Pediatric Nurse Exam Pediatric Nurse Respiratory and Cardiovascular Disorders 2 — Questions and Answers
Question 1: A 4-year-old with Tetralogy of Fallot is experiencing a hypercyanotic (tet) spell with sudden severe cyanosis and irritability. What is the priority nursing intervention?
- Administer supplemental oxygen via non-rebreather mask only
- Place the child in a knee-chest (squatting) position (Correct answer)
- Immediately administer IV morphine sulfate
- Prepare the child for emergent surgical repair
Correct answer: Place the child in a knee-chest (squatting) position
Placing the child in the knee-chest position increases systemic vascular resistance by compressing femoral arteries, which reduces right-to-left shunting and improves pulmonary blood flow and oxygenation.
Question 2: A 2-year-old is admitted with prolonged fever, bilateral conjunctival injection, cracked lips, and a strawberry tongue. Which diagnosis is most likely?
- Scarlet fever
- Measles (rubeola)
- Kawasaki disease (Correct answer)
- Staphylococcal scalded skin syndrome
Correct answer: Kawasaki disease
Kawasaki disease is characterized by fever lasting ≥5 days plus at least four of five classic features: conjunctival injection, oral mucosal changes (strawberry tongue, cracked lips), rash, extremity changes, and cervical lymphadenopathy.
Question 3: Why is a ventricular septal defect (VSD) classified as an acyanotic congenital heart defect?
- It involves a right-to-left shunt that bypasses the lungs
- It requires emergent surgical correction at birth
- Oxygenated blood shunts from the left ventricle to the right ventricle, recirculating to the lungs (Correct answer)
- Pulmonary blood flow is significantly decreased
Correct answer: Oxygenated blood shunts from the left ventricle to the right ventricle, recirculating to the lungs
In VSD, higher left ventricular pressure forces oxygenated blood across the defect into the right ventricle (left-to-right shunt), increasing pulmonary blood flow without systemic desaturation, so the child remains pink (acyanotic).
Question 4: A child diagnosed with coarctation of the aorta would most likely demonstrate which blood pressure finding on assessment?
- Equal blood pressures in all four extremities
- Lower blood pressure in the upper extremities than the lower extremities
- Bounding, equal pulses throughout all extremities
- Higher blood pressure in the upper extremities than the lower extremities (Correct answer)
Correct answer: Higher blood pressure in the upper extremities than the lower extremities
Coarctation of the aorta creates a mechanical obstruction that causes hypertension proximal to the narrowing (upper extremities) and hypotension or diminished pulses distal to it (lower extremities).
Question 5: Which medication is administered to a neonate with ductal-dependent congenital heart disease to maintain patency of the ductus arteriosus?
- Indomethacin (a prostaglandin inhibitor)
- Prostaglandin E1 (alprostadil) (Correct answer)
- Furosemide to reduce pulmonary congestion
- Digoxin to improve cardiac contractility
Correct answer: Prostaglandin E1 (alprostadil)
Prostaglandin E1 relaxes the smooth muscle of the ductus arteriosus to keep it open, which is essential in ductal-dependent lesions where survival depends on ductal flow for pulmonary or systemic circulation.
Question 6: Which is the most serious long-term complication of untreated or inadequately treated rheumatic fever?
- Chronic renal failure from immune complex deposition
- Peripheral arterial occlusive disease
- Cardiac valve damage leading to rheumatic heart disease (Correct answer)
- Persistent pulmonary hypertension
Correct answer: Cardiac valve damage leading to rheumatic heart disease
Rheumatic fever causes an autoimmune inflammatory response that damages cardiac valves (most commonly the mitral valve), leading to rheumatic heart disease with stenosis or regurgitation over time.
Question 7: A child with congestive heart failure is assessed. Which clinical findings are most consistent with right-sided heart failure?
- Pulmonary crackles and pink frothy sputum
- Hepatomegaly and dependent pitting edema (Correct answer)
- Severe dyspnea at rest and orthopnea
- Decreased oxygen saturation and tachypnea
Correct answer: Hepatomegaly and dependent pitting edema
Right-sided heart failure causes systemic venous congestion, resulting in hepatomegaly (from hepatic venous engorgement) and peripheral pitting edema as fluid backs up into the systemic circulation.
Pediatric Nurse Exam Pediatric Nurse Respiratory and Cardiovascular Disorders 2
A 4-year-old with Tetralogy of Fallot is experiencing a hypercyanotic (tet) spell with sudden severe cyanosis and irritability.
What is the priority nursing intervention?