Practice Question
An 8-month-old infant has a hypercyanotic spell while blood is being drawn. What is the priority nursing action?
Answer Choices:
Correct Answer:
Place the child in the knee-chest position
Rationale:
🧍♂️ A hypercyanotic spell, common in Tetralogy of Fallot, causes acute cyanosis due to increased right-to-left shunting.
🧍♂️ The knee-chest position increases systemic vascular resistance (SVR), reducing blood shunting and improving pulmonary blood flow.
🧍♂️ It also increases venous return to the heart, improving cardiac output and oxygenation.
🧍♂️ This is the first-line non-invasive intervention and often relieves symptoms within minutes.
🧍♂️ Immediate positioning is more urgent than neurological or resuscitative actions unless the child becomes unresponsive.
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This question is from RN ATI Pediatrics Exam IV which contains 35 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN ATI Pediatrics
- Answer Choices: 4