A newborn with meconium aspiration syndrome (MAS) is most at risk for developing:

Correct Answer: A

Rationale: The correct answer is A) Persistent pulmonary hypertension. When a newborn has meconium aspiration syndrome (MAS), which occurs when a baby inhales meconium-stained amniotic fluid into the lungs before or around the time of birth, they are at risk for developing persistent pulmonary hypertension. This is due to the meconium causing inflammation, airway obstruction, and surfactant inactivation in the lungs, leading to pulmonary hypertension. Option B) Neonatal sepsis is incorrect because although MAS can predispose a newborn to infections due to lung inflammation, it is not the most common complication associated with MAS. Option C) Congenital pneumonia is incorrect as meconium aspiration syndrome and pneumonia are two distinct conditions, with MAS involving meconium inhalation rather than a bacterial infection in the lungs. Option D) Surfactant deficiency is incorrect because while MAS can lead to surfactant dysfunction due to meconium inactivation, persistent pulmonary hypertension is a more direct and severe consequence of MAS. In an educational context, understanding the potential complications of MAS is crucial for pediatric nurses to provide appropriate care to newborns at risk. Recognizing the signs and symptoms of persistent pulmonary hypertension in infants with MAS is essential for early intervention and management to improve outcomes for these vulnerable patients.

Correct Answer: C

Rationale: In the context of a neonate with hyperbilirubinemia at risk of kernicterus, the most appropriate intervention is phototherapy (Option C). Phototherapy is the mainstay treatment for neonatal hyperbilirubinemia as it helps to convert unconjugated bilirubin into a water-soluble form that can be excreted from the body. This treatment is effective, non-invasive, and widely used in neonatal care settings. Exchange transfusion (Option A) is a more invasive procedure reserved for severe cases of hyperbilirubinemia that do not respond to phototherapy. It involves replacing the infant's blood with donor blood to rapidly reduce bilirubin levels. Intravenous fluids (Option B) may be used to maintain hydration in neonates with hyperbilirubinemia, but they do not directly address the elevated bilirubin levels. Oral phenobarbital (Option D) is not typically used to treat hyperbilirubinemia in neonates. It may be used in some cases of seizures but is not a first-line treatment for hyperbilirubinemia. In an educational context, it is crucial for pediatric nurses to understand the appropriate interventions for neonates with hyperbilirubinemia to prevent complications like kernicterus. Knowledge of the indications for phototherapy, exchange transfusion, and other treatments is essential for providing safe and effective care to neonates at risk for this condition.

Correct Answer: C

Rationale: In the context of bronchial asthma, the correct answer is C) Chest examination must reveal bilateral wheezes. This statement is false because wheezes in bronchial asthma are typically heard bilaterally and not unilaterally. Wheezes are caused by the turbulent airflow through narrowed airways due to inflammation and constriction, which is a hallmark of asthma. Option A is true as bronchial asthma presents with episodic symptoms of airflow obstruction, leading to wheezing, coughing, and shortness of breath during asthma attacks. Option B is correct because the symptoms of bronchial asthma can be reversed with the administration of β2 agonists, which act as bronchodilators to open up the airways and improve airflow. Option D is also true as inhaled corticosteroids are considered the cornerstone of long-term therapy for bronchial asthma. They work by reducing airway inflammation, which helps in preventing asthma attacks and controlling symptoms over time. Educationally, understanding the characteristics of bronchial asthma, including its symptoms, treatment options, and diagnostic findings like wheezes, is crucial for pediatric nurses caring for children with asthma. Recognizing the correct and incorrect statements about asthma helps nurses provide appropriate care, educate patients and families, and effectively manage asthma in pediatric patients.

Correct Answer: A

Rationale: The correct answer is A) It is audible during the inspiratory phase of breathing. A pleural friction rub is a specific type of lung sound that is typically heard during both the inspiratory and expiratory phases of breathing. This sound is caused by the rubbing together of inflamed pleural surfaces and is usually described as a grating or creaking sound. Therefore, the fact that it is audible during both phases of breathing makes option A incorrect. Option B) It may be associated with pain is a common characteristic of a pleural friction rub. Patients experiencing this lung sound may report chest pain that worsens with breathing or coughing due to the underlying inflammation. Option C) It is unaltered by coughing is incorrect because coughing can sometimes temporarily change or mask the sound of a pleural friction rub. Coughing can disrupt the rubbing of the inflamed pleural surfaces, leading to a temporary reduction in the sound heard. Option D) Better heard with the chest piece of the stethoscope tightly placed over the chest wall is incorrect because a pleural friction rub is usually best heard with the diaphragm of the stethoscope rather than the chest piece. Placing the stethoscope too tightly on the chest wall may dampen the sound rather than enhance it. Educationally, understanding lung sounds like pleural friction rubs is crucial for pediatric nurses as they assess and monitor respiratory conditions in children. Recognizing the characteristics of different lung sounds can help nurses make accurate assessments, provide appropriate interventions, and communicate effectively with healthcare providers about a child's respiratory status.

Correct Answer: D

Rationale: In Basic Life Support (BLS), it is crucial to immobilize the cervical spine if there is a possibility of a spinal cord injury, making option D the correct answer. Immobilizing the cervical spine helps prevent further damage to the spinal cord in case of an injury. This step is essential in emergency situations to ensure the safety and well-being of the patient. Option A, to get the 'sniffing' position, is incorrect as it refers to positioning the patient's head and neck to open the airway during intubation, not for cervical spine immobilization. Option B, to fix oral airway, is also incorrect as it pertains to maintaining a clear airway and is not specific to cervical spine immobilization. Option C, to clear the oropharynx, is important for airway management but does not address the need for cervical spine immobilization in the context of spinal cord injury. In an educational context, understanding the importance of cervical spine immobilization in BLS is critical for healthcare providers, especially those working in pediatric care. Proper training and knowledge in BLS techniques, including spinal immobilization, can make a significant difference in the outcomes of pediatric patients in emergency situations. Healthcare professionals must be well-versed in these techniques to provide effective and safe care to pediatric patients.