A pediatric nurse is seeing a B-year-old following a post-cardiac catheterization procedure. Which of the following interventions ordered by the physician should be questioned by the nurse? [Select All that Apply)

Obstructive congenital heart defects involve the presence of narrowing or constriction in various parts of the heart or major blood vessels. In the case of coarctation of the aorta, there is a narrowing or constriction in the aorta, which can obstruct blood flow. Aortic stenosis involves the narrowing of the aortic valve, and pulmonic stenosis involves the narrowing of the pulmonary valve. These defects create obstacles to the normal flow of blood out of the heart, leading to increased pressure within the heart and affecting blood circulation.

The other categories mentioned are:

B. Mixing defects: These defects involve abnormal mixing of oxygenated and deoxygenated blood within the heart, typically due to septal defects like atrial septal defect (ASD) or ventricular septal defect (VSD).

C. Decreased pulmonary blood flow: These defects are characterized by reduced blood flow to the lungs, such as in the tetralogy of Fallot.

D. Increased pulmonary blood flow: These defects involve increased blood flow to the lungs, often due to shunting of blood from the left side of the heart to the right side, as seen in atrial septal defects or ventricular septal defects.

When obtaining the history of a child with suspected rheumatic fever, the nurse should consider the following information to be most significant:

B. A recent episode of pharyngitis.

Explanation:

Rheumatic fever often follows an untreated or inadequately treated streptococcal pharyngitis (strep throat) infection caused by Group A Streptococcus bacteria. Therefore, a recent episode of pharyngitis is a key piece of information in the context of rheumatic fever. It is important to assess whether the child had a sore throat, fever, and other symptoms of streptococcal infection that may have triggered the development of rheumatic fever.

While the other symptoms (vomiting, lack of interest in food, fever) may be important for the overall assessment and management of the child, they are not as directly associated with the development of rheumatic fever as a recent episode of pharyngitis caused by Group A Streptococcus. Rheumatic fever is an autoimmune response to untreated streptococcal infection, and its diagnosis is often linked to the presence of preceding streptococcal pharyngitis.