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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An adult male client is admitted for Pneumocystis carinii pneumonia (PCP) secondary to AIDS. While hospitalized, he receives IV pentamidine isethionate therapy. In preparing this client for discharge, what important aspect regarding his medication therapy should the nurse explain?
- A. IV pentamidine may offer protection to other AIDS-related conditions, such as Kaposi's sarcoma
- B. It will be necessary to continue prophylactic doses of IV or aerosol pentamidine every month
- C. IV pentamidine will be given until oral pentamidine can be tolerated
- D. AZT (Azidothymidine) therapy must be stopped when IV or aerosol pentamidine is being used.
Correct Answer: B
Rationale: Prophylactic doses of pentamidine are necessary to prevent PCP recurrence and other AIDS-related infections.
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 differential diagnosis of the patient includes all of the following EXCEPT
- A. rheumatic fever
- B. SLE
- C. chronic atrial fibrillation
- D. postmeningococcal immune complexes
Correct Answer: C
Rationale: Chronic atrial fibrillation is unlikely in an 8-year-old with acute onset symptoms.
Which is a major clinical manifestation of rheumatic fever?
- A. Polyarthritis
- B. Osler nodes
- C. Janeway spots
- D. Splinter hemorrhages of distal third of nails
Correct Answer: A
Rationale: Polyarthritis, which is swollen, hot, red, and painful joints, is a major clinical manifestation of rheumatic fever. The affected joints will change every 1 to 2 days. Primarily the large joints are affected. Osler nodes, Janeway spots, and splinter hemorrhages are characteristic of infective endocarditis.
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.