The child in Question 24 has symptoms that worsen and are now persistent and of moderate severity... Which treatment option is most appropriate?

Correct Answer: D

Rationale: In pediatric nursing, managing asthma requires a comprehensive approach tailored to the severity of the symptoms. The most appropriate treatment option in this scenario is D) Daily inhaled corticosteroid and a long-acting inhaled β₂-agonist. This combination therapy is indicated for children with persistent asthma symptoms that are worsening and of moderate severity. Inhaled corticosteroids help reduce airway inflammation, while long-acting β₂-agonists provide bronchodilation and symptom control over an extended period, addressing both underlying inflammation and bronchoconstriction. Option A) Oral theophylline is not the first-line treatment for persistent asthma in children due to its narrow therapeutic window, potential for toxicity, and need for frequent monitoring. Option B) Inhaled β₂-agonist as needed is suitable for mild intermittent asthma, not for persistent symptoms. Option C) Daily inhaled corticosteroid alone is appropriate for persistent symptoms but may not provide optimal control in moderate to severe cases. Educationally, understanding the rationale behind different asthma treatment options is crucial for pediatric nurses to provide safe and effective care to children with asthma. Tailoring treatment to the child's symptom severity and individual needs is key to achieving optimal asthma management outcomes.

Correct Answer: D

Rationale: In pediatric nursing, understanding the causes of allergic bronchopulmonary aspergillosis (ABPA) is crucial for providing effective care to patients. In this case, the correct answer is D) Allergic rhinitis. ABPA is primarily associated with asthma and cystic fibrosis, making options A and B incorrect. Chronic obstructive pulmonary disease (COPD) is typically seen in adults, not commonly in pediatric populations, making option C less likely. Allergic rhinitis, on the other hand, is a common allergic condition affecting the upper respiratory tract, characterized by symptoms such as sneezing, nasal congestion, and itching. While it can be a precursor to lower respiratory conditions like asthma, it is not a common direct cause of ABPA in pediatric patients. Educationally, this question highlights the importance of recognizing the distinguishing factors between various respiratory conditions in pediatric patients. By understanding the specific risk factors and associations of ABPA, nurses can provide targeted interventions and management strategies to improve patient outcomes.

Correct Answer: D

Rationale: In this question, the correct answer is option D) Large atrial septal defect. The risk of developing infective endocarditis is least in a patient with a large atrial septal defect because the flow of blood in this defect is typically from the left atrium to the right atrium, which results in less turbulence and lower risk of bacterial adherence and subsequent infection. Option A) Severe aortic regurgitation, Option B) Small ventricular septal defect, and Option C) Severe mitral regurgitation are not the least risky in terms of developing infective endocarditis. Severe aortic and mitral regurgitation can lead to turbulent blood flow, increasing the risk of bacterial adherence. Small ventricular septal defects can also pose a higher risk due to the potential for turbulent flow and bacterial attachment. In an educational context, understanding the relationship between different types of cardiac defects and the risk of infective endocarditis is crucial for pediatric nurses. It is essential to grasp the hemodynamics of each defect to provide optimal care and prevent complications such as infective endocarditis. This knowledge allows nurses to prioritize interventions and educate patients and families effectively on infection prevention strategies.

Correct Answer: D

Rationale: In pediatric nursing, understanding neonatal cholestasis is crucial for providing effective care to newborns. The correct answer is D) Biliary atresia. Biliary atresia is the most common cause of neonatal cholestasis, characterized by the obstruction or absence of the bile ducts, leading to bile flow impairment and liver damage. Early identification and intervention are vital to prevent irreversible liver damage and improve outcomes. Option A) Idiopathic neonatal hepatitis is a broad term for liver inflammation of unknown cause, less common than biliary atresia in causing neonatal cholestasis. Option B) ABO incompatibility typically presents with hemolytic jaundice due to mismatched blood types between mother and baby, not causing cholestasis. Option C) Progressive familial intrahepatic cholestasis is a genetic disorder causing impaired bile formation but is less common than biliary atresia in neonates. Educationally, this question highlights the importance of recognizing biliary atresia as a primary cause of neonatal cholestasis, emphasizing the need for prompt diagnosis and appropriate management to prevent complications. It reinforces the significance of differential diagnosis skills in pediatric nursing to ensure timely and accurate treatment for neonatal conditions.

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.