Manifestation of the initial attack of rheumatic fever with carditis may include all Except:

Correct Answer: D

Rationale: In pediatric nursing, understanding the manifestations of rheumatic fever with carditis is crucial for providing effective care. The correct answer, option D, is "Harsh basal systolic murmur heard best on the second right intercostal space." This is because the characteristic murmur associated with carditis in rheumatic fever is typically best heard at the left lower sternal border, not the second right intercostal space. Option A, "Tachycardia out of proportion to fever," is a common finding in carditis due to the heart's inflammatory response, making it an expected manifestation. Option B, "Pericardial rub," is associated with inflammation of the pericardium, which can occur in carditis. Option C, "Heart failure," can also occur as a complication of carditis due to the strain on the heart from inflammation and damage. Educationally, it is important for nursing students to differentiate between the various manifestations of rheumatic fever with carditis to accurately assess and manage pediatric patients with this condition. Understanding the typical findings, such as specific murmur locations, helps in early detection and appropriate intervention to prevent further complications. This knowledge equips nurses to provide holistic care to pediatric patients with rheumatic fever, improving outcomes and quality of life.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Shift of the mediastinum to the right side in expiratory film. When a foreign body partially obstructs the left main bronchus, it creates a one-way valve effect where air can enter during inspiration but has difficulty exiting during expiration. This leads to hyperinflation of the affected lung (left) and subsequently causes a shift of the mediastinum to the contralateral side (right) in an expiratory film. Option A) Increased air entry on the left hemithorax is incorrect because an obstruction would impede air entry, not increase it. Option B) Homogenous opacity of the right hemithorax on CXR is incorrect as it does not correlate with the described obstruction. Option C) Hyperinflated right hemithorax on CXR is incorrect as the hyperinflation would occur in the affected (left) lung, not the right. Understanding these radiographic findings is crucial for pediatric nurses as they often encounter respiratory emergencies in children. Recognizing these abnormalities can prompt quick intervention and potentially lifesaving measures in a clinical setting. It is essential for nurses to have a strong foundation in pediatric respiratory anatomy and pathology to provide safe and effective care for their young patients.

Correct Answer: A

Rationale: Neonatal Respiratory Distress Syndrome (RDS) is primarily caused by surfactant deficiency in premature infants. Surfactant, a substance produced by the alveoli, helps maintain lung compliance and prevents collapse of the alveoli during expiration. In premature babies, especially those born before 28 weeks gestation, there is insufficient surfactant production, leading to difficulty in lung expansion and respiratory distress. Option B, congenital pneumonia, is not the primary cause of RDS. While pneumonia can lead to respiratory distress, it is not the main etiology in neonates. Option C, persistent pulmonary hypertension, is a condition where the blood vessels in the lungs remain constricted, leading to increased pressure in the pulmonary circulation. This is a separate entity from RDS. Option D, meconium aspiration, occurs when a newborn inhales meconium-stained amniotic fluid, which can lead to respiratory issues but is not the primary cause of RDS. Understanding the primary cause of RDS is crucial for pediatric nurses as they care for premature infants at risk for this condition. Recognizing the importance of surfactant in lung function and the vulnerability of preterm babies to RDS can guide nursing interventions such as respiratory support and surfactant replacement therapy. By focusing on surfactant deficiency as the main culprit, nurses can provide targeted care to improve outcomes for neonates with RDS.

Correct Answer: D

Rationale: Intraventricular hemorrhage (IVH) is a significant concern in preterm infants due to their underdeveloped blood vessels in the brain. The correct answer is D) Prematurity. Preterm infants are at a higher risk for IVH due to the fragility of their blood vessels, especially those in the germinal matrix. The germinal matrix is a highly vascularized region in the brain that is particularly susceptible to bleeding in preterm infants. Option A) Maternal hypertension is a risk factor for other complications in both the mother and the infant, but it is not directly linked to IVH. Option B) Low Apgar scores may indicate the infant's overall condition at birth but do not specifically increase the risk of IVH. Option C) High birth weight is not a risk factor for IVH; in fact, preterm infants are more likely to have low birth weight. Educationally, understanding the risk factors for IVH in preterm infants is crucial for pediatric nurses. This knowledge guides their assessments, interventions, and care planning to prevent or promptly address IVH, which can have serious neurological consequences for the infant. By grasping the specific vulnerabilities of preterm infants, nurses can deliver targeted care to improve outcomes for these vulnerable patients.

Correct Answer: A

Rationale: In the case of a neonate born to a diabetic mother, the correct answer is A) Hypoglycemia. The rationale behind this is that during pregnancy, a diabetic mother may have poorly controlled blood sugar levels, leading to the transfer of excess glucose to the fetus. After birth, the baby's insulin production remains high, causing a drop in blood sugar levels, resulting in hypoglycemia. Option B) Hypercalcemia is incorrect because it refers to elevated levels of calcium in the blood, which is not typically associated with neonates born to diabetic mothers. Option C) Polyuria, excessive urination, is not a common complication in neonates born to diabetic mothers. Polyuria is more commonly seen in conditions like diabetes insipidus, not in infants born to diabetic mothers. Option D) Hypertension, high blood pressure, is also not a typical complication in neonates born to diabetic mothers. Hypertension is more commonly associated with conditions like renal issues or certain congenital heart defects in infants. Educationally, understanding the increased risk of hypoglycemia in neonates born to diabetic mothers is crucial for pediatric nurses. It highlights the importance of close monitoring of blood glucose levels in these infants postnatally to prevent and manage potential complications effectively. This knowledge also underscores the significance of providing specialized care and education to parents on managing their baby's health in such situations.