A nurse is assessing a newborn who has a coarctation of the aorta. Which of the following should the nurse recognize is a clinical manifestation of coarctation of the aorta?
Decreased blood pressure in the arms with increased blood pressure in the legs
Increased blood pressure in the arms with decreased blood pressure in the legs
Decreased blood pressure in both the arms and the legs
Increased blood pressure in both the arms and the legs
The Correct Answer is B
A. This option is incorrect as it does not describe the expected blood pressure difference in coarctation of the aorta.
B. Coarctation of the aorta typically presents with higher blood pressure in the upper body (arms) and lower blood pressure in the lower body (legs) due to the obstruction of blood flow distal to the aortic arch.
C. This option is incorrect because while coarctation can lead to decreased perfusion in the lower extremities, it does not typically result in decreased blood pressure in both the arms and legs simultaneously.
D. While increased blood pressure may occur in the arms, the legs would not typically show increased blood pressure in cases of coarctation.
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Correct Answer is C
Explanation
A. Feeding on a strict schedule may not be beneficial for an infant with heart failure, as these babies often require more frequent, smaller feedings to prevent fatigue and ensure adequate nutrition.
B. Allowing the baby to take as much time as needed can be beneficial, but it is crucial to monitor for fatigue and ensure the infant receives sufficient nutrition within a reasonable time frame.
C. Adding increased calorie supplements to each bottle is an effective strategy to help meet the increased caloric needs of an infant with heart failure, indicating an understanding of the nutritional requirements.
D. While minimizing crying can be helpful, the focus should be on the infant's needs and ensuring they are fed before they become overly distressed, rather than a strict limit on crying time.
Correct Answer is C
Explanation
A. Clients on digoxin should actually have an adequate intake of potassium, as low potassium levels can increase the risk of digoxin toxicity.
B. If a pediatric client spits out digoxin, the dose should not be repeated automatically; instead, the nurse should assess the situation and follow the facility's protocol regarding missed doses.
C. Measuring the apical pulse for one full minute before administering digoxin is critical; if the pulse is below the established threshold (usually <60 bpm for children), the medication should be held and the provider notified.
D. While evaluating for nausea, vomiting, and anorexia is important, it is not an appropriate immediate action before administering the medication. The priority action is to assess the apical pulse.