A 2 years old girl presents with blue discoloration of nails and lips. On examination she is cyanosed and clubbed, heart auscultation reveals a short systolic murmur at left upper sternal border. The most likely diagnosis is?

Correct Answer: B

Rationale: The correct answer is B) Tetralogy of Fallot. In this case, the presentation of cyanosis, clubbing, systolic murmur, and the specific location of the murmur at the left upper sternal border points towards Tetralogy of Fallot. This congenital heart defect includes four main abnormalities: pulmonary stenosis, right ventricular hypertrophy, overriding aorta, and ventricular septal defect (VSD), which explains the clinical findings in this scenario. Option A) VSD is incorrect because VSD alone typically does not present with cyanosis and clubbing. Option C) Tricuspid atresia would present with cyanosis, but the absence of a VSD would not produce the systolic murmur described. Option D) Truncus arteriosus is unlikely due to the absence of a continuous murmur associated with this condition. In an educational context, understanding the specific signs and symptoms of different congenital heart defects is crucial for nurses working in pediatric emergency settings. Recognizing these clinical manifestations promptly can lead to timely interventions and improved outcomes for pediatric patients with cardiac conditions. This case highlights the importance of thorough assessment and knowledge of common pediatric emergencies.

Correct Answer: D

Rationale: In this scenario, the most beneficial treatment for the 1-year-old with acute renal failure (ARF) is option D - Placement of a Tenckhoff catheter for peritoneal dialysis. Explanation of why option D is correct: Peritoneal dialysis is a crucial intervention in pediatric patients with ARF who are unresponsive to conventional treatments like Kayexalate and diuretics. Peritoneal dialysis helps in removing excess potassium, managing fluid overload, and correcting acid-base imbalances, which are essential in the management of acute renal failure. Explanation of why other options are wrong: - Option A (Additional rectal Kayexalate) may not be effective in this situation as the child is already unresponsive to oral Kayexalate, indicating the need for a more aggressive intervention like dialysis. - Option B (Intravenous furosemide) may worsen the child's condition by further depleting fluid volume and electrolytes, leading to hemodynamic instability. - Option C (Endotracheal intubation and ventilatory assistance) is not the first-line treatment for acute renal failure and does not address the underlying cause of the condition. Educational context: Understanding the appropriate interventions for pediatric patients with acute renal failure is crucial for pediatric emergency nurses. Knowing when to escalate treatment to interventions like peritoneal dialysis can significantly impact patient outcomes and prevent further complications. This case highlights the importance of recognizing the signs of renal failure in pediatric patients and the appropriate steps to manage it effectively.

Correct Answer: D

Rationale: In the post-operative care of a child with repair of bladder exstrophy, the most likely medication included is Oxybutynin (Option D). Oxybutynin is a medication commonly used to treat bladder spasms by relaxing the bladder muscles, which is crucial in this scenario to prevent discomfort and complications post-surgery. Lasix (Option A) and Mannitol (Option B) are diuretics and are not typically indicated in the immediate post-operative care of bladder exstrophy repair in children. Meperidine (Option C) is an opioid analgesic that may be used for pain management but is not specifically targeted at addressing bladder-related issues post-surgery. In an educational context, it is important for pediatric emergency nurses to understand the rationale behind post-operative medication choices to ensure safe and effective care for pediatric patients. Understanding the pharmacological actions and indications of medications used in different clinical scenarios is essential for providing quality nursing care in pediatric emergency settings.

Correct Answer: B

Rationale: The correct answer is B) improper formula preparation. This option is the most likely cause as the infant's decline in growth coincided with the introduction of juices and cereals, which may have displaced the essential nutrients from breast milk or formula. Improper formula preparation can lead to inadequate nutrition, affecting the infant's growth. Option A) failed breastfeeding is less likely since the infant had normal growth until the introduction of juices and cereals. Option C) congenital syndromes and Option D) congenital infections are less likely as there are no clinical signs or symptoms suggestive of these conditions in the scenario provided. In the educational context, understanding the importance of proper nutrition in infant growth and development is crucial for pediatric emergency nurses. They should educate parents on appropriate feeding practices, formula preparation, and introduction of complementary foods to prevent conditions like failure to thrive. This case highlights the impact of nutrition on growth patterns and the need for vigilant monitoring to ensure optimal infant health.

Correct Answer: D

Rationale: In pediatric emergency nursing, understanding the features of rapid eye movement (REM) is crucial for assessing a child's neurological status. The correct answer, option D - CT scan of head and neck, is not typically associated with assessing REM. A) Polysomnography is a test used to monitor and record various physiological activities during sleep, including REM. It is a key tool in diagnosing sleep disorders but is not specific to REM alone. B) EEG (electroencephalogram) is a valuable tool for assessing brain activity, including during sleep stages like REM. EEG can detect abnormal brain waves associated with certain conditions, but it is not exclusive to REM. C) Fiberoptic nasopharyngeal examination may be used to assess airway patency and structures in emergency situations but is not directly related to monitoring REM. Educationally, understanding the features and monitoring techniques for REM in pediatric patients is essential for providing comprehensive care. By knowing the appropriate diagnostic tools and assessments for different aspects of neurological function, nurses can effectively evaluate and manage pediatric emergencies.