The definition of hypertension in children is
- A. average systolic blood pressure (SBP) and/or diastolic BP that is ≥95th percentile for age, sex, on ≥2 occasions
- B. average systolic blood pressure (SBP) and/or diastolic BP that is ≥95th percentile for age, sex, and height on ≥2 occasions
- C. average systolic blood pressure (SBP) and/or diastolic BP that is ≥95th percentile for age, sex, and height on ≥3 occasions
- D. average systolic blood pressure (SBP) and/or diastolic BP that is ≥90th percentile for age, sex, and height on ≥3 occasions
Correct Answer: C
Rationale: Hypertension in children is defined as BP ≥95th percentile for age, sex, and height on ≥3 occasions.
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Which plan would be appropriate in helping to control congestive heart failure (CHF) in an infant?
- A. Promoting fluid restriction
- B. Feeding a low-salt formula
- C. Feeding in semi-Fowler position
- D. Encouraging breast milk
Correct Answer: C
Rationale: Feeding in a more upright position helps fluid drain from the lungs, improving breathing and reducing cardiac workload.
An older woman who experienced a cerebrovascular accident (CVA) has difficulty with visual perception and she only eats half of the food on her meal tray. Her family expresses concern about her nutritional status. How should the nurse respond to the family's concern?
- A. Encourage the family to offer to feed the client when she does not eat her entire meal.
- B. Suggest that the family bring foods from home that the client enjoys
- C. Explain that weight loss will be reversed after the acute phase of the stroke has ended.
- D. Demonstrate the use of visual scanning during meals to the client and family.
Correct Answer: D
Rationale: Visual scanning techniques help the client become aware of the entire meal tray, improving food intake and addressing the family's concerns.
Increased TSH is seen in a neonate with:
- A. Thyroxine insensitivity
- B. Iodine deficiency
- C. Hyperbilirubinaemia
- D. Thyroid agenesis
Correct Answer: B
Rationale: Iodine deficiency: Neonates with iodine deficiency often present with increased TSH levels as the body attempts to compensate for low thyroid hormone production.
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.
The MOST common cyanotic congenital cardiac lesion to present in the newborn period is
- A. dextroposed heart
- B. transposition of great arteries
- C. tetralogy of Fallot
- D. truncus arteriosus
Correct Answer: B
Rationale: Transposition of the great arteries is the most common cyanotic congenital heart defect presenting in the neonatal period.