A 13-year-old adolescent female attained out-patient department (OPD), with a complaint of feeling fat especially over the stomach and thighs; she is also feeling cold, tired, weak, and lacking energy. Examination reveals heart rate 46 beats/min, blood pressure 70/40 mmHg, weight below 3rd centile, dry skin, and lanugo-type hair growth on face; lab investigations show hypokalemia and hypophosphatemia. Of the following, the MOST appropriate next action is

Correct Answer: A

Rationale: The correct answer is A) admission to the hospital. In this scenario, the adolescent female is presenting with signs and symptoms suggestive of an eating disorder, most likely anorexia nervosa. The critical findings such as bradycardia, hypotension, severe underweight, lanugo hair, electrolyte imbalances, and other physical signs indicate severe malnutrition and potential medical complications that require immediate intervention. Admitting the patient to the hospital allows for close monitoring of her condition, addressing immediate medical needs such as rehydration, electrolyte correction, and nutritional rehabilitation. It also provides an opportunity for a comprehensive assessment by a multidisciplinary team including pediatricians, dieticians, psychiatrists, and mental health professionals to develop a holistic treatment plan. Referral to a psychiatrist (option B) may be necessary in the long term for addressing the mental health aspects of the eating disorder, but the immediate priority is managing the medical complications and stabilizing the patient's condition. Referral to a dietician (option C) is important in the overall management of an eating disorder, but in this acute situation, the patient requires more intensive medical care and monitoring that can only be provided in a hospital setting. Making a scheduled outpatient visit (option D) would not be appropriate given the severity of the patient's condition and the need for urgent medical intervention. Educationally, this question highlights the importance of recognizing the medical urgency in cases of severe malnutrition due to eating disorders and the necessity of prompt hospitalization for stabilization and treatment. It emphasizes the need for a multidisciplinary approach in managing eating disorders in adolescents to address both the physical and psychological aspects of the condition.

Correct Answer: B

Rationale: In pediatric nursing, understanding the significance of maternal serum α-fetoprotein (MSAFP) levels is crucial for identifying potential fetal anomalies. A low MSAFP level is specifically associated with trisomy 21, or Down syndrome. This is because trisomy 21 is characterized by an extra copy of chromosome 21, leading to altered protein production including AFP. Option A, open neural tube defects, is typically associated with elevated MSAFP levels, not low levels. Neural tube defects are linked to inadequate closure of the neural tube during fetal development, leading to increased AFP leakage into the maternal serum. Options C and D, gastroschisis and omphalocele respectively, are abdominal wall defects. These conditions do not show a direct association with MSAFP levels. Gastroschisis involves herniation of abdominal organs through a defect next to the umbilical cord, while omphalocele involves herniation of abdominal organs into the base of the umbilical cord. Educationally, this question highlights the importance of interpreting MSAFP levels in the context of prenatal screening for fetal anomalies. Understanding the specific associations between MSAFP levels and different conditions helps pediatric nurses provide comprehensive care and support to families facing potential diagnoses during pregnancy.

Correct Answer: D

Rationale: The correct answer is D) a poor prognosis. After severe birth asphyxia, infants may develop motor automatisms which are involuntary, stereotypical movements. These automatisms are a sign of severe neurological damage and indicate a poor prognosis for the infant's long-term outcomes. It is essential for pediatric nurses to recognize and understand these signs to provide appropriate care and support to both the infant and their family. Option A) absence of oral-buccal-lingual movements is incorrect because motor automatisms typically involve repetitive movements rather than a complete absence of movements. Option B) time-synchronized electroencephalographic discharges is incorrect as it describes a phenomenon seen in epileptic seizures rather than motor automatisms following birth asphyxia. Option C) significant cortical epileptic activity is incorrect because while birth asphyxia can lead to seizures and abnormal brain activity, the presence of motor automatisms is more indicative of severe neurological damage rather than specific epileptic activity. Understanding the neurological consequences of birth asphyxia is crucial for pediatric nurses as they play a key role in monitoring, assessing, and providing care to these vulnerable infants. By recognizing the significance of motor automatisms as a poor prognostic indicator, nurses can work collaboratively with the healthcare team to optimize outcomes and provide holistic care to these infants and their families.

Correct Answer: D

Rationale: In the case of Respiratory Distress Syndrome (RDS) in newborns, the basic defect requiring treatment is inadequate pulmonary exchange of oxygen and carbon dioxide, which is option D. This is because RDS is primarily a condition characterized by surfactant deficiency in the lungs, leading to poor gas exchange. Treatment strategies for RDS focus on improving oxygenation and ventilation to support the infant's respiratory function. Option A, metabolic acidosis, is not the primary defect in RDS. While metabolic acidosis can occur as a result of respiratory distress, it is a secondary effect rather than the underlying cause of RDS. Option B, circulatory insufficiency, is also not the primary defect in RDS. While RDS can lead to complications that affect the circulatory system, such as hypotension, the main issue in RDS is related to respiratory function rather than circulatory problems. Option C, hypothermia, is not the basic defect requiring treatment in RDS. While maintaining appropriate body temperature is important in managing RDS, hypothermia itself is not the primary issue that needs to be addressed in this condition. In an educational context, understanding the underlying pathophysiology of RDS is crucial for nurses caring for newborns with this condition. By recognizing that the main defect is inadequate pulmonary exchange of oxygen and carbon dioxide, nurses can implement appropriate interventions to support respiratory function and improve outcomes for these vulnerable patients. This knowledge allows nurses to provide effective and evidence-based care for infants with RDS, optimizing their chances for recovery.

Correct Answer: B

Rationale: In the context of pediatric nursing, understanding congenital diaphragmatic hernia (CDH) and its associated anomalies is crucial for providing comprehensive care to affected infants. In this case, the correct answer is B) CNS lesions, as CNS anomalies are not commonly associated with CDH. Pulmonary hypoplasia is a key feature of CDH due to lung compression in utero, leading to respiratory distress at birth. Esophageal atresia can be present in CDH cases, as the herniation of abdominal contents can affect the development of the esophagus. Cardiovascular lesions are also commonly seen in CDH patients, as the defect can impact cardiac development and function. Educationally, this question serves to reinforce the understanding of common anomalies associated with CDH and the importance of recognizing atypical findings that may suggest additional complications. By differentiating between the expected and unexpected anomalies in CDH cases, nurses can better advocate for appropriate diagnostic and management strategies to optimize patient outcomes.