A 6-year-old child has been diagnosed with coarctation of the aorta. Lately, he has been complaining when he comes in from recess. The health nurse should question the child about which of the following?

Correct Answer: A

Rationale: The correct answer is A: Weakness and pain in legs. Coarctation of the aorta can lead to decreased blood flow to the lower extremities, causing symptoms like leg pain and weakness. The health nurse should question the child about this as it could be indicative of reduced blood flow from the aorta. Blurred vision (B) is not typically associated with coarctation of the aorta. Increased respiratory rate (C) is more commonly seen in conditions affecting the lungs or airways, not specifically related to coarctation of the aorta. Bruises on shins (D) are not directly related to the symptoms of coarctation of the aorta and do not provide relevant information in this context.

Correct Answer: A

Rationale: The correct answer is A: Transcutaneous pacer. In an emergency, a transcutaneous pacer is used because it can be quickly attached externally to the patient's chest, providing immediate pacing support. This type of pacer delivers electrical impulses through the skin to stimulate the heart, making it an effective temporary solution. Summary: B: Epicardial pacer is surgically placed on the heart's surface and is not typically used in emergency situations. C: Transvenous pacer is inserted through a vein and requires more time for placement, making it less suitable for emergencies. D: Permanent pacer is surgically implanted for long-term use and is not used in emergency situations.

Correct Answer: A

Rationale: Indications that the occluded artery is patent include relief of chest pain, return of ST segment to baseline on the ECG, the presence of reperfusion dysrhythmias, and a marked, rapid rise of the CK enzyme within 3 hours of therapy. If chest pain is unchanged, it is an indication that reperfusion has not occurred.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Troponin. Troponin is the most specific and sensitive biomarker for myocardial injury, making it the gold standard for diagnosing acute coronary syndrome (ACS). Elevated troponin levels indicate damage to the heart muscle, which is a hallmark of ACS. This information is crucial for determining the need for immediate intervention and treatment in the emergency department. Creatine kinase-MB (Option A) is less specific to cardiac injury compared to troponin and can also be elevated in conditions like skeletal muscle damage, limiting its utility in diagnosing ACS. Myoglobin (Option C) is an early marker of muscle injury but lacks the specificity of troponin for cardiac muscle, leading to higher false-positive results. C-reactive protein (Option D) is a marker of inflammation and does not provide direct evidence of myocardial injury. Educationally, understanding the significance of troponin in the context of ACS is vital for healthcare professionals working in emergency settings. It underscores the importance of accurate and timely diagnostic tests in guiding patient management decisions, especially in high-stakes situations like suspected heart attacks. This knowledge equips healthcare providers with the necessary tools to deliver optimal care and improve patient outcomes in critical situations.

Correct Answer: A

Rationale: In this scenario, the most appropriate task to delegate to an experienced nursing assistant is option A, which involves measuring ankle and brachial pressures for a patient having the ankle-brachial index calculated. This task is suitable for delegation because it involves obtaining basic physiological measurements that do not require specialized training or interpretation. Option B, checking blood pressure and pulse during exercise testing, involves continuous monitoring and interpretation of vital signs, which requires a higher level of clinical judgment and expertise typically possessed by a nurse or healthcare provider. Option C, taking an allergy history for contrast venography, requires knowledge of potential contrast agents, their side effects, and implications for the procedure, making it a task best suited for a nurse or provider with a clinical background. Option D, providing patient teaching for a right subclavian vein Doppler study, involves explaining a specific diagnostic procedure, potential risks, and post-procedure care, which necessitates a healthcare provider's in-depth knowledge and ability to address patient questions and concerns effectively. In an educational context, understanding the scope of practice for different healthcare team members is crucial for delegating tasks effectively. By recognizing the level of expertise and training required for various activities, healthcare professionals can optimize workflow, enhance patient care, and ensure safe and efficient delivery of services. Delegating appropriate tasks based on competency levels also helps in promoting professional growth and skill development within the healthcare team.