After days of phototherapy, the bilirubin level of the patient in Question 5 declines below mg/dL One day off phototherapy, the level of bilirubin remains less than mg/dL The patient is discharged home and grows well while breast-feeding At month of age, he returns with significant pallor, tachycardia, and a new heart murmur The most likely problem at this time is

Correct Answer: B

Rationale: In this scenario, the most likely problem the patient is experiencing at one month of age with significant pallor, tachycardia, and a new heart murmur is ductal dependent congenital heart disease (Option B). Ductal dependent congenital heart disease occurs when the ductus arteriosus, a connection between the pulmonary artery and the aorta that is crucial for fetal circulation, fails to close after birth. This leads to inadequate blood flow to the body, resulting in symptoms like pallor, tachycardia, and heart murmurs. Late-onset neonatal sepsis (Option A) is less likely in this case because the symptoms presented are more indicative of a cardiac issue rather than an infectious process. Hemolysis (Option C) is also less likely as the symptoms described are more suggestive of a cardiac etiology rather than hemolysis-related manifestations. Myocarditis (Option D) is less likely as well because the symptoms are more consistent with structural heart defects rather than inflammation of the heart muscle. Educationally, understanding the differentials for a child presenting with pallor, tachycardia, and a new heart murmur is crucial for pediatric nurses. Recognizing the signs and symptoms of ductal dependent congenital heart disease is essential for prompt identification and intervention to prevent potential complications and improve outcomes for the patient.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Separation Anxiety. A 7-year-old child expressing fear of being injured by a car is exhibiting separation anxiety. This is because the fear of being separated from their parents or caregivers can manifest in various forms, including fear of harm coming to them when apart. Phobia (option A) refers to an extreme or irrational fear of a specific object or situation, which is not the case here as the fear is related to separation anxiety rather than a specific trigger like cars. School refusal (option B) is characterized by a child's refusal to attend school due to emotional distress, which is not directly related to the fear of being injured by a car. Generalized Anxiety Disorder (option D) involves excessive worry and anxiety about a variety of events or activities, not specifically related to separation issues. Educationally, understanding these distinctions is crucial for pediatric nurses as it enables them to accurately assess and address a child's emotional needs. By recognizing the symptoms of separation anxiety, nurses can provide appropriate support and interventions to help the child cope with their fears and anxieties effectively. This knowledge enhances the quality of care provided to pediatric patients and promotes their overall well-being.

Correct Answer: A

Rationale: In pediatric nursing, it is crucial to understand the diagnostic criteria for major depressive episodes to provide appropriate care for children and adolescents experiencing mental health challenges. The correct answer is A) Hypomanic episode. This is because a hypomanic episode is actually a symptom of bipolar disorder and not a diagnostic criterion for major depressive episodes. Major depressive episodes are characterized by a persistent depressed mood or loss of interest or pleasure in activities previously enjoyed, lasting for at least two weeks. Option B) Depressed mood and Option C) Loss of interest or pleasure are both correct diagnostic criteria for major depressive episodes as per the DSM-5. These symptoms are key indicators of depression in children and adolescents. Option D) Significant weight loss is also a potential symptom of major depressive episodes, as changes in appetite and weight are commonly seen in individuals experiencing depression. However, it is not the defining diagnostic criterion for a major depressive episode. Educationally, understanding the nuances of diagnostic criteria for mental health disorders in children is crucial for pediatric nurses to accurately assess, diagnose, and provide interventions for young patients with mental health concerns. By knowing these criteria, nurses can ensure proper identification and management of mental health issues in pediatric populations.

Correct Answer: B

Rationale: In managing aggression and self-injurious behavior in a 6-year-old boy with autism, the best medication choice is Risperidone (Option B). Risperidone is an atypical antipsychotic commonly used in children with autism spectrum disorders to address behavioral symptoms such as aggression, irritability, and self-injurious behaviors. It helps regulate dopamine and serotonin levels in the brain, which can reduce these challenging behaviors. Methylphenidate (Option A) is a stimulant medication primarily used to treat attention deficit hyperactivity disorder (ADHD) and would not be effective in managing aggression and self-injury in autism. Escitalopram (Option C) is a selective serotonin reuptake inhibitor (SSRI) used to treat anxiety and depression, not typically indicated for aggression in autism. Atomoxetine (Option D) is a non-stimulant ADHD medication and also not the first-line choice for managing aggression in autism. Educationally, it's essential for healthcare providers and caregivers working with children with autism to understand the appropriate pharmacological interventions for behavioral symptoms. Knowing the rationale behind each medication option and how it specifically addresses the symptoms presented by the child is crucial in providing effective care and support for individuals with autism.

Correct Answer: B

Rationale: The best response in this scenario is option B) leave the behavior as complications usually start after 5 years. This option is the most appropriate because thumb-sucking is a common behavior in young children and typically resolves on its own by the age of 5 without causing significant dental issues. It is crucial to reassure the mother that this behavior is normal and usually self-limiting. Option A) reassurance to mother is a close contender but lacks the specific information regarding the typical timeline for resolution of thumb-sucking behavior. It is important for the mother to understand the natural course of this behavior to alleviate her concerns. Option C) ignore thumb-sucking and encourage a substituted behavior may not be the best approach as forcing a child to stop thumb-sucking abruptly or replacing it with another behavior could lead to increased anxiety and resistance. Option D) the use of bitter ointments will resolve the problem early is not recommended as it may be harsh and ineffective in addressing the underlying causes of thumb-sucking behavior. In an educational context, it is essential for healthcare providers to understand the developmental norms and variations in children's behaviors to provide appropriate guidance and support to parents. By explaining the natural history of thumb-sucking and offering reassurance, healthcare professionals can empower parents to effectively manage common childhood behaviors.