A practical nurse (PN) is caring for a child who demonstrates "squatting" during play and is admitted for corrective surgery of a congenital heart defect.
Upon rising in the morning, the child demonstrates tachypnea and tachycardia consistent with cyanotic (hypoxic) spells. Which procedure should the PN implement?
Give prescribed digoxin and furosemide.
Return the child to bed and elevate the head of the bed.
Offer to play a board game with the child as a distraction.
Provide oxygen and promote the knee-chest position.
The Correct Answer is D
Choice A rationale
Giving prescribed digoxin and furosemide is part of the long-term management for cardiac conditions, but these medications do not provide immediate relief for an acute hypoxic spell. Digoxin improves cardiac contractility, and furosemide promotes fluid excretion, but their onset of action is not rapid enough for emergent situations.
Choice B rationale
Returning the child to bed and elevating the head of the bed might provide some comfort but does not directly address the underlying physiological cause of the hypoxic spell. Elevating the head of the bed may slightly improve respiratory effort but won't reverse cyanosis effectively.
Choice C rationale
Offering to play a board game with the child as a distraction does not address the physiological emergency of a hypoxic spell. Distraction may be helpful for anxiety but is not an intervention for cyanosis, tachypnea, and tachycardia, which require medical intervention.
Choice D rationale
Providing oxygen increases the available oxygen for gas exchange, and promoting the knee-chest position reduces venous return to the heart, thereby decreasing right-to-left shunting and improving pulmonary blood flow in conditions like Tetralogy of Fallot, which commonly presents with "squatting" and hypoxic spells.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Consumption of whole milk as a toddler is generally appropriate for growth and development, providing essential fats and nutrients. Unless consumed in excessive quantities or as part of an overall diet high in calories without sufficient physical activity, it is not typically identified as a primary singular contributor to early obesity.
Choice B rationale
Dedicated breastfeeding for 6 months is protective against childhood obesity. Breast milk provides optimal nutrition and growth-promoting factors, and breastfeeding is associated with better self-regulation of caloric intake by infants, potentially reducing the risk of later obesity compared to formula feeding.
Choice C rationale
Exclusive soy-based formula for the first year, while an alternative for specific dietary needs, does not inherently contribute to early obesity more than other formulas. The caloric density and nutritional composition of standard infant formulas are regulated and designed to support healthy growth, making it unlikely to be a primary cause of obesity.
Choice D rationale
Introducing solid foods, such as fortified cereal, before 4 months of age is associated with an increased risk of obesity. Infants lack the necessary gastrointestinal and renal maturity to process solids effectively before this age, and early introduction can lead to excessive caloric intake, disruption of feeding cues, and altered gut microbiome development, predisposing to weight gain.
Correct Answer is A
Explanation
Choice A rationale
Daily washing with mild soap and warm water helps remove excess sebum, dead skin cells, and bacteria from the skin surface, which are primary contributors to acne lesion formation. This non-irritating approach prevents further inflammation and maintains skin barrier integrity without triggering compensatory oil production often seen with harsh cleansers.
Choice B rationale
While a dermatologist can provide advanced therapies, the initial approach to acne management often involves lifestyle modifications and over-the-counter treatments. Referring directly to a dermatologist for long-term therapy without first attempting conservative measures may be an overstep for initial PN recommendations, as many mild cases respond to basic hygiene.
Choice C rationale
Scientific evidence does not consistently support a direct causal link between dietary factors like chocolate, carbonated drinks, or fried foods and the exacerbation of acne. Acne development is primarily influenced by hormonal factors, sebum production, bacterial proliferation (Propionibacterium acnes), and follicular hyperkeratinization, not specific food consumption.
Choice D rationale
Manual expression of blackheads can push follicular contents deeper, leading to rupture of the follicle wall, increased inflammation, and potential scarring. Exfoliating scrubs can also irritate inflamed skin, disrupt the skin barrier, and worsen acne, making this an unscientific and potentially harmful recommendation.
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