The nurse explained how to position an infant with tetralogy of Fallot if the infant suddenly becomes cyanotic. Which statement by the father leads the nurse to determine he understood the instructions?
"If the baby turns blue, I will immediately put the baby upright in an infant seat."
"If the baby turns blue, I will lay him down on a firm surface with his head lower than the rest of his body."
"If the baby turns blue, I will put the baby in supine position with his head elevated."
"If the baby turns blue, I will hold him against my shoulder with his knees bent up toward his chest."
The Correct Answer is D
This position, often referred to as the "knee-to-chest" position, is recommended during a cyanotic spell in infants with tetralogy of Fallot because it can help increase venous return to the heart and improve oxygenation. It's important for caregivers to understand this positioning as part of the management for hypercyanotic spells in children with this condition.
A. Placing the baby upright in an infant seat may help improve blood flow and oxygenation, but it's not the recommended position for managing cyanosis in a baby with tetralogy of Fallot.
B. Placing the baby with the head lower than the rest of the body could potentially worsen cyanosis by increasing right-to-left shunting of blood and decreasing pulmonary blood flow.
C. Placing the baby in a supine position with the head elevated worsens pulmonary blood flow by increasing systemic vascular resistance. This position can help worsen cyanosis by promoting better oxygenation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Kawasaki disease is a systemic vasculitis that predominantly affects medium-sized arteries, including the coronary arteries of the heart. The inflammation of the blood vessels can lead to coronary artery aneurysms and other cardiovascular complications if not promptly treated.
B. The respiratory system is not primarily affected by Kawasaki disease. While Kawasaki disease is a systemic illness that can cause fever and inflammation, it primarily affects the cardiovascular system, with inflammation of blood vessels, particularly the coronary arteries.
C. The integumentary system (skin, hair, nails) is not primarily affected by Kawasaki disease. Although some children with Kawasaki disease may develop a rash, particularly in the acute phase of the illness, skin involvement is not the primary feature of the disease.
D. Gastrointestinal symptoms, such as abdominal pain, vomiting, or diarrhea, can occur in Kawasaki disease but they are not the primary focus of the disease. Kawasaki disease primarily affects the cardiovascular system, leading to inflammation of blood vessels and potential complications such as coronary artery aneurysms.
Correct Answer is C
Explanation
C. Salicylates, such as aspirin, should be avoided in children and adolescents with viral symptoms due to the association with Reye's syndrome. Instead, acetaminophen or other non-steroidal anti-inflammatory drugs (NSAIDs) without salicylates should be used for fever and pain relief.
A. Reye's syndrome typically presents with symptoms such as fever, vomiting, and lethargy. However, there isn't a specific test for Reye's syndrome itself. Diagnosis is often based on clinical symptoms, history of aspirin use, and laboratory findings.
B. Reye's syndrome is associated with the use of aspirin (salicylates) in children and adolescents with viral infections, particularly influenza and chickenpox. Acetaminophen (Tylenol) is recommended instead of aspirin for fever and pain relief in children with viral illnesses.
D. There isn't a specific vaccine for Reye's syndrome. Reye's syndrome is not caused by an infectious agent that can be prevented through vaccination.
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