Nokea
A fair-skinned female client who is an avid runner is diagnosed with malignant melanoma, located on the lateral surface of the lower leg. After wide margin resection, the nurse provides discharge teaching. It is most important for the nurse to emphasize the need to observe for changes in which characteristic?
- A. Elasticity of the skin
- B. Appearance of any moles
- C. Muscle aches and pains
- D. Pigmentation of the skin
Correct Answer: B
Rationale: Monitoring for changes in moles is critical for early detection of new or recurrent melanoma, which is essential for timely intervention.
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The nurse is caring for an 8-year-old girl whose parents indicate she has developed spastic movements of her extremities and trunk, facial grimace, and speech disturbances. They state it seems worse when she is anxious and does not occur while sleeping. The nurse questions the parents about which recent illness?
- A. Kawasaki disease (KD)
- B. Strep throat
- C. Malignant hypertension
- D. Atrial fibrillation
Correct Answer: B
Rationale: Chorea (spastic movements, facial grimacing, and speech disturbances) can be a manifestation of rheumatic fever following streptococcal pharyngitis, with a higher incidence in females.
Pulmonary hypertension is a complication of:
- A. ASD
- B. Eisenmenger syndrome
- C. Tricuspid atresia
- D. Tricuspid regurgitation
Correct Answer: B
Rationale: Eisenmenger syndrome is a well-known cause of pulmonary hypertension. The other options (a-d) can also lead to pulmonary hypertension but are less specific.
A wide splitting of S2 during expiration is auscultated in a 2-week-old infant.
- A. Atrial septal defect (ASD)
- B. Coarctation of the aorta (COA)
- C. Patent ductus arteriosis (PDA)
- D. Ventricular septal defect (VSD)
Correct Answer: A
Rationale: A wide splitting of S2 without becoming a single sound on expiration may indicate increased pulmonary flow, typical of atrial septal defect.
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.
Causes of a loin mass and haematuria:
- A. Wilm's tumour
- B. Polycystic kidney disease
- C. Pyonephrosis
- D. Renal vein thrombosis
Correct Answer: A
Rationale: Wilm's tumour is a common cause of a loin mass and haematuria in children. Polycystic kidney disease and pyonephrosis can also present similarly.