Nokea
A child has been diagnosed with valvular disease following rheumatic fever (RF). During patient teaching, the nurse discusses the child’s long-term prophylactic therapy with antibiotics for dental procedures, surgery, and childbirth. The parents Indicate they understand when they say:
- A. “She will need to take the antibiotics until she turns 18 years old.â€
- B. “She will need to take the antibiotics for 5 years after the last attack.â€
- C. “She will need to take the antibiotics for 10 years after the last attack.â€
- D. “She will need to take the antibiotics for the rest of her life.â€
Correct Answer: D
Rationale: Lifelong antibiotic prophylaxis is recommended for individuals with valvular disease following rheumatic fever to prevent recurrent infections and further cardiac damage.
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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
Correct Answer: B
Rationale: Coarctation of the aorta may not have symptoms until later childhood and may present as high blood pressure in the upper extremities and poor perfusion in the lower extremities.
The following investigations are not needed in a 3-year old on TPN for the past 3 weeks:
- A. Serum selenium
- B. Serum manganese
- C. Serum iron
- D. Serum calcium
Correct Answer: C
Rationale: The correct answer is C because serum iron is not typically monitored in children on total parenteral nutrition (TPN). The other options (a, b, d, e) are commonly monitored to prevent deficiencies or toxicities.
In homo cystinuria:
- A. Homocysteine accumulates just proximal to the enzyme defect
- B. Osteoporosis is a recognised feature
- C. Oral contraceptive pills with oestrogens are contraindicated
- D. Dislocation of lens is a feature
Correct Answer: D
Rationale: Dislocation of the lens is a well-documented feature of homocystinuria due to the accumulation of homocysteine, which affects connective tissue.
In hyper cyanotic spells in Fallots tetralogy
- A. Hypoxia is there
- B. Murmur disappear
- C. Right to left shunt increases
- D. Acidosis occur
Correct Answer: C
Rationale: During hypercyanotic spells in Tetralogy of Fallot, the right-to-left shunt increases, leading to worsening cyanosis.
An 8-year-old female presents with chest pain of 1 day's duration. Five days prior to the pain, she had fever, chills, and myalgias. Physical examination reveals an uncomfortable, anxious, afebrile patient with tachycardia, no murmur, and distant heart sounds. The chest x-ray is shown in Figure 19-2. There is a paradoxical pulse of 22 mm Hg. The most likely diagnosis is
- A. myocarditis
- B. cardiomyopathy
- C. Kawasaki disease
- D. pericarditis
Correct Answer: D
Rationale: Pericarditis causes distant heart sounds, paradoxical pulse, and can follow viral illnesses.