Through what does the infant born with hypoplastic left heart syndrome acquire oxygenated blood?

Correct Answer: D

Rationale: In infants born with hypoplastic left heart syndrome, the correct answer is D) An atrial septal defect, as this condition involves a severely underdeveloped left side of the heart, making it unable to adequately pump oxygenated blood to the body. In this situation, an atrial septal defect allows oxygenated blood from the lungs to mix with deoxygenated blood in the right atrium, providing at least some oxygenated blood to the systemic circulation. Option A) The patent ductus arteriosus is not the correct answer because this structure typically shunts blood away from the lungs in fetal circulation, which is the opposite of what is needed in hypoplastic left heart syndrome. Option B) A ventricular septal defect is unlikely to provide sufficient oxygenated blood to the systemic circulation in this condition, as it allows mixing of blood between the two ventricles rather than ensuring oxygenated blood reaches the body. Option C) The closure of the foramen ovale is not the correct answer because this structure is responsible for shunting blood between the atria in fetal circulation and is not sufficient to provide oxygenated blood to the body in hypoplastic left heart syndrome. Educationally, understanding the physiology of congenital heart defects like hypoplastic left heart syndrome is crucial for pediatric nurses to provide safe and effective care to these vulnerable patients. Recognizing the impact of specific cardiac anomalies on oxygenation and circulation helps nurses anticipate complications and intervene appropriately to optimize outcomes for these infants.

Correct Answer: C

Rationale: In the teaching plan for a client diagnosed with gastroesophageal reflux disease (GERD), including information on minimizing symptoms by wearing loose, comfortable clothing (option C) is crucial because tight clothing can exacerbate GERD symptoms by putting pressure on the abdomen and lower esophageal sphincter. Option A, sleeping without pillows at night to maintain neck alignment, is incorrect for GERD management because elevating the head of the bed is recommended to prevent acid reflux. Option B, adjusting food intake to three full meals per day and no snacks, is incorrect as it goes against the dietary recommendations for GERD, which include having smaller, more frequent meals and avoiding triggers like spicy foods and caffeine. Option D, avoiding participation in any aerobic exercise programs, is also incorrect as regular exercise is beneficial for managing GERD by promoting weight loss and reducing stress. Educationally, understanding the rationale behind lifestyle modifications for GERD is essential for nurses to provide comprehensive patient education and promote optimal management of the condition. By explaining the impact of clothing choices on GERD symptoms, nurses can empower clients to make informed decisions to improve their quality of life.

Correct Answer: B

Rationale: In this scenario, the correct intervention is to prepare the client to return to the operating room (Option B). When a wound dehiscence occurs with evisceration, it is a surgical emergency that requires immediate intervention to prevent further complications such as infection, further tissue damage, or potential sepsis. Returning the client to the operating room allows for proper assessment, wound closure, and management by the surgical team. Option A (Bring additional sterile dressing supplies to the room) is incorrect because just applying more dressings without addressing the underlying surgical emergency is inadequate and may delay appropriate treatment. Option C (Obtain a sample of the drainage to send to the lab) is also incorrect as it focuses on collecting a sample rather than addressing the immediate surgical issue. Option D (Auscultate the abdomen for bowel sound activity) is not the priority in this critical situation where prompt surgical intervention is required. From an educational perspective, this scenario highlights the importance of recognizing and responding to postoperative complications promptly in a healthcare setting. Nurses need to be trained to identify surgical emergencies like wound dehiscence and evisceration and understand the appropriate steps to take to ensure patient safety and optimal outcomes. This case underscores the critical nature of surgical wound care and the necessity of immediate action when faced with such complications in a clinical setting.

Correct Answer: A

Rationale: In the context of a client with Cushing's syndrome recovering from surgery, the immediate intervention warranted by the nurse is an irregular apical pulse, which is the correct answer (Option A). Cushing's syndrome is characterized by excess cortisol levels, which can lead to cardiovascular complications such as hypertension, fluid retention, and electrolyte imbalances. An irregular apical pulse could indicate cardiac arrhythmias or other cardiovascular issues that require prompt attention to prevent further complications or deterioration. Option B, purple marks on the skin of the abdomen (Cushing's striae), while associated with Cushing's syndrome, are not typically urgent or indicative of immediate complications post-surgery. Option C, a quarter-size blood spot on the dressing, may indicate some bleeding but is not as critical as a cardiac issue in this scenario. Option D, pitting ankle edema, is a common finding in both Cushing's syndrome and postoperative patients due to fluid retention, but it is not as urgent as addressing a potential cardiac problem. Educationally, understanding the specific manifestations of Cushing's syndrome, the postoperative care considerations for this population, and the prioritization of assessments based on potential complications are crucial for nurses caring for these patients. Recognizing the significance of cardiovascular assessments in high-risk patients like those with Cushing's syndrome can help prevent adverse events and promote better outcomes.

Correct Answer: C

Rationale: The most important instruction for the nurse to provide to the female client being discharged with an indwelling urinary catheter after bladder surgery is option C: Keep the drainage bag lower than the level of the bladder. Rationale: - Keeping the drainage bag lower than the bladder ensures a continuous flow of urine from the bladder to the bag, preventing backflow of urine or infections. - If the drainage bag is positioned above the level of the bladder, urine can flow back into the bladder, increasing the risk of urinary tract infections and compromising the surgical repair. Why the other options are incorrect: - Option A: Avoid coiling the tubing and keep it free of kinks is important but not as critical as preventing backflow of urine. - Option B: Cleansing the perineal area with soap and water twice daily is good hygiene practice but does not directly impact the function of the catheter. - Option D: Drinking 1,000 ml of fluids daily to irrigate the catheter is not necessary as the catheter is designed to drain urine effectively without additional irrigation. Educational context: Understanding proper care of indwelling urinary catheters is crucial for nurses caring for patients post-surgery. Teaching patients correct catheter care helps prevent complications and promotes optimal recovery. By emphasizing the importance of keeping the drainage bag below the level of the bladder, nurses can ensure patient safety and reduce the risk of post-operative infections.