Pediatrics Exam 1

A nurse assesses an infant with a large ventricular septal defect (VSD). Which manifestation is expected?

• Clubbing of fingers

• Cyanosis only when crying

• Loud, harsh murmur at the left sternal border

• Bounding pulses and wide pulse pressure

Answer explanation

Answer: B. Murmur is classic for VSD. Clubbing is late sign of chronic hypoxemia.

A VSD allows blood to shunt left → right, creating a turbulent flow that produces a loud harsh murmur, typically at the left sternal border. Cyanosis is not a hallmark unless Eisenmenger syndrome develops. Bounding pulses/wide pulse pressure are classic for PDA. Clubbing develops only after prolonged hypoxemia.

The nurse caring for a child with tetralogy of Fallot should prioritize which intervention during a “tet spell”?

• Place child in knee-chest position

• Start CPR

• Place child supine

• Administer oxygen via non-rebreather

Answer explanation

Rationale: A “tet spell” is acute hypoxemia due to right-to-left shunting. The knee-chest position increases systemic vascular resistance, forcing more blood into pulmonary circulation, improving oxygenation. Oxygen may help but positioning is the immediate priority. Supine worsens venous return. CPR is not indicated unless cardiac arrest occurs.

Which finding indicates a patent ductus arteriosus (PDA)?

• Cyanosis unrelieved by O₂

• Absent femoral pulses

• Machinery-like murmur

• Hypotension with weak pulses

Answer explanation

Rationale: PDA creates continuous blood flow between the aorta and pulmonary artery, producing a “machinery-like” murmur. Absent femoral pulses = coarctation. Cyanosis unrelieved by O₂ = mixing lesions like transposition of great arteries.

The nurse reviews orders for an infant with PDA scheduled for medical closure. Which medication does the nurse expect?

• Propranolol

• Indomethacin

• Digoxin

• Furosemide

Answer explanation

Rationale: Indomethacin (or ibuprofen) is a prostaglandin inhibitor that stimulates PDA closure. Propranolol is for arrhythmias. Digoxin/furosemide manage heart failure symptoms but do not close PDA.

Which clinical finding is most concerning in an infant with coarctation of the aorta?

• Bounding radial pulses

• Hypertension in upper extremities

• Weak femoral pulses

• Headache complaints

Answer explanation

Rationale: Coarctation causes obstructed blood flow to the lower body → diminished femoral pulses, cool lower extremities. Hypertension in arms is expected. Headaches result from hypertension but weak femoral pulses = decreased perfusion, more critical.

The nurse monitors a child with heart failure. Which finding suggests worsening condition?

• HR 90 bpm

• Warm, pink extremities

• Weight gain of 0.5 kg in 24 hrs

• Diuresis after furosemide

Answer explanation

Rationale: Sudden weight gain = fluid retention → worsening HF. HR 90 is normal for older child. Diuresis = expected response.

A child with HF is prescribed digoxin. Which parameter should the nurse check prior to administration?

• Respiratory rate

• Apical heart rate

• 
  Temperature

• Oxygen saturation

Answer explanation

Rationale: Digoxin slows conduction through AV node and strengthens contraction. If apical HR <90 (infants) or <70 (children), hold dose due to bradycardia risk.

Which manifestation supports diagnosis of acute rheumatic fever?

• Facial edema

• Strawberry tongue

• Joint pain and swelling

• Vesicular rash

Answer explanation

Rationale: Polyarthritis (migratory joint pain/swelling) is one of the Jones criteria for rheumatic fever. Strawberry tongue = Kawasaki disease.

What is the priority intervention in preventing recurrence of rheumatic fever?

• Iron supplementation

• Daily aspirin

• Long-term antibiotic prophylaxis

• Corticosteroids

Answer explanation

Rationale: Monthly IM benzathine penicillin or daily oral penicillin prevents group A strep reinfection → reduces recurrence and further valve damage.

Which sign indicates possible decreased cardiac output in a child?

• Polyuria

• Warm skin

• Tachycardia

• Bounding pulses

Answer explanation

Rationale: Tachycardia is an early compensatory mechanism for decreased CO. Bounding pulses = PDA. Polyuria not related.