Nokea
What is the most likely congenital heart lesion in a newborn with Trisomy 21?
- A. AVSD
- B. Tetralogy of Fallot
- C. Ventricular septal defect
- D. Pulmonary stenosis
Correct Answer: A
Rationale: Atrioventricular septal defect (AVSD) is highly associated with Trisomy 21 and is the most likely congenital heart lesion in these infants.
You may also like to solve these questions
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.
A nurse auscultated heart tones on an older adult client. Which action should the nurse take based on the heart tones heard?
- A. Administer a diuretic.
- B. Document the finding.
- C. Decrease the IV flow rate.
- D. Evaluate the client’s medications.
Correct Answer: B
Rationale: Documenting the findings is the appropriate action unless the heart tones indicate an abnormality requiring intervention.
An adult client is admitted with flank pain and is diagnosed with acute pyelonephritis. What is the priority nursing action?
- A. Auscultate for presence of bowel sounds.
- B. Monitor hemoglobin and hematocrit
- C. Encourage turning and deep breathing
- D. Administer IV antibiotics as prescribed.
Correct Answer: D
Rationale: Administering IV antibiotics promptly is critical to treat the infection and prevent complications in acute pyelonephritis.
Varying intensity of the first heart sound from a booming (bruit de canon) to virtual inaudibility is seen in which of the following?
- A. Mitral stenosis with atrial fibrillation
- B. Constant 2:1 AV block
- C. First-degree AV block
- D. Congenital complete heart block
Correct Answer: A
Rationale: In mitral stenosis with atrial fibrillation, the intensity of the first heart sound can vary depending on the dynamics of atrial contraction and ventricular filling.
An adolescent who sustained a tibia fracture in a motor vehicle accident has a cast. What should the nurse do to help relieve the itching?
- A. Apply cool air under the cast with a blow-dryer
- B. Use sterile applicators to scratch the itch
- C. Apply cool water under the cast
- D. Apply hydrocortisone cream under the cast using sterile applicator
Correct Answer: A
Rationale: Cool air helps relieve itching without damaging the cast or introducing moisture, which can lead to skin breakdown.