What finding would the nurse expect when measuring blood pressure on all four extremities of a child with coarctation of the aorta?

Correct Answer: D

Rationale: Rationale: In a child with coarctation of the aorta, there is a narrowing of the aorta, typically near the insertion of the ductus arteriosus. This narrowing leads to increased pressure proximal to the defect and decreased pressure distal to the defect. When measuring blood pressure on all four extremities, the nurse would expect to find a significant difference in blood pressure readings between the upper extremities (arms) and the lower extremities (legs). Correct Answer (D): Blood pressure lower in the legs than in the arms. This is because the narrowing of the aorta in coarctation of the aorta leads to decreased blood flow to the lower extremities, resulting in lower blood pressure readings in the legs compared to the arms. Incorrect Answer Choices: A) Blood pressure higher on the right side: This is incorrect as coarctation of the aorta does not specifically affect one side of the body over the other. B) Blood pressure higher on the left side: Similar to option A, coarctation of the aorta does not lead to unilateral differences in blood pressure. C) Blood pressure lower in the arms than in the legs: This is incorrect as coarctation of the aorta causes higher blood pressure in the arms due to the increased pressure proximal to the defect. Educational Context: Understanding the pathophysiology of coarctation of the aorta is crucial in recognizing the clinical manifestations associated with this condition. By assessing blood pressure differentials between the upper and lower extremities, healthcare providers can suspect coarctation of the aorta and initiate appropriate diagnostic and treatment interventions promptly. This knowledge is vital for nurses working in pediatric settings to provide safe and effective care for children with cardiovascular conditions.

Correct Answer: A

Rationale: In caring for a child with acute glomerulonephritis, an increased urine output with normal color and consistency would most likely indicate improvement because it suggests that the kidneys are functioning better and able to filter waste products effectively. This is a positive sign as it indicates improved kidney function and clearance of toxins from the body. Option B, a decrease in blood pressure, is not necessarily an indicator of improvement in acute glomerulonephritis as it could be due to other factors such as fluid restriction or medications. Option C, a reduction in protein levels in the urine, is also not the most reliable indicator of improvement as proteinuria can persist even after the condition starts to improve. Option D, a decrease in hematuria, is a positive sign but not as indicative of improvement as increased urine output. Educationally, it is crucial for nurses to understand the various indicators of improvement in pediatric patients with acute glomerulonephritis to provide effective care and monitor the child's progress accurately. Recognizing the significance of increased urine output in color and consistency can guide nursing interventions and help in assessing the child's response to treatment accurately.

Correct Answer: B

Rationale: In the case of a 2-year-old child being treated for lead poisoning, the correct answer is B) Decreased hemoglobin levels indicating the need for further intervention. Lead poisoning can lead to anemia by inhibiting the body's ability to produce hemoglobin. Monitoring hemoglobin levels is crucial in children with lead poisoning to assess the severity of anemia and the effectiveness of treatment. Option A) Increased urine output is not typically a concerning finding in the context of lead poisoning. It may actually be a positive sign as increased urine output can help in excreting lead from the body. Option C) Weight gain is also not a common indicator of the need for further intervention in lead poisoning. In fact, weight loss or failure to thrive may be more indicative of lead poisoning complications. Option D) Improved developmental milestones would generally be seen as a positive outcome of treatment for lead poisoning rather than a reason for further intervention. Monitoring developmental milestones is important in assessing the overall progress of the child's treatment. Educationally, understanding the potential complications of lead poisoning in pediatric patients is crucial for nurses and healthcare providers. Recognizing the signs and symptoms that require further intervention is vital for providing effective care and ensuring positive outcomes for children affected by lead poisoning. Regular monitoring of hemoglobin levels, along with other relevant parameters, is essential in managing lead poisoning in pediatric patients.

Correct Answer: D

Rationale: In recommending a heart-healthy diet for a child with high cholesterol, the school nurse should advocate for a significant reduction in fat intake. Option D, which suggests reducing fat intake by 25-35% of total calories, is the most appropriate choice. This level of reduction is crucial in managing cholesterol levels and promoting cardiovascular health in children. Option A, with a fat intake reduction of 5-10% of total calories, is too conservative and may not have a significant impact on lowering cholesterol levels. Option B, with a reduction of 10-15%, is also not substantial enough for a child with high cholesterol. Option C, suggesting a reduction of 15-20%, is closer but may still fall short of the necessary dietary changes needed to effectively manage high cholesterol in children. Educationally, it is important to highlight the link between dietary fat intake and cholesterol levels in pediatric patients. Teaching students and parents about the impact of dietary choices on cardiovascular health from a young age can instill lifelong habits that promote heart health. Emphasizing the significance of a well-balanced, low-fat diet in managing high cholesterol is essential in preventing long-term health complications in children.

Correct Answer: C

Rationale: In a child with tetralogy of Fallot experiencing a paroxysmal hypercyanotic episode, weakness would be a key assessment indicating the episode. This is because during a hypercyanotic episode, there is a sudden decrease in systemic vascular resistance leading to increased right-to-left shunting of unoxygenated blood, resulting in decreased oxygen delivery to the body. Weakness can be a manifestation of tissue hypoxia during such an episode. Spontaneous cyanosis is a common symptom in tetralogy of Fallot but is not specific to a hypercyanotic episode. Dyspnea may occur due to chronic hypoxemia in these patients but is not a hallmark of a paroxysmal hypercyanotic episode. Dry cough is not typically associated with tetralogy of Fallot or its complications. Educationally, understanding the specific signs and symptoms of a paroxysmal hypercyanotic episode in children with tetralogy of Fallot is crucial for nurses and healthcare providers working with pediatric patients. Recognizing the subtle changes indicating such an episode can prompt timely interventions to improve oxygenation and prevent further complications in these vulnerable patients.