An 18-month-old child presented with a second attack of sudden onset of harsh barking cough, hoarseness, and inspiratory stridor at night without a significant upper respiratory tract prodrome. Of the following, The MOST likely diagnosis is

Correct Answer: C

Rationale: The correct answer is C) Spasmodic croup. In this scenario, the child's presentation of sudden harsh barking cough, hoarseness, and inspiratory stridor at night without a preceding upper respiratory tract infection suggests spasmodic croup. This condition typically occurs at night, has a sudden onset, and is characterized by intermittent episodes of stridor and barking cough. A) Bacterial tracheitis: This condition usually presents with high fever, toxic appearance, and purulent secretions, which are not seen in this case. B) Epiglottitis: Epiglottitis is a medical emergency that presents with high fever, drooling, dysphagia, and a muffled voice. It is unlikely in this case due to the absence of these symptoms. D) Laryngotracheobronchitis (LTB): LTB typically presents with a gradual onset of symptoms, including fever, cough, and stridor. The sudden onset and intermittent nature of symptoms in this case make LTB less likely. Educational context: Understanding the distinct clinical presentations of pediatric respiratory conditions is crucial for nurses taking the NCLEX and for providing safe and effective care to pediatric patients. Recognizing the specific signs and symptoms of conditions like croup, tracheitis, epiglottitis, and LTB is essential for accurate diagnosis and timely intervention.

Correct Answer: A

Rationale: In older patients with cystic fibrosis, pneumonia is usually caused by Pseudomonas aeruginosa (Option A). This bacterium is commonly found in the respiratory tracts of individuals with cystic fibrosis due to the thick, sticky mucus that characterizes the condition. Pseudomonas aeruginosa is known for its ability to thrive in such environments and can lead to recurrent infections and worsening respiratory symptoms in these patients. Staphylococcus aureus (Option B) is more commonly associated with skin and soft tissue infections rather than pneumonia in cystic fibrosis patients. Chlamydia trachomatis (Option C) is a bacterium that typically causes sexually transmitted infections and is not a common cause of pneumonia in this population. Mycoplasma pneumoniae (Option D) is more commonly associated with atypical pneumonia in children and young adults, not typically seen in older patients with cystic fibrosis. Educationally, understanding the specific pathogens that commonly cause pneumonia in patients with cystic fibrosis is crucial for nurses and other healthcare providers. This knowledge helps in selecting appropriate treatment strategies, monitoring for complications, and educating patients and their families on infection prevention practices. Being able to differentiate between various pathogens and their associated conditions is essential for providing safe and effective care to this patient population.

Correct Answer: C

Rationale: The correct answer is C) Chlamydia trachomatis. Mild eosinophilia is characteristic of infantile pneumonia caused by Chlamydia trachomatis due to the immune response it triggers in the body. Chlamydia trachomatis is an intracellular bacterium that commonly causes pneumonia in infants, leading to symptoms such as cough, wheezing, and respiratory distress. Option A) Pseudomonas aeruginosa is a common pathogen in healthcare-associated pneumonia, particularly in immunocompromised individuals, but it does not typically cause infantile pneumonia associated with eosinophilia. Option B) Staphylococcus aureus is a common cause of skin and soft tissue infections, as well as respiratory infections in certain populations, but it is not typically associated with infantile pneumonia characterized by eosinophilia. Option D) Mycoplasma pneumoniae is a common cause of atypical pneumonia in older children and adults, but it is less commonly associated with infantile pneumonia and eosinophilia. Educationally, understanding the characteristic features of different pathogens causing pneumonia in pediatric patients is crucial for nurses who care for children with respiratory infections. Recognizing the specific signs and symptoms associated with different pathogens can aid in early identification, appropriate treatment, and improved patient outcomes. Eosinophilia, in the context of infantile pneumonia, can provide valuable diagnostic clues for healthcare providers.

Correct Answer: A

Rationale: Hypercarbic respiratory failure occurs when there is an excess of carbon dioxide in the blood, often due to inadequate ventilation. In the context of the options provided, interstitial lung disease (Option A) is the correct answer because it can lead to impaired gas exchange and retention of carbon dioxide, resulting in hypercarbia. Option B, Croup, is a condition characterized by upper airway inflammation, typically affecting children. While it can cause respiratory distress, it is more associated with airway obstruction rather than impaired gas exchange leading to hypercarbia. Option C, Bronchiolitis, is a viral infection that primarily affects the small airways in the lungs. It can lead to respiratory distress and hypoxemia (low oxygen levels) but is less likely to cause hypercarbia compared to interstitial lung disease. Option D, Fungal pneumonia, is an infection of the lungs caused by fungi. While it can severely compromise respiratory function and oxygen exchange, it is not commonly associated with hypercarbic respiratory failure. Educationally, understanding the etiology and pathophysiology of different respiratory conditions is crucial for nurses caring for pediatric patients. Recognizing the signs and symptoms of hypercarbic respiratory failure and understanding the underlying conditions that can lead to this complication is essential for providing effective and timely interventions to optimize patient outcomes.

Correct Answer: D

Rationale: The correct answer is D) 70 mEq/L for the sweat chloride test to be considered positive for cystic fibrosis (CF). This test is used to measure the amount of chloride in sweat, as individuals with CF have higher levels of chloride due to the dysfunctional CFTR gene. A result of 70 mEq/L or higher indicates a positive test for CF. Option A) 40 mEq/L is incorrect because this level is below the threshold for a positive result in the sweat chloride test for CF. Option B) 50 mEq/L is also below the threshold. Option C) 60 mEq/L is closer but still below the critical value of 70 mEq/L that indicates a positive test for CF. Educational context: Understanding the diagnostic tests for cystic fibrosis, such as the sweat chloride test, is crucial for pediatric nurses working with children who may have this genetic condition. By knowing the correct threshold for a positive result, nurses can assist in the early identification and management of CF in pediatric patients. This knowledge is essential for providing optimal care and support to children and families affected by cystic fibrosis.