Two weeks later, the patient described in Question 7 complains of headache, poor nasal airflow... The most likely diagnosis is

Correct Answer: A

Rationale: In this scenario, the most likely diagnosis for a patient presenting with headache, poor nasal airflow two weeks after initial symptoms is sinusitis (Option A). Sinusitis is characterized by inflammation of the paranasal sinuses, leading to symptoms like headache, nasal congestion, and facial pain. In the context of a pediatric patient with worsening symptoms after an initial upper respiratory infection, sinusitis is a common sequelae. Option B, foreign body, is less likely in this case as the symptoms described are more indicative of an inflammatory process rather than a persistent foreign object obstructing the nasal passage. Rhinitis medicamentosa (Option C) is associated with nasal decongestant overuse and typically presents with rebound nasal congestion, not necessarily headache. Choanal stenosis (Option D) is a congenital condition characterized by narrowing of the back of the nasal passage, usually presenting earlier in infancy rather than two weeks after initial symptoms. Educationally, understanding the progression of upper respiratory symptoms in pediatric patients is crucial for nursing practice. Recognizing the signs and symptoms of sinusitis, differentiating them from other conditions like foreign bodies or medication-induced rhinitis, and considering the timeline of symptom onset are all essential skills for pediatric nurses to provide timely and appropriate care for their patients.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) None of the above. This option is the most appropriate because the patient presents with acute urticaria, which is typically a self-limiting condition in pediatric patients. The symptoms have been present for 10 days, and given the acute onset and short duration, extensive diagnostic testing may not be necessary at this point. Option A) Systematic elimination diets to determine a possible ingestant cause is not recommended as the first step in the evaluation of acute urticaria. Ingestant causes are less common in acute urticaria, and initiating elimination diets without proper evaluation can lead to unnecessary dietary restrictions and potential nutritional deficiencies. Option B) Allergy skin testing is also not recommended as the initial diagnostic option in this case. Allergy testing is more appropriate for chronic or recurrent cases of urticaria, and it is not typically indicated for acute presentations unless specific allergens are suspected based on history. Option C) Serum IgE and RAST testing may be helpful in specific cases of chronic urticaria where an allergic cause is suspected. However, in acute urticaria with a short duration like in this case, these tests are not typically necessary as they may not provide additional meaningful information for management. In an educational context, it is important for healthcare providers to understand the appropriate approach to the evaluation of acute urticaria in pediatric patients. Emphasis should be placed on taking a detailed history, including potential triggers, recent illnesses, and medication use, before considering extensive diagnostic testing. This case highlights the importance of a systematic and evidence-based approach to diagnosing and managing pediatric patients with acute skin conditions.

Correct Answer: C

Rationale: Rationale: The correct answer is C) Rice. Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food hypersensitivity that primarily affects infants and young children. Rice is not a common cause of FPIES compared to milk, soy, and wheat. Milk and soy are two of the most common triggers for FPIES in infants. Cow's milk protein and soy protein are often implicated in FPIES reactions due to their allergenic potential. Wheat is another common trigger for FPIES, as gluten-containing grains can provoke inflammatory responses in the gastrointestinal tract. Educational Context: Understanding the common triggers for FPIES is crucial for pediatric nurses to provide optimal care for young patients. By recognizing the typical culprits like milk, soy, and wheat, nurses can assist in identifying and managing FPIES cases effectively. Moreover, knowledge of less common triggers like rice (Option C) helps in differentiating between various food-related conditions and ensuring accurate diagnosis and treatment plans for pediatric patients with gastrointestinal issues.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) All of these are effective. The symptoms described are indicative of allergic conjunctivitis, a common condition in individuals with hay fever. Each of the treatment options listed targets different aspects of the allergic response. Option A, topical sympathomimetics, work by constricting blood vessels in the eye, reducing redness and edema. Option B, topical levocabastine, is an H₁-receptor antagonist that helps to block the allergic response pathways in the eye. Option C, topical lodoxamide tromethamine, is a mast cell stabilizer that prevents the release of histamine and other inflammatory mediators. Educationally, understanding the mechanisms of action of these different medications is crucial for pediatric nurses preparing for exams. It highlights the importance of personalized treatment plans for patients with allergic conditions and the need to address multiple aspects of the allergic response for effective symptom management. Nurses need to be aware of these different treatment options to provide comprehensive care for pediatric patients with allergic conjunctivitis.

Correct Answer: D

Rationale: The correct answer is D) Presence of click. In pediatric nursing, the presence of a click during auscultation is indicative of a pathological murmur. Clicks are often associated with structural abnormalities in the heart valves or septa, such as in cases of congenital heart defects like tetralogy of Fallot or mitral valve prolapse. Clicks are typically heard immediately after the S1 heart sound. Option A) Splitting of the second heart sound at the pulmonary area is a normal finding in pediatric patients and is not necessarily indicative of a pathological murmur. It can be due to the closure of the aortic and pulmonary valves occurring at slightly different times. Option B) Ejection systolic in timing refers to the timing of the murmur and does not specifically point towards a pathological murmur. Ejection murmurs are common in children and can be benign. Option C) Systolic murmur best heard in the supine position is a nonspecific finding and does not definitively suggest a pathological murmur. The position of the patient can affect the intensity of murmurs but is not diagnostic of a pathological condition. In an educational context, understanding the characteristics of different heart sounds and murmurs is crucial for pediatric nurses to accurately assess and identify cardiac abnormalities in children. Recognizing the significance of specific auscultatory findings can lead to prompt referral, diagnosis, and management of pediatric patients with cardiac issues. Regular practice and exposure to various heart sounds will help nurses develop their auscultation skills and enhance their ability to differentiate between normal and abnormal findings.