A child aged 10 days has ambiguous genitalia:

Correct Answer: B

Rationale: In this scenario, the correct answer is B) A raised urinary output of pregnanetriol would confirm a diagnosis of CAR (congenital adrenal hyperplasia). The presence of ambiguous genitalia in a 10-day-old child can be indicative of a disorder like congenital adrenal hyperplasia (CAH). CAH is a genetic disorder that affects the adrenal glands' ability to produce cortisol, aldosterone, and sex hormones. Option A is incorrect because a buccal smear being chromatin negative does not indicate a serious risk of an Addisonian crisis. Addisonian crisis is typically associated with adrenal insufficiency, not ambiguous genitalia. Option C is incorrect because the genotype 45 XO is more commonly associated with Turner syndrome, not ambiguous genitalia. Option D is incorrect because Klinefelter's syndrome is characterized by the presence of an extra X chromosome in males (47 XXY), leading to specific physical and developmental differences, but it is not typically associated with ambiguous genitalia in infancy. Educationally, understanding the differential diagnoses of ambiguous genitalia in pediatric patients is crucial for nurses caring for children with these conditions. Recognizing the signs and symptoms, as well as the appropriate diagnostic tests and treatments for disorders like CAH, is essential for providing comprehensive and competent care to pediatric patients.

Correct Answer: B

Rationale: In a 20-month-old child, the inability to walk unaided is cause for concern as it is a key developmental milestone that should be achieved around 12-15 months of age. Walking unaided demonstrates gross motor skills, balance, and strength, which are important for overall physical development. It also signifies proper neurological and musculoskeletal development. The other options are not as critical at this age: A) Speaking in clear two to three word phrases is a language development milestone typically achieved around 18-24 months. C) Kicking a ball involves coordination and fine motor skills that may not fully develop until around 2-3 years of age. D) Building a tower of 8 blocks requires fine motor skills and hand-eye coordination, which may not be fully developed until closer to 2 years of age. Educationally, understanding developmental milestones in pediatric pharmacology is crucial for assessing a child's overall health and well-being. Nurses and healthcare providers must be able to recognize delays or abnormalities in development to provide appropriate interventions and support for optimal growth and development. This knowledge aids in early identification of potential issues and ensures timely referrals to specialists for further evaluation and management.

Correct Answer: C

Rationale: In this case, the correct answer is C) Cushing's syndrome. Avascular necrosis of the femoral head is associated with Cushing's syndrome due to the excessive glucocorticoid levels leading to bone tissue damage and compromised blood supply to the femoral head. Option A) Sickle cell trait is incorrect as it is associated with aseptic necrosis of the femoral head due to vaso-occlusive crises, not avascular necrosis. Option B) Nephrotic syndrome is incorrect as it is associated with renal disorders and not typically linked to avascular necrosis of the femoral head. Option D) Hypothyroidism is incorrect as it is more commonly linked to myxedema, not avascular necrosis of the femoral head. Educationally, understanding these associations is crucial for pediatric nurses as they care for children with various health conditions. Recognizing signs and symptoms early can lead to prompt interventions and improved outcomes for pediatric patients. It also emphasizes the importance of a thorough understanding of pharmacology and its impact on different body systems.

Correct Answer: C

Rationale: In the context of achondroplasia, the correct answer is C) Can be diagnosed radiologically at birth. Achondroplasia is a genetic disorder characterized by abnormal bone growth leading to dwarfism. It can be diagnosed through radiological imaging due to distinct skeletal abnormalities present at birth, such as shortened limbs and a prominent forehead. Option A) Shortened spine is incorrect because achondroplasia primarily affects the limbs, resulting in disproportionately short arms and legs, rather than the spine itself. Option B) Increased liability to pathological fractures is incorrect as achondroplasia does not inherently predispose individuals to fractures; the primary concern is related to skeletal deformities and complications from abnormal bone growth. Option D) Infertility is incorrect as achondroplasia does not affect reproductive capabilities; individuals with achondroplasia can have children without fertility issues. Understanding the diagnostic features of achondroplasia is crucial in pediatric nursing practice to facilitate early identification and appropriate management of the condition. This knowledge helps healthcare professionals provide comprehensive care and support to children and families affected by achondroplasia.

Correct Answer: A

Rationale: In pediatric patients with renal failure, certain drugs need to be avoided due to their potential to exacerbate renal dysfunction or cause serious adverse effects. Nitrofurantoin is contraindicated in renal failure because it is primarily eliminated through the kidneys, and in patients with compromised renal function, there is a risk of drug accumulation leading to toxicity. Carbamazepine is primarily metabolized by the liver and does not rely on renal excretion, so it is not contraindicated in renal failure. Salbutamol is a bronchodilator commonly used in pediatric patients with respiratory conditions, and it is not contraindicated in renal failure as it does not significantly affect renal function. Metolazone is a diuretic that can be used in renal failure to help manage fluid overload by promoting diuresis. It is not contraindicated in renal failure; in fact, it can be beneficial in certain cases to improve fluid balance. Educationally, understanding the contraindications of drugs in pediatric patients with renal failure is crucial for safe and effective nursing care. Nurses must be able to identify which medications to avoid in these patients to prevent potential harm and ensure optimal outcomes. This knowledge is essential when caring for pediatric patients with renal impairment to provide individualized and safe pharmacological interventions.