Pediatric Primary Care: Chapter 38:
Cardiovascular Disorders
The primary care pediatric nurse practitioner (PNP) is examining a 2-week-old infant and
auscultates a wide splitting of S during expiration. What condition may this finding
represent?
a. Atrial septal defect (ASD)
b. Coarctation of the aorta (COA)
c. Patent ductus arteriosis (PDA)
d. Ventricular septal defect (VSD) - ANSANS: A
A wide splitting of S without becoming a single sound on expiration may indicate increased
pulmonary flow, typical of atrial septal defect. Coarctation of the aorta may cause a systolic
ejection murmur. A patent ductus arteriosus has a characteristic machinery-like murmur. A
ventricular septal defect has a harsh, high-pitched, grade II to IV/VI holosystolic murmur.
The primary care pediatric nurse practitioner auscultates a new grade II vibratory,
mid-systolic murmur at the mid sternal border in a 4-year-old child that is louder when the
child is supine. What type of murmur is most likely?
a. Pathologic murmur
b. Pulmonary flow murmur
c. Still's murmur
d. Venous hum - ANSANS: C
A Still's murmur is characterized by a vibratory or musical low-grade sound, along the sternal
border, which is louder when the child is supine or during inspiration. It is usually heard in
children between the ages of 2 and 6 years old. Pathologic murmurs are usually harsh, not
vibratory. A pulmonary flow murmur has a soft, blowing sound and radiates to the lung fields.
A venous hum has a soft, high-pitched swishing sound.
During a well child assessment, the primary care pediatric nurse practitioner (PNP)
auscultates a harsh, blowing grade IV/VI murmur in a 6-month-old infant. What will the nurse
practitioner do next?
a. Get a complete blood count to rule out severe anemia.
b. Obtain an electrocardiogram to assess for arrhythmia.
c. Order a chest radiograph to evaluate for cardiomegaly.
d. Refer to a pediatric cardiologist for further evaluation. - ANSANS: D
A harsh, blowing murmur is suspicious for pathology, so a cardiology referral is warranted.
The cardiologist will determine which tests and procedures should be performed.
The primary care pediatric nurse practitioner provides primary care for a 4-month-old infant
who has a ventricular septal defect (VSD). The infant has been breastfeeding well but in the
past month has dropped from the 20th percentile to the 5th for weight. What will the nurse
practitioner recommend?
a. Adding solid foods to the infant's diet to increase caloric intake
b. Fortifying breast milk to increase the number of calories per ounce
, c. Stopping breastfeeding and giving 30 kcal/ounce formula
d. Supplementing breastfeeding with 24 kcal/ounce formula - ANSANS: B
Infants with heart defects who have congestive heart failure (CHF) may need modification of
formula or breast milk to increase calories. This infant is nursing well, so fortifying the breast
milk to increase calories is the first and best option. Adding solids does not significantly
increase caloric intake.
A 12-month-old infant who had cardiopulmonary bypass with red blood cell (RBC) and
plasma infusions during surgery at 8 months is seen for a well child examination. Which
vaccine may be administered at this visit?
a. Measles, mumps, and rubella (MMR)
b. oral polio vaccine (OPV)
c. Live-viruse (PCV-13)
d. Varivax - ANSANS: C
Live vaccines should be delayed until 6 months after cardiopulmonary bypass and exposure
to RBCs and plasma. The PCV-13 is not a live-virus vaccine and the others are.
The primary care pediatric nurse practitioner (PNP) performs a well child examination on a
12-month-old child who had repair of a congenital heart defect at 8 months of age. The child
has a normal exam. The parent reports that the child is not taking any medications. The
nurse
practitioner will contact the child's cardiologist to discuss whether the child needs which
medication?
a. Amoxicillin
b. Capoten
c. Digoxin
d. Furosemide - ANSANS: A
Children who have had complete repair of congenital heart defect (CHD) should have
subacute bacterial endocarditis (SBE) prophylaxis with amoxicillin for 6 months after the
procedure. Capoten, an antihypertensive, digoxin, an inotropic medication, and furosemide,
a diuretic, are given for specific symptoms as indicated.
During a well baby examination of a 6-week-old infant, the primary care pediatric nurse
practitioner notes poor weight gain, acrocyanosis of the hands and feet, and a respiratory
rate of 60 breaths per minute. Oxygen saturation on room air is 93%. The remainder of the
exam is unremarkable. Which action is correct?
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. - ANSANS: D
Infants with oxygen saturation less than 95% and those with poor feeding should be referred
emergently to a cardiologist. The infant may have congestive heart failure (CHF) and will
need to be evaluated.
A 3-month-old infant who was previously healthy now has a persistent cough, bilateral lung
crackles, and poor appetite. The primary care pediatric nurse practitioner auscultates a
grade III/VI, low-pitched, holosystolic murmur over the left lower sternal border and palpates
the liver at one centimeter below the ribs. What diagnosis is likely?
