Nokea
During a well baby examination of a 6-week-old infant, poor weight gain, acrocyanosis of the hands and feet, and a respiratory rate of 60 breaths per minute are noted. Oxygen saturation on room air is 93%. What is the correct action?
- A. Follow-up in 1 week to assess the infant's weight.
- B. Order a chest radiograph and an electrocardiogram.
- C. Reassure the parents that the exam is within normal limits.
- D. Refer the infant to a pediatric cardiologist.
Correct Answer: D
Rationale: Infants with oxygen saturation less than 95% and those with poor feeding should be referred emergently to a cardiologist.
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Which physiological changes occur as a result of hypoxemia in congestive heart failure (CHF)?
- A. Polycythemia and clubbing
- B. Anemia and barrel chest
- C. Increased white blood cells and low platelets
- D. Elevated erythrocyte sedimentation rate and peripheral edema
Correct Answer: A
Rationale: Hypoxemia stimulates erythropoiesis, causing polycythemia, which along with chronic hypoxemia can lead to digital clubbing.
A nurse is caring for a child with a diagnosis of Kawasaki disease. Which of the following is a common complication of this disease?
- A. Pulmonary hypertension
- B. Aneurysms of the coronary arteries
- C. Diabetes mellitus
- D. Ventricular arrhythmias
Correct Answer: B
Rationale: Aneurysms of the coronary arteries are a common and serious complication of Kawasaki disease.
A client with Guillain-Barre syndrome has paralysis of all extremities and requires mechanical ventilation. The nurse observes that the client is not blinking. Which action should the nurse implement?
- A. Protect cornea with lubricant and eye shields
- B. Administer artificial tears every hour.
- C. Encourage the client to blink every 10 minutes.
- D. Keep the client's eyes closed with adhesive tape.
Correct Answer: A
Rationale: Lack of blinking increases the risk of corneal damage. Lubricants and eye shields prevent dryness and injury to the cornea.
Clinical diagnostic clues in an adolescent female with chronic cough:
- A. Pale stools and diarrhoea
- B. Aspergillus precipitin positive
- C. Calcified bronchopulmonary lymph nodes
- D. Whooping cough in the past
Correct Answer: B
Rationale: Aspergillus precipitin positive: A positive Aspergillus precipitin test indicates Aspergillus exposure, which could lead to chronic pulmonary issues, especially in immunocompromised individuals.
Diagnostic signs of child abuse are:
- A. Sub-hyaloid bleeding
- B. Spiral fracture of a long bone
- C. Lacerated tongue
- D. Posterior rib fractures
Correct Answer: D
Rationale: Posterior rib fractures are highly suggestive of child abuse, as they are often caused by forceful squeezing or shaking.