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Miss OB's malignant tumor in her left breast was discovered to be spreading all over the surrounding and adjacent tissue and not entering the blood stream, it would be:
- A. Malignant
- B. Non-malignant
- C. Benign
- D. B and C
Correct Answer: C
Rationale: A malignant tumor is characterized by its ability to spread to surrounding tissues and potentially enter the bloodstream to form secondary tumors in distant organs (metastasis). In the scenario provided, the tumor in Miss OB's left breast is described as spreading all over the surrounding and adjacent tissue but specifically noted not to be entering the bloodstream. This behavior is more indicative of a benign tumor that is growing locally but is not capable of metastasis. Therefore, the tumor is best classified as benign in this case.
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A 5 months child is brought for routine care. During auscultation of heart you find a short systolic murmur at left upper sternal border with soft 2nd heart sound. The most likely diagnosis is?
- A. Ventricular septal defect
- B. Atrial septal defect
- C. Patent ductus arteriosus
- D. Pulmonary stenosis
Correct Answer: B
Rationale: Atrial septal defect (ASD) often presents with a systolic ejection murmur at the left upper sternal border and a fixed split second heart sound.
Which is an important nursing consideration when chest tubes will be removed from a child?
- A. Explain that it is not painful.
- B. Explain that only a Band-Aid will be needed.
- C. Administer analgesics before the procedure.
- D. Expect bright red drainage for several hours after removal.
Correct Answer: C
Rationale: Administering analgesics before removing chest tubes from a child is an important nursing consideration because the procedure may cause pain or discomfort. While it is ideal to minimize pain during and after the removal, it is essential to anticipate the possibility of discomfort and provide appropriate pain management to ensure the child's comfort and well-being. By administering analgesics before the procedure, nurses can help alleviate any potential pain and promote a more positive experience for the child.
A 3-year-old child from a suburban community presents with vomiting, diarrhea, and blurred vision. Physical examination reveals an afebrile child with pinpoint pupils, salivation, and muscular fasciculations. The child's lawn was treated yesterday for insects. Which of the following tests will establish the correct diagnosis?
- A. Blood-lead level
- B. 24-hour urine mercury level
- C. Plasma cholinesterase level
- D. Urine malathion level
Correct Answer: C
Rationale: The symptoms suggest organophosphate poisoning, which can be confirmed by measuring plasma cholinesterase levels, as organophosphates inhibit this enzyme.
Which clinical manifestation should the nurse expect to see as shock progresses in a child and becomes decompensated shock? (Select all that apply.)
- A. Thirst and diminished urinary output
- B. Irritability and apprehension
- C. Cool extremities and decreased skin turgor
- D. Confusion and somnolence
Correct Answer: C
Rationale: Cool extremities and decreased skin turgor (C) are indications of poor perfusion as shock progresses. The body is shunting blood away from the peripheries to maintain perfusion to vital organs.
When palpating the brachial, radial, and femoral pulses of a neonate, the nurse notes a difference in pulse amplitude between the femoral and radial pulses bilaterally. This difference suggests:
- A. Patent ductus arteriosus
- B. Coarctation of the aorta
- C. Diminished cardiac output
- D. Left to right shunting in the heart. 104 Practice Exam I
Correct Answer: B
Rationale: Coarctation of the aorta is a congenital heart defect in which there is a narrowing of the aorta leading to differential pulses in the upper and lower extremities. In neonates, this can manifest as weaker femoral pulses compared to radial pulses due to decreased blood flow to the lower body. This difference in pulse amplitude between the femoral and radial pulses bilaterally is a classic finding in coarctation of the aorta, making it the most likely cause in this scenario. Other conditions like patent ductus arteriosus, diminished cardiac output, or left to right shunting in the heart may not specifically present with this particular pulse amplitude difference.