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 group is different from the mother's, which can lead to hemolysis of the infant's red blood cells. This condition presents with symptoms such as pallor, apathy, and jaundice due to increased bilirubin levels from the breakdown of red blood cells. The systolic ejection murmur and tachycardia are signs of increased cardiac output in response to anemia. Option A) Anemia of chronic disease is unlikely in a neonate without a history of chronic illness. Option B) Cholestasis secondary to neonatal hepatitis typically presents with jaundice but not severe anemia and heart murmur. Option C) Hereditary spherocytosis would present with a different clinical picture, such as jaundice without hemolysis. Understanding neonatal conditions like ABO incompatibility is crucial for pediatric nurses as they care for newborns. Recognizing the signs and symptoms of hemolytic disease of the newborn allows for prompt treatment to prevent complications such as kernicterus. Nurses play a vital role in monitoring and managing neonatal jaundice, ensuring positive outcomes for infants.

Correct Answer: D

Rationale: In this question, the correct answer is D) Gilbert disease. Direct-reacting hyperbilirubinemia on the 5th day of life is suggestive of liver pathology. Gilbert disease is characterized by unconjugated hyperbilirubinemia, not direct-reacting hyperbilirubinemia. A) Cystic fibrosis and B) Galactosemia are metabolic disorders that can present with direct hyperbilirubinemia due to liver involvement. C) Neonatal hepatitis is a common cause of direct-reacting hyperbilirubinemia in newborns. Understanding the differential diagnoses of neonatal jaundice is crucial in pediatric nursing. Different etiologies require specific interventions and treatments. Recognizing the characteristics of various conditions aids in prompt diagnosis and appropriate management, ultimately improving patient outcomes. It is essential for nurses to be able to differentiate between different causes of neonatal jaundice to provide optimal care to newborns.

Correct Answer: B

Rationale: In pediatric nursing, understanding common behaviors associated with psychiatric illnesses is essential for providing comprehensive care to children. The correct answer, option B) Sudden overwhelming worries, is not true in many psychiatric illnesses because it specifically refers to symptoms of anxiety disorders rather than a broad range of psychiatric conditions. Option A) Eating very little is a common behavior seen in psychiatric illnesses such as depression or anorexia nervosa. Children may lose their appetite or have disordered eating patterns due to their mental health condition. Option C) Feeling sad or withdrawn is characteristic of mood disorders like depression or adjustment disorders. Children experiencing these conditions may exhibit withdrawal from activities they once enjoyed and have persistent feelings of sadness. Option D) Throwing up can be a symptom of various psychiatric illnesses, including eating disorders like bulimia nervosa or somatic symptom disorders where physical symptoms are manifested due to psychological distress. Educationally, it is vital for nursing students to differentiate between behaviors specific to certain psychiatric illnesses to accurately assess, diagnose, and plan interventions for pediatric patients. Understanding these distinctions helps in providing individualized care tailored to the child's needs and promoting their mental health and well-being.

Correct Answer: D

Rationale: In pediatric nursing, understanding school refusal is crucial as it can impact a child's well-being and academic success. The FALSE statement among the options is D) Somatic symptoms are common. This is incorrect because somatic symptoms are actually common in children with school refusal. These symptoms can manifest as physical complaints like headaches or stomach aches to avoid going to school. Option A is true as school refusal often overlaps with other conditions like anxiety disorders. Younger children commonly experience separation anxiety, making option B correct. Option C is also accurate as older children may have underlying obsessive-compulsive disorders contributing to school refusal. Educationally, knowing these distinctions helps nurses identify and support children experiencing school refusal effectively. By recognizing the false statement, nurses can provide appropriate interventions and collaborate with other healthcare professionals to address the physical and emotional needs of the child, promoting their overall well-being and academic success.

Correct Answer: C

Rationale: In this scenario, the most appropriate referral for a 13-year-old adolescent presenting with fatigue, low blood pressure, and hypokalemia would be option C: Referral to the hospital for investigations. This choice is correct because the symptoms described could indicate 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) is not the most appropriate initial step because the symptoms are physical in nature and suggest a potential medical issue rather than a primary psychiatric concern. While mental health should always be considered in a comprehensive assessment, in this case, the priority is to address the physical symptoms. Referring to a dietician (option B) could be beneficial in cases where poor nutrition is contributing to the symptoms. However, given the severity of the symptoms described (fatigue, low blood pressure, and hypokalemia), immediate medical evaluation and intervention are necessary before addressing dietary concerns. Scheduling an outpatient visit to a psychiatrist (option D) may delay the necessary medical investigations and interventions that are required urgently in this case. Outpatient psychiatric visits are more suitable for ongoing mental health management rather than addressing acute physical symptoms. In an educational context, it is essential for healthcare providers, especially those in pediatric nursing, to be able to recognize concerning symptoms in children and adolescents and understand the appropriate steps for referral and intervention. Prompt and accurate decision-making can have a significant impact on patient outcomes, especially in cases where timely medical attention is crucial.