A patient with no structural heart disease: a wide QRS tachycardia of RBBB morphology at a rate of 160 bpm, QRS axis of (-) 40 degrees and AV dissociation was recorded during palpitation. What is the likely diagnosis?

Correct Answer: A

Rationale: The correct answer is A) RV outflow ventricular tachycardia. In this scenario, the patient's presentation of wide QRS tachycardia with right bundle branch block (RBBB) morphology, a rate of 160 bpm, a QRS axis of (-) 40 degrees, and AV dissociation is highly indicative of RV outflow ventricular tachycardia. RV outflow ventricular tachycardia commonly presents with RBBB morphology, a leftward axis deviation, and AV dissociation due to its origin in the right ventricular outflow tract. The fast rate and wide QRS complex are consistent with this diagnosis. The other options can be ruled out based on specific characteristics: - Posterior fascicular VT typically presents with a right axis deviation, not a leftward deviation as seen in this case. - Anterior fascicular VT usually presents with a left axis deviation. - Antidromic AVRT typically does not present with RBBB morphology and AV dissociation. Understanding these distinguishing features is crucial in pediatric nursing when assessing and managing cardiovascular disorders. Recognizing the unique characteristics of different arrhythmias helps in accurate diagnosis and timely intervention, which is essential in providing effective care to pediatric patients with cardiac conditions.

Correct Answer: A

Rationale: In a neonate, an ejection systolic murmur in outflow is least likely to be due to a subaortic membrane. This is because subaortic membrane is a rare congenital heart defect that typically presents with a harsh systolic murmur on the left sternal border, not in the outflow tract. Unicuspid and bicuspid aortic valves are associated with aortic stenosis or regurgitation, which can cause an ejection systolic murmur in the outflow tract. Pulmonary stenosis can also lead to an ejection systolic murmur, as it obstructs the flow of blood from the right ventricle to the pulmonary artery. Educationally, understanding the etiology of murmurs in pediatric cardiovascular disorders is crucial for nurses caring for neonates. Recognizing the different causes of murmurs helps in early detection, appropriate intervention, and collaboration with the healthcare team to provide optimal care for these vulnerable patients.

Correct Answer: D

Rationale: The drug of choice for infective endocarditis due to HACEK (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, Kingella species) organisms is D) Ceftriaxone. Ceftriaxone is a third-generation cephalosporin with excellent coverage against Gram-negative organisms like those in the HACEK group. It also has good tissue penetration, making it effective in treating infective endocarditis. A) Vancomycin is a glycopeptide antibiotic used for Gram-positive infections, particularly for MRSA (Methicillin-resistant Staphylococcus aureus), not typically HACEK organisms. B) Gentamicin is an aminoglycoside antibiotic mainly used in combination therapy for serious Gram-negative infections, not usually a first-line choice for infective endocarditis due to HACEK organisms. C) Ampicillin is a penicillin-based antibiotic effective against certain Gram-positive and Gram-negative bacteria but is not the first-line choice for HACEK organisms causing infective endocarditis. Understanding the specific antimicrobial coverage for different organisms causing infective endocarditis is crucial in providing effective treatment and preventing complications. It is essential for pediatric nurses to have a sound knowledge of pharmacology to ensure safe and effective medication administration in pediatric patients with cardiovascular disorders.

Correct Answer: B

Rationale: In the context of pharmacology and pediatric nursing, understanding the formula to predict the maximum predicted heart rate for treadmill exercise testing in CAD patients on beta blockers is crucial for safe and effective patient care. The formula X - (0.7 x Age) is utilized to adjust the predicted maximum heart rate due to the blunting effect of beta blockers on heart rate response during exercise. The correct answer is B) 164 because the value of X represents the standard maximum heart rate (220 beats per minute) minus the age-predicted maximum heart rate without beta blockers (0.7 x Age). Therefore, X is 220 - (0.7 x Age), which equals 164. This adjusted value is essential for accurately interpreting exercise test results and ensuring appropriate exercise intensity for patients on beta blockers. Option A) 174, Option C) 184, and Option D) 154 are incorrect because they do not reflect the appropriate adjustment for the effect of beta blockers on heart rate response during exercise testing. Selecting these options could lead to incorrect interpretation of test results and potentially unsafe exercise prescriptions for pediatric patients with cardiovascular disorders. Educationally, this question highlights the importance of considering the impact of medications on physiological responses during exercise testing, especially in vulnerable patient populations like children with cardiovascular conditions. It underscores the need for healthcare providers to be knowledgeable about pharmacological influences on exercise physiology to deliver safe and effective care to pediatric patients with complex health needs.

Correct Answer: A

Rationale: The correct answer is A) Squatting increases the return of venous blood back to the heart. In Tetralogy of Fallot, a congenital heart defect, there is decreased pulmonary blood flow leading to cyanosis. By squatting, the child instinctively increases systemic vascular resistance and reduces the right-to-left shunting of blood in the heart, thus improving oxygenation. This position assists in maintaining cardiac output and systemic perfusion by reducing the pressure gradient across the right ventricular outflow tract. Option B) Squatting decreases arterial blood flow away from the heart is incorrect as squatting actually helps in improving systemic blood flow. Option C) Squatting is a common resting position when a child is tachycardic is incorrect as squatting in this context is not related to tachycardia but rather a compensatory mechanism for the underlying heart defect. Option D) Squatting increases the workload of the heart is incorrect as squatting actually helps in reducing the workload on the heart by improving venous return and systemic perfusion. Understanding the rationale behind why children with Tetralogy of Fallot assume a squatting position is crucial for nurses caring for pediatric patients with cardiovascular disorders. It highlights the body's innate compensatory mechanisms and the importance of recognizing and supporting these strategies to optimize patient outcomes.