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A nurse in a clinic is assessing a 9-month-old infant.
Which of the following findings requires further intervention?

Positive Babinski reflex.

Negative Doll’s eye reflex.

Negative Crawl reflex.

Positive Moro reflex.

Answer and Explanation

The Correct Answer is D

The correct answer is Choice D.

Choice A rationale

A positive Babinski reflex is normal in infants up to 2 years old and indicates normal neurological development.

Choice B rationale

A negative Doll’s eye reflex is concerning as it may indicate a neurological problem. However, it is not as critical as a positive Moro reflex in a 9-month-old.

Choice C rationale

A negative Crawl reflex may indicate developmental delays, but it is not as critical as a positive Moro reflex in a 9-month-old.

Choice D rationale

A positive Moro reflex is abnormal in a 9-month-old and may indicate neurological issues. This reflex typically disappears by 2 months of age. .

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Correct Answer is D

Explanation

The correct answer is Choice D.

Choice D rationale

Tetralogy of Fallot is a congenital heart defect that includes four heart abnormalities: ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and an overriding aorta. These defects cause altered blood flow and reduced oxygen levels in the blood.

Choice A rationale

Asthma is a chronic respiratory condition characterized by airway inflammation and bronchoconstriction. It is not commonly associated with tetralogy of Fallot.

Choice B rationale

Polycythemia, or an increased number of red blood cells, can occur as a compensatory mechanism in response to chronic hypoxia in tetralogy of Fallot. However, it is not a primary condition associated with tetralogy of Fallot.

Choice C rationale

Pulmonary hypertension is a condition characterized by increased blood pressure in the pulmonary arteries. While it can occur secondary to congenital heart defects, it is not a primary condition associated with tetralogy of Fallot.

A. Place him in knee-chest position. B. Have him lie supine with the head turned to one side. C. Have him lie prone, being sure he can breathe easily. D. Place him in semi-Fowler’s position in an infant seat.

Correct Answer is A

Explanation

The correct answer is Choice A.

Choice A rationale

Placing the child in a knee-chest position helps increase systemic vascular resistance, which reduces the right-to-left shunt and improves oxygenation during a cyanotic spell in children with Tetralogy of Fallot.

Choice B rationale

Having the child lie supine with the head turned to one side does not help in managing a cyanotic spell and may not improve oxygenation.

Choice C rationale

Lying prone does not specifically address the cyanotic spell and may not be the most effective position for improving oxygenation.

Choice D rationale

Placing the child in a semi-Fowler’s position in an infant seat does not specifically address the cyanotic spell and may not be the most effective position for improving oxygenation.

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A nurse in a clinic is assessing a 9-month-old infant.Which of the following findings requires further intervention?

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Naxlex Comprehensive Predictor Exams

Which of the following conditions is commonly associated with tetralogy of Fallot?

Correct Answer is D

Explanation

The nurse would teach the mother of a boy with Tetralogy of Fallot that if the child suddenly becomes cyanotic and dyspneic, the mother should:

Correct Answer is A

Explanation

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A nurse in a clinic is assessing a 9-month-old infant.
Which of the following findings requires further intervention?