A nurse is caring for an infant who has coarctation of the aorta. Which of the following should the nurse identify as an expected finding?

Frequent nosebleeds

Increased intracranial pressure

Upper extremity hypotension

Weak femoral pulses

Answer and Explanation

The Correct Answer is D

A. Frequent nosebleeds: While hypertension can occur in coarctation of the aorta, frequent nosebleeds are not a typical finding associated with this condition.

B. Increased intracranial pressure: This is not a direct finding of coarctation of the aorta. Increased intracranial pressure may be related to other conditions, but it is not specifically expected in this context.

C. Upper extremity hypotension: In coarctation of the aorta, the upper extremities usually experience higher blood pressure due to the narrowing of the aorta distal to the branches supplying the arms. Therefore, hypotension in the upper extremities is not expected.

D. Weak femoral pulses: This is an expected finding in coarctation of the aorta, as the narrowing of the aorta can lead to decreased blood flow to the lower body, resulting in weak or diminished femoral pulses compared to the upper extremities.

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Correct Answer is A

Explanation

A. "Advance directives can be signed without legal representation.": This statement is accurate and reassuring. Advance directives do not require legal representation to be valid; they can often be completed with forms available from healthcare facilities or online resources.

B. "A social worker will assist you to find affordable legal representation.": While this may be helpful, it may not address the immediate concern that the client has about needing legal representation to create advance directives.

C. "We can initiate medical care until you get legal assistance in preparing your advance directives.": This statement may not align with legal and ethical guidelines regarding treatment without clear advance directives, particularly if the client’s wishes are unknown.

D. "Advance directives can be a verbal agreement between you and your provider until legal review can be obtained.": This is misleading, as advance directives typically need to be documented in writing to be valid and honoured in a medical setting.

A. Provide chilled formula. B. Administer feedings at a slower rate. C. Discard the open can of formula after 36 hr. D. Flush the tube with 10 mL of water after feedings.

Correct Answer is B

Explanation

A. Provide chilled formula: Chilled formula can be less palatable and may cause gastrointestinal discomfort, potentially worsening diarrhea. Room temperature or slightly warmed formula is generally recommended for enteral feedings to enhance tolerance and digestion.

B. Administer feedings at a slower rate: Slowing the rate of enteral feedings can help reduce gastrointestinal irritation and improve absorption, which may be particularly beneficial for a client experiencing diarrhea. This approach allows the intestines more time to process the nutrients, potentially alleviating symptoms.

C. Discard the open can of formula after 36 hr: While proper storage is important, many enteral formulas can be stored for up to 48 hours once opened. The key is to ensure the formula is stored correctly to prevent bacterial growth, but the 36-hour guideline may not be strictly necessary in all cases.

D. Flush the tube with 10 mL of water after feedings: Flushing the tube is a good practice to maintain tube patency, but the volume may not be adequate depending on the tube size and the specific protocol. Adequate flushing is essential, but it does not directly address the issue of diarrhea, which is the priority concern in this scenario.

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A nurse is caring for an infant who has coarctation of the aorta. Which of the following should the nurse identify as an expected finding?

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Naxlex Comprehensive Predictor Exams

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