Initial management of the acute asthma exacerbation includes:

Correct Answer: A

Rationale: In the initial management of an acute asthma exacerbation in pediatric patients, the correct option is A) Oxygen therapy, nebulized β2 agonist, systemic steroids. Explanation of why A is correct: 1. Oxygen therapy is essential to correct hypoxemia, a common complication in acute asthma exacerbations. 2. Nebulized β2 agonists like albuterol help relieve bronchospasm by dilating the airways, improving airflow. 3. Systemic steroids such as prednisone or methylprednisolone reduce airway inflammation and prevent further exacerbations. Explanation of why others are wrong: B) Intravenous aminophylline: Aminophylline is not recommended as first-line treatment due to its narrow therapeutic window and potential for toxicity. C) Intravenous aminophylline, steroids: While steroids are essential in asthma exacerbations, aminophylline is not preferred due to its side effects and variable efficacy. D) Nebulized β2 agonist, intravenous magnesium sulfate: Magnesium sulfate is sometimes used in severe asthma exacerbations but is not typically part of initial management. Educational context: Understanding the rationale behind the initial management of acute asthma exacerbations is crucial for pediatric nurses to provide prompt and effective care. Oxygen therapy, nebulized β2 agonists, and systemic steroids are cornerstone treatments in managing acute exacerbations, aiming to improve oxygenation, relieve bronchospasm, and reduce airway inflammation. By selecting the correct interventions, nurses can help stabilize pediatric patients experiencing asthma exacerbations and prevent progression to severe respiratory distress.

Correct Answer: D

Rationale: In pediatric nursing, understanding the manifestations of various respiratory conditions is crucial for accurate assessment and intervention. Severe laryngitis typically presents with a diphasic stridor, which is characterized by a high-pitched sound on both inspiration and expiration. This is indicative of significant airway obstruction, requiring immediate attention. Option A, inspiratory stridor, is more commonly associated with croup or acute epiglottitis, not severe laryngitis. Suprasternal retraction (Option B) can be seen in conditions like asthma or foreign body aspiration but is not specific to severe laryngitis. Rhinorrhea (Option C) refers to a runny nose and is not a typical symptom of laryngitis. Educationally, this question emphasizes the importance of recognizing specific respiratory distress signs in pediatric patients. Understanding these distinctions is essential for providing timely and appropriate care in a clinical setting. By grasping these nuances, nurses can quickly assess and intervene in respiratory emergencies, optimizing patient outcomes.

Correct Answer: D

Rationale: In pediatric nursing, understanding raised intracranial pressure (ICP) is crucial as it can indicate serious neurological issues. The correct definition of raised ICP in children is when it exceeds 20 mmHg for more than five minutes (Option D). This level of ICP can lead to decreased cerebral perfusion, causing brain damage. Option A (Increased ICP more than 8 mmHg for more than one day) is incorrect as an ICP of 8 mmHg is within the normal range and one day is too long for a significant increase to occur. Option B (Increased ICP more than 6 mmHg for more than one hour) is also incorrect because an ICP of 6 mmHg is normal, and one hour is not enough time for a concerning increase. Option C (Increased ICP more than 10 mmHg for more than one minute) is incorrect as 10 mmHg is still within normal limits, and one minute is too short a time frame to assess for raised ICP accurately. Educationally, it is essential for pediatric nurses to be able to recognize the signs and symptoms of raised ICP promptly, as early intervention is crucial in preventing further complications. Monitoring ICP levels and understanding the thresholds for intervention are vital skills in pediatric critical care settings. Option D represents a critical level of raised ICP that requires immediate attention to prevent neurological damage, making it the correct answer in this scenario.

Correct Answer: B

Rationale: The correct answer is B) Expelling a foreign body in the airway in the unconscious child. The Heimlich maneuver is a first aid procedure used to help a choking person who is conscious or unconscious by dislodging an obstruction in their airway. In a pediatric setting, this maneuver is crucial as children are more prone to choking due to their exploratory behavior and small airways. Option A is incorrect because the Heimlich maneuver is not used to assess if a child is breathing or not; it is specifically used for airway obstruction. Option C is incorrect as chest compressions in a large child are part of CPR but not the Heimlich maneuver, which focuses on abdominal thrusts to expel the obstruction. Option D is incorrect because the Heimlich maneuver is not used to open the airway in the presence of a possible cervical spine injury; in such cases, manual stabilization of the head and neck would be necessary. In an educational context, understanding and being able to correctly perform the Heimlich maneuver is a critical skill for healthcare providers, particularly those working with pediatric populations. It can be life-saving in situations where a child is choking and unable to breathe. Proper training and practice in this maneuver can help prevent serious complications and even save lives in emergency situations involving pediatric patients.

Correct Answer: B

Rationale: In the treatment of hypernatremia, the maximum accepted rate of drop of serum sodium per 24 hours is 12 mmol/L (Option B). This rate is considered safe to prevent rapid changes in serum sodium levels that can lead to complications such as cerebral edema. Option A (8 mmol/L) is too conservative and may not effectively correct hypernatremia in a timely manner, especially in severe cases where a faster reduction is needed to prevent adverse effects on the brain. Options C (16 mmol/L) and D (20 mmol/L) are too aggressive and can lead to overly rapid correction of serum sodium levels, potentially causing neurological damage such as central pontine myelinolysis. In pediatric nursing practice, it is crucial to carefully monitor and control the rate of correction of electrolyte imbalances to ensure patient safety. By understanding the appropriate rate of change in serum sodium levels, nurses can provide optimal care and prevent complications associated with hypernatremia treatment.