Which of the following statements is TRUE regarding hypernatremic dehydration:

Correct Answer: A

Rationale: The correct answer is A) Net loss of water more than sodium. Rationale: Hypernatremic dehydration occurs when there is a deficit of water relative to sodium in the body, leading to elevated serum sodium levels. In this type of dehydration, more water is lost from the body than sodium, resulting in a relative excess of sodium. This imbalance causes water to move out of the cells into the extracellular space, leading to cellular dehydration. Explanation of why other options are incorrect: B) Marked loss of skin turgor while tongue is not dry: This statement describes characteristics of dehydration but does not specifically address hypernatremic dehydration. In hypernatremic dehydration, the focus is on the imbalance between water and sodium levels. C) Serum Na less than 135 mEq/L: This statement describes hyponatremia, which is the opposite of hypernatremia. In hypernatremic dehydration, serum sodium levels are elevated (>145 mEq/L). D) Low serum osmolality less than 275 mOsm/L: Hypernatremic dehydration is characterized by increased serum osmolality (>295 mOsm/L) due to the relative deficiency of water in relation to sodium. Educational context: Understanding the differences between various types of dehydration is crucial for healthcare professionals, especially pediatric clinical nurse specialists who care for vulnerable populations like children. Recognizing the specific characteristics of hypernatremic dehydration helps in accurate assessment, diagnosis, and management of pediatric patients with this condition. It is essential to differentiate hypernatremic dehydration from other types of dehydration to provide appropriate and timely interventions to prevent complications and promote optimal outcomes for pediatric patients.

Correct Answer: B

Rationale: The correct answer for this question is B) Weak brachial pulsation on the right arm. In a newborn with severe coarctation of the aorta, there is a narrowing of the aorta that leads to decreased blood flow to the lower part of the body. This results in weakened or absent pulses in the lower extremities (Option D) due to decreased perfusion. The weak or absent pulses in the left arm (Option C) are also expected due to reduced blood flow beyond the narrowing. Option A, feeding difficulties, can occur in infants with congenital heart defects due to poor perfusion and increased work of breathing. However, it is not specific to coarctation of the aorta. Educationally, understanding the clinical manifestations of coarctation of the aorta in newborns is crucial for pediatric clinical nurse specialists as early recognition can lead to prompt intervention and improved outcomes. This knowledge helps in providing comprehensive care and advocating for appropriate diagnostic tests and treatment strategies for these vulnerable patients.

Correct Answer: B

Rationale: In this case, option B is the correct answer. Normal growth parameters in a 6-month-old infant would not typically be suggestive of a large ventricular septal defect (VSD). Infants with significant VSDs often present with failure to thrive due to increased cardiac workload and inadequate systemic perfusion, leading to poor weight gain. Therefore, normal growth parameters would not align with the expected clinical presentation in this scenario. Option A, recurrent bronchopulmonary infection, is commonly seen in infants with VSDs due to increased pulmonary blood flow and susceptibility to respiratory infections. Option C, cardiomegaly with pulmonary plethora on plain chest radiography, is consistent with the signs of heart failure seen in infants with large VSDs. Option D, a local pulmonary component of the second heart sound, is often heard in infants with VSDs due to the increased blood flow across the defect. From an educational perspective, understanding the clinical manifestations of VSDs in infants is crucial for pediatric clinical nurse specialists. Recognizing these features can lead to early detection, appropriate management, and improved outcomes for infants with congenital heart defects. It also highlights the importance of comprehensive assessment and vigilant monitoring in pediatric patients to identify subtle changes that may indicate significant cardiac pathology.

Correct Answer: D

Rationale: In this scenario, the most appropriate test to assist in diagnosing a 6-year-old boy with a chronic cough exacerbated by night and exercise is spirometry (Option D). Spirometry is a pulmonary function test that measures how well the lungs are functioning by assessing airflow and lung volume. In this case, spirometry can help evaluate for conditions such as asthma, which often present with nighttime cough and exercise-induced symptoms. Option A, a barium swallow, is used to evaluate swallowing difficulties or anatomical abnormalities in the upper gastrointestinal tract, not respiratory issues. Option B, bronchoscopy, involves inserting a flexible tube into the airways to visualize the lungs and is more invasive and not typically a first-line diagnostic test for a chronic cough. Option C, a chest radiograph, may show abnormalities such as pneumonia or structural lung issues but may not provide specific information about lung function like spirometry. Educationally, understanding the appropriate diagnostic tests for pediatric respiratory conditions is crucial for healthcare providers working with children. Spirometry is a non-invasive, reliable tool to assess lung function and is commonly used in diagnosing and managing respiratory conditions in pediatric patients. By knowing when to order spirometry, healthcare professionals can expedite accurate diagnoses and provide timely interventions for pediatric patients with respiratory symptoms.

Correct Answer: D

Rationale: The correct answer is D) Respiratory syncytial virus (RSV). RSV is the most common cause of lower respiratory tract infections in infants and young children. It causes symptoms such as cough, tachypnea, and wheezing, which are characteristic of bronchiolitis in this age group. RSV is highly contagious and spreads through respiratory secretions. Option A) Adenovirus: Adenovirus can also cause respiratory infections in children, but it is less common than RSV in causing bronchiolitis in infants. Option B) Influenza: While influenza can cause respiratory symptoms in children, it is less likely in a 2-month-old infant compared to RSV, which is more prevalent in this age group. Option C) Parainfluenza: Parainfluenza virus can cause croup and upper respiratory infections in children. However, it is less likely to present with the combination of symptoms described in the question compared to RSV. Educational Context: Understanding the common viral causes of respiratory infections in infants is crucial for pediatric clinical nurse specialists. Recognizing the specific symptoms and typical age groups affected by each virus helps in accurate diagnosis and appropriate management, including infection control measures to prevent further spread in healthcare settings and communities.