The nurse finds that an infant has stronger pulses in the upper extremities than in the lower extremities. Which assessment will the nurse perform next on this infant?
Pedal pulses.
Blood pressure of the four extremities.
Lower extremity reflexes.
Hemoglobin and hematocrit values.
The Correct Answer is B
Choice A reason: Assessing pedal pulses is important, but it does not provide complete information about the circulatory status of the infant.
Choice B reason: This is the correct choice. Discrepancies in pulse strength between the upper and lower extremities may indicate a cardiovascular problem such as coarctation of the aorta, which can be further evaluated by comparing blood pressures in all four extremities.
Choice C reason: Lower extremity reflexes are not directly related to the strength of pulses.
Choice D reason: Hemoglobin and hematocrit values are important but would not be the next step in assessing the significance of the difference in pulse strength.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: This is the correct choice. Congestive heart failure can occur in chronic renal failure due to fluid overload and the inability of the kidneys to manage fluid balance.
Choice B reason: Metabolic alkalosis is not typically a major complication of chronic renal failure; metabolic acidosis is more common due to the accumulation of acids in the body.
Choice C reason: Excessive excretion of blood urea nitrogen is not a complication; rather, in renal failure, the kidneys cannot excrete urea nitrogen effectively.
Choice D reason: Hypokalemia (low potassium) can occur, but it is not as major a complication as congestive heart failure in the context of chronic renal failure.
Correct Answer is C
Explanation
Choice A reason: LTB, also known as croup, is not primarily caused by Haemophilus influenzae type B.
Choice B reason: Bronchiolitis is typically caused by viruses such as RSV, not Haemophilus influenzae type B.
Choice C reason: This is the correct choice. The Hib vaccine is effective in preventing epiglottitis, which can be caused by Haemophilus influenzae type B.
Choice D reason: While Hib can cause pneumonia, the vaccine is specifically known for its role in preventing invasive diseases like epiglottitis.
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