In assessing a client with ulcers on the lower extremity, which findings indicate that the ulcers are likely to be of venous, rather than arterial, origin?

Correct Answer: B

Rationale: In assessing a client with ulcers on the lower extremity, findings that indicate venous ulcers over arterial ulcers are irregular ulcer shapes and severe edema. Venous ulcers tend to have irregular shapes due to the underlying venous hypertension, while arterial ulcers are typically more uniform in shape. Severe edema is also more characteristic of venous insufficiency, as impaired venous return leads to fluid accumulation in the tissues. Option A, black ulcers and dependent rubor, are more indicative of arterial ulcers. Black ulcers suggest ischemia and necrosis, while dependent rubor is a sign of arterial insufficiency. Option C, absent pedal pulses and shiny skin, are also more indicative of arterial ulcers, as impaired arterial blood flow leads to diminished pulses and shiny, atrophic skin. Option D, hairless lower extremities and cool feet, can be seen in both arterial and venous insufficiency, but are not as specific to venous ulcers as irregular ulcer shapes and severe edema. Educationally, understanding the differences in presentation between venous and arterial ulcers is crucial for nurses caring for patients with cardiovascular disorders. Recognizing these differences can guide appropriate interventions and help prevent complications associated with mismanagement of these conditions.

Correct Answer: A

Rationale: The correct answer is A) “If my child vomits after the medication administration, I will repeat the dose.” Rationale: A) This statement indicates a need for further instruction because if a child vomits after taking digoxin, repeating the dose can lead to overdosing, which can be harmful. It is crucial for parents to understand not to double dose without healthcare provider guidance. B) Mixing digoxin with food can alter its absorption, so it is correct not to mix it with food. C) Taking the child’s pulse before administering digoxin is essential as it helps monitor for signs of digoxin toxicity, so this statement is correct. D) Contacting the healthcare provider if more than one dose is missed is crucial to ensure proper management of the child's condition, making this statement correct. Educational Context: Parents need clear instructions on administering medications like digoxin to avoid potential harm. Understanding the importance of proper dosing, monitoring for side effects, and when to seek medical advice is crucial in managing pediatric cardiovascular disorders effectively. Reinforcing these key points can help parents confidently care for their child at home.

Correct Answer: A

Rationale: In pediatric cardiovascular disorders, the primary goal of administering oxygen to an infant with heart failure is to improve oxygenation and relieve respiratory distress. The correct answer is A) During sleep. This is because during sleep, an infant's oxygen demand may increase due to decreased respiratory drive and increased work of breathing, especially in the setting of heart failure. Providing oxygen during sleep helps meet this increased demand and ensures adequate oxygenation. Option B) When changing the infant's diapers is incorrect because this activity does not directly impact the infant's respiratory status or oxygenation needs. Option C) When the mother is holding the infant is also incorrect as the presence of the mother does not alter the infant's physiological need for oxygen. Option D) When drawing blood for electrolyte level testing is not the ideal time to administer oxygen as the focus during blood sampling should be on obtaining accurate laboratory results, and oxygen administration may not be necessary during this procedure. Educationally, understanding the appropriate timing for oxygen administration in infants with heart failure is crucial for nurses caring for pediatric patients with cardiovascular disorders. This knowledge ensures optimal management of respiratory distress and helps prevent complications associated with inadequate oxygenation in this vulnerable population. Nurses must be able to identify situations where oxygen supplementation is needed to provide safe and effective care for infants with heart failure.

Correct Answer: D

Rationale: The correct answer is D) Polycythemia. In infants with a congenital heart defect (CHD) of decreased pulmonary blood flow, such as Tetralogy of Fallot, there is a right-to-left shunting of blood leading to decreased oxygen saturation in the systemic circulation. This chronic hypoxemia stimulates erythropoiesis, resulting in an increased production of red blood cells, hence causing polycythemia. This compensatory mechanism helps enhance oxygen-carrying capacity in the blood to address the reduced oxygen levels. Regarding why the other options are incorrect: A) Decreased platelet count: Platelet count is not typically affected in infants with CHD of decreased pulmonary blood flow. Platelet count alterations are more commonly associated with conditions like thrombocytopenia or thrombocytosis, which are not directly related to this type of CHD. B) Decreased ferritin level: Ferritin is a marker of iron storage in the body. In the context of decreased pulmonary blood flow, there is no direct relationship between the defect and a decrease in ferritin levels. Iron status may be affected in certain types of anemia but not specifically in this scenario. C) Respiratory alkalosis: While respiratory alkalosis can occur in infants with CHD due to increased respiratory rate to compensate for hypoxemia, it is not the laboratory finding directly associated with decreased pulmonary blood flow. Respiratory alkalosis is a result of hyperventilation and would be a clinical manifestation rather than a laboratory finding. Educational context: Understanding laboratory findings in pediatric cardiovascular disorders is crucial for nurses caring for infants with CHDs. Recognizing the implications of these findings helps in early identification of complications and appropriate intervention. In the case of decreased pulmonary blood flow, recognizing polycythemia as a potential laboratory finding aids in comprehensive patient assessment and management. Regular monitoring of laboratory values is essential to assess the effectiveness of treatment and the overall health status of infants with CHDs.

Correct Answer: C

Rationale: In the context of pediatric cardiovascular disorders nursing, understanding the prevention of rheumatic fever (RF) is crucial for parents. Option C, "If their culture is positive for group A streptococcus, I will give them a full course of their antibiotic," is the correct answer. This response shows an understanding of the importance of treating streptococcal infections promptly to prevent RF, as RF is a complication of untreated streptococcal infections. By treating the infection with a full course of antibiotics, the risk of developing RF is reduced. Option A is incorrect because not all sore throats are caused by streptococcal bacteria, and giving antibiotics unnecessarily can lead to antibiotic resistance. Option B is incorrect as RF is a complication of untreated streptococcal infections, not a viral illness. Option D is incorrect as staphylococcus A is not the causative agent of RF. Educationally, it is important for parents to understand the link between streptococcal infections and RF, as well as the appropriate use of antibiotics in the context of treating such infections. Teaching parents to seek medical attention for sore throats and to follow healthcare provider recommendations regarding antibiotic treatment can help prevent RF in children at risk.