An adolescent boy is admitted with the following symptoms: Slow onset of recurrent low-grade fever, fatigue, weakness, joint and muscle aches, loss of appetite, weight loss and diaphoresis.

On assessment the nurse auscultates a new heart murmur, splenomegaly, petechiae, splinter hemorrhages under the nails and Osler nodes (red, painful non-hemorrhagic nodules on the pads of fingers and toes.

Which of the following Acquired Heart Diseases does this best represent?

Infective endocarditis

Tetralogy of Fallot

Acute rheumatic fever

Pulmonary hypertension

Answer and Explanation

The Correct Answer is A

A. The symptoms described, including slow onset of recurrent low-grade fever, fatigue, weakness, joint and muscle aches, loss of appetite, weight loss, and diaphoresis, along with the presence of a new heart murmur, splenomegaly, petechiae, splinter hemorrhages under the nails, and Osler nodes, are classic signs and symptoms of infective endocarditis (IE).

B. Tetralogy of Fallot is a congenital heart defect characterized by four specific abnormalities in the heart's structure. The symptoms described do not align with the characteristic features of Tetralogy of Fallot.

C. Acute rheumatic fever is an inflammatory condition that can develop as a complication of untreated streptococcal infections, particularly strep throat. While it can lead to heart valve damage (rheumatic heart disease), the symptoms described are more indicative of infective endocarditis rather than acute rheumatic fever.

D. Pulmonary hypertension is a condition characterized by elevated blood pressure in the pulmonary arteries. While it can present with symptoms such as fatigue and weakness, it typically does not manifest with the constellation of symptoms described, including fever, joint and muscle aches, and the presence of Osler nodes and splinter hemorrhages.

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Correct Answer is B

Explanation

Red marks across the cheeks can be indicative of various conditions, including skin irritation, allergies, or infections. Before jumping to conclusions or taking further actions, the nurse should conduct a thorough assessment of the child's overall condition. Assessing the rest of the child's body for any additional signs or symptoms, such as a rash or other skin abnormalities, can provide more information about the cause of the red marks on the cheeks. Depending on the findings of the assessment, further action may be necessary, such as questioning the parents about potential causes or referring the family to appropriate services if there are concerns about the child's well-being. However, the initial step should be to assess the child's condition comprehensively.

A. "We will give our child pancreatic enzymes with snacks and meals." B. "We will restrict the amount of salt in our child's food." C. "I will limit my child's fluid intake." D. "I will prepare low-fat meals with limited protein for my child."

Correct Answer is A

Explanation

Children with CF often have pancreatic insufficiency, leading to malabsorption of nutrients. Pancreatic enzymes help digest fats, proteins, and carbohydrates, allowing for better absorption of nutrients from food.

B. This response is not specifically related to the nutritional management of CF. While individuals with CF may have increased salt loss through sweat and may need to consume more salt to maintain electrolyte balance, restricting salt is not typically part of CF nutrition management.

C. Hydration is important for individuals with CF to help maintain normal mucus consistency and prevent dehydration, especially during times of increased respiratory secretions.
D. Children with CF often have increased energy needs due to the increased work of breathing and malabsorption of nutrients. Therefore, it is important to provide a diet that is high in calories and nutrient-dense.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a child who has red marks across his cheeks. Which of the following actions should the nurse take?

Correct Answer is B

Explanation

A nurse is providing discharge teaching about nutrition to the parents of a child who has cystic fibrosis (CF). Which of the following responses by the parents indicates an understanding of the teaching?

Correct Answer is A

Explanation

A nurse is caring for a child who has been physically abused by a family member. Which of the following statements should the nurse say to the child?

A nurse in the outclient clinic is assessing a client who has psoriasis. The nurse should expect which of the following findings?

A school nurse is assessing a school-age child and notices white flakes that don't brush off the hair and a rash on the back of the child's neck. The nurse should suspect which of the following disorders?

A nurse is preparing to administer a vaccine into the deltoid muscle of a preschooler. Which of the following actions should the nurse take?

A nurse is obtaining a health history from a child who has suspected acute rheumatic fever. Which of the following questions should the nurse ask?

A nurse is providing teaching to the parents of a child who has streptococcal pharyngitis about ways to prevent disease transmission. Which of the following responses by the parents indicates an understanding of the teaching?

A nurse is providing teaching to a parent of a child who has celiac disease. The nurse should include which of the following food choices for this child?

A nurse is teaching about safety recommendations for car seats with the parents of a 24-month- old toddler who is in the 50th percentile for height and weight. Which of the following instructions should the nurse include in the teaching?