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What are FOUR possible differential diagnoses associated with aortopathy in a child, aside from Marfan’s?
- A. Ehlers-Danlos Syndrome (vascular type IV)
- B. Bicuspid aortic valve
- C. Takayasu Arteritis
- D. Unrepaired coarctation of the aorta
Correct Answer: A
Rationale: These are potential differential diagnoses associated with aortopathy in children, aside from Marfan’s syndrome, which is a common condition linked to aortic dilation.
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What does the nurse explain that a ventricular septal defect will allow?
- A. Blood to shunt left to right, causing increased pulmonary flow and no cyanosis
- B. Blood to shunt right to left, causing decreased pulmonary flow and cyanosis
- C. No shunting because of high pressure in the left ventricle
- D. Increased pressure in the left atrium, impeding circulation of oxygenated blood in the circulating volume
Correct Answer: A
Rationale: Pulmonary blood flow is increased when a ventricular septal defect exists. The blood shifts from left to right because of the higher pressure in the left ventricle. This particular shift does not cause cyanosis.
While looking through the chart of an infant with a congenital heart defect (CHD) of decreased pulmonary blood flow, the nurse would expect which laboratory finding?
- A. Decreased platelet count
- B. Polycythemia
- C. Decreased ferritin level
- D. Shift to the left
Correct Answer: B
Rationale: Chronic hypoxemia in CHD leads to polycythemia as a compensatory mechanism.
The differential in a 5-year old with a 2-week history of painful joints is all the following except:
- A. Viral polyarthritis
- B. Rheumatoid arthritis
- C. Lyme disease
- D. Rheumatic fever
Correct Answer: B
Rationale: rheumatoid arthritis is rare in a 5-year-old with a 2-week history of joint pain. The other options (a-d) are more likely differentials.
The nurse is preparing an adolescent for discharge after a cardiac catheterization. Which statement by the adolescent would indicate a need for further teaching?
- A. “I should avoid tub baths but may shower.â€
- B. “I have to stay on strict bed rest for 3 days.â€
- C. “I should remove the pressure dressing the day after the procedure.â€
- D. “I may attend school but should avoid exercise for several days.â€
Correct Answer: B
Rationale: The child does not need to be on strict bed rest for 3 days. Showers are recommended; children should avoid a tub bath. The pressure dressing is removed the day after the catheterization and replaced by an adhesive bandage to keep the area clean. Strenuous activity must be avoided for several days, but the child can return to school.
Features differentiating renal tubular acidosis type II from type I include:
- A. Increased anion gap
- B. Nephrocalcinosis
- C. Urinary pH can be lowered < 5.5 in ammonium chloride loading test in type I
- D. Aminoaciduria
Correct Answer: C
Rationale: In type I renal tubular acidosis, urinary pH can be lowered below 5.5 during an ammonium chloride loading test, unlike in type II.