Family discharge teaching has been effective when the parent of a toddler diagnosed with Kawasaki disease (KD) states:

Correct Answer: C

Rationale: The correct answer is C) "I know she will be irritable for 2 months after her symptoms start." In Kawasaki disease (KD), a vasculitis affecting children, irritability is a common symptom during the subacute phase which occurs after the acute phase. This phase can last for several weeks to a couple of months, and it is important for parents to be aware of this to provide appropriate support and care for their child during this time. Option A is incorrect because arthritis is not a typical manifestation of KD, and knee replacements are not a standard treatment for this condition. Option B is incorrect as diphenhydramine is not used for peeling palms and soles in KD. Option D is incorrect as high doses of Tylenol are not the primary treatment for inflammation in KD. Educationally, this question reinforces the importance of patient education in pediatric cardiovascular nursing. It highlights the need for parents to understand the different phases and symptoms of KD to effectively care for their child at home. By knowing what to expect, parents can better support their child's recovery and communicate effectively with healthcare providers.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Coarctation of the aorta (COA). COA is a congenital heart defect characterized by a narrowing of the aorta, leading to increased blood pressure proximal to the defect and decreased pressure distally. The symptoms of dizziness, headache, fainting, and epistaxis (nosebleed) are indicative of the increased pressure in the upper body and head due to the narrowing of the aorta. The bounding radial pulses are a sign of increased pressure in the upper extremities. Option A) Transposition of the great vessels is incorrect because it typically presents with cyanosis in newborns due to a mixing of oxygenated and deoxygenated blood. Option C) Aortic stenosis is unlikely as it would present with a systolic ejection murmur and possibly chest pain, not the symptoms described in the scenario. Option D) Pulmonic stenosis is also not the correct answer as it would manifest with a systolic ejection murmur and possibly cyanosis, not the symptoms presented. Educationally, understanding the different congenital heart defects and their clinical presentations is crucial for pediatric nurses to provide timely and appropriate care. Recognizing the specific signs and symptoms of COA can lead to prompt intervention and prevent further complications in pediatric patients with this condition.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) ACE inhibitors. ACE inhibitors are contraindicated in pregnancy due to their potential to cause fetal harm, especially in the second and third trimesters. Since the sexually active adolescent female is using intermittent birth control, there is a risk of pregnancy if she were to become pregnant while on ACE inhibitors, it could harm the fetus. Beta blockers (option A) are generally considered safe for use in hypertension, but they may not be the best choice in this case due to their potential to mask certain symptoms of hypoglycemia, which could affect the efficacy of birth control. Calcium channel blockers (option B) are also commonly used in treating hypertension, but they do not carry the same risks as ACE inhibitors in pregnancy. Diuretics (option D) are another class of medications used in hypertension, but they do not pose the same risks in pregnancy as ACE inhibitors. Educationally, this question highlights the importance of considering the individual patient's circumstances when selecting medications, especially in vulnerable populations like adolescents. It underscores the need for healthcare providers to be aware of potential drug interactions and contraindications to ensure safe and effective treatment.

Correct Answer: C

Rationale: In managing congestive heart failure (CHF) in an infant, feeding in a semi-Fowler position (Option C) is the most appropriate plan. This position helps reduce the workload on the heart by decreasing venous return and preventing excessive fluid accumulation in the lungs. By positioning the infant upright, gravity assists in reducing the pooling of blood in the lungs and aids in easier breathing. Option A, promoting fluid restriction, may be necessary in some cases of CHF, but it is not the primary intervention for controlling CHF in infants. Option B, feeding a low-salt formula, may be beneficial in adult patients with heart failure, but infants require adequate salt for normal growth and development. Option D, encouraging breast milk, is generally beneficial for infants but does not directly address the management of CHF. In an educational context, understanding the physiology of CHF in infants is crucial for pediatric nurses. Teaching about proper positioning during feeding can significantly impact the management of CHF and improve outcomes for infants with this condition. Nurses need to be aware of the rationale behind each intervention to provide safe and effective care for pediatric patients with cardiovascular conditions.

Correct Answer: B

Rationale: In this case, the correct answer is B) Patent ductus arteriosus (PDA). A PDA is a congenital heart defect where the ductus arteriosus, a blood vessel connecting the pulmonary artery to the aorta, fails to close after birth. This results in a continuous flow of blood between the aorta and pulmonary artery, leading to the characteristic machine-like heart murmur, wide pulse pressure, and respiratory symptoms seen in this newborn. Option A) Pulmonary hypertension typically presents with different clinical manifestations such as cyanosis, right heart failure, and a loud P2 sound on auscultation. Option C) Ventricular septal defect (VSD) would present with a different murmur quality, usually a harsh holosystolic murmur, and may not be associated with the specific respiratory symptoms described. Option D) Bronchopulmonary dysplasia is a lung condition seen in premature infants due to prolonged mechanical ventilation or oxygen exposure, and it would not explain the cardiovascular findings in this case. Understanding these distinctions is crucial for nurses working in pediatric cardiovascular care to accurately assess and provide appropriate interventions for newborns with respiratory distress. Recognizing the signs and symptoms of various cardiac defects can lead to timely interventions and improved outcomes for pediatric patients.