A 7-year-old child brought by his father to your clinic often expresses fear of being injured by a car accident during transport to school. He expresses this fear to teachers and parents. Of the following, the TRUE description of his reaction is

Correct Answer: C

Rationale: The correct answer is C) separation anxiety. In this scenario, the child's fear of being injured during transport to school and expressing it to teachers and parents indicates separation anxiety. Separation anxiety is a developmentally normal fear experienced by children when separated from their primary caregivers or familiar surroundings. This fear often manifests as concerns about safety and well-being when apart from their attachment figures. Option A) nonpathological anxiety is incorrect because the child's fear is related to separation from his father and is developmentally appropriate. Option B) school phobia refers to an intense fear or refusal to attend school due to various reasons like social anxiety or specific phobias, which is not the case here. Option D) generalized anxiety disorder involves excessive worry and anxiety about various aspects of life, not just separation from caregivers. Understanding childhood anxiety disorders and their presentations is crucial for pediatric nurses as they play a vital role in early identification, intervention, and support for children and families dealing with such issues. Recognizing separation anxiety helps nurses provide appropriate education and support to both the child and the family to address the underlying concerns and promote healthy coping strategies.

Correct Answer: C

Rationale: The most important next action in this scenario is to conduct lead level testing (Option C). Lead exposure has been associated with developmental delays, behavioral problems, and cognitive impairments in children. Children with ASD may be at higher risk for lead exposure due to their behavior patterns, such as pica eating habits. Identifying and addressing lead exposure is crucial in managing the child's overall health and development. Physical examination for dysmorphic features (Option A) may be important in assessing for certain genetic disorders but is not the most pressing concern in this case. Hearing tests (Option B) are important but are not the priority given the child's specific symptoms and risk factors. Wood's lamp (Option D) is used to assess for certain skin conditions and is not relevant to the child's presentation of delayed speech and behavioral concerns. In an educational context, this question highlights the importance of considering environmental factors and potential comorbidities in children with developmental disorders like ASD. It underscores the need for a comprehensive approach to assessment and management that takes into account the specific needs and risks of each individual child. By understanding the rationale behind prioritizing lead level testing in this case, healthcare providers can improve their ability to provide holistic and effective care for children with ASD.

Correct Answer: A

Rationale: In pediatric nursing, it is crucial to understand the safety considerations when administering drugs to breastfeeding mothers. The correct answer, psychotropic drugs (Option A), can be given with caution to breastfeeding mothers due to their relatively low transfer into breast milk and established safety profiles in lactation. Psychotropic drugs such as selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to nursing mothers with minimal adverse effects on the infant. Amphetamines (Option B) are not recommended during breastfeeding due to their potential for significant transfer into breast milk, leading to adverse effects on the infant's central nervous system and potential for stimulation. Bromocriptine (Option C) is contraindicated in breastfeeding mothers as it has been associated with severe adverse effects in infants, including respiratory distress and seizures. Methimazole (Option D) is also not recommended during breastfeeding as it can accumulate in the infant's thyroid gland, leading to potential hypothyroidism. Educationally, understanding the compatibility of medications with breastfeeding is essential for pediatric nurses to provide safe and effective care to both the mother and the infant. It is crucial to assess the risks and benefits of medications, consider alternative treatment options, and consult with healthcare providers to ensure the well-being of the breastfeeding dyad. This knowledge empowers nurses to advocate for evidence-based care and promote maternal and infant health during the breastfeeding period.

Correct Answer: C

Rationale: In a very low birthweight (VLBW) infant, the sudden onset of hypotension suggests bacterial sepsis (Option C). This is because bacterial sepsis can lead to systemic inflammatory response syndrome (SIRS) which can result in hypotension. Sepsis is a serious condition in infants that requires prompt recognition and treatment to prevent complications. Option A, pneumothorax, typically presents with respiratory distress rather than hypotension. Option B, necrotizing enterocolitis, may present with abdominal distension and bloody stools but is less likely to cause sudden hypotension. Option D, hypoglycemia, can cause symptoms such as lethargy and poor feeding but is less likely to be the primary cause of sudden hypotension in this scenario. Educationally, it is crucial for pediatric nurses to understand the different conditions that can present in VLBW infants and recognize the signs and symptoms of each. This knowledge helps in early identification, appropriate interventions, and prevention of adverse outcomes in these vulnerable patients. Understanding the specific clinical manifestations of various conditions is essential for providing safe and effective care to neonates in the pediatric setting.

Correct Answer: C

Rationale: In this question, the correct answer is C) total anomalous pulmonary venous return (TAPVR). This condition can mimic Respiratory Distress Syndrome (RDS) both clinically and radiographically. TAPVR is a congenital heart defect where the pulmonary veins do not connect normally to the left atrium. This results in oxygenated blood from the lungs returning to the right side of the heart instead of the left side. This can lead to severe hypoxemia and respiratory distress in newborns, mimicking the symptoms of RDS. Option A) persistent pulmonary hypertension usually presents with signs of right heart failure and cyanosis rather than mimicking RDS. Option B) meconium aspiration syndrome presents with respiratory distress due to meconium in the lungs, which is different from the pathophysiology of RDS. Option D) lobar emphysema would show radiographic findings of hyperinflation of a lobe of the lung, which is distinct from the findings in RDS or TAPVR. Educationally, understanding the differential diagnosis of conditions that mimic each other is crucial in pediatric nursing. Recognizing these similarities and differences can guide appropriate diagnostic and treatment strategies, leading to better patient outcomes. This knowledge helps nurses provide accurate assessments and interventions for infants presenting with respiratory distress, ensuring prompt and effective care.