Cardiovascular Disorders
The primary care pediatric nurse practitioner (PNP) is examining a 2-week-old infant and
auscultates a wide splitting of S during expiration. What condition may this finding
represent?
a. Atrial septal defect (ASD)
b. Coarctation of the aorta (COA)
c. Patent ductus arteriosis (PDA)
d. Ventricular septal defect (VSD) - ANSANS: A
A wide splitting of S without becoming a single sound on expiration may indicate increased
pulmonary flow, typical of atrial septal defect. Coarctation of the aorta may cause a systolic
ejection murmur. A patent ductus arteriosus has a characteristic machinery-like murmur. A
ventricular septal defect has a harsh, high-pitched, grade II to IV/VI holosystolic murmur.
The primary care pediatric nurse practitioner auscultates a new grade II vibratory,
mid-systolic murmur at the mid sternal border in a 4-year-old child that is louder when the
child is supine. What type of murmur is most likely?
a. Pathologic murmur
b. Pulmonary flow murmur
c. Still's murmur
d. Venous hum - ANSANS: C
A Still's murmur is characterized by a vibratory or musical low-grade sound, along the sternal
border, which is louder when the child is supine or during inspiration. It is usually heard in
children between the ages of 2 and 6 years old. Pathologic murmurs are usually harsh, not
vibratory. A pulmonary flow murmur has a soft, blowing sound and radiates to the lung fields.
A venous hum has a soft, high-pitched swishing sound.
During a well child assessment, the primary care pediatric nurse practitioner (PNP)
auscultates a harsh, blowing grade IV/VI murmur in a 6-month-old infant. What will the nurse
practitioner do next?
a. Get a complete blood count to rule out severe anemia.
b. Obtain an electrocardiogram to assess for arrhythmia.
c. Order a chest radiograph to evaluate for cardiomegaly.
d. Refer to a pediatric cardiologist for further evaluation. - ANSANS: D
A harsh, blowing murmur is suspicious for pathology, so a cardiology referral is warranted.
The cardiologist will determine which tests and procedures should be performed.
The primary care pediatric nurse practitioner provides primary care for a 4-month-old infant
who has a ventricular septal defect (VSD). The infant has been breastfeeding well but in the
past month has dropped from the 20th percentile to the 5th for weight. What will the nurse
practitioner recommend?
a. Adding solid foods to the infant's diet to increase caloric intake
b. Fortifying breast milk to increase the number of calories per ounce
, c. Stopping breastfeeding and giving 30 kcal/ounce formula
d. Supplementing breastfeeding with 24 kcal/ounce formula - ANSANS: B
Infants with heart defects who have congestive heart failure (CHF) may need modification of
formula or breast milk to increase calories. This infant is nursing well, so fortifying the breast
milk to increase calories is the first and best option. Adding solids does not significantly
increase caloric intake.
A 12-month-old infant who had cardiopulmonary bypass with red blood cell (RBC) and
plasma infusions during surgery at 8 months is seen for a well child examination. Which
vaccine may be administered at this visit?
a. Measles, mumps, and rubella (MMR)
b. oral polio vaccine (OPV)
c. Live-viruse (PCV-13)
d. Varivax - ANSANS: C
Live vaccines should be delayed until 6 months after cardiopulmonary bypass and exposure
to RBCs and plasma. The PCV-13 is not a live-virus vaccine and the others are.
The primary care pediatric nurse practitioner (PNP) performs a well child examination on a
12-month-old child who had repair of a congenital heart defect at 8 months of age. The child
has a normal exam. The parent reports that the child is not taking any medications. The
nurse
practitioner will contact the child's cardiologist to discuss whether the child needs which
medication?
a. Amoxicillin
b. Capoten
c. Digoxin
d. Furosemide - ANSANS: A
Children who have had complete repair of congenital heart defect (CHD) should have
subacute bacterial endocarditis (SBE) prophylaxis with amoxicillin for 6 months after the
procedure. Capoten, an antihypertensive, digoxin, an inotropic medication, and furosemide,
a diuretic, are given for specific symptoms as indicated.
During a well baby examination of a 6-week-old infant, the primary care pediatric nurse
practitioner notes poor weight gain, acrocyanosis of the hands and feet, and a respiratory
rate of 60 breaths per minute. Oxygen saturation on room air is 93%. The remainder of the
exam is unremarkable. Which action is correct?
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. - ANSANS: D
Infants with oxygen saturation less than 95% and those with poor feeding should be referred
emergently to a cardiologist. The infant may have congestive heart failure (CHF) and will
need to be evaluated.
A 3-month-old infant who was previously healthy now has a persistent cough, bilateral lung
crackles, and poor appetite. The primary care pediatric nurse practitioner auscultates a
grade III/VI, low-pitched, holosystolic murmur over the left lower sternal border and palpates
the liver at one centimeter below the ribs. What diagnosis is likely?
