A nurse is assessing a child with coarctation of the aorta.
The nurse expects to find weaker pulses in the lower extremities compared to the upper extremities.
True
False
The Correct Answer is A
Coarctation of the aorta is a congenital heart defect characterized by a narrowing of the aortic lumen, typically distal to the left subclavian artery. This narrowing creates an obstruction to blood flow, resulting in increased proximal pressure (upper extremities, head) and decreased distal pressure (lower extremities). Consequently, pulses and blood pressure are stronger in the arms than in the legs due to the mechanical obstruction limiting adequate systemic perfusion beyond the narrowed segment. Choice False rationale:
The assertion is inaccurate because coarctation, a stricture of the aorta, significantly impedes systemic blood flow to the distal body. The pressure gradient created across the narrowing causes the blood pressure and pulse amplitude to be significantly higher and stronger in the vessels proximal to the coarctation (upper body) and notably diminished in the vessels distal to the coarctation (lower body).
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
An oxygen saturation SpO_2 of 88% indicates significant hypoxemia (low blood oxygen), which is the most critical physiological derangement in respiratory distress. Sustained hypoxemia can rapidly lead to cerebral hypoxia, increasing intracranial pressure, and cardiac arrest, necessitating immediate intervention. Normal is ≥ 94-95% in most children.
Choice B rationale
A heart rate of 160 beats per minute in a school-age child (6-12 years) is tachycardia (normal is 75-115 bpm), often an initial compensatory response to hypoxemia and increased work of breathing. While concerning, it is an attempt to maintain cardiac output, making the SpO_2 decline a more immediate life threat.
Choice C rationale
A temperature of 100.4°F is a low-grade fever, which can increase metabolic demand and O_2 consumption, potentially worsening respiratory status. While it warrants management, it is not the most immediate life-threatening sign compared to severe hypoxemia (SpO_2 of 88%). Normal is 97.7°F to 99.5°F.
Choice D rationale
A respiratory rate of 40 breaths per minute in a toddler (1-3 years) is near the upper limit of normal (25-35 bpm) and indicates tachypnea, a compensatory mechanism to improve gas exchange. While significant, it is a sign of compensation, whereas the low SpO_2 suggests decompensation.
Correct Answer is A
Explanation
Choice A rationale
The constellation of fever (101.5°F or 38.6°C), irritability, and tachycardia (160 bpm, normal for a 2-year-old is ∼80-130 bpm) in a child with a ventricular shunt is highly suggestive of a shunt infection (ventriculitis or meningitis). A shunt infection can lead to septicemia and shunt malfunction, potentially causing rapidly increased intracranial pressure (ICP). Given the high morbidity, this finding requires immediate notification of the provider for prompt diagnostic workup (e.g., shunt tap) and empiric antibiotics.
Choice B rationale
While tachycardia and irritability can sometimes be non-specific symptoms, a fever of 101.5°F is abnormal. The presence of a ventricular shunt significantly raises the index of suspicion for shunt infection, a neurosurgical emergency, which is a life-threatening condition. Documenting and observing without immediate intervention is dangerously negligent given the clinical picture.
Choice C rationale
Administering antipyretics addresses only the fever, a symptom, and does not treat the underlying potentially fatal shunt infection. Delaying notification to reassess in one hour risks rapid neurological deterioration, as shunt infections can progress quickly to sepsis, severe ventriculitis, or uncompensated increased intracranial pressure (ICP). Immediate medical evaluation is the priority.
Choice D rationale
Encouraging oral fluids is a supportive measure for fever and dehydration, but it is not the priority for a child highly suspected of having a ventricular shunt infection. Oral fluid intake can be impaired due to irritability and potential nausea/vomiting associated with increased intracranial pressure, and this action delays definitive diagnosis and treatment of the infection.
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