Nursing Elites

1. Which of the following findings is abnormal?

• A. Rapid, irregular breathing in a newly born infant
• B. Heart rate of 80 beats/min in a 3-month-old infant
• C. Respiratory rate of 26 breaths/min in a 2-year-old child
• D. Systolic BP of 100 mm Hg in a 10-year-old child

Correct answer: B

Rationale: A heart rate of 80 beats per minute in a 3-month-old infant is abnormally low for that age group and could indicate underlying health issues. The normal heart rate for a 3-month-old infant is typically higher, around 100-150 beats per minute. Therefore, this finding stands out as abnormal and warrants further evaluation. Choice A is not necessarily abnormal in a newly born infant as irregular breathing patterns can be common during the neonatal period. Choice C falls within the normal respiratory rate range for a 2-year-old child, which is around 20-30 breaths per minute. Choice D reflects a systolic blood pressure value within the normal range for a 10-year-old child, which is typically around 90-110 mm Hg.

2. How will a ventricular septal defect affect blood flow?

• A. Blood will shunt left to right, causing increased pulmonary flow and no cyanosis.
• B. Blood will shunt right to left, causing decreased pulmonary flow and cyanosis.
• C. No shunting occurs due to high pressure in the left ventricle.
• D. Increased pressure in the left atrium hinders the circulation of oxygenated blood in the circulating volume.

Correct answer: A

Rationale: A ventricular septal defect allows blood to shunt left to right, leading to increased pulmonary flow. This results in oxygenated blood mixing with deoxygenated blood, causing no cyanosis as the mixed blood is still oxygenated. The shunting from left to right overloads the pulmonary circulation, leading to increased pulmonary flow. Choice B is incorrect because blood does not shunt right to left in a ventricular septal defect. Choice C is incorrect as shunting does occur due to the pressure differences between the ventricles. Choice D is incorrect because the defect affects the ventricles, not the atrium, and does not hinder the circulation of oxygenated blood in the circulating volume.

3. Why should small children ride in the backseat of a vehicle?

• A. They are much less likely to be ejected from the vehicle.
• B. The back of the front seat will provide a cushion during a crash.
• C. They can experience severe injury or death if the airbag deploys.
• D. Their legs are highly prone to injury from striking the dashboard.

Correct answer: C

Rationale: Small children should ride in the backseat of a vehicle primarily to avoid severe injury or death that may occur if the airbag deploys. In the event of a crash, the force of an airbag deployment can be dangerous for a child seated in the front seat. Placing them in the backseat reduces the risk of serious harm from airbag impact and is a safer seating position for young passengers.

4. Sometimes, people with congestive heart failure develop arrhythmias of the heart. These irregular rhythms can be conducive to developing a blood clot. Physicians frequently treat people with 'blood thinning' medicines that require regulation of the density of the blood. Which of these is the name for a blood-thinner?

• A. Erythromycin
• B. Tetracycline
• C. Warfarin
• D. Amoxicillin

Correct answer: C

Rationale: Warfarin is a medication commonly used as a blood thinner to prevent blood clot formation. It works by inhibiting the clotting factors in the blood, thereby reducing the risk of clot formation and helping in the management of conditions like congestive heart failure and arrhythmias. Choices A, B, and D are antibiotics and do not have blood-thinning properties like Warfarin.

5. In the pediatric ward at Nyamebekyere teaching hospital, when should oxygen be applied to children?

• A. Central cyanosis
• B. Respiratory rate >70 breaths per minute
• C. Grunting noted on assessment
• D. All of the above

Correct answer: D

Rationale: All the listed conditions, central cyanosis, respiratory rate >70 breaths per minute, and grunting on assessment, are indicative of the need for oxygen therapy. Central cyanosis suggests severe hypoxemia, a respiratory rate >70 breaths per minute can indicate respiratory distress, and grunting is a sign of increased work of breathing. Administering oxygen in these situations can help improve oxygenation and support the child's respiratory function, making option D the correct choice.

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