The following are causes of congestive heart failure and cardiomegaly during the newborn period but no murmur EXCEPT
- A. endocardial fibroelastosis
- B. asphyxia
- C. glycogen storage disease (Pompe disease)
- D. sepsis
Correct Answer: D
Rationale: Sepsis can cause heart failure and cardiomegaly but often presents with other systemic signs.
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A nurse assesses a client who is recovering from a myocardial infarction. The client’s pulmonary artery pressure reading is 25/12 mm Hg. Which action should the nurse take first?
- A. Compare the results with previous pulmonary artery pressure readings.
- B. Increase the intravenous fluid rate because these readings are low.
- C. Immediately notify the health care provider of the elevated pressures.
- D. Document the finding in the client’s chart as the only action.
Correct Answer: A
Rationale: Comparing the current pulmonary artery pressure readings with previous ones helps determine if the values are stable or changing, which guides further intervention.
What information should the nurse include in the teaching plan of a client diagnosed with gastroesophageal reflux disease (GERD)?
- A. Sleep without pillows at night to maintain neck alignment.
- B. Adjust food intake to three full meals per day and no snacks.
- C. Minimize symptoms by wearing loose, comfortable clothing
- D. Avoid participation in any aerobic exercise programs
Correct Answer: C
Rationale: Loose clothing reduces pressure on the abdomen, which can help minimize GERD symptoms.
Closure of the ductus will worsen following conditions
- A. Transposition of great vessels
- B. Tricuspid Atresia
- C. Hypoplastic Left heart syndrome
- D. Tetrology of Fallots
Correct Answer: C
Rationale: Closure of the ductus arteriosus worsens hypoplastic left heart syndrome by removing the only source of systemic circulation.
Of the following, the cardiac lesion resulting in increased volume load is
- A. valvular pulmonic stenosis
- B. patent ductus arteriosus
- C. valvular aortic stenosis
- D. mitral stenosis
Correct Answer: B
Rationale: Patent ductus arteriosus leads to increased volume load on the left side of the heart.
What should the school nurse recommend when encouraging a heart-healthy diet for a child with high cholesterol?
- A. A fat intake reduction of 5-10% of total calories
- B. A fat intake reduction of 10-15% of total calories
- C. A fat intake reduction of 15-20% of total calories
- D. A fat intake reduction of 25-35% of total calories
Correct Answer: D
Rationale: For a child with increased cholesterol, a fat reduction of 25-35% of total calories with less than 75 saturated fat and less than 200 mg of cholesterol per day is advised.