Initial management of the acute asthma exacerbation includes:

Correct Answer: A

Rationale: In managing an acute asthma exacerbation in pediatric patients, the initial approach should focus on addressing airway inflammation and bronchoconstriction. Option A, which includes oxygen therapy, nebulized β2 agonist (such as albuterol), and systemic steroids (such as prednisolone), is the correct choice. Oxygen therapy is crucial to correct hypoxemia, nebulized β2 agonists help bronchodilation rapidly, and systemic steroids reduce airway inflammation. This combination targets both the acute symptoms and underlying inflammation seen in asthma exacerbations. Option B, intravenous aminophylline, is not recommended as a first-line treatment due to its narrow therapeutic window and potential for toxicity. Option C includes intravenous aminophylline which is not part of the initial management. Option D includes intravenous magnesium sulfate, which may be considered in severe cases but is not typically part of the initial management. Educationally, understanding the rationale behind each treatment option helps nurses provide safe and evidence-based care to pediatric patients with asthma exacerbations. Recognizing the importance of each component in the initial management ensures optimal outcomes and prevents potential complications.

Correct Answer: D

Rationale: In pediatric nursing, understanding the manifestations of various respiratory conditions is crucial for accurate assessment and intervention. In the context of severe laryngitis, the correct indicator is a diphasic stridor (Option D). A diphasic stridor is characterized by a high-pitched sound heard during both inspiration and expiration and is indicative of significant airway obstruction. This is a concerning sign in laryngitis as it suggests a narrowing of the upper airway, potentially compromising the child's ability to breathe effectively. Now, let's explore why the other options are incorrect: - Inspiratory stridor (Option A) is a high-pitched sound heard during inspiration and is commonly associated with conditions like croup or epiglottitis, not severe laryngitis. - Suprasternal retraction (Option B) is a sign of increased work of breathing but is not specific to laryngitis. - Rhinorrhea (Option C) refers to a runny nose and is not a typical indicator of severe laryngitis. Educational context: Understanding the specific signs and symptoms of respiratory conditions in children is essential for pediatric nurses to provide prompt and effective care. By recognizing the significance of a diphasic stridor in severe laryngitis, nurses can advocate for timely interventions to maintain airway patency and support the child's respiratory function. This knowledge enhances clinical decision-making and improves patient outcomes.

Correct Answer: D

Rationale: In pediatric nursing, understanding raised intracranial pressure (ICP) is crucial for timely intervention and prevention of serious complications. The correct definition of raised ICP in children is when the pressure exceeds 20 mmHg for more than five minutes (Option D). This definition is based on the fact that children's developing brains are more vulnerable to pressure changes, requiring prompt recognition and management to prevent neurological damage. Option A (Increased ICP more than 8 mmHg for more than one day) is incorrect because an ICP of 8 mmHg is within normal limits, and the time frame mentioned is not clinically significant for defining raised ICP. Option B (Increased ICP more than 6 mmHg for more than one hour) is incorrect as an ICP of 6 mmHg is also considered normal, and one hour is not typically a critical timeframe for raised ICP assessment. Option C (Increased ICP more than 10 mmHg for more than one minute) is incorrect as an ICP of 10 mmHg is still within normal limits, and one minute is too short to diagnose raised ICP accurately. Understanding these distinctions is vital for nurses caring for pediatric patients at risk for increased ICP due to conditions such as head trauma, tumors, or infections. Early recognition of raised ICP signs and symptoms can lead to prompt interventions, potentially preventing further brain damage in children.

Correct Answer: B

Rationale: The correct answer is B) Expelling a foreign body in the airway in the unconscious child. The Heimlich maneuver, also known as abdominal thrusts, is a first-aid procedure used to dislodge an obstruction in the airway, particularly in cases where the person is choking and unable to breathe or speak. In pediatric nursing, this skill is crucial as children are prone to putting small objects in their mouths, which can lead to choking emergencies. Performing the Heimlich maneuver promptly can save a child's life by clearing the airway and restoring normal breathing. Option A) Assessing if the child is breathing or not is incorrect because the Heimlich maneuver is not used for assessment but for intervention in cases of airway obstruction. Option C) Chest compression in a large child to ensure adequate compression is incorrect as chest compressions are part of CPR (Cardiopulmonary Resuscitation) and are not performed during the Heimlich maneuver. Option D) Opening airway in the presence of a possible cervical spine injury is incorrect because the Heimlich maneuver is specifically for clearing airway obstructions and is not indicated for suspected cervical spine injuries where movement of the neck should be minimized. Educational Context: Pediatric nurses must be well-versed in emergency procedures like the Heimlich maneuver to respond effectively to choking incidents in children. Understanding the correct technique, indications, and contraindications of the Heimlich maneuver is crucial for pediatric healthcare providers to provide timely and life-saving interventions in emergency situations. Regular training, practice, and staying updated on pediatric emergency protocols are essential for pediatric nurses to deliver safe and competent care to pediatric patients.

Correct Answer: B

Rationale: In the treatment of hypernatremia, the maximum accepted rate of drop of serum sodium per 24 hours is crucial to prevent complications like cerebral edema. The correct answer is B) 12 mmol/L. This rate is considered safe and effective in correcting hypernatremia without causing rapid shifts in osmolarity, which can lead to neurological damage. Option A) 8 mmol/L is too conservative and may not effectively correct hypernatremia in a timely manner, potentially prolonging the patient's risk of complications. Option C) 16 mmol/L and Option D) 20 mmol/L represent overly aggressive decreases in serum sodium levels, which can precipitate cerebral edema and other neurological issues. In an educational context, understanding the appropriate rate of correction for electrolyte imbalances like hypernatremia is essential for pediatric nurses to provide safe and effective care to their patients. Nurses must carefully monitor serum sodium levels, collaborate with the healthcare team to adjust treatment plans as needed, and ensure that corrections are made within the recommended parameters to promote optimal patient outcomes.