A 10 years old girl presented with fever and bruises for last 2 weeks. On examination she is pale; however there is no evidence of lymphadenopathy or hepatosplenomegaly. Her Hb is 6g/dl, TLC is 2700 and platelets are 90000. The most appropriate investigation to clinch the diagnosis is:

Correct Answer: A

Rationale: The most appropriate investigation to clinch the diagnosis in this scenario is A) Bone marrow aspiration. Rationale: - Bone marrow aspiration is necessary to diagnose conditions like aplastic anemia or leukemia, which can present with symptoms of fever, bruises, anemia, and thrombocytopenia in a pediatric patient. - Reticulocyte count (Option B) would help determine if the bone marrow is responding adequately to the anemia but is not the primary investigation to clinch the diagnosis. - Bleeding time (Option C) and PT & APTT (Option D) are more related to assessing coagulation factors and platelet function, which are not the primary concerns in this case of unexplained anemia and thrombocytopenia in a child. Educational Context: Understanding the importance of appropriate diagnostic investigations in pediatric patients is crucial for nurses to provide safe and effective care. In this case, recognizing the significance of bone marrow aspiration in diagnosing serious hematological conditions highlights the need for thorough assessment and diagnostic reasoning skills in pediatric nursing practice.

Correct Answer: C

Rationale: The best response to the parents' question regarding their 8-day-old's vital signs is option C: "The heart rate is elevated; normal for a neonate is 90-160 bpm." This response is correct because it provides accurate information about the normal heart rate range for a neonate. In newborns, a heart rate of 170 beats per minute (bpm) is considered elevated and requires further evaluation by healthcare providers. Option A is incorrect because the blood pressure provided (85/52) is actually low for a neonate, not elevated. Option B is incorrect because the temperature of 99°F is within the normal range for a newborn and is not elevated. Option D is incorrect because a respiratory rate of 44 breaths per minute is also within the normal range for a newborn and not elevated. Educationally, it is important for nursing students to understand the normal vital sign ranges for different age groups, especially neonates, as deviations from these ranges can indicate underlying health issues. Providing accurate information to parents about their child's vital signs helps build trust and ensures appropriate care is provided. Understanding these nuances in vital signs is crucial for pediatric nursing practice.

Correct Answer: C

Rationale: In this question regarding Wilms tumor, option C is correct because Wilms tumor can occur on its own or be associated with congenital anomalies, such as WAGR syndrome. This knowledge is crucial for nurses caring for pediatric patients as it helps in early detection and appropriate management. Option A is incorrect because a Wilms tumor is not referred to as neuroblastoma; neuroblastoma is a separate type of cancer that affects nerve tissue. Option B is incorrect as Wilms tumor is most commonly seen in children under the age of 5, with peak incidence around 3 years old. Option D is incorrect because Wilms tumor is actually a fast-growing tumor originating from the kidneys, not a slow-growing one. Understanding the characteristics of Wilms tumor is important for nurses working in pediatric oncology to provide optimal care, educate families about the condition, and recognize associated anomalies that may impact treatment decisions. Nurses need to be knowledgeable about pediatric cancers to effectively support patients and families through diagnosis, treatment, and survivorship.

Correct Answer: D

Rationale: In understanding Failure to Thrive (FTT), it is crucial to recognize how malnutrition impacts growth parameters in infants and young children. In this context, the correct answer is D) head circumference. Head circumference is usually not significantly affected by malnutrition compared to other growth parameters. This is because the brain growth is prioritized in cases of malnutrition, hence head circumference is relatively maintained. Weight (option A) is commonly affected by malnutrition as it reflects overall body mass and nutritional status. Height (option B) can be impacted by malnutrition as it indicates linear growth. Weight for height ratio (option C) can also be altered in malnourished children as it reflects the adequacy of weight relative to height, indicating acute malnutrition. Educationally, understanding the impact of malnutrition on growth parameters is essential for healthcare providers working with pediatric populations. It aids in early identification of FTT, appropriate interventions, and monitoring of growth and development in children at risk. By grasping these concepts, nurses and other healthcare professionals can provide comprehensive care to promote optimal growth and development in pediatric patients.