Which of the following can cause distributive shock

Correct Answer: A

Rationale: Rationale: The correct answer is A) Early sepsis, as it can cause distributive shock. Distributive shock, also known as vasogenic shock, is characterized by widespread vasodilation and decreased systemic vascular resistance, leading to inadequate tissue perfusion and oxygen delivery. Early sepsis, a systemic inflammatory response to infection, can trigger a cascade of events that result in the release of vasodilatory mediators, causing distributive shock. Option B) Tension pneumothorax is incorrect as it causes obstructive shock due to impaired venous return caused by increased intrathoracic pressure. This leads to decreased cardiac output and inadequate tissue perfusion. Option C) Cardiac tamponade causes obstructive shock by compressing the heart chambers, impairing filling and reducing cardiac output, resulting in inadequate tissue perfusion. Option D) Aortic stenosis causes cardiogenic shock due to the heart's inability to pump effectively against increased afterload, leading to decreased cardiac output and inadequate tissue perfusion. Educational Context: Understanding the different types of shock is crucial in pediatric nursing as it helps in timely recognition and appropriate management of critically ill pediatric patients. Distributive shock, like in early sepsis, requires interventions such as fluid resuscitation and vasopressor therapy to restore adequate tissue perfusion. By differentiating between distributive, obstructive, and cardiogenic shock and recognizing their specific etiologies, nurses can provide targeted care to stabilize pediatric patients in shock.

Correct Answer: D

Rationale: In the treatment of infective endocarditis, option D, which is the administration of an immunosuppressive dose of corticosteroids tapered over 4-6 weeks, is contraindicated. This is because corticosteroids can suppress the immune system, which is essential in fighting off the infection in infective endocarditis. By using immunosuppressive therapy, the body's ability to combat the infection is compromised, leading to potential worsening of the condition and increased risk of complications. Option A, intravenous antibiotics empiric therapy till culture results, is a common initial approach to treating infective endocarditis to provide immediate coverage while awaiting culture results. Option B, long-term antibiotics based on culture results, is also a standard treatment for infective endocarditis to target the specific causative microorganism for an extended duration to eradicate the infection. Option C, surgical removal of vegetation, may be considered in certain cases of infective endocarditis where there are large or complicated vegetations that are causing severe issues like valve obstruction or systemic embolization. In an educational context, understanding the contraindications in the treatment of infective endocarditis is crucial for nursing students and healthcare professionals to provide safe and effective care for pediatric patients. Recognizing the inappropriate use of immunosuppressive therapy in this condition is essential to prevent potential harm and complications. It also highlights the importance of evidence-based practice and following established guidelines in pediatric nursing to optimize patient outcomes.

Correct Answer: B

Rationale: The correct answer is B) Increased prothrombin time unresponsive to vitamin K administration. In fulminant hepatitis, the liver is unable to produce clotting factors, leading to prolonged prothrombin time. If the prothrombin time does not improve with vitamin K administration, it indicates severe liver dysfunction and poor outcome. Option A) Decreased blood ammonia is not an index of poor outcome in fulminant hepatitis. Elevated blood ammonia levels are seen in hepatic encephalopathy, which can occur in fulminant hepatitis but is not a specific indicator of poor outcome. Option C) Hepatomegaly is simply an enlargement of the liver and can occur in various liver conditions, but it is not a specific indicator of poor outcome in fulminant hepatitis. Option D) Factor VII level <80% of normal is not a specific index of poor outcome in fulminant hepatitis. While clotting factor levels may be affected in liver dysfunction, the prothrombin time is a more sensitive indicator in this context. Educationally, understanding the significance of prothrombin time in fulminant hepatitis is crucial for nurses caring for pediatric patients with liver disease. Recognizing this indicator helps in early identification of poor outcomes and enables timely interventions to improve patient outcomes.

Correct Answer: D

Rationale: In pediatric nursing, calculating maintenance fluid requirements is crucial to ensure optimal hydration and prevent dehydration or fluid overload in children. For a 25 kg child, the general rule of thumb is to use the Holliday-Segar method, which calculates the daily fluid requirement as follows: 100 ml/kg for the first 10 kg, 50 ml/kg for the next 10 kg, and 20 ml/kg for every additional kg over 20 kg. In this case, for a 25 kg child: - 100 ml/kg for the first 10 kg = 1000 ml - 50 ml/kg for the next 10 kg = 500 ml - 20 ml/kg for the additional 5 kg = 100 ml Total = 1000 ml + 500 ml + 100 ml = 1600 ml Therefore, the correct answer is D) 1600 ml because it adheres to the Holliday-Segar method for calculating maintenance fluid requirements based on the child's weight. Explanation for why the other options are incorrect: A) 2000 ml: This option is incorrect as it does not align with the calculated maintenance fluid requirement based on the child's weight using the Holliday-Segar method. B) 1000 ml: This option is incorrect as it only accounts for the first 10 kg of the child's weight and does not consider the additional weight beyond 10 kg. C) 2500 ml: This option is incorrect as it overestimates the fluid requirement for a 25 kg child, leading to potential fluid overload. Educational Context: Understanding how to calculate maintenance fluid requirements in pediatric patients is essential for nurses to provide safe and effective care. By using standardized methods like the Holliday-Segar formula, nurses can accurately determine the appropriate fluid volume to maintain hydration and support the child's physiological needs. This knowledge is crucial in preventing complications related to improper fluid management in pediatric patients.

Correct Answer: A

Rationale: Diastolic dysfunction and normal systolic function are key characteristics of hypertrophic cardiomyopathy (HCM). In HCM, the heart muscle becomes abnormally thick, leading to impaired relaxation during the diastolic phase while maintaining normal contractility during systole. This results in a stiff and non-compliant left ventricle, causing impaired filling of the ventricle. Option A, hypertrophic cardiomyopathy, is the correct answer because it specifically presents with diastolic dysfunction and normal systolic function. Barth disease (Option B) is an X-linked condition that primarily affects the heart, skeletal muscles, and growth, but it is not specifically associated with diastolic dysfunction. Myocarditis (Option C) is an inflammatory condition affecting the heart muscle, typically leading to systolic dysfunction rather than isolated diastolic dysfunction. Left ventricular non-compliance (Option D) is a general term that can describe various conditions but does not specifically point to the unique features of HCM. Understanding these distinctions is crucial in pediatric nursing as it can guide appropriate diagnostic tests, treatment strategies, and patient education. Recognizing the specific cardiac manifestations of different conditions helps nurses provide targeted care and support to pediatric patients with cardiac issues.