Despite popular belief, there is a rare type of hemophilia that affects women of childbearing age. Von Willebrand disease is the most common of the hereditary bleeding disorders and can affect males and females alike. It results from a factor VIII deficiency and platelet dysfunction. Although factor VIII levels rise naturally during pregnancy, there is an increased risk for postpartum hemorrhage from birth until 4 weeks postpartum as levels of von Willebrand factor (vWf) and factor VIII fall. The treatment that should be considered first for the client with von Willebrand disease who experiences a postpartum hemorrhage is:

Correct Answer: A

Rationale: The correct answer is A) Desmopressin. Desmopressin is the first-line treatment for von Willebrand disease as it stimulates the release of von Willebrand factor (vWf) and factor VIII from storage sites in the body, thereby increasing their levels and improving clotting. This medication is particularly effective in type 1 von Willebrand disease, which is the most common and mildest form of the condition. Option B) Factor VIII concentrate is not the first-line treatment for von Willebrand disease. While factor VIII concentrate can be used in severe cases of the disease, desmopressin is preferred due to its effectiveness and lower risk of complications. Option C) Fresh frozen plasma contains various clotting factors, including von Willebrand factor and factor VIII, but it is not the first-line treatment for postpartum hemorrhage in von Willebrand disease. Desmopressin is more specific and targeted in increasing the deficient clotting factors. Option D) Platelet transfusion is not indicated for von Willebrand disease as the primary issue in this condition is a deficiency in von Willebrand factor and factor VIII, not platelets. In an educational context, it is crucial for nurses to understand the specific treatments for different bleeding disorders like von Willebrand disease, especially in the context of postpartum hemorrhage where quick and accurate interventions are essential to prevent complications and ensure the well-being of the mother. Understanding the appropriate use of medications like desmopressin can significantly impact patient outcomes and safety.

Correct Answer: C

Rationale: The correct answer is "C) Thirty minutes after feeding your child breakfast." This timing is important in pediatric cystic fibrosis management as it allows for digestion to occur, reducing the risk of regurgitation or aspiration during chest physiotherapy (CPT). Performing CPT too close to feeding can lead to discomfort or vomiting. Option A is incorrect because performing CPT before feeding may cause discomfort due to pressure on the full stomach. Option B is incorrect as deep-suctioning is a separate intervention and not directly related to timing of CPT. Option D is incorrect as CPT is a preventive maintenance therapy in cystic fibrosis, not solely for treating symptoms like congestion or coughing. In an educational context, understanding the timing and rationale behind interventions in pediatric cystic fibrosis management is crucial for optimal health outcomes. Educating parents on the proper timing of CPT helps them integrate it effectively into their child's daily routine, promoting airway clearance and overall respiratory health.

Correct Answer: C

Rationale: In pediatric patients, the primary purpose of a cardiac catheterization is to evaluate heart defects (Option C). This procedure involves inserting a thin tube called a catheter into a blood vessel and guiding it to the heart to assess its structure and function. The correct answer is C because cardiac catheterization allows healthcare providers to directly visualize the heart chambers, valves, and blood vessels, helping to diagnose congenital heart defects, assess cardiac function, measure blood flow, and determine the need for further interventions like surgery or medication. Option A, diagnosing respiratory infections, is incorrect as this procedure is not used for respiratory issues but specifically for evaluating heart conditions. Option B, treating ear infections, is also incorrect as cardiac catheterization is unrelated to the treatment of ear infections. Option D, assessing kidney function, is incorrect because while kidney function may be indirectly impacted by heart conditions, cardiac catheterization is not the primary method for assessing kidney function. In an educational context, understanding the purpose of cardiac catheterization in pediatric patients is crucial for pediatric nurses specializing in respiratory care. It allows nurses to grasp the significance of this procedure in diagnosing and managing heart conditions in children, equipping them with the knowledge to provide comprehensive care to pediatric patients with cardiac issues.

Correct Answer: A

Rationale: In the scenario presented, the correct next best treatment option is A) IV magnesium sulphate. IV magnesium sulfate is indicated in cases of severe acute asthma exacerbation that is unresponsive to initial bronchodilator therapy. Magnesium sulfate acts as a bronchodilator and has been shown to help relax smooth muscle in the airways, thereby improving airflow. IV epinephrine (option B) is not recommended in the treatment of acute asthma exacerbation as it can lead to adverse cardiovascular effects and is not considered a first-line therapy. IM epinephrine (option C) is also not recommended due to the risk of systemic side effects and potential for delayed response compared to other treatment options. IV aminophylline (option D) is no longer considered a first-line treatment for acute asthma exacerbation due to its narrow therapeutic window, potential for toxicity, and availability of safer and more effective treatment options. Educationally, understanding the appropriate management of acute asthma exacerbation in pediatric patients is crucial for healthcare providers working in emergency departments or pediatric settings. Knowing when to escalate treatment to IV magnesium sulfate in cases of severe exacerbation is essential for improving patient outcomes and preventing complications. It is important to stay updated on current guidelines and evidence-based practices to provide optimal care for pediatric patients with respiratory conditions.

Correct Answer: B

Rationale: In the context of pediatric nursing, it is crucial to understand the appropriate treatments for common cold in children. The correct answer, B) First generation antihistamine, is the exception among the options provided. While antihistamines are commonly used in adults for cold symptoms, they are not recommended for young children due to the risk of side effects such as sedation and paradoxical excitation. A) Vitamin C is often used as a supplement to boost the immune system, although its efficacy in preventing or treating the common cold is debated. Some studies suggest it may reduce the duration of cold symptoms. C) Topical or oral adrenergic agents are used for symptomatic relief of nasal congestion in children with colds. They work by constricting blood vessels in the nasal passages, reducing swelling and congestion. D) Ipratropium bromide is a medication used to alleviate symptoms of runny nose caused by colds or allergies by decreasing nasal discharge. Educationally, it is important for pediatric nurses to be aware of the appropriate treatment options for common cold in children to ensure safe and effective care. Understanding the rationale behind each treatment option helps in making informed clinical decisions and promoting the well-being of pediatric patients.