Of the following, the MOST common clinical sign of coarctation of the aorta in older children is

Correct Answer: B

Rationale: In pediatric nursing, understanding cardiovascular disorders like coarctation of the aorta is crucial. The correct answer for the most common clinical sign of coarctation of the aorta in older children being notching of the inferior border of the ribs (Option B) is due to the pathophysiology of this condition. Coarctation of the aorta causes a narrowing of the aorta, leading to increased pressure proximal to the constriction and decreased pressure distally. This pressure difference results in collateral circulation formation, which leads to rib notching due to dilated intercostal arteries. Option A, cardiac enlargement, is less common in coarctation of the aorta compared to other congenital heart defects. Option C, a systolic ejection click or thrill in the suprasternal notch, is more indicative of aortic stenosis. Option D, differential blood pressure with higher readings in the arms than the legs, is a classic finding in coarctation of the aorta but is not as specific or commonly seen as rib notching. Educationally, it is essential for nursing students to grasp the unique clinical manifestations of different cardiovascular conditions to provide accurate assessments and interventions. Understanding the specific signs and symptoms of coarctation of the aorta aids in timely diagnosis and management, ultimately improving patient outcomes.

Correct Answer: B

Rationale: In pediatric nursing, understanding signs of coarctation of the aorta is critical. The correct answer is B) bounding pulses of the arms. This is because coarctation of the aorta typically presents with weak or absent femoral pulses (option A), lower blood pressure in the legs compared to the arms (option C), and usually normal precordial impulse and heart sounds (option D). Bounding pulses in the arms are not a typical sign of coarctation of the aorta. This is due to the narrowing of the aorta that results in decreased blood flow to the lower extremities, leading to weaker pulses in the femoral arteries. Understanding these signs is important for nurses caring for pediatric patients as early recognition of coarctation of the aorta can lead to prompt intervention and management to prevent complications. Educationally, nurses need to be able to differentiate between the various signs and symptoms of cardiovascular conditions in pediatric patients to provide safe and effective care. By understanding the unique manifestations of coarctation of the aorta, nurses can advocate for appropriate diagnostic testing and interventions to improve patient outcomes.

Correct Answer: D

Rationale: In this question, the correct answer is D) pentostam. Pentostam is not known to cause long Q-T syndrome (LQTS). A) Trimethoprim/sulfamethoxazole, B) erythromycin, and C) imipramine are medications that have been associated with prolonging the QT interval and potentially leading to LQTS. Educationally, understanding the potential side effects of medications on cardiac conduction, such as prolonging the QT interval, is crucial for nurses caring for pediatric patients with cardiovascular conditions. Nurses must be able to identify medications that can cause LQTS to prevent adverse cardiac events in vulnerable populations. This knowledge informs safe medication administration practices and helps in early recognition and management of potential complications. It highlights the importance of thorough medication assessment, monitoring, and patient education to ensure safe pharmacological care in pediatric patients.

Correct Answer: D

Rationale: In this scenario, tall (>25 mm), narrow, and spiked P waves are indicative of severe mitral stenosis. This finding is known as P mitrale and is a result of left atrial enlargement due to the increased pressure in the left atrium caused by the stenotic mitral valve. Option A, Ebstein anomaly, is characterized by a congenital malformation of the tricuspid valve and displacement of the valve leaflets into the right ventricle. This condition typically presents with a wide range of ECG findings but not specifically tall, narrow, and spiked P waves. Option B, ventricular septal defect (VSD), is a congenital heart defect where there is an abnormal opening between the ventricles. This condition may lead to various ECG changes, but tall, narrow, and spiked P waves are not a typical finding associated with VSD. Option C, patent ductus arteriosus (PDA), is a congenital heart condition characterized by the persistence of the fetal connection between the aorta and pulmonary artery. ECG findings in PDA typically do not include tall, narrow, and spiked P waves. In a pediatric nursing context, understanding ECG findings specific to different cardiac conditions is crucial for early identification and management. Recognizing the ECG pattern of severe mitral stenosis can prompt timely interventions and prevent complications. Nurses caring for pediatric patients with cardiac conditions should be knowledgeable about these ECG findings to provide safe and effective care.

Correct Answer: B

Rationale: In pediatric nursing, understanding pharmacology is crucial for safe and effective patient care. In the context of this question on sildenafil, a medication commonly used for erectile dysfunction and pulmonary arterial hypertension, it is important to recognize the common side effects to monitor for adverse reactions in pediatric patients. The correct answer, B) elevated liver function tests, is not a common side effect of sildenafil. This is crucial to note as liver function should be monitored due to potential adverse effects on the liver, but elevated liver function tests are not typically associated with sildenafil use. A) Flushing is a common side effect of sildenafil due to its vasodilatory effect. C) Headache is also common, as sildenafil can cause headaches due to changes in blood flow. D) Myalgia, or muscle pain, can occur as a side effect of sildenafil due to its effects on blood flow and muscle relaxation. Educationally, this question highlights the importance of understanding common medication side effects in pediatric patients. Monitoring for and recognizing these side effects is essential for providing quality nursing care and ensuring patient safety when administering medications like sildenafil to children.