Which of the following infants is least probable to develop sudden infant death syndrome (SIDS)?
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Solution
Baby Gabby who sleeps on his back
D: Infants who sleep on their back are least likely to develop SIDS. However, SIDS has been associated with infants who sleep on their abdomens.
A,B,C: Being premature, having a sibling who died of SIDS, and being prenatally exposed to drugs all place the infant at high risk for developing SIDS.
Alice is rushed to the emergency department during an acute, severe prolonged asthma attack and is unresponsive to usual treatment. The condition is referred to as which of the following?
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Solution
Status asthmaticus
A: Status asthmaticus is an acute, prolonged, severe asthma attack that is unresponsive to usual treatment. Typically, the child requires hospitalization.
B: Reactive airway disease is another general term for asthma.
C: Intrinsic is a term used to denote internal precipitating factors, such as viruses.
D: Extrinsic is a term used to denote external precipitating factors, such as allergens.
Beta-adrenergic agonists such as albuterol are given to Reggie, a child with asthma. Such drugs are administered primarily to do which of the following?
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Solution
Dilate the bronchioles
A: Beta-adrenergic agonists, such as albuterol, are highly effective bronchodilators and are used to dilate the narrow airways associated with asthma.
B: Antibiotics are used to prevent secondary infection.
C: Decongestants may be given to decrease postnasal drip.
D: Corticosteroids may be used for their anti-inflammatory effect.
Veronica’s parents were told that their daughter needs ribavirin (Virazole). This drug is used to treat which of the following?
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Solution
Respiratory syncytial virus (RSV)
C: Ribavirin is an antiviral medication used for treating RSV infection and for children with RSV who are compromised (such as children with bronchopulmonary dysplasia or heart disease).
A,B,D: The drug is not used to treat bronchiolitis, otitis media, or CF.
Betty is a 9-year-old girl diagnosed with cystic fibrosis. Which of the following must Nurse Archie keep in mind when developing a care plan for the child?
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Solution
Pulmonary secretions are abnormally thick.
A: CF is identified by abnormally thick pulmonary secretions.
B: Diagnosis of CF is based on elevated chloride levels detected in sweat.
C: It is a chronic, inherited disorder, particularly an autosomal recessive hereditary disorder concerning the exocrine, not endocrine glands.
D: The thick mucus blocks the exocrine glands.
The ductus arteriosus is another fetal structure that is important in the intrauterine life. It functions to:
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Solution
Shunts the combined cardiac output from the pulmonary artery to the systemic circulation
Option B: In the developing fetus, the ductus arteriosus, also called the ductus Botalli, is a blood vessel connecting the pulmonary artery to the proximal descending aorta. It allows most of the blood from the right ventricle to bypass the fetus’s fluid-filled non-functioning lungs.
The procedure that has to be performed in order to shift the high pressure from the right ventricle to the left ventricle in Transposition of the Great Arteries (TGA) is:
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Solution
Jatene Procedure
Option D: The Jatene procedure, arterial switch operation or arterial switch, is an open heart surgical procedure used to correct dextro-transposition of the great arteries (d-TGA).
Option B: The Rastelli operation was originally used for the repair of d-transposition of the great vessels with ventricular septal defect and pulmonary stenosis. It has subsequently been utilized for a variety of congenital heart defects characterized by two ventricles and overriding of the aorta with severe pulmonary stenosis or pulmonary atresia. Pulmonary atresia with ventricular septal defect and double outlet right ventricle with pulmonary stenosis or atresia are anatomic subtypes also frequently submitted for the Rastelli procedure. Cyanosis is the prevailing preoperative pathophysiology.
Option A: A Balloon Atrial Septostomy (Rashkind procedure) is a procedure that is used to create an opening in the wall between the upper chambers of the heart (atria). This is performed in certain cases to improve blood oxygenation, particularly for congenital heart defects. A deflated balloon catheter is guided into the heart and into a small hole in the atrial septum. The balloon is then inflated, created a larger hole in the atrial septum.
Option C: The purpose of PAB is to lessen pulmonary artery pressure and excess pulmonary blood flow. PAB requires the insertion of a band around the pulmonary artery to reduce blood flow into the lungs. A variety of banding materials are used; one commonly used material is polytetrafluoroethylene.
Which of the following disorders leads to cyanosis from deoxygenated blood entering the systemic arterial circulation?
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Solution
Tetralogy of Fallot
Option D: Tetralogy of Fallot consists of four major anomalies: ventricular septal defect, right ventricular hypertrophy, pulmonic stenosis (PS), aorta overriding the ventricular septal defect. PS impedes the flow of blood to the lungs, causing increased pressure in the right ventricle, forcing deoxygenated blood through the septal defect the left ventricle. As a result of this decreased pulmonary flow, deoxygenated blood is shunted into the systemic circulation. The increased workload on the right ventricle causes hypertrophy. The overriding aorta receives blood from both the right and left ventricles. This is the definition of defect with decreased pulmonary blood flow where unoxygenated blood is shunted into the systemic circulation.
Options A,B: Coarctation of aorta and AS are obstructive defects where obstruction, not shunting, is the problem.
Option C: With PDA, blood flows from the aorta through the PDA and back to the pulmonary artery and lungs (shunting of oxygenated blood to the pulmonic system), causing increased pulmonary vascular congestion.
Which of these statements regarding the conduction system of the heart is NOT correct? Select all that apply.
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Solution
Answer: B, C, and D
Option B: The SA node consists of a cluster of cells that are situated in the upper part of the wall of the right atrium (the right upper chamber of the heart).
Option C: When action potentials reach the AV node, they spread slowly through it.
Option D: Action potentials pass slowly through the atrioventricular node.
Option A: The SA node is the heart’s natural pacemaker.
Arrange these parts of the conduction system of the heart in the correct order as an action potential would pass through them.
1.AV node
2.Purkinje fibers
3.Atrioventricular bundle
4.R and L bundle of His
5.SA node
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Solution
5—1—3—4—2
Option D: The SA node is the natural pacemaker of the heart. The electrical stimulus from the SA node eventually reaches the AV node and is delayed briefly so that the contracting atria have enough time to pump all the blood into the ventricles. Once the atria are empty of blood the valves between the atria and ventricles close. At this point, the atria begin to refill and the electrical stimulus passes through the AV node and Bundle of His into the Bundle branches and Purkinje fibers.