All are true about massive pleural effusion except:

Correct Answer: C

Rationale: In the context of pediatric nursing, understanding pleural effusion is crucial for providing quality care to pediatric patients. In this question, the correct answer is C) Tactile vocal fremitus is increased. The rationale for why this is the correct answer lies in the pathophysiology of pleural effusion. Pleural effusion refers to the accumulation of fluid in the pleural space, which can lead to increased tactile vocal fremitus due to the consolidation of the lung tissue caused by the fluid. This increased fremitus can be detected during a physical examination. Now let's analyze why the other options are incorrect: A) Trachea is shifted to the opposite side: This is a classic sign of a tension pneumothorax, not pleural effusion. B) Overlying stony dullness: This is a characteristic finding on percussion in pleural effusion, indicating a fluid-filled space. D) It may be complicated by purulent pericarditis: Pleural effusion is not typically associated with purulent pericarditis; this complication is more commonly seen in conditions like pneumonia or empyema. Educationally, understanding the clinical manifestations and complications of pleural effusion is vital for nurses caring for pediatric patients. Recognizing the signs and symptoms can aid in early detection and appropriate management, ultimately improving patient outcomes. This question reinforces the importance of thorough assessment and knowledge of pediatric respiratory conditions.

Correct Answer: C

Rationale: In cases of drowning, the most urgent immediate line of management at the scene is option C) Mouth-to-mouth breathing. This is the correct answer because in drowning, the primary concern is the lack of oxygen reaching the lungs due to water entering the airway. Performing mouth-to-mouth breathing helps to deliver much-needed oxygen to the individual's lungs and can be life-saving in this situation. Option A) Chest compression is not the most urgent immediate line of management in drowning cases because the priority is to address the lack of oxygen rather than circulation issues. Option B) Draining water from the stomach is not the most urgent immediate action to take because the main problem in drowning is not the water in the stomach but the lack of oxygen reaching the lungs. Option D) Taking off wet clothing, while important for preventing hypothermia and assessing injuries, is not the most urgent immediate line of management in drowning cases. Educationally, understanding the correct response in a drowning scenario is crucial for healthcare providers, especially those working in pediatric nursing where drowning incidents are more common. Knowing the correct sequence of actions can significantly impact patient outcomes and potentially save lives. Practicing scenarios and staying updated on the latest resuscitation guidelines are essential for healthcare professionals working in pediatric settings.

Correct Answer: B

Rationale: Expiratory grunting is a common sign seen in pediatric patients with pneumonia. This occurs due to the child's attempt to force air out of the lungs against the increased resistance caused by the infection in the alveoli. The grunting sound is produced during expiration when the child tries to keep the alveoli open to prevent them from collapsing, indicating respiratory distress. Asthma exacerbation (Option A) typically presents with wheezing rather than expiratory grunting. Wheezing is caused by narrowed airways due to bronchoconstriction, not the same mechanism seen in pneumonia. Pleural effusion (Option C) is characterized by decreased breath sounds and dullness to percussion on physical examination, rather than expiratory grunting. Croup (Option D) is associated with a barking cough, stridor, and respiratory distress, but not specifically expiratory grunting. In an educational context, understanding these respiratory signs and symptoms is crucial for pediatric nurses to accurately assess and provide appropriate interventions for children with respiratory conditions. Recognizing the significance of expiratory grunting in pneumonia can aid in early detection and prompt management to prevent respiratory compromise in pediatric patients.

Correct Answer: D

Rationale: In pediatric nursing, understanding the early manifestations of hypoxemia in young infants is crucial for timely intervention. The correct answer is D) Irritability. Infants, especially young ones, often display irritability as an early sign of hypoxemia. This is due to their inability to effectively communicate or verbalize discomfort, leading to increased fussiness and irritability. Option A) Cyanosis is typically a late sign of hypoxemia in infants, appearing after significant oxygen deprivation has occurred. It manifests as a bluish discoloration of the skin and mucous membranes and indicates severe oxygen deficiency. Option B) Glasgow Coma Score of six is not specific to hypoxemia in infants. It is a tool used to assess neurological status and is not directly related to respiratory distress or oxygenation. Option C) Irregular breathing can be a sign of distress in infants, but it is not specific to hypoxemia. Irregular breathing patterns can be caused by various factors such as infection, airway obstruction, or central nervous system issues. Educationally, it is essential for healthcare providers working with infants to recognize subtle signs of hypoxemia to prevent complications. Understanding these early manifestations can lead to prompt interventions such as providing supplemental oxygen or addressing underlying respiratory issues. Regular training and review of pediatric nursing principles are vital to ensure healthcare professionals can effectively assess and respond to the needs of their young patients.

Correct Answer: C

Rationale: Metabolic acidosis with a large anion gap can result from an excess of unmeasured anions in the blood. In the context of the given options, a salicylate overdose is a likely cause of this condition. Salicylate is an organic acid that can lead to metabolic acidosis by increasing the anion gap. Option A, diarrhea, typically causes a non-anion gap metabolic acidosis due to bicarbonate loss. Option B, renal failure on regular dialysis, can lead to acidosis but is usually not associated with a large anion gap. Option D, severe chronic iron deficiency anemia, is not a common cause of metabolic acidosis with a large anion gap. In an educational context, understanding the causes of metabolic acidosis is crucial for pediatric nurses as they care for children with various health conditions. Recognizing the specific etiology of acid-base disorders is essential for accurate assessment, diagnosis, and appropriate intervention to ensure optimal patient outcomes. This question reinforces the importance of differentiating between causes of metabolic acidosis in pediatric patients, enhancing the nurse's critical thinking skills and clinical knowledge.