The nurse would teach the mother of a boy with Tetralogy of Fallot that if the child suddenly becomes cyanotic and dyspneic, the mother should:
Place him in knee-chest position
Have him lie prone, being sure he can breathe easily
Have him lie supine with the head turned to one side
Place him in semi-fowler's position in an infant seat
The Correct Answer is A
A. The knee-chest position increases systemic vascular resistance, which helps to divert more blood to the pulmonary circulation, improving oxygenation in a child experiencing a "tet spell" or hypercyanotic episode.
B. The prone position does not help in relieving cyanosis and dyspnea in Tetralogy of Fallot.
C. The supine position with the head turned does not assist in improving oxygenation during a cyanotic episode.
D. The semi-Fowler's position may aid breathing but is less effective than the knee-chest position in managing cyanotic spells.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. The Doll's eye reflex is expected to be negative in older infants. It is present in newborns but should be absent by 2 months of age.
B. The Crawl reflex, which involves the infant moving forward when placed on their stomach, should disappear by 6-8 months. A negative reflex at 9 months is expected.
C. The Babinski reflex, where the toes fan out when the sole of the foot is stroked, is normal in infants up to 12-18 months.
D. The Moro reflex, or startle reflex, should disappear by 4-6 months of age. A positive Moro reflex at 9 months indicates a delay in neurological development and requires further evaluation.
Correct Answer is A,B,C,D
Explanation
A. Inspection: The nurse begins with a visual examination of the abdomen, looking for any abnormalities in skin color, shape, or movement.
B. Auscultation: Next, the nurse listens to the bowel sounds using a stethoscope. This step is performed before palpation to avoid altering the bowel sounds.
C. Superficial palpation: The nurse gently presses the surface of the abdomen to assess for any tenderness, distension, or masses.
D. Deep palpation: Finally, the nurse applies deeper pressure to feel for any deeper structures or masses within the abdomen.
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
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.