A 3-year-old has a sudden onset of cough and respiratory distress while playing with siblings in the playroom. There is wheezing over the left lung. The chest x-ray is shown in Figure 18-1. The most likely diagnosis is

Correct Answer: D

Rationale: The most likely diagnosis for the 3-year-old with sudden-onset cough, respiratory distress, wheezing over the left lung, and the chest x-ray showing an abnormality indicative of a foreign body is D) foreign body aspiration. Rationale: 1. Foreign body aspiration is common in young children who tend to explore objects by putting them in their mouths, leading to accidental inhalation. 2. The sudden onset of symptoms like cough, wheezing, and respiratory distress during play activities is typical of foreign body aspiration. 3. Wheezing over one lung can indicate partial airway obstruction, which is often seen in foreign body aspiration. 4. The chest x-ray in Figure 18-1 may show hyperinflation, focal atelectasis, or air trapping, which are common findings in foreign body aspiration. Why others are wrong: - Tuberculosis (A) typically presents with constitutional symptoms, prolonged cough, and systemic signs like weight loss, night sweats, and fever. - Asthma (B) usually presents with recurrent episodes of wheezing, coughing, chest tightness, and shortness of breath triggered by factors like allergens or exercise. - Aspergillosis (C) is a fungal infection that can present with respiratory symptoms but is less likely in a child with acute onset symptoms and wheezing. Educational context: Understanding the differential diagnosis of respiratory distress in children is crucial for nurses caring for pediatric patients. Recognizing the signs and symptoms of foreign body aspiration, along with interpreting diagnostic tests like chest x-rays, helps in prompt identification and management of this potentially life-threatening condition. Nurses play a vital role in providing education to parents on preventing foreign body aspiration and recognizing early warning signs.

Correct Answer: D

Rationale: The correct answer is D) "Epiglottitis is rapidly progressive; you could not have predicted his symptoms would worsen so quickly." This response is the best because it provides the mother with accurate information about the nature of epiglottitis. Epiglottitis is a medical emergency that can rapidly progress and compromise the airway, leading to respiratory distress. By acknowledging the rapid progression of the condition, the nurse can help the mother understand the seriousness of the situation and the need for immediate medical intervention. Option A is incorrect because it dismisses the severity of epiglottitis in children and may lead the mother to underestimate the condition. Option B, while emphasizing early evaluation, does not specifically address the rapid progression of epiglottitis. Option C is misleading as epiglottitis is actually an acute condition that can progress rapidly rather than slowly. In an educational context, it is crucial for nurses to have a solid understanding of pediatric respiratory conditions like epiglottitis. By providing accurate information and support to parents, nurses can help ensure timely interventions and better outcomes for pediatric patients. This scenario underscores the importance of clear communication with parents about the nature of their child's condition and the need for prompt medical attention.

Correct Answer: B

Rationale: The correct answer is B) Not compliant with taking her enzymes. In cystic fibrosis (CF), the pancreas is often affected, leading to pancreatic insufficiency. This results in a deficiency of digestive enzymes like lipase, amylase, and protease, necessary for proper digestion. This deficiency leads to malabsorption of fats (steatorrhea) and proteins (azotorrhea), as seen in the stool sample analysis. Option A) Not compliant with taking her vitamins is incorrect because the primary issue in CF related to digestion is the lack of pancreatic enzymes, not vitamins. While CF patients may also have fat-soluble vitamin deficiencies due to malabsorption, the primary concern is the lack of enzymes. Option C) Eating too many foods high in fat is incorrect because the issue lies in the child's inability to digest and absorb fats due to the lack of enzymes, not the quantity of fat intake. Option D) Eating too many foods high in fiber is incorrect because fiber does not directly contribute to the malabsorption of fats and proteins seen in CF. The main issue in CF is the lack of pancreatic enzymes necessary for digestion, not fiber intake. Understanding these concepts is crucial for pediatric nurses caring for children with CF. Proper administration of pancreatic enzyme replacement therapy is essential to support digestion and prevent malabsorption-related complications in these patients. Educating patients and families on the importance of enzyme compliance can improve outcomes and quality of life for children with CF.

Correct Answer: A

Rationale: In the context of pediatric respiratory nursing, the correct answer, option A, is when the first chest physiotherapy (CPT) should be performed for a 4-month-old with cystic fibrosis (CF). Performing CPT before feeding the child breakfast helps in clearing the airways of mucus and promoting effective breathing. This timing ensures that the child's airways are clear before any potential risk of aspiration during feeding, which is crucial for infants with CF who are prone to respiratory complications. Option B, after deep suctioning each morning, is incorrect because CPT should be done before feeding to prevent complications during feeding. Option C, thirty minutes after feeding, is incorrect as it does not address the immediate need to clear the airways for optimal respiratory function. Option D, performing CPT only when the child has congestion or coughing, is incorrect as CPT is a proactive treatment to prevent respiratory issues in CF patients rather than a reactive measure. Educationally, understanding the timing and importance of CPT in pediatric patients with CF is crucial for nursing professionals to provide optimal care. By performing CPT before feeding, nurses can help prevent respiratory complications, improve airway clearance, and promote better respiratory health outcomes for these vulnerable patients.

Correct Answer: D

Rationale: The correct answer is D) Avoid purchasing upholstered furniture. Parents of a child with asthma should aim to make their home as allergy-free as possible to minimize triggers that can exacerbate asthma symptoms. Upholstered furniture can harbor dust mites, pet dander, and other allergens that can worsen asthma. Choosing furniture made of easy-to-clean materials like wood or leather can help reduce allergen exposure in the home. Option A, using a humidifier, is not recommended as it can actually increase humidity levels and promote mold and dust mite growth, worsening allergies and asthma symptoms. Option B, chemically cleaning the carpet once a month, can introduce more irritants into the environment and may not be necessary if regular vacuuming with a HEPA filter vacuum is done. Option C, washing household pets weekly, may not be practical or necessary if the child is not specifically allergic to pet dander. For educational context, it is important for pediatric nurses to educate parents on creating an asthma-friendly environment at home. Understanding common allergens and triggers, as well as practical steps to minimize exposure, can significantly improve the quality of life for children with asthma. Encouraging parents to make informed choices about home furnishings and cleaning practices can help manage asthma symptoms and reduce the need for medical interventions.