A term infant presents with tachypnea, grunting, and nasal flaring shortly after birth. A chest X-ray shows fluid in the lung fissures. What is the most likely diagnosis?

Correct Answer: C

Rationale: The correct answer is C) Transient tachypnea of the newborn. Transient tachypnea of the newborn (TTN) is a common respiratory condition in term infants. The presentation of tachypnea, grunting, nasal flaring, and chest X-ray findings of fluid in lung fissures are classic signs of TTN. TTN occurs due to delayed reabsorption of fetal lung fluid after birth, leading to respiratory distress. Option A) Neonatal pneumonia typically presents with fever, poor feeding, and signs of systemic infection, which are not described in the scenario. Option B) Respiratory distress syndrome (RDS) is more common in preterm infants and is due to surfactant deficiency. Chest X-ray findings in RDS would show a ground-glass appearance rather than fluid in lung fissures. Option D) Meconium aspiration syndrome is characterized by meconium-stained amniotic fluid, respiratory distress, and possible chemical pneumonitis from meconium aspiration. It does not typically present with the chest X-ray findings described in the scenario. Educationally, understanding the differential diagnoses of respiratory distress in newborns is crucial for pediatric nurses. Recognizing the signs and symptoms of TTN, as well as differentiating it from other conditions, allows for prompt and appropriate management to ensure optimal outcomes for the newborn.

Correct Answer: C

Rationale: In pediatric nursing, understanding the manifestation of atelectasis due to foreign body inhalation is crucial for prompt diagnosis and intervention. In this scenario, the correct answer is C) Percussion note is usually normal. This is because atelectasis, which is the collapse of lung tissue, typically results in a dull percussion note due to the consolidation of lung tissue. Option A) states that the mediastinum is pulled towards the affected side, which can occur due to lung collapse and volume loss. Option B) mentions narrowed intercostal spaces on the affected side, which can be seen as a compensatory mechanism to reduce the volume of the collapsed lung. Option D) indicates reduced breath sounds, which is expected when there is a decrease in air movement in the affected area. Educationally, understanding these clinical signs helps nurses differentiate atelectasis from other respiratory conditions. By recognizing the absence of a dull percussion note in atelectasis due to foreign body inhalation, nurses can provide timely care and prevent potential complications. This knowledge is vital for pediatric nurses working in emergency departments or pediatric clinics where prompt assessment and intervention are critical for positive patient outcomes.

Correct Answer: B

Rationale: In pediatric nursing, understanding the causes of normal anion gap metabolic acidosis is crucial for providing appropriate care to children. 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 acidosis with a normal anion gap. This can occur in children due to various reasons such as genetic disorders or kidney damage. A) Diabetic ketoacidosis is a high anion gap metabolic acidosis commonly seen in children with diabetes mellitus. It is characterized by the presence of ketones in the blood. C) Lactic acidosis is another high anion gap metabolic acidosis that can occur in children due to conditions such as sepsis, shock, or hypoxia. It is characterized by elevated levels of lactic acid in the blood. D) Salicylate poisoning can also lead to high anion gap metabolic acidosis in children. Salicylates can cause metabolic acidosis by directly affecting cellular metabolism. Educationally, understanding the different causes of metabolic acidosis in children is essential for nurses to accurately assess and provide appropriate interventions. Recognizing the specific etiologies of acid-base disorders allows for targeted treatment and management strategies to improve patient outcomes.

Correct Answer: D

Rationale: In pediatric nursing practice, understanding the characteristics of lobar pneumonia is crucial for accurate assessment and intervention. In this case, option D, "Hyper-resonance on percussion," is the correct answer as it is not typically associated with lobar pneumonia. Lobar pneumonia is characterized by consolidation of a lobe of the lung, leading to specific clinical findings. Bronchial breathing (Option A) is a classic sign, indicating consolidation and loss of air in the alveoli. Fine consonating crepitations (Option B) are commonly heard due to the movement of thick secretions in the consolidated lobe. Increased vocal resonance (Option C) occurs due to the solid nature of the lung tissue, enhancing sound transmission. Understanding these distinctions is vital for nurses caring for pediatric patients with respiratory conditions. Recognizing these clinical manifestations aids in early identification, prompt treatment, and prevention of complications associated with lobar pneumonia in children. By differentiating these signs, nurses can provide timely and appropriate care to improve patient outcomes.

Correct Answer: D

Rationale: In pediatric nursing, understanding the causes of unilateral dilated fixed pupil is crucial for timely and accurate assessment and intervention. The correct answer is D) Tentorial herniation. Tentorial herniation occurs when there is displacement of brain tissue through the tentorial notch, resulting in compression of the oculomotor nerve. This compression leads to a unilateral dilated fixed pupil on the affected side. Option A) Narcotics can cause bilateral fixed pupils, not unilateral. Narcotics affect the central nervous system and can lead to miosis (constricted pupils) rather than mydriasis (dilated pupils). Option B) Organophosphates typically cause miosis due to their effects on the muscarinic receptors, leading to excessive parasympathetic stimulation and constricted pupils. Option C) Anticholinergics cause mydriasis bilaterally due to their blockade of acetylcholine receptors, resulting in dilated pupils on both sides rather than unilaterally. Educational context: Understanding the etiology of unilateral dilated fixed pupil is essential in pediatric nursing to differentiate between various possible causes, such as traumatic brain injury, intracranial hemorrhage, or herniation syndromes. Recognizing this clinical sign promptly can guide appropriate interventions and prevent potential complications.