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 in children requires a comprehensive understanding of treatment options based on symptom severity. The most appropriate treatment option in this scenario is D) Daily inhaled corticosteroid and a long-acting inhaled β₂-agonist. This option is correct because the child's symptoms have worsened and are now persistent and of moderate severity, indicating the need for a step-up in treatment to achieve better control and prevent exacerbations. Option A) Oral theophylline is less commonly used in current asthma management guidelines due to its narrow therapeutic window and potential for side effects, especially in children. Option B) Using inhaled β₂-agonist as needed for symptoms is appropriate for mild intermittent asthma but not for persistent symptoms of moderate severity, as described in the scenario. Option C) Daily inhaled corticosteroid alone is recommended for persistent asthma symptoms, but in this case, the severity of symptoms warrants a combination therapy with a long-acting β₂-agonist to achieve better control and prevent exacerbations. Educationally, understanding the rationale behind each treatment option helps nurses make informed clinical decisions based on the child's presentation and current asthma management guidelines. It emphasizes the importance of individualizing treatment based on symptom severity and the need for step-wise approaches to asthma management in children.

Correct Answer: D

Rationale: Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to the fungus Aspergillus fumigatus. In this condition, the immune system overreacts to the presence of the fungus in the airways, leading to inflammation and damage. The correct answer, option D) Allergic rhinitis, is not a common cause of ABPA. Allergic rhinitis primarily affects the upper respiratory tract, specifically the nasal passages, and does not typically progress to involve the lower airways as seen in ABPA. Option A) Asthma is a common predisposing factor for ABPA. Patients with poorly controlled asthma are at higher risk of developing ABPA due to the chronic airway inflammation and immune dysregulation associated with asthma. Option B) Cystic fibrosis is also a known risk factor for ABPA. Patients with cystic fibrosis have thick mucus that can trap Aspergillus spores in the airways, leading to infection and subsequent allergic reaction. Option C) Chronic obstructive pulmonary disease (COPD) is not typically associated with ABPA, as it is more commonly linked to conditions involving chronic inflammation and structural damage of the lungs, such as bronchiectasis. In an educational context, understanding the common causes and risk factors for ABPA is crucial for healthcare providers working with pediatric patients. Recognizing these predisposing conditions can aid in early identification, prompt treatment, and improved outcomes for children at risk for or diagnosed with ABPA. Educating students and healthcare professionals on the nuances of respiratory conditions and their associated complications is essential in providing comprehensive care to pediatric patients with respiratory issues.

Correct Answer: D

Rationale: In this question, the correct answer is D) Large atrial septal defect. The risk of developing infective endocarditis is the least in a patient with a large atrial septal defect because atrial septal defects do not cause turbulent blood flow like ventricular septal defects or valvular regurgitation. Turbulent blood flow increases the risk of bacterial seeding and subsequent development of infective endocarditis. In contrast, atrial septal defects allow blood to flow between the atria without causing turbulence. Option A) Severe aortic regurgitation and Option C) Severe mitral regurgitation both involve valvular regurgitation, which can lead to turbulent blood flow and an increased risk of infective endocarditis. Option B) Small ventricular septal defects can also cause turbulent blood flow due to the pressure difference between the ventricles, increasing the risk of infective endocarditis compared to a large atrial septal defect. Educationally, understanding the relationship between specific cardiac defects and their impact on blood flow dynamics and the risk of infective endocarditis is crucial for pediatric nurses caring for patients with congenital heart conditions. This knowledge informs patient assessment, intervention strategies, and patient education to prevent complications such as infective endocarditis.

Correct Answer: D

Rationale: The correct answer is D) Biliary atresia. Biliary atresia is the most common cause of neonatal cholestasis, which is a condition characterized by the obstruction of bile flow from the liver to the intestine. This obstruction can lead to liver damage and impaired bile excretion. Option A) Idiopathic neonatal hepatitis is a broad term that refers to liver inflammation of unknown cause in neonates. While it can present with cholestasis, it is not the most common cause. Option B) ABO incompatibility is a condition where the mother's blood type is incompatible with the baby's, leading to hemolytic disease of the newborn. This condition affects the red blood cells, not the liver. Option C) Progressive familial intrahepatic cholestasis is a genetic disorder that impairs bile flow from the liver, but it is not as common as biliary atresia in causing neonatal cholestasis. Understanding the most common causes of neonatal cholestasis is crucial for nurses caring for newborns. Early identification and management of biliary atresia are essential to prevent further liver damage and improve outcomes for the infant. Nurses play a key role in monitoring newborns for signs of cholestasis and facilitating prompt diagnostic evaluation and treatment.

Correct Answer: B

Rationale: The correct answer is B) The murmur of venous hum has some features as the murmur of PDA regarding its timing and duration. In a large PDA, the continuous murmur heard is similar to a venous hum in timing and duration due to the constant flow through the patent vessel. This is an important distinction to make in clinical practice to differentiate the murmur of PDA from other cardiac murmurs. Option A is incorrect because the typical murmur of a large PDA is continuous, not pansystolic. Option C is incorrect as a normal pulmonary vascularity in a plain chest X-ray is not expected with a large PDA, which would typically result in increased pulmonary blood flow. Option D is incorrect as the apical impulse is more likely to be displaced laterally due to left ventricular enlargement rather than suggesting right ventricular dilatation in a large PDA. Understanding the characteristics of murmurs associated with different cardiac conditions is crucial for pediatric nurses in assessing and managing patients with congenital heart defects. This knowledge helps in making accurate clinical assessments, determining appropriate interventions, and providing quality care to pediatric patients with complex cardiac conditions.