Nokea
An 8-year-old from the former Soviet Union is brought to your office because of a heart murmur and dusty blue skin. He has marked clubbing of his fingers and toes, and his hematocrit is 70%. He has a grade 4/6 holosystolic murmur. His chest x-ray reveals a normal pulmonary blood flow as well as a right-sided aortic arch. What is the likely diagnosis?
- A. total anomalous venous return
- B. tetralogy of Fallot
- C. Eisenmenger syndrome
- D. transposition of the great vessels
Correct Answer: C
Rationale: Eisenmenger syndrome involves reversal of shunt direction due to long-standing pulmonary hypertension, explaining the cyanosis and clubbing.
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Blueberry muffin' lesions seen in rubella is due to
- A. Dermal erythropoiesis
- B. Thrombocytopenia
- C. Ecchymosis
- D. Vasculitis
Correct Answer: A
Rationale: Blueberry muffin' lesions in congenital rubella are due to dermal erythropoiesis, where extramedullary hematopoiesis occurs in the skin.
When planning care for a client newly diagnosed with open angle glaucoma, the nurse identifies a priority nursing diagnosis of, 'visual sensory/perceptual alterations.' This diagnosis is based on which etiology?
- A. Limited eye movement
- B. Decreased peripheral vision
- C. Blurred distance vision
- D. Photosensitivity
Correct Answer: B
Rationale: Open angle glaucoma primarily affects peripheral vision, leading to visual sensory/perceptual alterations.
The nurse determines that a client who arrives in the preoperative holding area before surgery is allergic to bananas. Which action should the nurse implement prior to taking the client into the operative area?
- A. Replace latex-containing devices in the OR with alternate synthetic materials
- B. Administer an antihistamine before surgery.
- C. Notify the surgeon about the client's allergy to bananas.
- D. Prepare to administer an epinephrine injection during surgery
Correct Answer: A
Rationale: Banana allergy is associated with latex allergy. Replacing latex-containing devices prevents potential allergic reactions during surgery.
Consequences of a median nerve section in the ante-cubital fossa include:
- A. Complete paralysis of pronation
- B. Loss of sensation over palmar aspect of middle finger
- C. Wasting of hypothenar eminence
- D. Paralysis of abductor pollicis brevis
Correct Answer: D
Rationale: The median nerve controls the abductor pollicis brevis, and its injury at the ante-cubital fossa results in an inability to perform thumb abduction.
Which of the following is an example of ductus dependent systemic circulation?
- A. Severe Ebstein's anomaly
- B. Pulmonary atresia
- C. Tricuspid atresia
- D. Interruption of aortic arch
Correct Answer: D
Rationale: Interruption of aortic arch is ductus dependent as it relies on the ductus arteriosus for systemic blood flow.