During play, a toddler with a history of tetralogy of Fallot (TOF) might assume which position?

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: B

Rationale: In this scenario, the correct answer is B) Strep throat. This child is presenting with symptoms suggestive of Sydenham chorea, a complication of untreated streptococcal infection. Sydenham chorea is characterized by spastic movements, facial grimaces, and speech disturbances, worsened by anxiety and relieved by sleep. Understanding this association between streptococcal infection and Sydenham chorea is crucial for nurses to provide appropriate care and education to patients and families. A) Kawasaki disease (KD) is unlikely in this case as it presents with symptoms like fever, rash, conjunctivitis, strawberry tongue, and swollen hands/feet. These symptoms do not align with the clinical presentation described in the question. C) Malignant hypertension typically presents with severe hypertension, headache, blurred vision, and can lead to end-organ damage. The symptoms described do not match those of malignant hypertension. D) Atrial fibrillation is an abnormal heart rhythm that can present with palpitations, chest discomfort, dizziness, and fatigue. The symptoms described in the question are not indicative of atrial fibrillation. Nurses need to be knowledgeable about the various manifestations of different conditions, especially in pediatrics, to provide timely and effective care. Understanding the link between streptococcal infection and Sydenham chorea can prompt early intervention and prevent long-term complications.

Correct Answer: B

Rationale: In pediatric patients, administering digoxin requires a thorough assessment to ensure safe and effective medication administration. The correct answer is option B, which is to assess the apical pulse rate. This is crucial because digoxin is a medication that affects the heart by increasing the strength and efficiency of its contractions. Monitoring the pulse rate helps to prevent potential toxicity, as bradycardia is a common sign of digoxin overdose in children. Option A, assessing the sclera, is not directly related to digoxin administration in pediatrics. While jaundice may indicate liver dysfunction, it is not a specific assessment for digoxin. Option C, assessing cough, is not a primary concern before administering digoxin. Cough could be indicative of respiratory issues or other conditions, but it is not a direct consideration for digoxin administration. Option D, liver function tests, are important for monitoring patients on long-term digoxin therapy due to the drug's hepatic metabolism. However, this is not typically assessed prior to a single dose administration of digoxin in a pediatric setting. Educationally, understanding the rationale behind assessing the apical pulse rate before administering digoxin highlights the importance of tailored assessments for pediatric patients to ensure medication safety and efficacy. Nurses must be diligent in their assessments to prevent adverse reactions and promote positive patient outcomes.

Correct Answer: B

Rationale: In the context of pediatric cardiovascular conditions, the correct answer to the question, "Which patient could require feeding by gavage?" is option B) Toddler with repair of transposition of the great vessels. Gavage feeding, also known as tube feeding, may be necessary in this case due to the postoperative recovery period following a major cardiac surgery like the repair of transposition of the great vessels. In this scenario, the correct answer is right because after undergoing such a complex surgical procedure, the toddler may have temporary difficulty with oral feeding due to factors like intubation, prolonged anesthesia, or decreased appetite. Gavage feeding ensures adequate nutrition and hydration during this critical recovery phase when oral intake may be insufficient. Now, let's explore why the other options are incorrect: - Option A) Infant with congestive heart failure (CHF): While infants with CHF may have feeding difficulties, gavage feeding is not typically the first-line intervention in managing CHF unless there are severe complications affecting oral intake. - Option C) Toddler with Kawasaki disease (KD) in the acute phase: Children with KD may have fever and inflammation, but gavage feeding is not typically a primary intervention for this condition unless there are specific complications impacting oral feeding. - Option D) School-age child with rheumatic fever (RF) and chorea: Chorea, a movement disorder associated with RF, does not directly indicate the need for gavage feeding. Nutritional support in RF is generally managed through standard oral intake unless there are specific complications. Educationally, understanding the rationale behind the need for gavage feeding in pediatric patients with complex cardiovascular conditions is crucial for nurses and healthcare providers. It highlights the importance of individualized care and appropriate nutrition support strategies in addressing the unique needs of children recovering from cardiac surgeries. This knowledge enhances patient safety, promotes optimal recovery outcomes, and underscores the significance of comprehensive care in pediatric pharmacology and nursing practice.

Correct Answer: C

Rationale: In the context of caring for a child with rheumatic fever (RF), option C, "I will give him the aspirin that is ordered for pain and inflammation," is the correct choice. This statement demonstrates a good understanding because aspirin is commonly prescribed to manage pain and inflammation in RF due to its anti-inflammatory and analgesic properties. Aspirin also helps prevent complications like rheumatic heart disease in RF patients. Option A suggesting applying heat to swollen joints is incorrect because heat can exacerbate inflammation and should be avoided in RF. Option B recommending gentle stretching exercises is also incorrect as aggressive exercise can lead to further joint damage in RF. Option D suggesting cold packs for reducing pain is not ideal as cold therapy can worsen vasoconstriction and pain in RF. Educationally, understanding the rationale behind the use of aspirin in RF is crucial for nursing students to provide safe and effective care to pediatric patients with this condition. It is essential for nurses to be aware of the appropriate pharmacological interventions and their implications in managing RF symptoms to promote optimal outcomes for these young patients.