Deck 31: Cardiovascular Disorders

Question 1

A 12­year­old child whose BMI is greater than the 95th percentile has a blood
pressure at the 98th percentile for age, sex, and height. After lifestyle changes that include diet and exercise, the child's BMI drops to the 90th percentile, but the blood pressure remains the same. What is the primary care pediatric nurse practitioner's next step in treating this child?
A. Continued close monitoring of blood pressure
B. Ordering an echocardiogram or MRI
C. Prescribing an ACE inhibitor medication
D. Referral to a nephrologist or cardiologist

Answer 1

Referral to a nephrologist or cardiologist

Question 2

The primary care pediatric nurse practitioner provides primary care for a 4­month­
old infant who has a ventricular septal defect. The infant has been breastfeeding well but in the past month has dropped from the 20th percentile to the 5th for weight. What will the nurse practitioner recommend?
A. Adding solid foods to the infant's diet to increase caloric intake
B. Fortifying breast milk to increase the number of calories per ounce
C. Stopping breastfeeding and giving 30 kcal/ounce formula
D. Supplementing breastfeeding with 24 kcal/ounce formula

Answer 2

Fortifying breast milk to increase the number of calories per ounce

Question 3

A 12­month­old infant who had cardiopulmonary bypass with RBC and plasma
infusions during surgery at 8 months is seen for a well child examination. Which vaccine may be administered at this visit?
A. MMR
B. OPV
C. PCV­13
D. Varivax

Answer 3

PCV­13

Question 4

A 3­month­old infant who was previously healthy now has a persistent cough,
bilateral lung crackles, and poor appetite. The primary care pediatric nurse practitioner auscultates a grade III/VI, low­pitched, holosystolic murmur over the left lower sternal border and palpates the liver at one centimeter below the ribs. What diagnosis is likely?
A. Atrial septal defect
B. Coarctation of the aorta
C. Patent ductus arteriosis
D. Ventricular septal defect

Question 5

A 12­year­old child whose weight and BMI are in the 75th percentile has a
diastolic blood pressure that is between the 95th and 99th percentiles for age, sex, and height on three separate occasions. Initial tests for this child will include
A. complete blood count.
B. erythrocyte sedimentation rate.
C. renal function and plasma renin tests.
D. urinalysis and electrolytes.

Question 6

An infant with trisomy 21 has a complete AV canal defect. Which finding,
associated with having both of these conditions, will the primary care pediatric nurse practitioner expect?
A. Crackles in both lungs
B. Hepatomegaly
C. Oxygen desaturation
D. Peripheral edema

Question 7

During a well child assessment, the primary care pediatric nurse practitioner
auscultates a harsh, blowing grade IV/VI murmur in a 6­month­old infant. What will the nurse practitioner do next?
A. Get a complete blood count to rule out severe anemia.
B. Obtain an electrocardiogram to assess for arrhythmia.
C. Order a chest radiograph to evaluate for cardiomegaly.
D. Refer to a pediatric cardiologist for further evaluation.

Question 8

A 5­year­old child has an elevated blood pressure during a well child exam. The
primary care pediatric nurse practitioner notes mottling and pallor of the child's feet and lower legs and auscultates a systolic ejection murmur in the left infraclavicular region radiating to the child's back. The nurse practitioner will suspect which condition?
A. Aortic stenosis
B. Coarctation of the aorta
C. Patent ductus arteriosus
D. Pulmonic stenosis

Question 9

A 7­year­old child who has a history of a repaired congenital heart defect has
many dental caries along with gingival erythema and irritation and a temperature of 102.5°F. What will the primary care pediatric nurse practitioner do next?
A. Admit to the hospital with a pediatric cardiology consult.
B. Obtain blood cultures and a CBC and consult a pediatric cardiologist.
C. Refer the child to a pediatric dental surgeon immediately.
D. Start prophylactic antibiotics such as penicillin twice daily for 2 weeks.

Question 10

During a well baby examination of a 6­week­old infant, the primary care pediatric
nurse practitioner notes poor weight gain, acrocyanosis of the hands and feet, and a respiratory rate of 60 breaths per minute. Oxygen saturation on room air is 93%. The remainder of the exam is unremarkable. Which action is correct?
A. Follow­up in 1 week to assess the infant's weight.
B. Order a chest radiograph and an electrocardiogram.
C. Reassure the parents that the exam is within normal limits.
D. Refer the infant to a pediatric cardiologist.

