Nokea
Fluids are restricted to 1,500 ml daily for a male client with acute kidney injury (AKI). He is frustrated and complaining of constant thirst, and the nurse discovers that the family is providing the client with additional fluids. Which intervention should the nurse implement?
- A. Remove all sources of liquids from the client's room
- B. Allow family to give client a measured amount of ice chips
- C. Restrict family visiting until the client's condition is stable
- D. Provide the client with oral swabs to moisten his mouth
Correct Answer: D
Rationale: Oral swabs can help alleviate thirst without increasing fluid intake, which is restricted in AKI.
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A 12-year-old child whose body mass index (BMI) is greater than the 95th percentile has a blood pressure at the 98th percentile for age, sex, and height. After lifestyle changes that include diet and exercise, the child's BMI drops to the 90th percentile, but the blood pressure remains the same. What is the primary care pediatric nurse practitioner's next step in treating this child?
- A. Continued close monitoring of blood pressure
- B. Ordering an echocardiogram
- C. Prescribing an ACE inhibitor medication
- D. Referral to a nephrologist or cardiologist
Correct Answer: D
Rationale: Children who have persistent BP elevation after lifestyle changes are made should be referred to a nephrologist or cardiologist who has experience using antihypertensive agents in children.
Which of the following statements is true regarding alcohol septal ablation?
- A. Indicated when dynamic LV outflow gradient is more than 50 mm Hg at rest
- B. Targeted septal thickness less than 16 mm is a contraindication
- C. Usually preferred over surgical myomectomy
- D. Reduces risk of sudden death
Correct Answer: A
Rationale: Alcohol septal ablation is indicated when the dynamic LV outflow gradient is more than 50 mm Hg at rest.
The nurse reviews the laboratory results of a client during an annual physical examination and identifies a positive guaiac test of stool. Which additional serum laboratory test result should the nurse review?
- A. Glucose
- B. Platelet count
- C. White blood cell count
- D. Amylase
Correct Answer: B
Rationale: A positive guaiac test indicates gastrointestinal bleeding. A platelet count is essential to assess for thrombocytopenia, which could contribute to bleeding.
Tall (>25 mm), narrow, and spiked P waves are seen in
- A. Ebstein anomaly
- B. ventricular septal defect
- C. patent ductus arteriosus
- D. severe mitral stenosis
Correct Answer: D
Rationale: Severe mitral stenosis can cause tall, narrow, and spiked P waves due to left atrial enlargement.
Appropriate investigations in the emergency management of a 4-year-old presenting in a coma:
- A. Serum magnesium level
- B. Throat swabs
- C. Arterial blood gas
- D. CT scan
Correct Answer: C
Rationale: Arterial blood gas analysis is crucial in the emergency management of a comatose child to assess oxygenation, ventilation, and acid-base status.