A 6-week-old male born to para 1, gravida 1, 44-year-old woman presents with a week of recurrent nonbilious emesis and dehydration. The serum levels of sodium are 138, potassium 2.9, and bicarbonate 34. The most likely diagnosis is

Correct Answer: C

Rationale: The correct answer is C) Adrenogenital syndrome. This condition typically presents in infancy with symptoms such as recurrent vomiting, dehydration, hyponatremia, hyperkalemia, and metabolic acidosis. The electrolyte imbalances seen in the patient (low potassium, high bicarbonate) are indicative of this syndrome, caused by a defect in cortisol biosynthesis leading to increased adrenal androgen production. Option A) Duodenal stenosis typically presents with bilious vomiting and is unlikely in this case as the emesis is nonbilious. Option B) Annular pancreas would present with duodenal obstruction and symptoms of bilious vomiting, which are not seen in this patient. Option D) Galactosemia would present with symptoms related to galactose metabolism such as jaundice, liver dysfunction, and coagulopathy, which are not evident in this case. Educationally, understanding the clinical presentation and key laboratory findings of various pediatric gastrointestinal disorders is crucial for nurses preparing for the NCLEX exam as it helps in accurate diagnosis and management of these conditions in pediatric patients. It also highlights the importance of recognizing electrolyte imbalances and metabolic disturbances in infants to provide timely and appropriate interventions.

Correct Answer: A

Rationale: The correct answer is A) orlistat. Orlistat is the only FDA-approved medication for obesity in children under 16 years old. Orlistat works by blocking the absorption of fat in the gastrointestinal tract, leading to weight loss. It is generally well-tolerated and has been shown to be effective in managing obesity in pediatric patients. Option B) phentermine is not FDA-approved for use in children under 16 years old. Phentermine is typically prescribed for short-term weight loss in adults and is not recommended for pediatric use due to potential adverse effects on growth and development. Option C) topiramate is not FDA-approved for pediatric obesity. While it has been used off-label for weight management in some cases, its safety and efficacy in children for this indication have not been well established. Option D) amylin is not an FDA-approved medication for pediatric obesity. Amylin is a hormone involved in regulating blood sugar levels and is not indicated for weight loss in children. In an educational context, it is important for healthcare professionals to be aware of the limited options for pharmacological management of obesity in pediatric patients. Understanding the available medications, their mechanisms of action, and their approved indications can help in making informed decisions when treating children with obesity. Additionally, emphasizing the importance of lifestyle modifications, such as diet and exercise, as first-line interventions is crucial in managing pediatric obesity effectively.

Correct Answer: A

Rationale: The correct answer is A) mental status changes, ocular signs, and ataxia. This classic triad is indicative of Wernicke encephalopathy due to thiamine deficiency. Mental status changes such as confusion and disorientation are often present. Ocular signs include nystagmus or abnormal eye movements. Ataxia, which is a lack of muscle coordination, is also a key feature. Option B) cardiac involvement, peripheral neuritis, and aphonia are not characteristic of Wernicke encephalopathy. Cardiac involvement is more commonly seen in conditions like beriberi. Peripheral neuritis and aphonia are not part of the classic triad. Option C) depression, drowsiness, and poor mental concentration do not encompass the classic triad of Wernicke encephalopathy. While these symptoms may be present in thiamine deficiency, they do not specifically define the triad. Option D) increased intracranial pressure, meningismus, and coma are not part of the classic triad of Wernicke encephalopathy. These symptoms are more indicative of other neurological conditions and not specific to thiamine deficiency. Educationally, understanding the classic triad of Wernicke encephalopathy is crucial for healthcare providers, especially when working with pediatric patients. Recognizing these key clinical manifestations can prompt timely intervention and treatment to prevent potentially severe neurological consequences. It is important for nurses and other healthcare professionals to be able to differentiate between different clinical presentations to provide appropriate care for their patients.

Correct Answer: A

Rationale: The correct answer is A) skin biopsy for confirming a diagnosis of pellagra in children. Pellagra is a condition caused by niacin deficiency, leading to symptoms such as dermatitis, diarrhea, and dementia. Pellagra typically presents with a characteristic rash in areas exposed to sunlight. A skin biopsy can reveal the specific dermatological changes associated with pellagra, providing a definitive diagnosis. Option B) urinary 2-pyridone is not a reliable or commonly used method for diagnosing pellagra in children. Option C) niacin response refers to the improvement of symptoms with niacin supplementation, which is a treatment rather than a diagnostic test. Option D) urinary N1-methyl-nicotinamide is not a standard diagnostic test for pellagra in children. In an educational context, understanding the diagnostic approach to pediatric gastrointestinal conditions is crucial for nurses preparing for the NCLEX exam. Knowing the specific diagnostic tests for different conditions will help nurses provide optimal care to pediatric patients. Remembering the importance of evidence-based practice in diagnosing and managing pediatric conditions is essential for ensuring positive patient outcomes.

Correct Answer: D

Rationale: Folate deficiency is a condition that can result from various factors affecting the absorption or utilization of folate in the body. In this case, option D, methylene tetrahydrofolate reductase deficiency, is the exception as it is actually a genetic enzyme deficiency that affects the body's ability to convert folate into its active form. This directly leads to folate deficiency. Option A, celiac disease, can cause folate deficiency as it results in damage to the small intestine, affecting the absorption of nutrients including folate. Option B, sickle cell anemia, can lead to folate deficiency due to an increased turnover of red blood cells, requiring more folate for their synthesis. Option C, inflammatory bowel disease, can also cause folate deficiency due to malabsorption issues in the inflamed intestinal tract. Educationally, understanding the causes of folate deficiency is crucial for healthcare professionals, especially when caring for pediatric patients. Recognizing the conditions that can lead to folate deficiency allows for early identification, appropriate interventions, and prevention of complications such as anemia and developmental issues. This knowledge is particularly relevant for nurses and doctors working in pediatric gastroenterology or primary care settings where they may encounter patients at risk for folate deficiency.