Hemophilia A is characterized by:

Correct Answer: C

Rationale: In hemophilia A, which is a genetic disorder caused by deficiency of clotting factor VIII, the correct answer is C) Prolonged APTT (activated partial thromboplastin time). This is because hemophilia A specifically affects the intrinsic pathway of the coagulation cascade, leading to a prolonged APTT due to the deficiency of factor VIII. Option A) Prolonged bleeding time is incorrect because hemophilia A primarily affects clotting factors, not platelet function, which is assessed by bleeding time. Option B) Prolonged prothrombin time is incorrect because prothrombin time primarily evaluates the extrinsic pathway of the coagulation cascade, which is not primarily affected in hemophilia A. Option D) Prolonged thrombin time is incorrect because thrombin time evaluates the conversion of fibrinogen to fibrin, which is not directly impacted by factor VIII deficiency in hemophilia A. Educationally, understanding the specific clotting factors involved in hemophilia A and how they affect different parts of the coagulation cascade is crucial for accurate diagnosis and management of patients with this condition. Nurses caring for pediatric patients with hemophilia A need to recognize the importance of monitoring APTT levels and administering factor replacement therapy to prevent and treat bleeding episodes effectively.

Correct Answer: B

Rationale: In the case of an infant with marked cyanotic heart defect and decreased pulmonary vascularity, the correct treatment option is Prostaglandin E1 (Option B). Prostaglandin E1 is used to maintain the patency of the ductus arteriosus in such cases, allowing for improved mixing of oxygenated and deoxygenated blood, which can help alleviate cyanosis and improve oxygenation. Epinephrine (Option A) is a medication used in cases of cardiac arrest or severe allergic reactions and would not be the primary treatment for this specific cardiac condition. Dopamine (Option C) is a medication used to support blood pressure and cardiac output in cases of hypotension, which may not directly address the underlying cyanotic heart defect. Digoxin (Option D) is a medication used in some cases of heart failure but is not the first-line treatment for a marked cyanotic heart defect with decreased pulmonary vascularity. In an educational context, understanding the rationale behind the correct treatment is crucial for pediatric nurses caring for infants with complex cardiac conditions. Knowing the appropriate medications and their mechanisms of action can significantly impact patient outcomes and ensure safe and effective care delivery. This knowledge also highlights the importance of thorough assessment, accurate diagnosis, and evidence-based treatment interventions in pediatric nursing practice.

Correct Answer: A

Rationale: In pediatric nursing, understanding the timing of heart murmurs is crucial for accurate assessment and diagnosis. In this case, the correct answer is A) Ejection systolic. An innocent murmur is typically heard during systole, which is the contraction phase of the heart cycle. Ejection systolic murmurs are the most common innocent murmurs in children and are often heard during the ejection phase of systole when blood is being pumped out of the heart through the semilunar valves. Option B) Pansystolic murmurs occur throughout systole and are more commonly associated with pathological conditions such as mitral regurgitation. Option C) Early diastolic murmurs are heard during the early filling phase of the heart, not during systole where innocent murmurs are usually found. Option D) Mid diastolic murmurs occur during the middle of diastole, which is the relaxation phase of the heart cycle, and are typically associated with conditions like mitral stenosis. Educationally, it is important for nursing students to grasp the timing characteristics of heart murmurs to differentiate between innocent murmurs and pathological murmurs. This knowledge is vital for providing safe and effective care to pediatric patients, as misinterpreting a murmur could lead to unnecessary interventions or missed diagnoses. Understanding the timing helps in making accurate clinical judgments and appropriate referrals for further evaluation or treatment.

Correct Answer: A

Rationale: In pediatric nursing, recognizing specific heart murmurs is crucial for accurate assessment and diagnosis of structural heart diseases. The correct answer, A) Large atrial septal defect, is associated with a left-to-right shunt, which does not cause turbulent blood flow leading to an apical mid diastolic rumble. Option B) Severe mitral incompetence results in turbulent blood flow during systole, which can create a murmur heard at the apex but not a diastolic rumble. Option C) Mitral valve stenosis produces a diastolic murmur, not a mid diastolic rumble. Option D) Aortic rheumatic carditis with mitral valvulitis typically presents with a diastolic murmur due to stenosis or regurgitation, not a mid diastolic rumble. Educationally, understanding the specific characteristics of heart murmurs associated with different structural heart diseases is vital for pediatric nurses to provide comprehensive care. By differentiating between murmurs, nurses can assist in prompt identification, appropriate referral, and effective management of pediatric patients with congenital or acquired heart conditions.

Correct Answer: D

Rationale: The correct answer is D) Prolonged PR interval on ECG. In pediatric patients with rheumatic fever (RF), an active phase is characterized by the presence of certain clinical manifestations. These include fever, elevated acute phase reactants, and tachycardia. However, a prolonged PR interval on an ECG is not a defining feature of active RF. Fever of 38°C or more for 3 successive days is a common symptom of active RF due to the inflammatory response. A positive acute phase reactant, such as elevated C-reactive protein or erythrocyte sedimentation rate, indicates ongoing inflammation in the body. A sleeping pulse rate > 100 beats per minute is a sign of tachycardia, which can occur in RF due to cardiac involvement. Educationally, understanding the clinical manifestations of RF is crucial for pediatric nurses to provide appropriate care. Recognizing the signs of active RF helps in timely interventions and prevents complications. By knowing the specific criteria for diagnosing active RF, nurses can advocate for prompt treatment and monitoring to improve patient outcomes.