All the following can cause folate deficiency EXCEPT

Correct Answer: D

Rationale: Folate deficiency is a condition that can result from various factors affecting the absorption or utilization of folate in the body. In this case, option D, methylene tetrahydrofolate reductase deficiency, is the exception as it is actually a genetic enzyme deficiency that affects the body's ability to convert folate into its active form. This directly leads to folate deficiency. Option A, celiac disease, can cause folate deficiency as it results in damage to the small intestine, affecting the absorption of nutrients including folate. Option B, sickle cell anemia, can lead to folate deficiency due to an increased turnover of red blood cells, requiring more folate for their synthesis. Option C, inflammatory bowel disease, can also cause folate deficiency due to malabsorption issues in the inflamed intestinal tract. Educationally, understanding the causes of folate deficiency is crucial for healthcare professionals, especially when caring for pediatric patients. Recognizing the conditions that can lead to folate deficiency allows for early identification, appropriate interventions, and prevention of complications such as anemia and developmental issues. This knowledge is particularly relevant for nurses and doctors working in pediatric gastroenterology or primary care settings where they may encounter patients at risk for folate deficiency.

Correct Answer: A

Rationale: In pediatric patients with vitamin B12 deficiency, common observations may include a variety of symptoms due to the essential role of vitamin B12 in neurological function and red blood cell production. The correct answer, option A) hyperpigmentation, is the exception because it is not typically associated with vitamin B12 deficiency in children. Option B) involuntary movements, can be seen in children with vitamin B12 deficiency due to its impact on the nervous system. Option C) developmental regression is another possible symptom as vitamin B12 deficiency can affect cognitive function. Option D) peripheral neuritis is also commonly observed in children with vitamin B12 deficiency as it affects the peripheral nerves. Educationally, understanding the symptoms of vitamin B12 deficiency in children is crucial for healthcare providers to recognize and intervene early. By knowing the typical and atypical signs, appropriate diagnostic testing and treatment can be initiated promptly to prevent further complications. This question reinforces the importance of recognizing the diverse presentations of vitamin deficiencies in pediatric patients.

Correct Answer: C

Rationale: The correct answer is C) osmotic diarrhea. Large doses of vitamin C, also known as ascorbic acid, can lead to gastrointestinal disturbances due to its osmotic effects. Vitamin C is water-soluble, and excess amounts that the body cannot absorb can accumulate in the intestines, drawing water into the gut and causing osmotic diarrhea. This can result in symptoms such as abdominal cramping, bloating, and increased bowel movements. Option A) musculoskeletal pain is not typically associated with large doses of vitamin C ingestion. Vitamin C is essential for collagen synthesis and may actually help in reducing musculoskeletal pain rather than causing it. Option B) headache is not a common side effect of vitamin C overdose. Headaches are more likely to occur due to other factors such as dehydration or tension. Option D) severe respiratory symptoms are not directly linked to vitamin C ingestion. Vitamin C is generally well-tolerated, and respiratory symptoms are not a known consequence of excessive intake. Educationally, understanding the potential side effects of high doses of vitamin C is crucial for healthcare professionals, especially when advising patients on supplementation. It highlights the importance of recommending appropriate dosages and being aware of the impact of excessive intake on gastrointestinal health. This knowledge is particularly relevant in pediatric care, where dosages need to be carefully monitored to prevent adverse effects.

Correct Answer: C

Rationale: In this question, the correct answer is C) hypophosphatasia. Hypophosphatasia is a rare genetic disorder characterized by low levels of alkaline phosphatase, leading to impaired bone mineralization. Parathyroid hormone levels are reduced in hypophosphatasia due to the disruption in bone metabolism caused by the deficiency of alkaline phosphatase. Option A) vitamin D dependent rickets is incorrect because in this condition, there is a defect in the metabolism of vitamin D, leading to impaired calcium absorption in the gut and resulting in elevated parathyroid hormone levels. Option B) X-linked hypophosphatemic rickets is incorrect because it is characterized by low levels of phosphate in the blood, leading to elevated levels of fibroblast growth factor 23 (FGF23) and compensatory increased levels of parathyroid hormone. Option D) dietary calcium deficiency is incorrect because in this scenario, the parathyroid hormone levels would be elevated due to the body's attempt to maintain calcium levels by increasing bone resorption. Educationally, understanding the relationship between different pediatric conditions and their impact on hormone levels is crucial for nurses preparing for the NCLEX exam. This knowledge helps in making clinical decisions and providing appropriate care to pediatric patients with gastrointestinal disorders.

Correct Answer: A

Rationale: Rationale: The correct answer is A) 25-hydroxy vitamin D level. When assessing a patient's vitamin D status, the 25-hydroxy vitamin D level is the standard method used. This is because 25-hydroxy vitamin D is the major circulating form of vitamin D in the body and reflects the overall vitamin D status, making it a reliable indicator of a patient's vitamin D levels. Option B) 1,25-dihydroxy vitamin D level is the active form of vitamin D, but its levels are more tightly regulated by the body and are not as reflective of overall vitamin D status as 25-hydroxy vitamin D. Option C) D-binding protein is involved in the transport of vitamin D in the blood but does not directly indicate vitamin D status. Option D) PTH (parathyroid hormone) level is not a direct measure of vitamin D status, although it is involved in the regulation of calcium and phosphate metabolism in relation to vitamin D. Educational Context: Understanding how to assess and interpret vitamin D status is crucial in pediatric healthcare. By knowing that 25-hydroxy vitamin D levels are the standard method for determining vitamin D status, healthcare providers can effectively evaluate and monitor a child's nutritional status and make appropriate recommendations for supplementation if necessary. This knowledge is vital in promoting optimal bone health and overall well-being in pediatric patients.