A -week-old, A-positive, African-American former -week’s-gestational-age infant was born to an O-positive mother and experienced hyperbilirubinemia requiring days of phototherapy on the newborn nursery after birth The infant appears apathetic and demonstrates pallor, a grade /6 systolic ejection murmur, and a heart rate of 7 The most likely diagnosis is

Correct Answer: D

Rationale: The correct answer is D) ABO incompatibility with continued hemolysis. In this case, the infant's ABO blood type is incompatible with the mother's blood type, leading to hemolysis of the infant's red blood cells. This results in hyperbilirubinemia, pallor, and apathy due to anemia from ongoing hemolysis. The presence of a systolic ejection murmur and tachycardia are signs of anemia and increased cardiac output to compensate for decreased oxygen-carrying capacity. Option A) Anemia of chronic disease is unlikely in this scenario as the infant's symptoms are more consistent with acute hemolysis rather than a chronic disease process. Option B) Cholestasis secondary to neonatal hepatitis typically presents with jaundice and liver function abnormalities, which are not prominent features in this case. Option C) Hereditary spherocytosis would present with jaundice, anemia, and a positive family history, which are not described in the scenario. Understanding neonatal jaundice causes is crucial in pediatric nursing. ABO incompatibility is a common cause of neonatal jaundice, requiring prompt recognition and management to prevent complications such as kernicterus. Nurses must be able to recognize clinical manifestations and risk factors to provide appropriate care and education to families. This case highlights the importance of understanding hemolytic diseases in newborns and the need for close monitoring and interventions to manage complications effectively.

Correct Answer: D

Rationale: In pediatric nursing, understanding neonatal jaundice is crucial. Direct-reacting hyperbilirubinemia on the 5th day of life suggests an obstructive cause of jaundice. Gilbert disease is an unconjugated hyperbilirubinemia disorder due to a deficiency in the enzyme UDP-glucuronosyltransferase. This enzyme is responsible for conjugating bilirubin in the liver. Therefore, it is not associated with direct-reacting hyperbilirubinemia. Option A, cystic fibrosis, is incorrect as it can present with meconium ileus and subsequent liver involvement leading to jaundice. Option B, galactosemia, is incorrect due to the accumulation of galactose-1-phosphate, leading to liver damage and jaundice. Option C, neonatal hepatitis, can cause direct-reacting hyperbilirubinemia due to liver inflammation. Understanding the different causes of neonatal jaundice is essential for nurses caring for newborns. Recognizing the specific characteristics of each condition helps in prompt diagnosis and appropriate management. This knowledge ensures the well-being of neonates and highlights the importance of comprehensive pediatric nursing education.

Correct Answer: B

Rationale: The correct answer is B) Sudden overwhelming worries. This behavior is not necessarily a common feature in many psychiatric illnesses, unlike the other options provided. Eating very little (option A) can be a symptom of various psychiatric disorders such as anorexia nervosa or depression. Feeling sad or withdrawn (option C) is a hallmark of conditions like major depressive disorder or post-traumatic stress disorder. Throwing up (option D) can be a manifestation of certain disorders like bulimia nervosa or generalized anxiety disorder. In the context of pediatric nursing, understanding the behavioral symptoms associated with different psychiatric illnesses is crucial for early identification and intervention. By recognizing these behaviors, healthcare providers can provide appropriate support and treatment to children and adolescents experiencing mental health challenges. It is important to differentiate between normal developmental behaviors and those that may indicate an underlying psychiatric condition to ensure comprehensive care for pediatric patients.

Correct Answer: D

Rationale: In this question regarding school refusal in pediatric nursing, the correct answer is D) Somatic symptoms are common. This statement is FALSE because somatic symptoms are actually less common in school refusal compared to other anxiety disorders. Option A) It is overlapping refers to the overlap between school refusal and anxiety disorders, which is true. Many children who refuse to go to school have underlying anxiety issues. Option B) Younger children usually have separation anxiety disorder is also true. Young children may exhibit school refusal due to separation anxiety from their parents or caregivers. Option C) Older children usually suffer from obsessive disorders is incorrect. While older children may have comorbid conditions like obsessive-compulsive disorder, it is not a distinguishing feature of school refusal. Educationally, understanding the reasons behind school refusal is crucial for pediatric nurses to provide appropriate care and support to children and their families. Recognizing the underlying anxiety issues and addressing them effectively can help in managing school refusal and promoting the child's overall well-being and academic success.

Correct Answer: C

Rationale: The most appropriate referral for a 13-year-old adolescent presenting with fatigue, low blood pressure, and hypokalemia is option C: Referral to the hospital for investigations. This option is correct because the symptoms described could be indicative of a serious underlying medical condition that requires immediate attention and thorough investigation by healthcare professionals in a hospital setting. Referring the adolescent to a psychiatrist (option A) may not address the potential physical health issues causing the symptoms described. Fatigue, low blood pressure, and hypokalemia are primarily medical concerns that warrant a medical evaluation. Referring to a dietician (option B) may be beneficial for addressing nutritional deficiencies that could contribute to the symptoms, but given the severity of the presentation, immediate medical evaluation in a hospital is more appropriate. Scheduling an outpatient visit to a psychiatrist (option D) may delay the necessary medical assessment and intervention needed for the adolescent's current health issues. In an educational context, it is important for healthcare providers, especially those in pediatric nursing, to recognize red flags in adolescent patients' presentations and make timely and appropriate referrals for further evaluation and management. Understanding the significance of certain symptoms and the urgency of medical intervention is crucial for providing safe and effective care to pediatric patients.