A newborn is delivered at 30 weeks gestation and requires respiratory support. Which intervention is most effective in preventing respiratory distress syndrome?

Correct Answer: B

Rationale: In the case of a newborn delivered at 30 weeks gestation requiring respiratory support to prevent respiratory distress syndrome (RDS), the most effective intervention is option B: Surfactant replacement. Surfactant is a substance that coats the alveoli in the lungs and reduces surface tension, preventing alveolar collapse and improving lung compliance. In preterm infants, especially those born before 34 weeks, surfactant production may be insufficient, leading to RDS. Administering exogenous surfactant helps replace this deficiency, improving lung function and reducing the risk of RDS development. Option A, oral corticosteroids, is not the primary intervention for preventing RDS in preterm infants. While corticosteroids may be used in some cases to reduce inflammation and improve lung maturity in the mother before delivery, they are not a direct treatment for RDS in the newborn. CPAP without intubation (Option C) and high-flow nasal cannula (Option D) are both forms of respiratory support, but they may not be as effective as surfactant replacement in preventing RDS in a preterm newborn. While these interventions can provide respiratory support, they may not address the underlying issue of surfactant deficiency in the same way that exogenous surfactant administration does. From an educational standpoint, understanding the pathophysiology of RDS in preterm infants and the role of surfactant in lung function is crucial for pediatric nurses. Knowing the most effective interventions for preventing and managing RDS can improve outcomes for preterm infants and guide nursing care in neonatal intensive care settings. Nurses must be knowledgeable about evidence-based practices to provide safe and effective care for this vulnerable population.

Correct Answer: D

Rationale: In pediatric nursing, understanding the signs and symptoms of respiratory distress is crucial for early recognition and intervention. In this case, the correct answer is D) Diphasic stridor, indicating severe laryngitis. Diphasic stridor is characterized by a high-pitched sound on both inspiration and expiration, which can be a sign of significant airway obstruction. This is a red flag in pediatric patients as it suggests a more severe level of laryngeal inflammation and compromise compared to inspiratory stridor (option A), which is typically seen in milder cases and indicates partial upper airway obstruction. Suprasternal retraction (option B) is a sign of increased work of breathing but is not specific to severe laryngitis. Rhinorrhea (option C) refers to a runny nose and is not directly related to laryngitis unless accompanied by other symptoms. Educationally, understanding these distinctions helps nurses and healthcare providers differentiate between different respiratory presentations in pediatric patients, guiding appropriate treatment and escalation of care. Early recognition of severe laryngitis can prevent respiratory compromise and potentially life-threatening situations in children.

Correct Answer: D

Rationale: In pediatric nursing, understanding raised intracranial pressure (ICP) is crucial as it can lead to serious complications. The correct answer is D) Increased ICP more than 20 mmHg for more than five minutes. This option is correct because an ICP of more than 20 mmHg for an extended period indicates significant intracranial pressure, which can compromise cerebral perfusion and lead to brain damage. Option A) Increased ICP more than 8 mmHg for more than one day is incorrect as an ICP of 8 mmHg is within normal limits and one day is not a clinically significant timeframe for defining raised ICP. Option B) Increased ICP more than 6 mmHg for more than one hour is incorrect as an ICP of 6 mmHg is also within normal limits and one hour is not a significant duration to indicate raised ICP. Option C) Increased ICP more than 10 mmHg for more than one minute is incorrect as a threshold of 10 mmHg is relatively low and one minute is too short a duration to assess raised ICP accurately. Educationally, understanding the correct definition of raised ICP in children is vital for pediatric nurses as early recognition and intervention are essential in preventing complications such as brain herniation. Monitoring ICP levels, recognizing signs of increased ICP, and implementing appropriate interventions are key aspects of pediatric nursing care in managing neurologically compromised children.

Correct Answer: A

Rationale: In pediatric nursing, foreign body aspiration is a critical emergency that requires prompt recognition and intervention. The correct answer, A) History of foreign body aspiration is essential for diagnosis, is not true because often young children may aspirate a foreign body without any witnessed event, hence absence of relevant history. This is why healthcare providers must maintain a high index of suspicion for this condition. Option B) Negative clinical manifestations do not exclude F.B. aspiration, is correct because symptoms can be subtle or absent, making it crucial to consider foreign body aspiration even in the absence of overt clinical signs. Option C) Normal chest X-ray does not exclude F.B. aspiration, is also correct because not all foreign bodies are radiopaque and may not be visualized on an X-ray, necessitating a high level of clinical suspicion and potentially other diagnostic modalities. Option D) When F.B. aspiration is suspected, bronchoscopy must be done, is also correct because bronchoscopy is the definitive diagnostic and therapeutic intervention for foreign body aspiration. In an educational context, it is important for healthcare providers to be aware of the nuances of foreign body aspiration in pediatric patients, as early recognition and management can prevent serious complications such as respiratory distress or even death. Understanding the key clinical presentations, diagnostic modalities, and interventions is crucial for providing safe and effective care to children at risk for foreign body aspiration.

Correct Answer: C

Rationale: In the scenario of drowning, the most urgent immediate line of management at the scene is performing mouth-to-mouth breathing (Option C). This is crucial because in drowning, the primary concern is the lack of oxygen reaching the brain and other vital organs, leading to hypoxia and ultimately cardiac arrest. Mouth-to-mouth breathing helps to provide oxygen to the victim's lungs and subsequently to the bloodstream, improving oxygenation and increasing the chances of survival. Chest compression (Option A) may be needed if the victim has entered cardiac arrest, but without providing oxygen through mouth-to-mouth breathing first, the compressions alone are not as effective. Draining water from the stomach (Option B) and taking off wet clothing (Option D) are not immediate priorities in the management of a drowning victim. Educationally, it is crucial for healthcare providers, first responders, and the general public to understand the correct immediate actions to take in a drowning scenario. Quick and appropriate interventions can significantly impact the outcome for the victim. Training in basic life support techniques, including mouth-to-mouth breathing, should be widely encouraged to equip individuals with the skills needed to respond effectively in emergencies like drowning.