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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Which of the following is least considered to be a normal variant in newborns?
- A. Milia
- B. Neonatal pustular melanosis
- C. Dermal melanocytosis
- D. Infantile acropustulosis
Correct Answer: D
Rationale: Infantile acropustulosis is not considered a normal variant in newborns; it is a rare condition characterized by recurrent pustular eruptions.
A nurse prepares a client for coronary artery bypass graft surgery. The client states, I am afraid I might die. How should the nurse respond?
- A. This is a routine surgery and the risk of death is very low.
- B. Would you like to speak with a chaplain before surgery?
- C. Tell me more about your concerns about the surgery.
- D. What support systems do you have to assist you?
Correct Answer: C
Rationale: Encouraging the client to express their concerns allows the nurse to provide emotional support and address specific fears.
Gingival hyperplasia is an adverse effect of therapy with:
- A. Phenytoin
- B. Cyclophosphamide
- C. Frusemide
- D. Carbamazepine
Correct Answer: A
Rationale: Phenytoin, an anticonvulsant medication, is well-known for causing gingival hyperplasia as a side effect.
The most likely diagnosis in the patient described is
- A. persistent pulmonary hypertension
- B. transposition of the great arteries
- C. truncus arteriosus
- D. pulmonary atresia
Correct Answer: B
Rationale: Transposition of the great arteries often presents with cyanosis due to mixing of oxygenated and deoxygenated blood.
A male client is recovering from an episode of urinary tract calculi. During discharge teaching, the client asks about the dietary restriction he should follow. In discussing fluid intake, the nurse should include which type of fluid limitation?
- A. Low-sodium soups.
- B. Over all fluid intake
- C. Tea and hot chocolate
- D. Citrus fruit juices
Correct Answer: C
Rationale: Tea and hot chocolate contain oxalates, which can contribute to the formation of calcium oxalate stones. Limiting these fluids helps prevent recurrence.