A 6 months old boy presents with respiratory distress and feeding difficulty. On examination heart rate is 130/min and there is a pansystolic murmur at left lower sternal border. What is the most likely diagnosis?

Correct Answer: C

Rationale: The most likely diagnosis for the 6-month-old boy presenting with respiratory distress, feeding difficulty, a heart rate of 130/min, and a pansystolic murmur at the left lower sternal border is a Ventricular Septal Defect (VSD). Ventricular septal defects are common congenital heart defects where there is an abnormal opening between the ventricles, leading to a left-to-right shunt and causing symptoms such as respiratory distress and feeding difficulties. The pansystolic murmur at the left lower sternal border is characteristic of VSD due to the turbulent blood flow across the defect. Option A, Mitral regurgitation, and option B, Mitral valve prolapse, are less likely in infants and are not typically associated with the symptoms described. Option D, Coarctation of the aorta, presents with hypertension in the upper extremities and weak pulses in the lower extremities, which are not seen in this case. Educationally, understanding the clinical presentation and auscultatory findings associated with different congenital heart defects is crucial for healthcare providers working with pediatric patients. Recognizing these key features can aid in prompt diagnosis and appropriate management, ultimately improving patient outcomes.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Record the urine output in the chart. The rationale behind this is that the child's urine output of 150 mL in 10 hours falls within the expected range for a 4-year-old weighing 15 kg. By recording this urine output in the chart, the nurse is documenting the child's renal function, which is crucial for monitoring overall health status. Option A) Notify the physician; urine output is too low is incorrect because the urine output is actually within the normal range for a child of this age and weight. There is no indication of renal impairment based on this information alone. Option B) Encourage increased oral intake is not necessary in this case as the child's urine output is normal. Increasing oral intake without a clinical indication could lead to overhydration, which can be harmful. Option D) Administer IV fluids to rehydrate is not warranted as there is no indication of dehydration based on the urine output provided. Administering IV fluids without a valid reason can lead to fluid overload and potential complications. From an educational standpoint, understanding normal pediatric urine output parameters is essential for nurses caring for pediatric patients. By accurately assessing and documenting urine output, nurses can detect early signs of renal dysfunction or dehydration. This question highlights the importance of critical thinking and clinical judgment in pediatric nursing practice.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Offer a diet high in protein. Encopresis is a condition characterized by chronic constipation leading to fecal incontinence, and it is essential to offer a diet high in fiber to help alleviate constipation. High-protein diets can exacerbate constipation due to their low fiber content, so this instruction would be inappropriate for a child with encopresis. Option A, limiting milk intake, is a common recommendation for children with constipation as excessive dairy consumption can contribute to the issue. Option B, obtaining a complete dietary log, is a good practice to identify any dietary patterns that may be exacerbating the condition. Option C, following up with a child psychologist, may be beneficial to address any psychological issues contributing to the encopresis. In an educational context, it is crucial for nurses to understand the dietary considerations for children with gastrointestinal issues like encopresis. Providing appropriate discharge instructions can significantly impact the child's health outcomes and quality of life. Understanding the rationale behind each instruction helps nurses tailor their care to meet the unique needs of each child.

Correct Answer: A

Rationale: In the context of refeeding syndrome, the major changes that may occur typically affect electrolytes. Refeeding syndrome is a potentially fatal condition that can occur when an individual who is malnourished or starved undergoes rapid reinstitution of feeding. When food is reintroduced, there is an increase in insulin secretion, leading to a shift of electrolytes (especially phosphorus, potassium, and magnesium) into cells for energy metabolism and storage. This shift can result in severe electrolyte imbalances, particularly hypophosphatemia, which can lead to cardiac arrhythmias, respiratory failure, seizures, and even death. Option A is correct because electrolyte imbalances are the hallmark of refeeding syndrome. Options B, C, and D are incorrect because while serum proteins, hormones, and liver enzymes may also be affected during refeeding syndrome, electrolyte disturbances are the most significant and life-threatening consequences. Educationally, understanding the pathophysiology of refeeding syndrome is crucial for healthcare providers working with malnourished individuals, especially in pediatric patients who may be more vulnerable. Proper monitoring, gradual reintroduction of nutrition, and close observation for signs of electrolyte imbalances are essential in preventing and managing refeeding syndrome in pediatric patients.