The nurse is caring for a newborn diagnosed with patent ductus arteriosus. What assessment findings would be consistent with this diagnosis? (Select All that Apply.)
Circumoral cyanosis
Tachycardia
Elevated diastolic blood pressure
Bradycardia
Bounding peripheral pulses
Continuous murmur
Narrow pulse pressure
Correct Answer : B,E,F
A. Circumoral cyanosis. This can occur but is less specific for PDA and more related to general issues with oxygenation.
B. Tachycardia. PDA can lead to increased heart rate as the heart works harder to manage the increased blood flow.
C. Elevated diastolic blood pressure. PDA usually causes a decrease in diastolic pressure, not an increase.
D. Bradycardia. Bradycardia is not typically associated with PDA.
E. Bounding peripheral pulses. PDA allows more blood to flow into the systemic circulation, leading to stronger pulses.
F. Continuous murmur. PDA typically causes a continuous "machine-like" murmur because of the continuous flow of blood from the aorta to the pulmonary artery.
G. Narrow pulse pressure. PDA often causes a wide pulse pressure, not a narrow one.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Keep the newborn in a well-lit nursery: A well-lit nursery can overstimulate a preterm newborn. Preterm infants benefit more from a dim, quiet environment that mimics the womb.
B. Cluster the newborn's care activities: This helps minimize disruptions to the newborn’s rest periods, which is crucial for their growth and neurodevelopment. Clustering care reduces stress and promotes better sleep cycles.
C. Position the newborn to promote extension of muscles: Preterm infants generally benefit from a flexed position, which is more comforting and developmentally appropriate, rather than promoting muscle extension.
D. Use fingertips when calming the newborn: Using fingertips might be too stimulating for a preterm newborn. Instead, a gentle, whole-hand touch is often more comforting and less likely to cause overstimulation.
Correct Answer is ["A","C","D"]
Explanation
A. I perform a range of motion exercises every 4 hours to help prevent contractures. This helps prevent the tightening of muscles and joints, reducing the risk of contractures common in spastic cerebral palsy.
B. I make sure that I use toys and activities that are appropriate for my child's chronological age. While important, this does not specifically address the care needs related to spastic cerebral palsy.
C. I have utensils with large, padded handles to make it easier for my child to feed himself. Adaptive utensils promote independence in self-care activities.
D. I play games with my child every day to keep them as independent as possible. Engaging in activities that promote independence and social interaction is beneficial for children with cerebral palsy.
E. I give my child carbidopa so that he will stop drooling. Medications like carbidopa are not typically used to manage drooling associated with cerebral palsy and are not a primary care measure.
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