Pleural friction rub is characterized by all the following EXCEPT:

Correct Answer: A

Rationale: In the context of pediatric nursing, understanding the characteristics of pleural friction rub is essential for accurate assessment and diagnosis of respiratory conditions in children. The correct answer, option A, states that pleural friction rub is audible during the inspiratory phase of breathing. This is correct because pleural friction rub is a specific adventitious breath sound caused by the inflamed pleural surfaces rubbing together during breathing, typically heard during inspiration and expiration. Option B states that it may be associated with pain. This is incorrect as pleural friction rub itself is a sound and not a sensation felt by the patient. Pain may be present in conditions causing pleural friction rub, but it is not a direct characteristic of the sound itself. Option C mentions that it is unaltered by coughing. This is incorrect because pleural friction rub can sometimes change or temporarily disappear with coughing due to the mechanical effects of coughing on the pleural surfaces. Option D suggests that it is better heard with the chest piece of the stethoscope tightly placed over the chest wall. This is incorrect as pleural friction rub is typically best heard with the diaphragm of the stethoscope rather than the bell, and pressing too tightly may actually dampen the sound. Educationally, this question highlights the importance of recognizing and interpreting abnormal breath sounds in pediatric patients. By understanding the characteristics of pleural friction rub, nurses can provide better care, make accurate assessments, and communicate effectively with other healthcare team members regarding a child's respiratory status.

Correct Answer: A

Rationale: In this question, the correct answer is A) The mechanism of action is not known. Corticosteroids are commonly used in the treatment of allergies, asthma, and various inflammatory conditions. The mechanism of action of corticosteroids is well understood - they work by inhibiting the production of inflammatory mediators by suppressing the immune response. Option B) Corticosteroids are lymphopenic is incorrect because corticosteroids actually cause lymphocytosis, an increase in the number of lymphocytes in the blood. Option C) Corticosteroids decrease synthesis of prostaglandins is incorrect because corticosteroids mainly inhibit the synthesis of leukotrienes, not prostaglandins. Option D) Long-term usage suppresses linear growth in children is incorrect because while long-term corticosteroid use in children can lead to various side effects, such as adrenal suppression or decreased bone density, it does not directly suppress linear growth. Educationally, understanding the mechanism of action and common side effects of corticosteroids is crucial for healthcare professionals, especially pediatric nurses, who may be administering these medications to children. It is important to be aware of the potential effects of corticosteroids on growth and development in children to provide safe and effective care.

Correct Answer: D

Rationale: The correct answer is D) Anaphylactic shock. Anaphylactic shock is a severe, life-threatening allergic reaction that can occur rapidly after exposure to an allergen, such as a vaccine component. In this scenario, the sudden onset of symptoms like flushing, tachycardia, tachypnea, weak peripheral pulses, and altered consciousness are classic signs of anaphylactic shock. Option A) Cardiogenic shock is unlikely in this case because the symptoms described are more indicative of a systemic allergic reaction rather than a primary cardiac issue. Option B) Distributive shock, often seen in conditions like sepsis or anaphylaxis, involves widespread vasodilation and hypoperfusion but does not fully explain the specific symptoms presented in the case. Option C) Hypovolemic shock results from a significant loss of blood or fluid volume, which is not a primary cause of the symptoms observed post-vaccination in this scenario. In an educational context, it is crucial for pediatric nurses to be able to recognize and respond promptly to allergic reactions, including anaphylactic shock, especially in the context of vaccine administration. Understanding the signs and symptoms of anaphylaxis, along with appropriate interventions such as administering epinephrine, can be life-saving in such situations. Nurses should also be trained to differentiate between different types of shock to provide optimal care for pediatric patients.

Correct Answer: D

Rationale: In pediatric basic life support (BLS), it is crucial to follow guidelines tailored to children to ensure the best possible outcomes in an emergency situation. The correct answer, option D, states that the encircling technique is used to perform chest compressions on a child during BLS. This technique involves encircling the child's chest with both hands to provide effective and appropriate compressions to the sternum, reflecting the importance of proper hand placement and technique in pediatric BLS. Option A, stating that the priority is to intubate the child, is incorrect. In pediatric BLS, the immediate focus should be on providing high-quality chest compressions to maintain circulation before considering advanced airway interventions like intubation. Option B, mentioning that chest compressions are indicated if heart sounds are weak, is also incorrect. In pediatric BLS, chest compressions are initiated based on the absence of a pulse or effective circulation, not solely on the strength of heart sounds. Option C, suggesting a compression to ventilation ratio of 15:2, is outdated. Current guidelines recommend a compression to ventilation ratio of 30:2 for single rescuer CPR in children, emphasizing the importance of providing adequate chest compressions to maintain perfusion. Educationally, understanding the specific techniques and guidelines for pediatric BLS is essential for healthcare providers working with children. Proper training and adherence to current protocols can significantly impact the outcomes of pediatric cardiac arrest situations, making this knowledge critical for pediatric nurses and other healthcare professionals caring for children.

Correct Answer: C

Rationale: Understanding the concept of metabolic acidosis with a high anion gap is crucial for pediatric nurses as it helps in identifying and managing various pediatric conditions effectively. In this scenario, the correct answer is option C) Renal tubular acidosis. Renal tubular acidosis is a condition where the kidneys are unable to effectively excrete acids into the urine, leading to metabolic acidosis. This results in an elevated anion gap due to the accumulation of unmeasured anions. Therefore, it is the only option in the list that directly causes metabolic acidosis with a high anion gap. The other options, A) Diabetic ketoacidosis, B) Salicylate poisoning, and D) Renal failure, can all lead to metabolic acidosis, but they typically present with a normal anion gap. Diabetic ketoacidosis and salicylate poisoning lead to an increased anion gap due to the presence of ketones and salicylate metabolites, respectively. Renal failure can cause metabolic acidosis, but it is characterized by a normal anion gap as the kidneys are unable to excrete normal amounts of acid. Educationally, this question serves to reinforce the understanding of metabolic acidosis, anion gap, and various causes of acid-base disturbances in pediatric patients. Pediatric nurses need to be able to differentiate between different etiologies of acidosis to provide appropriate and timely interventions for their patients.