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 notes mild shortness of breath with exertion and dizziness. What will the nurse practitioner do?

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Refer the child to the cardiologist immediately. The child with a history of repair for transposition of the great arteries who presents with new symptoms of mild shortness of breath and dizziness may be experiencing cardiac complications or issues related to the previous surgery. Referring the child to the cardiologist promptly is essential to assess the cardiovascular status, ensure appropriate management, and prevent potential complications. Option A) Order an echocardiogram and chest radiograph could be seen as a reasonable choice, but given the symptoms of shortness of breath and dizziness, immediate referral to a specialist for further evaluation and management is more appropriate. Option B) Perform pulmonary function testing is not indicated in this case as the symptoms are more suggestive of a cardiac issue rather than a primary pulmonary problem. Option C) Reassure the parent that these symptoms are common is not advisable, as these new symptoms in a child with a history of cardiac surgery should not be dismissed without further evaluation. It is crucial to take these symptoms seriously and seek appropriate medical follow-up promptly. Educational Context: This question highlights the importance of recognizing and promptly addressing new or concerning symptoms in children with a history of congenital heart conditions. It emphasizes the role of healthcare providers, such as nurse practitioners, in advocating for the health and well-being of pediatric patients by ensuring timely referrals and appropriate follow-up care to prevent complications and promote optimal outcomes.

Correct Answer: A

Rationale: The correct answer is A) 12-lead electrocardiogram. In this case, the primary care pediatric nurse practitioner suspects a cardiac cause for the adolescent's fainting episodes. A 12-lead ECG is a non-invasive and essential test to evaluate the electrical activity of the heart. It can help identify any abnormal rhythms or structural abnormalities that could be causing the fainting episodes. Option B) Echocardiogram is used to assess the structure and function of the heart. While it is a valuable diagnostic tool for many cardiac conditions, it may not be the initial test of choice in this scenario where the focus is on assessing the electrical activity of the heart. Option C) Tilt table testing is typically used to evaluate orthostatic intolerance and autonomic nervous system function, not necessarily cardiac causes of fainting in this context. Option D) Treadmill exercise testing is used to assess cardiovascular fitness and function during exercise and may not be the most appropriate initial test for evaluating the cause of fainting episodes in a 15-year-old with suspected cardiac issues. In an educational context, understanding the appropriate diagnostic tests for evaluating cardiovascular conditions in pediatric patients is crucial for healthcare providers working in pediatrics. Knowing when to order specific tests based on the patient's presentation and suspected underlying condition is essential for providing timely and accurate care. A strong foundation in pharmacology is also essential to interpret test results and make informed decisions regarding treatment and referrals to specialists.

Correct Answer: B

Rationale: The correct answer is B) Beta blocker. In a scenario where a child presents with a Glasgow Coma Scale of 3, bradycardia (HR of 88), hypotension (BP 78/52), and hypoglycemia (blood sugar of 35 mg/dL), the most likely cause would be a beta blocker overdose. Beta blockers can lead to decreased heart rate, hypotension, altered mental status, and hypoglycemia. A) Calcium channel blockers primarily cause hypotension and bradycardia but are less likely to cause hypoglycemia or altered mental status in overdose situations. C) ACE inhibitors and D) ARBs are less likely to cause the combination of symptoms seen in this case. ACE inhibitors and ARBs primarily cause hypotension and renal insufficiency in overdose situations. In an educational context, understanding the toxic effects of different cardiovascular medications is crucial for nurses caring for pediatric patients. Recognizing the signs and symptoms of drug toxicity can help in prompt identification and management of overdoses, thereby improving patient outcomes. It is essential for nurses to be familiar with the specific effects of different drug classes to provide safe and effective care to pediatric patients.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Supraventricular tachycardia (SVT). SVT is characterized by a rapid heart rate (HR: 220 beats per minute) with a regular rhythm, which matches the toddler's presentation. SVT is common in infants and young children and can be triggered by factors like dehydration, fever, or infection, which align with the child's history of gastroenteritis. Option A) Rapid pulmonary flutter is incorrect because it is not a recognized dysrhythmia in pediatric patients. Option B) Sinus bradycardia is also incorrect as it describes a slow heart rate, which is not consistent with the child's rapid heart rate. Option C) Rapid atrial fibrillation is unlikely in a pediatric patient, especially with a regular rhythm. Educationally, understanding pediatric dysrhythmias is crucial for nurses caring for children, especially in acute care settings. Recognizing the signs and symptoms of SVT and other dysrhythmias enables prompt intervention and can prevent serious complications. Nurses must be adept at assessing vital signs, recognizing abnormal findings, and initiating appropriate actions to ensure optimal patient outcomes.

Correct Answer: C

Rationale: In the case of a toddler with a history of tetralogy of Fallot (TOF), the correct position they may assume during play is squatting (Option C). This is because squatting helps reduce the systemic vascular resistance by increasing the systemic venous return to the heart, ultimately leading to an increase in systemic circulation. This position helps improve the mixing of oxygen-poor and oxygen-rich blood in the heart, which can be beneficial for a child with TOF as it helps increase oxygen saturation levels. Sitting (Option A) and standing (Option D) are less likely positions for a child with TOF during play because they do not promote the same physiological benefits as squatting. Sitting and standing do not assist in optimizing systemic circulation in the same way squatting does for a child with TOF. Supine (Option B) is also not the preferred position for a child with TOF during play, as lying flat can potentially worsen cyanosis by reducing venous return and increasing systemic vascular resistance. In an educational context, understanding the preferred positions for children with specific cardiovascular conditions like TOF is crucial for nurses and healthcare providers working in pediatric settings. This knowledge helps in promoting optimal circulation and oxygenation in these patients, ultimately contributing to their overall well-being and health outcomes.