Cyanotic congenital heart disease in newborn with pulmonary oligemia and left ventricular hypertrophy is suggestive of

Correct Answer: B

Rationale: In a newborn with cyanotic congenital heart disease, pulmonary oligemia, and left ventricular hypertrophy, the correct diagnosis is likely tricuspid atresia. Tricuspid atresia is a congenital heart defect where the tricuspid valve is either missing or abnormally developed, leading to decreased blood flow to the lungs (pulmonary oligemia) and subsequent left ventricular hypertrophy due to increased workload. Option A, truncus arteriosus, is characterized by a single arterial trunk arising from the heart, which would typically present with increased pulmonary blood flow rather than oligemia. Option C, tetralogy of Fallot, usually presents with pulmonary stenosis leading to right ventricular hypertrophy, not left ventricular hypertrophy. Option D, transposition of the great arteries with a large ventricular septal defect (VSD), would present with a different set of hemodynamic findings, such as increased pulmonary blood flow and cyanosis without left ventricular hypertrophy. Understanding the pathophysiology of each congenital heart defect is crucial for pediatric nurses to provide optimal care. Recognizing the specific signs and symptoms associated with each condition is vital for timely interventions and improving patient outcomes. This question challenges students to apply their knowledge of cyanotic heart defects and hemodynamic consequences in newborns, reinforcing the importance of accurate clinical assessment and critical thinking skills in pediatric nursing practice.

Correct Answer: B

Rationale: The correct answer is B) Increased prothrombin time unresponsive to vitamin K administration. In fulminant hepatitis, the liver is unable to produce clotting factors, leading to prolonged prothrombin time. If the prothrombin time does not improve with vitamin K administration, it indicates severe liver dysfunction and poor outcome. Option A) Decreased blood ammonia is not an index of poor outcome in fulminant hepatitis. Elevated blood ammonia levels are seen in hepatic encephalopathy, which can occur in fulminant hepatitis but is not a specific indicator of poor outcome. Option C) Hepatomegaly is simply an enlargement of the liver and can occur in various liver conditions, but it is not a specific indicator of poor outcome in fulminant hepatitis. Option D) Factor VII level <80% of normal is not a specific index of poor outcome in fulminant hepatitis. While clotting factor levels may be affected in liver dysfunction, the prothrombin time is a more sensitive indicator in this context. Educationally, understanding the significance of prothrombin time in fulminant hepatitis is crucial for nurses caring for pediatric patients with liver disease. Recognizing this indicator helps in early identification of poor outcomes and enables timely interventions to improve patient outcomes.

Correct Answer: D

Rationale: In pediatric nursing, calculating maintenance fluid requirements is crucial to ensure optimal hydration and prevent dehydration or fluid overload in children. For a 25 kg child, the general rule of thumb is to use the Holliday-Segar method, which calculates the daily fluid requirement as follows: 100 ml/kg for the first 10 kg, 50 ml/kg for the next 10 kg, and 20 ml/kg for every additional kg over 20 kg. In this case, for a 25 kg child: - 100 ml/kg for the first 10 kg = 1000 ml - 50 ml/kg for the next 10 kg = 500 ml - 20 ml/kg for the additional 5 kg = 100 ml Total = 1000 ml + 500 ml + 100 ml = 1600 ml Therefore, the correct answer is D) 1600 ml because it adheres to the Holliday-Segar method for calculating maintenance fluid requirements based on the child's weight. Explanation for why the other options are incorrect: A) 2000 ml: This option is incorrect as it does not align with the calculated maintenance fluid requirement based on the child's weight using the Holliday-Segar method. B) 1000 ml: This option is incorrect as it only accounts for the first 10 kg of the child's weight and does not consider the additional weight beyond 10 kg. C) 2500 ml: This option is incorrect as it overestimates the fluid requirement for a 25 kg child, leading to potential fluid overload. Educational Context: Understanding how to calculate maintenance fluid requirements in pediatric patients is essential for nurses to provide safe and effective care. By using standardized methods like the Holliday-Segar formula, nurses can accurately determine the appropriate fluid volume to maintain hydration and support the child's physiological needs. This knowledge is crucial in preventing complications related to improper fluid management in pediatric patients.

Correct Answer: A

Rationale: Diastolic dysfunction and normal systolic function are key characteristics of hypertrophic cardiomyopathy (HCM). In HCM, the heart muscle becomes abnormally thick, leading to impaired relaxation during the diastolic phase while maintaining normal contractility during systole. This results in a stiff and non-compliant left ventricle, causing impaired filling of the ventricle. Option A, hypertrophic cardiomyopathy, is the correct answer because it specifically presents with diastolic dysfunction and normal systolic function. Barth disease (Option B) is an X-linked condition that primarily affects the heart, skeletal muscles, and growth, but it is not specifically associated with diastolic dysfunction. Myocarditis (Option C) is an inflammatory condition affecting the heart muscle, typically leading to systolic dysfunction rather than isolated diastolic dysfunction. Left ventricular non-compliance (Option D) is a general term that can describe various conditions but does not specifically point to the unique features of HCM. Understanding these distinctions is crucial in pediatric nursing as it can guide appropriate diagnostic tests, treatment strategies, and patient education. Recognizing the specific cardiac manifestations of different conditions helps nurses provide targeted care and support to pediatric patients with cardiac issues.

Correct Answer: D

Rationale: In pediatric nursing, understanding the characteristics of different types of dehydration is crucial for effective assessment and intervention. In the case of hypertonic dehydration, the correct characteristic is option D, which states that shock occurs late because of relatively preserved volume. This is because in hypertonic dehydration, there is a higher concentration of solutes outside the cells, causing water to shift from the intracellular space to the extracellular space. This shift maintains or even increases extracellular volume temporarily, delaying the onset of shock. Option A is incorrect because marked loss of skin turgor and a dry tongue are characteristic signs of dehydration, but not specific to hypertonic dehydration. Option B is incorrect as a moist tongue is actually an early sign of dehydration. Option C is incorrect as CNS complications, such as lethargy and irritability, are common in hypertonic dehydration due to the effects of increased serum osmolality on brain function. Educationally, understanding the nuances of different types of dehydration helps nurses provide appropriate care based on accurate assessment findings. By knowing the specific characteristics of hypertonic dehydration, nurses can intervene promptly to prevent complications and reestablish fluid balance in pediatric patients. This knowledge is vital in ensuring positive patient outcomes and providing safe, effective nursing care.