Nokea
A 3-month-old infant who was previously healthy now has a persistent cough, bilateral lung crackles, and poor appetite. A grade III/VI, low-pitched, holosystolic murmur over the left lower sternal border and palpates the liver at one centimeter below the ribs. What diagnosis is likely?
- A. Atrial septal defect (ASD)
- B. Coarctation of the aorta (COA)
- C. Patent ductus arteriosis (PDA)
- D. Ventricular septal defect (VSD)
Correct Answer: D
Rationale: The symptoms above are characteristic of a VSD and may not present at birth but appear later as CHF becomes more pronounced.
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Which plan would be appropriate in helping to control congestive heart failure (CHF) in an infant?
- A. Promoting fluid restriction
- B. Feeding a low-salt formula
- C. Feeding in semi-Fowler position
- D. Encouraging breast milk
Correct Answer: C
Rationale: Feeding in a more upright position helps fluid drain from the lungs, improving breathing and reducing cardiac workload.
Aspirin has been ordered for the child with rheumatic fever (RF) in order to:
- A. Keep the patent ductus arteriosus (PDA) open
- B. Reduce joint inflammation
- C. Decrease swelling of strawberry tongue
- D. Treat ventricular hypertrophy of endocarditis
Correct Answer: B
Rationale: Aspirin helps alleviate the joint inflammation and pain experienced in RF.
An older male client tells the nurse that he is losing sleep because he has to get up several times at night to go to the bathroom, that he has trouble starting his urinary stream, and that he does not feel like his bladder is ever completely empty. Which intervention should the nurse implement?
- A. Collect a urine specimen for culture analysis
- B. Review the client's fluid intake prior to bedtime
- C. Palpate the bladder above the symphysis pubis
- D. Obtain a fingerstick blood glucose level
Correct Answer: C
Rationale: Palpating the bladder helps assess for urinary retention, which is common in older males with prostate issues.
Duchenne muscular dystrophy (DMD):
- A. Affects dystrophin gene
- B. Features usually present before five years of age
- C. Frontal baldness occurs
- D. Is part of the differential diagnosis in a floppy infant
Correct Answer: B
Rationale: Features usually present before five years of age
Indications for an exchange transfusion include:
- A. ABO incompatibility
- B. Acute chest syndrome
- C. Sepsis
- D. Polycythaemia
Correct Answer: A
Rationale: Exchange transfusion is indicated in conditions like ABO incompatibility to prevent severe hemolytic disease in newborns. Acute chest syndrome sepsis polycythaemia and sickle nephropathy are not typical indications for exchange transfusion.