A -day-old term breast-fed male appears icteric The physical examination reveals mild pallor and significant jaundice with a palpable liver 5 cm below the right rib margin His mother has a vague history of anemia and his older sister had prolonged neonatal jaundice The next logical step to evaluate the patient includes all of the following EXCEPT

Correct Answer: D

Rationale: In this pediatric nursing scenario, the correct answer is D) Hemoglobin electrophoresis. The reason for this is that the patient is presenting with jaundice, pallor, and a palpable liver, which are indicative of hemolytic jaundice. Given the family history of anemia and prolonged neonatal jaundice in the older sister, the most likely cause of the current patient's symptoms is hemolytic disease, possibly due to an underlying hemoglobinopathy like G6PD deficiency or hereditary spherocytosis. Total and direct bilirubin levels (Option A) are important to assess the severity of jaundice and determine if the cause is unconjugated hyperbilirubinemia. CBC with RBC morphology (Option B) can help identify any abnormalities in red blood cells that may suggest a hemolytic process. Reticulocyte count (Option C) is essential to evaluate the bone marrow response to anemia and can indicate increased red blood cell turnover. Understanding why each option is important in the context of a neonate presenting with jaundice and anemia is crucial for pediatric nurses to provide comprehensive care and accurate diagnostic evaluation. By focusing on the specific clinical presentation and family history, nurses can effectively prioritize diagnostic tests and interventions to ensure optimal patient outcomes.

Correct Answer: A

Rationale: In pediatric nursing, understanding stereotypic movements is crucial for assessing and caring for children effectively. A stereotypic movement is a repetitive, non-functional motor behavior that is often seen in children with developmental disorders or neurological conditions. In this case, the correct answer is A) Hand shaking. Hand shaking is not typically recognized as a stereotypic movement in the context of pediatric nursing. It is a normal physiological response and can occur for various reasons such as excitement, fear, or even hunger. On the other hand, options B, C, and D - Eye blinking, Head banging, and Self-biting - are all recognized as stereotypic movements. Eye blinking can be a sign of tics or Tourette syndrome. Head banging is often seen in children with autism spectrum disorder or sensory processing issues. Self-biting is a behavior observed in some children with developmental delays or behavioral challenges. Educationally, understanding stereotypic movements helps nurses identify underlying conditions, provide appropriate interventions, and offer support to both the child and their family. By differentiating between normal and abnormal movements, nurses can enhance their assessment skills and contribute to the holistic care of pediatric patients.

Correct Answer: B

Rationale: In pediatric nursing, understanding child development and behavior is crucial for providing effective care. The correct answer, option B, "It indicates a potential for future lying behavior," is not true because frequent lying behavior in a 3-year-old is developmentally appropriate and does not necessarily predict future lying tendencies. Young children engage in fantasy play and storytelling as part of their cognitive and social development, rather than with the intent to deceive. Option A, "It is a method of playing with language," is a common behavior in preschool-aged children as they explore language and communication skills through imaginative play. Option C, "It is a part of magical thinking," is also accurate as young children often have difficulty distinguishing between fantasy and reality at this age. Option D, "It is an approach to avoid unwanted confrontation with adults," may seem plausible, but at the age of 3, children are more likely to lie as a form of creative play or to test boundaries rather than to consciously avoid confrontation. Educationally, it is important for pediatric nurses to have a solid understanding of child development to differentiate between normal behaviors and potential concerns. By recognizing typical behaviors like frequent lying in young children as part of their development, healthcare providers can offer appropriate support and guidance to both the child and their caregivers.

Correct Answer: D

Rationale: In evaluating a symptomatic toddler for autistic spectrum disorders, the test that should NOT be included is a Woods lamp examination, making option D the correct answer. A Woods lamp is used to detect certain skin conditions like fungal infections or pigment changes, and it is not a standard diagnostic tool for evaluating autism spectrum disorders. Physical examination (option A) is essential to assess the overall health and developmental milestones of the child. Hearing tests (option B) are crucial to rule out any hearing impairments that might be affecting the child's communication skills. A brain CT scan (option C) may be ordered to evaluate any structural abnormalities in the brain, which can sometimes be associated with certain developmental disorders but is not typically used as a primary tool for diagnosing autism spectrum disorders. In the context of pediatric nursing, it is important to prioritize evidence-based assessment tools and diagnostic tests that are relevant to the specific condition being evaluated. Understanding the rationale behind choosing or excluding certain tests is crucial for providing optimal care to pediatric patients.

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.