Nokea
An asymptomatic 45-year old male with newly diagnosed atrial fibrillation and normal echo, refused cardioversion while suggested. The next optimal management strategy for him is
- A. Sedate and cardiovert against patient wishes
- B. Aspirin
- C. Anticoagulation
- D. Rate control
Correct Answer: D
Rationale: Rate control is the optimal management strategy for asymptomatic atrial fibrillation when cardioversion is refused.
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How would the nurse caring for an infant with congestive heart failure (CHF) modify feeding techniques to adapt for the child's weakness and fatigue? (Select all that apply.)
- A. Feeding more frequently with smaller feedings
- B. Using a soft nipple with enlarged holes
- C. Holding and cuddling the child during feeding
- D. Substituting glucose water for formula
Correct Answer: A
Rationale: Infants with CHF fatigue easily. Feeding can be given more frequently in smaller amounts through a soft, large-holed nipple. Formulas with a denser caloric content can be offered. The child may be encouraged to nurse if he or she is held.
The differential in a 5-year old with a 2-week history of painful joints is all the following except:
- A. Viral polyarthritis
- B. Rheumatoid arthritis
- C. Lyme disease
- D. Rheumatic fever
Correct Answer: B
Rationale: rheumatoid arthritis is rare in a 5-year-old with a 2-week history of joint pain. The other options (a-d) are more likely differentials.
Increased left ventricular end diastolic volume is seen in:
- A. Mitral regurgitation
- B. Congestive cardiomyopathy
- C. Hypertrophic obstructive cardiomyopathy
- D. Aortic stenosis
Correct Answer: A
Rationale: Mitral regurgitation leads to increased left ventricular end-diastolic volume due to backflow of blood into the left atrium.
A parent brings a toddler, age 19 months, to the clinic for a regular check-up. When palpating the toddler’s fontanels, what should the nurse expects to find?
- A. Closed anterior fontanel and open posterior fontanel
- B. Open anterior and fontanel and closed posterior fontanel
- C. Closed anterior and posterior fontanels
- D. Open anterior and posterior fontanels
Correct Answer: C
Rationale: By 19 months, both the anterior and posterior fontanels should be closed as the skull bones have fused.
A client with stage IV bone cancer is admitted to the hospital for pain control. The client verbalizes continuous, severe pain of 8 on a 1 to 10 scale. Which intervention should the nurse implement?
- A. Administer opioid and non-opioid medication simultaneously
- B. Administer only opioid medication as prescribed.
- C. Encourage the client to practice relaxation techniques
- D. Delay medication administration until reassessment.
Correct Answer: A
Rationale: Combining opioid and non-opioid medications provides more effective pain relief for severe cancer-related pain.