Nokea
An 8-year-old female presents with chest pain of 1 day's duration. Five days prior to the pain, she had fever, chills, and myalgias. Physical examination reveals an uncomfortable, anxious, afebrile patient with tachycardia, no murmur, and distant heart sounds. The chest x-ray is shown in Figure 19-2. There is a paradoxical pulse of 22 mm Hg. The most likely diagnosis is
- A. myocarditis
- B. cardiomyopathy
- C. Kawasaki disease
- D. pericarditis
Correct Answer: D
Rationale: Pericarditis causes distant heart sounds, paradoxical pulse, and can follow viral illnesses.
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Respiratory pathogens in the immunosuppressed include:
- A. Staphylococcus aureus
- B. Legionella
- C. Pneumocystis carinii
- D. Chlamydia
Correct Answer: C
Rationale: Pneumocystis carinii: Pneumocystis carinii pneumonia is a life-threatening infection in immunocompromised patients, especially those with HIV/AIDS or undergoing immunosuppressive therapy.
The healthcare provider prescribes an IV solution of regular insulin (Hummulin-R) 100 units in 250 ml of 0.45% saline to infuse at 12 units/hour. The nurse should program the infusion pump to deliver how many ml/hour?
- A. 30
- B. 3
- C. 40
- D. 15
Correct Answer: A
Rationale: To calculate the infusion rate in ml/hour, the nurse needs to divide the prescribed units per hour by the concentration of insulin. 12 units/hour ÷ (100 units/250 ml) = 30 ml/hour.
Congenital toxoplasmosis is associated with:
- A. Microcephaly
- B. Chorioretinitis
- C. Sore throat
- D. Sacroileitis
Correct Answer: B
Rationale: Chorioretinitis is a common manifestation of congenital toxoplasmosis, often leading to vision problems and ocular abnormalities.
A female client who was involved in a motor vehicle collision with a fractured left femur which is immobilized using a fracture traction splint in preparation for an open reduction internal fixation (ORIF). The nurse determines that her distal pulses are diminished in the left foot. Which interventions should the nurse implement? Select all that apply.
- A. Monitor left leg for pain, pallor, paresthesia, paralysis, pressure. Verify pedal pulses using a doppler pulse device. Evaluate the application of the splint to the left leg
- B. Verify pedal pulses using a Doppler pulse device
- C. Evaluate the application of the splint to the left leg.
- D. Administer pain medication to alleviate discomfort.
Correct Answer: A
Rationale: Monitoring for signs of compartment syndrome and verifying pulses are critical to ensure adequate circulation and prevent complications.
A 9-month-old infant has a grade III/VI, harsh, rumbling, continuous murmur in the left infraclavicular fossa and pulmonic area. A chest radiograph reveals cardiac enlargement. The primary care pediatric nurse practitioner will refer the infant to a pediatric cardiologist and prepare the parents for which intervention to repair this defect?
- A. Cardiopulmonary bypass surgery
- B. Coil insertion in the catheterization laboratory
- C. Indomethacin administration
- D. Observation for spontaneous closure
Correct Answer: B
Rationale: This murmur is characteristic of a PDA and, because of cardiac enlargement, represents a larger shunt, requiring repair. Infants older than 8 months may have a coil or plug inserted into the shunt in the cardiac catheterization laboratory.