A preterm infant develops sudden onset respiratory distress with decreased breath sounds and increased transillumination on one side. What is the most likely diagnosis?

Correct Answer: C

Rationale: In this scenario, the most likely diagnosis for a preterm infant with sudden onset respiratory distress, decreased breath sounds, and increased transillumination on one side is C) Pneumothorax. Pneumothorax occurs when air enters the pleural space, leading to lung collapse and subsequent respiratory distress. The decreased breath sounds and increased transillumination are indicative of air accumulation in the pleural space, supporting the diagnosis of pneumothorax in this case. A) Transient tachypnea of the newborn is characterized by respiratory distress shortly after birth due to retained lung fluid, typically improving within 24-72 hours without the need for specific interventions. The absence of breath sounds and transillumination findings make this choice less likely. B) Meconium aspiration syndrome occurs when a newborn inhales meconium-stained amniotic fluid, leading to airway obstruction and respiratory distress. This condition is not typically associated with the unilateral presentation described in the question. D) Neonatal pneumonia can present with respiratory distress in infants but is less likely in this case due to the unilateral findings and sudden onset of symptoms, which are more characteristic of pneumothorax. Educationally, understanding the clinical manifestations and differential diagnoses of respiratory distress in neonates is crucial for pediatric nurses. Recognizing the signs and symptoms of pneumothorax and differentiating it from other common conditions allows for prompt diagnosis and intervention, ultimately improving patient outcomes.

Correct Answer: C

Rationale: The most likely diagnosis for the term infant presenting with tachypnea, grunting, nasal flaring, and fluid in the lung fissures shortly after birth is option C) Transient tachypnea of the newborn (TTN). Rationale for the correct answer: Transient tachypnea of the newborn is a common condition characterized by respiratory distress due to delayed clearance of fetal lung fluid. This results in tachypnea, grunting, and nasal flaring. Chest X-ray findings typically show fluid in the lung fissures, which is consistent with the presentation described in the question. Rationale for why others are wrong: A) Neonatal pneumonia would typically present with other symptoms such as fever, poor feeding, and respiratory distress not solely due to delayed clearance of lung fluid. B) Respiratory distress syndrome is more common in preterm infants and is due to surfactant deficiency, presenting with a ground-glass appearance on chest X-ray. D) Meconium aspiration syndrome would present with meconium-stained amniotic fluid, respiratory distress, and possible pneumothorax, which are not mentioned in the scenario provided. Educational context: Understanding common neonatal respiratory conditions is crucial for pediatric nurses as timely recognition and appropriate management can significantly impact outcomes. Transient tachypnea of the newborn is typically a self-limiting condition that improves with supportive care, such as oxygen therapy and close monitoring. Nurses play a vital role in assessing and managing neonates with respiratory distress to ensure optimal care and outcomes.

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.