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.
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The treatment of the patient is best performed by which methods (Select one that doesn't apply)?
- A. Intravenous indomethacin
- B. Surgical closure
- C. Catheter coil closure
- D. Digoxin until the PDA closes spontaneously
Correct Answer: D
Rationale: Indomethacin, surgical closure, and catheter coil closure are standard treatments for patent ductus arteriosus.
Bronchoconstriction is a recognised side effect of:
- A. Captopril
- B. Salbutamol
- C. Ibuprofen
- D. Paracetamol
Correct Answer: B
Rationale: Salbutamol can cause bronchoconstriction in some cases due to its paradoxical effect, especially if overused or misused.
The following conditions may present with microcephaly:
- A. Dandy-Walker malformation
- B. Congenital rubella
- C. Rett syndrome
- D. Edward's syndrome
Correct Answer: B
Rationale: Congenital rubella syndrome is associated with microcephaly due to intrauterine infection affecting brain development.
False statements include:
- A. Curosurf is a natural surfactant
- B. Antenatal steroids are usually given as two oral doses of dexamethasone
- C. Increasing the rate on the ventilator raises the mean airway pressure
- D. CPAP is a common weaning tool in ventilated pre terms
Correct Answer: B
Rationale: The correct answer is B because antenatal steroids are typically given intramuscularly, not orally. The other options (a, c, d, e) are true statements.
A client with pheochromocytoma reports the onset of a severe headache. The nurse observes that the client is very diaphoretic. Which assessment data should the nurse obtain next?
- A. Blood pressure
- B. Blood glucose level
- C. Respiratory rate
- D. Oxygen saturation
Correct Answer: A
Rationale: Pheochromocytoma can lead to hypertension, which may be responsible for the client’s symptoms. Monitoring blood pressure is crucial to assess for potential hypertensive crisis.