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 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: 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.

Correct Answer: D

Rationale: In pediatric nursing, understanding the characteristics of lobar pneumonia is crucial for accurate assessment and treatment. In this case, the correct answer is D) Hyper-resonance on percussion. Lobar pneumonia typically presents with bronchial breathing (A), fine consonating crepitations (B), and increased vocal resonance (C) due to consolidation of a lobe of the lung. Hyper-resonance on percussion (D) is not a typical finding in lobar pneumonia; instead, it is associated with conditions like emphysema where there is increased air in the lung causing a hyper-resonant sound. By recognizing this distinction, nurses can differentiate between various respiratory conditions and provide appropriate care. Educationally, this question helps reinforce the importance of assessing lung sounds, vocal resonance, and percussion findings in pediatric patients with respiratory conditions. Understanding these nuances can guide nursing interventions, such as positioning, respiratory treatments, and monitoring for complications like respiratory distress. By explaining these distinctions, nurses can enhance their clinical reasoning skills and provide optimal care for pediatric patients with respiratory conditions.

Correct Answer: D

Rationale: In pediatric nursing, understanding the etiology of unilateral dilated fixed pupils is crucial for prompt and effective intervention. The correct answer is D) Tentorial herniation. When a child experiences tentorial herniation, increased intracranial pressure causes the brain to herniate through the tentorium cerebelli, resulting in compression of the oculomotor nerve. This compression leads to unilateral dilated fixed pupil, a critical neurological sign indicating impending herniation and brainstem compromise. Option A) Narcotics may cause bilateral pinpoint pupils, not unilateral dilated fixed pupil. Option B) Organophosphates typically manifest as miosis, not mydriasis. Option C) Anticholinergics can cause bilateral dilated pupils but not specifically unilateral dilated fixed pupil. In an educational context, this question highlights the importance of recognizing neurological signs in pediatric patients. Understanding the specific causes of unilateral dilated fixed pupils can guide nurses in assessing and managing children with neurological emergencies effectively. By grasping these nuances, pediatric nurses can provide timely interventions and prevent further deterioration in patients with critical conditions such as tentorial herniation.