One of the following is a major Jones criteria for diagnosis of rheumatic fever:

Correct Answer: C

Rationale: In the diagnosis of rheumatic fever, one major Jones criteria is Erythema marginatum. Erythema marginatum is a painless, non-pruritic rash with characteristic serpiginous borders. It is important to recognize this criteria as it helps in confirming the diagnosis of rheumatic fever. Arthralgia (option B) is a common symptom of rheumatic fever, but it is not a major Jones criteria for its diagnosis. Fever (option A) is also a common symptom, but not specific to rheumatic fever. Prolonged PR-interval (option D) is associated with rheumatic carditis, a complication of rheumatic fever, but it is not a major diagnostic criteria on its own. Educationally, understanding the major Jones criteria for rheumatic fever is crucial for healthcare providers, especially pediatric nurses, as they play a key role in early recognition and management of this condition in children. By knowing the specific criteria, nurses can advocate for timely treatment and help prevent complications associated with rheumatic fever.

Correct Answer: B

Rationale: In pediatric nursing, understanding respiratory distress signs is crucial for timely intervention. Expiratory grunting is a sign of bacterial pneumonia. This occurs due to the child's attempt to keep the airways open during expiration, indicating respiratory distress and potential lung consolidation typical of pneumonia. Option A, bronchial asthma, is characterized by wheezing on expiration rather than grunting. Option C, viral croup, presents with a barking cough, stridor, and inspiratory distress rather than expiratory grunting. Option D, acute epiglottitis, manifests with drooling, dysphagia, and a muffled voice rather than expiratory grunting. Educationally, it's essential to differentiate these respiratory distress signs accurately as misinterpretation can lead to delayed treatment. Nurses caring for pediatric patients need to be adept at recognizing subtle yet critical signs like expiratory grunting to provide prompt and appropriate care. Regular education and skill development in pediatric respiratory assessments are vital for nursing professionals to ensure high-quality care delivery.

Correct Answer: C

Rationale: In this case, the most likely diagnosis for the newborn presenting with respiratory distress, scaphoid abdomen, and decreased breath sounds on the left is Congenital Diaphragmatic Hernia (CDH). The diaphragm is a crucial muscle for breathing, separating the chest cavity from the abdominal cavity. In CDH, there is a defect in the diaphragm that allows abdominal contents to herniate into the chest cavity, compromising lung development and leading to respiratory distress. Option A, Transient tachypnea of the newborn, is characterized by mild respiratory distress shortly after birth due to delayed clearance of fetal lung fluid. It does not typically present with a scaphoid abdomen or decreased breath sounds on one side. Option B, Meconium aspiration syndrome, occurs when a newborn inhales meconium-stained amniotic fluid, leading to respiratory distress. However, it does not typically cause a scaphoid abdomen or decreased breath sounds on one side. Option D, Neonatal pneumonia, can present with respiratory distress and decreased breath sounds, but it is less likely to cause a scaphoid abdomen, which is more indicative of CDH. Understanding these differential diagnoses is crucial in pediatric nursing as prompt and accurate identification of conditions like CDH is vital for immediate intervention and management to improve outcomes for newborns. Early recognition of respiratory distress in newborns and appropriate actions can significantly impact their prognosis and overall health.

Correct Answer: B

Rationale: In the case of a newborn diagnosed with hypoxic-ischemic encephalopathy, the most effective treatment for improving neurological outcomes is therapeutic hypothermia (Option B). Therapeutic hypothermia involves carefully lowering the body temperature of the newborn to reduce the risk of brain injury and improve long-term neurological function. This intervention has been supported by evidence-based research and guidelines from organizations like the American Academy of Pediatrics. IV antibiotics (Option A) are used to treat bacterial infections and would not directly address the neurological consequences of hypoxic-ischemic encephalopathy. Hyperbaric oxygen (Option C) therapy involves breathing pure oxygen in a pressurized room and is not considered a standard treatment for this condition. High-dose corticosteroids (Option D) are not recommended for hypoxic-ischemic encephalopathy and may even have harmful effects. Educationally, understanding the rationale behind why therapeutic hypothermia is the preferred treatment in this scenario is crucial for pediatric nursing students and healthcare professionals working in neonatal care. By grasping the principles of therapeutic hypothermia and its impact on neurological outcomes, providers can deliver evidence-based care and improve the chances of positive outcomes for newborns with hypoxic-ischemic encephalopathy.

Correct Answer: B

Rationale: In the case of a newborn delivered at 30 weeks gestation who requires respiratory support, the most effective intervention in preventing respiratory distress syndrome is option B) Surfactant replacement. Surfactant is a substance produced by the lungs that helps keep the air sacs open and prevents them from collapsing. Premature infants often lack sufficient surfactant, leading to respiratory distress syndrome (RDS). Administering exogenous surfactant replacement therapy can significantly improve lung function and prevent RDS in preterm infants. Option A) Oral corticosteroids are not typically used in the immediate management of respiratory distress syndrome in newborns. While corticosteroids may have a role in certain situations to accelerate lung maturation in the antenatal period, they are not the primary treatment for RDS after birth. Option C) CPAP without intubation can be beneficial in providing respiratory support to preterm infants with certain conditions, but in the case of preventing RDS in a newborn delivered at 30 weeks gestation, surfactant replacement is more effective. Option D) High-flow nasal cannula is a mode of respiratory support that can be used in various respiratory conditions in newborns, but when it comes to preventing RDS in a preterm infant, surfactant replacement therapy has been shown to be more efficacious. Educationally, understanding the pathophysiology of RDS in preterm infants and the role of surfactant replacement therapy is crucial for pediatric nursing practice. It highlights the importance of timely interventions to support respiratory function in vulnerable newborns and emphasizes evidence-based approaches to neonatal care.