A 3.5-kg full-term infant is born after an uncomplicated delivery with Apgar scores of 9and 9 at 1 and 5 minutes. The infant cries vigorously after birth but then goes into a quiet state. Within 10 minutes, the infant experiences cyanosis and respiratory arrest. During resuscitation, the nurse is unable to pass a nasogastric tube. The most likely diagnosis is

Correct Answer: D

Rationale: In this scenario, the most likely diagnosis is choanal atresia (Option D). Choanal atresia is a congenital condition where there is a blockage of the posterior nasal passage, leading to respiratory distress, especially in newborns. In this case, the infant's initial ability to cry vigorously and then sudden onset of cyanosis and respiratory distress point towards a possible airway obstruction, which aligns with choanal atresia. Option A, tracheoesophageal fistula, would typically present with symptoms such as choking, coughing, and respiratory distress immediately after birth due to abnormal connection between the trachea and esophagus. Option B, pneumothorax, would present with sudden onset respiratory distress, but the inability to pass a nasogastric tube is not consistent with this diagnosis. Option C, persistent fetal circulation, would not typically present with sudden respiratory distress and cyanosis after an initial period of normalcy. Educationally, this question highlights the importance of recognizing the signs and symptoms of choanal atresia in newborns, as prompt diagnosis and intervention are critical for the infant's well-being. Understanding common respiratory conditions in newborns is essential for pediatric nurses to provide timely and appropriate care in emergent situations.

Correct Answer: D

Rationale: The correct answer for the treatment of the 3-year-old in Question 11 being D) catheter snare removal is based on the scenario presented, which likely involves a foreign body being lodged in the airway. In pediatric respiratory emergencies, prompt removal of the obstruction is crucial to ensure adequate oxygenation. Catheter snare removal is a method commonly used to extract foreign bodies from the airway in pediatric patients, as it allows for precise and controlled retrieval. Option A) amoxicillin is an antibiotic and not appropriate for the immediate treatment of an airway obstruction. Option B) hydrogen peroxide is a disinfectant and should not be used in the airway. Option C) local anesthesia followed by suction is not suitable for acute airway obstruction in a pediatric patient. In an educational context, it is essential for nurses to be well-versed in pediatric respiratory emergencies, including the appropriate interventions for airway obstructions. Understanding the correct treatment modalities can make a significant difference in the outcomes of pediatric patients experiencing respiratory distress. Nurses must be prepared to act quickly and decisively in such critical situations to ensure the safety and well-being of their young patients.

Correct Answer: D

Rationale: The correct answer is D) cystic fibrosis. Nasal polyps are more commonly seen in children with cystic fibrosis due to the underlying pathophysiology of this genetic disorder. Cystic fibrosis is characterized by thick, sticky mucus production in the respiratory tract, which can lead to the development of nasal polyps. These polyps are noncancerous growths that can obstruct the nasal passages and cause symptoms like nasal congestion, runny nose, and decreased sense of smell. Option A) aspirin allergy is incorrect because nasal polyps associated with aspirin allergy are more commonly seen in adults rather than children. Option B) juvenile nasopharyngeal angiofibroma is a benign tumor that occurs predominantly in adolescent males and is not typically associated with nasal polyps in children. Option C) Peutz-Jeghers syndrome is a rare genetic disorder characterized by the development of polyps in the gastrointestinal tract, but it is not a common cause of nasal polyps in children. Educationally, understanding the association between cystic fibrosis and nasal polyps is important for pediatric nurses as they care for children with this condition. Recognizing the signs and symptoms of nasal polyps in children with cystic fibrosis can help in early detection and management, ultimately improving the quality of care provided to these patients.

Correct Answer: D

Rationale: The correct answer is D) bacterial tracheitis. This condition is not typically included in the differential diagnosis for pediatric patients with respiratory issues related to the larynx. Bacterial tracheitis presents with distinct symptoms such as high fever, barking cough, and toxic appearance, whereas the other options are more commonly associated with laryngeal issues in pediatric patients. A) Laryngeal papillomatosis is caused by HPV and presents with hoarseness and respiratory distress in children. B) Laryngeal hemangioma is a vascular lesion that can cause airway obstruction and stridor. C) Laryngeal web is a congenital anomaly that can cause respiratory distress in infants. Understanding the differential diagnosis for pediatric respiratory conditions is crucial for nurses preparing for the NCLEX exam and in clinical practice. Recognizing the distinguishing features of each condition helps in prompt diagnosis and appropriate management, ensuring optimal patient outcomes.

Correct Answer: C

Rationale: In this scenario, the correct treatment of choice for the patient is C) rigid bronchoscopy. Rigid bronchoscopy is the most appropriate intervention for a patient with a respiratory issue that requires direct visualization and potential intervention within the airway. It allows for the removal of foreign bodies, evaluation of airway anatomy, and intervention if needed. Option A) steroids are often used in the treatment of inflammation in various respiratory conditions like asthma, but they would not be the immediate treatment of choice in a situation requiring direct airway intervention. Option B) albuterol is a bronchodilator commonly used in conditions like asthma to relieve bronchospasm but is not the primary treatment for a patient needing airway intervention. Option D) postural drainage is a technique used in conditions like cystic fibrosis to assist with mucous clearance but would not be the primary treatment in a scenario requiring direct airway intervention. In an educational context, understanding the appropriate interventions for pediatric respiratory issues is crucial for nursing practice. Rigid bronchoscopy is a specialized procedure that requires skilled professionals and is essential in managing certain respiratory emergencies in children. Nurses need to have a solid understanding of respiratory procedures to provide safe and effective care to pediatric patients.