A systolic ejection murmur at upper left parasternal associated with ejection click is best heard with:

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Valvular pulmonary stenosis. A systolic ejection murmur at the upper left sternal border with an associated ejection click is classic for valvular pulmonary stenosis. This murmur is caused by the turbulent blood flow across the pulmonary valve during systole, and the ejection click is produced by the opening of the valve. Option A) Aortic stenosis typically presents with a systolic murmur at the right upper sternal border and may have a paradoxical split S2. Option C) Infundibular pulmonary stenosis is associated with a harsh systolic ejection murmur at the left upper sternal border but does not have an associated ejection click. Option D) Ventricular septal defect (VSD) typically presents with a holosystolic murmur heard best at the lower left sternal border and does not usually have an associated ejection click. Understanding the characteristics of different heart murmurs and associated findings is crucial for clinical nurses specializing in pediatrics. Recognizing specific murmur patterns can help in the early identification and management of congenital heart defects in pediatric patients. This knowledge is essential for providing quality care and improving patient outcomes.

Correct Answer: B

Rationale: In infants with a large ventricular septal defect (VSD), normal growth parameters are not typically seen due to increased metabolic demand and inadequate caloric intake. Therefore, Option B is correct as it is not suggestive of a large VSD. Option A, recurrent bronchopulmonary infection, is often seen in infants with large VSD due to increased pulmonary blood flow and susceptibility to respiratory infections. Option C, cardiomegaly with pulmonary plethora on plain chest radiography, is a common finding in infants with large VSD due to the volume overload on the heart leading to enlargement and increased blood flow to the lungs. Option D, a local pulmonary component of the second heart sound, is also typical in infants with large VSD due to increased blood flow through the defect. Educationally, understanding the clinical features of large VSD in infants is crucial for pediatric clinical nurse specialists to provide timely and appropriate care. Recognizing these features helps in early identification, management, and referral for further evaluation and treatment, ultimately improving patient outcomes.

Correct Answer: D

Rationale: The correct answer is D) Spirometry. Spirometry is the most appropriate test in this scenario because the symptoms of cough worse at night and with exercise suggest possible asthma, which is a common condition in children. Spirometry measures lung function, specifically airflow and volume, which can help diagnose asthma by identifying any obstruction in the airways. Option A) Barium swallow is not indicated for evaluating a chronic cough associated with asthma-like symptoms as it is used to assess the esophagus and swallowing function. Option B) Bronchoscopy is an invasive procedure that examines the airways directly and is not typically the initial diagnostic test for asthma in a child with this presentation. Option C) Chest radiograph may show findings consistent with asthma such as hyperinflation or peribronchial thickening but is not as specific or sensitive as spirometry for diagnosing asthma. Educationally, understanding the appropriate diagnostic tests for common pediatric conditions like asthma is crucial for pediatric clinical nurse specialists to provide timely and accurate care to their young patients. Spirometry not only aids in diagnosing asthma but also helps in monitoring disease progression and treatment efficacy.

Correct Answer: D

Rationale: The correct answer is D) Respiratory syncytial virus (RSV). RSV is the most common viral cause of lower respiratory tract infections in infants and young children. It often presents with symptoms like cough, tachypnea, and wheezing, especially in the winter months. RSV can cause bronchiolitis and pneumonia in this age group. Option A) Adenovirus typically presents with symptoms like fever, sore throat, and conjunctivitis, rather than the respiratory symptoms described in the case. Option B) Influenza can cause respiratory symptoms but is less common in infants compared to RSV. Influenza is more likely to present with systemic symptoms like fever, muscle aches, and fatigue. Option C) Parainfluenza virus can cause croup, a condition characterized by a barking cough and hoarseness, which is different from the wheezing described in the case. Educationally, understanding the common viral causes of respiratory infections in pediatric patients is crucial for clinical nurse specialists to provide timely and appropriate care. Recognizing the specific presentations of each virus helps in accurate diagnosis and management, including infection control measures and supportive care tailored to the specific viral pathogen.

Correct Answer: B

Rationale: The correct answer is B) Gastroschisis. In this condition, the abdominal wall does not close completely, leading to intestines protruding through a hole next to the umbilical cord. Unlike omphalocele, where the intestines are covered by a sac, gastroschisis involves exposed bowel without a protective covering. Option A) Omphalocele is incorrect because in omphalocele, the abdominal organs are covered by a sac that protrudes through the belly button. Option C) Congenital diaphragmatic hernia involves a defect in the diaphragm leading to abdominal organs moving into the chest cavity, not outside the abdominal wall. Option D) Hirschsprung disease is a condition where there is a lack of nerve cells in the muscles of part of the colon, leading to difficulty passing stool. It is unrelated to abdominal wall defects. In an educational context, understanding these distinctions is crucial for pediatric clinical nurse specialists to provide accurate assessments and interventions for neonates with different congenital anomalies. Recognizing the specific features of each condition allows for appropriate care planning and management to optimize outcomes for these vulnerable patients.