A nurse is assessing a child with suspected infective endocarditis. Which finding is most indicative of this condition?
Periorbital edema.
Bounding pulses in lower extremities.
High-pitched cry.
Splinter hemorrhages under nails.
The Correct Answer is D
Choice A rationale
Periorbital edema (swelling around the eyes) is a common sign of nephrotic syndrome or other systemic fluid overload states, such as congestive heart failure. While heart failure can be a complication of severe infective endocarditis (IE), periorbital edema is a non-specific finding and not a primary, classic physical finding of the infection itself.
Choice B rationale
Bounding pulses in the lower extremities are most characteristic of a condition causing a wide pulse pressure, such as a large patent ductus arteriosus (PDA) or aortic regurgitation. While aortic valve damage can occur in IE, the bounding pulse is not a hallmark finding directly resulting from the infectious process.
Choice C rationale
A high-pitched cry is a non-specific sign of neurological distress or pain in an infant. While systemic infection and potential septic emboli from infective endocarditis could affect the central nervous system, this symptom is not a primary or expected clinical manifestation of the localized heart valve infection.
Choice D rationale
Splinter hemorrhages are small, linear, dark-red streaks that appear under the nails. They are a classic peripheral sign of infective endocarditis caused by microemboli (tiny fragments of the infected vegetation) lodging in the distal capillaries of the nail bed, making this a highly indicative finding.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","D","E"]
Explanation
Choice A rationale
Diaphoresis (sweating) during feeding in an infant is a key sign of increased sympathetic nervous system activity and extreme work of breathing due to pulmonary venous congestion. The significant physical effort required for sucking and swallowing rapidly increases oxygen consumption, triggering a stress response and signaling profound respiratory distress and cardiac compromise in congestive heart failure (CHF).
Choice B rationale
Bounding peripheral pulses are typically indicative of conditions with a wide pulse pressure (high systolic, low diastolic), such as a patent ductus arteriosus (PDA) or severe aortic regurgitation, or hyperdynamic states like fever or sepsis. Congestive heart failure (CHF) due to poor contractility generally results in diminished or thready pulses due to low cardiac output and peripheral vasoconstriction.
Choice C rationale
Weight loss or, more commonly, failure to thrive, is an expected finding due to the combination of poor caloric intake (infants fatigue easily during feeding) and the dramatically increased metabolic rate associated with the persistently high work of breathing and cardiac effort in congestive heart failure (CHF). However, fluid retention can sometimes mask this.
Choice D rationale
Tachycardia (increased heart rate, normal range varies by age) is the primary physiological compensatory mechanism in congestive heart failure (CHF) to maintain cardiac output (Cardiac Output = Stroke Volume×Heart Rate) when the stroke volume is reduced due to myocardial dysfunction or volume overload. It is an almost universally expected finding.
Choice E rationale
Hepatomegaly (enlarged liver) is a consequence of systemic venous congestion due to failure of the right side of the heart to effectively pump blood forward. The resulting increase in systemic central venous pressure causes the blood to back up into the inferior vena cava and subsequently into the hepatic veins, causing passive liver congestion.
Correct Answer is ["73.1"]
Explanation
Step 1 is: Calculate the total daily fluid requirement using the Holliday-Segar formula. The child weighs 32.7 kg. For the first 10 kg: 10 kg× 100 mL/kg = 1000 mL. For the next 10 kg (from 10.1 kg to 20 kg): 10 kg× 50 mL/kg = 500 mL. For the remaining weight: 32.7 kg - 20 kg = 12.7 kg. Remaining weight fluid: 12.7 kg× 20 mL/kg = 254 mL. Total daily fluid requirement: 1000 mL + 500 mL + 254 mL = 1754 mL.
Step 2 is: Calculate the infusion rate in milliliters per hour (mL/hr). Rate = Total fluid÷Total hours. Rate = 1754 mL÷ 24 hr = 73.0833… mL/hr.
Step 3 is: Round the answer to the nearest tenth. 73.1 mL/hr. The infusion rate is 73.1 mL/hr.
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