A 3-week-old neonate is brought to the emergency department because of a three-day history of intermittent vomiting. His mother reports that he has not urinated for eight hours. On physical examination, his eyes are sunken. Which of the following will MOST likely require correction before surgery is performed?

Correct Answer: A

Rationale: The correct answer is A) Hypochloremia. In this scenario, the neonate is presenting with signs of dehydration, as indicated by sunken eyes and decreased urine output. Hypochloremia, an electrolyte imbalance often associated with dehydration, needs correction before surgery to ensure the neonate's safety during the procedure. Regarding the other options: - B) Hyperkalemia is less likely in a dehydrated neonate and is not the immediate concern in this case. - C) Hypernatremia is also less likely in a dehydrated neonate and is not the primary electrolyte imbalance needing correction. Educationally, understanding the importance of correcting electrolyte imbalances, especially in pediatric patients, is crucial for providing safe and effective care. Dehydration can lead to significant complications if not addressed promptly, highlighting the need for healthcare providers to be vigilant in assessing and managing electrolyte imbalances in pediatric patients.

Correct Answer: B

Rationale: The correct answer is B) Newborns can lose up to 10% of their birth weight and regain it by 2 weeks of age. This is the best response because it provides the mother with reassurance based on normal newborn weight fluctuation patterns. It is important for parents, especially first-time mothers, to understand that slight weight loss in the first few days is common and typically resolves on its own as the baby adjusts to feeding. Option A is incorrect because notifying the doctor about this weight loss without providing context or reassurance may unnecessarily worry the mother. Option C is dismissive and does not address the mother's concerns. Option D jumps to conclusions about feeding issues without considering the normal weight loss pattern in newborns. Educationally, this question highlights the importance of educating parents about normal newborn weight changes and reassuring them about common concerns. It emphasizes the role of healthcare providers in providing accurate information and support to alleviate parental anxiety and promote positive parenting experiences.

Correct Answer: A

Rationale: In pediatric primary care, understanding the signs associated with glomerulonephritis is crucial for accurate diagnosis and appropriate management. In this context, the correct answer is A) Mild proteinuria, hematuria, decreased urine output, and lethargy. Mild proteinuria, hematuria, decreased urine output, and lethargy are commonly associated with glomerulonephritis in children. Proteinuria and hematuria are classic signs of glomerular injury, while decreased urine output and lethargy can indicate compromised renal function. Option B) Massive proteinuria, hematuria, increased output, and lethargy is incorrect because massive proteinuria and increased urine output are less likely in glomerulonephritis, where renal function is typically impaired. Option C) Mild proteinuria, increased output, and lethargy is incorrect as increased urine output is not typically seen in glomerulonephritis due to impaired renal function. Option D) Massive proteinuria, decreased output, and hypotension is incorrect because hypotension is not a common sign of glomerulonephritis in children. Educationally, this question highlights the importance of recognizing key clinical manifestations of glomerulonephritis in pediatric patients, emphasizing the significance of specific signs such as proteinuria, hematuria, and changes in urine output in guiding diagnostic considerations and treatment decisions.

Correct Answer: A

Rationale: The correct answer is A) 1 week of age. In the case of a baby with birth brachial plexus palsy (BBPP), early intervention is crucial for optimizing outcomes. Starting occupational or physical therapy at approximately 1 week of age allows for the initiation of gentle range of motion exercises, positioning techniques, and parental education on handling the affected limb. This early intervention helps prevent contractures, muscle atrophy, and promotes proper muscle development as the baby grows. Option B) 2 weeks of age is incorrect because delaying therapy by another week can lead to missed opportunities for early intervention and potential complications associated with BBPP. Option C) 3 weeks of age is also incorrect as waiting until this time could result in further progression of muscle tightness and contractures, making it more challenging to achieve optimal outcomes through therapy. Option D) 4 weeks of age is the furthest from the correct answer and is not recommended as it delays crucial therapy that could prevent long-term complications associated with BBPP. Educational context: As healthcare providers in pediatric primary care, it is essential to understand the importance of early intervention in conditions like BBPP. By starting therapy promptly at 1 week of age, healthcare professionals can positively impact the baby's outcomes and provide support and guidance to parents in managing the condition effectively. This question highlights the critical role of early therapy initiation in improving the quality of care for infants with BBPP.