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 C

Explanation

C. Cerebral palsy is a chronic condition that affects muscle control and movement. It is caused by damage to or abnormal development of the parts of the brain that control movement, balance, and posture. This damage can occur before, during, or shortly after birth, and it results in difficulties with muscle coordination, balance, and motor skills.

A. Cerebral palsy is not caused by an infectious agent; it is a non-progressive neurological disorder that affects movement, posture, and muscle coordination. It is primarily caused by abnormal development or damage to the brain before, during, or shortly after birth, rather than by an infectious disease.

B. Cerebral palsy is not caused by inflammation of the brain due to a viral illness. While viral illnesses can lead to complications, such as encephalitis (inflammation of the brain), cerebral palsy itself is not caused by inflammation but rather by neurological damage or abnormal development.

D. Cerebral palsy primarily affects movement and muscle control but it does not necessarily result in intellectual disability. Intellectual disability can occur in some cases of cerebral palsy, but it is not a defining characteristic of the condition.

A. Cool extremities and decreased urine output B. Bradycardia and hypotension C. Increased appetite and excessive weight gain D. Poor feeding and weight gain E. Tachypnea and respiratory distress

Correct Answer is ["A","D","E"]

Explanation

A. Decreased cardiac output in heart failure can lead to poor perfusion of the extremities, resulting in cool skin and decreased urine output due to reduced renal perfusion and impaired kidney function.

D. Poor feeding is often observed due to increased respiratory effort, tachypnea, and fatigue associated with heart failure. Additionally, infants may exhibit failure to thrive or inadequate weight gain despite increased caloric intake due to metabolic demands and inefficient utilization of nutrients.

E. Tachypnea and respiratory distress occur due to pulmonary congestion and increased respiratory effort in response to heart failure. Infants may exhibit signs such as nasal flaring, grunting, retractions, and cyanosis.

B. Bradycardia and hypotension are not typical manifestations of heart failure in infants. Instead, infants with heart failure often present with tachycardia (rapid heart rate) as a compensatory mechanism to maintain cardiac output. Hypotension may occur in severe cases but is not a common finding.

C. Increased appetite and excessive weight gain are not typical manifestations of heart failure in infants. Infants with heart failure often experience poor feeding and failure to thrive due to inadequate cardiac output and oxygen delivery to meet metabolic demands.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a child recently diagnosed with cerebral palsy. The parents of the child ask the nurse about the disorder. The nurse bases the response to the parents on the understanding that cerebral palsy is best described by which statement?

Correct Answer is C

Explanation

Which of the following are common manifestations of heart failure in infants? (SELECT ALL THAT APPLY)

Correct Answer is ["A","D","E"]

Explanation

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