Nokea
Ten hours following thrombolysis for an ST elevation myocardial infarction (STEMI), a client is receiving a lidocaine infusion for isolated runs of ventricular tachycardia (VT). Which finding should the nurse document in the electronic medical record as a therapeutic response to the lidocaine infusion?
- A. Stabilization of blood pressure ranges
- B. Cessation of chest pain
- C. Reduce heart rate
- D. Decreased frequency of episodes of VT
Correct Answer: D
Rationale: Lidocaine is used to suppress ventricular tachycardia, so a decrease in episodes indicates a therapeutic response.
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What is the most likely congenital heart lesion in a newborn with Trisomy 21?
- A. AVSD
- B. Tetralogy of Fallot
- C. Ventricular septal defect
- D. Pulmonary stenosis
Correct Answer: A
Rationale: Atrioventricular septal defect (AVSD) is highly associated with Trisomy 21 and is the most likely congenital heart lesion in these infants.
Which painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis?
- A. Osler nodes
- B. Janeway lesions
- C. Subcutaneous nodules
- D. Aschoff nodes
Correct Answer: A
Rationale: Osler nodes are red, painful, intradermal nodes found on pads of the phalanges in bacterial endocarditis. Janeway lesions are painless hemorrhagic areas on palms and soles in bacterial endocarditis. Subcutaneous odules are nontender swellings, located over bony prominences, commonly found in rheumatic fever. Aschoff nodules are small nodules composed of cells and leukocytes found in the interstitial tissues of the heart in rheumatic myocarditis
Regarding body iron stores:
- A. Serum ferritin is a poor guide to iron stores
- B. A healthy young man will have more iron stored as ferritin than in the circulating red cell mass
- C. Iron is the stimulant for ferritin production
- D. In iron deficiency, stores of haemosiderin are mobilised before ferritin
Correct Answer: C
Rationale: Iron is a key regulator for ferritin production, and as iron levels rise, ferritin synthesis is stimulated to store excess iron.
Regarding cystic fibrosis:
- A. It is inherited as autosomal recessive
- B. There is increased risk of bronchial carcinoma in late adulthood
- C. Biliary cirrhosis is a recognised feature
- D. In neonates, intestinal obstruction may be the first presentation
Correct Answer: A
Rationale: Cystic fibrosis is an autosomal recessive disorder caused by mutations in the CFTR gene.
Seventy-two hours after cardiac surgery, a young child has a temperature of 101° F. Which action should the nurse take?
- A. Keep child warm with blankets.
- B. Apply a hypothermia blanket.
- C. Record temperature on nurses’ notes.
- D. Report findings to physician.
Correct Answer: D
Rationale: In the first 24 to 48 hours after surgery, the body temperature may increase to 37.7° C (100° F) as part of the inflammatory response to tissue trauma. If the temperature is higher or continues after this period, it is most likely a sign of an infection and immediate investigation is indicated. Blankets should be removed from the child to keep the temperature from increasing. Hypothermia blanket is not indicated for this level of temperature. The temperature should be recorded, but the physician must be notified for evaluation. Suctioning should be done only as indicated, not on a routine basis. The child should be suctioned for no more than 5 seconds at one time. Symptoms of respiratory distress are avoided by using appropriate technique.