Practice Question
A nurse is collecting data from a newborn, including obtaining blood pressure measurements at each extremity. Which of the following findings suggests coarctation of the aorta?
Answer Choices:
Correct Answer:
Elevated systolic blood pressure in the upper extremities and low systolic blood pressure in the lower extremities
Rationale:
🔷 Coarctation of the aorta is a narrowing of the aorta, usually just past the vessels that supply the upper body, leading to higher pressure proximally (arms) and lower pressure distally (legs).
🔷 Blood flow to the upper extremities and head faces increased resistance, which results in elevated systolic blood pressure in the arms.
🔷 In contrast, the lower extremities receive blood beyond the narrowed segment, causing reduced perfusion and lower systolic blood pressure in the legs.
🔷 Clinically, this is often accompanied by strong upper pulses (e.g., radial) and weak or delayed femoral pulses.
🔷 Therefore, a BP pattern of high upper and low lower extremity systolic pressures is a classic finding suggesting coarctation of the aorta in a newborn or child.
Low systolic blood pressure in the upper extremities and elevated systolic blood pressure in the lower extremities
🔷 This pattern would imply that there is more resistance to flow into the lower body, which is the opposite of what occurs in coarctation of the aorta.
🔷 Coarctation typically affects the aorta after the branches to the head and arms, so the upper body is exposed to higher pressures, not lower.
🔷 Having higher pressure in the lower extremities is not characteristic of this condition and would prompt consideration of other hemodynamic patterns.
🔷 This mismatched description does not align with the pathophysiology of the defect, where the narrowed segment is between the upper body branches and the descending aorta.
🔷 Therefore, this BP pattern does not suggest coarctation of the aorta.
Low systolic blood pressure in the upper extremities and low systolic blood pressure in the lower extremities
🔷 Global low blood pressures in all extremities may suggest systemic hypotension, shock, or other causes of overall decreased cardiac output, not a segmental narrowing like coarctation.
🔷 Coarctation specifically produces a gradient between the upper and lower body, not uniformly low pressures.
🔷 In coarctation, the pressure differential (higher in arms, lower in legs) is a key diagnostic clue and helps distinguish it from generalized circulatory problems.
🔷 If both upper and lower pressures are low, the nurse should consider conditions such as sepsis, heart failure, or dehydration, rather than isolated aortic narrowing.
🔷 Thus, this finding is not typical for coarctation of the aorta.
Elevated systolic blood pressure in the upper extremities and elevated systolic blood pressure in the lower extremities
🔷 Elevated pressures in all extremities could reflect systemic hypertension, but would not highlight the pressure difference characteristic of coarctation.
🔷 Coarctation is defined by a disparity in pressures, not just generally high values; the upper body is hypertensive while the lower body is relatively hypotensive.
🔷 If both upper and lower BPs are similarly elevated, this suggests a different pathophysiological process or systemic cause, not localized aortic narrowing.
🔷 The absence of a gradient between arm and leg pressures would make coarctation less likely.
🔷 Therefore, this pattern does not represent the classic BP finding in coarctation of the aorta.
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This question is from Custom PNSG Respiratory Cardiac Exam Fall 2025 which contains 42 questions.
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From Exam
Custom PNSG Respiratory Cardiac Exam Fall 2025
42 Questions
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- Category: LPN Nursing Exam(s)
- Subcategory: LPN ATI Exams
- Domain: 💫PN Custom Exam(s)
- Answer Choices: 4