A wide splitting of S2 during expiration is auscultated in a 2-week-old infant.

Correct Answer: A

Rationale: In a 2-week-old infant, a wide splitting of S2 during expiration is indicative of an atrial septal defect (ASD). The correct answer is A) Atrial septal defect (ASD). In ASD, there is a delay in the closure of the atrioventricular valves, leading to a wide splitting of S2. This delay allows more time for blood to flow from the right atrium to the left atrium, causing the characteristic sound. This finding is specific to ASD and helps differentiate it from other cardiovascular conditions in this scenario. Option B) Coarctation of the aorta (COA) typically presents with hypertension in the upper extremities and weak or absent pulses in the lower extremities, not with S2 splitting. Option C) Patent ductus arteriosus (PDA) may present with a continuous heart murmur and bounding pulses but not with S2 splitting. Option D) Ventricular septal defect (VSD) may present with a harsh holosystolic murmur but not with S2 splitting during expiration. Understanding auscultation findings in pediatric cardiovascular conditions is crucial for nurses caring for infants. Recognizing the significance of S2 splitting in differentiating between various cardiac defects helps in accurate diagnosis and appropriate management, highlighting the importance of pharmacology knowledge in pediatric nursing practice.

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: C

Rationale: In an adolescent female with a history of repaired tetralogy of Fallot (TOF), the long-term complication of concern is mitral valve prolapse (Option C). This is because TOF is a congenital heart defect that affects the structure of the heart, particularly the right ventricle. The repaired TOF can lead to alterations in the heart's anatomy and function, potentially causing mitral valve issues in the long term. Option A, aortic stenosis, is incorrect because TOF primarily affects the pulmonary valve rather than the aortic valve. Chronic cyanosis (Option B) is a common symptom of unrepaired TOF but is less likely in a patient with a history of repaired TOF. Ventricular failure (Option D) could occur due to the strain on the heart caused by TOF, but mitral valve prolapse is a more specific concern in this case. Educationally, understanding the long-term complications of congenital heart defects like TOF is crucial for nurses caring for pediatric patients. Recognizing potential issues such as mitral valve prolapse in patients with a history of TOF can help in early intervention and optimizing patient outcomes. It highlights the importance of ongoing monitoring and follow-up care for these patients to address any emerging complications promptly.

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.