Nokea
A nurse assesses an older adult client who is experiencing a myocardial infarction. Which clinical manifestation should the nurse expect?
- A. Excruciating pain on inspiration
- B. Left lateral chest wall pain
- C. Disorientation and confusion
- D. Numbness and tingling of the arm
Correct Answer: C
Rationale: Older adults may present with atypical symptoms of myocardial infarction, such as confusion or disorientation, rather than classic chest pain.
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A 5-year-old child who had a repair for transposition of the great arteries shortly after birth is growing normally and has been asymptomatic since the surgery. The primary care nurse practitioner notes mild shortness of breath with exertion and dizziness. What will the nurse practitioner do?
- A. Order an echocardiogram and chest radiograph.
- B. Perform pulmonary function testing.
- C. Reassure the parent that these symptoms are common.
- D. Refer the child to the cardiologist immediately.
Correct Answer: D
Rationale: Children with a history of transposition of the great arteries (d-TGA) who have a history of palpitations, syncope, or shortness of breath should be referred to a cardiologist.
Type I renal tubular acidosis:
- A. Only occurs in children
- B. Is caused by a failure of ammonium ion secretion
- C. Is associated with renal calcification
- D. Typically leads to hypovolaemia
Correct Answer: B
Rationale: Type I renal tubular acidosis is characterized by a failure in ammonium ion secretion, leading to a failure to acidify urine, which can result in metabolic acidosis.
Prior to the patient being given medication, he becomes hypotensive, mottled, and cold. His heart rate is 240. The next therapeutic step should be
- A. digoxin
- B. synchronized DC cardioversion
- C. lidocaine
- D. defibrillation
Correct Answer: B
Rationale: Synchronized DC cardioversion is indicated for unstable tachycardia unresponsive to pharmacological agents.
The following are suggestive of abnormal language development:
- A. Not localising sound at 4 months of age
- B. No response to human words at 6 weeks
- C. Not understanding 'no' at 18 months of age
- D. Does not move to music at 2 years of age
Correct Answer: C
Rationale: Failure to understand simple commands like 'no' by 18 months is a red flag for abnormal language development.
Obstructed total anomalous pulmonary venous return (TAPVR) is a pediatric surgical emergency because
- A. therapy is usually not effective
- B. severe pulmonary congestion
- C. left atrium may be small
- D. left ventricle may be small
Correct Answer: B
Rationale: Obstructed TAPVR requires immediate surgical intervention due to severe pulmonary congestion.