Nokea
A 5-year-old child who had a repair for transposition of the great arteries shortly after birth is growing normally and has been asymptomatic since the surgery. The primary care nurse practitioner notes mild shortness of breath with exertion and dizziness. What will the nurse practitioner do?
- A. Order an echocardiogram and chest radiograph.
- B. Perform pulmonary function testing.
- C. Reassure the parent that these symptoms are common.
- D. Refer the child to the cardiologist immediately.
Correct Answer: D
Rationale: Children with a history of transposition of the great arteries (d-TGA) who have a history of palpitations, syncope, or shortness of breath should be referred to a cardiologist.
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Evidence of increased pulmonary flow is associated with:
- A. Coarctation of the aorta
- B. Fallot's tetralogy
- C. Pneumocystis infection
- D. Ventricular septal defect
Correct Answer: D
Rationale: A ventricular septal defect (VSD) leads to increased pulmonary blood flow due to left-to-right shunting, resulting in pulmonary congestion.
An infant aged 16 months was referred for assessment of suspected mental retardation. Which of the following findings is/are outside the normal range?
- A. He does not scribble spontaneously with pencil on paper
- B. He does not walk alone
- C. Ma' and 'Dada' are the only recognisable words
- D. He is unable to build a tower of four cubes
Correct Answer: B
Rationale: Not walking alone by 16 months is a concern. Scribbling, limited vocabulary, and building towers are less concerning at this age.
The clinical features of subaortic membrane stenosis can include all, except
- A. Ejection systolic murmur
- B. Ejection click
- C. End-diastolic murmur of aortic regurgitation
- D. Low pulse volume
Correct Answer: B
Rationale: An ejection click is not typically a feature of subaortic membrane stenosis.
The healthcare provider prescribes epoetin alfa (Procrit) 8,200 units subcutaneously for a client with chronic kidney disease (CKD). The 2 ml multidose vial is labeled, 'Each 1 ml of solution contains 10,000 units of epoetin alfa.' How many ml should the nurse administer?
- A. 0.8
- B. 8
- D. 1
Correct Answer: A
Rationale: To calculate the dose, the nurse must divide the prescribed dose (8,200 units) by the concentration (10,000 units per ml). 8,200 ÷ 10,000 = 0.82 ml, rounded to 0.8 ml.
The nurse determines that a client who arrives in the preoperative holding area before surgery is allergic to bananas. Which action should the nurse implement prior to taking the client into the operative area?
- A. Replace latex-containing devices in the OR with alternate synthetic materials
- B. Administer an antihistamine before surgery.
- C. Notify the surgeon about the client's allergy to bananas.
- D. Prepare to administer an epinephrine injection during surgery
Correct Answer: A
Rationale: Banana allergy is associated with latex allergy. Replacing latex-containing devices prevents potential allergic reactions during surgery.