The school nurse has been following a child who frequently complains of dizziness and headache. Today, she is brought in after fainting in the cafeteria following a nosebleed. Her BP is 122/85, and her radial pulses are bounding. The nurse suspects she has:

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 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.

Correct Answer: B

Rationale: In pediatric cardiovascular nursing, understanding congenital cardiac lesions is crucial. The correct answer to the question is B) transposition of great arteries. This is the most common cyanotic congenital cardiac lesion to present in the newborn period. In transposition of the great arteries, the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle, leading to a mixing of oxygenated and deoxygenated blood without a communication between the two circulations. Option A) dextroposed heart refers to the heart being positioned more to the right within the chest, which is a structural variation and not a specific congenital cardiac lesion. Option C) tetralogy of Fallot consists of four classic components (ventricular septal defect, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy). While common, it is not the most common to present in the newborn period. Option D) truncus arteriosus is a rare congenital heart defect where a single blood vessel comes out of the heart, instead of the usual two vessels (aorta and pulmonary artery). It is less common than transposition of great arteries in newborns. Educationally, it is important to understand the prevalence and presentation of different congenital cardiac lesions in pediatric patients to provide appropriate care and interventions. By knowing the most common conditions, nurses can be better prepared to recognize and manage these critical situations effectively.

Correct Answer: D

Rationale: In pediatric cardiovascular nursing, it is crucial to understand the common causes of syncope in children to provide effective care. The correct answer is D) neurocardiogenic syncope. Neurocardiogenic syncope, also known as vasovagal syncope, is the most common cause of syncope in children. It occurs due to a sudden drop in heart rate and blood pressure, leading to temporary loss of consciousness. This is often triggered by emotional stress, pain, or standing for long periods. Option A) Wolff-Parkinson-White syndrome and option C) atrioventricular block are less common causes of syncope in children compared to neurocardiogenic syncope. Wolff-Parkinson-White syndrome is characterized by an accessory electrical pathway in the heart, leading to episodes of rapid heart rate, but it is not the most common cause of syncope. Atrioventricular block involves a disruption in the electrical signals between the atria and ventricles, which can lead to fainting but is not as prevalent in children as neurocardiogenic syncope. Option B) prolonged QT syndrome is a genetic disorder that affects the heart's electrical activity, potentially causing life-threatening arrhythmias. While prolonged QT syndrome can lead to fainting episodes, it is not as common a cause of syncope in children as neurocardiogenic syncope. Understanding the most common cause of syncope in children, such as neurocardiogenic syncope, is essential for nurses caring for pediatric patients. By recognizing the triggers and symptoms of neurocardiogenic syncope, nurses can implement appropriate interventions to prevent or manage episodes of syncope effectively, ensuring the safety and well-being of their young patients.