A chest radiograph should be performed with the first episode of asthma. Repeat chest radiographs are not needed unless there is

Correct Answer: C

Rationale: In pediatric nursing, the correct answer is C) high-grade fever. When assessing a child with asthma, a chest radiograph is typically not necessary with the first episode unless there are complicating factors. A high-grade fever could indicate a possible underlying infection like pneumonia, which may warrant a chest radiograph to assess for complications or co-existing conditions. Option A) tachycardia is a common symptom in asthma due to increased work of breathing and is not a direct indication for a chest radiograph. Option B) poor air movement is a clinical sign of asthma exacerbation but does not necessarily require a chest radiograph unless accompanied by other concerning symptoms. Option D) pulsus paradoxus, a finding of decreased systolic blood pressure during inspiration, is associated with severe asthma but is not a direct indication for a chest radiograph. Educationally, understanding the appropriate indications for diagnostic tests like chest radiographs in pediatric asthma is crucial for nurses caring for children with respiratory conditions. It is important to prioritize diagnostic interventions based on evidence-based guidelines to provide efficient and effective care while minimizing unnecessary procedures and patient discomfort.

Correct Answer: D

Rationale: In pediatric nursing, understanding the use of topical anti-inflammatory agents for atopic dermatitis is crucial. The correct answer, D, states that reduced efficacy of topical corticosteroids is usually related to glucocorticoid resistance. This is incorrect because reduced efficacy is more commonly associated with factors like incorrect application techniques, insufficient quantity used, or non-compliance with treatment regimens. Option A is true because ointments provide better occlusion and hydration for the skin compared to creams and lotions. Option B is correct as the goal is to use the least potent corticosteroid that is effective to minimize side effects, especially in children. Option C is also accurate as low-potency, nonfluorinated corticosteroids are recommended for sensitive areas like the face to reduce the risk of skin thinning and other adverse effects. In an educational context, it is important for pediatric nurses to be knowledgeable about the appropriate use of topical anti-inflammatory agents in managing atopic dermatitis in children. Understanding the nuances of different types of corticosteroids, their potencies, and proper application techniques ensures safe and effective care for pediatric patients with skin conditions.

Correct Answer: A

Rationale: In pediatric nursing, diagnosing food allergies accurately is crucial to ensure the safety and well-being of children. The standard method for diagnosing food allergy is oral food challenges (Option A). This method involves administering increasing doses of the suspected food under controlled conditions to see if a reaction occurs. This is considered the gold standard as it provides the most definitive diagnosis of a food allergy. Serum specific IgE assay (Option B) measures the levels of specific IgE antibodies in the blood in response to a particular food. While this test can indicate sensitization to a food, it may not always correlate with clinical symptoms or accurately diagnose a true food allergy. Prick skin tests (Option C) involve placing a small amount of the food allergen on the skin and pricking the skin to see if a reaction occurs. While this test is useful for identifying potential allergens, it may produce false-positive results and cannot confirm a true food allergy on its own. Patch testing (Option D) is typically used to diagnose contact dermatitis and is not a standard method for diagnosing food allergies in children. Educationally, understanding the differences between these diagnostic methods is essential for pediatric nurses to provide safe and effective care to children with food allergies. By knowing when to use oral food challenges and interpreting the results accurately, nurses can play a critical role in managing food allergies in pediatric patients.

Correct Answer: B

Rationale: The correct answer is B) Aortic valve regurgitation. In a 12-year-old boy with a history of ventricular septal defect presenting with heart failure, a bulging praecordium, and murmurs, aortic valve regurgitation is the best explanation for his condition. A ventricular septal defect leads to increased blood flow from the left ventricle to the right ventricle, causing volume overload in the left side of the heart. This increased volume can lead to dilation of the aortic valve annulus, resulting in aortic valve regurgitation. Option A) Acute rheumatic fever is unlikely in this case as there is no mention of a recent streptococcal infection, which is a prerequisite for rheumatic fever. Option C) Eisenmenger syndrome typically occurs in patients with long-standing untreated left-to-right shunts, leading to pulmonary hypertension and right heart failure. This condition usually presents later in life and is not the most likely complication in this 12-year-old with a ventricular septal defect. Option D) Increasing left-to-right shunt could be a complication of a ventricular septal defect, but in this case, the clinical presentation of heart failure and a bulging praecordium points more towards aortic valve regurgitation as the primary complication. Educationally, understanding the pathophysiology of congenital heart defects and their potential complications is crucial for pediatric nurses. This knowledge helps in early identification of complications, appropriate management, and improved outcomes for pediatric patients with cardiac conditions.

Correct Answer: D

Rationale: The correct answer is D) Urinary alkalinization. In the case of aspirin overdose, which causes salicylate poisoning, urinary alkalinization is the most appropriate therapy to enhance the elimination of aspirin through the urine. Aspirin is a weak acid that is excreted more rapidly in alkaline urine. By alkalinizing the urine, the renal elimination of aspirin is increased, preventing its accumulation and potential toxicity. Option A) Allopurinol is used to decrease uric acid production in conditions like gout and hyperuricemia, but it is not indicated for aspirin overdose. Option B) Forced diuresis with furosemide is not recommended in aspirin overdose as it can lead to volume depletion and electrolyte imbalances without effectively enhancing aspirin excretion. Option C) Hyperhydration alone without urinary alkalinization may not significantly increase aspirin excretion and could potentially exacerbate electrolyte imbalances. In a pediatric nursing context, understanding the appropriate interventions for toxic ingestions is crucial. Educating healthcare providers on the rationale behind treatments for specific poisonings, like the use of urinary alkalinization in aspirin overdose, ensures safe and effective care for pediatric patients. It is essential to grasp the pharmacokinetics and toxic effects of common medications in children to provide optimal care in emergency situations.