Nokea
A 9-month-old infant has a grade III/VI, harsh, rumbling, continuous murmur in the left infraclavicular fossa and pulmonic area. A chest radiograph reveals cardiac enlargement. The primary care pediatric nurse practitioner will refer the infant to a pediatric cardiologist and prepare the parents for which intervention to repair this defect?
- A. Cardiopulmonary bypass surgery
- B. Coil insertion in the catheterization laboratory
- C. Indomethacin administration
- D. Observation for spontaneous closure
Correct Answer: B
Rationale: This murmur is characteristic of a PDA and, because of cardiac enlargement, represents a larger shunt, requiring repair. Infants older than 8 months may have a coil or plug inserted into the shunt in the cardiac catheterization laboratory.
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Klinefelter's syndrome:
- A. Has a karyotype XXV
- B. Is the result of meiotic non-dysjunction
- C. Shows delay in bone age/maturation
- D. Is a recognised cause of hypogonadotrophic hypogonadism
Correct Answer: B
Rationale: Klinefelter's syndrome is caused by meiotic non-dysjunction, resulting in an extra X chromosome (karyotype XXY). It is not inherited as an X-linked recessive trait, and it is not a cause of hypogonadotrophic hypogonadism.
Right to left shunts include:
- A. Fallot's tetralogy
- B. Tricuspid atresia
- C. Eisenmenger complex
- D. Ductus arteriosus in the fetus
Correct Answer: A
Rationale: Fallot's tetralogy is a congenital heart defect that includes a right-to-left shunt, allowing deoxygenated blood to bypass the lungs.
Which medication should the nurse give to a child diagnosed with transposition of the great vessels?
- A. Ibuprofen
- B. Betamethasone
- C. Prostaglandin E
- D. Indocin
Correct Answer: C
Rationale: Prostaglandin E keeps the ductus arteriosus open, which is essential for maintaining adequate circulation in transposition of the great vessels until corrective surgery is performed.
Regarding hand innervation:
- A. Median nerve supplies all thenar muscles except adductor pollicis
- B. The sensory supply to the dorsal surface of the medial two digits is via the radial nerve
- C. In ulnar nerve damage at the elbow there is sensory loss over the medial aspect of forearm proximal to the wrist
- D. Radial nerve provides the sensory innervation to the terminal areas of the dorsal surfaces of the lateral three digits
Correct Answer: A
Rationale: The median nerve innervates most thenar muscles, except for the adductor pollicis, which is supplied by the ulnar nerve.
Which statement by the mother of a child with rheumatic fever (RF) shows she has an understanding of prevention for her other children?
- A. Whenever one of them gets a sore throat, I will give that child an antibiotic.
- B. There is no treatment. It must run its course.
- C. If their culture is positive for group A streptococcus, I will give them their antibiotic.
- D. If their culture is positive for staphylococcus A, I will give them their antibiotic.
Correct Answer: A
Rationale: Preventive antibiotic therapy is indicated when a culture is positive for group A streptococcus, but unnecessary antibiotic use (if the infection is viral) should be avoided.