A school nurse called you to see a 6-year-old boy with school refusal. He is always crying after parental leaving, refuses to stay in the classroom, and the school nurse tried her best during the last 4 weeks. Of the following, the BEST action is to

Correct Answer: A

Rationale: The best action in this scenario is to refer the child to a pediatric psychologist (Option A). This is the correct choice because the child's behavior of school refusal, excessive crying, and difficulty separating from parents indicates possible underlying psychological issues that require specialized professional intervention. A pediatric psychologist is trained to assess and address these emotional and behavioral concerns in children. Starting selective serotonin reuptake inhibitor treatment (Option B) without a comprehensive evaluation by a mental health professional is not appropriate as it may not target the root cause of the child's behavior and can have potential risks and side effects in children. While assessing the home environment (Option C) is important, in this case, the child's symptoms are more indicative of a psychological issue rather than environmental factors being the primary cause. Arranging for parent management training (Option D) could be beneficial for addressing behavioral issues, but in this case, the child's symptoms appear to require more specialized psychological intervention rather than solely focusing on parenting strategies. Educationally, understanding the importance of recognizing signs of psychological distress in children, appropriate referral pathways to mental health professionals, and the limitations of solely behavioral interventions are crucial for healthcare providers working with pediatric populations. This case highlights the need for a multidisciplinary approach to address complex behavioral concerns in children.

Correct Answer: D

Rationale: The correct answer is D) night terror. Night terrors are a type of sleep disorder that occurs during non-REM sleep and are more common in children. They often involve intense episodes of screaming, fear, and confusion. In this case, the child's symptoms of imagining a snake crawling over him and trying to remove it are consistent with the characteristics of night terrors. Option A) acute phobic hallucination is incorrect because phobic hallucinations are not typically associated with night terrors and do not explain the child's behavior during sleep. Option B) early sign of schizophrenia is incorrect as schizophrenia is a serious mental disorder that typically presents later in adolescence or early adulthood, and the child's symptoms are not indicative of schizophrenia. Option C) delusional infestation is also incorrect as this refers to a psychiatric disorder where individuals have a fixed, false belief of being infested with parasites, which does not align with the child's symptoms. In an educational context, understanding common pediatric sleep disorders like night terrors is crucial for healthcare providers working with children and families. Recognizing and differentiating between various sleep disturbances can help in providing appropriate support and guidance to parents and caregivers dealing with such issues.

Correct Answer: D

Rationale: In this question, the correct answer is D) maternal hypertensive and renal vascular disease. A delay in fetal pulmonary maturation can be associated with maternal conditions that affect placental blood flow and oxygen delivery to the fetus. Maternal hypertensive and renal vascular diseases can lead to poor perfusion of the placenta, resulting in decreased oxygen and nutrient exchange, which can impede fetal lung development. Option A) hydrops fetalis is incorrect because it is a condition characterized by excessive fluid accumulation in two or more fetal compartments and is not directly related to pulmonary maturation delays. Option B) severe premature separation of the placenta is incorrect as it can lead to fetal distress and compromise, but it is not directly linked to delays in pulmonary maturation. Option C) premature rupture of the fetal membranes can lead to preterm birth but is not specifically associated with delays in fetal pulmonary maturation. Educationally, understanding the impact of maternal health on fetal development is crucial for nurses and healthcare providers caring for pregnant individuals. Recognizing how maternal conditions can affect fetal well-being underscores the importance of early detection, monitoring, and management to optimize outcomes for both the mother and the baby. This knowledge is essential for pediatric nurses who play a vital role in caring for newborns with potential complications related to maternal conditions.

Correct Answer: C

Rationale: In the neonatal period, vomiting is a common issue that can have various causes. In this scenario, the correct answer is C) overfeeding. Neonates have small stomach capacities and immature digestive systems, making them prone to vomiting if they are overfed. This can overwhelm their digestive system, leading to regurgitation of milk. Option A) pyloric stenosis is a condition that typically presents later in infancy with projectile vomiting and is not a common cause of vomiting in the neonatal period. Option B) milk allergy can cause symptoms like vomiting, but it usually presents with other symptoms such as rash, diarrhea, or irritability. Option D) an inborn error of metabolism would typically present with more systemic issues rather than isolated vomiting. In an educational context, understanding common causes of vomiting in neonates is crucial for healthcare professionals working with this population. Recognizing the signs and symptoms of overfeeding can help prevent complications and ensure appropriate feeding practices are followed to support optimal neonatal health and development.

Correct Answer: B

Rationale: In the context of pediatric care and respiratory support, understanding the use of CPAP (Continuous Positive Airway Pressure) is crucial. In this question, option B is the correct answer because CPAP is actually indicated when oxygen saturation cannot be maintained above 95%. Option A is incorrect because CPAP does indeed prevent the collapse of surfactant-deficient alveoli by providing a continuous pressure to keep the airways open. Option C is also incorrect as CPAP does improve the functional residual capacity (FRC) by keeping the alveoli open and preventing collapse. Option D is incorrect as well because CPAP actually increases ventilatory needs by improving oxygenation and reducing the work of breathing, which can lead to increased ventilation needs. Educationally, understanding the indications and effects of CPAP in pediatric patients is vital for nurses and healthcare providers working in pediatric settings. It helps in providing appropriate respiratory support and optimizing patient care for children with respiratory distress or failure.