Regarding a large patent ductus arteriosus (PDA), one of the following statements IS TRUE

Correct Answer: B

Rationale: In the context of a large patent ductus arteriosus (PDA), option B is correct because the murmur of venous hum shares similarities with the murmur of PDA in terms of timing and duration. A venous hum is continuous and can mimic the continuous machinery-like murmur of a large PDA. This is an important distinction to make in pediatric nursing as it helps differentiate between the two conditions based on auscultation findings. Option A is incorrect because the typical murmur heard in a large PDA is continuous or machinery-like, not pansystolic. Option C is incorrect because in the case of a large PDA, there would be increased pulmonary blood flow resulting in prominent pulmonary vascularity on a plain chest X-ray. Option D is incorrect because right ventricular dilatation is not typically associated with a large PDA; instead, left ventricular enlargement may be seen due to increased left-to-right shunting. Understanding these nuances in auscultation findings and associated clinical presentations is crucial for pediatric nurses in accurately assessing and managing pediatric patients with congenital heart defects like PDA. It helps in providing timely interventions and improving patient outcomes.

Correct Answer: A

Rationale: The correct answer is A) Respiratory acidosis, uncompensated. In this scenario, the pH is below the normal range (<7.35), indicating acidosis. The PaCO2 is elevated at 80 mm Hg, indicating respiratory acidosis as it is the primary cause of the acid-base imbalance. The HCO3 level is normal, suggesting the body has not fully compensated for the respiratory acidosis. The PaO2 level is low, indicating hypoxemia, which can further exacerbate the acidosis. Option B) Respiratory acidosis, partially compensated is incorrect because the HCO3 level is within normal range, indicating incomplete compensation for the respiratory acidosis. Option C) Metabolic acidosis, partially uncompensated is incorrect because the primary disturbance is respiratory (elevated PaCO2), not metabolic, and the HCO3 level is normal. Option D) Metabolic alkalosis, uncompensated is incorrect as none of the ABG values suggest metabolic alkalosis. Understanding how to interpret ABG values is crucial in pediatric nursing to assess a child's respiratory and metabolic status accurately. Recognizing the underlying acid-base imbalance helps in determining appropriate interventions and treatments to restore balance and improve patient outcomes.

Correct Answer: A

Rationale: In pediatric nursing, understanding the causes of shock is crucial for timely and effective interventions. Obstructive shock occurs when there is a physical obstruction to blood flow, leading to inadequate tissue perfusion. In this context, the correct answer is A) Tension pneumothorax. Tension pneumothorax involves a buildup of air in the pleural space, causing compression of the lung and major vessels, impairing venous return, and leading to obstructive shock. Anaphylaxis (B) is characterized by a systemic allergic reaction, resulting in distributive shock due to vasodilation and increased capillary permeability. Sepsis (C) is a systemic inflammatory response to infection, causing distributive shock through vasodilation and endothelial damage. Hemorrhage (D) leads to hypovolemic shock due to decreased circulating blood volume. Educationally, understanding the specific etiologies of shock in pediatric patients is essential for nurses to recognize early signs, implement appropriate treatments, and prevent complications. This knowledge aids in prioritizing patient care and improving outcomes in emergency situations. By mastering these concepts, nurses can provide safe and effective care to pediatric patients experiencing shock.

Correct Answer: A

Rationale: The correct answer is option A: Fever, new cardiac murmur, splenomegaly. This clinical scenario raises suspicion for bacterial endocarditis in a child because bacterial endocarditis often presents with nonspecific symptoms like fever and can lead to the development of new cardiac murmurs due to valvular damage. Splenomegaly can also be a common finding in bacterial endocarditis due to embolic phenomena affecting the spleen. Option B (Tachypnea, tachycardia, cardiac murmur, sudden onset leg swelling) is less indicative of bacterial endocarditis as sudden onset leg swelling is more commonly associated with conditions like deep vein thrombosis or heart failure. Option C (Positive CRP, skin lesion, hepatomegaly) does not strongly suggest bacterial endocarditis as the presence of skin lesions and hepatomegaly are not specific to this condition. Option D (Positive ASO titre, progressively louder heart murmur, marked hepatomegaly) is more suggestive of acute rheumatic fever rather than bacterial endocarditis due to the positive ASO titre and the association with a progressively louder heart murmur. In an educational context, understanding the clinical manifestations and diagnostic indicators of bacterial endocarditis in children is crucial for timely identification and treatment of this serious condition. This knowledge helps pediatric nurses provide comprehensive care and support to children at risk for or diagnosed with bacterial endocarditis.

Correct Answer: C

Rationale: In the case of pulseless ventricular tachycardia, the correct action is to administer a synchronized direct current (DC) shock at 4J/kg. This is the most appropriate intervention to attempt to restore a normal sinus rhythm in a pediatric patient experiencing this life-threatening arrhythmia. DC shocks are effective in terminating ventricular tachycardia by depolarizing the myocardium and allowing the normal pacemaker activity to resume. Option A, DC 2J/kg, is incorrect because the recommended energy for a pediatric patient in pulseless ventricular tachycardia is 4J/kg, not 2J/kg. Administering a lower energy level may not be effective in terminating the arrhythmia. Option B, endotracheal intubation, is not the initial intervention for pulseless ventricular tachycardia. While airway management is important in resuscitation, the priority in this situation is to deliver a DC shock to attempt to restore a perfusing rhythm. Option D, giving epinephrine, is also not the initial intervention for pulseless ventricular tachycardia. Although epinephrine is part of the advanced life support algorithm, in this scenario, the immediate action should be to deliver a DC shock. In an educational context, it is crucial for healthcare providers, especially those working in pediatric settings, to be proficient in recognizing and managing life-threatening arrhythmias in children. Understanding the correct interventions for pulseless ventricular tachycardia and being able to quickly and effectively implement them can significantly impact patient outcomes. Regular training and simulation exercises can help healthcare providers maintain the necessary skills to respond to such critical situations.