Mid diastolic rumble murmur at the lower left sternal border may be heard in the following structural heart disease:

Correct Answer: D

Rationale: The correct answer is D) Large atrial septal defect (ASD). A mid-diastolic rumble murmur at the lower left sternal border is characteristic of ASD. This murmur occurs due to increased flow across the tricuspid valve during diastole, leading to turbulence. Option A) Large PDA usually presents with a continuous murmur, not a mid-diastolic rumble. Option B) Severe mitral incompetence typically causes a holosystolic murmur, not a mid-diastolic rumble. Option C) Aortic rheumatic carditis with mitral valvulitis would manifest with different murmurs associated with valvular dysfunction, not a mid-diastolic rumble. Educationally, it is crucial for pediatric nurses to understand the specific characteristics of murmurs associated with different structural heart diseases to accurately assess and diagnose pediatric patients. Recognizing the unique features of each murmur can guide appropriate interventions and referrals for further evaluation and treatment.

Correct Answer: A

Rationale: In the severe form of Tetralogy of Fallot, marked cardiomegaly in chest X-ray is not typically seen. The correct answer, A, is true because cardiomegaly is not a common feature of Tetralogy of Fallot. Central cyanosis and clubbing (B) are common due to decreased pulmonary blood flow and chronic hypoxemia. Basal ejection systolic murmur and a single 2nd heart sound (C) are characteristic of Tetralogy of Fallot due to the pulmonary stenosis and right ventricular outflow tract obstruction. Right ventricular hypertrophy on ECG (D) is also expected in Tetralogy of Fallot due to the increased workload on the right ventricle. Educationally, understanding the specific signs and symptoms of Tetralogy of Fallot is crucial for pediatric nurses to provide appropriate care and interventions for children with this congenital heart defect. By knowing the distinct features of the condition, nurses can monitor and manage the child's condition effectively, ensuring optimal outcomes and quality of life. This knowledge also enables early recognition of complications and timely interventions, ultimately improving patient outcomes and well-being.

Correct Answer: D

Rationale: In pediatric nursing, understanding the manifestations of rheumatic fever with carditis is crucial for early recognition and appropriate intervention. The correct answer, D) Apical mid-diastolic rumbling murmur with pre-systolic accentuation, is incorrect because this is actually a characteristic finding in rheumatic carditis due to mitral valve involvement. Option A) Tachycardia out of proportion to fever is a common manifestation of carditis as the heart works harder to compensate for inflammation. Option B) Pericardial rub is associated with pericarditis, not rheumatic carditis. Option C) Heart failure can occur due to the strain on the heart from inflammation and damage caused by rheumatic fever. Educationally, understanding these distinctions is important for nurses caring for pediatric patients at risk for rheumatic fever. Recognizing these signs early can lead to prompt treatment and prevention of further cardiac damage. It is essential for nurses to be able to differentiate between various cardiac sounds and symptoms to provide optimal care for their patients.

Correct Answer: C

Rationale: Acute laryngotracheobronchitis, also known as croup, is a common respiratory condition in children characterized by inflammation of the larynx, trachea, and bronchi. The radiological sign associated with acute laryngotracheobronchitis is the "steeple sign," which refers to the characteristic subglottic narrowing and tapered appearance on imaging studies. This sign is indicative of the narrowing of the airway at the level of the cricoid cartilage, a hallmark feature of croup. Option A, generalized hyperinflation, is not typically seen in acute laryngotracheobronchitis. Hyperinflation is more commonly associated with conditions like asthma or chronic obstructive pulmonary disease. Option B, lobar consolidation, is not a typical finding in croup. Lobar consolidation is more commonly seen in conditions such as pneumonia, where there is a buildup of fluid or pus in a specific lobe of the lung. Option D, thumb sign, is associated with epiglottitis, another upper airway condition. The thumb sign refers to swelling of the epiglottis, leading to a thumb-like appearance on imaging studies. This finding is not specific to acute laryngotracheobronchitis. Understanding the radiological signs associated with different respiratory conditions is crucial for pediatric nurses in diagnosing and managing these conditions effectively. Recognizing the steeple sign in acute laryngotracheobronchitis can help healthcare providers initiate appropriate treatment promptly. It is essential for nurses to be able to differentiate between various radiological signs to provide optimal care for pediatric patients with respiratory illnesses.

Correct Answer: C

Rationale: In this scenario, the most likely diagnosis for a preterm infant presenting with sudden respiratory distress, decreased breath sounds, and increased transillumination on one side is C) Pneumothorax. A pneumothorax occurs when air leaks into the space between the lung and chest wall, causing lung collapse and subsequent respiratory distress. Transient tachypnea of the newborn (A) is characterized by rapid breathing due to retained lung fluid, typically resolving within 24-72 hours without decreased breath sounds or transillumination. Meconium aspiration syndrome (B) results from fetal distress causing the infant to pass meconium into the amniotic fluid, leading to airway obstruction and chemical pneumonitis, not pneumothorax. Neonatal pneumonia (D) presents with systemic signs of infection and may have abnormal breath sounds but is less likely to cause unilateral transillumination. Educational context: Understanding these differential diagnoses in pediatric nursing is crucial for timely and accurate intervention. Pneumothorax can be life-threatening in infants and requires immediate attention to prevent respiratory compromise. Nurses must be able to recognize the signs and symptoms of various respiratory conditions in neonates to provide prompt and effective care.