A 32-week preterm baby on mechanical ventilation, recovering from RDS, has a satisfactory blood gas, and ventilatory settings are being reduced for weaning. What is the most valuable indicator that the baby is ready for extubation?

Correct Answer: B

Rationale: The correct answer is B) fraction of inspired O2 0.55. In a preterm baby recovering from RDS on mechanical ventilation, a decreasing need for supplemental oxygen indicates improved lung function and gas exchange. A fraction of inspired oxygen (FiO2) of 0.55 is relatively low and suggests that the baby's lungs are able to adequately oxygenate the blood on their own. This is a key indicator that the baby may be ready for extubation. Option A) frequency of respiration 35 is not the most valuable indicator for extubation readiness. While respiratory rate is important, it alone does not provide enough information about the baby's respiratory status and ability to maintain adequate oxygenation. Option C) peak expiratory end pressure 6 and D) inspiratory pressure 8 are related to ventilator settings but do not directly indicate the baby's readiness for extubation. These parameters are more about the support provided by the ventilator rather than the baby's ability to breathe independently. In the context of pediatric nursing, understanding the significance of various ventilator parameters and blood gas values is crucial for making decisions about respiratory care for preterm infants. Monitoring trends in these parameters helps nurses and healthcare providers assess the baby's progress and determine the appropriate time for interventions like weaning off mechanical ventilation.

Correct Answer: D

Rationale: The correct answer is D because it provides incorrect information about the postoperative care required for a 3-month-old, former 29-week-premature infant undergoing surgery for bilateral inguinal hernias. Infants with a history of prematurity and apnea are at increased risk for postoperative apnea, regardless of the type of anesthesia used. Therefore, close monitoring for apnea is necessary after surgery. Sending the infant home on the same day without monitoring can be dangerous. Option A is incorrect because anemia can indeed increase the risk of postoperative apnea due to decreased oxygen-carrying capacity of the blood. Option B is correct as it highlights the need for overnight inpatient apnea monitoring, given the infant's history. Option C is also true, emphasizing the risks associated with delaying surgery in this case. In an educational context, it is crucial for healthcare providers to understand the unique needs and risks associated with premature infants, especially when considering surgical interventions. This case underscores the importance of tailored, evidence-based care to ensure the best outcomes for this vulnerable population.

Correct Answer: A

Rationale: The correct answer is A) panniculitis. In this scenario, the child presents with nodules over the cheeks following outdoor activity in cold weather. Panniculitis is characterized by inflammation of the subcutaneous fat tissue, often triggered by exposure to cold (cold panniculitis). The nodules are typically blue-red and non-tender, consistent with the presentation described. Facial cellulitis (B) is unlikely as it presents with warmth, erythema, tenderness, and swelling. Thrombocytopenic purpura (C) typically presents with petechiae and bruising, not nodules. Henoch-Schonlein purpura (D) presents with palpable purpura on the buttocks and lower extremities, joint pain, abdominal pain, and renal involvement, which are not seen in this case. Educationally, understanding the clinical presentation and distinguishing features of different pediatric dermatological conditions is crucial for accurate diagnosis and appropriate management in pediatric nursing practice. Recognizing the specific characteristics of panniculitis in this case emphasizes the importance of thorough assessment and knowledge of pediatric skin conditions.

Correct Answer: C

Rationale: In the context of pediatric nursing, it is crucial to understand the appropriate interventions for common conditions like infant colic. The correct answer, option C - simethicone, is effective in calming a crying infant with colic due to its ability to break down gas bubbles in the gastrointestinal tract, thus reducing discomfort and colic symptoms. Option A, diphenhydramine, is an antihistamine that is not recommended for infants due to potential side effects like sedation and respiratory depression. Option B, phenobarbital, is a barbiturate with sedative effects that are not indicated for infant colic and can have serious adverse effects in this population. Option D, lactase, is an enzyme that helps digest lactose and would not be effective in calming a crying infant with colic, as colic is not primarily caused by lactose intolerance. Educationally, it is essential for healthcare providers working with infants to be knowledgeable about safe and evidence-based interventions for common issues like colic. Understanding the rationale behind each option helps in making informed clinical decisions and providing optimal care for pediatric patients.

Correct Answer: B

Rationale: In pediatric nursing practice, understanding the associations between Epstein-Barr virus (EBV) infection and malignancies is crucial for providing comprehensive care to patients. The correct answer, option B, is nasopharyngeal T-cell lymphoma. This is because EBV is strongly linked to the development of Burkitt lymphoma, carcinoma, and Hodgkin lymphoma, but not nasopharyngeal T-cell lymphoma. Burkitt lymphoma is a known malignancy associated with EBV due to the virus' ability to immortalize B-cells. Carcinoma, although less common, has also been linked to EBV infection, particularly in nasopharyngeal and gastric cancers. Hodgkin lymphoma is another malignancy where EBV has been implicated, especially in immunocompromised individuals. Educationally, this question reinforces the importance of understanding the relationship between viral infections such as EBV and the development of different malignancies in pediatric patients. It highlights the need for nurses to be aware of these associations to provide appropriate care, monitor for signs and symptoms, and collaborate effectively with the healthcare team to ensure optimal patient outcomes.