A nurse is assessing a young child and suspects coarctation of the aorta based on which finding?
Hypotension
Unequal upper and lower extremity pulses
Excessive crying
Diastolic murmur
The Correct Answer is B
A. Hypotension is not typically associated with coarctation of the aorta; it more often leads to hypertension in the upper body.
B. Unequal pulses in the upper and lower extremities are a classic sign of coarctation of the aorta, as the obstruction typically affects blood flow to the lower body.
C. Excessive crying is not a specific indicator of coarctation of the aorta and can occur due to various reasons.
D. A diastolic murmur is not a primary indicator of coarctation of the aorta; it is more associated with other cardiac conditions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A,B,C,D,E
Explanation
A. Trust vs. Mistrust: This stage occurs from birth to approximately 18 months of age. During this period, infants learn to trust their caregivers to meet their needs. If their needs are consistently met, they develop a sense of trust; otherwise, they may develop mistrust.
B. Autonomy vs. Shame and Doubt: From 18 months to 3 years, children begin to assert their independence. If caregivers encourage self-sufficient behavior, children become more autonomous; if they're overly criticized, they may develop feelings of shame and doubt.
C. Initiative vs. Guilt: Between the ages of 3 and 5, children start to initiate activities and assert control over their world through play and social interactions. Successful initiation leads to a sense of purpose, while failure results in feelings of guilt.
D. Industry vs. Inferiority: From 6 years to puberty, children compare themselves to their peers. They develop a sense of pride and accomplishment through their successes, or they may feel inferior if they do not measure up.
E. Identity vs. Role Confusion: During adolescence, teens explore different roles and ideas to form a personal identity. A well-established identity leads to the ability to stay true to oneself, while failure to establish an identity results in role confusion.
Correct Answer is B
Explanation
Assessing the erythematous rash is important, as it can indicate the presence of erythema marginatum, a common symptom of rheumatic fever, but it is not the priority.
B. Auscultating the rate and characteristics of the child's heart sounds is the priority assessment because acute rheumatic fever can cause carditis, which affects the heart valves and can lead to serious complications. Early detection of any cardiac involvement is crucial for timely intervention and management.
C. Assessing joint pain is necessary for comfort and symptom management but does not take precedence over potential cardiac complications.
D. Identifying parental anxiety is important for providing emotional support but is not the immediate priority in managing the child's acute condition.
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