A worried mother of a 4-year-old boy describes attacks of inconsolable crying and prefers to play alone. The MOST appropriate action is

Correct Answer: B

Rationale: The correct answer is B) seek more history regarding other skills and developmental domains. This is the most appropriate action because the child's behavior may be indicative of underlying developmental issues that need to be further assessed. By gathering more information about the child's overall development, the healthcare provider can better understand the root cause of the behavior and provide appropriate interventions or referrals if necessary. Option A) reassuring the mother that this is a normal phenomenon may overlook potential developmental concerns and delay necessary intervention. Option C) referring the child to pediatric psychiatry may be premature without a comprehensive assessment of the child's developmental milestones. Option D) investigating social issues of the family is important but may not address the child's specific developmental needs in this scenario. In an educational context, understanding the importance of thorough assessment and evaluation in pediatric nursing is crucial for identifying and addressing developmental concerns early on. By honing assessment skills and knowledge of child development, nurses can provide holistic care that meets the unique needs of pediatric patients and their families.

Correct Answer: C

Rationale: The most appropriate regimen for perioperative management in children receiving steroid therapy is option C) Hydrocortisone 5 mg/kg IV given 24 and 12 hours before surgery. Hydrocortisone is a short-acting glucocorticoid that mimics the body's natural cortisol production. Administering hydrocortisone before surgery helps prevent adrenal insufficiency in patients on chronic steroid therapy by providing the necessary cortisol levels during the stress of surgery. This helps maintain hemodynamic stability and prevents potential complications. Option A) Prednisone is a long-acting steroid and may not provide immediate coverage needed for the perioperative period. Option B) Dexamethasone is a potent glucocorticoid with a longer half-life than hydrocortisone, but it is not the preferred choice for perioperative steroid coverage in this scenario. Option D) Methylprednisolone is a long-acting steroid and may not be as suitable for perioperative management as hydrocortisone. In an educational context, understanding the appropriate perioperative management of children on steroid therapy is crucial for pediatric nurses. This knowledge ensures safe and effective care for these patients undergoing surgical procedures, minimizing the risk of adrenal insufficiency complications. Nurses must be familiar with the pharmacokinetics and pharmacodynamics of different steroid preparations to provide optimal care for pediatric patients requiring perioperative steroid coverage.

Correct Answer: D

Rationale: In toddler development, being potty-trained is a significant milestone according to developmental theories. This skill represents the child's increasing autonomy and mastery over their bodily functions, fostering a sense of independence and self-control. It also indicates cognitive and physical readiness for this task, showcasing the child's growing capabilities. Learning to feed oneself, while important for fine motor skills and independence, is not as crucial in developmental theories as being potty-trained. Developing friendships, while essential for social development, typically becomes more prominent in later childhood stages. Learning to walk is a major milestone but is not as directly linked to the development theories as being potty-trained. Educationally, understanding these developmental milestones is crucial for caregivers and healthcare professionals working with toddlers. It helps in providing appropriate support and guidance to promote healthy development and independence in children. By recognizing the significance of potty-training in toddlerhood, caregivers can create a supportive environment that fosters the child's autonomy and self-esteem.

Correct Answer: D

Rationale: The correct answer for the care priority for a newborn with bladder exstrophy and a malformed pelvis is option D) Cluster care to allow the child uninterrupted sleep and strength for upcoming surgical repair. Rationale: Correct Answer (D): Cluster care is essential for a newborn with bladder exstrophy and a malformed pelvis as it helps to promote rest and conserve energy for upcoming surgical interventions. Surgical repair is a critical aspect of managing bladder exstrophy, and ensuring the child is well-rested and has optimal strength is vital for successful surgical outcomes. Incorrect Answers: A) Changing the diaper frequently and assessing for skin breakdown is important in general newborn care but is not the priority in this case where surgical intervention is imminent. B) Keeping the exposed bladder open in a warm, dry environment is not appropriate and can lead to infection and further complications. C) Offering formula for growth and fluid management is not the priority in this scenario as the primary focus should be on preparing the newborn for surgical repair. Educational Context: Understanding the care priorities for newborns with complex conditions like bladder exstrophy is crucial for pediatric nurses. By prioritizing interventions that optimize the child's health and readiness for surgical procedures, healthcare providers can ensure the best possible outcomes for these vulnerable patients. Cluster care is a valuable strategy in managing pediatric patients, especially those with complex medical needs, as it promotes rest, reduces stress, and conserves energy.

Correct Answer: D

Rationale: The correct answer is D) 80-90%. In individuals with myelomeningocele, hindbrain herniation or Chiari type II malformation is a common occurrence. This condition involves the displacement of the cerebellum and brainstem through the foramen magnum, leading to various neurological symptoms. Option A) 10-20% is incorrect because hindbrain herniation is seen at a much higher rate in individuals with myelomeningocele. Option B) 20-30% is also incorrect as the prevalence of hindbrain herniation in this population is higher than this range. Option C) 40-50% is not the correct answer as well, as the actual percentage is even higher than this range. Educationally, understanding the association between myelomeningocele and hindbrain herniation is crucial for healthcare professionals caring for pediatric patients with these conditions. Recognizing the potential neurological complications can guide appropriate monitoring and interventions to optimize patient outcomes. This knowledge is essential for pediatric nurses to provide comprehensive care and support to children with myelomeningocele.