The nurse is collecting data on a 2 month-old-child with left-sided congestive heart failure. Which clinical manifestation would support this diagnosis of left-sided congestive heart failure?
Edema in the lower extremities
Ascites
Shortness of breath
Hepatomegaly
The Correct Answer is C
A. Edema in the lower extremities:
Incorrect: Edema in the lower extremities is more characteristic of right-sided heart failure. In left-sided failure, pulmonary congestion is more prominent.
B. Ascites:
Incorrect: Ascites, or fluid accumulation in the abdominal cavity, is also more commonly associated with right-sided heart failure.
C. Shortness of breath:
Correct Answer: Left-sided congestive heart failure can lead to pulmonary congestion, resulting in difficulty breathing or shortness of breath. This is often observed as increased work of breathing, rapid breathing, or other signs of respiratory distress in infants.
D. Hepatomegaly:
Incorrect: Hepatomegaly, or enlargement of the liver, is another manifestation more commonly associated with right-sided heart failure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. "The immunization schedule will need to be altered."
Incorrect: This is too vague and does not provide specific information about the child's immunization schedule.
B. "The child will receive all of the immunizations except for the polio series."
Incorrect: There is no indication that the child should not receive the polio vaccine. Children with cystic fibrosis are generally recommended to receive all appropriate vaccinations.
C. "The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination."
Correct Answer: Children with cystic fibrosis should receive the recommended basic series of immunizations, including vaccines for diseases such as diphtheria, pertussis, tetanus, measles, mumps, rubella, polio, Haemophilus influenzae type b (Hib), hepatitis B, and others. Additionally, they should receive a yearly influenza vaccination to help prevent respiratory complications.
D. "The child should not receive any hepatitis vaccines."
Incorrect: There is no general contraindication for children with cystic fibrosis to receive hepatitis vaccines. The nurse should recommend the appropriate vaccines, including those for hepatitis B, as per the standard immunization schedule.
Correct Answer is ["A","C","D"]
Explanation
A. Lateral deviation and rotation of each vertebra:
Correct Answer: Correct.
Explanation: Scoliosis involves a lateral (side-to-side) curvature of the spine and often includes some degree of vertebral rotation. Assessing for these deviations is crucial in diagnosing scoliosis.
B. Equal rib prominences:
Correct Answer: Incorrect.
Explanation: In scoliosis, the ribs may appear more prominent on one side due to the lateral curvature of the spine. Therefore, equal rib prominences would not typically be observed in scoliosis.
C. Unequal rib heights:
Correct Answer: Correct.
Explanation: Unequal heights of the ribs are commonly seen in scoliosis due to the asymmetrical nature of the spine's curvature.
D. Chest asymmetry:
Correct Answer: Correct.
Explanation: Asymmetry in the chest area, including differences in the shape or appearance of the chest, can be indicative of scoliosis, especially when associated with the spinal curvature.
E. Equal shoulder heights:
Correct Answer: Incorrect.
Explanation: In scoliosis, one shoulder might appear higher than the other due to the lateral curvature of the spine. Therefore, equal shoulder heights would not typically be observed in scoliosis.
F. Equal waist angles:
Correct Answer: Incorrect.
Explanation: Scoliosis often causes an asymmetrical appearance of the waistline due to the lateral curvature of the spine, resulting in unequal waist angles rather than equal ones.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today