The nurse is assessing a child and hears a widely split S2, which ...

[daltonest1984]

The nurse is assessing a child and hears a widely split S2, which is not affected by the respiratory pattern. The physician verifies the finding and orders a chest X-ray, which shows an enlarged heart.
 
  An echocardiogram is ordered, which shows the defect. The finding by the nurse is a classic murmur found in which of the following cardiac defects? a. atrial septal defect c. patent ductus arteriosus (PDA)
  b. tetralogy of Fallot d. transposition of the great arteries (TGA)

Question 2

A mother calls the pediatrician's office and asks the nurse if she should bring the baby for scheduled immunizations.
 
  The baby has a clear nasal discharge and a little cough, and the mother thinks perhaps the baby should not get immunizations if he has a cold. The nurse's best response is: a. You are correct not to bring the baby to the office and expose other children.
  b. Let's wait until the baby is free of these symptoms. There is no hurry for these immunizations.
  c. Immunizations are not usually contraindicated with a mild illness such as a cold.
  d. Take the baby's temperature. If it is not over 38.8 degrees C (101.8 degrees F), we will go ahead with the immunizations.

[sultansheikh]

Answer to Question 1

A

Feedback
A Correct. In atrial septal defect, the infant is generally asymptomatic. There is often a soft systolic murmur and more classically a widely split S2 unaffected by respiratory pattern. Chest X rays will usually demonstrate an increased heart size.
B Incorrect. In tetralogy of Fallot there is a characteristic systolic murmur resulting from the right ventricular outflow tract obstruction and is generally moderate in severity.
C Incorrect. The murmur of a PDA is often continuous, and a chest X ray is normal.
D Incorrect. These findings are not indicative of TGA. TGA should be suspected in an otherwise healthy newborn with acute cyanosis that is not responsive to oxygen. Chest X ray may be within normal limits or show a mildly enlarged right heart.

Answer to Question 2

C

Feedback
A Incorrect. You are correct not to bring the baby to the office and expose other children is not the best response when advising a mother about keeping an appointment for scheduled immunizations.
B Incorrect. Let's wait until the baby is free of these symptoms. There is no hurry for these immunizations. This is not the best response when advising a mother about keeping an appointment for scheduled immunizations.
C Correct. Immunizations are not usually contraindicated with a mild illness such as a cold is the best response when advising a mother about keeping an appointment for scheduled immunizations.
D Incorrect. Take the baby's temperature. If it is not over 38.8 degrees C (101.8 degrees F), we will go ahead with the immunizations is not the best response when advising a mother about keeping an appointment for scheduled immunizations.

[daltonest1984]

Excellent

[cam1229]

Gracias!