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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All of the following are conditions with combined cellular and antibody immunodeficiency, except
- A. Ataxia telangiectasia
- B. Reticular dysgenesis
- C. Common variable immunodeficiency
- D. Severe combined immunodeficiency
Correct Answer: C
Rationale: Common variable immunodeficiency (CVID) is primarily an antibody deficiency, not a combined immunodeficiency.
A client is brought to the ED by ambulance in cardiac arrest with cardiopulmonary resuscitation (CPR) in progress. The client is intubated and is receiving 100% oxygen per self-inflating (ambu) bag. The nurse determines that the client is cyanotic, cold, and diaphoretic. Which assessment is most important for the nurse to obtain?
- A. Breath sounds over bilateral lung fields.
- B. Carotid pulsation during compressions
- C. Deep tendon reflexes
- D. Core body temperature
Correct Answer: A
Rationale: Assessing breath sounds ensures that the endotracheal tube is properly placed and that ventilation is effective, which is critical in a cardiac arrest situation.
A 4-month-old infant with a ventricular septal defect (VSD) has dropped from the 20th percentile to the 5th for weight. What will the nurse practitioner recommend?
- A. Adding solid foods to the infant's diet to increase caloric intake
- B. Fortifying breast milk to increase the number of calories per ounce
- C. Stopping breastfeeding and giving 30 kcal/ounce formula
- D. Supplementing breastfeeding with 24 kcal/ounce formula
Correct Answer: B
Rationale: Infants with heart defects who have congestive heart failure (CHF) may need modification of formula or breast milk to increase calories. Fortifying breast milk is the first and best option.
A child aged 10 days has ambiguous genitalia:
- A. If a buccal smear is chromatin negative, there is a serious risk of an Addisonian crisis
- B. A raised urinary output of pregnanetriol would confirm a diagnosis of CAR
- C. The finding of the genotype 45 XO would reliably explain the anomaly
- D. If testicles were present in the 'labia', an acceptable explanation would be Klinefelter's syndrome
Correct Answer: B
Rationale: A raised urinary pregnanetriol indicates congenital adrenal hyperplasia (CAR). Chromatin-negative buccal smear suggests male genotype, and 45 XO is Turner syndrome, not related to ambiguous genitalia. Klinefelter's syndrome does not explain testicles in the labia.
All the following are true regarding coarctation of the aorta EXCEPT
- A. notching of ribs is noted
- B. doppler is useful for demonstrating severe obstruction
- C. diagnostic catheterization is mandatory before surgery
- D. CT and MRI are valuable noninvasive tools for evaluation when the echocardiogram is equivocal
Correct Answer: C
Rationale: Diagnostic catheterization is not always mandatory before surgery for coarctation of the aorta.