The nurse is caring for a newly-admitted infant diagnosed with "failure to thrive." The nurse begins to implement the healthcare provider prescribed orders by taking blood pressures in all four extremities. Which congenital cardiac defect does the nurse anticipate based on the prescribed order?

Pulmonary atresia

Tetralogy of Fallot

Ventricular septal defect

Coarctation of the aorta

Answer and Explanation

The Correct Answer is D

A. Pulmonary atresia involves a blockage of blood flow to the lungs, but it does not specifically lead to differences in blood pressure in the extremities.

B. Tetralogy of Fallot involves four defects, but it does not directly correlate with differences in blood pressure between the extremities.

C. A ventricular septal defect can cause heart failure, but it typically doesn’t affect blood pressure in the extremities.

D. Coarctation of the aorta is a congenital defect where the aorta is narrowed, leading to higher blood pressure in the upper extremities and lower blood pressure in the lower extremities. This is why blood pressures are measured in all four extremities to identify this condition.

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Correct Answer is D

Explanation

A. A WBC of 6,000/mm³ is within the normal range (4,500-11,000/mm³), and a postoperative infection is more likely to result in an elevated WBC count.

B. Purulent nasogastric drainage is more suggestive of a gastrointestinal issue unrelated to a perforated appendix and is not a common finding post-surgery.

C. Passage of dark red stool with mucus could suggest gastrointestinal bleeding or infection, but it is not typical postoperatively after a perforated appendix.

D. After surgery for a perforated appendix, peristalsis may be absent initially due to the effects of anesthesia, bowel manipulation, or inflammation from the infection. This is a normal postoperative finding.

A. A sibling who had a sore throat 3 weeks ago B. A classmate who has fifth disease C. The father who had gastritis 2 weeks ago D. A neighbor's child who has chickenpox

Correct Answer is A

Explanation

A. Rheumatic fever can develop after a group A streptococcal throat infection (strep throat), typically 2 to 4 weeks after exposure. The sibling with a recent sore throat is likely the source of the infection.

B. Fifth disease is caused by parvovirus B19 and is not linked to the development of rheumatic fever.

C. Gastritis is unrelated to rheumatic fever, which stems from a streptococcal throat infection.

D. Chickenpox is caused by varicella zoster virus and does not lead to rheumatic fever.

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The nurse is caring for a newly-admitted infant diagnosed with "failure to thrive." The nurse begins to implement the healthcare provider prescribed orders by taking blood pressures in all four extremities. Which congenital cardiac defect does the nurse anticipate based on the prescribed order?

Nursing Test Bank

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Correct Answer is D

Explanation

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Correct Answer is A

Explanation

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