Which of the following disorders leads to cyanosis from deoxygenated blood entering the systemic arterial circulation?

Correct Answer: D

Rationale: Tetralogy of Fallot is a congenital heart defect characterized by four primary abnormalities: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. Due to the pulmonary stenosis, less blood reaches the lungs to be oxygenated, resulting in deoxygenated blood entering the systemic arterial circulation. This leads to cyanosis, which is often referred to as "Tet spells" in these patients. Cyanosis is the bluish discoloration of the skin and mucous membranes caused by the presence of deoxygenated hemoglobin. The other conditions listed do not typically result in deoxygenated blood entering the systemic arterial circulation and causing cyanosis.

Correct Answer: C

Rationale: Infants with congenital heart disease who have been admitted with heart failure may have difficulty feeding due to increased work of breathing and poor energy reserves. Offering small, frequent feedings can help prevent fatigue and provide adequate nutrition to support the infant's growth and recovery. It also helps to prevent overloading the heart with a large volume of fluids at once. This approach allows the infant to receive enough calories while reducing the risk of aspiration and conserving energy for feeding and breathing. Positioning the infant flat on the back may worsen respiratory distress, encouraging nutritional fluids alone may not address the feeding challenges faced by the infant, and measuring the head circumference is important for growth monitoring but may not be the priority when managing heart failure in this case.

Correct Answer: C

Rationale: Corticosteroids, such as prednisone, are commonly used in the treatment of juvenile rheumatoid arthritis (JRA) to reduce inflammation and pain. However, one of the complications associated with corticosteroid use is immune suppression. Corticosteroids can suppress the immune system by reducing the activity and effectiveness of white blood cells, making individuals more susceptible to infections. It is important for healthcare providers, including nurses, to educate adolescents and their families about the risks and possible complications of corticosteroid therapy, including immune suppression.

Correct Answer: D

Rationale: Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes characterized by hyperglycemia, ketosis, and metabolic acidosis. The initial treatment for DKA requires correcting dehydration and electrolyte imbalances. Normal saline infusion is the preferred choice for initial fluid resuscitation in patients with DKA to address dehydration and restore intravascular volume. It helps improve organ perfusion and correct electrolyte imbalances such as hyponatremia and dehydration commonly seen in DKA patients. Administering normal saline helps replace lost fluids and improve circulation, which is crucial in the management of DKA. Potassium infusion may be needed later to replete potassium levels once the patient's kidney function has been assessed. NPH insulin infusion is not the initial treatment for DKA, although insulin therapy is an essential component of DKA management. 5% dextrose infusion is contraindicated in the initial treatment

Correct Answer: C

Rationale: Positioning the child on his right side after surgery for pyloric stenosis helps to promote the flow of formula through the pylorus and into the intestines. Placing the child in this position can aid in preventing any potential complications from the surgery and promote proper digestion. The right side position assists in the drainage of the stomach contents, thereby reducing the risk of complications related to the surgery and promoting the healing process. It is essential to follow this positioning recommendation as part of the post-operative care for a child who has undergone surgery for pyloric stenosis.