A previously well 3½-month-old presents with poor feeding, diaphoresis during feeding, and poor growth. Vital signs reveal respirations of 70, pulse of 175, and blood pressure of 90/65 mm Hg in the upper and lower extremities. The cardiac examination reveals a palpable parasternal lift and a systolic thrill. A grade 4 holosystolic murmur and a mid-diastolic rumble are noted. The chest radiograph reveals cardiomegaly. The most likely diagnosis is

Correct Answer: C

Rationale: In this case, the most likely diagnosis is a Ventricular Septal Defect (VSD). VSD is a common congenital heart defect in infants and young children. The clinical presentation of poor feeding, diaphoresis during feeding, poor growth, tachypnea, tachycardia, and signs of heart failure like a palpable parasternal lift, systolic thrill, and abnormal heart sounds are indicative of VSD. The chest radiograph showing cardiomegaly further supports this diagnosis. Option A, cardiomyopathy, is less likely in this case as the symptoms and signs described are more suggestive of a structural defect like VSD rather than a primary myocardial disease. Myocarditis (Option B) typically presents with more systemic symptoms like fever, malaise, and viral prodrome in addition to cardiac symptoms. Coarctation of the aorta (Option D) would not typically present with the combination of symptoms and signs described, such as the holosystolic murmur and mid-diastolic rumble. Educationally, understanding the clinical manifestations and diagnostic approach to pediatric cardiovascular conditions is crucial for nurses caring for pediatric patients. Recognizing the specific signs and symptoms associated with different cardiac defects allows for timely intervention and appropriate management to improve patient outcomes. A thorough understanding of the pathophysiology of congenital heart defects, such as VSD, is essential for providing safe and effective care to pediatric patients with cardiovascular issues.

Correct Answer: D

Rationale: In this scenario, the correct approach to the management of the 12-year-old male with a history of a heart murmur and symptoms of dyspnea, light-headedness, and findings of a grade 4/6 systole ejection murmur, ejection click, and left ventricular hypertrophy on ECG is to perform an echocardiography (Option D). Echocardiography is a non-invasive diagnostic tool that allows for the visualization of the heart's structure and function, providing critical information on cardiac anatomy, chamber sizes, ventricular function, and assessing for any valvular abnormalities. In this case, echocardiography will help in confirming the presence and severity of any structural abnormalities, such as valve defects or hypertrophy, which can be causing the symptoms experienced by the patient. Chest x-ray (Option A) may provide information on the size and shape of the heart, but it is not as specific or detailed as an echocardiogram in evaluating structural abnormalities. An exercise test (Option B) may not be safe to perform in a patient presenting with severe symptoms like dyspnea and light-headedness. Digitalization (Option C) refers to the administration of digoxin, which is not indicated as the initial step in the management of this patient. In an educational context, understanding the importance of utilizing appropriate diagnostic tools based on the patient's presentation is crucial in pediatric cardiovascular nursing. Echocardiography plays a vital role in the evaluation and management of pediatric patients with suspected cardiac conditions, allowing for accurate diagnosis and guiding further treatment strategies.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) embolic stroke. An embolic stroke occurs when a blood clot or debris travels through the bloodstream and blocks a blood vessel in the brain. This blockage leads to a sudden loss of blood flow to the affected area, resulting in symptoms like headache and hemiplegia (inability to move one side of the body). Option B) cerebral thrombosis refers to a blood clot forming in a blood vessel in the brain, causing a localized blockage. While it can also present with similar symptoms, the sudden onset seen in the case described is more indicative of an embolic stroke. Option C) cerebral abscess is a localized infection in the brain, typically presenting with symptoms like fever and neurological deficits, but not usually causing sudden hemiplegia as described in the case. Option D) moyamoya disease involves progressive narrowing of the blood vessels leading to reduced blood flow to the brain, but it typically presents with gradual symptoms like recurrent transient ischemic attacks (TIAs) rather than the sudden onset seen in this case. In an educational context, understanding the different types of strokes and their presentations is crucial for healthcare providers, especially in pediatric cardiovascular nursing. Recognizing the signs and symptoms of an embolic stroke promptly is essential for timely intervention and improving patient outcomes. This case highlights the importance of clinical reasoning and differential diagnosis in pediatric patients with cardiovascular issues.

Correct Answer: A

Rationale: In pediatric cardiovascular nursing, understanding the risk factors for bacterial endocarditis is crucial to providing optimal care. The correct answer is A) repaired simple atrial septal defect. Patients with this condition are not at increased risk for bacterial endocarditis post-repair as the risk is primarily associated with residual defects or prosthetic material. Option B) aortic stenosis is incorrect as it can predispose patients to endocarditis due to turbulent blood flow causing endothelial damage. Option C) rheumatic fever heart disease is associated with scarring of heart valves, increasing the risk of endocarditis. Option D) palliative vascular shunts can also lead to endocarditis due to altered blood flow patterns. Educationally, this question highlights the importance of understanding the specific cardiac conditions and their implications for developing endocarditis. It emphasizes the need for vigilant monitoring and appropriate prophylaxis in high-risk patients to prevent serious complications. Understanding these nuances is vital for pediatric nurses to provide safe and effective care to their patients.