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 this case, option B is the correct answer. Normal growth parameters in a 6-month-old infant would not typically be suggestive of a large ventricular septal defect (VSD). Infants with significant VSDs often present with failure to thrive due to increased cardiac workload and inadequate systemic perfusion, leading to poor weight gain. Therefore, normal growth parameters would not align with the expected clinical presentation in this scenario. Option A, recurrent bronchopulmonary infection, is commonly seen in infants with VSDs due to increased pulmonary blood flow and susceptibility to respiratory infections. Option C, cardiomegaly with pulmonary plethora on plain chest radiography, is consistent with the signs of heart failure seen in infants with large VSDs. Option D, a local pulmonary component of the second heart sound, is often heard in infants with VSDs due to the increased blood flow across the defect. From an educational perspective, understanding the clinical manifestations of VSDs in infants is crucial for pediatric clinical nurse specialists. Recognizing these features can lead to early detection, appropriate management, and improved outcomes for infants with congenital heart defects. It also highlights the importance of comprehensive assessment and vigilant monitoring in pediatric patients to identify subtle changes that may indicate significant cardiac pathology.

Correct Answer: D

Rationale: The correct answer is D) Respiratory syncytial virus (RSV). RSV is the most common cause of lower respiratory tract infections in infants and young children. It causes symptoms such as cough, tachypnea, and wheezing, which are characteristic of bronchiolitis in this age group. RSV is highly contagious and spreads through respiratory secretions. Option A) Adenovirus: Adenovirus can also cause respiratory infections in children, but it is less common than RSV in causing bronchiolitis in infants. Option B) Influenza: While influenza can cause respiratory symptoms in children, it is less likely in a 2-month-old infant compared to RSV, which is more prevalent in this age group. Option C) Parainfluenza: Parainfluenza virus can cause croup and upper respiratory infections in children. However, it is less likely to present with the combination of symptoms described in the question compared to RSV. Educational Context: Understanding the common viral causes of respiratory infections in infants is crucial for pediatric clinical nurse specialists. Recognizing the specific symptoms and typical age groups affected by each virus helps in accurate diagnosis and appropriate management, including infection control measures to prevent further spread in healthcare settings and communities.

Correct Answer: B

Rationale: The correct answer is B) Gastroschisis. In this condition, neonates have an opening in the abdominal wall, usually to the right of the umbilical cord, through which intestines protrude without a protective covering. This differs from omphalocele (option A) where the intestines are covered by a membrane outside the abdomen. Congenital diaphragmatic hernia (option C) involves a defect in the diaphragm, allowing abdominal organs to move into the chest cavity, not outside the abdominal wall. Hirschsprung disease (option D) is a congenital condition affecting the large intestine's nerve cells, leading to bowel obstruction, not an abdominal wall defect. Educationally, understanding these distinctions is crucial for pediatric clinical nurse specialists to provide accurate assessments and interventions. Recognizing the specific features of each condition guides appropriate care, such as preventing infection in an exposed bowel in gastroschisis. Clinical expertise in neonatal conditions enhances patient outcomes and ensures effective collaboration within the healthcare team.

Correct Answer: B

Rationale: The correct answer is B) Congenital heart defects. Neonates with an omphalocele are at increased risk for congenital heart defects due to the association between omphalocele and cardiac anomalies. This is because both conditions can arise from disturbances in early fetal development. Congenital heart defects are a common comorbidity seen in neonates with omphalocele and require close monitoring and appropriate management. Option A) Neural tube defects are not typically associated with omphalocele. Neural tube defects involve malformations of the brain, spinal cord, or their coverings, which are distinct from omphalocele. Option C) Cystic fibrosis is a genetic disorder that affects the lungs and digestive system. It is not directly related to omphalocele, which is a congenital abdominal wall defect. Option D) Necrotizing enterocolitis is a gastrointestinal emergency that primarily affects premature infants. While neonates with omphalocele may be at risk for gastrointestinal complications, necrotizing enterocolitis is not a typical associated condition with omphalocele. Educationally, this question highlights the importance of understanding common comorbidities and associations in pediatric patients, particularly those with complex congenital anomalies like omphalocele. It reinforces the need for thorough assessment and monitoring in neonates with omphalocele to promptly identify and manage any associated conditions, such as congenital heart defects.

Correct Answer: B

Rationale: In bronchial asthma, eosinophils are the main effector cells involved in the inflammatory response within the airways. This is why option B is the correct answer. Eosinophils release inflammatory mediators that contribute to bronchoconstriction, mucus production, and airway remodeling seen in asthma. Option A (TH1 immune response) is incorrect because asthma is primarily 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 incorrect as IgE antibodies play a more significant role in the pathophysiology of asthma, triggering the release of inflammatory mediators from mast cells and basophils. Option D (Viral infection is the main cause) is incorrect because while viral infections can exacerbate asthma symptoms, they are not the primary cause of the condition. Asthma is a complex chronic inflammatory disorder influenced by genetic and environmental factors. Educationally, understanding the correct effector cells in asthma is crucial for pediatric clinical nurse specialists as it guides treatment strategies targeting inflammation and airway hyperresponsiveness. Recognizing the role of eosinophils in asthma pathophysiology helps in providing effective care and management for pediatric patients with asthma.