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. This scenario describes a classic presentation of anorexia nervosa, a serious eating disorder that requires immediate medical attention due to the life-threatening complications associated with severe malnutrition. The adolescent's low heart rate, low blood pressure, weight below the 3rd centile, and electrolyte imbalances indicate a critical state that necessitates inpatient care for stabilization, monitoring, and initiating refeeding protocols to prevent further deterioration and potential cardiac complications. Referral to a psychiatrist (option B) may be necessary for long-term management of the underlying psychological issues contributing to the eating disorder but is not the most urgent intervention in this acute phase. Referral to a dietician (option C) is important for nutritional rehabilitation, but in this case, the patient's condition requires immediate medical intervention in a hospital setting. Making a scheduled outpatient visit to both you and a psychiatrist (option D) is not appropriate given the severity of the physical findings and the need for urgent medical care. In an educational context, it is crucial for healthcare providers, especially those working with pediatric populations, to recognize the signs and symptoms of eating disorders, understand the potential medical complications, and know the appropriate steps for immediate intervention to ensure patient safety and well-being. Early identification and prompt treatment can significantly improve outcomes for individuals with eating disorders.

Correct Answer: B

Rationale: In pediatric nursing, understanding maternal serum α-fetoprotein (MSAFP) levels is crucial for early detection of certain fetal abnormalities. A low MSAFP level is associated with trisomy 21, also known as Down syndrome. This is because fetuses with trisomy 21 often have lower levels of MSAFP due to impaired placental functioning. Option A, open neural tube defects, are associated with high MSAFP levels, not low. Options C and D, gastroschisis and omphalocele, are related to defects in the abdominal wall and are not typically linked to MSAFP levels. Educationally, knowing the correlation between MSAFP levels and specific fetal abnormalities helps nurses provide anticipatory guidance to families, facilitating early interventions and support. This knowledge also underscores the importance of prenatal screening and the role of healthcare providers in guiding families through potential diagnoses.

Correct Answer: D

Rationale: The correct answer is D) a poor prognosis. After severe birth asphyxia, infants may exhibit motor automatisms as a sign of central nervous system damage. These automatisms are often associated with a poor prognosis due to the extent of brain injury sustained during the asphyxial event. Motor automatisms in this context can manifest as abnormal, involuntary movements or posturing that indicate significant neurological impairment. Option A) absence of oral-buccal-lingual movements is incorrect because motor automatisms after severe birth asphyxia typically involve abnormal movements rather than a lack of movement. Option B) time-synchronized electroencephalographic discharges is incorrect as it describes a specific EEG finding and not motor automatisms. Option C) significant cortical epileptic activity is incorrect because while seizures can occur after birth asphyxia, it is not indicative of motor automatisms specifically. In an educational context, understanding the implications of motor automatisms following severe birth asphyxia is crucial for pediatric nurses. Recognizing these signs can prompt early intervention and appropriate care planning for infants with neurological sequelae. It underscores the importance of timely assessments, monitoring, and collaboration with the healthcare team to optimize outcomes for these vulnerable patients.

Correct Answer: D

Rationale: In the case of Respiratory Distress Syndrome (RDS) in neonates, the basic defect requiring treatment is inadequate pulmonary exchange of oxygen and carbon dioxide, which is correctly identified in option D. RDS, also known as Hyaline Membrane Disease, occurs due to a lack of surfactant in the immature lungs of preterm infants, leading to difficulty in oxygen uptake and carbon dioxide removal. Option A, metabolic acidosis, is incorrect because though it can be a consequence of inadequate oxygen exchange, it is not the primary defect in RDS. Option B, circulatory insufficiency, is also incorrect as the main issue in RDS lies within the lungs, affecting gas exchange, not the overall circulation. Option C, hypothermia, is unrelated to the pathophysiology of RDS. In an educational context, understanding the pathophysiology of RDS is crucial for pediatric nurses as they care for neonates at risk. Recognizing the primary defect guides appropriate interventions such as oxygen therapy, mechanical ventilation, and surfactant replacement therapy, which are vital in managing RDS and improving outcomes for these vulnerable patients.

Correct Answer: B

Rationale: In the context of pediatric nursing practice, understanding congenital diaphragmatic hernia (CDH) and its associated anomalies is crucial for providing comprehensive care to infants affected by this condition. In this question, the correct answer is B) CNS lesions. The correct answer is B because CNS lesions are not typically associated with CDH. CDH primarily affects the respiratory system, leading to pulmonary hypoplasia as a common complication. Cardiovascular lesions are also frequently seen in CDH cases due to the impact on the developing heart and blood vessels. Esophageal atresia can occur concurrently with CDH due to the malformation of the diaphragm. Educationally, it is important to highlight the diverse range of anomalies that can coexist with CDH to prepare nurses to anticipate and manage potential complications in affected infants. By understanding the typical and atypical associations, nurses can contribute to early detection, intervention, and holistic care for infants with CDH, optimizing outcomes and promoting family-centered care.