The nurse calculates the body mass index (BMI) for an obese adult. Which additional assessment finding places the client at high risk for cardiac disease?

Correct Answer: A

Rationale: In pediatric nursing, understanding the relationship between obesity and cardiovascular risk factors is crucial. In this scenario, option A, "Large waist circumference with central fat," is the correct answer. Central obesity, often indicated by a large waist circumference, is a significant risk factor for cardiac disease. Excess visceral fat around the abdomen is associated with insulin resistance, inflammation, and dyslipidemia, all contributing to cardiovascular complications. Option B, "High serum insulin level," while indicative of metabolic dysfunction in obesity, is more directly related to diabetes risk rather than specifically cardiac disease in this context. Option C, "Hyperpigmentation on neck skin folds," is a sign of conditions like acanthosis nigricans, which is associated with insulin resistance and obesity-related metabolic issues rather than cardiac disease specifically. Option D, "Poor muscle tone," is not directly linked to cardiac disease risk in the context of obesity. While physical inactivity related to poor muscle tone can contribute to cardiovascular issues, central obesity is a more significant and direct risk factor in this scenario. Educationally, this question helps pediatric nursing students understand the importance of assessing obesity-related risk factors for cardiovascular disease in pediatric patients. Understanding these relationships is crucial for providing holistic care and early interventions to prevent long-term complications related to obesity in children.

Correct Answer: D

Rationale: In the context of pediatric nursing and cardiovascular disorders, understanding the management of Addison's disease is crucial. The correct answer is D) Take prescribed cortisone accurately. This instruction is paramount because Addison's disease results from adrenal insufficiency, leading to decreased cortisol production. Cortisone replacement therapy is essential to manage the condition and prevent adrenal crisis. Option A) Use a walker when weakness occurs is incorrect as it does not address the primary treatment for Addison's disease. Option B) Avoid extreme environmental temperatures is important for some conditions but is not the priority in Addison's disease management. Option C) Increase daily intake of sodium in the diet is relevant for Addison's disease due to mineralocorticoid deficiency, but ensuring proper cortisone replacement is the primary focus. In an educational context, it is vital for pediatric nurses to prioritize teaching accurate medication administration to children with chronic conditions like Addison's disease. Emphasizing the significance of adherence to cortisone therapy can prevent life-threatening complications and empower patients and families to manage the condition effectively.

Correct Answer: C

Rationale: The correct answer is C: Maintain the client's methadone and medicate surgical pain based on pain rating. This choice is appropriate because abrupt discontinuation of methadone can lead to withdrawal symptoms, and methadone should be continued to manage the client's chronic pain. Additionally, surgical pain should be managed based on the client's pain rating to ensure adequate pain control postoperatively. Option A is incorrect because increasing methadone in lieu of parenteral opioids may not be necessary if the client's chronic pain is well managed with their current dose of methadone. Option B is incorrect because using minimal parenteral opioids in addition to oral methadone may not provide adequate pain control for the client postoperatively, especially after urological surgery which can be painful. Option D is incorrect because holding methadone can lead to withdrawal symptoms and inadequate pain management for the client. It is important to maintain continuity of care and manage both chronic and acute pain appropriately. Educationally, this scenario highlights the importance of understanding the principles of pain management in clients with chronic opioid therapy undergoing surgery. It emphasizes the need for individualized pain management plans that consider both the chronic pain regimen and acute postoperative pain control.

Correct Answer: A

Rationale: In this scenario, the correct action for the nurse to implement is to review the client's most recent thyroid function test results (Option A). This is the most appropriate course of action because the client's difficulty falling asleep and feelings of depression may be attributed to their hypothyroidism. By reviewing the thyroid function test results, the nurse can assess the client's thyroid hormone levels and determine if they are within the therapeutic range. If the levels are suboptimal, adjustments to the client's thyroid replacement therapy may be necessary to address their symptoms. Option B, encouraging the client to take an afternoon nap, is not the most appropriate action in this case as it does not address the underlying cause of the client's sleep difficulties and depression. While adequate rest is important, simply taking a nap does not address the potential thyroid-related issues contributing to the client's symptoms. Referring the client for a psychiatric evaluation (Option C) is not the initial step to take in this situation. It is important to first assess and address any physiological factors, such as thyroid function, that may be contributing to the client's symptoms before considering psychiatric evaluation. Suggesting reducing fluid intake before bedtime (Option D) is not relevant to the client's reported symptoms of difficulty falling asleep due to depression in the context of hypothyroidism. While good sleep hygiene practices are important, they are not the primary intervention needed in this case. Educationally, this question highlights the importance of holistic nursing care and the need to consider underlying physiological factors when addressing symptoms in clients with chronic conditions like hypothyroidism. It also emphasizes the significance of thorough assessment and using diagnostic results to guide nursing interventions.

Correct Answer: D

Rationale: In the context of pediatric nursing and cardiovascular disorders, the correct answer to the question is option D) No gag reflex after thirty minutes. This is the most critical assessment finding that the nurse should immediately report to the healthcare provider following a bronchoscopy in a pediatric patient. A lack of gag reflex after thirty minutes could indicate a potential complication such as airway compromise, aspiration, or neurological deficit, which require prompt intervention to prevent respiratory distress or other serious consequences. Option A) Slight blood-tinged sputum is a common and expected finding post-bronchoscopy, usually resolving on its own without intervention. Option C) Sore throat and hoarseness are also common after the procedure due to irritation from the scope and typically do not require immediate intervention. Option B) Dyspnea and dysphagia could be concerning symptoms, but they are not as immediately critical as the absence of a gag reflex. Dyspnea and dysphagia may be expected to some extent after a bronchoscopy and can be managed with close monitoring and supportive care unless they worsen or persist. Understanding these assessment findings in the context of pediatric nursing and cardiovascular disorders is crucial for providing safe and effective care to pediatric patients undergoing bronchoscopy procedures. Early identification and reporting of concerning signs and symptoms can help prevent complications and ensure timely interventions to promote positive patient outcomes.