The combination of recurrent wheezing, abnormal stool & marked failure to thrive are suggestive of:

Correct Answer: B

Rationale: The correct answer is B) Cystic fibrosis. Cystic fibrosis is a genetic disorder that affects the respiratory, digestive, and reproductive systems. In this case, the combination of recurrent wheezing (respiratory symptom), abnormal stool (digestive symptom), and marked failure to thrive (nutritional symptom) are classic signs of cystic fibrosis in pediatric patients. Option A) Bronchopulmonary dysplasia is a lung condition that primarily affects premature infants who have been on mechanical ventilation. This condition does not typically present with the combination of symptoms described in the question. Option C) Chronic persistent asthma is a common respiratory condition in children characterized by recurrent episodes of wheezing and breathing difficulties. However, it does not usually cause abnormal stool or failure to thrive. Option D) Missed foreign body aspiration may present with respiratory symptoms such as wheezing but would not explain the presence of abnormal stool and failure to thrive. Educationally, understanding the specific signs and symptoms of pediatric conditions like cystic fibrosis is crucial for healthcare providers working with children. Recognizing these clinical manifestations early can lead to prompt diagnosis and intervention, ultimately improving patient outcomes. It is important for pediatric nurses to be able to differentiate between various conditions based on presenting symptoms to provide appropriate care and support to their patients and families.

Correct Answer: C

Rationale: In this scenario, the most appropriate treatment for a term newborn with jaundice and a total bilirubin level of 20 mg/dL is phototherapy (Option C). Phototherapy is the primary treatment for neonatal jaundice as it helps convert bilirubin into a form that can be easily excreted by the body. Option A, intravenous fluids, would not directly address the elevated bilirubin levels in the newborn, so it is not the most appropriate treatment. Option B, exchange transfusion, is a more invasive procedure and is usually reserved for severe cases of jaundice that do not respond to phototherapy. Option D, oral phenobarbital, is not the first-line treatment for neonatal jaundice and is typically used in specific cases where phototherapy is ineffective. In an educational context, understanding the appropriate management of neonatal jaundice is crucial for pediatric nurses. Phototherapy is a common intervention that nurses will encounter in their practice, and knowing when to initiate it can prevent complications associated with untreated hyperbilirubinemia. Nurses must be aware of the different treatment options available and their indications to provide safe and effective care for newborns with jaundice.

Correct Answer: C

Rationale: In the context of a neonate with hyperbilirubinemia at risk of kernicterus, the most appropriate intervention is phototherapy (Option C). Phototherapy is the mainstay treatment for neonatal hyperbilirubinemia as it helps to convert unconjugated bilirubin into a water-soluble form that can be excreted from the body. This treatment is effective, non-invasive, and widely used in neonatal care settings. Exchange transfusion (Option A) is a more invasive procedure reserved for severe cases of hyperbilirubinemia that do not respond to phototherapy. It involves replacing the infant's blood with donor blood to rapidly reduce bilirubin levels. Intravenous fluids (Option B) may be used to maintain hydration in neonates with hyperbilirubinemia, but they do not directly address the elevated bilirubin levels. Oral phenobarbital (Option D) is not typically used to treat hyperbilirubinemia in neonates. It may be used in some cases of seizures but is not a first-line treatment for hyperbilirubinemia. In an educational context, it is crucial for pediatric nurses to understand the appropriate interventions for neonates with hyperbilirubinemia to prevent complications like kernicterus. Knowledge of the indications for phototherapy, exchange transfusion, and other treatments is essential for providing safe and effective care to neonates at risk for this condition.

Correct Answer: C

Rationale: In the context of bronchial asthma, the correct answer is C) Chest examination must reveal bilateral wheezes. This statement is false because wheezes in bronchial asthma are typically heard bilaterally and not unilaterally. Wheezes are caused by the turbulent airflow through narrowed airways due to inflammation and constriction, which is a hallmark of asthma. Option A is true as bronchial asthma presents with episodic symptoms of airflow obstruction, leading to wheezing, coughing, and shortness of breath during asthma attacks. Option B is correct because the symptoms of bronchial asthma can be reversed with the administration of β2 agonists, which act as bronchodilators to open up the airways and improve airflow. Option D is also true as inhaled corticosteroids are considered the cornerstone of long-term therapy for bronchial asthma. They work by reducing airway inflammation, which helps in preventing asthma attacks and controlling symptoms over time. Educationally, understanding the characteristics of bronchial asthma, including its symptoms, treatment options, and diagnostic findings like wheezes, is crucial for pediatric nurses caring for children with asthma. Recognizing the correct and incorrect statements about asthma helps nurses provide appropriate care, educate patients and families, and effectively manage asthma in pediatric patients.

Correct Answer: A

Rationale: The correct answer is A) It is audible during the inspiratory phase of breathing. A pleural friction rub is a specific type of lung sound that is typically heard during both the inspiratory and expiratory phases of breathing. This sound is caused by the rubbing together of inflamed pleural surfaces and is usually described as a grating or creaking sound. Therefore, the fact that it is audible during both phases of breathing makes option A incorrect. Option B) It may be associated with pain is a common characteristic of a pleural friction rub. Patients experiencing this lung sound may report chest pain that worsens with breathing or coughing due to the underlying inflammation. Option C) It is unaltered by coughing is incorrect because coughing can sometimes temporarily change or mask the sound of a pleural friction rub. Coughing can disrupt the rubbing of the inflamed pleural surfaces, leading to a temporary reduction in the sound heard. Option D) Better heard with the chest piece of the stethoscope tightly placed over the chest wall is incorrect because a pleural friction rub is usually best heard with the diaphragm of the stethoscope rather than the chest piece. Placing the stethoscope too tightly on the chest wall may dampen the sound rather than enhance it. Educationally, understanding lung sounds like pleural friction rubs is crucial for pediatric nurses as they assess and monitor respiratory conditions in children. Recognizing the characteristics of different lung sounds can help nurses make accurate assessments, provide appropriate interventions, and communicate effectively with healthcare providers about a child's respiratory status.