A 2-month-old infant presents with cough, tachypnea, and wheezing. The most likely viral cause is:

Correct Answer: D

Rationale: The correct answer is D) Respiratory syncytial virus (RSV). RSV is the most common cause of lower respiratory tract infections in infants and young children. It causes symptoms such as cough, tachypnea, and wheezing, which are characteristic of bronchiolitis in this age group. RSV is highly contagious and spreads through respiratory secretions. Option A) Adenovirus: Adenovirus can also cause respiratory infections in children, but it is less common than RSV in causing bronchiolitis in infants. Option B) Influenza: While influenza can cause respiratory symptoms in children, it is less likely in a 2-month-old infant compared to RSV, which is more prevalent in this age group. Option C) Parainfluenza: Parainfluenza virus can cause croup and upper respiratory infections in children. However, it is less likely to present with the combination of symptoms described in the question compared to RSV. Educational Context: Understanding the common viral causes of respiratory infections in infants is crucial for pediatric clinical nurse specialists. Recognizing the specific symptoms and typical age groups affected by each virus helps in accurate diagnosis and appropriate management, including infection control measures to prevent further spread in healthcare settings and communities.

Correct Answer: B

Rationale: The correct answer is B) Congenital heart defects. Neonates with an omphalocele are at increased risk for congenital heart defects due to the association between omphalocele and cardiac anomalies. This is because both conditions can arise from disturbances in early fetal development. Congenital heart defects are a common comorbidity seen in neonates with omphalocele and require close monitoring and appropriate management. Option A) Neural tube defects are not typically associated with omphalocele. Neural tube defects involve malformations of the brain, spinal cord, or their coverings, which are distinct from omphalocele. Option C) Cystic fibrosis is a genetic disorder that affects the lungs and digestive system. It is not directly related to omphalocele, which is a congenital abdominal wall defect. Option D) Necrotizing enterocolitis is a gastrointestinal emergency that primarily affects premature infants. While neonates with omphalocele may be at risk for gastrointestinal complications, necrotizing enterocolitis is not a typical associated condition with omphalocele. Educationally, this question highlights the importance of understanding common comorbidities and associations in pediatric patients, particularly those with complex congenital anomalies like omphalocele. It reinforces the need for thorough assessment and monitoring in neonates with omphalocele to promptly identify and manage any associated conditions, such as congenital heart defects.

Correct Answer: B

Rationale: In bronchial asthma, eosinophils are the main effector cells involved in the inflammatory response within the airways. This is why option B is the correct answer. Eosinophils release inflammatory mediators that contribute to bronchoconstriction, mucus production, and airway remodeling seen in asthma. Option A (TH1 immune response) is incorrect because asthma is primarily associated with a TH2 immune response characterized by the release of cytokines like IL-4, IL-5, and IL-13, which promote eosinophil activation. Option C (Increased serum IgA levels) is incorrect as IgE antibodies play a more significant role in the pathophysiology of asthma, triggering the release of inflammatory mediators from mast cells and basophils. Option D (Viral infection is the main cause) is incorrect because while viral infections can exacerbate asthma symptoms, they are not the primary cause of the condition. Asthma is a complex chronic inflammatory disorder influenced by genetic and environmental factors. Educationally, understanding the correct effector cells in asthma is crucial for pediatric clinical nurse specialists as it guides treatment strategies targeting inflammation and airway hyperresponsiveness. Recognizing the role of eosinophils in asthma pathophysiology helps in providing effective care and management for pediatric patients with asthma.

Correct Answer: C

Rationale: The correct answer is C) Hyperventilation. In the context of acid-base balance, when there is bicarbonate loss in the urine, the body initiates compensatory mechanisms to maintain a normal pH level. In this scenario, the kidneys excrete bicarbonate, leading to a metabolic acidosis. To counteract this acidosis, the respiratory system responds by increasing the rate and depth of breathing, which is known as hyperventilation. Option A) Extracellular shift of potassium is not the correct compensatory mechanism for bicarbonate loss in urine. Potassium shifts are more relevant in conditions such as metabolic alkalosis. Option B) Hyperchloremia refers to an excess of chloride in the blood and is not a compensatory mechanism for bicarbonate loss in urine. Option D) Loss of organic acid in urine is not a compensatory mechanism for bicarbonate loss. Understanding the body's compensatory mechanisms in acid-base balance is crucial for nurses, especially Pediatric Clinical Nurse Specialists, as imbalances can have serious implications for pediatric patients. Recognizing these mechanisms allows nurses to provide appropriate interventions and support to maintain optimal patient health. It is essential for nurses to be able to assess acid-base disorders accurately and intervene effectively to restore balance and prevent complications.

Correct Answer: D

Rationale: In early compensated shock, the correct option is D) Normal blood pressure. In compensated shock, the body is able to maintain blood pressure within normal limits through various compensatory mechanisms such as vasoconstriction and increased heart rate. This is why a normal blood pressure is expected during this phase. Option A) Capillary refill time > 5 seconds is incorrect because in compensated shock, peripheral vasoconstriction will often maintain normal capillary refill time. Option B) Bradycardia is incorrect because in compensated shock, the body typically responds with tachycardia to maintain cardiac output. Option C) Altered consciousness is incorrect because altered mental status typically occurs in decompensated shock when perfusion to vital organs is severely compromised. Educationally, understanding the progression of shock is crucial for pediatric clinical nurse specialists to recognize early signs and symptoms, intervene promptly, and prevent further deterioration in pediatric patients. Recognizing the differences between compensated and decompensated shock is essential for providing optimal care and improving patient outcomes.