The parent of a 1-year-old child with tetralogy of Fallot asks the nurse, "Why do my child's fingertips look like that?" On what understanding does the nurse base a response?

Clubbing occurs as a result of decreased cardiac output.

Clubbing occurs as a result of a left-to-right shunting of blood.

Clubbing occurs as a result of chronic hypoxia

Clubbing occurs as a result of untreated congestive heart failure.

Answer and Explanation

The Correct Answer is C

C. Clubbing, characterized by bulbous enlargement of the fingertips and nail bed, is a result of chronic hypoxia in tetralogy of Fallot. In tetralogy of Fallot, there is a right-to-left shunting of blood due to the presence of a ventricular septal defect, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy. This leads to reduced oxygenation of blood and chronic hypoxia, which can result in clubbing of the fingertips over time.

A This option is not the primary explanation for clubbing in tetralogy of Fallot. While decreased cardiac output may contribute to some manifestations of the condition, clubbing specifically results from chronic hypoxia rather than decreased cardiac output alone.

B Clubbing is not directly caused by a left-to-right shunting of blood. Instead, it is associated with chronic hypoxia, which can occur due to right-to-left shunting of blood in tetralogy of Fallot.

D Congestive heart failure may occur in individuals with tetralogy of Fallot but it is not the primary cause of clubbing. Clubbing in tetralogy of Fallot is primarily attributed to chronic hypoxia rather than heart failure alone.

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Correct Answer is D

Explanation

D. Pancreatic enzymes should not be mixed with acidic foods or liquids, as this can reduce their effectiveness. Instead, the enzymes should be sprinkled on soft, non-acidic foods or swallowed whole with a glass of water or juice.

A. Pancreatic enzymes are generally safe and well-tolerated when taken as prescribed but they can cause side effects in some individuals. Common side effects may include abdominal pain, diarrhea, constipation, nausea, and bloating.

B. Pancreatic enzymes help individuals with cystic fibrosis digest fat, as well as proteins and carbohydrates. In cystic fibrosis, the pancreas does not produce enough digestive enzymes, leading to malabsorption of nutrients, particularly fat. Supplemental pancreatic enzymes help compensate for this deficiency and improve nutrient absorption.

C. Pancreatic enzymes are typically taken with meals or snacks to aid in digestion. However, if the child is consuming a small meal or snack that contains minimal fat, the enzymes may not be necessary. It's important for the mother to follow the healthcare provider's instructions regarding when and how to administer the enzymes.

A. The child may attend school if antibiotics have been started. B. Wipe any crusted material from the eye with a cotton ball soaked in warm water, starting at the outer aspect of the eye and moving toward the inner aspect. C. The child's towels and washcloths should not be used by other members of the household. D. Save any unused eye medication in case a sibling gets the eye infection.

Correct Answer is C

Explanation

This aligns with general guidelines for managing bacterial conjunctivitis, which emphasize the importance of cleanliness and avoiding the sharing of personal items to contain the infection.

A. Bacterial conjunctivitis is highly contagious, and the child should not attend school until they have been on antibiotics for at least 24 hours and their symptoms are improving. Allowing the child to attend school before this time could lead to the spread of the infection to other children.

B. Crusted material around the eye should be gently wiped away using a clean cotton ball soaked in warm water. It's important to start wiping from the inner aspect of the eye and move toward the outer aspect to prevent spreading any infectious material into the eye.

D. Eye medications, especially antibiotics prescribed for bacterial conjunctivitis, should not be saved for future use or shared with others. Each individual should have their own prescribed medication to avoid the risk of improper dosing or spread of infection.

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The parent of a 1-year-old child with tetralogy of Fallot asks the nurse, "Why do my child's fingertips look like that?" On what understanding does the nurse base a response?

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