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 is Tourette's disorder (Option A). Tourette's disorder is characterized by the presence of both motor and vocal tics lasting for more than a year. The scenario describes the presence of recurrent eye blinking behavior and recurrent extension of extremities, which are classic motor tics seen in Tourette's disorder. Option B, persistent motor tic disorder, is incorrect because this diagnosis requires the presence of motor tics only, without any vocal tics, which is not the case in this scenario. Option C, provisional tic disorder, is not the best choice as this diagnosis is used when the tics have been present for less than a year, and this patient has been experiencing symptoms for the last 9 months, exceeding the time frame for provisional tic disorder. Option D, post-viral encephalitis, is not the correct diagnosis as the symptoms described are more characteristic of a tic disorder rather than an encephalitis-related condition. Educationally, understanding the differentiation between various tic disorders is crucial for pediatric nurses to accurately assess and diagnose children presenting with these symptoms. Recognizing the specific criteria for each disorder helps in providing appropriate interventions and support for the child and their family.

Correct Answer: D

Rationale: In pediatric nursing, it is crucial to be able to recognize early signs of developmental disorders such as autistic spectrum disorders (ASD) to provide timely interventions and support. In this scenario, the correct answer is D) pediatrician concern. The rationale for D being the correct answer is that pediatricians are trained to identify developmental red flags and have the expertise to raise concerns about ASD based on their assessments and observations during well-child visits. Therefore, if a pediatrician expresses concern about a child possibly having ASD, it should be taken seriously and further evaluations should be pursued. Sibling with ASD (option A) can raise suspicion of ASD due to the genetic component of the disorder. Playmate concern (option B) and parental concern (option C) are also valid indicators that may suggest the need for further evaluation for ASD, as both peers and parents may notice atypical behaviors or delays in a child's development. Understanding the significance of different indicators and who is best positioned to raise concerns about ASD is crucial for healthcare professionals working with children. By recognizing the importance of each stakeholder's observations and concerns, healthcare providers can work collaboratively to ensure early detection and intervention for children with ASD, ultimately improving outcomes and quality of life.

Correct Answer: D

Rationale: In pediatric nursing, understanding the significance of fontanelles is crucial as they provide insights into a child's development and health. The anterior fontanel, in particular, is a key indicator of intracranial pressure and cranial growth. In this question, the correct answer is D) Russell-Silver syndrome. This is because Russell-Silver syndrome is not typically associated with abnormalities in the fontanel size. It is a condition characterized by intrauterine growth retardation, body asymmetry, and distinctive facial features, but not specifically related to fontanelle abnormalities. A) Congenital rubella syndrome is associated with a large anterior fontanel due to the effects of the rubella virus on the developing fetus. B) Hypophosphatasia can also cause a large anterior fontanel due to abnormal bone mineralization. C) Apert syndrome is characterized by craniosynostosis, which can lead to abnormal fontanelle sizes, including a large anterior fontanel. In an educational context, this question reinforces the importance of recognizing clinical manifestations associated with different pediatric disorders. Understanding the link between specific conditions and physical exam findings, such as fontanelle abnormalities, aids in accurate diagnosis and appropriate management of pediatric patients. It also highlights the need for nurses to have a comprehensive knowledge base to provide quality care to pediatric populations.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) dexamethasone. Pyloric stenosis is a condition characterized by the narrowing of the opening from the stomach to the small intestine (pylorus). Dexamethasone is a corticosteroid that can contribute to the development of pyloric stenosis in premature infants due to its effect on the muscular structure of the pylorus. Option A) intravenous vitamin E is incorrect because it is not associated with causing pyloric stenosis in premature infants. Option B) indomethacin is typically used to treat patent ductus arteriosus in premature infants and is not linked to pyloric stenosis. Option C) enteric gentamicin is an antibiotic that is not known to cause pyloric stenosis in premature infants. Educationally, understanding the potential side effects of medications in neonates and premature infants is crucial for healthcare providers working in pediatric settings. This knowledge ensures safe administration practices and helps in early identification of adverse reactions. It also highlights the importance of individualizing drug therapy based on patient factors such as age, weight, and gestational age to minimize risks and optimize outcomes in this vulnerable population.

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 can be a normal physiological event, especially during sleep, and may not always indicate a serious underlying issue. This distinction is important to prevent unnecessary alarm among parents and healthcare providers. 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 it describes central apnea, not obstructive apnea, which is characterized by lack of chest wall movement. Option D is incorrect as serious apnea in infants is typically defined as cessation of breathing for longer than 20 seconds in preterm infants and longer than 15 seconds in term infants. In an educational context, it is essential for pediatric nurses to differentiate between normal and abnormal apnea patterns in infants to provide appropriate care and support. Understanding the nuances of apnea in different age groups and contexts is crucial for effective pediatric nursing practice and ensuring optimal patient outcomes.