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: In this case, the most likely diagnosis for the 2-year-old girl presenting with cyanosis, clubbing, a short systolic murmur at the left upper sternal border, and blue discoloration of nails and lips is B) Tetralogy of Fallot. Tetralogy of Fallot is a congenital heart defect characterized by four components: pulmonary stenosis, overriding aorta, ventricular septal defect (VSD), and right ventricular hypertrophy. The symptoms presented align with this condition as cyanosis is due to right-to-left shunting of blood caused by the VSD, leading to decreased oxygen in the systemic circulation. The other options can be ruled out based on the clinical presentation and findings. A) VSD alone typically presents with a harsh holosystolic murmur at the lower left sternal border, not the upper sternal border as described. C) Tricuspid atresia would present with profound cyanosis from birth, not at 2 years of age. D) Truncus arteriosus usually presents with a single loud heart sound and a continuous murmur. In an educational context, understanding the distinctive features of each congenital heart defect is crucial for pediatric emergency nurses to accurately assess and manage children with cardiac conditions. Recognizing the signs and symptoms early can lead to prompt intervention, improving outcomes for pediatric patients with congenital heart defects.

Correct Answer: D

Rationale: In this scenario, the correct treatment option for the child with acute renal failure (ARF) who is edematous, has minimal urine output, and elevated potassium levels is the placement of a Tenckhoff catheter for peritoneal dialysis (Option D). Peritoneal dialysis is a crucial intervention in pediatric patients with ARF as it helps to remove excess fluid, correct electrolyte imbalances such as hyperkalemia, and eliminate waste products when the kidneys are not functioning effectively. This intervention is particularly beneficial in children as it provides a gentler form of renal replacement therapy compared to hemodialysis. Option A, additional rectal Kayexalate, is not the most appropriate choice in this situation as the child is not responding to oral Kayexalate, and rectal administration may not provide the rapid and effective reduction in potassium levels required in this critical condition. Intravenous furosemide (Option B) may exacerbate the child's fluid overload and electrolyte imbalances by promoting further diuresis without addressing the underlying cause of ARF. Endotracheal intubation and ventilatory assistance (Option C) are not indicated solely for the management of ARF with electrolyte imbalances. While respiratory distress is present in this case, addressing the renal failure and associated complications should take precedence. Educationally, understanding the rationale behind choosing peritoneal dialysis in pediatric patients with ARF is essential for nurses working in pediatric emergency settings. It highlights the importance of timely and appropriate interventions to manage critical conditions effectively and underscores the significance of considering renal replacement therapies in pediatric patients with renal failure.

Correct Answer: D

Rationale: In the post-operative care of a child with repair of bladder exstrophy, the most appropriate medication is Oxybutynin (Option D). Oxybutynin is a medication commonly used to treat bladder spasms by relaxing the bladder muscles, which is crucial after bladder surgery to prevent discomfort and promote healing. Lasix (Option A) and Mannitol (Option B) are diuretics used to increase urine output and reduce edema, which are not typically indicated in this scenario. Meperidine (Option C) is an opioid analgesic, which may be used for pain management but is not specifically targeted at bladder spasms or post-operative bladder care. Educationally, understanding the rationale behind medication choices in pediatric emergency nursing is vital for providing safe and effective care to pediatric patients. By knowing the appropriate medications for specific conditions, nurses can ensure optimal outcomes and prevent potential complications. It is essential for nurses to stay updated on evidence-based practices in pediatric emergency nursing to deliver high-quality care to children in various clinical settings.

Correct Answer: B

Rationale: In this case, the most likely cause of the infant's decline in growth pattern is option B) improper formula preparation. This is because the infant had a normal growth pattern till the introduction of juices and cereals at 6 months, which coincides with when the formula was introduced. Improper formula preparation can lead to inadequate nutrition, which can result in failure to thrive (FTT) in infants. Option A) failed breast feeding is less likely in this scenario as the infant had a normal growth pattern when breastfed exclusively for the first 4 months of life. Congenital syndromes (option C) and congenital infections (option D) would typically present with symptoms earlier in life and would not explain the sudden decline in growth pattern after the introduction of new foods. Educationally, this case highlights the importance of proper infant feeding practices and the potential consequences of improper formula preparation on a child's growth and development. It emphasizes the need for healthcare providers to educate caregivers on appropriate feeding techniques and the introduction of complementary foods to ensure optimal nutrition for infants.