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A client with Addison's disease started taking hydrocortisone in a divided daily dose last week. It is most important for the nurse to monitor which serum laboratory value?
- A. Osmolarity
- B. Glucose
- C. Albumin
- D. Platelets
Correct Answer: B
Rationale: Hydrocortisone can affect blood glucose levels, making it important to monitor for hyperglycemia.
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A 15-year-old female reports fainting at school in class on two occasions. The adolescent's orthostatic blood pressures are normal. The primary care pediatric nurse practitioner suspects a cardiac cause for these episodes and will order which tests before referring her to a pediatric cardiologist?
- A. 12-lead electrocardiogram
- B. Echocardiogram
- C. Tilt table testing
- D. Treadmill exercise testing
Correct Answer: A
Rationale: A 12-lead ECG is useful for initial evaluation.
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.
What finding would the nurse expect when measuring blood pressure on all four extremities of a child with coarctation of the aorta?
- A. Blood pressure higher on the right side
- B. Blood pressure higher on the left side
- C. Blood pressure lower in the arms than in the legs
- D. Blood pressure lower in the legs than in the arms
Correct Answer: D
Rationale: The characteristic symptoms of coarctation of the aorta are a marked difference in blood pressure and pulses between the upper and lower extremities. Pressure is increased proximal to the defect and decreased distal to the coarctation.
Which is an important nursing consideration when chest tubes will be removed from a child?
- A. Explain that it is not painful.
- B. Explain that only a Band-Aid will be needed.
- C. Administer analgesics before the procedure.
- D. Expect bright red drainage for several hours after removal.
Correct Answer: C
Rationale: It is appropriate to prepare the child for the removal of chest tubes with analgesics. Short-acting medications can be used that are administered through an existing IV line. A sharp, momentary pain is felt. This should not be misrepresented to the child. A petroleum gauze, air-tight dressing will be needed, but it is not a pain-free procedure. Little or no drainage should be found on removal.
The causative organisms for endocarditis in pediatric patients are
- A. enterococci
- B. group B streptococci
- C. viridans-type streptococci
- D. Pseudomonas aeruginosa
Correct Answer: C
Rationale: Viridans streptococci are the most common cause of endocarditis in pediatric patients.