Nokea
A 9-month-old infant has a grade III/VI, harsh, rumbling, continuous murmur in the left infraclavicular fossa and pulmonic area. A chest radiograph reveals cardiac enlargement. The primary care pediatric nurse practitioner will refer the infant to a pediatric cardiologist and prepare the parents for which intervention to repair this defect?
- A. Cardiopulmonary bypass surgery
- B. Coil insertion in the catheterization laboratory
- C. Indomethacin administration
- D. Observation for spontaneous closure
Correct Answer: B
Rationale: This murmur is characteristic of a PDA and, because of cardiac enlargement, represents a larger shunt, requiring repair. Infants older than 8 months may have a coil or plug inserted into the shunt in the cardiac catheterization laboratory.
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A female client who was involved in a motor vehicle collision with a fractured left femur which is immobilized using a fracture traction splint in preparation for an open reduction internal fixation (ORIF). The nurse determines that her distal pulses are diminished in the left foot. Which interventions should the nurse implement? Select all that apply.
- A. Monitor left leg for pain, pallor, paresthesia, paralysis, pressure. Verify pedal pulses using a doppler pulse device. Evaluate the application of the splint to the left leg
- B. Verify pedal pulses using a Doppler pulse device
- C. Evaluate the application of the splint to the left leg.
- D. Administer pain medication to alleviate discomfort.
Correct Answer: A
Rationale: Monitoring for signs of compartment syndrome and verifying pulses are critical to ensure adequate circulation and prevent complications.
The MOST common early long-term complication for those patients who underwent repair of complete atrioventricular canal before the development of pulmonary vascular disease is
- A. left AV valve regurgitation
- B. subaortic stenosis
- C. residual ventricular level shunts
- D. complete heart block
Correct Answer: A
Rationale: Left AV valve regurgitation is a common complication after complete atrioventricular canal repair.
A nurse assesses a client who had a myocardial infarction and is hypotensive. Which additional assessment finding should the nurse expect?
- A. Heart rate of 120 beats/min
- B. Cool, clammy skin
- C. Oxygen saturation of 90%
- D. Respiratory rate of 8 breaths/min
Correct Answer: A
Rationale: A heart rate of 120 beats/min (tachycardia) is a common compensatory response to hypotension following a myocardial infarction, as the body attempts to maintain cardiac output.
Which is the leading cause of death after heart transplantation?
- A. Infection
- B. Rejection
- C. Cardiomyopathy
- D. Heart failure
Correct Answer: B
Rationale: The posttransplant course is complex. The leading cause of death after cardiac transplantation is rejection. Infection is a continued risk secondary to the immunosuppression necessary to prevent rejection. Cardiomyopathy is one of the indications for cardiac transplant. Heart failure is not a leading cause of death.
Features of severe haemophilia A include:
- A. Retroperitoneal bleed
- B. Chronic arthropathy
- C. Prolonged bleeding time
- D. Increased APTT
Correct Answer: D
Rationale: Increased activated partial thromboplastin time (APTT) is a characteristic feature of haemophilia A due to the deficiency of clotting factor VIII.