point. A pediatric cardiologist may be consulted for further evaluation if needed, but the initial step would be to understand the relationship between the fever and the murmur. Educationally, this case highlights the importance of considering all factors when evaluating a child with a murmur, including their current health status such as the presence of fever. It also emphasizes the need for healthcare providers to communicate effectively with parents, explaining how different factors can influence the detection and characteristics of murmurs in children.