Nokea
Increased left ventricular end diastolic volume is seen in:
- A. Mitral regurgitation
- B. Congestive cardiomyopathy
- C. Hypertrophic obstructive cardiomyopathy
- D. Aortic stenosis
Correct Answer: A
Rationale: Mitral regurgitation leads to increased left ventricular end-diastolic volume due to backflow of blood into the left atrium.
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Which among the following is not a feature of low flow - low gradient severe aortic stenosis with preserved left ventricular function?
- A. Mean trans aortic pressure gradient < 40 mm Hg
- B. Aortic valve area < 1 cm²
- C. Stroke volume > 35 ml/m²
- D. Left ventricular ejection fraction > 50%
Correct Answer: C
Rationale: Stroke volume is typically reduced, not increased, in low flow - low gradient severe aortic stenosis.
BP screenings to detect end-organ damage should be done routinely beginning at what age?
- A. Birth
- B. 3 years
- C. 8 years
- D. 13 years
Correct Answer: B
Rationale: The recommended age to establish a baseline blood pressure in a healthy child is around 3 years.
Which of the following skills would be expected of a 7-month-old infant but not of a 5-month-old infant?
- A. Crawls
- B. Smiles socially
- C. Controls bowel and bladder
- D. Sits unsupported
Correct Answer: D
Rationale: A 7-month-old can typically sit unsupported, while a 5-month-old cannot. Crawling and social smiling develop earlier, and bowel control is not expected at this age.
The clinic nurse reviews the record of a child just seen by the health care provider and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder?
- A. Pallor
- B. Hyperactivity
- C. Exercise intolerance
- D. Gastrointestinal disturbances
Correct Answer: C
Rationale: Exercise intolerance is a common clinical manifestation of aortic stenosis due to the heart's inability to pump sufficient blood during increased physical activity.
A 12-year-old child whose body mass index (BMI) is greater than the 95th percentile has a blood pressure at the 98th percentile for age, sex, and height. After lifestyle changes that include diet and exercise, the child's BMI drops to the 90th percentile, but the blood pressure remains the same. What is the primary care pediatric nurse practitioner's next step in treating this child?
- A. Continued close monitoring of blood pressure
- B. Ordering an echocardiogram
- C. Prescribing an ACE inhibitor medication
- D. Referral to a nephrologist or cardiologist
Correct Answer: D
Rationale: Children who have persistent BP elevation after lifestyle changes are made should be referred to a nephrologist or cardiologist who has experience using antihypertensive agents in children.