Nokea
During a well baby examination of a 6-week-old infant, poor weight gain, acrocyanosis of the hands and feet, and a respiratory rate of 60 breaths per minute are noted. Oxygen saturation on room air is 93%. What is the correct action?
- 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.
Correct Answer: D
Rationale: Infants with oxygen saturation less than 95% and those with poor feeding should be referred emergently to a cardiologist.
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The Duke criterion for the diagnosis of endocarditis is a major
- A. new regurgitant flow by echocardiography
- B. Osler nodes
- C. single positive blood culture
- D. serologic evidence of infection
Correct Answer: C
Rationale: A single positive blood culture is one of the major criteria for diagnosing endocarditis.
Accepted maintenance treatment for chronic asthma includes the following:
- A. High-dose inhaled steroids and long-acting bronchodilators
- B. Montelucast
- C. Montelucast and inhaled steroids
- D. Long-acting ~2-agonists alone
Correct Answer: A
Rationale: The correct answer is A because high-dose inhaled steroids and long-acting bronchodilators are the mainstay of chronic asthma management. The other options (b-e) are less commonly used or not first-line.
The child becomes unresponsive. The most likely underlying lesion is
- A. cardiomyopathy
- B. anomalous coronary artery
- C. tetralogy of Fallot
- D. constipation
Correct Answer: C
Rationale: Tetralogy of Fallot can cause hypoxic spells leading to unresponsiveness.
Nurse Victoria is teaching the parents of a school-age child. Which teaching topic should take priority?
- A. Prevent accidents
- B. Keeping a night light on to allay fears
- C. Explaining normalcy of fears about body integrity
- D. Encouraging the child to dress without help
Correct Answer: A
Rationale: Accident prevention is a priority for school-age children as they become more independent and engage in activities that may pose risks.
The MOST common cause of pulmonary hypertension in pediatric patients is
- A. idiopathic pulmonary hypertension
- B. pulmonary venoocclusive disease
- C. left-sided valvular heart disease
- D. chronic obstructive pulmonary disease
Correct Answer: A
Rationale: Idiopathic pulmonary hypertension is a rare but recognized cause of pulmonary hypertension in children.