Nokea
A 5-month-old previously well infant is found to have a loud holosystolic murmur (4/6) at the left sternal border. The first and second heart sounds are normal; there is no tachycardia, rumble, or gallop; and hepatomegaly is not noted. The child feeds well and has grown adequately. You suspect
- A. spontaneous closure is more common in muscular vs. membranous defects
- B. closure usually occurs in the first 2 years of life
- C. there is no risk of endocarditis
- D. pulmonary pressures are normal
Correct Answer: C
Rationale: Small VSDs still carry a risk of endocarditis despite being asymptomatic.
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Which action by the school nurse is important in the prevention of rheumatic fever?
- A. Encourage routine cholesterol screenings.
- B. Conduct routine blood pressure screenings.
- C. Refer children with sore throats for throat cultures.
- D. Recommend salicylates instead of acetaminophen for minor discomforts.
Correct Answer: C
Rationale: Nurses have a role in prevention—primarily in screening school-age children for sore throats caused by group A β-hemolytic streptococci. They can achieve this by actively participating in throat culture screening or by referring children with possible streptococcal sore throats for testing. Cholesterol and blood pressure screenings do not facilitate the recognition and treatment of group A β-hemolytic streptococci. Salicylates should be avoided routinely because of the risk of Reye syndrome after viral illnesses.
Skin lesions characteristically associated with CNS problems:
- A. Dermatitis herpetiformis
- B. Vitiligo
- C. Strawberry angioma on face
- D. Axillary freckling
Correct Answer: D
Rationale: Axillary freckling
The following features are more suggestive of biliary atresia rather than neonatal hepatitis in an infant 6 weeks of age:
- A. Hepatomegaly
- B. Prolonged INR (prothrombin time)
- C. Biopsy specimen showed proliferation of bile ductules, periportal fibrosis and bile lakes
- D. HillA scan reveals delayed uptake and excretion of the contrast material
Correct Answer: C
Rationale: Proliferation of bile ductules, periportal fibrosis, and bile lakes on biopsy are hallmark features of biliary atresia.
It is reasonable to suspect child abuse in the following situations:
- A. 6-month old with a large scalp bruise
- B. 7-year-old girl who is found masturbating
- C. 2-year old with multiple bruises of different ages over the shins
- D. 3-month old with failure to thrive
Correct Answer: A
Rationale: The correct answer is A because a large scalp bruise in a 6-month-old is highly suspicious for abuse. The other options (b-e) are less indicative of abuse.
The Norwood procedure is used to correct:
- A. Transposition of the great vessels
- B. Hypoplastic left heart syndrome
- C. Tetralogy of Fallot (TOF)
- D. Patent ductus arteriosus (PDA)
Correct Answer: B
Rationale: The Norwood procedure is specifically performed for hypoplastic left heart syndrome.