Nokea
A child aged 10 days has ambiguous genitalia:
- A. If a buccal smear is chromatin negative, there is a serious risk of an Addisonian crisis
- B. A raised urinary output of pregnanetriol would confirm a diagnosis of CAR
- C. The finding of the genotype 45 XO would reliably explain the anomaly
- D. If testicles were present in the 'labia', an acceptable explanation would be Klinefelter's syndrome
Correct Answer: B
Rationale: A raised urinary pregnanetriol indicates congenital adrenal hyperplasia (CAR). Chromatin-negative buccal smear suggests male genotype, and 45 XO is Turner syndrome, not related to ambiguous genitalia. Klinefelter's syndrome does not explain testicles in the labia.
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Which is an important nursing consideration when suctioning a young child who has had heart surgery?
- A. Perform suctioning at least every hour.
- B. Suction for no longer than 30 seconds at a time.
- C. Administer supplemental oxygen before and after suctioning.
- D. Expect symptoms of respiratory distress when suctioning.
Correct Answer: C
Rationale: If suctioning is indicated, supplemental oxygen is administered with a manual resuscitation bag before and after the procedure to prevent hypoxia. Suctioning should be done only as indicated, not on a routine basis. The child should be suctioned for no more than 5 seconds at one time. Symptoms of respiratory distress are avoided by using appropriate technique.
A child has an elevated antistreptolysin O (ASO) titer. Which combination of symptoms, in conjunction with this finding, would confirm a diagnosis of rheumatic fever?
- A. Subcutaneous nodules and fever
- B. Painful, tender joints, and carditis
- C. Erythema marginatum and arthralgia
- D. Chorea and elevated sedimentation rate
Correct Answer: B
Rationale: The presence of two major Jones criteria would indicate a high probability of rheumatic fever.
Which among the following is not a feature of low flow - low gradient severe aortic stenosis with preserved left ventricular function?
- A. Mean trans aortic pressure gradient < 40 mm Hg
- B. Aortic valve area < 1 cm²
- C. Stroke volume > 35 ml/m²
- D. Left ventricular ejection fraction > 50%
Correct Answer: C
Rationale: Stroke volume is typically reduced, not increased, in low flow - low gradient severe aortic stenosis.
The nurse is teaching a client with glomerulonephritis about self-care. Which dietary recommendations should the nurse encourage the client to follow?
- A. Increase intake of high-fiber foods, such as bran cereal
- B. Restrict protein intake by limiting meats and other high-protein foods
- C. Limit oral fluid intake to 500 ml per day
- D. Increase intake of potassium-rich foods such as bananas or cantaloupe
Correct Answer: B
Rationale: Reducing protein intake helps decrease the workload on the kidneys, which is beneficial in glomerulonephritis.
HLA B27 positivity is least common in
- A. Ankylosing spondylosis
- B. Juvenile psoriatic arthritis
- C. Inflammatory bowel disease
- D. Reactive arthritis
Correct Answer: C
Rationale: HLA B27 positivity is least common in inflammatory bowel disease compared to the other conditions listed.