A neonate presents with cyanosis that worsens with feeding and improves with crying. What is the most likely diagnosis?

Correct Answer: D

Rationale: In this case, the correct answer is D) Choanal atresia. Choanal atresia is a congenital condition where there is a blockage or narrowing of the back of the nasal passage by abnormal bony or soft tissue. The presentation of worsening cyanosis with feeding (due to increased nasal breathing demand) and improvement with crying (due to mouth breathing) is classic for choanal atresia. Option A) Tetralogy of Fallot typically presents with cyanosis that is not specifically related to feeding or crying. Option B) Respiratory distress syndrome usually presents with respiratory distress, tachypnea, and retractions without the specific pattern described in the question. Option C) Transposition of the great arteries presents with profound cyanosis immediately after birth and is not typically influenced by feeding or crying. Educationally, understanding the distinct clinical presentations of pediatric conditions is vital in providing appropriate care as a nurse. Recognizing the specific signs and symptoms of conditions like choanal atresia can lead to early diagnosis and intervention, ultimately improving patient outcomes. This question highlights the importance of considering congenital abnormalities in neonates presenting with cyanosis.

Correct Answer: D

Rationale: In the context of pediatric nursing, understanding acute bronchiolitis is crucial for providing effective care to infants. The correct answer, D, states that the disease is more benign in infants born prematurely. This is false because premature infants are actually at a higher risk for severe complications from bronchiolitis due to their underdeveloped respiratory systems. Option A is true as epidemics of acute bronchiolitis often occur during winter months due to increased viral activity and close contact among individuals indoors. Option B is accurate as the disease predominantly affects infants younger than 2 years old, with a peak incidence around 3-6 months of age. Option C is incorrect because immunodeficiency is not an indication for treatment with ribavirin in acute bronchiolitis. Ribavirin is reserved for severe cases and is not routinely recommended due to limited efficacy and potential side effects. Educationally, it is important for nurses to have a solid understanding of acute bronchiolitis, including risk factors, clinical manifestations, and appropriate management strategies. By knowing the key facts about the condition, nurses can provide prompt and effective care, educate families on prevention measures, and recognize when to escalate care for infants with severe bronchiolitis symptoms.

Correct Answer: C

Rationale: In the case of atelectasis due to foreign body inhalation, the correct answer is C) Percussion note is usually normal. A normal percussion note indicates that there is no dullness or abnormal density in the affected area of the lung. This is because atelectasis is characterized by the collapse or closure of a lung or part of a lung, leading to reduced air exchange in that area. Therefore, the percussion note would typically be normal as there is no consolidation or fluid present. Option A) Mediastinum is pulled towards the affected side is incorrect because in atelectasis, the mediastinum typically shifts towards the unaffected side due to the collapse of the affected lung. Option B) Intercostal spaces on the affected side may be narrowed is incorrect because atelectasis does not specifically cause narrowing of intercostal spaces. Instead, it leads to reduced breath sounds and potential chest retractions. Option D) Breath sounds are reduced is correct in atelectasis due to foreign body inhalation as the collapsed lung area would result in diminished or absent breath sounds upon auscultation. In an educational context, understanding the characteristics of atelectasis due to foreign body inhalation is crucial for pediatric nurses to assess and manage respiratory conditions promptly and effectively in children. Recognizing the clinical manifestations and differentiating them from other respiratory conditions is essential for providing appropriate care and interventions to prevent complications associated with atelectasis.

Correct Answer: B

Rationale: In this pediatric nursing practice question, the correct answer is B) Renal tubular acidosis. Renal tubular acidosis is a condition where the kidneys are unable to effectively excrete acids into the urine, leading to a normal anion gap metabolic acidosis. This occurs due to defects in the renal tubules that impair acid-base regulation. A) Diabetic ketoacidosis is a high anion gap metabolic acidosis caused by the accumulation of ketones in the blood due to insulin deficiency in diabetes. C) Lactic acidosis is also a high anion gap metabolic acidosis caused by the accumulation of lactic acid, often seen in conditions like sepsis or hypoperfusion. D) Salicylate poisoning can lead to high anion gap metabolic acidosis due to the toxic effects of salicylates on cellular metabolism. Educationally, understanding the different types of metabolic acidosis and their underlying causes is crucial for pediatric nurses to assess and manage patients effectively. Recognizing the specific characteristics of normal anion gap metabolic acidosis, such as in renal tubular acidosis, helps in providing appropriate interventions and treatment to pediatric patients with this condition.

Correct Answer: D

Rationale: In pediatric nursing, understanding the characteristics of lobar pneumonia is crucial for accurate assessment and treatment. In this case, the correct answer is D) Hyper-resonance on percussion. Lobar pneumonia typically presents with bronchial breathing (A), fine consonating crepitations (B), and increased vocal resonance (C) due to consolidation of a lobe of the lung. Hyper-resonance on percussion (D) is not a typical finding in lobar pneumonia; instead, it is associated with conditions like emphysema where there is increased air in the lung causing a hyper-resonant sound. By recognizing this distinction, nurses can differentiate between various respiratory conditions and provide appropriate care. Educationally, this question helps reinforce the importance of assessing lung sounds, vocal resonance, and percussion findings in pediatric patients with respiratory conditions. Understanding these nuances can guide nursing interventions, such as positioning, respiratory treatments, and monitoring for complications like respiratory distress. By explaining these distinctions, nurses can enhance their clinical reasoning skills and provide optimal care for pediatric patients with respiratory conditions.