Nokea
Which defect results in increased pulmonary blood flow?
- A. Pulmonic stenosis
- B. Tricuspid atresia
- C. Atrial septal defect
- D. Transposition of the great arteries
Correct Answer: C
Rationale: Atrial septal defect (ASD) is a congenital heart defect where there is an abnormal opening in the atrial septum, leading to a left-to-right shunt of blood. This shunt causes increased pulmonary blood flow, as oxygenated blood from the left atrium is shunted back into the right atrium and then into the pulmonary circulation. Over time, this increased pulmonary blood flow can lead to pulmonary hypertension and potentially Eisenmenger syndrome if left untreated. Pulmonic stenosis, tricuspid atresia, and transposition of the great arteries all typically result in decreased pulmonary blood flow rather than increased pulmonary blood flow.
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Nursing measures in hemodynamic monitoring include assessing for localized ischemia owing to inadequate arterial flow. The nurse should:
- A. Assess the involved extremity for color and temperature
- B. Check for capillary refill
- C. Evaluate pulse rate
- D. Do all of the above
Correct Answer: D
Rationale: When assessing for localized ischemia owing to inadequate arterial flow, it is important for the nurse to perform all of the mentioned actions:
You are examining an infant with multiple cutaneous hemangiomas; you suspect involvement of internal organs. The MOST common site of visceral involvement by hemangiomas is
- A. brain
- B. heart
- C. lung
- D. liver
Correct Answer: D
Rationale: Liver is the most common site of visceral involvement by hemangiomas.
Which of the following conditions is suspected?
- A. Anemia
- B. Rheumatic arthritis
- C. Leukemia
- D. Systematic Lupus Erythematosus (SLE)
Correct Answer: C
Rationale: Leukemia is a type of cancer that affects the blood and bone marrow, leading to an overproduction of abnormal white blood cells. The symptoms of leukemia can include fatigue, weakness, weight loss, frequent infections, fever, bruising or bleeding easily, and bone pain. Given the vague presenting symptoms and the potential involvement of multiple bodily systems, leukemia is a condition that should be suspected and investigated further. Anemia, rheumatic arthritis, and systematic lupus erythematosus can also present with some similar symptoms, but for the given scenario, leukemia is the most probable condition to suspect.
Which clinical manifestation should the nurse expect to see as shock progresses in a child and becomes decompensated shock? (Select all that apply.)
- A. Thirst and diminished urinary output
- B. Irritability and apprehension
- C. Cool extremities and decreased skin turgor
- D. Confusion and somnolence
Correct Answer: C
Rationale: Cool extremities and decreased skin turgor (C) are indications of poor perfusion as shock progresses. The body is shunting blood away from the peripheries to maintain perfusion to vital organs.
The client with epilepsy is taking the prescribed dose of phenytoin (Dilantin) to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/ml. Which of the following symptoms would be expected as a result of this laboratory result?
- A. Nystagmus
- B. No symptoms, because this is normal
- C. Tachycardia therapeutic level
- D. Slurred speech
Correct Answer: A
Rationale: A phenytoin blood level of 35 mcg/ml is considered to be above the therapeutic range (usually 10-20 mcg/ml for phenytoin). At this elevated level, the client is at risk for phenytoin toxicity. Symptoms of phenytoin toxicity include nystagmus (rapid, involuntary eye movements), as well as other symptoms such as confusion, slurred speech, ataxia, and tremors. Tachycardia is not typically associated with phenytoin toxicity. Therefore, the expected symptom in this case would be nystagmus.