Question

The physician has ordered blood pressures and pulses to be taken in all four extremities of a six-month old admitted with a congenital heart defect. Which congenital heart defect is associated with elevated blood pressures and bounding pulses in the upper extremities, but low blood pressures and faint pulses in the lower extremities: A. Ventricular septal defect B. Coarctation of the aorta C. Transposition of the great vessels D. Patent ductus arteriosus

Short answer

Answer: B. Coarctation of the aorta

Step-by-step solution

Ventricular septal defect

Ventricular septal defect (VSD) is a hole in the wall separating the two lower chambers of the heart. This condition can cause a mixing of oxygenated and deoxygenated blood but does not typically cause differences in blood pressure and pulses between the upper and lower extremities. So, this option is not the correct answer.

Coarctation of the aorta

Coarctation of the aorta is a narrowing of the aorta, which is the main blood vessel carrying oxygen-rich blood from the heart to the rest of the body. The narrowing may cause differences in blood pressure and pulse between the upper and lower extremities, as it restricts blood flow to the lower extremities, resulting in elevated blood pressure and bounding pulses in the upper extremities, and low blood pressure and faint pulses in the lower extremities. This condition matches the given scenario.

Transposition of the great vessels

Transposition of the great vessels is a condition where the pulmonary artery and the aorta are switched (connected to the wrong ventricles). This condition causes a mixing of oxygenated and deoxygenated blood but does not lead to differences in blood pressure and pulses between the upper and lower extremities. Hence, this option is not the correct answer.

Patent ductus arteriosus

Patent ductus arteriosus (PDA) is a persistent opening between the aorta and the pulmonary artery, which are the two major blood vessels leading from the heart. While PDA can cause some issues in circulation, it does not generally cause differences in blood pressure and pulses between the upper and lower extremities. Therefore, this option is not the correct answer.

Select the correct option

After analyzing all the given options, we can conclude that the congenital heart defect associated with elevated blood pressures and bounding pulses in the upper extremities, but low blood pressures and faint pulses in the lower extremities is: B. Coarctation of the aorta

Key concepts

Coarctation of the Aorta

Coarctation of the aorta is a congenital heart defect characterized by the narrowing of the aorta. The aorta is the large blood vessel that carries oxygen-rich blood from the heart to the rest of the body. This narrowing, or "coarctation," typically occurs in the section of the aorta just beyond the arteries to the head and arms.

As a result of this defect, there is a significant difference in blood pressure readings between the upper and lower parts of the body. Blood pressure is typically elevated in the arms and decreased in the legs. This occurs because the narrowed aorta impedes normal blood flow to the lower body. Consequently, doctors may notice bounding pulses in the arms, indicating strong blood flow, whereas the pulse in the legs is weak or faint.

Common symptoms of coarctation of the aorta include:

• High blood pressure in the arms
• Weak or absent pulse in the legs and feet
• Shortness of breath, especially during exercise
• Headaches due to high blood pressure
• Cold feet or legs

Detecting coarctation of the aorta early is crucial for effective management and treatment, which may involve surgical procedures to repair or circumvent the narrowed part of the aorta.

NCLEX-PN Exam

The NCLEX-PN exam is a standardized test that aspiring Practical Nurses (PNs) must pass to obtain licensure in the United States. The exam is designed to assess the knowledge and skills required to provide safe and effective nursing care at the entry-level.

The test covers a variety of topics, including safety and infection control, health promotion, and psychosocial integrity. For questions related to congenital heart defects like coarctation of the aorta, the exam will evaluate your ability to monitor and report on patient conditions. It will also test your knowledge about related physiology and necessary precautions.

Successful preparation for the NCLEX-PN includes:

• Reviewing the format and types of questions asked
• Understanding the nursing process and how to apply it
• Studying key diseases and conditions that might affect patient care
• Engaging in practice tests to familiarize yourself with exam protocols

Always focus on the rationale behind nursing interventions, as understanding "why" a procedure is performed can be crucial to success on the exam.

Pediatric Nursing

Pediatric nursing is a nursing specialty that focuses on the care of infants, children, and adolescents. Nurses in this field must adapt to the physiological and developmental differences between children and adults.

When dealing with congenital heart defects like coarctation of the aorta, pediatric nurses play a critical role in assessment and management. They need to be adept at taking and interpreting vital signs in children, which can differ considerably from adults.

Important considerations in pediatric nursing include:

• Communicating effectively with both children and their families, often requiring age-appropriate language
• Very precise assessment skills, as symptoms in children may be subtle
• Administration of medication requires careful dosing calculated based on the child's weight

Pediatric nurses also educate families about ongoing care and monitor for complications that may arise from conditions or treatments. Compassion and attention to detail are essential qualities for success in this field.