Nokea
Which statement by the father leads the nurse to determine he understood the instructions?
- A. If the baby turns blue, I will hold him against my shoulder with his knees bent up toward his chest.'
- B. If the baby turns blue, I will lay him down on a firm surface with his head lower than the rest of his body.'
- C. If the baby turns blue, I will immediately put the baby upright in an infant seat.'
- D. If the baby turns blue, I will put the baby in supine position with his head elevated.'
Correct Answer: A
Rationale: The knee-chest position during a hypercyanotic spell in tetralogy of Fallot increases venous return and reduces cyanosis.
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What does the nurse recognize as a sign of digoxin toxicity?
- A. Restlessness
- B. Decreased respiratory rate
- C. Increased urinary output
- D. Vomiting
Correct Answer: D
Rationale: Vomiting is a common sign of digoxin toxicity, along with nausea, anorexia, and pulse irregularities.
Which assessment would lead the nurse to suspect that a newborn infant has a ventricular septal defect?
- A. A loud, harsh murmur with a systolic thrill
- B. Cyanosis when crying
- C. Blood pressure higher in the arms than in the legs
- D. A machinery-like murmur
Correct Answer: A
Rationale: A loud, harsh murmur with a systolic thrill is a hallmark sign of a ventricular septal defect in newborns.
What is accurate about the characteristics of high-density lipoproteins (HDLs)?
- A. They have high amounts of triglycerides.
- B. They have only small amounts of protein.
- C. They have little cholesterol.
- D. They aid in steroid production.
Correct Answer: C
Rationale: HDLs have low triglycerides, high protein content, low cholesterol, and are excreted via the liver, not involved in steroid production.
Which combination of symptoms, in conjunction with this finding, would confirm a diagnosis of rheumatic fever?
- A. Subcutaneous nodules and fever
- B. Painful, tender joints, and carditis
- C. Erythema marginatum and arthralgia
- D. Chorea and elevated sedimentation rate
Correct Answer: B
Rationale: Painful, tender joints and carditis, along with an elevated ASO titer, meet the major Jones criteria for diagnosing rheumatic fever.
Which areas of the heart are affected by carditis?
- A. Coronary arteries
- B. Heart muscle and the mitral valve
- C. Aortic and pulmonic valves
- D. Contractility of the ventricles
Correct Answer: B
Rationale: Rheumatic fever carditis affects the heart muscle and commonly the mitral valve, causing inflammation and potential damage.