Nokea
A 4-month-old infant with a ventricular septal defect (VSD) has dropped from the 20th percentile to the 5th for weight. What will the nurse practitioner recommend?
- A. Adding solid foods to the infant's diet to increase caloric intake
- B. Fortifying breast milk to increase the number of calories per ounce
- C. Stopping breastfeeding and giving 30 kcal/ounce formula
- D. Supplementing breastfeeding with 24 kcal/ounce formula
Correct Answer: B
Rationale: Infants with heart defects who have congestive heart failure (CHF) may need modification of formula or breast milk to increase calories. Fortifying breast milk is the first and best option.
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Regarding resuscitation of a three-year old with asystole:
- A. Hypoxia is the commonest cause
- B. It commonly leads to ventricular fibrillation
- C. Intracardiac adrenaline is an absolute indication
- D. IV calcium gluconate is the first line of therapy
Correct Answer: A
Rationale: Hypoxia is the most common cause of asystole in children, emphasizing the importance of oxygenation during resuscitation.
A 6-month-old presents with tachycardia, tachypnea, and poor feeding for 3 months. Physical examination reveals a continuous machinery murmur and a wide pulse pressure with a prominent apical impulse. The most likely diagnosis is
- A. pulmonic stenosis
- B. aortic stenosis
- C. ventricular septal defect
- D. patent ductus arteriosus
Correct Answer: D
Rationale: Patent ductus arteriosus causes a continuous machinery murmur and wide pulse pressure.
Which high level labs should the nurse explain can prevent cardiovascular disease?
- A. Cholesterol
- B. Triglycerides
- C. Low-density lipoproteins (LDLs)
- D. High-density lipoproteins (HDLs)
Correct Answer: D
Rationale: HDLs contain very low concentrations of triglycerides, relatively little cholesterol, and high levels of proteins. It is thought that HDLs protect against cardiovascular disease. Cholesterol, triglycerides, and LDLs are not protective against cardiovascular disease.
In 90% of cases of endocarditis, the causative agent is recovered from the first 2 blood cultures. Antimicrobial pretreatment of the patient reduces the yield of blood cultures to
- A. 10%
- B. 20%
- C. 30%
- D. 40%
Correct Answer: A
Rationale: Antimicrobial pretreatment can significantly reduce the yield of blood cultures, often to 10-20%.
Which statement by a parent of an infant with congestive heart failure (CHF) who is being sent home on digoxin indicates the need for further education?
- A. I will give the medication at regular 12-hour intervals.
- B. If he vomits, I will not give a make-up dose.
- C. If I miss a dose, I will not give an extra dose.
- D. I will mix the digoxin in some formula to make it taste better.
Correct Answer: D
Rationale: Mixing digoxin with formula can lead to incomplete ingestion and inadequate dosing. Digoxin must be given in its entirety at the prescribed times.