A nurse on the pediatric unit is caring for a child.
Complete the following sentence by using the lists of options.
The nurse suspects that the child is experiencing
The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}
Cardiac catheterization in children involves the percutaneous insertion of a catheter into a major vessel, typically the femoral artery, to diagnose or treat structural heart defects. Arterial thrombosis is a recognized post-operative complication where a blood clot forms at the site of the arterial puncture or along the catheter track, obstructing distal blood flow. This represents a medical emergency in pediatric patients because rapid intervention is required to prevent permanent tissue ischemia, nerve damage, and limb loss.
Rationale for correct choices:
• Arterial thrombosis is the most likely complication following cardiac catheterization due to endothelial injury at the catheter insertion site, which can trigger clot formation within the artery. This obstructs blood flow to the distal extremity, leading to ischemic symptoms such as pain, numbness, and decreased perfusion. The unilateral nature of symptoms strongly suggests a localized arterial occlusion rather than a systemic process.
• A weak pedal pulse on the affected side combined with a cool extremity and prolonged capillary refill indicates reduced arterial blood flow distal to the catheter site. These are classic signs of limb ischemia following arterial compromise. The presence of numbness and tingling further supports decreased oxygen delivery to tissues. These findings together strongly indicate impaired arterial circulation consistent with thrombosis.
Rationale for incorrect choices:
• Venous thromboembolism typically presents with swelling, warmth, redness, and pain in the affected limb rather than coolness and diminished pulses. It involves impaired venous return rather than arterial obstruction. In this case, the extremity is cool with weak pulses, which is not consistent with venous occlusion. Additionally, neurological symptoms like numbness are more indicative of arterial insufficiency than venous disease.
• Infective endocarditis usually presents with systemic signs such as fever, chills, new or changing heart murmur, and possibly embolic phenomena over time. This child is afebrile and has localized limb findings directly related to the catheter insertion site. The sudden onset of unilateral distal ischemia immediately after catheterization does not align with an infectious process.
• Bilateral crackles would suggest fluid accumulation in the lungs, commonly associated with conditions such as heart failure or fluid overload. The assessment findings are localized to the right lower extremity following a femoral catheter insertion, not respiratory compromise. The lung fields were previously clear and there are no documented signs of pulmonary congestion such as dyspnea or bilateral lung changes.
• A heart murmur accompanied by fever and chills is more consistent with infective endocarditis, which develops over time due to bacterial infection of the heart valves. This condition typically presents with systemic infection signs rather than immediate post-procedural localized limb ischemia. The child’s symptoms developed shortly after cardiac catheterization and are confined to the catheterized extremity. There is no indication of systemic infection.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Immunization schedules for infants are designed to protect against serious infectious diseases early in life when susceptibility is highest. Vaccines are introduced at specific ages based on immune system maturity, disease risk, and effectiveness of antibody response. In the United States, the Centers for Disease Control and Prevention (CDC) provides a standardized timeline for vaccine administration. At 1 month of age, most routine vaccines have not yet begun, but parents should be educated on upcoming immunization timelines.
Rationale:
A. Hepatitis A immunization is not recommended for infants at 1 month of age. The standard pediatric immunization schedule dictates that the first dose of the Hepatitis A vaccine should be administered no earlier than 12 months (1 year) of age, with a second dose following at least 6 months later. Since this infant is only 1 month old, including this in the immediate anticipatory guidance for upcoming "first" vaccines would be premature and clinically inappropriate.
B. Inactivated poliovirus (IPV) is the correct answer because the first dose of the series is recommended to be administered at 2 months of age. Polio is a highly infectious viral disease that can lead to irreversible paralysis; therefore, starting the series early in infancy is vital. When providing guidance to a parent of a 1-month-old, the nurse should explain that at the next visit, the child will receive the first dose of IPV along with other primary vaccines like DTaP and Hib.
C. Measles, mumps, and rubella (MMR) is a live attenuated vaccine that is generally not administered to infants under the age of 12 months. Maternal antibodies passed to the fetus during pregnancy can interfere with the immune response to the MMR vaccine if it is given too early. Consequently, this vaccine is not part of the initial primary series for a 2-month-old and would not be the focus of anticipatory guidance for a parent of a 1-month-old infant.
D. Varicella (chickenpox) vaccine, much like the MMR vaccine, is a live virus immunization that is first administered when the child reaches 12 to 15 months of age. Administering it to a 1-month-old or 2-month-old would not provide effective immunity and is not supported by current pediatric clinical guidelines. The nurse should focus on the vaccines scheduled for the 2-month visit, which include IPV, rotavirus, and the pneumococcal conjugate vaccine.
Correct Answer is A
Explanation
Acute acetylsalicylic acid (aspirin) poisoning in children is a serious toxicologic emergency that affects multiple body systems. It commonly results in metabolic acidosis, respiratory alkalosis, and disruption of thermoregulation due to uncoupling of oxidative phosphorylation. Pediatric patients are especially vulnerable to rapid deterioration, including neurologic changes, acid-base imbalance, and altered temperature regulation. Recognizing key clinical manifestations such as abnormal body temperature is essential for early intervention.
Rationale:
A. Hyperpyrexia is expected in aspirin poisoning because salicylates uncouple oxidative phosphorylation, leading to increased metabolic activity and excessive heat production. This disrupts the body’s ability to regulate temperature, resulting in dangerously elevated body temperature. Hyperthermia is a hallmark sign of moderate to severe salicylate toxicity in children.
B. Neck vein distention is not associated with aspirin toxicity. It is more commonly seen in conditions involving fluid overload or cardiac dysfunction, such as heart failure or cardiac tamponade. Salicylate poisoning primarily affects metabolic and respiratory systems rather than causing venous congestion.
C. Jaundice is not a typical manifestation of acute aspirin poisoning. While severe overdose may eventually affect liver function, jaundice is more commonly associated with hepatic diseases or hemolytic conditions rather than early salicylate toxicity. The primary effects are metabolic and neurologic rather than hepatic in presentation.
D. Polyuria is not a characteristic finding in acute acetylsalicylic acid poisoning. Although fluid and electrolyte disturbances can occur, aspirin toxicity does not typically present with increased urine output as a primary symptom. Instead, early signs include hyperventilation, tinnitus, fever, and metabolic disturbances.
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