Features suggestive of large ventricular septal defect (VSD) in an infant 6 months old may include all of the following Except:

Correct Answer: B

Rationale: In infants with a large ventricular septal defect (VSD), normal growth parameters are not typically seen due to increased metabolic demand and inadequate caloric intake. Therefore, Option B is correct as it is not suggestive of a large VSD. Option A, recurrent bronchopulmonary infection, is often seen in infants with large VSD due to increased pulmonary blood flow and susceptibility to respiratory infections. Option C, cardiomegaly with pulmonary plethora on plain chest radiography, is a common finding in infants with large VSD due to the volume overload on the heart leading to enlargement and increased blood flow to the lungs. Option D, a local pulmonary component of the second heart sound, is also typical in infants with large VSD due to increased blood flow through the defect. Educationally, understanding the clinical features of large VSD in infants is crucial for pediatric clinical nurse specialists to provide timely and appropriate care. Recognizing these features helps in early identification, management, and referral for further evaluation and treatment, ultimately improving patient outcomes.

Correct Answer: D

Rationale: The correct answer is D) Respiratory syncytial virus (RSV). RSV is the most common viral cause of lower respiratory tract infections in infants and young children. It often presents with symptoms like cough, tachypnea, and wheezing, especially in the winter months. RSV can cause bronchiolitis and pneumonia in this age group. Option A) Adenovirus typically presents with symptoms like fever, sore throat, and conjunctivitis, rather than the respiratory symptoms described in the case. Option B) Influenza can cause respiratory symptoms but is less common in infants compared to RSV. Influenza is more likely to present with systemic symptoms like fever, muscle aches, and fatigue. Option C) Parainfluenza virus can cause croup, a condition characterized by a barking cough and hoarseness, which is different from the wheezing described in the case. Educationally, understanding the common viral causes of respiratory infections in pediatric patients is crucial for clinical nurse specialists to provide timely and appropriate care. Recognizing the specific presentations of each virus helps in accurate diagnosis and management, including infection control measures and supportive care tailored to the specific viral pathogen.

Correct Answer: B

Rationale: The correct answer is B) Gastroschisis. In this condition, the abdominal wall does not close completely, leading to intestines protruding through a hole next to the umbilical cord. Unlike omphalocele, where the intestines are covered by a sac, gastroschisis involves exposed bowel without a protective covering. Option A) Omphalocele is incorrect because in omphalocele, the abdominal organs are covered by a sac that protrudes through the belly button. Option C) Congenital diaphragmatic hernia involves a defect in the diaphragm leading to abdominal organs moving into the chest cavity, not outside the abdominal wall. Option D) Hirschsprung disease is a condition where there is a lack of nerve cells in the muscles of part of the colon, leading to difficulty passing stool. It is unrelated to abdominal wall defects. In an educational context, understanding these distinctions is crucial for pediatric clinical nurse specialists to provide accurate assessments and interventions for neonates with different congenital anomalies. Recognizing the specific features of each condition allows for appropriate care planning and management to optimize outcomes for these vulnerable patients.

Correct Answer: B

Rationale: The correct answer is B) Congenital heart defects. Omphalocele is a congenital abdominal wall defect where some of the abdominal organs protrude through the umbilical cord. Neonates with omphalocele often have associated congenital anomalies, with congenital heart defects being one of the most common. This is due to the complex embryological development of the heart and abdominal organs occurring concurrently during fetal development. Option A) Neural tube defects are not typically associated with omphalocele. Neural tube defects involve the brain, spine, or spinal cord and are not directly related to abdominal wall defects like omphalocele. Option C) Cystic fibrosis is a genetic disorder that primarily affects the lungs and digestive system. It is not directly linked to omphalocele, an anatomical defect involving the abdominal wall. Option D) Necrotizing enterocolitis is a condition that primarily affects premature infants and involves inflammation of the intestines. While neonates with omphalocele may have gastrointestinal complications, necrotizing enterocolitis is not a common association with omphalocele specifically. Understanding the potential associated conditions of omphalocele is crucial for healthcare providers, especially pediatric clinical nurse specialists, to provide comprehensive care to neonates with this condition. Recognizing the increased risk of congenital heart defects in these patients can lead to early detection, appropriate monitoring, and timely intervention, ultimately improving outcomes for these vulnerable infants.

Correct Answer: B

Rationale: In bronchial asthma, eosinophils are the main effector cells involved in the inflammatory response. Eosinophils release inflammatory mediators that contribute to airway hyperresponsiveness and remodeling. This is why option B is the correct answer. Option A, the TH1 immune response, is not correct for asthma. Asthma is associated with a TH2 immune response characterized by the release of cytokines like IL-4, IL-5, and IL-13, which promote eosinophil activation. Option C, increased serum IgA levels, is not a characteristic feature of bronchial asthma. While immunoglobulins play a role in allergic reactions, IgE is the key immunoglobulin involved in asthma, not IgA. Option D, viral infection as the main cause of asthma, is incorrect. While viral infections can trigger asthma exacerbations, asthma is a complex condition with various triggers including allergens, pollutants, and occupational exposures. In an educational context, understanding the pathophysiology of asthma is crucial for pediatric clinical nurse specialists to provide effective care. Recognizing the role of eosinophils in asthma can guide treatment strategies aimed at reducing airway inflammation and improving patient outcomes. Educators should emphasize the importance of differentiating asthma from other respiratory conditions and the significance of evidence-based practice in managing pediatric asthma effectively.