Despite the use of antibiotic agents, mortality remains high, in the range of 20-25%. Serious morbidity occurs in 50-60% of children with documented infective endocarditis. Of the following, the MOST common morbidity is

Correct Answer: A

Rationale: In pediatric nursing, understanding the complications of infective endocarditis is crucial for providing effective care. In this scenario, the correct answer is A) heart failure. This is the most common morbidity because infective endocarditis can lead to significant damage to the heart valves, resulting in impaired cardiac function and ultimately heart failure. Option B) pulmonary emboli is less common in pediatric infective endocarditis compared to adults. Pulmonary emboli occur when blood clots travel to the lungs, which is not a primary complication seen in pediatric cases. Option C) mycotic aneurysms can occur in infective endocarditis, but they are not as common as heart failure in terms of morbidity. Mycotic aneurysms are localized dilations of blood vessels due to infection, which can lead to serious complications but are not as prevalent as heart failure. Option D) acquired ventricular septal defect is a possible complication of infective endocarditis, but it is not as common as heart failure. Ventricular septal defects are abnormal communications between the two lower chambers of the heart and can result from the infection damaging the heart structures. Educationally, understanding the most common morbidities associated with infective endocarditis in pediatric patients is essential for nurses to provide optimal care and monitoring. Recognizing signs of heart failure early, such as respiratory distress, poor feeding, and tachycardia, can lead to timely interventions and improved outcomes for these vulnerable patients.

Correct Answer: D

Rationale: In pediatric nursing, understanding the importance of measuring serum potassium levels in children with confirmed hypertension is crucial for detecting potential underlying conditions. In this scenario, the correct answer is D) apparent mineralocorticoid excess (AME). AME is a rare genetic disorder characterized by hypertension, low renin and aldosterone levels, and hyperkalemia. Due to the impaired activity of the enzyme 11-beta hydroxysteroid dehydrogenase type 2, which normally inactivates cortisol to cortisone in the kidney, cortisol can bind to mineralocorticoid receptors, leading to increased sodium reabsorption and potassium excretion. Option A) Liddle syndrome and B) Gordon syndrome are both characterized by hypertension but typically present with hypokalemia rather than hyperkalemia. In Liddle syndrome, there is increased renal sodium reabsorption through epithelial sodium channels, while Gordon syndrome involves mutations in WNK kinases affecting sodium-chloride cotransporters. Option C) glucocorticoid remediable aldosteronism (GRA) is associated with hypertension and low renin levels, but hyperkalemia is not a typical feature. In GRA, aldosterone is produced under the control of adrenocorticotropic hormone (ACTH) due to a chimeric gene. Educationally, recognizing these distinct genetic disorders affecting potassium levels and blood pressure regulation in pediatric patients is vital for accurate diagnosis and management. Monitoring serum potassium levels helps identify specific conditions like AME, guiding appropriate treatment strategies and improving patient outcomes.

Correct Answer: A

Rationale: The correct match in this question is A) Tuberous sclerosis-Cardiac rhabdomyoma. Tuberous sclerosis is a genetic disorder characterized by the growth of noncancerous tumors in multiple organs, including the heart. Cardiac rhabdomyomas are a type of tumor commonly seen in infants with tuberous sclerosis. This association is important to recognize for early diagnosis and management of cardiovascular complications in pediatric patients with tuberous sclerosis. Option B) WPW syndrome-SVT is incorrect because Wolff-Parkinson-White (WPW) syndrome is a cardiac condition characterized by an accessory pathway that can lead to supraventricular tachycardia (SVT), but the direct match here is not accurate for this question. Option C) Maternal SLE-Irreversible complete heart block is incorrect because systemic lupus erythematosus (SLE) can lead to congenital heart block in infants born to mothers with SLE, not necessarily irreversible complete heart block as stated in the option. Option D) Parvo B19-Roseola infectiosum is incorrect because Parvovirus B19 is associated with fifth disease (erythema infectiosum) and not with roseola infectiosum, which is usually caused by human herpesvirus 6. Understanding these associations is crucial for nurses caring for pediatric patients with cardiovascular disorders. Recognizing these relationships can aid in early identification, appropriate interventions, and improved outcomes for these vulnerable patients.

Correct Answer: B

Rationale: In pediatric nursing, understanding the changes that occur in the cardiovascular (CVS) and respiratory systems at birth is crucial for providing optimal care to newborns. The correct answer is B) Increase in Oxygen concentration in Aorta. At birth, there is a significant transition in the CVS and respiratory systems. The closure of the fetal shunts, such as the ductus arteriosus and foramen ovale, leads to an increase in oxygen concentration in the aorta. This occurs because, during fetal life, the majority of oxygenated blood bypasses the lungs through these shunts, but at birth, when the lungs start functioning, oxygenated blood directly enters the systemic circulation through the aorta. Now, let's discuss why the other options are incorrect: A) Increase in pulmonary vascular resistance: This is not a change that occurs at birth. In fact, there is a decrease in pulmonary vascular resistance after birth to facilitate blood flow through the lungs for oxygenation. C) Increase in the right ventricular pressure: Right ventricular pressure actually decreases at birth as the resistance in the pulmonary circulation decreases and the left side of the heart takes over pumping oxygenated blood to the body. D) Reversal of flow through the ductus arteriosus: At birth, the ductus arteriosus constricts and eventually closes due to the increase in oxygen concentration in the aorta, stopping the flow of blood from the pulmonary artery to the aorta through this shunt. Understanding these physiological changes is essential for nurses caring for newborns with cardiovascular disorders. It helps in recognizing normal adaptations and identifying any abnormalities that may require intervention. By grasping these concepts, nurses can provide appropriate care and support to newborns during this critical transitional period.

Correct Answer: C

Rationale: The correct answer is C) Pulmonary Atresia. Closure of the ductus arteriosus is essential in fetal development to redirect blood flow away from the pulmonary circulation. In conditions like pulmonary atresia where there is absence of a pulmonary valve, closure of the ductus arteriosus will result in severe hypoxemia as blood cannot flow to the lungs for oxygenation. Option A) Coarctation of Aorta is a condition where there is a narrowing of the aorta, closure of the ductus arteriosus would not directly worsen this condition. Option B) TGA without VSD (Transposition of the great arteries without ventricular septal defect) is a condition where the aorta and pulmonary artery are switched. Closure of the ductus arteriosus may not significantly worsen this condition. Option D) Hypoplastic left heart is a condition where the left side of the heart is underdeveloped. Closure of the ductus arteriosus may not worsen this condition as it is mainly related to the left side of the heart. Understanding the impact of ductal closure in different cardiovascular conditions is crucial in pediatric nursing, especially in managing patients with complex congenital heart defects. Nurses need to be aware of how ductal closure can affect hemodynamics and oxygenation in these patients to provide appropriate care.