ATI RN
Pediatric Cardiovascular Nursing Questions Questions
Question 1 of 5
An older female client with long term type 2 diabetes mellitus (DM) is seen in the clinic for a routine health assessment. To determine if the client is experiencing any long-term complication of DM, which assessments should the nurse obtain?
Correct Answer: B
Rationale: In this scenario, option B) Sensation in feet and legs is the correct assessment to determine if the client is experiencing long-term complications of diabetes mellitus (DM). This is crucial because diabetic neuropathy is a common long-term complication of diabetes that affects sensation in the extremities. Assessing sensation in the feet and legs helps identify peripheral neuropathy, which can lead to serious complications such as foot ulcers and amputations if not managed appropriately. Option A) Serum creatinine and blood urea nitrogen (BUN) are important assessments to monitor kidney function in diabetes, but they are more related to renal complications rather than neurological complications like peripheral neuropathy. Option C) Skin condition of lower extremities is important for assessing for complications like diabetic ulcers or infections but does not specifically target neurological complications like peripheral neuropathy. Option D) Visual acuity is important for monitoring complications related to the eyes in diabetes (diabetic retinopathy), which is a common long-term complication, but it is not directly related to assessing for peripheral neuropathy. In an educational context, it is essential for nurses caring for diabetic patients, especially those with long-term type 2 diabetes, to be vigilant in assessing for complications early to prevent further deterioration of health. Understanding the specific assessments required for different complications of diabetes aids in providing comprehensive care and improving patient outcomes.
Question 2 of 5
The nurse is teaching the importance of an exercise regime that includes walking daily for a group of clients with asthma, chronic bronchitis, and emphysema at a pulmonary rehabilitation clinic. Which rationale should the nurse include when motivating the clients?
Correct Answer: A
Rationale: The correct answer is A) Daily exercise and walking enhances cardiovascular fitness. This option is the most appropriate because regular physical activity, such as walking, has been shown to improve cardiovascular health by strengthening the heart, improving circulation, and increasing overall fitness levels. In the context of clients with asthma, chronic bronchitis, and emphysema, enhancing cardiovascular fitness can lead to better endurance, reduced shortness of breath, and improved quality of life. Option B) Exercise eliminates the need for bronchodilator medications is incorrect because while exercise can improve respiratory function and overall health, it is not a replacement for essential medications like bronchodilators that help manage symptoms in clients with respiratory conditions. Option C) Walking daily reverses lung damage caused by chronic conditions is incorrect because while exercise can improve lung function and overall health, it cannot reverse existing structural damage caused by chronic conditions like asthma, chronic bronchitis, or emphysema. Option D) Physical activity increases mucus production to clear airways is incorrect because while staying active can help mobilize mucus and improve airway clearance in some cases, it does not directly increase mucus production and may not be suitable for all individuals with respiratory conditions, as increased mucus production can exacerbate symptoms in certain cases. In an educational context, it is crucial for nurses to provide evidence-based information to clients with respiratory conditions to empower them to make informed decisions about their health. Encouraging regular exercise, like walking, as part of a comprehensive management plan can have numerous benefits for cardiovascular health and overall well-being in individuals with asthma, chronic bronchitis, and emphysema.
Question 3 of 5
An older adult man recently diagnosed with chronic obstructive pulmonary disease (COPD) is admitted with shortness of breath. The nurse observes the client sitting upright and leaning over the bedside table, using accessory muscles to assist in breathing. What action should the nurse take?
Correct Answer: D
Rationale: In this scenario, the correct action for the nurse to take is option D: Instruct the client in pursed lip breathing techniques. This is the most appropriate intervention for a patient with COPD experiencing shortness of breath. Pursed lip breathing can help improve gas exchange and decrease the work of breathing in COPD patients. By teaching the client this technique, the nurse empowers the individual to better manage their respiratory distress. Option A is incorrect because simply moving the client to a high Fowler's position may not address the underlying issue of ineffective breathing. Option B, observing for a barrel chest, is not the priority intervention in this acute situation. Option C, preparing to transfer to a critical care unit, is premature without first implementing non-invasive interventions like pursed lip breathing techniques. Educationally, understanding the rationale behind interventions in respiratory conditions like COPD is crucial for nurses caring for these patients. Teaching patients effective breathing techniques empowers them in self-management and can improve outcomes and quality of life. Nurses must be adept at recognizing respiratory distress and implementing appropriate interventions promptly.
Question 4 of 5
An older client is admitted after falling while walking. The left leg is externally rotated and shorter than the right leg, and the client is having severe pain and tingling in the left foot. The nurse is unable to palpate the left pedal pulses. Which action is most important for the nurse to implement?
Correct Answer: A
Rationale: In this scenario, the most important action for the nurse to implement is option A, using a doppler to assess bilateral pedal pulses. This is crucial in determining the vascular status of the affected leg, especially in a situation where a client presents with an externally rotated and shortened leg, severe pain, tingling, and absent pedal pulses. Without proper circulation, there is a risk of ischemia and potential long-term complications. Option B, administering pain medication, is not the most critical action at this stage. While managing pain is important, assessing vascular status takes precedence to ensure adequate blood flow to the affected limb. Option C, positioning the client's left leg in a neutral position, may offer some comfort but does not address the urgent need to assess circulation. Delaying vascular assessment can lead to further complications. Option D, immobilizing the left leg, is not appropriate without first assessing the vascular status. Immobilization may be necessary later for treatment but should not delay immediate assessment and intervention for vascular compromise. In an educational context, this scenario highlights the importance of prompt and systematic assessment in nursing practice, especially in emergencies involving potential vascular compromise. Nurses must prioritize actions based on the client's condition to provide safe and effective care. Understanding the rationale behind each option helps nurses develop critical thinking skills to make sound clinical judgments in similar situations.
Question 5 of 5
The nurse is assessing a client who has tinea pedis. Which question will allow the nurse to gather further information about this condition?
Correct Answer: A
Rationale: The correct answer is A) Do you see any improvement when using tolnaftate? This question is pertinent because tinea pedis is a fungal infection of the feet, commonly known as athlete's foot, and tolnaftate is an antifungal medication used to treat this condition. By asking about improvement with tolnaftate, the nurse can assess the effectiveness of the treatment and the client's adherence to it. Option B) Have you been avoiding wearing tight-fitting shoes? While wearing loose-fitting shoes can help prevent tinea pedis, this question does not directly address the current status or treatment of the condition. Option C) Are you experiencing pain or itching in your feet? While pain and itching are common symptoms of tinea pedis, this question does not specifically address the treatment or improvement of the condition. Option D) How often do you wash your feet and change socks? While proper hygiene practices can help prevent tinea pedis, this question does not address the specific treatment or improvement with tolnaftate. In an educational context, understanding the rationale behind the correct question allows nurses to assess the effectiveness of treatment interventions, monitor client response to therapy, and make informed decisions regarding ongoing care for clients with tinea pedis. This approach enhances the nurse's ability to provide individualized, evidence-based care and promote positive health outcomes for pediatric clients with cardiovascular conditions.