What assessment finding would the nurse expect in an infant with coarctation of the aorta?
Point of maximum impulse is shifted to the right
Weak or absent lower extremity pulses
Apical pulse is greater than radial pulse
Systolic murmur at the left sternal border
The Correct Answer is B
A. Point of maximum impulse is shifted to the right. This is not typically associated with coarctation of the aorta, but with other cardiac abnormalities.
B. Weak or absent lower extremity pulses. Coarctation of the aorta causes narrowing of the aorta, which restricts blood flow to the lower body, leading to diminished pulses in the lower extremities.
C. Apical pulse is greater than radial pulse. This finding is not specifically related to coarctation of the aorta.
D. Systolic murmur at the left sternal border. While murmurs may be present, coarctation typically causes a murmur best heard in the back or left infraclavicular area.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Keep eye shields on at all times, including when feeding. Incorrect because while eye protection is crucial under the lights, they can be removed during feedings to allow for parent-infant bonding and eye contact.
B. Routinely monitor temperature while the infant is in the crib. Incorrect, because temperature should be closely monitored while the infant is under phototherapy due to potential changes in body temperature caused by the exposure.
C. Tightly swaddle the infant in a blanket. Incorrect, as this would reduce the amount of skin exposed to the phototherapy lights and decrease the treatment's effectiveness.
D. Expose as much of the infant's skin to the lights as possible. Phototherapy is most effective when as much skin as possible is exposed to the lights because it allows for maximum light absorption and more effective bilirubin breakdown.
Correct Answer is B
Explanation
A. Provide education on oral contraceptives. This is not a priority for treating acute PID, though education on preventing sexually transmitted infections (STIs) that can lead to PID is important.
B. Removal of intrauterine device prior to treatment. This is a priority intervention because an intrauterine device (IUD) can be a source of infection and inflammation, exacerbating pelvic inflammatory disease (PID). Removing it can help reduce infection risk and facilitate treatment.
C. Institute contact precautions. PID is typically not spread by casual contact, so standard precautions are sufficient.
D. Administer acyclovir as ordered. Acyclovir is used to treat viral infections like herpes and is not relevant for bacterial infections like PID, which is usually treated with antibiotics.
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