A third-grade student refuses to go back to school after the winter break. She now needs her mother to go to sleep with her and complains of headache, bellyache, and muscle pain. The physical exam is totally normal, but you notice the child is very clingy to the mother. The most likely diagnosis is

Correct Answer: D

Rationale: In this scenario, the most likely diagnosis is D) separation anxiety disorder. Separation anxiety disorder is characterized by excessive fear or anxiety about separation from those to whom the individual is attached. The child's refusal to go back to school, physical complaints in the absence of physical findings, and clinginess to the mother all point towards separation anxiety disorder. Option A) stranger anxiety refers to a fear of unfamiliar people and is more commonly seen in infants and toddlers, not in a child of this age exhibiting symptoms of school refusal. Option B) school anxiety is not a recognized diagnosis and is too vague to explain the specific symptoms displayed by the child in the scenario. Option C) stranger reaction is not a formal diagnosis and does not align with the symptoms and behaviors described. From an educational perspective, understanding childhood anxiety disorders, such as separation anxiety disorder, is crucial for healthcare providers working with pediatric populations. Recognizing the signs and symptoms, as well as differentiating them from other common issues like school phobia or transient fears, is essential for accurate diagnosis and appropriate intervention to support the child's well-being and academic success. By learning to identify and address separation anxiety disorder early on, healthcare professionals can help children and their families navigate this common but often distressing condition effectively.

Correct Answer: B

Rationale: In the context of pediatric nursing and managing childhood victims of biologic or chemical attacks, the correct answer to the question is B) nerve agent intoxication. This is because nerve agents can rapidly lead to neuromuscular symptoms such as muscle weakness, twitching, and paralysis, which align with the scenario described in the question. Option A) botulism is incorrect because while it also causes neuromuscular symptoms, the onset is not as rapid as with nerve agents. Botulism typically presents with descending weakness and paralysis. Options C) chlorine and D) phosgene are also incorrect as they are not nerve agents and do not typically cause rapid onset of neuromuscular symptoms. Chlorine exposure primarily affects the respiratory system, leading to coughing, breathing difficulties, and pulmonary edema. Phosgene exposure can cause delayed onset pulmonary edema. Educationally, understanding the differential diagnosis of potential biologic or chemical exposures is crucial for pediatric healthcare providers to effectively and promptly manage such emergencies. Recognizing the distinct clinical manifestations of different agents is essential for accurate diagnosis and timely intervention to optimize patient outcomes. This knowledge can help nurses and physicians in the pediatric setting to provide appropriate care and ensure the safety and well-being of children in the event of a biologic or chemical attack.

Correct Answer: A

Rationale: In pediatric nursing, understanding risk factors for conditions like allergic rhinitis is crucial for early identification and intervention. The correct answer is A) positive family history. This is because allergic rhinitis has a strong genetic component, making children with a family history of allergies more predisposed to developing the condition. Educational context: By recognizing this risk factor, nurses can educate families on allergy prevention strategies and early symptom recognition, leading to better management and improved outcomes for the child. Option B) serum IgA higher than 100 iu/ml is incorrect because elevated serum IgA levels are not a known risk factor for allergic rhinitis in children. IgA levels are more associated with mucosal immunity. Option C) alcoholic mother is incorrect as alcohol consumption during pregnancy can lead to fetal alcohol spectrum disorders and other complications, but it is not directly linked to the development of allergic rhinitis in children. Option D) diabetic mother is incorrect as diabetes in the mother is not a recognized risk factor specifically for allergic rhinitis in children. Diabetes can have implications for the pregnancy itself but is not directly related to allergic conditions in offspring. In summary, understanding the specific risk factors for allergic rhinitis in children, such as a positive family history, is essential for pediatric nurses to provide targeted care and education to families, emphasizing preventative measures and early intervention strategies.

Correct Answer: C

Rationale: In pediatric nursing, understanding the correlation between allergic rhinitis and allergic conjunctivitis is crucial for providing comprehensive care to children with allergies. The correct answer, option C (>50%), is based on the high prevalence of allergic conjunctivitis among allergic rhinitis patients. Allergic rhinitis and allergic conjunctivitis often coexist due to the common allergic pathways in the respiratory and ocular systems. Option A (>30%) is incorrect because the prevalence of allergic conjunctivitis is typically higher than 30% in patients with allergic rhinitis. Option B (>40%) is also incorrect as it underestimates the significant association between allergic rhinitis and allergic conjunctivitis. Option D (>60%) is not the best choice as it overestimates the prevalence, though it is closer to the actual percentage. Educationally, this question reinforces the importance of recognizing the systemic nature of allergies and the need to assess and manage both respiratory and ocular symptoms in pediatric patients with allergic rhinitis. Understanding these connections can improve clinical decision-making and patient outcomes in pediatric nursing practice.

Correct Answer: C

Rationale: The correct answer is C) one-third. In pediatric nursing, understanding the prevalence and progression of asthma is crucial for providing effective care. Recurrent coughing and wheezing in preschool-age children is a common early sign of asthma. Research shows that about 35% of preschool-age children experience these symptoms. It is important to note that not all children with early symptoms of asthma will continue to have persistent asthma into later childhood. The option A) one-fifth is incorrect because it underestimates the proportion of children who continue to have asthma into later childhood. Option B) one-fourth is also incorrect as it does not accurately reflect the prevalence of persistent asthma in children with recurrent symptoms. Option D) one-half is incorrect as it overestimates the likelihood of children with recurrent symptoms developing persistent asthma. Educationally, this question highlights the importance of early recognition and management of asthma in pediatric patients. By understanding the prevalence and progression of asthma, nurses can intervene early, provide appropriate treatment, and help improve the long-term outcomes for children with asthma.