The nurse is caring for an adolescent who has just started dialysis. The child seems always angry, hostile, or depressed. To what are these behaviors most likely related?

Correct Answer: D

Rationale: Adolescents often resent the control and enforced dependence imposed by dialysis. Adolescence is a challenging time marked by striving for independence and autonomy. When adolescents have to rely on medical interventions like dialysis that impose control and dependence, it can lead to feelings of anger, hostility, and depression. This is a normal psychological response to feeling restricted and not in control of their own lives. It is important for healthcare providers to recognize these emotions and provide support and coping strategies to help the adolescent adjust to the situation.

Correct Answer: A

Rationale: Osler nodes are painful, tender, pea-sized nodules that can appear on the pads of the fingers or toes and are associated with bacterial endocarditis. These nodules result from immune-complex deposition in the small blood vessels of the skin. They are not to be confused with Janeway lesions, which are painless, non-tender macules found on the palms and soles in infective endocarditis. Subcutaneous nodules are seen in conditions like rheumatic fever, while Aschoff nodes are characteristic of rheumatic fever involving the heart.

Correct Answer: B

Rationale: In this scenario, the highest-priority intervention is option B) Place the infant in knee-chest position. This position helps improve systemic vascular resistance and reduces venous return to the heart, thus decreasing the degree of right-to-left shunting in tetralogy of Fallot, ultimately improving oxygenation. Option A) Administer 100% oxygen by blow-by is not as high a priority as changing the infant's position. While oxygen is essential, in tetralogy of Fallot, addressing the physiological shunting through positioning is critical before oxygen administration. Option C) Remaining calm is important for the nurse's demeanor but is not a direct intervention to address the cyanosis in the infant. Maintaining composure can help in delivering effective care, but it is not the immediate action needed in this situation. Option D) Giving morphine subcutaneously or through an existing IV line is not appropriate in this case. Morphine can cause respiratory depression, further compromising the infant's oxygenation status. It is not the recommended treatment for cyanosis in tetralogy of Fallot. Educationally, this scenario highlights the importance of understanding the pathophysiology of congenital heart defects like tetralogy of Fallot and the critical thinking skills needed to prioritize interventions based on the patient's condition. Nurses must be able to quickly assess and respond to emergent situations in pediatric patients with complex cardiac issues.

Correct Answer: C

Rationale: When performing perineal care on an uncircumcised male patient, it is important to replace the foreskin over the head of the penis after washing. The foreskin should not be left retracted or pulled back forcibly as it can cause irritation and discomfort to the patient. Leaving the foreskin retracted can also lead to potential complications such as paraphimosis, where the foreskin becomes trapped behind the head of the penis. Proper hygiene involves gently retracting the foreskin to clean underneath it and then returning it to its natural position to protect the sensitive glans penis. Using gentle, warm water with mild soap is typically sufficient for cleaning, and alcohol should be avoided as it can cause irritation and dryness to the sensitive genital area.

Correct Answer: B

Rationale: Hypernatremia is a condition characterized by high levels of sodium in the blood. When hypernatremia is treated too rapidly or aggressively, a rapid decrease in serum sodium levels may occur. This rapid change in serum sodium concentration can cause water to move into brain cells, leading to cerebral edema. Cerebral edema is a dangerous complication associated with the potential to cause increased intracranial pressure, neurological deficits, and even death. It is crucial to correct hypernatremia slowly and carefully to prevent such complications.