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 scenario, the most likely diagnosis for a neonate presenting with cyanosis that worsens with feeding and improves with crying is choanal atresia, making option D the correct answer. Choanal atresia is a congenital condition where there is a blockage of the nasal passage due to bony or membranous tissue, leading to difficulty breathing through the nose. When the neonate cries, they are able to improve oxygenation by breathing through their mouth, alleviating the cyanosis temporarily. Option A, Tetralogy of Fallot, is characterized by a set of four heart defects and typically presents with cyanosis that is not influenced by crying or feeding. Option B, Respiratory distress syndrome, usually presents with respiratory distress, tachypnea, and grunting, rather than the specific cyanosis pattern described in the question. Option C, Transposition of the great arteries, would present with severe cyanosis from birth and would not typically improve with crying. Educationally, understanding the different presentations of cyanosis in neonates is crucial for pediatric nurses to provide timely and appropriate care. Recognizing the specific signs and symptoms associated with various conditions allows for prompt intervention and treatment, ultimately improving patient outcomes. It is essential for nurses to have a solid foundation in pediatric conditions to accurately assess, diagnose, and intervene in neonatal emergencies.

Correct Answer: D

Rationale: In pediatric nursing, understanding acute bronchiolitis is crucial due to its prevalence and impact on infants. The correct answer, option D, states that the disease is more benign in infants born prematurely. This is incorrect because infants born prematurely are actually at higher risk for severe bronchiolitis due to their underdeveloped immune systems and respiratory function. Option A is true because epidemics of bronchiolitis often occur during winter when respiratory viruses are more prevalent. Option B is correct as the disease primarily affects infants younger than 2 years of age due to their smaller airways and immature immune systems. Option C is incorrect because ribavirin is not recommended for routine treatment of acute bronchiolitis, and immunodeficiency is not an indication for its use. Educationally, this question highlights the importance of understanding the specific characteristics of acute bronchiolitis in pediatric patients. It emphasizes the need for nurses to be knowledgeable about risk factors, clinical manifestations, and evidence-based treatments for this common respiratory condition in infants. By understanding these key points, nurses can provide optimal care and support to pediatric patients with acute bronchiolitis.

Correct Answer: C

Rationale: In pediatric nursing, understanding the manifestation of atelectasis due to foreign body inhalation is crucial for prompt diagnosis and intervention. In this scenario, the correct answer is C) Percussion note is usually normal. This is because atelectasis, which is the collapse of lung tissue, typically results in a dull percussion note due to the consolidation of lung tissue. Option A) states that the mediastinum is pulled towards the affected side, which can occur due to lung collapse and volume loss. Option B) mentions narrowed intercostal spaces on the affected side, which can be seen as a compensatory mechanism to reduce the volume of the collapsed lung. Option D) indicates reduced breath sounds, which is expected when there is a decrease in air movement in the affected area. Educationally, understanding these clinical signs helps nurses differentiate atelectasis from other respiratory conditions. By recognizing the absence of a dull percussion note in atelectasis due to foreign body inhalation, nurses can provide timely care and prevent potential complications. This knowledge is vital for pediatric nurses working in emergency departments or pediatric clinics where prompt assessment and intervention are critical for positive patient outcomes.

Correct Answer: B

Rationale: In pediatric nursing, understanding the causes of normal anion gap metabolic acidosis is crucial for providing appropriate care to children. 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 acidosis with a normal anion gap. This can occur in children due to various reasons such as genetic disorders or kidney damage. A) Diabetic ketoacidosis is a high anion gap metabolic acidosis commonly seen in children with diabetes mellitus. It is characterized by the presence of ketones in the blood. C) Lactic acidosis is another high anion gap metabolic acidosis that can occur in children due to conditions such as sepsis, shock, or hypoxia. It is characterized by elevated levels of lactic acid in the blood. D) Salicylate poisoning can also lead to high anion gap metabolic acidosis in children. Salicylates can cause metabolic acidosis by directly affecting cellular metabolism. Educationally, understanding the different causes of metabolic acidosis in children is essential for nurses to accurately assess and provide appropriate interventions. Recognizing the specific etiologies of acid-base disorders allows for targeted treatment and management strategies to improve patient outcomes.

Correct Answer: D

Rationale: In pediatric nursing practice, understanding the characteristics of lobar pneumonia is crucial for accurate assessment and intervention. In this case, option D, "Hyper-resonance on percussion," is the correct answer as it is not typically associated with lobar pneumonia. Lobar pneumonia is characterized by consolidation of a lobe of the lung, leading to specific clinical findings. Bronchial breathing (Option A) is a classic sign, indicating consolidation and loss of air in the alveoli. Fine consonating crepitations (Option B) are commonly heard due to the movement of thick secretions in the consolidated lobe. Increased vocal resonance (Option C) occurs due to the solid nature of the lung tissue, enhancing sound transmission. Understanding these distinctions is vital for nurses caring for pediatric patients with respiratory conditions. Recognizing these clinical manifestations aids in early identification, prompt treatment, and prevention of complications associated with lobar pneumonia in children. By differentiating these signs, nurses can provide timely and appropriate care to improve patient outcomes.