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An emergency room nurse obtains the health history of a client. Which statement by the client should alert the nurse to the occurrence of heart failure?
- A. I get short of breath when I climb stairs.
- B. I see halos floating around my head.
- C. I have trouble remembering things.
- D. I have lost weight over the past month.
Correct Answer: A
Rationale: Shortness of breath, especially during exertion, is a classic symptom of heart failure due to the heart's inability to pump blood effectively.
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During a routine well child exam on a 5-year-old child, a grade II/VI, harsh, late systolic ejection murmur at the upper left sternal border that transmits to both lung fields is auscultated. The child has normal growth and development. What will the nurse practitioner suspect?
- A. Aortic stenosis (AS)
- B. Patent ductus arteriosus (PDA)
- C. Pulmonic stenosis
- D. Tricuspid atresia
Correct Answer: C
Rationale: Pulmonic stenosis may be asymptomatic with a murmur as described above.
The following are strongly associated with Kawasaki disease EXCEPT
- A. duration of fever of >16 days
- B. first-degree heart block
- C. male gender
- D. age of <1 year
Correct Answer: B
Rationale: First-degree heart block is less commonly associated with Kawasaki disease compared to other factors.
A chest radiograph film is ordered for a child with suspected cardiac problems. The child’s parent asks the nurse, “What will the radiograph show about the heart?†What knowledge about the x-ray should the nurse include in the response to the parents?
- A. Bones of chest but not the heart
- B. Measurement of electrical potential generated from heart muscle
- C. Permanent record of heart size and configuration
- D. Computerized image of heart vessels and tissues
Correct Answer: C
Rationale: A chest radiograph will provide information on the heart size and pulmonary blood-flow patterns. It will provide a baseline for future comparisons. The heart will be visible, as well as the sternum and ribs. Electrocardiography (ECG) measures the electrical potential generated from heart muscle. Echocardiography will produce a computerized image of the heart vessels and tissues by using sound waves.
Cataracts are recognised in:
- A. Hyperthyroidism
- B. Down syndrome
- C. Graves' disease
- D. PKU
Correct Answer: B
Rationale: Cataracts are a recognized feature in Down syndrome. They are not typically associated with Hyperthyroidism, Graves' disease, or PKU.
A child aged 10 days has ambiguous genitalia:
- A. If a buccal smear is chromatin negative, there is a serious risk of an Addisonian crisis
- B. A raised urinary output of pregnanetriol would confirm a diagnosis of CAR
- C. The finding of the genotype 45 XO would reliably explain the anomaly
- D. If testicles were present in the 'labia', an acceptable explanation would be Klinefelter's syndrome
Correct Answer: B
Rationale: A raised urinary pregnanetriol indicates congenital adrenal hyperplasia (CAR). Chromatin-negative buccal smear suggests male genotype, and 45 XO is Turner syndrome, not related to ambiguous genitalia. Klinefelter's syndrome does not explain testicles in the labia.