Nokea
An infant with trisomy 21 has a complete AV canal defect. Which finding associated with both conditions will the primary care pediatric nurse practitioner expect?
- A. Crackles in both lungs
- B. Hepatomegaly
- C. Oxygen desaturation
- D. Peripheral edema
Correct Answer: C
Rationale: Because infants with trisomy 21 maintain neonatal high pulmonary vascular resistance, they often do not show signs of CHF but instead will have signs of pulmonary hypertension with loud single S2 and desaturation with agitation or effort.
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Surgical repair of VSD should be considered at the time of diagnosis
- A. small supracristal VSD
- B. VSD with heart failure
- C. hemodynamically restrictive VSD
- D. significant VSD
Correct Answer: B
Rationale: Significant or symptomatic VSDs warrant early surgical intervention.
Treatment for congestive heart failure (CHF) in an infant began 3 days ago and has included digoxin and furosemide. The child no longer has retractions, lungs are clear, and HR is 96 beats per minute while sleeping. The nurse is confident that the child has diuresed successfully and has good renal perfusion when the nurse notes the child's urine output is:
- A. 0.5 cc/kg/hr
- B. 1 cc/kg/hr
- C. 30 cc/hr
- D. 1 oz/hr
Correct Answer: B
Rationale: Normal pediatric urine output is approximately 1 cc/kg/hr.
During a routine well child exam on a 5-year-old child, a grade II/VI, harsh, late systolic ejection murmur at the upper left sternal border that transmits to both lung fields is auscultated. 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
Correct Answer: C
Rationale: Pulmonic stenosis may be asymptomatic with a murmur as described above.
All of the following are conditions with combined cellular and antibody immunodeficiency, except
- A. Ataxia telangiectasia
- B. Reticular dysgenesis
- C. Common variable immunodeficiency
- D. Severe combined immunodeficiency
Correct Answer: C
Rationale: Common variable immunodeficiency (CVID) is primarily an antibody deficiency, not a combined immunodeficiency.
Which finding might delay a cardiac catheterization procedure on a 1-year-old?
- A. 30th percentile for weight
- B. Severe diaper rash
- C. Allergy to soy
- D. Oxygen saturation of 91% on room air
Correct Answer: B
Rationale: A severe diaper rash may indicate potential infection, which is a contraindication for the standard groin approach during catheterization.