A nurse is planning the discharge of an infant who has tetralogy of Fallot. The nurse anticipates the need for which of the following equipment?
Portable suction
Cervical collar
Hemodialyzer
Pulse oximeter
The Correct Answer is D
A. Portable suction may be needed for some infants but is not specifically indicated for tetralogy of Fallot.
B. A cervical collar is used for neck support in patients with suspected cervical spine injuries and is not indicated for tetralogy of Fallot.
C. A hemodialyzer is used for renal replacement therapy and is not indicated for tetralogy of Fallot.
D. A pulse oximeter is essential for monitoring oxygen saturation levels in infants with tetralogy of Fallot, as they may experience cyanosis and hypoxemia. Monitoring oxygen saturation helps guide interventions and management.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Administering furosemide may also be appropriate for managing heart failure symptoms, but the priority action based on the client's condition is to withhold digoxin.
B. The client's vital signs indicate bradycardia (pulse 52/min), which is a common adverse effect of digoxin, especially in the setting of heart failure. Withholding digoxin is necessary to prevent further exacerbation of bradycardia and potential toxicity.
C. Withholding spironolactone may be considered if there are concerns about electrolyte imbalances, but it is not the priority action in this scenario.
D. Administering ferrous sulfate is not indicated based on the client's chart findings; there is no indication of anemia or iron deficiency.
Correct Answer is D
Explanation
A. Constipation is not typically associated with TPN because the client is receiving nutrients intravenously rather than through the gastrointestinal tract.
B. Respiratory depression is not a direct complication of TPN administration.
C. Hypotension is not a common complication of TPN unless associated with fluid shifts or infection.
D. Electrolyte imbalance is a potential complication of TPN due to the high concentrations of glucose, electrolytes, and other nutrients. Rapid infusion, improper formulation, or abrupt discontinuation can lead to imbalances in sodium, potassium, calcium, magnesium, and phosphate. Frequent monitoring of laboratory values is essential to prevent metabolic complications.
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