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

Correct Answer: D

Rationale: In this question, the correct answer is option D: Apical mid-diastolic rumbling murmur with pre-systolic accentuation. This answer is correct because this specific murmur pattern is characteristic of mitral stenosis, which is a sequela of rheumatic fever, not an initial manifestation during the acute attack with carditis. Option A, tachycardia out of proportion to fever, is often seen in rheumatic fever due to the inflammatory process involving the heart. Option B, pericardial rub, may be present in pericarditis, which can occur in rheumatic fever. Option C, heart failure, can also occur as a result of carditis in rheumatic fever. In an educational context, understanding the manifestations of rheumatic fever, including carditis, is crucial for pediatric nurses. Recognizing the signs and symptoms can lead to early detection and appropriate management, thus preventing further complications. It is important for nurses to be able to differentiate between different cardiac sounds and symptoms to provide optimal care for pediatric patients with rheumatic fever.

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.

Correct Answer: D

Rationale: In the context of pediatric nursing, understanding acute bronchiolitis is crucial for providing effective care to infants. The correct answer, D, states that the disease is more benign in infants born prematurely. This is false because premature infants are actually at a higher risk for severe complications from bronchiolitis due to their underdeveloped respiratory systems. Option A is true as epidemics of acute bronchiolitis often occur during winter months due to increased viral activity and close contact among individuals indoors. Option B is accurate as the disease predominantly affects infants younger than 2 years old, with a peak incidence around 3-6 months of age. Option C is incorrect because immunodeficiency is not an indication for treatment with ribavirin in acute bronchiolitis. Ribavirin is reserved for severe cases and is not routinely recommended due to limited efficacy and potential side effects. Educationally, it is important for nurses to have a solid understanding of acute bronchiolitis, including risk factors, clinical manifestations, and appropriate management strategies. By knowing the key facts about the condition, nurses can provide prompt and effective care, educate families on prevention measures, and recognize when to escalate care for infants with severe bronchiolitis symptoms.