An adolescent female has a history of repaired tetralogy of Fallot (TOF). Which long-term complication is a concern for this patient?

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: 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.

Correct Answer: C

Rationale: The correct answer is C) Supraventricular tachycardia. In pediatrics, supraventricular tachycardia (SVT) is the most common cardiac dysrhythmia. SVT is characterized by a rapid heart rate originating above the ventricles. This dysrhythmia can present with symptoms such as palpitations, chest pain, dizziness, and fatigue in pediatric patients. Option A) Ventricular tachycardia is less common in pediatric patients compared to SVT. Ventricular tachycardia is a serious arrhythmia that originates in the ventricles and can lead to hemodynamic instability. Option B) Sinus bradycardia refers to a slow heart rate originating from the sinus node. While it can occur in pediatrics, it is not as common as SVT. Option D) First-degree heart block is a conduction abnormality characterized by a delay in the electrical conduction between the atria and ventricles. It is not typically the most common dysrhythmia in pediatrics. Understanding the prevalence of different cardiac dysrhythmias in pediatric patients is crucial for nurses and healthcare providers involved in the care of children with cardiovascular conditions. Recognizing and managing SVT promptly is essential to prevent complications and ensure optimal outcomes for pediatric patients.