A healthy 3-year-old boy reports to his mother that he accidentally swallowed a small plastic toy and is brought to the emergency department for evaluation. The mother recalls that the other toys in the playset are all 1 to 2 cm in length and have no sharp edges. On examination, the child appears to be in no distress and is playing in the examination room with his sister. His vital signs are normal. Of the following, the BEST next step is

Correct Answer: B

Rationale: The best next step in this scenario is option B) observation. In the case of a healthy child who has swallowed a small, non-sharp object and is asymptomatic, observation is a safe and appropriate approach. Observation allows for monitoring the child for any signs of distress, such as difficulty breathing, coughing, choking, abdominal pain, vomiting, or drooling. If any of these symptoms develop, further intervention can be initiated promptly. Barium swallow and meal imaging (option A) may be invasive and unnecessary in a child who is asymptomatic, as it exposes the child to radiation without clear benefit at this stage. Chest and abdominal radiograph series (option C) may not always detect small non-radiopaque objects and may not change management if the child remains asymptomatic. Upper endoscopy (option D) is invasive and carries risks, which should be reserved for cases where there are symptoms or complications. Educationally, it is important to emphasize the principle of assessing the child's clinical status and symptoms before deciding on the appropriate intervention. In cases where a child swallows a foreign body, a systematic approach based on the child's condition and the nature of the object is crucial to provide safe and effective care. Observation in this case aligns with the principles of conservative management in asymptomatic children, preventing unnecessary interventions and minimizing risks.

Correct Answer: A

Rationale: The correct answer is A) migration of pain to the right lower quadrant. The Alvarado/MANTRELS rule is a scoring system used to aid in the diagnosis of acute appendicitis. Migration of pain to the right lower quadrant is a classic symptom associated with appendicitis due to the inflammation and irritation of the appendix. This symptom is given 2 points in the scoring system because of its strong correlation with appendicitis. Option B) anorexia is a common symptom in appendicitis, but it is not specific to this condition and can be present in many other gastrointestinal issues. Option C) rebound pain is also seen in appendicitis, but it is not a specific criteria in the Alvarado/MANTRELS rule. Option D) WBC shift to greater than 75% neutrophils is a laboratory finding associated with appendicitis, but it is not part of the clinical criteria used in the scoring system. Understanding the Alvarado/MANTRELS rule is essential for nurses working in pediatric gastrointestinal care as it helps in the timely and accurate diagnosis of acute appendicitis. Recognizing the key clinical signs and symptoms, such as migration of pain to the right lower quadrant, aids in prompt intervention and prevents complications associated with a delayed diagnosis.

Correct Answer: D

Rationale: The correct answer is D) Prader-Willi syndrome. Prader-Willi syndrome is a genetic disorder characterized by obesity, short stature, intellectual disability, and hypogonadism. Individuals with Prader-Willi syndrome have an insatiable appetite, which leads to obesity if food intake is not controlled. In this case, the presence of obesity along with other clinical features such as mental retardation and syndactyly point towards Prader-Willi syndrome as the most likely cause. Option A) Alström syndrome is characterized by obesity, retinal degeneration, and hearing loss, but it does not typically present with syndactyly or mental retardation as seen in the case provided. Option B) Laurence-Moon-Bardet-Biedl syndrome is characterized by obesity, retinal degeneration, and polydactyly, but it does not typically present with mental retardation or syndactyly. Option C) Fröhlich syndrome, also known as hypothalamic obesity, is characterized by obesity due to hypothalamic dysfunction, but it does not typically present with syndactyly, retinal degeneration, or intellectual disability. Understanding the distinguishing features of each syndrome is crucial in pediatric nursing practice to accurately identify and provide appropriate care for children with genetic disorders. Recognizing the signs and symptoms of Prader-Willi syndrome early can help healthcare providers intervene with dietary management and behavioral strategies to mitigate the complications associated with this condition.

Correct Answer: A

Rationale: In pediatric gastrointestinal nursing, understanding the causes of smooth tongue in nutritional deficiency disorders is crucial for effective care. In this scenario, the correct answer is A) iron deficiency. Iron is essential for the production of hemoglobin, which carries oxygen in the blood. A deficiency in iron leads to anemia, resulting in symptoms like pallor, fatigue, and a smooth, sore tongue. This glossitis is a common manifestation of iron deficiency and is an important clinical indicator for nurses to recognize. B) Copper deficiency does not typically cause a smooth tongue. Copper is more closely associated with neurological symptoms and bone abnormalities when deficient. C) Biotin deficiency can lead to hair loss, dermatitis, and neurological symptoms, but it is not a common cause of a smooth tongue. D) Iodine deficiency is linked to thyroid disorders like goiter, but it does not directly cause a smooth tongue in nutritional deficiency disorders. Educationally, this question highlights the importance of recognizing specific clinical manifestations of nutritional deficiencies in pediatric patients. Nurses need to be able to identify these signs early to provide appropriate interventions and prevent complications. Understanding the unique symptoms associated with different nutrient deficiencies is essential for providing holistic care to children with gastrointestinal issues.

Correct Answer: D

Rationale: In pediatric gastrointestinal nursing, understanding the relationship between drugs and vitamin/nutrient deficiencies is crucial for providing holistic care to children. In this scenario, option D, which states that isoniazid causes vitamin B12 deficiency, is incorrect. Isoniazid actually causes pyridoxine (vitamin B6) deficiency, leading to peripheral neuropathy. Option A is correct as sulfonamides are known to interfere with folate metabolism, potentially causing folate deficiency. This can lead to anemia and developmental issues in children. Option B is correct as phenytoin has been linked to vitamin D deficiency due to its interference with vitamin D metabolism and absorption. Vitamin D deficiency can result in skeletal issues in pediatric patients. Option C is correct as certain antibiotics can disrupt the gut flora, leading to decreased synthesis of vitamin K. This deficiency can result in impaired blood clotting, which is critical for pediatric patients undergoing procedures or surgeries. Understanding these drug-nutrient interactions is essential for nurses working with pediatric patients, as it helps in anticipating and preventing potential deficiencies and their associated complications. By recognizing these relationships, nurses can tailor interventions to address and mitigate the impact of drug-induced nutrient deficiencies on pediatric patients' health and well-being.