Cardiac Disorders: PNP Certification Review Guide Questions With Verified Answers

©BRIGHTSTARS EXAM SOLUTIONS 2024/2025 ALL RIGHTS RESERVED. 1 Cardiac Disorders: PNP Certification Review Guide Questions With Verified Answers A 9-year-old boy presents with a fever of 102°F and complaints of leg pains. His mother reports that he had an upper respiratory infection with a sore throat approximately 2 weeks ago, which subsided without therapy. On physical examination, he has tender, swollen knees bilaterally. His heart rate is 120 beats per minute and a blowing systolic murmur is heard at the apex. No murmur was noted at a previous well-child visit. The most likely diagnosis is: A) Kawasaki disease B) Rheumatic fever C) Sickle cell anemia D) Viral illness - AnswersB: This is a classic presentation of rheumatic fever: previous viral illness typically with pharyngitis, subsequent fever, polyarthritis, tachycardia, and carditis manifested by the appearance of a murmur. Kawasaki disease would include a fever higher than 102°F for at least 5 days and to be diagnosed must include clinical manifestations other than joint pain. Typically, a pathologic murmur is not associated with Kawasaki disease. Although sickle cell anemia may produce a new murmur and tachycardia, joint pain and fever would not be seen. A recurrent viral illness may produce a new murmur, but it is typically an innocent murmur that is systolic, low frequency, vibratory in quality, and heard at the left lower sternal border. A 3-week-old infant has a 1-day history of irritability, pallor, and poor feeding. He is afebrile. On physical examination, his heart rate is 240 beats per minute while asleep. The most likely diagnosis is: A) Supraventricular tachycardia B) Premature ventricular contractions C) Sinus tachycardia ©BRIGHTSTARS EXAM SOLUTIONS 2024/2025 ALL RIGHTS RESERVED. 2 D) Cyanotic heart defect - AnswersA: Supraventricular tachycardia (SVT) in an infant is defined as a heart rate greater than 220 beats per minute with no variability and no other underlying pathologic states. Premature ventricular contractions (PVCs) are intermittent and would not produce a heart rate this high. Sinus tachycardia does not typically reach rates greater than 220 beats per minute and is associated with an etiology that causes the heart rate to increase such as fever, pain, or anxiety. Congenital heart defects, cyanotic or acyanotic, do not cause altered rate response such as this. Which of the following is not an expected finding in a child with myocarditis? A) Persistent tachycardia B) History of antecedent illness with nonspecific cold symptoms C) A gallop rhythm D) A significant heart murmur - AnswersD: The sympathetic response attempting to compensate for poor contractility will cause an elevated heart rate and frequently a gallop rhythm due to the rapid filling of a noncompliant, poorly contractile left ventricle. Murmurs are less common unless there is valvular insufficiency. The most common etiology of myocarditis is a preceding viral illness. Principal clinical features of Kawasaki disease are: A) Low-grade fever for 24 hours and a pruritic rash B) Conjunctivitis with exudate and facial rash C) Arthritis and chorea D) Fever persisting at least 5 days and acute erythema and/or edema of hands and feet - AnswersD: Diagnosis of Kawasaki disease includes a high fever for at least 5 days and erythema of hands and feet. Although the eyes may be injected, there is not necessarily exudate; joints may be sore, but chorea is not associated with this process. Any rash associated with Kawasaki disease is not typically pruritic. The least likely physical finding in a 2-month-old with congestive heart failure is: A) Tachypnea ©BRIGHTSTARS EXAM SOLUTIONS 2024/2025 ALL RIGHTS RESERVED. 3 B) Tachycardia C) Hepatomegaly D) Pedal edema - AnswersD: Tachycardia and tachypnea are early signs of congestion and increased work of the heart. Hepatomegaly is also an early finding. Children may develop peripheral edema, but there must be a 10% increase in weight and the edema is initially noted in eyelids; it can be a very subtle finding. Chest pain in young children is usually: A) symptom of congenital heart disease B) Noncardiac in origin C) A sign of hypercholesterolemia D) A symptom of congestive heart failure - AnswersB: The most common etiology of chest pain in children is noncardiac, typically idiopathic or musculoskeletal. Only rare congenital heart disease such as anomalous origin of the left coronary artery has been noted to cause chest pain. Although children may demonstrate evidence of hypercholesterolemia, they do not present with the associated coronary artery disease that causes chest pain. Chest pain is not seen in congestive heart failure. The most common cause of myocarditis in North America is: A) Bacterial B) Viral C) Drug reaction D) Radiation therapy - AnswersB: Viral infections are the most common cause of myocarditis in North America, with typical agents including enteroviruses, adenovirus, and parvovirus B19. Diphtheria often causes myocarditis in countries without widespread immunizations. Hypersensitivity and toxic reactions to medications can cause myocarditis, but these are less common. The initial attack of acute rheumatic fever is preceded by: