A nurse is assessing an infant who has Tetralogy of Fallot. Which of the following clinical manifestations should the nurse expect?

Select all that apply.

Bounding peripheral pulses

Cyanotic spells

Stridor

Anemia

heart murmur

Answer and Explanation

Correct Answer : B,E

A. "Bounding peripheral pulses." Bounding pulses are not characteristic of Tetralogy of Fallot. Instead, pulses may be normal or diminished, depending on the severity of the defect.
B. "Cyanotic spells." Tetralogy of Fallot causes decreased oxygenation, leading to periodic cyanotic episodes, particularly during crying or feeding ("tet spells").
C. "Stridor." Stridor is associated with upper airway obstructions, not cardiac defects like Tetralogy of Fallot.
D. "Anemia." Anemia is not a primary finding in Tetralogy of Fallot. Polycythemia (increased red blood cells) is more common due to chronic hypoxia.
E. "Heart murmur." A systolic murmur is common due to the pulmonary stenosis and ventricular septal defect associated with Tetralogy of Fallot.

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Correct Answer is A

Explanation

A. "Maintain aseptic technique during the child's dressing changes." Aseptic technique reduces the risk of infection, which is critical for children with burns as their immune response may be compromised.
B. "Provide low-calorie snacks for the child several times each day." Children with burns require a high-calorie, high-protein diet to promote healing and compensate for increased metabolic demands.
C. "Apply continuous passive motion devices to the child's lower extremities during periods of rest." Passive motion devices are not typically indicated for burn injuries unless there is joint involvement requiring physical therapy for mobility restoration.
D. "Administer pain medication to the child 30 min following physical therapy." Pain medication should be administered before physical therapy to improve tolerance and participation.

Correct Answer is ["12.5"]

Explanation

Dose required per day = 50mg/kg/day × 40 kg = 2000 mg/day

Dose per administration = 2000mg4 doses= 500 mg/dose

Volume to administer:

200mg5ml=40mg/ml

500mg40mg/ml=12.5ml/dose

Correct answer =12.5mL/dose

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A nurse is assessing an infant who has Tetralogy of Fallot. Which of the following clinical manifestations should the nurse expect? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is creating a plan of care for a school-age child who has moderate partial-thickness burns on both lower extremities. Which of the following interventions should the nurse include in the plan?

Correct Answer is A

Explanation

Correct Answer is ["12.5"]

Explanation

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A nurse is assessing an infant who has Tetralogy of Fallot. Which of the following clinical manifestations should the nurse expect?

Select all that apply.