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What are FOUR possible differential diagnoses associated with aortopathy in a child, aside from Marfan’s?
- A. Ehlers-Danlos Syndrome (vascular type IV)
- B. Bicuspid aortic valve
- C. Takayasu Arteritis
- D. Unrepaired coarctation of the aorta
Correct Answer: A
Rationale: These are potential differential diagnoses associated with aortopathy in children, aside from Marfan’s syndrome, which is a common condition linked to aortic dilation.
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The nurse is caring for a child with cystic fibrosis. Which intervention is most important when the child is hospitalized with a respiratory infection?
- A. Administer prescribed antibiotics as soon as possible.
- B. Increase fluid intake to help thin mucus.
- C. Provide respiratory treatments and postural drainage.
- D. Encourage high-calorie, high-protein meals.
Correct Answer: C
Rationale: Respiratory treatments and postural drainage are critical to help clear mucus from the lungs in children with cystic fibrosis, especially during respiratory infections.
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 clinic nurse reviews the record of a child just seen by the health care provider and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder?
- A. Pallor
- B. Hyperactivity
- C. Exercise intolerance
- D. Gastrointestinal disturbances
Correct Answer: C
Rationale: Exercise intolerance is a common clinical manifestation of aortic stenosis due to the heart's inability to pump sufficient blood during increased physical activity.
An adult female with multiple sclerosis (MS) falls while walking to the bathroom. On transfer to the intensive care unit, she is confused and has had projectile vomiting twice. Which intervention should the nurse implement first?
- A. Determine client's last dose of corticosteroids
- B. Determine neurological baseline prior to the fall
- C. Administer a PRN IV antiemetic as prescribed
- D. Complete head to toe neurological assessment.
Correct Answer: D
Rationale: The symptoms suggest increased intracranial pressure or a neurological emergency. A thorough neurological assessment is necessary to identify the cause and guide further interventions.
How would the nurse caring for an infant with congestive heart failure (CHF) modify feeding techniques to adapt for the child's weakness and fatigue? (Select all that apply.)
- A. Feeding more frequently with smaller feedings
- B. Using a soft nipple with enlarged holes
- C. Holding and cuddling the child during feeding
- D. Substituting glucose water for formula
Correct Answer: A
Rationale: Infants with CHF fatigue easily. Feeding can be given more frequently in smaller amounts through a soft, large-holed nipple. Formulas with a denser caloric content can be offered. The child may be encouraged to nurse if he or she is held.