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: The correct answer is D) Hemoglobin electrophoresis. In this scenario, the infant presents with significant jaundice, pallor, and a palpable liver, which are indicative of hemolytic disease such as ABO or Rh incompatibility. Hemoglobin electrophoresis is not necessary at this point as the clinical presentation does not suggest a hemoglobinopathy. Option A) Total and direct bilirubin levels are essential to assess the severity of jaundice and determine if there is conjugated hyperbilirubinemia, which could indicate liver disease or biliary obstruction. Option B) CBC with RBC morphology is important to assess for anemia, hemolysis, or other hematologic abnormalities that could contribute to the jaundice. Option C) Reticulocyte count helps to differentiate between hemolysis and liver pathology as a cause of jaundice. Elevated reticulocyte count would support a diagnosis of hemolysis. In an educational context, understanding the appropriate diagnostic steps in evaluating neonatal jaundice is crucial for pediatric nursing practice. This question highlights the importance of considering differentials and selecting appropriate investigations based on the clinical presentation to provide optimal care for neonates.

Correct Answer: A

Rationale: In pediatric nursing, understanding stereotypic movements is crucial for assessing and providing care for children. Stereotypic movements are repetitive, seemingly purposeless behaviors that may indicate underlying neurological or developmental conditions. In this question, the correct answer is A) Hand shaking. Hand shaking is not typically recognized as a stereotypic movement in the context of pediatric nursing. Eye blinking, head banging, and self-biting are commonly known stereotypic movements observed in children with various developmental disorders like autism spectrum disorder, Tourette syndrome, or intellectual disabilities. Educationally, it is important for nursing students to differentiate between stereotypic movements to accurately assess and intervene for their pediatric patients. Understanding the nuances of these movements can help identify underlying conditions, tailor care plans, and advocate for appropriate interventions. It also enables nurses to educate families about these behaviors and provide support and resources for managing them effectively. Being able to discern between different types of stereotypic movements enhances the quality of care provided to children with complex needs.

Correct Answer: B

Rationale: In pediatric nursing, understanding the behavior of children, including lying, is crucial for providing appropriate care. The correct answer, B) It indicates a potential for future lying behavior, is true because frequent lying in a 3-year-old may not necessarily predict future lying tendencies. At this age, children are still developing a sense of reality and fantasy, and their imaginative play may involve storytelling that is not intended to deceive. Option A) It is a method of playing with language, is incorrect because while children may use language creatively in play, lying typically involves intentionally deceiving others, which is not the primary goal of a 3-year-old's behavior. Option C) It is a part of magical thinking, is incorrect as well. Magical thinking in children involves believing in fantasy or supernatural events, not necessarily intentional deception through lying. Option D) It is an approach to avoid unwanted confrontation with adults, is also incorrect because at age 3, children may not have developed the cognitive skills to strategize lying as a means to avoid confrontation. In an educational context, it is important for healthcare providers to understand the developmental stages of children to interpret their behaviors accurately. By recognizing that frequent lying in a young child is often linked to their cognitive and imaginative development rather than a precursor to future dishonesty, healthcare professionals can provide appropriate guidance and support to both the child and their caregivers.

Correct Answer: D

Rationale: In pediatric nursing, evaluating a symptomatic toddler for autistic spectrum disorders requires a comprehensive assessment. The correct answer, option D) Woods lamp, should not be included in this evaluation. A Woods lamp is used to assess skin conditions like fungal infections or pigment changes, which are not directly related to the core symptoms of autism spectrum disorders. Option A) Physical examination is crucial to assess the overall health of the child and rule out any physical abnormalities that could be causing symptoms resembling autism. Option B) Hearing tests are important to evaluate the child's auditory processing, as hearing difficulties can sometimes present similarly to autism symptoms. Option C) Brain CT is not typically used as a routine diagnostic tool for autism spectrum disorders. Diagnosing autism involves behavioral observations, developmental history, and standardized assessments rather than neuroimaging studies like CT scans. In an educational context, understanding the rationale behind selecting appropriate diagnostic tests is essential for providing quality care to pediatric patients. By knowing which tests are relevant and which are not, nurses can ensure accurate assessments and timely interventions for children with developmental concerns.

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.