Nokea
The severity of symptoms of Ebstein anomaly and the degree of cyanosis are high and depend on the extent of
- A. displacement of the tricuspid valve
- B. cardiac dysrhythmias
- C. atrial right-to-left shunt
- D. pulmonary vascular resistance
Correct Answer: A
Rationale: Displacement of the tricuspid valve is a key determinant of symptom severity in Ebstein anomaly.
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A nurse cares for a client who has advanced cardiac disease and states, I am having trouble sleeping at night. How should the nurse respond?
- A. I will consult the provider to prescribe a sleep study to determine the problem.
- B. You become hypoxic while sleeping; oxygen therapy via nasal cannula will help.
- C. A continuous positive airway pressure, or CPAP, breathing mask will help you breathe at night.
- D. Use pillows to elevate your head and chest while you are sleeping.
Correct Answer: D
Rationale: Elevating the head and chest can reduce fluid accumulation in the lungs, improving breathing and sleep quality in clients with advanced cardiac disease.
The nurse is evaluating a male client’s understanding of diet teaching about the DASH (Dietary Approaches to Stop Hypertension) eating plan. Which behavior indicates that the client is adhering to the eating plan?
- A. Uses only lactose-free dairy products
- B. Enjoys fat free yogurt as an occasional snack food
- C. No longer includes grains in his daily diet
- D. Carefully cleans and peels all fresh fruit and vegetables
Correct Answer: D
Rationale: Cleaning and peeling fruits and vegetables is consistent with the DASH plan, which promotes a high intake of fresh produce.
After a transurethral resection of the prostate (TURP), a client has bloody urine output with large clots. The nurse implements the postoperative prescription to irrigate the indwelling catheter PRN to maintain the catheter's patency. Which action should the nurse implement?
- A. Clamp the catheter for 30 minutes prior to irrigating with saline
- B. Manually irrigate the catheter with sterile saline as prescribed
- C. Increase the client's oral fluid intake to flush out clots naturally
- D. Remove the catheter and notify the healthcare provider immediately
Correct Answer: A
Rationale: Clamping the catheter before irrigation prevents sudden fluid shifts and ensures that irrigation is performed effectively.
Which is the most appropriate nursing action related to the administration of digoxin (Lanoxin) to an infant?
- A. Counting the apical rate for 30 seconds before administering the medication
- B. Withholding a dose if the apical heart rate is less than 100 beats/min
- C. Repeating a dose if the child vomits within 30 minutes of the previous dose
- D. Checking respiratory rate and blood pressure before each dose
Correct Answer: B
Rationale: As a rule, if the pulse rate of an infant is below 100 beats/min, the medication is withheld and the physician is notified.
What is the Duke Treadmill score for a patient who exercised for 10 minutes (12 METS) and had a maximum of 1 mm ST depression at peak exercise without angina?
- A. 5
- B. 7
- C. 9
- D. 10
Correct Answer: C
Rationale: The Duke Treadmill score is calculated based on exercise duration