In severe form of Tetralogy of Fallot, all are true Except:

Correct Answer: A

Rationale: The correct answer is A) Marked cardiomegaly in chest X-ray. In severe Tetralogy of Fallot, cardiomegaly is not typically seen on chest X-ray. This condition is characterized by four heart defects: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. Option B, central cyanosis and clubbing, is often seen in Tetralogy of Fallot due to decreased pulmonary blood flow. Option C, basal ejection systolic murmur and single 2nd heart sound, are common findings in Tetralogy of Fallot due to the pulmonary stenosis. Option D, right ventricular hypertrophy on ECG, is also a common finding in Tetralogy of Fallot due to increased right ventricular workload. In an educational context, understanding the clinical features of Tetralogy of Fallot is crucial for pediatric nurses to provide safe and effective care for pediatric patients with this condition. Recognizing the signs and symptoms allows nurses to intervene promptly and advocate for appropriate treatment strategies. This knowledge helps to improve patient outcomes and quality of care provided.

Correct Answer: C

Rationale: In pediatric nursing, understanding radiological signs associated with various conditions is crucial for accurate diagnosis and appropriate management. In the case of acute laryngotracheobronchitis, the correct radiological sign is the "steeple sign" (Option C). This term refers to the characteristic subglottic narrowing of the trachea seen on a frontal neck X-ray, resembling a steeple shape. Option A, generalized hyperinflation, is not typically associated with acute laryngotracheobronchitis. Hyperinflation is more commonly seen in conditions like asthma or chronic obstructive pulmonary disease. Option B, lobar consolidation, is not a typical finding in acute laryngotracheobronchitis. Lobar consolidation is more often seen in conditions like bacterial pneumonia. Option D, thumb sign, is associated with epiglottitis, not acute laryngotracheobronchitis. The thumb sign refers to the swollen epiglottis seen on lateral neck X-rays in cases of epiglottitis. Understanding these radiological signs is essential for healthcare providers caring for pediatric patients with respiratory conditions. Recognizing the steeple sign in acute laryngotracheobronchitis can aid in prompt diagnosis and appropriate treatment, highlighting the importance of radiological assessment in pediatric nursing practice.

Correct Answer: C

Rationale: In this scenario, the most likely diagnosis for a preterm infant with sudden onset respiratory distress, decreased breath sounds, and increased transillumination on one side is C) Pneumothorax. Pneumothorax occurs when air enters the pleural space, leading to lung collapse and subsequent respiratory distress. The decreased breath sounds and increased transillumination are indicative of air accumulation in the pleural space, supporting the diagnosis of pneumothorax in this case. A) Transient tachypnea of the newborn is characterized by respiratory distress shortly after birth due to retained lung fluid, typically improving within 24-72 hours without the need for specific interventions. The absence of breath sounds and transillumination findings make this choice less likely. B) Meconium aspiration syndrome occurs when a newborn inhales meconium-stained amniotic fluid, leading to airway obstruction and respiratory distress. This condition is not typically associated with the unilateral presentation described in the question. D) Neonatal pneumonia can present with respiratory distress in infants but is less likely in this case due to the unilateral findings and sudden onset of symptoms, which are more characteristic of pneumothorax. Educationally, understanding the clinical manifestations and differential diagnoses of respiratory distress in neonates is crucial for pediatric nurses. Recognizing the signs and symptoms of pneumothorax and differentiating it from other common conditions allows for prompt diagnosis and intervention, ultimately improving patient outcomes.

Correct Answer: D

Rationale: In this case, the correct answer is D) Choanal atresia. Choanal atresia is a congenital condition where there is a blockage or narrowing of the back of the nasal passage by abnormal bony or soft tissue. The presentation of worsening cyanosis with feeding (due to increased nasal breathing demand) and improvement with crying (due to mouth breathing) is classic for choanal atresia. Option A) Tetralogy of Fallot typically presents with cyanosis that is not specifically related to feeding or crying. Option B) Respiratory distress syndrome usually presents with respiratory distress, tachypnea, and retractions without the specific pattern described in the question. Option C) Transposition of the great arteries presents with profound cyanosis immediately after birth and is not typically influenced by feeding or crying. Educationally, understanding the distinct clinical presentations of pediatric conditions is vital in providing appropriate care as a nurse. Recognizing the specific signs and symptoms of conditions like choanal atresia can lead to early diagnosis and intervention, ultimately improving patient outcomes. This question highlights the importance of considering congenital abnormalities in neonates presenting with cyanosis.

Correct Answer: C

Rationale: The most likely diagnosis for the term infant presenting with tachypnea, grunting, nasal flaring, and fluid in the lung fissures shortly after birth is option C) Transient tachypnea of the newborn (TTN). Rationale for the correct answer: Transient tachypnea of the newborn is a common condition characterized by respiratory distress due to delayed clearance of fetal lung fluid. This results in tachypnea, grunting, and nasal flaring. Chest X-ray findings typically show fluid in the lung fissures, which is consistent with the presentation described in the question. Rationale for why others are wrong: A) Neonatal pneumonia would typically present with other symptoms such as fever, poor feeding, and respiratory distress not solely due to delayed clearance of lung fluid. B) Respiratory distress syndrome is more common in preterm infants and is due to surfactant deficiency, presenting with a ground-glass appearance on chest X-ray. D) Meconium aspiration syndrome would present with meconium-stained amniotic fluid, respiratory distress, and possible pneumothorax, which are not mentioned in the scenario provided. Educational context: Understanding common neonatal respiratory conditions is crucial for pediatric nurses as timely recognition and appropriate management can significantly impact outcomes. Transient tachypnea of the newborn is typically a self-limiting condition that improves with supportive care, such as oxygen therapy and close monitoring. Nurses play a vital role in assessing and managing neonates with respiratory distress to ensure optimal care and outcomes.