A 12-year-old black female presents with malaise, fatigue, anorexia, and jaundice. The differential diagnosis should include all of the following EXCEPT

Correct Answer: D

Rationale: In this scenario, the correct answer is D) chronic fatigue syndrome. 1. Chronic fatigue syndrome: This condition is characterized by extreme fatigue that cannot be explained by any underlying medical condition. While fatigue is a symptom shared with the patient's presentation, the presence of jaundice and other symptoms points more towards a hepatobiliary condition rather than chronic fatigue syndrome. 2. Mononucleosis: Mononucleosis can present with symptoms such as malaise, fatigue, anorexia, and jaundice, which overlap with the patient's symptoms. However, considering the patient's demographic and the presence of jaundice, other hepatobiliary conditions are more likely. 3. Chronic active hepatitis: Given the patient's symptoms of jaundice and liver involvement, chronic active hepatitis is a pertinent consideration in the differential diagnosis. 4. Hepatitis B: Hepatitis B is a viral infection that affects the liver and can present with symptoms like jaundice, fatigue, and anorexia, making it relevant to consider in this case. Educational context: Understanding the differential diagnosis in a pediatric patient presenting with symptoms like malaise, fatigue, anorexia, and jaundice is crucial for healthcare providers. This question challenges critical thinking by assessing the ability to differentiate between conditions with overlapping symptoms. By recognizing the specific features of each condition, healthcare professionals can provide accurate diagnosis and appropriate management for pediatric patients with gastrointestinal issues.

Correct Answer: A

Rationale: In the context of pediatric gastrointestinal health, understanding the causes of vomiting is crucial for accurate assessment and intervention. In this question, the correct answer is A) atrial septal defect. An atrial septal defect is a congenital heart condition that affects the heart's structure, leading to abnormal blood flow between the atria. While it can cause symptoms like fatigue and shortness of breath, vomiting is not a typical manifestation of this cardiac defect. Option B) migraine is a common cause of vomiting in children, often accompanied by headache and sensitivity to light and sound. Migraines are a neurological disorder that can trigger gastrointestinal symptoms like nausea and vomiting. Option C) pregnancy is obviously not applicable in a pediatric context and can be ruled out as a cause of vomiting in children. Option D) labyrinthitis is an inner ear disorder that can lead to vertigo, nausea, and vomiting due to disturbances in the vestibular system. It is a possible cause of vomiting in children, especially if associated with dizziness or balance issues. Educationally, this question highlights the importance of recognizing both gastrointestinal and non-digestive causes of vomiting in pediatric patients. It underscores the need for a comprehensive assessment that considers various systemic conditions beyond the gastrointestinal tract. This knowledge is vital for nurses and healthcare providers working with pediatric populations to ensure accurate diagnosis and appropriate management of vomiting in children.

Correct Answer: D

Rationale: Palatopharyngeal incompetence is a condition where the soft palate fails to close against the back of the throat, leading to speech and swallowing difficulties. In this context, the correct answer, D) improvement after adenoidectomy, is the exception because palatopharyngeal incompetence does not typically improve after adenoidectomy. Adenoidectomy primarily addresses issues with the adenoids, not the soft palate. Option A) hypernasal speech is characteristic of palatopharyngeal incompetence due to the inability to properly close the soft palate, leading to air escaping through the nose during speech. Option B) presence of a submucosal cleft is relevant because it can contribute to palatopharyngeal incompetence by affecting the structure of the palate. Option C) difficulty in pronouncing certain sounds like p, b, d, t, h, and v is common due to the impaired function of the soft palate in forming these sounds correctly. In an educational context, understanding the manifestations of palatopharyngeal incompetence is crucial for healthcare professionals, especially those working with pediatric populations. Recognizing the symptoms and characteristics can aid in early detection and appropriate interventions to improve speech and swallowing functions in affected individuals.

Correct Answer: C

Rationale: The correct answer to the question is C) feed the infant. In the case of pyloric stenosis, feeding the infant can help to trigger the characteristic projectile vomiting associated with this condition. Pyloric stenosis is a condition where there is an obstruction at the junction between the stomach and the small intestine, leading to symptoms such as non-bilious vomiting, weight loss, and dehydration. By feeding the infant, you can elicit the vomiting that is typical of pyloric stenosis, aiding in the diagnosis. Option A) keeping the patient NPO would not help in demonstrating the abnormal physical findings of pyloric stenosis as it would not provoke the vomiting necessary for diagnosis. Option B) giving intravenous glucagon is not the standard diagnostic method for pyloric stenosis. It is not routinely used in diagnosing this condition. Option D) examining the infant under anesthesia is not necessary for diagnosing pyloric stenosis. The characteristic vomiting pattern seen after feeding is usually sufficient for diagnosis. Educationally, understanding the importance of eliciting specific symptoms through appropriate interventions is crucial in pediatric nursing practice. Recognizing the signs and symptoms of pyloric stenosis and knowing how to elicit them can lead to timely diagnosis and treatment, ultimately improving patient outcomes.

Correct Answer: D

Rationale: In this question, option D is the correct answer. Hirschsprung disease is a condition where there is a lack of ganglion cells in the distal colon, leading to functional obstruction. Breast-fed infants may appear less ill than formula-fed infants because breast milk is easier to digest and can mask some symptoms of Hirschsprung disease, delaying diagnosis. Option A is incorrect because Hirschsprung disease can occur in preterm infants, although it is more common in full-term infants. Option B is incorrect as males are more commonly affected by Hirschsprung disease than females. Option C is incorrect as Hirschsprung disease is not typically associated with VATER syndrome, which is a different set of congenital anomalies. Educationally, understanding Hirschsprung disease is crucial for nursing students preparing for the NCLEX exam, as it is a common pediatric gastrointestinal disorder. Knowing the signs and symptoms, diagnostic procedures, and treatment options for this condition is essential for providing safe and effective care to pediatric patients. Recognizing the unique clinical presentations in different patient populations, such as breast-fed vs. formula-fed infants, can aid in early identification and management of Hirschsprung disease.