Clinical picture of a 15-day-old newborn with severe coarctation of aorta will include the following Except:

Correct Answer: B

Rationale: The correct answer is B) Weak brachial pulsation on right arm. In a newborn with severe coarctation of the aorta, there is a narrowing of the aorta which leads to decreased blood flow to the lower part of the body. This results in weak or absent femoral pulsation on both lower limbs (option D) due to reduced blood flow beyond the narrowing. Similarly, weak or absent brachial pulsation on the left arm (option C) can occur due to reduced blood flow to the upper body. Feeding difficulties (option A) can also be present due to poor perfusion to the gastrointestinal system. The incorrect option, B, stating weak brachial pulsation on the right arm is not typically seen in coarctation of the aorta. This option is designed to test your understanding of the expected clinical presentation of this condition. Educational Context: Understanding the clinical manifestations of congenital heart defects like coarctation of the aorta is crucial for pediatric clinical nurse specialists to provide timely and appropriate care. Recognizing the signs and symptoms allows for prompt intervention and management to prevent complications and improve outcomes for newborns with these conditions.

Correct Answer: D

Rationale: The correct answer is D) Spirometry. Spirometry is the most appropriate test in this scenario because the symptoms of cough worse at night and with exercise suggest possible asthma, which is a common condition in children. Spirometry measures lung function, specifically airflow and volume, which can help diagnose asthma by identifying any obstruction in the airways. Option A) Barium swallow is not indicated for evaluating a chronic cough associated with asthma-like symptoms as it is used to assess the esophagus and swallowing function. Option B) Bronchoscopy is an invasive procedure that examines the airways directly and is not typically the initial diagnostic test for asthma in a child with this presentation. Option C) Chest radiograph may show findings consistent with asthma such as hyperinflation or peribronchial thickening but is not as specific or sensitive as spirometry for diagnosing asthma. Educationally, understanding the appropriate diagnostic tests for common pediatric conditions like asthma is crucial for pediatric clinical nurse specialists to provide timely and accurate care to their young patients. Spirometry not only aids in diagnosing asthma but also helps in monitoring disease progression and treatment efficacy.

Correct Answer: D

Rationale: The correct answer is D) Respiratory syncytial virus (RSV). RSV is the most common viral cause of lower respiratory tract infections in infants and young children. It often presents with symptoms like cough, tachypnea, and wheezing, especially in the winter months. RSV can cause bronchiolitis and pneumonia in this age group. Option A) Adenovirus typically presents with symptoms like fever, sore throat, and conjunctivitis, rather than the respiratory symptoms described in the case. Option B) Influenza can cause respiratory symptoms but is less common in infants compared to RSV. Influenza is more likely to present with systemic symptoms like fever, muscle aches, and fatigue. Option C) Parainfluenza virus can cause croup, a condition characterized by a barking cough and hoarseness, which is different from the wheezing described in the case. Educationally, understanding the common viral causes of respiratory infections in pediatric patients is crucial for clinical nurse specialists to provide timely and appropriate care. Recognizing the specific presentations of each virus helps in accurate diagnosis and management, including infection control measures and supportive care tailored to the specific viral pathogen.

Correct Answer: B

Rationale: The correct answer is B) Gastroschisis. In this condition, the abdominal wall does not close completely, leading to intestines protruding through a hole next to the umbilical cord. Unlike omphalocele, where the intestines are covered by a sac, gastroschisis involves exposed bowel without a protective covering. Option A) Omphalocele is incorrect because in omphalocele, the abdominal organs are covered by a sac that protrudes through the belly button. Option C) Congenital diaphragmatic hernia involves a defect in the diaphragm leading to abdominal organs moving into the chest cavity, not outside the abdominal wall. Option D) Hirschsprung disease is a condition where there is a lack of nerve cells in the muscles of part of the colon, leading to difficulty passing stool. It is unrelated to abdominal wall defects. In an educational context, understanding these distinctions is crucial for pediatric clinical nurse specialists to provide accurate assessments and interventions for neonates with different congenital anomalies. Recognizing the specific features of each condition allows for appropriate care planning and management to optimize outcomes for these vulnerable patients.

Correct Answer: B

Rationale: The correct answer is B) Congenital heart defects. Omphalocele is a congenital abdominal wall defect where some of the abdominal organs protrude through the umbilical cord. Neonates with omphalocele often have associated congenital anomalies, with congenital heart defects being one of the most common. This is due to the complex embryological development of the heart and abdominal organs occurring concurrently during fetal development. Option A) Neural tube defects are not typically associated with omphalocele. Neural tube defects involve the brain, spine, or spinal cord and are not directly related to abdominal wall defects like omphalocele. Option C) Cystic fibrosis is a genetic disorder that primarily affects the lungs and digestive system. It is not directly linked to omphalocele, an anatomical defect involving the abdominal wall. Option D) Necrotizing enterocolitis is a condition that primarily affects premature infants and involves inflammation of the intestines. While neonates with omphalocele may have gastrointestinal complications, necrotizing enterocolitis is not a common association with omphalocele specifically. Understanding the potential associated conditions of omphalocele is crucial for healthcare providers, especially pediatric clinical nurse specialists, to provide comprehensive care to neonates with this condition. Recognizing the increased risk of congenital heart defects in these patients can lead to early detection, appropriate monitoring, and timely intervention, ultimately improving outcomes for these vulnerable infants.