A term infant is born with Apgar scores of 5 at minute and 7 at 5 minutes The infant has a heart rate of 7 and demonstrates pallor with hepatosplenomegaly A Coombs test on maternal blood yields positive results The most likely diagnosis is

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Erythroblastosis fetalis. Erythroblastosis fetalis occurs when there is an incompatibility between the blood types of the mother and the fetus, leading to the mother's antibodies attacking the baby's red blood cells. This condition can cause anemia, jaundice, and hepatosplenomegaly in the newborn. Option B) Hereditary spherocytosis is a genetic disorder that leads to hemolytic anemia due to abnormal red blood cell shape. However, the clinical presentation in the question, including the positive Coombs test and Apgar scores, is more indicative of an immune response causing hemolysis rather than a genetic defect. Option C) Chronic fetal-maternal hemorrhage is unlikely in this case as the infant's symptoms are more suggestive of a hemolytic process rather than hemorrhage. Option D) ABO incompatibility is another condition where the mother's antibodies attack the baby's red blood cells, but it typically presents with less severe symptoms compared to erythroblastosis fetalis. Educationally, understanding these differentials is crucial for pediatric nurses to provide appropriate care for neonates experiencing hemolytic processes. Recognizing the signs and symptoms of erythroblastosis fetalis can lead to prompt interventions such as exchange transfusions to prevent severe complications in affected infants.

Correct Answer: A

Rationale: In pediatric nursing, understanding hyperbilirubinemia in infants is crucial as it is a common condition that requires prompt assessment and management. In this scenario, the correct answer is A) Physiologic jaundice. Physiologic jaundice is a normal occurrence in newborns due to the immature liver's inability to efficiently process bilirubin. It typically appears after the first 24 hours of life, peaks around 3-5 days, and resolves within a week. It is considered a benign and self-limiting condition that does not require immediate intervention. Option B) Hypothyroidism is incorrect because hypothyroidism can present with jaundice due to decreased conjugation of bilirubin, but it usually occurs later in infancy and is not a common cause of jaundice in the first weeks of life. Option C) Pyloric stenosis is incorrect as it presents with non-bilious vomiting and failure to thrive, rather than jaundice. Option D) Biliary atresia is incorrect because it is a serious condition that presents with persistent jaundice, acholic stools, and hepatomegaly within the first few weeks of life, not at weeks of age as mentioned in the question. Educationally, understanding the differential diagnoses of hyperbilirubinemia in infants is essential for nurses to provide comprehensive care. Recognizing the differences between physiologic jaundice and pathological causes like hypothyroidism, pyloric stenosis, and biliary atresia helps in early identification and appropriate management of these conditions to prevent complications and ensure optimal outcomes for neonates.

Correct Answer: D

Rationale: In pediatric nursing, understanding the associations between psychiatric illnesses in childhood and their appropriate treatments is crucial for providing safe and effective care to young patients. In this case, the correct answer is D) Depression and atypical antipsychotic. Depression in children is typically not treated with atypical antipsychotics as first-line therapy. Antidepressants, psychotherapy, and lifestyle modifications are usually the primary modalities for managing childhood depression. Atypical antipsychotics are more commonly prescribed for conditions like schizophrenia or bipolar disorder in pediatric patients. A) ADHD and atomoxetine: Atomoxetine is a common medication used to treat ADHD by increasing the levels of norepinephrine in the brain. B) Anxiety and antidepressant: Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are often used to manage anxiety disorders in children. C) Psychosis and typical antipsychotic: Typical antipsychotics are prescribed for conditions like psychosis to help manage symptoms such as hallucinations or delusions. Educationally, it is important for pediatric nurses to have a solid understanding of psychiatric illnesses in children and the appropriate pharmacological treatments. This knowledge allows nurses to advocate for appropriate care, monitor for side effects, and educate patients and their families about the treatment plan. By understanding these associations, nurses can contribute to improved outcomes and quality of life for pediatric patients with psychiatric conditions.

Correct Answer: A

Rationale: In this scenario, the best action for a 6-year-old boy with school refusal is to refer him to a pediatric psychologist (Option A). This choice is correct because school refusal can stem from various underlying psychological issues such as anxiety, separation anxiety, or other emotional challenges. A pediatric psychologist is trained to assess and address these underlying causes through therapy and interventions tailored to the child's specific needs. Option B, starting a selective serotonin reuptake inhibitor, is not the best initial action without a comprehensive evaluation by a mental health professional. Medication should not be the first line of treatment for school refusal in a young child. Option C, assessing the home environment, is important but may not directly address the child's emotional struggles that are leading to school refusal. While environmental factors can play a role, a psychological evaluation is crucial. Option D, giving the child special attention from the teacher, is not the most appropriate response as it does not address the underlying reasons for the school refusal and may inadvertently reinforce the behavior. In an educational context, it is important for healthcare providers and educators to collaborate in understanding and addressing school refusal in children. By recognizing the psychological factors at play and involving the appropriate mental health professionals, we can provide holistic support to help the child overcome their challenges and thrive in the school environment.

Correct Answer: D

Rationale: In this question, the correct answer is D) Stereotyped absence of motor use. Autistic spectrum disorder (ASD) is a neurodevelopmental disorder characterized by challenges in social interaction and communication, as well as restricted and repetitive behaviors. While individuals with ASD may exhibit stereotyped or repetitive motor movements, the absence of motor use is not a characteristic feature of ASD. Option A, defective social communication, is a hallmark feature of ASD. Individuals with ASD often have difficulties in understanding and using verbal and nonverbal communication cues. Option B, fixated interests, is another common characteristic where individuals with ASD may display intense focus on specific topics or activities. Option C, highly restricted routines, refers to the preference for sameness and adherence to specific routines or rituals commonly seen in individuals with ASD. Educationally, understanding the distinguishing features of ASD is crucial for healthcare professionals, especially pediatric nurses, who may encounter children with this condition in their care. By recognizing the core characteristics of ASD, nurses can provide appropriate support, accommodations, and interventions to meet the unique needs of these individuals and promote their overall well-being and development.