A 5-year-old girl was brought to the ED with altered mental status. Kernig and Brudzinski signs were present. CSF shows: WBCs 1500/ul (80% neutrophils), Sugar 20 mg/dl, Protein 400 mg/dl, Positive Gram stain. You would interpret the CSF as:

Correct Answer: B

Rationale: The correct interpretation of the cerebrospinal fluid (CSF) findings in this scenario is B) Bacterial Meningitis. In bacterial meningitis, the CSF typically shows elevated white blood cells (WBCs), predominantly neutrophils, low glucose levels, high protein levels, and a positive Gram stain indicative of bacterial presence. The CSF findings in this case align with bacterial meningitis, which is a medical emergency requiring prompt treatment with antibiotics to prevent serious complications such as brain damage or death. Option A) Normal is incorrect because the CSF findings clearly indicate an abnormality with the presence of elevated WBCs, low glucose, and high protein levels. Option C) Viral encephalitis typically presents with lymphocytic pleocytosis in the CSF, and Option D) TB Meningitis would show a lymphocytic predominance in the CSF. Educational Context: Understanding the interpretation of CSF findings is crucial in pediatric nursing, especially in emergency situations like suspected meningitis. Recognizing the specific patterns associated with different types of meningitis is essential for timely and accurate diagnosis and management. This knowledge can significantly impact patient outcomes by facilitating rapid initiation of appropriate treatment.

Correct Answer: C

Rationale: In pediatric nursing, understanding congenital heart diseases is crucial for providing safe and effective care to newborns. The correct answer to the question is C) d-Transposition of great arteries. d-Transposition of the great arteries is the most common congenital cyanotic heart disease in newborns. In this condition, the aorta arises from the right ventricle, and the pulmonary artery arises from the left ventricle, leading to two separate circulatory systems. This results in severe cyanosis shortly after birth, requiring prompt medical intervention. Option A) Tetralogy of Fallot is a cyanotic heart defect characterized by four components: pulmonary stenosis, overriding aorta, ventricular septal defect, and right ventricular hypertrophy. While it is a common congenital heart defect, it is not the most common cyanotic heart disease in newborns. Option B) Ebstein anomaly is a rare congenital heart defect characterized by the displacement of the tricuspid valve into the right ventricle. It is not typically associated with cyanosis in newborns. Option D) Hypoplastic left heart syndrome is a severe congenital heart defect where the left side of the heart is underdeveloped. While it can present with cyanosis, it is not as common as d-Transposition of the great arteries in newborns. Understanding the prevalence, pathophysiology, and clinical manifestations of congenital heart diseases in newborns is essential for pediatric nurses to recognize early signs, provide appropriate care, and collaborate with the healthcare team to optimize outcomes for these vulnerable patients.

Correct Answer: D

Rationale: In this question, the correct answer is D) Harsh basal systolic murmur heard best on the second right intercostal space. This is because a harsh basal systolic murmur heard best on the second right intercostal space is not a manifestation typically associated with the initial attack of rheumatic fever with carditis. A) Tachycardia out of proportion to fever is a common manifestation of carditis in rheumatic fever due to inflammation of the heart muscle. B) Pericardial rub can be present in cases of pericarditis, which can be a complication of rheumatic fever. C) Heart failure can occur in severe cases of carditis due to the damage to the heart valves and muscle. Educationally, understanding the manifestations of rheumatic fever, especially in the context of carditis, is crucial for pediatric nurses to provide appropriate care to patients. Recognizing the signs and symptoms helps in early detection and management of complications, leading to better outcomes for the pediatric population. It is essential for nurses to be able to differentiate between common and atypical symptoms to provide effective care and support to children with rheumatic fever.

Correct Answer: C

Rationale: The correct answer is C) Pruritic erythematous rash over the face. This is not a major manifestation of acute rheumatic fever. In acute rheumatic fever, major manifestations typically involve the heart, joints, skin, and central nervous system. Option A) Involuntary purposeless, jerky dysrhythmic movement of hands and arms is known as Sydenham's chorea and is a major manifestation of acute rheumatic fever. Option B) Swollen tender large joint is a common symptom seen in acute rheumatic fever, known as migratory polyarthritis. Option D) Auscultation of a new apical pansystolic murmur in a previously normal heart is a classic finding in acute rheumatic fever due to carditis. In an educational context, understanding the major manifestations of acute rheumatic fever is crucial for pediatric nurses to provide timely and accurate care to affected children. Recognizing these signs and symptoms can lead to early detection and appropriate management to prevent complications such as rheumatic heart disease. It is essential for healthcare professionals to be well-versed in the distinguishing features of acute rheumatic fever to ensure optimal patient outcomes.

Correct Answer: D

Rationale: The correct answer is D) Shift of the mediastinum to the right side in expiratory film. When a foreign body partially obstructs the left main bronchus, it can cause air trapping in the left lung, leading to hyperinflation and subsequent mediastinal shift to the right side during expiration. This occurs because the obstructed lung cannot fully exhale air, causing the mediastinum to shift towards the contralateral side. Option A) Increased air entry on the left hemithorax is incorrect because partial obstruction would not result in increased air entry but rather decreased air entry due to the blockage. Option B) Homogenous opacity of the right hemithorax on CXR is incorrect as it does not correlate with a foreign body in the left bronchus. Opacity typically indicates fluid or tissue, not a foreign body obstruction. Option C) Hyperinflated right hemithorax on CXR is also incorrect because the hyperinflation would occur in the obstructed lung (left side) due to air trapping, not in the contralateral lung. Understanding the radiological findings associated with bronchial foreign body obstruction is crucial in pediatric nursing. Recognizing these abnormalities can aid in prompt diagnosis and intervention, preventing potential complications such as respiratory distress and lung collapse. Nurses caring for pediatric patients with suspected foreign body aspiration should be knowledgeable about interpreting chest X-rays and understanding the implications of different radiological findings.