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 option A) Bone marrow aspiration. In a 10-year-old girl presenting with fever, bruises, pallor, low Hb, low TLC, and low platelets, the clinical picture is suggestive of a hematologic disorder such as aplastic anemia, leukemia, or immune thrombocytopenic purpura (ITP). Bone marrow aspiration is crucial in diagnosing these conditions as it allows for the assessment of the bone marrow cellularity, morphology, and presence of abnormal cells. In this case, it can help identify the underlying cause of the pancytopenia and thrombocytopenia seen in the patient. The other options (B) Reticulocyte count, (C) Bleeding time, and (D) PT and APTT are not the most appropriate investigations in this context. Reticulocyte count is useful in evaluating bone marrow response to anemia, bleeding time assesses platelet function, and PT and APTT are coagulation studies. However, given the clinical presentation of pancytopenia and thrombocytopenia, bone marrow aspiration is the investigation of choice to determine the underlying hematologic disorder. In an educational context, understanding the rationale behind selecting the appropriate investigation based on the clinical presentation is essential for nurses to provide safe and effective care to pediatric patients. It highlights the importance of critical thinking, clinical reasoning, and evidence-based practice in nursing assessment and decision-making.

Correct Answer: C

Rationale: The best response to the parents' inquiry 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 normal vital signs for a neonate. In pediatrics, it is crucial to understand the normal vital sign ranges for different age groups to identify deviations early and intervene promptly. Option A is incorrect because the blood pressure provided falls within the normal range for a neonate. Option B is incorrect as the temperature of 99°F is within the normal range for an infant. Option D is also incorrect as a respiratory rate of 44 is within the normal range for a neonate. Educationally, this question highlights the importance of knowing normal vital sign ranges for pediatric patients. Understanding these ranges enables healthcare providers to assess and monitor patients effectively, leading to early detection of abnormalities and timely interventions to ensure optimal patient outcomes. This rationale emphasizes the significance of accurate assessment and interpretation of vital signs in pediatric nursing practice.

Correct Answer: C

Rationale: In this question about Wilms tumor, option C is correct, while the others are incorrect. Wilms tumor, also known as nephroblastoma, is a type of kidney cancer that primarily affects children. The correct answer, option C, states that it can occur on its own or be associated with congenital anomalies. This is true as Wilms tumor can occur sporadically or in association with certain genetic syndromes like WAGR syndrome. Option A is incorrect because Wilms tumor is not referred to as neuroblastoma. Neuroblastoma is a different type of childhood cancer that arises in immature nerve cells. Option B is incorrect because Wilms tumor is commonly seen in children under the age of 5, not specifically between 2 and 5 years. Option D is also incorrect as Wilms tumor is considered a fast-growing tumor rather than slow-growing, which underscores the importance of early detection and intervention. Educationally, understanding the characteristics and features of pediatric cancers like Wilms tumor is crucial for nurses caring for pediatric patients. Recognizing the signs and symptoms, risk factors, and appropriate nursing interventions for pediatric cancers ensures timely diagnosis and treatment. Nurses play a critical role in supporting children and their families through the challenging journey of cancer diagnosis and treatment, making knowledge of pediatric oncology essential in their practice.

Correct Answer: D

Rationale: Failure to thrive (FTT) is a condition where infants and young children fail to meet expected growth standards due to malnutrition. In this context, the growth parameter that is usually not affected by malnutrition is head circumference (Option D). Head circumference is primarily determined by brain growth, which is a relatively metabolically stable process compared to overall body growth affected by malnutrition. Option A (weight) is commonly affected by malnutrition as it reflects overall body mass and nutritional status. Option B (height) can be impacted by malnutrition as it represents linear growth and skeletal development which can be stunted with inadequate nutrition. Option C (weight for height ratio) is also influenced by malnutrition as it indicates if the child's weight is appropriate for their height, reflecting overall nutritional status. In an educational context, understanding the growth parameters affected by malnutrition is crucial for healthcare professionals, especially in pediatrics. By knowing which growth parameters are more resilient to malnutrition, healthcare providers can better assess and monitor the nutritional status and overall health of children. This knowledge aids in early detection and intervention for children at risk of FTT, ultimately improving their outcomes and quality of life.

Correct Answer: D

Rationale: In the context of pediatric nursing, understanding the causes of secondary nocturnal enuresis is crucial for providing effective care to children. Secondary nocturnal enuresis refers to the involuntary passage of urine during sleep in a child who previously had established nighttime bladder control. In this scenario, the correct answer is D) psychosocial stressor. Children with secondary nocturnal enuresis may experience psychosocial stressors such as anxiety, emotional disturbances, changes in the family environment, or trauma. These stressors can disrupt the child's normal bladder control mechanisms, leading to bedwetting episodes. Addressing and managing these stressors are essential components of the nursing care plan for a child with secondary nocturnal enuresis. Option A) UTI (urinary tract infection) is not typically associated with secondary nocturnal enuresis unless there are other symptoms present to suggest an infection, such as fever, dysuria, or frequency. Option B) diabetes mellitus and option C) diabetes insipidus are metabolic conditions that may lead to increased urine output but are less likely causes of secondary nocturnal enuresis compared to psychosocial stressors. Educationally, this question highlights the importance of considering psychosocial factors in the assessment and management of pediatric patients with secondary nocturnal enuresis. By understanding the underlying causes, nurses can provide holistic care that addresses both the physical and emotional needs of the child and their family.