A 3-month-old baby girl admitted to pediatric intensive care unit with severe head injury (evident by CT scan), the history given by parents was trivial and not informative. You suspected child abuse. Of the following, the MOST helpful study to support your suspicion is

Correct Answer: D

Rationale: In the case of suspected child abuse in a 3-month-old with a severe head injury, the most helpful study to support this suspicion is a radionuclide bone scan (Option D). This is because a radionuclide bone scan can detect skeletal injuries that may not be visible on X-rays, especially in infants where their bones are still developing and may not show fractures easily. Choosing Option A, an infantogram, is not the best choice as it provides an overall body image but may miss specific bone injuries. Option B, X-rays of the spine, and Option C, X-rays of the skull, are limited in their ability to detect subtle fractures or injuries in other parts of the body. Educationally, understanding the importance of choosing the most appropriate diagnostic study in cases of suspected child abuse is crucial for healthcare providers working with pediatric patients. It highlights the need for thorough evaluation and consideration of imaging modalities that can provide the most comprehensive information to support a diagnosis and ensure the safety and well-being of the child.

Correct Answer: C

Rationale: The correct answer is C) Renal ultrasonography. In this case, the patient presents with multiple congenital anomalies including a ventricular septal defect, cleft lip and palate, and imperforate anus. Renal ultrasonography is not necessary in the initial workup of these specific conditions. A) A karyotype analysis would be appropriate to check for any chromosomal abnormalities that may be associated with multiple congenital anomalies. B) TORCH titer is important to rule out infections such as toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus which can cause congenital defects. D) Ultrasonography of the brain can help in assessing for any structural abnormalities in the brain that could be associated with the other congenital anomalies present. Educationally, understanding the rationale behind selecting appropriate laboratory tests based on the clinical presentation is crucial in pediatric nursing practice. It helps in providing comprehensive care and early interventions for newborns with complex medical conditions.

Correct Answer: A

Rationale: In this scenario, the most likely diagnosis is Stage I hypoxic ischemic encephalopathy (HIE). Apgar scores of 9 and 9 at 1 and 5 minutes indicate good initial adaptation to extrauterine life. However, the clinical presentation of hyperalertness, hyperactive deep tendon reflexes, and mydriasis suggests central nervous system irritability, which is consistent with Stage I HIE. Option A is correct because Stage I HIE typically manifests with central nervous system signs such as irritability and hyperreflexia. Options B, C, and D are incorrect because they represent more severe stages of HIE or a different condition like kernicterus, which is characterized by bilirubin-induced brain damage, not the acute hypoxic insult seen in this case. Educationally, understanding the progression of HIE stages is crucial for pediatric nurses and nurse practitioners. Recognizing subtle neurological signs and symptoms can lead to early intervention and prevention of further brain injury in neonates. This knowledge is essential for providing safe and effective care to infants at risk for HIE.

Correct Answer: D

Rationale: In this question from a Pediatric NCLEX Practice Quiz, the correct answer is D) Graft-versus-host disease. Late complications of Rhesus sensitization hyperbilirubinemia include transient aregenerative anemia, direct-reacting hyperbilirubinemia, and hypoglycemia. Graft-versus-host disease is not typically associated with Rhesus sensitization hyperbilirubinemia and its treatment. Educationally, understanding the late complications of Rhesus sensitization hyperbilirubinemia is crucial for pediatric healthcare providers. This knowledge helps in recognizing and managing potential complications in infants with this condition, ensuring optimal care and outcomes. By knowing which complications are commonly associated and which are not, healthcare professionals can provide more effective and targeted care to pediatric patients.

Correct Answer: D

Rationale: In this question, the correct answer is D) Risperidone - Tricyclic Antidepressants. Risperidone belongs to the atypical antipsychotic class, not tricyclic antidepressants. A) Methylphenidate is correctly matched with stimulant medications commonly used to treat ADHD in children. B) Atomoxetine is correctly matched with serotonin-norepinephrine reuptake inhibitors, also used for ADHD. C) Fluoxetine is a Selective Serotonin Reuptake Inhibitor (SSRI) used for treating depression and other mental health disorders in children. Educationally, understanding the classifications of medications is crucial for safe prescribing and effective treatment. For pediatric patients, this knowledge is especially vital due to their unique physiology and vulnerability to adverse effects. By grasping the pharmacological groups of medications commonly used in pediatrics, nurses and healthcare providers can ensure accurate administration and monitor for potential side effects, promoting optimal patient outcomes.