Nokea
The school nurse has been following a child who frequently complains of dizziness and headache. Today, she is brought in after fainting in the cafeteria following a nosebleed. Her BP is 122/85, and her radial pulses are bounding. The nurse suspects she has:
- A. Transposition of the great vessels
- B. Coarctation of the aorta (COA)
- C. Aortic stenosis (AS)
- D. Pulmonic stenosis (PS)
Correct Answer: B
Rationale: In older children, COA can cause elevated blood pressure, headache, fainting, and bounding radial pulses.
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Recognised features of anorexia nervosa include:
- A. T-wave inversion on ECG
- B. Hypocholesterolaemia
- C. Peripheral oedema
- D. Sinus bradycardia
Correct Answer: D
Rationale: Sinus bradycardia, a slower than normal heart rate, is a recognized feature of anorexia nervosa due to the body's adaptation to starvation.
When caring for a client with nephrotic syndrome, which assessment is most important for the nurse to obtain?
- A. Daily weight
- B. Vital signs
- C. Level of consciousness
- D. Bowel sounds
Correct Answer: A
Rationale: Daily weight is crucial in monitoring fluid balance in clients with nephrotic syndrome, as they are prone to edema.
Indomethacin is being given to an infant with a patent ductus arteriosus in an attempt to promote closure of the PDA. The nurse caring for this infant becomes concerned about adverse side effects when noticing:
- A. decreased urine output, decreased platelets, and abdominal distention.
- B. increased blood pressure, tachycardia, and decreased oxygen requirements.
- C. increased urine output, increased white blood cell count, and increased reticulocyte count.
- D. Jaundice, pallor, and a petechial rash
Correct Answer: A
Rationale: Indomethacin can cause renal side effects, including decreased urine output, as well as hematologic effects such as decreased platelets, and gastrointestinal effects like abdominal distention, which are concerning adverse effects in an infant.
The main risk factor for developing deep vein thrombosis is:
- A. Prolonged immobility
- B. Age
- C. Obesity
- D. Family history
Correct Answer: A
Rationale: Prolonged immobility, such as during long flights or post-surgery, is a significant risk factor for developing deep vein thrombosis (DVT).
Nurse Kelly is teaching the parents of a young child how to handle poisoning. If the child ingests poison, what should the parents do first?
- A. Administer ipecac syrup
- B. Call an ambulance immediately
- C. Call the poison control center
- D. Punish the child for being bad
Correct Answer: C
Rationale: Calling the poison control center provides immediate guidance on how to handle the specific type of poisoning and whether further medical intervention is needed.