A heart transplant may be indicated for a child with severe heart failure and:

Correct Answer: C

Rationale: In pediatric nursing, understanding the indications for a heart transplant is crucial. The correct answer is C) Hypoplastic left heart syndrome (HLHS). HLHS is a severe congenital heart defect where the left side of the heart is underdeveloped, leading to profound heart failure. In such cases, a heart transplant may be the only viable treatment option to improve the child's survival and quality of life. Option A) Patent ductus arteriosus (PDA) is a common congenital heart defect where the ductus arteriosus fails to close after birth. While it may require treatment, it typically does not necessitate a heart transplant. Option B) Ventricular septal defect (VSD) is another common congenital heart defect involving a hole in the wall separating the heart's lower chambers. Most VSDs can be managed without the need for a heart transplant. Option D) Pulmonic stenosis (PS) is a condition characterized by narrowing of the pulmonary valve, which can lead to right heart strain. While severe cases may require interventions like valve replacement, it rarely leads to the need for a heart transplant. Educationally, understanding the specific cardiac conditions that may warrant a heart transplant in pediatric patients is crucial for pediatric nurses. This knowledge allows nurses to provide informed care, support families facing such difficult decisions, and collaborate effectively with the healthcare team to optimize patient outcomes.

Correct Answer: C

Rationale: In pediatric nursing, understanding congenital heart defects (CHDs) is crucial for providing safe and effective care to pediatric patients. In the context of this question, the correct answer is C) Coarctation of the aorta (COA). This defect involves a narrowing of the aorta, leading to decreased blood flow to the lower extremities. When assessing a child with COA, it is essential to take blood pressure measurements in both the upper and lower extremities. Discrepancies in blood pressure readings between the two extremities can indicate the presence of COA. The higher blood pressure in the upper extremities compared to the lower extremities suggests obstruction in blood flow, a hallmark feature of COA. Regarding the incorrect options: A) Transposition of the great vessels: This defect involves a complete switch of the aorta and pulmonary artery, but it does not typically present with discrepancies in blood pressure between upper and lower extremities. B) Aortic stenosis (AS): While AS involves narrowing of the aortic valve, it does not specifically result in differences in blood pressure measurements between upper and lower extremities. D) Tetralogy of Fallot (TOF): TOF is characterized by four specific heart defects, including pulmonary stenosis, overriding aorta, ventricular septal defect, and right ventricular hypertrophy. However, it does not typically manifest with differences in blood pressure between the upper and lower extremities. Educationally, understanding the rationale behind why blood pressure measurements in both upper and lower extremities are crucial in COA helps nurses in early identification and prompt management of this condition in pediatric patients. This knowledge can lead to improved patient outcomes and prevent potential complications associated with untreated COA.

Correct Answer: D

Rationale: In this scenario, the correct action for the nurse to take is option D, which is to apply direct pressure 1 inch above the puncture site. This is the most appropriate initial intervention to control the bleeding from the cardiac catheterization site. Direct pressure helps to promote hemostasis and prevent further blood loss, which is crucial in this situation to stabilize the child. Option A, calling the interventional cardiologist, and option B, notifying the cardiac catheterization laboratory, are not the first actions to take in a situation where active bleeding is present. These actions may lead to delays in providing immediate care to the child. Option C, applying a bulky pressure dressing over the present dressing, is also not the best initial action as it does not address the source of bleeding directly. In cases of active bleeding, direct pressure is more effective in controlling and stopping the bleeding. In an educational context, it is important for nurses caring for pediatric patients post-cardiac catheterization to be prepared to manage potential complications such as bleeding. Understanding the correct steps to take in emergency situations like this can help nurses provide prompt and effective care to ensure the safety and well-being of their patients.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) 1 cc/kg/hr. A urine output of 1 cc/kg/hr indicates adequate renal perfusion and successful diuresis in an infant being treated for congestive heart failure with digoxin and furosemide. This level of urine output signifies that the kidneys are effectively eliminating excess fluid and waste from the body, helping to alleviate the symptoms of CHF. Option A) 0.5 cc/kg/hr would indicate inadequate diuresis and may suggest ongoing fluid retention and poor renal perfusion, which is not ideal for a child with CHF. Option C) 30 cc/hr and Option D) 1 oz/hr do not account for the infant's weight, which is crucial in determining appropriate urine output in pediatrics. Using weight-based calculations ensures that the urine output is tailored to the individual needs of the child. Educationally, this question highlights the importance of monitoring urine output as an indicator of renal function and the effectiveness of treatment in pediatric patients with CHF. Understanding the significance of urine output in assessing renal perfusion and diuresis is essential for nurses caring for infants with cardiac conditions.

Correct Answer: B

Rationale: In the context of a pediatric nursing cardiovascular NCLEX practice quiz, the correct answer to the question, "Which finding might delay a cardiac catheterization procedure on a 1-year-old?" is option B) Severe diaper rash. Rationale: Severe diaper rash can delay a cardiac catheterization procedure in a 1-year-old due to the risk of infection. Performing a cardiac catheterization involves inserting a catheter through the skin into blood vessels, which can introduce bacteria and increase the risk of infection. Therefore, it is crucial to ensure that the skin is free from any open wounds or infections before proceeding with the procedure. Option A) 30th percentile for weight is not a contraindication for cardiac catheterization. While weight can be a factor in determining medication dosages or equipment sizes, it alone would not usually delay the procedure. Option C) Allergy to soy is also not directly related to delaying a cardiac catheterization procedure unless the contrast medium used during the procedure contains soy, which can be easily substituted with a different contrast medium if needed. Option D) Oxygen saturation of 91% on room air is slightly lower than the normal range but is not significantly low enough to typically delay a cardiac catheterization procedure. Oxygen supplementation can be provided if necessary during the procedure to maintain adequate oxygenation. Educational Context: Understanding the factors that can impact procedural readiness in pediatric patients is crucial for nurses and healthcare providers. In this scenario, recognizing the potential complications of performing a cardiac catheterization in the presence of severe diaper rash highlights the importance of maintaining skin integrity to prevent infections and ensure optimal patient outcomes. This knowledge is essential for providing safe and effective care to pediatric patients undergoing cardiac procedures.