Question 11

The primary care pediatric nurse practitioner is performing a well child
examination on a school­age child who had complete repair of a tetralogy of Fallot defect in infancy. What is important in this child's health maintenance regime?
A. Cardiology clearance for sports participation
B. Restriction of physical activity to avoid pulmonary complications
C. Sub­acute bacterial endocarditis prophylaxis precautions
D. Teaching about management of hypercyanotic episodes

Question 12

An adolescent female has a history of repaired tetralogy of Fallot. Which long­ term complication is a concern for this patient?
A. Aortic stenosis
B. Chronic cyanosis
C. Mitral valve prolapse
D. Ventricular failure

Question 13

A 5­year­old child who had a repair for transposition of the great arteries shortly
after birth is growing normally and has been asymptomatic since the surgery. The primary care nurse practitioner notes mild shortness of breath with exertion and, upon questioning, learns that the child has recently complained of dizziness. What will the nurse practitioner do?
A. Order an echocardiogram and chest radiograph.
B. Perform pulmonary function testing.
C. Reassure the parent that these symptoms are common.
D. Refer the child to the cardiologist immediately.

Question 14

A 6­year­old child has a systolic blood pressure between the 95th and 99th
percentile for age, sex, and height and a diastolic blood pressure between the 90th and the 95th percentile on three separate clinic visits. This child's blood pressure is classified as
A. normotensive.
B. pre­hypertensive.
C. stage 1 hypertensive.
D. stage 2 hypertensive.

Question 15

During a routine well child exam on a 5­year­old child, the primary care pediatric
nurse practitioner auscultates a grade II/VI, harsh, late systolic ejection murmur at the upper left sternal border that transmits to both lung fields. The child has normal growth and development. What will the nurse practitioner suspect?
A. Aortic stenosis
B. Patent ductus arteriosus
C. Pulmonic stenosis
D. Tricuspid atresia

Question 16

The primary care pediatric nurse practitioner is examining a 2­week­old infant and
auscultates a wide splitting of S2 during expiration. What condition may this finding represent?
A. Atrial septal defect
B. Coarctation of the aorta
C. Patent ductus arteriosis
D. Ventricular septal defect

Question 17

A 9­month­old infant has a grade III/VI, harsh, rumbling, continuous murmur in the
left infraclavicular fossa and pulmonic area. A chest radiograph reveals cardiac enlargement. The primary care pediatric nurse practitioner will refer the infant to a pediatric cardiologist and prepare the parents for which intervention to repair this defect?
A. Cardiopulmonary bypass surgery
B. Coil insertion in the catheterization laboratory
C. Indomethacin administration
D. Observation for spontaneous closure

Question 18

The primary care pediatric nurse practitioner is performing a sports physical on an
adolescent whose history reveals mild aortic stenosis. What will the nurse practitioner recommend?
A. Avoidance of all sports to prevent sudden death
B. Clearance for any sports since this is mild
C. Evaluation by a cardiologist prior to participation
D. Low­intensity sports, such as golf or bowling

Question 19

The primary care pediatric nurse practitioner performs a well child examination on
a 12­month­old child who had repair of a congenital heart defect at 8 months of age. The child has a normal exam. The parent reports that the child is not taking any medications. The nurse practitioner will contact the child's cardiologist to discuss whether the child needs which medication?
A. Amoxicillin
B. Capoten
C. Digoxin
D. Furosemide

Question 20

The primary care pediatric nurse practitioner auscultates a new grade II vibratory,
mid­systolic murmur at the mid sternal border in a 4­year­old child that is louder when the child is supine. What type of murmur is most likely?
A. Pathologic murmur
B. Pulmonary flow murmur
C. Still's murmur
D. Venous hum

Question 21

A 15­year­old female reports fainting at school in class on two occasions. The
adolescent's orthostatic blood pressures are normal. The primary care pediatric nurse practitioner suspects a cardiac cause for these episodes and will order which tests before referring her to a pediatric cardiologist?
A. 12­lead electrocardiogram
B. Echocardiogram
C. Tilt table testing
D. Treadmill exercise testing