A child has been diagnosed with valvular disease following rheumatic fever (RF). During patient teaching, the nurse discusses the child's long-term prophylactic therapy with antibiotics for dental procedures, surgery, and childbirth. The parents indicate they understand when they say:
- A. She will need to take the antibiotics until she is 18 years old.
- B. She will need to take the antibiotics for 5 years after the last attack.
- C. She will need to take the antibiotics for 10 years after the last attack.
- D. She will need to take the antibiotics for the rest of her life.
Correct Answer: D
Rationale: Valvular involvement indicates significant damage; therefore, lifelong prophylactic antibiotics are required.
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A grade II vibratory, mid-systolic murmur at the mid sternal border in a 4-year-old child that is louder when the child is supine is most likely which type of murmur?
- A. Pathologic murmur
- B. Pulmonary flow murmur
- C. Still's murmur
- D. Venous hum
Correct Answer: C
Rationale: A Still's murmur is characterized by a vibratory or musical low-grade sound, along the sternal border, which is louder when the child is supine or during inspiration.
A male client complains of pain in his right calf, and the nurse determines that his calf is edematous and deep red. What intervention has the highest priority?
- A. Tell the client to remain in bed
- B. Apply warm compresses to the affected leg.
- C. Administer pain medication as prescribed.
- D. Encourage the client to elevate the affected leg.
Correct Answer: A
Rationale: The symptoms suggest deep vein thrombosis (DVT). Bed rest prevents dislodgment of the clot, reducing the risk of pulmonary embolism.
Which assessment indicates that the parent of a 7-year-old is following the prescribed treatment for congestive heart failure (CHF)?
- A. HR of 56 beats per minute
- B. Elevated red blood cell count
- C. 50th percentile height and weight for age
- D. Urine output of 0.5 cc/kg/hr
Correct Answer: C
Rationale: Normal growth (50th percentile) indicates good nutrition and overall health, suggesting that CHF is well controlled.
Rett syndrome is characterised by:
- A. Social withdrawal
- B. Self-mutilation
- C. Macrocephaly
- D. Wringing hand movements
Correct Answer: D
Rationale: Wringing hand movements are a hallmark feature of Rett syndrome, a neurodevelopmental disorder primarily affecting females.
Regarding idiopathic thrombocytopenic purpura (ITP):
- A. The more severe the disease
- B. the faster is the recovery to therapy
- C. Alloimmunisation occurs due to fetomaternal incompatibility
- D. Splenomegaly is a recognised feature
Correct Answer: C
Rationale: ITP is characterized by low platelet counts due to immune-mediated destruction. Splenomegaly is a recognized feature but the other options are incorrect. Recovery is not necessarily faster with more severe disease alloimmunisation is not a feature of ITP and not all children with platelet counts below 50 000 require hospitalization. IV immunoglobulin is not indicated in all cases.