Cardiac Disorders: PNP Certification Review Guide Questions and Other Quizlet Questions
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 - correct answer B:
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
D) Cyanotic heart defect - correct answer A:
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?
, Cardiac Disorders: PNP Certification Review Guide Questions and Other Quizlet Questions
A) Persistent tachycardia
B) History of antecedent illness with nonspecific cold symptoms
C) A gallop rhythm
D) A significant heart murmur - correct answer D:
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 -
correct answer D:
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
B) Tachycardia
C) Hepatomegaly
D) Pedal edema - correct answer D:
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.
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 - correct answer B:
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
D) Cyanotic heart defect - correct answer A:
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?
, Cardiac Disorders: PNP Certification Review Guide Questions and Other Quizlet Questions
A) Persistent tachycardia
B) History of antecedent illness with nonspecific cold symptoms
C) A gallop rhythm
D) A significant heart murmur - correct answer D:
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 -
correct answer D:
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
B) Tachycardia
C) Hepatomegaly
D) Pedal edema - correct answer D:
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.
