A 1-year-old with acute renal failure (ARF) is edematous with minimal urine output. Vital signs: HR 146, BP 176/92, RR 42; the child has nasal flaring and retractions. Despite oral Kayexalate, serum potassium continues to rise. Which treatment will most benefit the child?

Correct Answer: D

Rationale: In this scenario, the most beneficial treatment for the 1-year-old with acute renal failure (ARF) is option D - Placement of a Tenckhoff catheter for peritoneal dialysis. Explanation of why option D is correct: Peritoneal dialysis is a crucial intervention in pediatric patients with ARF who are unresponsive to conventional treatments like Kayexalate and diuretics. Peritoneal dialysis helps in removing excess potassium, managing fluid overload, and correcting acid-base imbalances, which are essential in the management of acute renal failure. Explanation of why other options are wrong: - Option A (Additional rectal Kayexalate) may not be effective in this situation as the child is already unresponsive to oral Kayexalate, indicating the need for a more aggressive intervention like dialysis. - Option B (Intravenous furosemide) may worsen the child's condition by further depleting fluid volume and electrolytes, leading to hemodynamic instability. - Option C (Endotracheal intubation and ventilatory assistance) is not the first-line treatment for acute renal failure and does not address the underlying cause of the condition. Educational context: Understanding the appropriate interventions for pediatric patients with acute renal failure is crucial for pediatric emergency nurses. Knowing when to escalate treatment to interventions like peritoneal dialysis can significantly impact patient outcomes and prevent further complications. This case highlights the importance of recognizing the signs of renal failure in pediatric patients and the appropriate steps to manage it effectively.

Correct Answer: B

Rationale: The correct answer is B) improper formula preparation. This option is the most likely cause as the infant's decline in growth coincided with the introduction of juices and cereals, which may have displaced the essential nutrients from breast milk or formula. Improper formula preparation can lead to inadequate nutrition, affecting the infant's growth. Option A) failed breastfeeding is less likely since the infant had normal growth until the introduction of juices and cereals. Option C) congenital syndromes and Option D) congenital infections are less likely as there are no clinical signs or symptoms suggestive of these conditions in the scenario provided. In the educational context, understanding the importance of proper nutrition in infant growth and development is crucial for pediatric emergency nurses. They should educate parents on appropriate feeding practices, formula preparation, and introduction of complementary foods to prevent conditions like failure to thrive. This case highlights the impact of nutrition on growth patterns and the need for vigilant monitoring to ensure optimal infant health.

Correct Answer: D

Rationale: In pediatric emergency nursing, understanding the features of rapid eye movement (REM) is crucial for assessing a child's neurological status. The correct answer, option D - CT scan of head and neck, is not typically associated with assessing REM. A) Polysomnography is a test used to monitor and record various physiological activities during sleep, including REM. It is a key tool in diagnosing sleep disorders but is not specific to REM alone. B) EEG (electroencephalogram) is a valuable tool for assessing brain activity, including during sleep stages like REM. EEG can detect abnormal brain waves associated with certain conditions, but it is not exclusive to REM. C) Fiberoptic nasopharyngeal examination may be used to assess airway patency and structures in emergency situations but is not directly related to monitoring REM. Educationally, understanding the features and monitoring techniques for REM in pediatric patients is essential for providing comprehensive care. By knowing the appropriate diagnostic tools and assessments for different aspects of neurological function, nurses can effectively evaluate and manage pediatric emergencies.

Correct Answer: A

Rationale: In pediatric emergency nursing, understanding poor prognostic factors in conditions like Hodgkin lymphoma is crucial for providing effective care. In this scenario, the correct answer is option A - age of more than 15 years at the time of diagnosis. This is because younger age at diagnosis is generally associated with better outcomes in Hodgkin lymphoma due to factors like better tolerance to treatment and lower risk of complications. Option B - stage IV disease is a poor prognostic factor as it indicates advanced disease with spread to distant sites, making treatment more challenging and outcomes less favorable. Option C - manifestation by PET scan positivity is also a poor prognostic factor as it suggests a higher tumor burden and more aggressive disease, which can impact treatment response and overall prognosis. Option D - presence of bulky mediastinal mass is another poor prognostic factor as it is associated with more extensive disease involvement and can complicate treatment and increase the risk of complications. Educationally, understanding these prognostic factors is vital for nurses caring for pediatric patients with Hodgkin lymphoma. It helps in anticipating potential challenges, individualizing care plans, and providing appropriate support to patients and their families throughout the treatment process. By differentiating between these factors, nurses can contribute to improved patient outcomes and quality of care in pediatric oncology settings.

Correct Answer: D

Rationale: In the case of a 2-year-old with an asymptomatic right flank mass suspected to be a Wilms tumor, the least likely investigation to be performed is a biopsy of the mass (Option D). This is because in pediatric oncology, especially when dealing with suspected Wilms tumor, biopsies are generally avoided due to the risk of tumor spillage and seeding. A plain abdominal radiography (Option A) is less likely to provide detailed information compared to a CT scan of the abdomen (Option B) which is preferred for evaluating the extent of the tumor. A CT scan of the chest (Option C) is important to assess for metastasis, a common occurrence in Wilms tumor. Educationally, understanding the appropriate diagnostic approach in pediatric oncology is crucial for nurses caring for children with suspected malignancies. It is essential to grasp the rationale behind choosing specific investigations to ensure accurate diagnosis and appropriate management without compromising the child's well-being.