Pts 1 dif cognitive level application ref 1323 obj

PTS: 1 DIF: Cognitive Level: Application REF: 1323
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic
Integrity
37.
What is an expected assessment finding in a child with
coarctation of the aorta?
a.
Orthostatic hypotension
b.
Systolic hypertension in the lower extremities
c.
Blood pressure higher on the left side of the body
d.
Disparity in blood pressure between the upper and
lower extremities
ANS: D
The classic finding in children with coarctation of the aorta is a
disparity in pulses and blood pressures between the upper and
lower extremities. Orthostatic hypotension is not present with
coarctation of the aorta. Systolic hypertension may be detected in
the upper extremities. The left arm may not accurately reflect
systolic hypertension because the left subclavian artery can be
involved in the coarctation.

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PTS: 1 DIF: Cognitive Level: Application REF: 1324
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic
Integrity
38.
A child with pulmonary atresia exhibits cyanosis with
feeding. On reviewing this childs laboratory values, the nurse is
not surprised to notice which abnormality?
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PTS: 1 DIF: Cognitive Level: Analysis REF: 1337
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic
Integrity
39.
When assessing a child for possible congenital heart defects
(CHDs), where should the nurse measure blood pressure?

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When a CHD is suspected, the blood pressure should be
measured in all four extremities while the child is quiet.
Discrepancies between upper and lower extremities may indicate
cardiac disease. Blood pressure measurements for upper and
lower extremities are compared during an assessment for CHDs.
Blood pressure measurements when the child is crying are likely
to be elevated; thus the readings will be inaccurate.
PTS: 1 DIF: Cognitive Level: Application REF: 1334
OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion
and Maintenance