Nokea
When a father asks why his child with tetralogy of Fallot seems to favor a squatting position, the nurse would explain that squatting:
- A. Increases peripheral vascular resistance
- B. Decreases arterial blood flow away from the heart
- C. It's a common resting position when a child is tachycardic
- D. Increases the workload of the heart
Correct Answer: A
Rationale: Squatting increases systemic vascular resistance, which leads to a reduction in the right-to-left shunting of blood in children with tetralogy of Fallot. This helps improve oxygenation by balancing the pulmonary and systemic blood flow. The squatting position decreases the pressure in the right ventricle and reduces the magnitude of the right-to-left shunt by increasing afterload, thereby improving oxygenation. Choices B, C, and D are incorrect because squatting does not decrease arterial blood flow away from the heart, is not related to being tachycardic, and does not increase the workload of the heart.
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In the Integrated Management of Neonatal and Childhood Illnesses, one of the things to look for is danger signs. Which of the following will you consider a danger sign in a child?
- A. The child vomits everything
- B. A child with diarrhea
- C. A child with headache
- D. All of the above
Correct Answer: A
Rationale: The correct answer is A: 'The child vomits everything.' Vomiting everything is considered a danger sign in a child as it can lead to dehydration and other serious complications. Recognizing this sign early can help in timely intervention and management of the child's condition. Choices B and C are incorrect as diarrhea and headache, while concerning, are not specific danger signs highlighted in the Integrated Management of Neonatal and Childhood Illnesses.
A clinic nurse reviews the record of a child just seen by a doctor and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder?
- A. Pallor
- B. Hyperactivity
- C. Exercise intolerance
- D. Gastrointestinal disturbances
Correct Answer: C
Rationale: Aortic stenosis is a condition characterized by the narrowing of the aortic valve, leading to reduced blood flow from the heart to the body. This narrowing restricts the amount of oxygenated blood that can reach various tissues, including muscles. As a result, individuals with aortic stenosis may experience exercise intolerance, as their muscles may not receive an adequate oxygen supply during physical activity. This can manifest as fatigue, shortness of breath, and overall decreased exercise capacity. Pallor (choice A) is a pale appearance that may be seen in anemia or other conditions affecting blood flow but is not specific to aortic stenosis. Hyperactivity (choice B) and gastrointestinal disturbances (choice D) are not typically associated with aortic stenosis.
Based on the complaints provided by Madam KK, is the child exhibiting danger signs?
- A. Yes
- B. No
- C. I don't know
- D. Yes
Correct Answer: A
Rationale: Yes, the child is displaying danger signs with symptoms such as fever and rapid breathing, indicating a potential serious health issue that requires immediate attention. The correct answer is 'Yes' because the symptoms described in Madam KK's complaints align with danger signs that suggest a severe health problem. Choices B and C are incorrect because the symptoms mentioned clearly indicate the presence of danger signs. Choice D is a duplicate of choice A and does not provide a valid alternative.
The mother of an 11-year-old girl confides to the nurse that her child has no interest in school activities, exercise, or even family outings. The most appropriate response by the nurse would be:
- A. I would recommend that she see a counselor at school.
- B. I would not worry; she will grow out of it.
- C. Many girls this age go through a time of malaise and disinterest.
- D. If she still feels the same way when you come back for the next well-child visit, I will recommend a therapist.
Correct Answer: A
Rationale: When a child shows a lack of interest in various activities, including school, exercise, and family outings, it is essential to address the underlying reasons. Recommending that the child see a counselor at school is crucial to explore potential issues and provide appropriate support and guidance. This approach can help identify any emotional, social, or behavioral concerns the child may be experiencing and facilitate early intervention and support. Choice B is incorrect because dismissing the mother's concerns and assuming the child will grow out of it without addressing the issue is not appropriate. Choice C is incorrect because while some children may go through phases of disinterest, it is essential to investigate further rather than generalizing. Choice D is incorrect because waiting until the next visit without taking proactive steps to address the current lack of interest may delay necessary support and intervention.
Fred is a 12-year-old boy diagnosed with pneumococcal pneumonia. Which of the following would Nurse Nica expect to assess?
- A. Mild cough
- B. Slight fever
- C. Chest pain
- D. Bulging fontanel
Correct Answer: C
Rationale: Chest pain is a common symptom seen in patients with pneumococcal pneumonia. It can result from inflammation of the pleura or irritation of the diaphragm due to the infection. While cough and fever are also common symptoms, chest pain is particularly significant in pneumonia cases as it can be a distressing symptom for the patient and may indicate complications or severity of the infection. Bulging fontanel, on the other hand, is more indicative of conditions affecting infants and is not typically associated with pneumococcal pneumonia in a 12-year-old boy.