An 18-year-old female presents with an acute onset of chest pain, tachypnea, and cyanosis 1 week after the birth of her first child. Her chest radiograph is nondiagnostic, but her Pao, is 60 mm Hg on 40% oxygen. The most likely diagnosis is

Correct Answer: C

Rationale: The correct answer is C) a pulmonary embolism. In this case, the clinical presentation of an 18-year-old female with chest pain, tachypnea, cyanosis, and a Pao2 of 60 mm Hg on 40% oxygen suggests a pulmonary embolism. This condition occurs when a blood clot travels to the lungs, obstructing blood flow and causing respiratory distress. Option A) pre-eclampsia is unlikely as the symptoms described are more indicative of a pulmonary issue rather than a hypertensive disorder related to pregnancy. Option B) Legionella pneumonia is less likely as the symptoms and presentation do not align with typical pneumonia symptoms such as fever and productive cough. Option D) hysterical hyperventilation is improbable given the severity of the symptoms and the presence of objective findings like low Pao2 levels. Educationally, this question highlights the importance of recognizing the signs and symptoms of a pulmonary embolism, especially in young adults with risk factors like recent childbirth. Understanding the clinical manifestations and appropriate diagnostic steps is crucial in the timely management of this life-threatening condition. This scenario also emphasizes the significance of differentiating between various respiratory conditions based on clinical presentations to provide optimal patient care.

Correct Answer: D

Rationale: The correct answer is D) cystic fibrosis. Nasal polyps are more commonly seen in children with cystic fibrosis due to the underlying pathophysiology of this genetic disorder. Cystic fibrosis is characterized by thick, sticky mucus production in the respiratory tract, which can lead to the development of nasal polyps. These polyps are noncancerous growths that can obstruct the nasal passages and cause symptoms like nasal congestion, runny nose, and decreased sense of smell. Option A) aspirin allergy is incorrect because nasal polyps associated with aspirin allergy are more commonly seen in adults rather than children. Option B) juvenile nasopharyngeal angiofibroma is a benign tumor that occurs predominantly in adolescent males and is not typically associated with nasal polyps in children. Option C) Peutz-Jeghers syndrome is a rare genetic disorder characterized by the development of polyps in the gastrointestinal tract, but it is not a common cause of nasal polyps in children. Educationally, understanding the association between cystic fibrosis and nasal polyps is important for pediatric nurses as they care for children with this condition. Recognizing the signs and symptoms of nasal polyps in children with cystic fibrosis can help in early detection and management, ultimately improving the quality of care provided to these patients.

Correct Answer: D

Rationale: The correct answer is D) bacterial tracheitis. This condition is not typically included in the differential diagnosis for pediatric patients with respiratory issues related to the larynx. Bacterial tracheitis presents with distinct symptoms such as high fever, barking cough, and toxic appearance, whereas the other options are more commonly associated with laryngeal issues in pediatric patients. A) Laryngeal papillomatosis is caused by HPV and presents with hoarseness and respiratory distress in children. B) Laryngeal hemangioma is a vascular lesion that can cause airway obstruction and stridor. C) Laryngeal web is a congenital anomaly that can cause respiratory distress in infants. Understanding the differential diagnosis for pediatric respiratory conditions is crucial for nurses preparing for the NCLEX exam and in clinical practice. Recognizing the distinguishing features of each condition helps in prompt diagnosis and appropriate management, ensuring optimal patient outcomes.

Correct Answer: C

Rationale: In this scenario, the correct treatment of choice for the patient is C) rigid bronchoscopy. Rigid bronchoscopy is the most appropriate intervention for a patient with a respiratory issue that requires direct visualization and potential intervention within the airway. It allows for the removal of foreign bodies, evaluation of airway anatomy, and intervention if needed. Option A) steroids are often used in the treatment of inflammation in various respiratory conditions like asthma, but they would not be the immediate treatment of choice in a situation requiring direct airway intervention. Option B) albuterol is a bronchodilator commonly used in conditions like asthma to relieve bronchospasm but is not the primary treatment for a patient needing airway intervention. Option D) postural drainage is a technique used in conditions like cystic fibrosis to assist with mucous clearance but would not be the primary treatment in a scenario requiring direct airway intervention. In an educational context, understanding the appropriate interventions for pediatric respiratory issues is crucial for nursing practice. Rigid bronchoscopy is a specialized procedure that requires skilled professionals and is essential in managing certain respiratory emergencies in children. Nurses need to have a solid understanding of respiratory procedures to provide safe and effective care to pediatric patients.

Correct Answer: C

Rationale: The correct answer is option C: Your child will need oral penicillin for 10 days and should feel better in a few days. Rationale: Strep throat is caused by group A Streptococcus bacteria, and the treatment of choice is oral penicillin for a full course of at least 10 days to completely eradicate the infection and prevent complications. Penicillin is effective in treating strep throat and helps to reduce the risk of spreading the infection to others. Option A is incorrect because strep throat requires antibiotic treatment to prevent complications such as rheumatic fever or kidney inflammation. Bedrest alone will not adequately treat the infection. Option B is incorrect as tonsillectomy is not the first-line treatment for strep throat. Tonsillectomy is considered only if the child has recurrent episodes of strep throat despite appropriate antibiotic treatment. Option D is incorrect as hospitalization and intravenous antibiotics are typically reserved for severe cases of strep throat with complications such as abscess formation or difficulty swallowing. Most cases of strep throat can be effectively treated on an outpatient basis with oral antibiotics. Educational context: It is crucial for nursing students preparing for the NCLEX to understand the appropriate treatment for common pediatric conditions like strep throat. By knowing the correct treatment regimen, nurses can provide optimal care, prevent complications, and educate families on the importance of completing the full course of antibiotics to ensure complete recovery and prevent the spread of infection. Understanding the rationale behind treatment options helps nurses make informed clinical decisions and deliver safe and effective care to pediatric patients.