A nurse is assessing a newborn who has a coarctation of the aorta. Which of the following should the nurse recognize as a clinical manifestation of coarctation of the aorta?
Increased blood pressure in the arms with decreased blood pressure in the legs
Increased blood pressure in both the arms and the legs
Decreased blood pressure in both the arms and the legs
Decreased blood pressure in the arms with increased blood pressure in the legs
The Correct Answer is A
Choice A Reason:
In coarctation of the aorta, the narrowing of the aorta typically occurs after the arteries that supply the upper body branch off. This results in higher blood pressure in the arms and lower blood pressure in the legs. The difference in blood pressure between the upper and lower extremities is a key diagnostic indicator of this condition.
Choice B Reason:
Increased blood pressure in both the arms and the legs is not characteristic of coarctation of the aorta. This condition specifically causes a disparity in blood pressure between the upper and lower parts of the body due to the narrowing of the aorta.
Choice C Reason:
Decreased blood pressure in both the arms and the legs is not a typical manifestation of coarctation of the aorta. The condition usually leads to increased blood pressure in the upper body and decreased blood pressure in the lower body.
Choice D Reason:
Decreased blood pressure in the arms with increased blood pressure in the legs is the opposite of what is seen in coarctation of the aorta. The narrowing of the aorta causes higher pressure in the upper body and lower pressure in the lower body.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A Reason:
Elevating the affected part is a standard first aid measure to control bleeding. Elevation helps reduce blood flow to the area, which can minimize bleeding and swelling. This method is commonly recommended for minor bleeding episodes in hemophilia patients.
Choice B Reason:
Applying heat to a bleeding site is not recommended for hemophilia patients. Heat can increase blood flow to the area, potentially worsening the bleeding. Instead, cold compresses or ice packs are advised to constrict blood vessels and reduce bleeding. This statement indicates a need for further teaching as it suggests a harmful practice.
Choice C Reason:
Compressing the site of bleeding is an effective way to control minor bleeding episodes. Applying pressure helps to stop the bleeding by promoting clot formation. This is a correct and recommended practice for managing minor bleeds in hemophilia patients.
Choice D Reason:
Having the child rest is another appropriate measure to control bleeding. Resting helps to prevent further injury and allows the body to focus on healing. This practice is beneficial and aligns with standard care recommendations for hemophilia patients.
Correct Answer is D
Explanation
Choice A Reason:
The statement “I will report a change in her breathing” is appropriate. Changes in breathing can indicate worsening of the upper respiratory infection or complications such as diabetic ketoacidosis (DKA), which requires immediate medical attention. Reporting such changes is crucial for timely intervention.
Choice B Reason:
The statement “I will notify the doctor if her temperature is not controlled with acetaminophen” is also appropriate. Persistent fever despite acetaminophen can indicate a more serious infection or other complications that need medical evaluation. This ensures that the child receives appropriate care and treatment.
Choice C Reason:
The statement “I will encourage her to drink half a cup of water or sugar-free fluids every 30 minutes” is correct. Staying hydrated is essential, especially for a child with diabetes, to prevent dehydration and help manage blood sugar levels. Sugar-free fluids are recommended to avoid spikes in blood sugar.
Choice D Reason:
The statement “I will continue to check her blood sugar two times per day when she is sick” indicates a need for further instruction. When a child with type 1 diabetes is sick, blood sugar levels can fluctuate more than usual. It is generally recommended to check blood sugar levels more frequently, such as every 3-4 hours, to ensure they remain within a safe range and to detect any signs of hyperglycemia or hypoglycemia early.
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