Definitive diagnosis of pulmonary arterial hypertension is made by

Correct Answer: D

Rationale: The correct answer is D) Cardiac catheterization for the definitive diagnosis of pulmonary arterial hypertension. Pulmonary arterial hypertension (PAH) is a serious condition that requires accurate diagnosis for appropriate management. Cardiac catheterization is considered the gold standard for diagnosing PAH as it directly measures the pressure in the pulmonary arteries and assesses the response to vasodilator medications, which is crucial for determining the severity of the condition and guiding treatment decisions. Option A) ECG is not the definitive diagnostic test for PAH. While an ECG may show signs of right ventricular hypertrophy, it does not provide direct measurements of pulmonary artery pressure. Option B) Echocardiography can provide valuable information about the heart's structure and function, including signs of PAH, but it does not directly measure pulmonary artery pressure like cardiac catheterization. Option C) CXR may show signs of pulmonary hypertension such as enlarged pulmonary arteries or changes in lung vasculature, but it does not provide direct measurements of pulmonary artery pressure needed for a definitive diagnosis of PAH. In an educational context, understanding the diagnostic modalities for PAH is essential for nursing students preparing for the NCLEX exam. This question helps reinforce the importance of cardiac catheterization in diagnosing PAH accurately and highlights the limitations of other diagnostic tests in providing definitive measurements of pulmonary artery pressure. Nurses need to be familiar with these diagnostic procedures to ensure timely and appropriate management of patients with PAH.

Correct Answer: D

Rationale: In this scenario, the most likely diagnosis is choanal atresia (Option D). Choanal atresia is a congenital condition where there is a blockage of the posterior nasal passage, leading to respiratory distress, especially in newborns. In this case, the infant's initial ability to cry vigorously and then sudden onset of cyanosis and respiratory distress point towards a possible airway obstruction, which aligns with choanal atresia. Option A, tracheoesophageal fistula, would typically present with symptoms such as choking, coughing, and respiratory distress immediately after birth due to abnormal connection between the trachea and esophagus. Option B, pneumothorax, would present with sudden onset respiratory distress, but the inability to pass a nasogastric tube is not consistent with this diagnosis. Option C, persistent fetal circulation, would not typically present with sudden respiratory distress and cyanosis after an initial period of normalcy. Educationally, this question highlights the importance of recognizing the signs and symptoms of choanal atresia in newborns, as prompt diagnosis and intervention are critical for the infant's well-being. Understanding common respiratory conditions in newborns is essential for pediatric nurses to provide timely and appropriate care in emergent situations.

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 for the treatment of the 3-year-old in Question 11 being D) catheter snare removal is based on the scenario presented, which likely involves a foreign body being lodged in the airway. In pediatric respiratory emergencies, prompt removal of the obstruction is crucial to ensure adequate oxygenation. Catheter snare removal is a method commonly used to extract foreign bodies from the airway in pediatric patients, as it allows for precise and controlled retrieval. Option A) amoxicillin is an antibiotic and not appropriate for the immediate treatment of an airway obstruction. Option B) hydrogen peroxide is a disinfectant and should not be used in the airway. Option C) local anesthesia followed by suction is not suitable for acute airway obstruction in a pediatric patient. In an educational context, it is essential for nurses to be well-versed in pediatric respiratory emergencies, including the appropriate interventions for airway obstructions. Understanding the correct treatment modalities can make a significant difference in the outcomes of pediatric patients experiencing respiratory distress. Nurses must be prepared to act quickly and decisively in such critical situations to ensure the safety and well-being of their young patients.

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.