Early sign of shock is:

Correct Answer: D

Rationale: In pediatric nursing, recognizing early signs of shock is crucial for timely intervention and prevention of further deterioration in a child's condition. The correct answer is D) Tachycardia. Tachycardia, an elevated heart rate, is a common early sign of shock in children. When the body senses decreased perfusion due to various reasons like dehydration, infection, or trauma, it compensates by increasing the heart rate to maintain adequate blood flow to vital organs. Option A) Hypotension is a late sign of shock in pediatric patients. Children are able to maintain their blood pressure within normal limits until shock has progressed significantly, making hypotension a less reliable early indicator. Option B) Disturbed consciousness level typically occurs in later stages of shock when brain perfusion is severely compromised. It is a critical sign but usually appears after tachycardia in the sequence of shock progression. Option C) Cheyne-Stokes breathing is a pattern of breathing characterized by alternating periods of deep, rapid breathing followed by apnea. While it can be seen in some conditions associated with shock, it is not as specific or early an indicator as tachycardia. Educationally, understanding the hierarchy of signs of shock in pediatric patients is essential for nurses to provide prompt and effective care. By recognizing tachycardia as an early sign, nurses can initiate interventions such as fluid resuscitation or oxygen therapy to prevent further deterioration and improve outcomes for the child.

Correct Answer: D

Rationale: The correct interpretation of the ABG results (pH: 7.48, PaCO2: 42, HCO3: 30) is D) Metabolic alkalosis without compensation. Explanation: 1. Metabolic alkalosis: The pH is elevated (alkalotic) above the normal range of 7.35-7.45, indicating alkalosis. The HCO3 level of 30 is also elevated, indicating a primary metabolic alkalosis. 2. Without compensation: In metabolic alkalosis, the respiratory system should respond by decreasing ventilation to retain CO2. However, the PaCO2 level of 42 is within normal range, indicating that there is no compensatory respiratory response. Why other options are incorrect: A) Metabolic acidosis without compensation: pH is alkalotic, not acidic. B) Respiratory alkalosis with partial compensation: HCO3 is elevated, indicating a metabolic, not respiratory, imbalance. C) Respiratory alkalosis with full compensation: HCO3 level being elevated contradicts respiratory alkalosis, and the PaCO2 is within the normal range. Educational context: Understanding ABG interpretation is crucial in pediatric nursing as it helps in assessing a child's acid-base balance, respiratory, and metabolic status. This knowledge is essential for providing appropriate interventions and monitoring the effectiveness of treatments. Recognizing the specific acid-base disturbances and their compensatory mechanisms is vital for delivering quality care to pediatric patients.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Von Willebrand disease. Von Willebrand disease is a genetic bleeding disorder characterized by a deficiency or dysfunction of von Willebrand factor, a protein that helps with platelet adhesion and blood clot formation. Despite having a normal platelet count, patients with Von Willebrand disease experience prolonged bleeding times due to the impaired platelet function caused by the deficiency of von Willebrand factor. Option A) Hemophilia A is incorrect because it is a disorder caused by a deficiency of clotting factor VIII, leading to prolonged clotting time, not bleeding time. Option C) Leukemia is incorrect as it is a type of cancer affecting white blood cells and does not directly impact platelet count or bleeding time. Option D) Hypersplenism is incorrect because while it can lead to a decrease in platelet count due to sequestration of platelets in the spleen, it does not cause prolonged bleeding time. Educationally, understanding the relationship between platelet count, bleeding time, and specific bleeding disorders is crucial for pediatric nurses. Recognizing the unique features of each condition and how they manifest in patients is essential for accurate diagnosis, treatment, and patient care. This knowledge ensures appropriate interventions are implemented promptly to prevent complications and improve outcomes for pediatric patients with bleeding disorders.

Correct Answer: D

Rationale: The correct answer is D) Beta-thalassemia. Beta-thalassemia is associated with microcytosis, which is characterized by smaller than normal red blood cells. This condition occurs due to a genetic defect in the production of beta-globin chains in hemoglobin, leading to ineffective erythropoiesis and subsequent microcytic anemia. A) Folic acid deficiency does not typically cause microcytic anemia. Folic acid deficiency is associated with macrocytic anemia, characterized by larger than normal red blood cells. B) Immune hemolytic anemia is not typically associated with microcytosis. This type of anemia results from the destruction of red blood cells by the immune system, leading to hemolysis but not necessarily microcytosis. C) Hypothyroidism is not directly linked to microcytic anemia. While hypothyroidism can lead to various hematologic abnormalities, microcytosis is not a typical feature of anemia associated with hypothyroidism. Understanding the etiology of different types of anemia is crucial for pediatric nurses to accurately assess and manage pediatric patients presenting with signs and symptoms of anemia. Recognizing the characteristic features of beta-thalassemia, such as microcytosis, can aid in early identification and appropriate intervention for affected children. This knowledge helps provide comprehensive care and support for pediatric patients with hematologic disorders.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Parvovirus type B 19. Parvovirus B19 is known to cause transient aplastic crisis in patients with hereditary spherocytosis due to their increased susceptibility to parvovirus infections. Parvovirus B19 specifically targets red blood cell precursors, leading to a temporary halt in red blood cell production, exacerbating anemia in these patients. Option A) German measles virus (rubella) does not typically cause aplastic crisis in hereditary spherocytosis. Option B) Human herpes virus 6 and Option C) Adenovirus are not commonly associated with aplastic crisis in these patients either. Educationally, understanding the relationship between specific viral infections and their effects on patients with underlying conditions like hereditary spherocytosis is crucial for pediatric nurses. This knowledge aids in early recognition of potential complications, appropriate management, and patient education. It also highlights the importance of tailored care for pediatric patients with underlying hematologic disorders during viral infections.