Nokea
Down syndrome and VSD
- A. Doesn't close spontaneously as in children without downs
- B. Inaudible murmur is a characteristic feature / Murmur is not audible
- C. Pulmonary Hypertension is a late complication
- D. If no murmur, condition need not be investigated
Correct Answer: C
Rationale: Pulmonary hypertension is a known late complication in Down syndrome with VSD.
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A previously well 3½-month-old presents with poor feeding, diaphoresis during feeding, and poor growth. Vital signs reveal respirations of 70, pulse of 175, and blood pressure of 90/65 mm Hg in the upper and lower extremities. The cardiac examination reveals a palpable parasternal lift and a systolic thrill. A grade 4 holosystolic murmur and a mid-diastolic rumble are noted. The chest radiograph reveals cardiomegaly. The most likely diagnosis is
- A. cardiomyopathy
- B. myocarditis
- C. VSD
- D. coarctation of the aorta
Correct Answer: C
Rationale: The presentation suggests a large ventricular septal defect (VSD) causing significant left-to-right shunting and heart failure.
Treatment options in the management of an intussusception include:
- A. Contrast enema
- B. Air enema
- C. Water enema
- D. Open surgery
Correct Answer: B
Rationale: Air enema is a common non-surgical treatment for intussusception. Contrast enema and open surgery are also options, but air enema is often preferred.
A seizure episode may be mimicked by:
- A. Breath-holding episode
- B. Choreoathetosis
- C. Hysterical reactions
- D. Vasovagal attack
Correct Answer: A
Rationale: Breath-holding episodes in children can mimic seizures due to transient loss of consciousness, often triggered by emotional stress or pain.
Which plan would be appropriate in helping to control congestive heart failure (CHF) in an infant?
- A. Promoting fluid restriction
- B. Feeding a low-salt formula
- C. Feeding in semi-Fowler position
- D. Encouraging breast milk
Correct Answer: C
Rationale: Feeding in a more upright position helps fluid drain from the lungs, improving breathing and reducing cardiac workload.
A nurse assesses an older adult client who has multiple chronic diseases. The client’s heart rate is 48 beats/min. Which action should the nurse take first?
- A. Document the finding in the chart.
- B. Initiate external pacing.
- C. Assess the client’s medications.
- D. Administer 1 mg of atropine.
Correct Answer: C
Rationale: A heart rate of 48 beats/min (bradycardia) in an older adult with multiple chronic diseases may be due to medication side effects. Assessing the client’s medications is the first step to determine if any drugs are contributing to the bradycardia.