Deck 38: Cardiovascular Disorders

Question 1

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

Answer 1

C

Question 2

A 12-year-old child whose weight and body mass index (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. Which test will be prescribed for this child initially?

A) complete blood count
B) erythrocyte sedimentation rate
C) renal function
D) urinalysis and electrolytes

Answer 2

C

Question 3

The primary care pediatric nurse practitioner (PNP) is performing a well child examination on a school-age child who had complete repair of a tetralogy of Fallot (TOF)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) Sub-acute bacterial endocarditis prophylaxis precautions
D) Teaching about management of hypercyanotic episodes

Answer 3

A

Question 4

The primary care pediatric nurse practitioner (PNP) performs a well child examination on a 12-month-old 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 5

The primary care pediatric nurse practitioner auscultates a new grade II vibratory, mid-systolic murmur at the mid sternal border in a 4-year-old 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 6

A 3-month-old 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, low-pitched, 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 (ASD)
B) Coarctation of the aorta (COA)
C) Patent ductus arteriosis (PDA)
D) Ventricular septal defect (VSD)

Question 7

The primary care pediatric nurse practitioner (PNP) is examining a 2-week-old infant and auscultates a wide splitting of S during expiration. What condition may this finding represent?

A) Atrial septal defect (ASD)
B) Coarctation of the aorta (COA)
C) Patent ductus arteriosis (PDA)
D) Ventricular septal defect (VSD)

Question 8

A 7-year-old child who has a history of a repaired congenital heart defect (CHD)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 9

A 12-year-old child whose body mass index (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
C) Prescribing an ACE inhibitor medication
D) Referral to a nephrologist or cardiologist

Question 10

The primary care pediatric nurse practitioner (PNP) is performing a sports physical on an adolescent whose history reveals mild aortic stenosis (AS). 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) Low-intensity sports, such as golf or bowling

Question 11

During a well baby examination of a 6-week-old 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) Follow-up 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 12

An adolescent female has a history of repaired tetralogy of Fallot (TOF). 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

During a well child assessment, the primary care pediatric nurse practitioner (PNP) auscultates a harsh, blowing grade IV/VI murmur in a 6-month-old 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 14

The primary care pediatric nurse practitioner provides primary care for a 4-month-old infant who has a ventricular septal defect (VSD). 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

Question 15

A 6-year-old 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 placed in which classification?

A) normotensive
B) pre-hypertensive
C) stage 1 hypertensive
D) stage 2 hypertensive

Question 16

During a routine well child exam on a 5-year-old 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 (AS)
B) Patent ductus arteriosus (PDA)
C) Pulmonic stenosis
D) Tricuspid atresia

Question 17

A 5-year-old 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 (AS)
B) Coarctation of the aorta (COA)
C) Patent ductus arteriosus (PDA)
D) Pulmonic stenosis

Question 18

A 9-month-old 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 19

A 12-month-old infant who had cardiopulmonary bypass with red blood cell (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) Measles, mumps, and rubella (MMR)
B) oral polio vaccine (OPV)
C) Live-viruse (PCV-13)
D) Varivax

Question 20

A 5-year-old 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 (PNP)notes mild shortness of breath with exertion and, upon questioning, learns that the child has recently reported 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 21

A 15-year-old 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) 12-lead electrocardiogram
B) Echocardiogram
C) Tilt table testing
D) Treadmill exercise testing