Nokea
An older adult man recently diagnosed with chronic obstructive pulmonary disease (COPD) is admitted with shortness of breath. The nurse observes the client sitting upright and leaning over the bedside table, using accessory muscles to assist in breathing. What action should the nurse take?
- A. Assist the client to a high Fowler's position in bed
- B. Observe the client for the presence of a barrel chest
- C. Prepare to transfer the client to a critical care unit
- D. Instruct the client in pursed lip breathing techniques
Correct Answer: D
Rationale: Pursed lip breathing helps reduce dyspnea and improves oxygenation in clients with COPD.
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True statements about the use of the new Child Health Foundation growth charts include:
- A. Immediate referral is advised if the height of a child is on the second centile
- B. The midparental height of a child, whose parents are 176 and 160 cm tall, is 175 cm
- C. They can be used for all children including those with Down's syndrome
- D. The target centile range for a girl is midparental height ± 10 cm
Correct Answer: C
Rationale: The growth charts are designed to be inclusive and can be used for children with Down's syndrome, among others.
ECG
- A. Bifid P waves in large VSD
- B. Complete Ht block in cyanotic attacks of fallots
- C. RBBB in Ebstein anomaly
- D. Right axis deviation in tricuspid atresia
Correct Answer: C
Rationale: In Ebstein's anomaly, right bundle branch block (RBBB) is commonly seen on ECG.
The primary care pediatric nurse practitioner is performing a sports physical on an adolescent whose history reveals mild aortic stenosis (AS). What will the nurse practitioner recommend?
- A. Avoidance of all sports to prevent sudden death
- B. Clearance for any sports since this is mild
- C. Evaluation by a cardiologist prior to participation
- D. Low-intensity sports
Correct Answer: C
Rationale: Children with mild AS may participate in any sport but must have annual cardiac evaluations.
Regarding a supracristal VSD, the following are true EXCEPT
- A. incidence is higher in Asian children
- B. complicated by aortic insufficiency in 50-90% of patients
- C. aortic insufficiency is most often not recognized until late in the lst decade of life
- D. murmur of a supracristal VSD is usually heard at the mid to upper left sternal border
Correct Answer: D
Rationale: Closure of asymptomatic supracristal VSDs at the time of diagnosis is not recommended.
An adolescent who sustained a tibia fracture in a motor vehicle accident has a cast. What should the nurse do to help relieve the itching?
- A. Apply cool air under the cast with a blow-dryer
- B. Use sterile applicators to scratch the itch
- C. Apply cool water under the cast
- D. Apply hydrocortisone cream under the cast using sterile applicator
Correct Answer: A
Rationale: Cool air helps relieve itching without damaging the cast or introducing moisture, which can lead to skin breakdown.