An infant with trisomy 21 has a complete AV canal defect. Which finding associated with both conditions will the primary care pediatric nurse practitioner expect?

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Oxygen desaturation. Children with trisomy 21 (Down syndrome) are at increased risk for congenital heart defects, with a common one being a complete atrioventricular (AV) canal defect. This defect involves an abnormality in the development of the heart structures, leading to mixing of oxygenated and deoxygenated blood. As a result, there is inadequate oxygenation of the blood, which can manifest as oxygen desaturation. A) Crackles in both lungs are more commonly associated with conditions like pneumonia or heart failure due to fluid accumulation in the lungs, not specifically with a complete AV canal defect in trisomy 21. B) Hepatomegaly can occur in heart failure as the liver becomes congested with blood due to poor heart function, but it is not a typical finding associated with a complete AV canal defect in trisomy 21. D) Peripheral edema is also a symptom of heart failure, where fluid accumulates in the tissues due to the heart's inability to pump effectively. While it can be seen in some cases of congenital heart defects, it is not a specific finding for a complete AV canal defect in trisomy 21. Educational Context: Understanding the association between trisomy 21 and congenital heart defects, such as a complete AV canal defect, is crucial for healthcare providers caring for pediatric patients. Recognizing the expected clinical manifestations allows for early identification and intervention, improving outcomes for these vulnerable patients. Nurses and nurse practitioners play a key role in monitoring and managing the health of children with trisomy 21 and associated cardiac conditions, making this knowledge essential for pediatric healthcare practice.

Correct Answer: D

Rationale: The correct answer is D) Referral to a nephrologist or cardiologist. When a child's BMI decreases but blood pressure remains elevated, it suggests the presence of underlying cardiovascular or renal issues that may require specialized care. Referring the child to a nephrologist or cardiologist allows for a more in-depth evaluation of the cardiovascular system and kidneys to identify any potential causes for the persistent high blood pressure. Option A) Continued close monitoring of blood pressure is not sufficient in this case as the child's elevated blood pressure is not responsive to lifestyle changes alone, indicating a need for further evaluation and intervention. Option B) Ordering an echocardiogram may be necessary in certain cases to assess cardiac structure and function, but it is not the primary next step when dealing with persistent high blood pressure after BMI reduction. Option C) Prescribing an ACE inhibitor medication is not appropriate as the first step without a thorough evaluation by a specialist to determine the underlying cause of the high blood pressure. In an educational context, understanding the importance of interdisciplinary collaboration and referral to specialists in cases where primary interventions are not effective is crucial for pediatric nurses. This case highlights the need for comprehensive care and the involvement of specialists to ensure optimal management of cardiovascular health in pediatric patients.

Correct Answer: A

Rationale: In the context of pediatric nursing and pharmacology, understanding cardiac manifestations associated with Down syndrome is crucial for providing comprehensive care to children with this condition. The correct answer is A) Congenital heart defect (CHD). Down syndrome is commonly associated with congenital heart defects, with nearly half of infants born with Down syndrome having some form of CHD. These defects can range from atrioventricular septal defects to ventricular septal defects. Option B) Systemic hypertension is not a common cardiac manifestation seen in children with Down syndrome. While individuals with Down syndrome may have an increased risk of developing hypertension later in life, it is not a primary cardiac concern in the pediatric population with Down syndrome. Option C) Hyperlipidemia is not a cardiac manifestation specifically associated with Down syndrome. While individuals with Down syndrome may have alterations in lipid profiles, it is not a primary cardiac manifestation seen in this population. Option D) Cardiomyopathy is not a common cardiac manifestation in children with Down syndrome. While cardiomyopathy can occur in some individuals with Down syndrome, it is not as prevalent or strongly associated as congenital heart defects. Educationally, understanding the cardiac manifestations associated with Down syndrome is essential for nurses caring for pediatric patients. Recognizing the increased risk of CHD in children with Down syndrome allows for timely assessment, monitoring, and intervention to optimize outcomes and provide holistic care to these individuals.

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: B

Rationale: In pediatric nursing, conducting blood pressure (BP) screenings is crucial to detect end-organ damage early. The correct age to start routine BP screenings is at 3 years old (Option B) because this is when most children can cooperate with the procedure and accurate readings can be obtained. Starting BP screenings at birth (Option A) is not necessary as newborns may have transient fluctuations in BP due to various factors such as delivery stress. Waiting until 8 years (Option C) or 13 years (Option D) to begin BP screenings is too late as early detection of hypertension or other cardiovascular issues is essential for timely intervention and prevention of end-organ damage. Educationally, understanding the rationale behind the timing of BP screenings in children is vital for pediatric nurses to provide evidence-based care. It ensures that healthcare providers can monitor and intervene early in case of abnormal BP readings, thus safeguarding the cardiovascular health of pediatric patients. By starting screenings at 3 years old, healthcare professionals can establish a baseline for each child and track any deviations over time, contributing to comprehensive pediatric care.