The nurse is conducting an admission assessment of an infant with heart failure who is scheduled for repair of restenosis of coarctation of the aorta that was repaired 4 days after birth. Findings include blood pressure higher in the arms than the lower extremities, pounding brachial pulses, and slightly palpable femoral pulses. Which pathophysiologic mechanism supports these findings?

Choice A reason: Scheduling the child for a STAT magnetic resonance imaging (MRI) of the neck is not a priority action for the nurse. MRI is a diagnostic test that uses magnetic fields and radio waves to produce images of the internal structures of the body. MRI of the neck may be useful to rule out other causes of respiratory distress, such as tumors, abscesses, or foreign bodies, but it is not an urgent procedure. Moreover, MRI requires the child to lie still for a long time, which may be difficult or impossible for a child who is anxious and in respiratory distress.

Choice B reason: Providing a nebulizer treatment with bronchodilators is not a suitable action for the nurse. Nebulizer is a device that delivers medication in the form of a mist that can be inhaled into the lungs. Bronchodilators are medications that relax the smooth muscles of the airways and improve airflow. Nebulizer treatment with bronchodilators may be helpful for children with respiratory distress caused by asthma, bronchiolitis, or chronic obstructive pulmonary disease, but not for children with respiratory distress caused by upper airway obstruction, which is the most likely scenario for this child.

Choice C reason: Obtaining bedside trays for intubation or tracheotomy by the healthcare provider is the most appropriate action for the nurse. Intubation is a procedure that involves inserting a tube through the mouth or nose into the trachea to secure the airway and provide ventilation. Tracheotomy is a surgical procedure that involves creating an opening in the neck and inserting a tube into the trachea to bypass the upper airway obstruction. Both procedures are life-saving interventions for children with respiratory distress caused by upper airway obstruction, which is the most likely scenario for this child. The nurse should prepare the necessary equipment and assist the healthcare provider in performing these procedures.

Choice D reason: Beginning prescribed intravenous antibiotic administration is not a relevant action for the nurse. Antibiotics are medications that kill or inhibit the growth of bacteria that cause infections. Antibiotics may be indicated for children with respiratory distress caused by bacterial infections, such as pneumonia, tonsillitis, or epiglottitis, but not for children with respiratory distress caused by non-infectious causes, such as foreign bodies, anaphylaxis, or congenital anomalies. Moreover, antibiotics are not an immediate intervention for respiratory distress, as they take time to exert their effects.

Choice A reason: Autonomy is not the stage of Erikson's theory of psychosocial development that the nurse is addressing when teaching this client about insulin injections. Autonomy is the stage that occurs from 18 months to 3 years of age, when the child develops a sense of independence and self-control. The conflict in this stage is between autonomy and shame and doubt. The nurse may address this stage when teaching the client's parents about how to support their child's autonomy and avoid overprotection or criticism.

Choice B reason: Identity is not the stage of Erikson's theory of psychosocial development that the nurse is addressing when teaching this client about insulin injections. Identity is the stage that occurs from 12 to 18 years of age, when the adolescent develops a sense of self and personal identity. The conflict in this stage is between identity and role confusion. The nurse may address this stage when teaching the client about how to cope with the psychosocial challenges of having a chronic condition and how to maintain a positive self-image and self-esteem.

Choice C reason: Industry is the stage of Erikson's theory of psychosocial development that the nurse is addressing when teaching this client about insulin injections. Industry is the stage that occurs from 6 to 11 years of age, when the child develops a sense of competence and achievement. The conflict in this stage is between industry and inferiority. The nurse may address this stage when teaching the client about how to manage their diabetes and how to acquire the skills and knowledge needed for self-care and health promotion.

Choice D reason: Initiative is not the stage of Erikson's theory of psychosocial development that the nurse is addressing when teaching this client about insulin injections. Initiative is the stage that occurs from 3 to 6 years of age, when the child develops a sense of initiative and creativity. The conflict in this stage is between initiative and guilt. The nurse may address this stage when teaching the client about how to express their feelings and opinions about their diabetes and how to participate in decision-making and problem-solving.