A newborn presents with respiratory distress, scaphoid abdomen, and decreased breath sounds on the left. What is the most likely diagnosis?

Correct Answer: C

Rationale: The most likely diagnosis for the newborn presenting with respiratory distress, scaphoid abdomen, and decreased breath sounds on the left is Congenital Diaphragmatic Hernia (CDH). Rationale for the correct answer (C): CDH is a condition where there is a defect in the diaphragm, allowing abdominal contents to herniate into the chest cavity, leading to pulmonary hypoplasia and respiratory compromise. The scaphoid abdomen is a classic sign due to the abdominal contents being pushed into the thoracic cavity. Decreased breath sounds on the affected side are due to lung compression by the herniated viscera. Rationale for why the other options are wrong: A) Transient tachypnea of the newborn is characterized by respiratory distress shortly after birth due to delayed clearance of fetal lung fluid. It does not typically present with a scaphoid abdomen or decreased breath sounds on one side. B) Meconium aspiration syndrome occurs when a newborn inhales meconium-stained amniotic fluid, leading to respiratory distress. It may present with meconium in the airway but not with a scaphoid abdomen. D) Neonatal pneumonia presents with signs of infection such as fever, tachypnea, and respiratory distress, but it does not typically cause a scaphoid abdomen or decreased breath sounds on one side. Educational context: Understanding the different respiratory conditions affecting newborns is crucial for pediatric nurses. Recognizing the signs and symptoms of CDH is essential for early identification and prompt intervention to optimize outcomes for the newborn. This case highlights the importance of a thorough assessment and knowledge of neonatal conditions in pediatric nursing practice.

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 causes of wheezing in infants is crucial for providing effective care. In this question, the correct answer is D) Hypocalcemia. Wheezing in infancy can be caused by various conditions, with hypocalcemia being a less common cause compared to the other options. Hypocalcemia, a low level of calcium in the blood, can lead to muscle spasms and laryngospasm but is not a typical cause of wheezing in infancy. Bronchiolitis (Option A) is a common viral respiratory infection that often leads to wheezing in infants. Asthma (Option B) is a chronic respiratory condition characterized by wheezing and is common in older children but can also present in infants. Gastroesophageal reflux (Option C) can lead to wheezing when stomach contents flow back into the esophagus and irritate the airways. Educationally, understanding the differential diagnosis of wheezing in infants is essential for nurses working in pediatric settings. By recognizing the various causes, nurses can provide timely and appropriate interventions to manage respiratory issues in infants effectively. This knowledge helps in assessing, planning, and implementing care plans tailored to the specific underlying cause of wheezing, promoting better outcomes for pediatric patients.

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.