A 13-year-old male presents with fever, sore throat, difficulty swallowing, and a garbled “hot potato” voice. He was well until 7 days before admission, when he had a mild sore throat that did not remit and then rapidly worsened 1 day before admission. The most likely diagnosis is

Correct Answer: D

Rationale: The most likely diagnosis in this case is D) peritonsillar abscess. This condition typically presents with fever, sore throat, difficulty swallowing, and a muffled or "hot potato" voice due to the accumulation of pus beside the tonsil. It is common in adolescents and young adults and can rapidly worsen. Peritonsillar abscess is the correct answer because the symptoms described fit this condition perfectly. The history of a mild sore throat that worsened rapidly, along with the specific symptoms mentioned, strongly suggest a peritonsillar abscess. Option A) foreign body is unlikely in this case as the symptoms are more indicative of an infection rather than a mechanical obstruction. Option B) rheumatic fever typically presents with joint pain, fever, and a history of untreated strep throat, which are not prominent in this case. Option C) retropharyngeal abscess is less likely as it would typically present with neck stiffness and may be more common in younger children. Educationally, understanding the different presentations of pediatric respiratory distress conditions is crucial for nurses. Recognizing the specific symptoms and history of a peritonsillar abscess can lead to prompt diagnosis and treatment, preventing potential complications such as airway compromise. This case emphasizes the importance of clinical assessment and knowledge of common pediatric respiratory conditions.

Correct Answer: B

Rationale: In the context of pediatric respiratory distress due to possible aspiration of carrots, the correct diagnostic evaluation to confirm this is option B) Bronchoscopy. A bronchoscopy is a procedure that allows direct visualization of the airways, providing a clear view of any foreign bodies, such as carrot pieces, lodged in the air passages. This procedure is crucial in identifying and removing the aspirated material promptly to prevent complications like pneumonia or respiratory distress. Option A) Chest x-ray may show signs of aspiration such as lung infiltrates, but it may not definitively confirm the presence of carrot aspiration as clearly as a bronchoscopy would. Option C) Arterial blood gas (ABG) is used to assess oxygenation and ventilation status but would not directly visualize the aspirated carrots. Option D) Sputum culture is used to identify respiratory infections but is not specific for detecting aspirated foreign bodies like carrots. In an educational context, understanding the appropriate diagnostic evaluations for pediatric respiratory distress is vital for nurses caring for children. Knowing when to recommend a bronchoscopy for suspected foreign body aspiration, like carrot aspiration, can facilitate prompt and accurate diagnosis, leading to timely interventions and improved patient outcomes. This knowledge enhances nursing practice and ensures the delivery of safe and effective care to pediatric patients with respiratory issues.

Correct Answer: C

Rationale: In managing constipation in a child with cystic fibrosis (CF), the correct option is C) Your child will likely be given MiraLAX. MiraLAX is a widely used osmotic laxative that is safe and effective for pediatric patients with CF. It helps soften stool and promote regular bowel movements without causing dependence. Option A is incorrect because surgery is not typically the first-line treatment for constipation in CF. Option B, IV fluids, may be used in cases of dehydration but does not directly address constipation. Option D, placing the child on a clear liquid diet, is not a standard approach for managing constipation in CF. Educationally, it is important to understand the specific challenges children with CF face, such as increased risk of constipation due to thick mucus in the intestines. Teaching caregivers about appropriate interventions like MiraLAX can improve the child's comfort and overall health outcomes. Regular monitoring and communication with healthcare providers are also crucial in managing constipation in children with CF.

Correct Answer: B

Rationale: In understanding the double lung transplant for a child with cystic fibrosis (CF), it is crucial for the parent to grasp that option B) "The transplant will not cure CF but will allow the child to live longer" is the correct choice. This is because cystic fibrosis is a genetic disease affecting multiple organs, and a lung transplant only addresses the respiratory aspect by replacing damaged lungs, not curing the underlying condition. Option A is incorrect because a lung transplant does not cure CF, as it is a systemic disease. Option C is inaccurate as the transplant does not reverse the multisystem damage caused by CF in other organs. Option D is not entirely accurate as a lung transplant may prolong the child's life but does not guarantee them to live long enough to graduate college. Educationally, this rationale is important for parents to understand the limitations and benefits of a lung transplant in CF management. It emphasizes the need for ongoing comprehensive care even post-transplant to address other manifestations of the disease. Parents need to be informed decision-makers in their child's care, understanding the complexities of treatment options to make informed choices for their child's well-being.

Correct Answer: B

Rationale: In a 15-month-old experiencing respiratory distress, the option B, sitting in the tripod position with diminished breath sounds and a muffled cough, is of the greatest concern. This is indicative of severe respiratory distress, as the tripod position helps maximize air entry. Diminished breath sounds and a muffled cough suggest potential airway obstruction requiring immediate intervention. Option A describes moderate respiratory distress with retractions and fever, but the child's position and symptoms are not as severe as in option B. Option C presents with coarse breath sounds and coughing, which are concerning but not as critical as the signs in option B. Option D includes wheezes and poor feeding, which may indicate asthma but are not as urgent as the potential airway compromise in option B. Educationally, understanding these specific respiratory distress symptoms in pediatric patients is crucial for nurses to prioritize care and intervene promptly to prevent respiratory failure. Recognizing the tripod position and diminished breath sounds as severe signs of distress can lead to timely and potentially life-saving interventions.