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 for this question is B) Weak brachial pulsation on the right arm. In a newborn with severe coarctation of the aorta, there is a narrowing of the aorta that leads to decreased blood flow to the lower part of the body. This results in weakened or absent pulses in the lower extremities (Option D) due to decreased perfusion. The weak or absent pulses in the left arm (Option C) are also expected due to reduced blood flow beyond the narrowing. Option A, feeding difficulties, can occur in infants with congenital heart defects due to poor perfusion and increased work of breathing. However, it is not specific to coarctation of the aorta. Educationally, understanding the clinical manifestations of coarctation of the aorta in newborns is crucial for pediatric clinical nurse specialists as early recognition can lead to prompt intervention and improved outcomes. This knowledge helps in providing comprehensive care and advocating for appropriate diagnostic tests and treatment strategies for these vulnerable patients.

Correct Answer: D

Rationale: In this scenario, the most appropriate test to assist in diagnosing a 6-year-old boy with a chronic cough exacerbated by night and exercise is spirometry (Option D). Spirometry is a pulmonary function test that measures how well the lungs are functioning by assessing airflow and lung volume. In this case, spirometry can help evaluate for conditions such as asthma, which often present with nighttime cough and exercise-induced symptoms. Option A, a barium swallow, is used to evaluate swallowing difficulties or anatomical abnormalities in the upper gastrointestinal tract, not respiratory issues. Option B, bronchoscopy, involves inserting a flexible tube into the airways to visualize the lungs and is more invasive and not typically a first-line diagnostic test for a chronic cough. Option C, a chest radiograph, may show abnormalities such as pneumonia or structural lung issues but may not provide specific information about lung function like spirometry. Educationally, understanding the appropriate diagnostic tests for pediatric respiratory conditions is crucial for healthcare providers working with children. Spirometry is a non-invasive, reliable tool to assess lung function and is commonly used in diagnosing and managing respiratory conditions in pediatric patients. By knowing when to order spirometry, healthcare professionals can expedite accurate diagnoses and provide timely interventions for pediatric patients with respiratory symptoms.

Correct Answer: D

Rationale: The correct answer is D) Respiratory syncytial virus (RSV). RSV is the most common cause of lower respiratory tract infections in infants and young children. It causes symptoms such as cough, tachypnea, and wheezing, which are characteristic of bronchiolitis in this age group. RSV is highly contagious and spreads through respiratory secretions. Option A) Adenovirus: Adenovirus can also cause respiratory infections in children, but it is less common than RSV in causing bronchiolitis in infants. Option B) Influenza: While influenza can cause respiratory symptoms in children, it is less likely in a 2-month-old infant compared to RSV, which is more prevalent in this age group. Option C) Parainfluenza: Parainfluenza virus can cause croup and upper respiratory infections in children. However, it is less likely to present with the combination of symptoms described in the question compared to RSV. Educational Context: Understanding the common viral causes of respiratory infections in infants is crucial for pediatric clinical nurse specialists. Recognizing the specific symptoms and typical age groups affected by each virus helps in accurate diagnosis and appropriate management, including infection control measures to prevent further spread in healthcare settings and communities.

Correct Answer: B

Rationale: The correct answer is B) Gastroschisis. In this condition, neonates have an opening in the abdominal wall, usually to the right of the umbilical cord, through which intestines protrude without a protective covering. This differs from omphalocele (option A) where the intestines are covered by a membrane outside the abdomen. Congenital diaphragmatic hernia (option C) involves a defect in the diaphragm, allowing abdominal organs to move into the chest cavity, not outside the abdominal wall. Hirschsprung disease (option D) is a congenital condition affecting the large intestine's nerve cells, leading to bowel obstruction, not an abdominal wall defect. Educationally, understanding these distinctions is crucial for pediatric clinical nurse specialists to provide accurate assessments and interventions. Recognizing the specific features of each condition guides appropriate care, such as preventing infection in an exposed bowel in gastroschisis. Clinical expertise in neonatal conditions enhances patient outcomes and ensures effective collaboration within the healthcare team.

Correct Answer: B

Rationale: The correct answer is B) Congenital heart defects. Neonates with an omphalocele are at increased risk for congenital heart defects due to the association between omphalocele and cardiac anomalies. This is because both conditions can arise from disturbances in early fetal development. Congenital heart defects are a common comorbidity seen in neonates with omphalocele and require close monitoring and appropriate management. Option A) Neural tube defects are not typically associated with omphalocele. Neural tube defects involve malformations of the brain, spinal cord, or their coverings, which are distinct from omphalocele. Option C) Cystic fibrosis is a genetic disorder that affects the lungs and digestive system. It is not directly related to omphalocele, which is a congenital abdominal wall defect. Option D) Necrotizing enterocolitis is a gastrointestinal emergency that primarily affects premature infants. While neonates with omphalocele may be at risk for gastrointestinal complications, necrotizing enterocolitis is not a typical associated condition with omphalocele. Educationally, this question highlights the importance of understanding common comorbidities and associations in pediatric patients, particularly those with complex congenital anomalies like omphalocele. It reinforces the need for thorough assessment and monitoring in neonates with omphalocele to promptly identify and manage any associated conditions, such as congenital heart defects.