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 with complaints of headache, poor nasal airflow two weeks later is sinusitis (Option A). Sinusitis is characterized by inflammation of the sinuses, leading to symptoms such as headache and nasal congestion. The patient's symptoms of poor nasal airflow align with the hallmark signs of sinusitis. Option B, foreign body, is less likely in this case as the patient's symptoms are more indicative of an inflammatory condition rather than a mechanical obstruction. Rhinitis medicamentosa (Option C) is characterized by rebound nasal congestion due to overuse of topical decongestants, which does not fit the patient's presentation. Choanal stenosis (Option D) refers to a narrowing or blockage of the back of the nasal passage, which would typically present with more severe and persistent symptoms than described. In an educational context, understanding the differential diagnosis of common pediatric respiratory conditions is crucial for nurses caring for children. Recognizing the signs and symptoms of sinusitis, as well as distinguishing it from other conditions like foreign bodies or medication-induced rhinitis, is essential for providing appropriate care and treatment to pediatric patients. This case highlights the importance of clinical reasoning and thorough assessment in pediatric nursing practice.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) None of the above. The reason for this is that acute urticaria in a 14-year-old does not typically warrant immediate extensive diagnostic testing such as systematic elimination diets, allergy skin testing, or serum IgE and RAST levels. For a patient presenting with acute urticaria, the first step in management is to focus on symptomatic relief through antihistamines and identifying potential triggers through a detailed history. Most cases of acute urticaria are self-limiting and resolve within a few days to weeks without the need for extensive testing. Systematic elimination diets are more applicable in chronic cases of urticaria where specific food triggers are suspected. Allergy skin testing and serum IgE levels are more commonly used in cases of suspected allergic reactions or in chronic urticaria cases when an allergic component is suspected. From an educational perspective, it is important for nursing students to understand the appropriate approach to managing acute urticaria in pediatric patients. Emphasizing the importance of obtaining a thorough history, providing symptomatic relief, and reserving extensive diagnostic testing for cases where it is clinically indicated are key learning points. This case highlights the significance of evidence-based practice and efficient resource utilization in pediatric nursing care.

Correct Answer: C

Rationale: The correct answer is option C) Rice. Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food hypersensitivity most commonly seen in infants and young children. Rice is not a common cause of FPIES compared to milk, soy, and wheat which are more frequently implicated. Milk and soy are known common triggers for FPIES in infants. Milk proteins, especially cow's milk, are a leading cause of FPIES reactions due to the complex proteins that can trigger an immune response. Soy protein is also a common allergen that can lead to gastrointestinal symptoms in susceptible individuals. Wheat is another common allergen that can cause FPIES reactions. Wheat proteins can be challenging for some individuals to digest, leading to gastrointestinal distress and potential allergic reactions. Educationally, understanding the common triggers of FPIES is crucial for healthcare providers working with pediatric patients. Recognizing the signs and symptoms of FPIES, as well as knowing the common allergens that can cause this condition, is essential for accurate diagnosis and management. By knowing which foods are more likely to trigger FPIES, healthcare providers can effectively educate parents and caregivers on proper dietary management and avoidance strategies to prevent potential allergic reactions in children with FPIES.

Correct Answer: D

Rationale: In this case, the correct answer is D) All of these are effective. The symptoms described suggest allergic conjunctivitis, a common condition in individuals with hay fever. Each of the treatment options listed targets different aspects of the allergic response in the eyes. Option A, topical sympathomimetics, help by constricting blood vessels in the eyes, reducing redness and swelling. Option B, topical levocabastine, works as an H₁-receptor antagonist, blocking histamine release and alleviating itching. Option C, topical lodoxamide tromethamine, acts as a mast cell stabilizer, preventing the release of histamine and other inflammatory mediators. Choosing any single one of these options could provide relief for the ocular symptoms in this patient. Understanding the mechanisms of action of each treatment option is crucial in pediatric nursing to tailor interventions based on the patient's specific symptoms and needs. It is important to educate students on the variety of treatment modalities available for allergic conditions and the importance of individualizing care for pediatric patients.

Correct Answer: D

Rationale: In pediatric nursing, identifying pathological murmurs is crucial for early detection and management of heart conditions. The correct answer is D) Presence of click. This is indicative of conditions like mitral valve prolapse, aortic valve stenosis, or other structural abnormalities. The presence of a click suggests a mechanical issue in the heart valves or walls. Option A) Splitting of the second heart sound at the pulmonary area is often associated with conditions like pulmonary hypertension or pulmonary stenosis, not necessarily pathological murmurs. Option B) Ejection systolic in timing typically occurs in innocent murmurs, common in children, and is not usually indicative of pathological conditions. Option C) A systolic murmur best heard in the supine position is more likely to be a functional or innocent murmur rather than a pathological one, as positional changes can affect the intensity of innocent murmurs. Educationally, understanding these auscultatory findings helps nurses differentiate between innocent murmurs and pathological ones, guiding them in deciding when to refer a patient for further evaluation by a pediatric cardiologist. It underscores the importance of thorough assessment and knowledge in pediatric cardiology to provide quality care to children with heart conditions.