A 7-year-old boy presented with recurrent eye blinking behavior and recurrent extension of extremities. The mother describes the movement as sudden, rapid, and repetitive movements, present for the last 9 months. Of the following, the MOST appropriate diagnosis is

Correct Answer: A

Rationale: In this case, the most appropriate diagnosis for the 7-year-old boy presenting with recurrent eye blinking behavior and recurrent extension of extremities is A) Tourette's disorder. Tourette's disorder is characterized by the presence of both multiple motor and one or more vocal tics, which are sudden, rapid, and repetitive movements or sounds. The symptoms described by the mother align with the diagnostic criteria for Tourette's disorder. Option B) persistent motor tic disorder refers to the presence of motor tics without vocal tics for at least 1 year, which does not fit the presentation described in the question. Option C) provisional tic disorder involves the presence of motor or vocal tics for less than 1 year, which is also inconsistent with the duration of symptoms in this case. Option D) post-viral encephalitis is unlikely given the chronic nature of the symptoms and the absence of other signs of encephalitis. Educationally, understanding the differences between these disorders is crucial for healthcare providers working with pediatric patients. Recognizing the specific criteria for Tourette's disorder, persistent motor tic disorder, and provisional tic disorder is essential for accurate diagnosis and appropriate management. This case highlights the importance of thorough assessment and knowledge of developmental disorders in pediatric nursing practice.

Correct Answer: D

Rationale: Rationale: The correct answer is D) pediatrician concern. This is because pediatricians are trained to identify signs and symptoms of ASD during routine well-child visits. Therefore, if a pediatrician has concerns about a child potentially having ASD, it is a significant red flag that should not be ignored. Option A) sibling with ASD is a valid concern as there is a genetic component to ASD, increasing the likelihood of a sibling also being diagnosed. Option B) playmate concern is relevant as peers and playmates may notice social or behavioral differences in a child that could indicate ASD. Option C) parental concern is important since parents are often the first to notice atypical behaviors or developmental delays in their child. In an educational context, it is crucial for healthcare providers and educators to be aware of the various signs and symptoms of ASD to facilitate early detection and intervention. Understanding the red flags associated with ASD can lead to timely diagnosis and appropriate support services for children and their families. Collaboration between healthcare providers, educators, and families is essential in providing comprehensive care for children with ASD.

Correct Answer: D

Rationale: In pediatric nursing, understanding the significance of fontanelles is crucial as they provide insight into an infant's neurological status. The correct answer, D) Russell-Silver syndrome, is not associated with a large anterior fontanel. This condition is characterized by growth failure and distinctive facial features, but not by fontanel abnormalities. A) Congenital rubella syndrome is associated with a large anterior fontanel due to the impact of the rubella virus on the developing fetus. B) Hypophosphatasia is a genetic disorder that can cause skeletal abnormalities, including a large fontanel. C) Apert syndrome is a genetic disorder that affects skull development, leading to a large fontanel among other craniofacial abnormalities. Educationally, this question emphasizes the importance of recognizing clinical manifestations associated with different pediatric disorders. Understanding these associations aids in timely diagnosis and appropriate management of conditions affecting infants and children. Pediatric nurses must be able to recognize abnormal findings like fontanel size to provide comprehensive care to pediatric patients.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) dexamethasone. Dexamethasone, a corticosteroid, is known to potentially cause pyloric stenosis in premature infants due to its impact on muscle tone and motility in the digestive system. Pyloric stenosis is a condition where the muscle at the base of the stomach thickens, leading to a blockage in the opening to the small intestine. Now, let's address why the other options are incorrect: A) Intravenous vitamin E: Vitamin E supplementation is not associated with pyloric stenosis in premature infants. It is generally considered safe and essential for premature infants' health. B) Indomethacin: While indomethacin is a nonsteroidal anti-inflammatory drug commonly used to treat patent ductus arteriosus in premature infants, it is not linked to causing pyloric stenosis. C) Enteric gentamicin: Gentamicin, an antibiotic, is not known to cause pyloric stenosis in premature infants. Its route of administration and mechanism of action do not typically lead to this condition. Educational Context: Understanding the potential adverse effects of medications on premature infants is crucial for pediatric nurses. By knowing which drugs can lead to complications like pyloric stenosis, nurses can make informed decisions when administering medications to this vulnerable population. This knowledge ensures safe and effective care for premature infants in neonatal settings.

Correct Answer: B

Rationale: In pediatric nursing, understanding apnea is crucial as it can be a life-threatening condition in infants. The correct answer, B) in term infants, apnea is always worrisome, is right because apnea in term infants may not always be indicative of a serious underlying issue and can sometimes be normal or benign. This distinction is important for healthcare providers to make appropriate clinical judgments. Option A is incorrect because apnea is indeed a common problem in preterm infants due to their immature respiratory control. Option C is incorrect as obstructive apnea is characterized by the absence of both airflow and chest wall motion due to upper airway obstruction. Option D is incorrect as serious apnea is usually defined as cessation of breathing for longer than 20 seconds in infants, not shorter. In an educational context, it is essential for pediatric nurses to be able to differentiate between normal, benign apnea and worrisome apnea that requires immediate intervention. This knowledge helps in providing timely and appropriate care to infants experiencing apnea, ensuring their safety and well-being. Understanding the nuances of apnea in different age groups is vital for pediatric nurses to deliver high-quality care.