A 7-year-old child who has a history of a repaired congenital heart defect (CHD)has many dental caries along with gingival erythema and irritation and a temperature of 102.5°F. What will the primary care pediatric nurse practitioner do next?
- A. Admit to the hospital with a pediatric cardiology consult.
- B. Obtain blood cultures and a CBC and consult a pediatric cardiologist.
- C. Refer the child to a pediatric dental surgeon immediately.
- D. Start prophylactic antibiotics such as penicillin twice daily for 2 weeks.
Correct Answer: A
Rationale: Children who are suspected of having SBE should be admitted to the hospital and referred to pediatric cardiology.
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An adult client is admitted with diabetic ketoacidosis (DKA) and a urinary tract infection (UTI). Prescriptions for intravenous antibiotics and an insulin infusion are initiated. Which serum laboratory value warrants the most immediate intervention by the nurse?
- A. Glucose of 350 mg/dl
- B. White blood cell count of 15,000 mm3
- C. Blood PH of 7.30
- D. Potassium of 2.5 mEq/L
Correct Answer: D
Rationale: A potassium level of 2.5 mEq/L is dangerously low and must be corrected immediately to prevent cardiac arrhythmias.
A VII nerve injury at the exit from the stylomastoid foramen would explain all except:
- A. Loss of sensation over the vallecula
- B. Loss of taste over the anterior third of the tongue
- C. Increased responsiveness to loud noises
- D. Inability to open the ipsilateral eye
Correct Answer: D
Rationale: The correct answer is D because the facial nerve (VII) does not control eye opening; this is controlled by the oculomotor nerve (III). The other options (a, b, c, e) are consistent with a VII nerve injury.
An 8-year-old female presents with chest pain of 1 day's duration. Five days prior to the pain, she had fever, chills, and myalgias. Physical examination reveals an uncomfortable, anxious, afebrile patient with tachycardia, no murmur, and distant heart sounds. The chest x-ray is shown in Figure 19-2. There is a paradoxical pulse of 22 mm Hg. The most likely diagnosis is
- A. myocarditis
- B. cardiomyopathy
- C. Kawasaki disease
- D. pericarditis
Correct Answer: D
Rationale: Pericarditis causes distant heart sounds, paradoxical pulse, and can follow viral illnesses.
A child of 36 months would be expected to:
- A. Build a tower of 5 cubes
- B. Repeat back 5 digits
- C. Draw a man with a head and body
- D. Demonstrate symbolic play
Correct Answer: D
Rationale: At 36 months, a child is expected to demonstrate symbolic play. Building a tower of 5 cubes and drawing a man with a head and body are also typical milestones.
Hyperkalaemia:
- A. Is exacerbated by acidosis
- B. Is a finding in Conn's syndrome
- C. ECG findings include peaked tall T-waves
- D. Should be treated if serum K+ > 6mmol/l
Correct Answer: A
Rationale: Acidosis exacerbates hyperkalaemia by causing a shift of potassium from intracellular to extracellular space, worsening the condition.