A nurse is caring for an infant who has coarctation of the aorta.
Which of the following should the nurse identify as an expected finding?

Upper extremity hypotension.

Frequent nosebleeds.

Weak femoral pulses.

Increased intracranial pressure.

Answer and Explanation

The Correct Answer is C

Choice A rationale:

Upper extremity hypotension is not a common finding in coarctation of the aorta. Coarctation of the aorta typically results in narrowing of the aorta, leading to decreased blood flow to the lower part of the body. This can cause weak or absent femoral pulses and lower extremity hypotension, not upper extremity hypotension.

Choice B rationale:

Frequent nosebleeds are not directly associated with coarctation of the aorta. The symptoms of coarctation of the aorta are primarily related to decreased blood flow to the lower extremities, leading to symptoms such as weak femoral pulses, lower extremity hypotension, and leg cramping or pain.

Choice D rationale:

Increased intracranial pressure is not a typical finding in coarctation of the aorta. Coarctation of the aorta affects blood flow to the lower part of the body and does not directly impact intracranial pressure.

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Correct Answer is B

Explanation

Choice A rationale:

Having the client exhale deeper than she inhales is a breathing technique that can help manage pain but does not specifically address the request for pain management techniques during natural childbirth. Option A does not provide comprehensive information about pain management strategies during labor.

Choice B rationale:

Providing information about the use of hydrotherapy during labor is a valid suggestion. Hydrotherapy, such as taking a warm bath or using a shower during labor, can help alleviate pain and promote relaxation. It is a non-pharmacological pain management option that the client can consider.

Choice C rationale:

Encouraging the client to have the family exit the room when the pain is unbearable may offer emotional support, but it does not provide a direct pain management technique. Additionally, the presence of loved ones can be a source of comfort for the client during labor.

Choice D rationale:

Informing the client that using pharmacological pain management will not impact the delivery is a true statement. Pharmacological pain relief methods, such as epidural anesthesia, do not affect the progress of labor or the outcome of delivery. However, this option does not provide an alternative pain management technique for the client who desires natural childbirth.

A. Instruct the client's loved ones that the client should not have fresh flowers in their room. B. Wear a surgical mask when within 0.9 m (3 feet) of the client. C. Place the client in a room with negative-airflow pressure. D. Instruct the client that visitors will not be allowed while they are in isolation.

Correct Answer is B

Explanation

The correct answer is choice B: Wear a surgical mask when within 0.9 m (3 feet) of the client.

Choice A rationale:

Fresh flowers are generally discouraged in hospital settings for clients with compromised immune systems due to the risk of infection from soil or water, which can harbor harmful microorganisms. However, this is not specifically related to rubella, which is an airborne virus.

Choice B rationale:

Rubella is transmitted through airborne droplets when an infected person coughs or sneezes. Wearing a surgical mask when close to the client can help prevent the spread of the virus. This is especially important to protect individuals who are pregnant or may become pregnant, as rubella can cause serious birth defects.

Choice C rationale:

Negative-airflow pressure rooms are used for clients with airborne infections, such as tuberculosis. While rubella is also airborne, the current guidelines do not require a negative pressure room for its management.

Choice D rationale:

While limiting visitors can help control the spread of infection, it is not the primary action to take for a client with rubella. The focus should be on preventing the spread through droplet transmission, which is addressed by wearing a mask and practicing good hand hygiene.

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A nurse is caring for an infant who has coarctation of the aorta.Which of the following should the nurse identify as an expected finding?

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A nurse is caring for an infant who has coarctation of the aorta.
Which of the following should the nurse identify as an expected finding?