Which of the following is an index of poor outcome in fulminant hepatitis

Correct Answer: B

Rationale: In pediatric nursing, understanding the indicators of poor outcomes in fulminant hepatitis is crucial for providing effective care. In this scenario, the correct answer is B) Increased prothrombin time unresponsive to vitamin K administration. Prothrombin time measures the time it takes for blood to clot. In fulminant hepatitis, severe liver damage can lead to impaired synthesis of clotting factors, resulting in prolonged prothrombin time. If the prothrombin time remains elevated despite vitamin K administration, it indicates severe liver dysfunction and a poor prognosis. Option A, decreased blood ammonia, is not an index of poor outcome in fulminant hepatitis. Typically, elevated blood ammonia levels are seen in liver failure due to impaired ammonia metabolism. Option C, hepatomegaly, is a physical finding of an enlarged liver. While hepatomegaly can be present in hepatitis, it is not a specific indicator of poor outcomes in fulminant hepatitis. Option D, Factor VII level <80% of normal, is not a commonly used marker in assessing fulminant hepatitis outcomes. Prothrombin time is a more sensitive and specific measure of liver synthetic function in this context. Educationally, this question highlights the importance of recognizing clinical indicators of poor outcomes in pediatric patients with fulminant hepatitis. Understanding these indicators can guide nursing interventions, monitoring, and communication with the healthcare team to optimize patient care and outcomes.

Correct Answer: A

Rationale: In the context of pediatric nursing, understanding cardiac conditions is crucial. Diastolic dysfunction and normal systolic function are key features of hypertrophic cardiomyopathy (HCM). HCM is characterized by the thickening of the heart muscle, particularly the left ventricle, leading to impaired ventricular relaxation during diastole. This results in diastolic dysfunction while systolic function remains preserved. Option A, HCM, is the correct answer because it aligns with the described features. Hypertrophic cardiomyopathy is a genetic condition that can manifest in childhood, making it relevant to pediatric nursing. Option B, Barth disease, is a metabolic disorder primarily affecting the heart and skeletal muscles, leading to cardiomyopathy. While it can impact both systolic and diastolic function, the characteristic diastolic dysfunction with normal systolic function is more indicative of HCM. Option C, myocarditis, is an inflammatory condition of the heart muscle that can affect both diastolic and systolic function, typically resulting in decreased cardiac output. However, the specific feature of normal systolic function points more towards HCM in this scenario. Option D, left ventricular non-compliance, describes a condition where the left ventricle has reduced ability to relax and fill properly during diastole, leading to diastolic dysfunction. While this aligns with one aspect of the presentation, the preservation of systolic function points more towards HCM as the correct diagnosis. Educationally, understanding these distinctions is vital for pediatric nurses to accurately assess, diagnose, and manage cardiac conditions in children. Recognizing the unique features of each condition allows for timely interventions and improved outcomes for pediatric patients with cardiac issues.

Correct Answer: D

Rationale: In pediatric nursing, understanding the characteristics of dehydration is crucial for providing effective care to children. In the case of hypertonic dehydration, the correct answer is D) Shock occurs late because of relatively preserved volume. This is because in hypertonic dehydration, there is a higher concentration of solutes outside the cells, causing water to move from inside the cells to the extracellular space, maintaining the overall volume for longer compared to isotonic dehydration. Option A) Marked loss of skin turgor while tongue is not dry is incorrect because in hypertonic dehydration, both skin turgor and mucous membranes like the tongue are likely to be dry due to the increased osmolarity of the extracellular space. Option B) Moist tongue is a late sign is incorrect because a moist tongue is not typically associated with dehydration of any type, including hypertonic dehydration. Dry mucous membranes are a common finding in dehydrated patients. Option C) CNS complications are relatively infrequent is incorrect because hypertonic dehydration can indeed lead to serious central nervous system (CNS) complications such as seizures due to the shift of water out of brain cells in response to increased osmolarity. Educationally, understanding the specific characteristics of different types of dehydration helps nurses accurately assess and manage pediatric patients. Recognizing the signs and symptoms of hypertonic dehydration can guide appropriate interventions to prevent complications and optimize outcomes for children in their care.

Correct Answer: A

Rationale: In pediatric nursing, administering medications via endotracheal tube may be necessary in emergency situations where intravenous access is not readily available. The correct answer is A) Lidocaine, naloxone, atropine, epinephrine. Lidocaine is a local anesthetic used for managing arrhythmias. Naloxone is an opioid antagonist used to reverse opioid overdose. Atropine is a medication used to increase heart rate in bradycardia. Epinephrine is a vasopressor used in cardiac arrest and anaphylaxis. These drugs can be given via endotracheal tube in appropriate doses in emergencies. Option B is incorrect as digoxin, a cardiac glycoside, is not recommended for administration via endotracheal tube due to possible complications and lack of efficacy through this route. It is crucial for pediatric nurses to be familiar with drugs that can be administered via endotracheal tube, understand their indications, dosages, and potential complications. This knowledge is vital in providing timely and effective care to critically ill pediatric patients.

Correct Answer: B

Rationale: The correct answer is B) Viral croup. The Steeple sign refers to the characteristic subglottic narrowing seen on a frontal neck X-ray in children with viral croup. This narrowing resembles the shape of a church steeple. Understanding this sign is crucial for diagnosing and managing pediatric patients with respiratory distress. Option A) Acute epiglottitis presents with a thumbprint sign on X-ray and is a medical emergency requiring prompt intervention. Streptococcal pharyngitis (Option C) typically presents with sore throat, fever, and swollen lymph nodes, and is diagnosed through throat swab culture. Acute bronchitis (Option D) is characterized by inflammation of the bronchi and does not involve the characteristic Steeple sign. Educationally, recognizing the Steeple sign in viral croup highlights the importance of clinical assessment skills and imaging interpretation in pediatric nursing practice. Understanding these distinctions is vital for accurate diagnosis, appropriate treatment, and ensuring positive patient outcomes in pediatric respiratory conditions.