Nokea
How will a ventricular septal defect affect blood flow?
- A. Blood will shunt left to right, causing increased pulmonary flow and no cyanosis.
- B. Blood will shunt right to left, causing decreased pulmonary flow and cyanosis.
- C. No shunting occurs due to high pressure in the left ventricle.
- D. Increased pressure in the left atrium hinders the circulation of oxygenated blood in the circulating volume.
Correct Answer: A
Rationale: A ventricular septal defect allows blood to shunt left to right, leading to increased pulmonary flow. This results in oxygenated blood mixing with deoxygenated blood, causing no cyanosis as the mixed blood is still oxygenated. The shunting from left to right overloads the pulmonary circulation, leading to increased pulmonary flow. Choice B is incorrect because blood does not shunt right to left in a ventricular septal defect. Choice C is incorrect as shunting does occur due to the pressure differences between the ventricles. Choice D is incorrect because the defect affects the ventricles, not the atrium, and does not hinder the circulation of oxygenated blood in the circulating volume.
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How should the nurse prepare the sibling of a near-drowning accident victim who wants to see his brother in the pediatric intensive care unit, considering the child was present during the accident?
- A. Have the parents explain to the child why the sibling is so sick and inform the child that this could be the last time he sees his brother.
- B. Reassure the sibling not to cry in the child's room to avoid upsetting the ill child.
- C. If death is imminent, avoid informing the child about it and minimize involvement in care to protect the child from further trauma.
- D. Cover tubes and wires with a sheet, wash off any existing blood, and prepare him for what he will see.
Correct Answer: D
Rationale: When preparing a sibling to see their brother in the pediatric intensive care unit after a near-drowning accident, it is essential to cover tubes and wires with a sheet, wash off any existing blood, and explain what the sibling will see. This approach helps the sibling understand the situation better and prepares them emotionally for the encounter, reducing potential distress and trauma. By providing information and visual preparation, the sibling can have a more controlled and less overwhelming experience when visiting their brother in the intensive care unit. Choice A is incorrect as informing the child that this could be the last time he sees his sibling may cause unnecessary distress and anxiety. Choice B is incorrect as it dismisses the sibling's emotional response, which is essential to address in a supportive manner. Choice C is incorrect as honesty and appropriate information sharing are crucial, even in difficult situations, to help the child cope effectively with the circumstances.
A 6-year-old male is hospitalized in stable condition with multiple fractures following a car accident. The child's parents tell the nurse that their 7-year-old daughter is very upset about the accident and is concerned that her brother will die. Which suggestion by the nurse is most appropriate?
- A. Encourage the parents to phone the sister frequently with updates on her brother's condition.
- B. Suggest that the sister come to the hospital for a visit.
- C. Suggest that one parent leave the hospital to spend extra time with their daughter at home.
- D. Remind the parents that it is normal for children to be upset when their sibling is hospitalized.
Correct Answer: B
Rationale: In situations where a sibling is upset about a family member being hospitalized, suggesting that the sister come to the hospital for a visit can help alleviate her concerns. This allows the sister to see her brother, ask questions, and receive reassurance from seeing him in stable condition. Direct contact and interaction can often provide more comfort and understanding than phone calls or staying at home. Encouraging phone calls (Choice A) might not provide the same level of comfort as a physical visit. While spending extra time with the daughter at home (Choice C) is important, in this scenario, facilitating a visit to the hospital can address the daughter's immediate concerns better. Reminding the parents that it is normal for children to be upset (Choice D) is not as proactive as arranging for the sister to visit her brother.
The Andrews family has been taking good care of their youngest, Archie, who was diagnosed with asthma. Which of the following statements indicate a need for further home care teaching?
- A. He should increase his fluid intake regularly to thin secretions.
- B. We'll make sure he avoids exercise to prevent attacks.
- C. He is to use his bronchodilator inhaler before the steroid inhaler.
- D. We need to identify what triggers his attacks.
Correct Answer: B
Rationale: The correct answer is B. Avoiding exercise entirely is not recommended for asthma management. Regular exercise can actually help strengthen the lungs and improve overall respiratory function. Teaching should focus on appropriate exercise routines that are suitable for individuals with asthma to prevent attacks. Choices A, C, and D are all appropriate and indicate good understanding of asthma management. Increasing fluid intake helps thin secretions, using the bronchodilator inhaler before the steroid inhaler follows the correct order of inhaler administration, and identifying triggers is essential for asthma control.
What is the most appropriate technique to use when explaining a central line dressing change to a preschool-age client?
- A. Show a picture of the procedure in a book.
- B. Explain the procedure with clear instructions.
- C. Let the child perform a dressing change on a doll.
- D. None of the above.
Correct Answer: C
Rationale: The most appropriate technique to use when explaining a central line dressing change to a preschool-age client is to let the child perform a dressing change on a doll. Preschool-age children learn best through play and hands-on activities. Allowing the child to practice on a doll helps them understand the procedure in a non-threatening and interactive way. This technique can reduce anxiety, increase cooperation, and enhance the child's understanding of the dressing change process. Choices A and B do not provide a hands-on approach, which is crucial for preschool-age children. Choice D is incorrect as providing an interactive experience is more effective than just showing pictures or giving verbal instructions.
An infant with congestive heart failure is receiving diuretic therapy. A nurse is closely monitoring the intake and output. The nurse uses which most appropriate method to assess the urine output?
- A. Weighing the diapers
- B. Inserting a Foley catheter
- C. Comparing intake with output
- D. Measuring the amount of water added to formula
Correct Answer: A
Rationale: Weighing the diapers is the most appropriate method to assess urine output in infants. Diapers will absorb and retain urine, providing a measurable indicator of urine output without invasive procedures. This method is non-invasive, simple, and convenient for monitoring urine output, especially in infants who may not be able to use other urine output measurement techniques. Inserting a Foley catheter is invasive and not indicated for routine urine output monitoring in infants. Comparing intake with output does not directly measure urine output. Measuring the amount of water added to formula does not provide an accurate assessment of urine output.