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?
Upper extremity hypotension
Weak femoral pulses
Frequent nosebleeds
Increased intracranial pressure
The Correct Answer is B
A. Coarctation of the aorta typically results in hypertension in the upper extremities due to increased pressure proximal to the coarctation.
B. Weak or absent femoral pulses are characteristic findings in coarctation of the aorta due to reduced blood flow to the lower extremities beyond the coarctation. This finding indicates peripheral vascular compromise in the lower limbs.
C. Frequent nosebleeds are not typically associated with coarctation of the aorta.
D. Coarctation of the aorta does not directly affect intracranial pressure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. A towel on the floor outside of the shower could be a tripping hazard.
B. This prevents slipping and falls, which is crucial for someone recovering from knee surgery.
C. Slippers with non-slip soles would be a safer choice to prevent falls.
D. While handrails are helpful for mobility and safety, this recommendation does not address the immediate postoperative care needs of the client following knee surgery.
Correct Answer is D
Explanation
A. While completing an incident report is important for addressing the medication error and implementing corrective actions, the immediate priority is to assess the client's condition for signs of bleeding, which could be life-threatening.
B. Monitoring aPTT levels is important to assess the client's response to heparin therapy, but it does not address the immediate risk of bleeding from the overdose.
C. Notifying the risk manager is essential for reporting the medication error and implementing strategies to prevent future occurrences, but the nurse's first action should be to assess the client's condition for any indications of bleeding.
D. Administering a high dose of heparin increases the risk of bleeding, so the nurse should first assess the client for any signs or symptoms of bleeding, such as unexplained bruising, hematuria, or hypotension, to ensure timely intervention and prevent complication.
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