An 11-month-old girl infant is found to have low weight and height consistent with FTT. She was exclusively breast feeding till the age of 4 month, and then artificial milk-formula was added. She has had a normal growth pattern till the age of 6 month when the mother introduced juices and cereals. Examination is unremarkable apart from significant decline of normal growth pattern. Of the following, the MOST likely cause is

Correct Answer: B

Rationale: The correct answer is B) improper formula preparation. This option is the most likely cause as the infant's decline in growth coincided with the introduction of juices and cereals, which may have displaced the essential nutrients from breast milk or formula. Improper formula preparation can lead to inadequate nutrition, affecting the infant's growth. Option A) failed breastfeeding is less likely since the infant had normal growth until the introduction of juices and cereals. Option C) congenital syndromes and Option D) congenital infections are less likely as there are no clinical signs or symptoms suggestive of these conditions in the scenario provided. In the educational context, understanding the importance of proper nutrition in infant growth and development is crucial for pediatric emergency nurses. They should educate parents on appropriate feeding practices, formula preparation, and introduction of complementary foods to prevent conditions like failure to thrive. This case highlights the impact of nutrition on growth patterns and the need for vigilant monitoring to ensure optimal infant health.

Correct Answer: A

Rationale: In pediatric emergency nursing, understanding poor prognostic factors in conditions like Hodgkin lymphoma is crucial for providing effective care. In this scenario, the correct answer is option A - age of more than 15 years at the time of diagnosis. This is because younger age at diagnosis is generally associated with better outcomes in Hodgkin lymphoma due to factors like better tolerance to treatment and lower risk of complications. Option B - stage IV disease is a poor prognostic factor as it indicates advanced disease with spread to distant sites, making treatment more challenging and outcomes less favorable. Option C - manifestation by PET scan positivity is also a poor prognostic factor as it suggests a higher tumor burden and more aggressive disease, which can impact treatment response and overall prognosis. Option D - presence of bulky mediastinal mass is another poor prognostic factor as it is associated with more extensive disease involvement and can complicate treatment and increase the risk of complications. Educationally, understanding these prognostic factors is vital for nurses caring for pediatric patients with Hodgkin lymphoma. It helps in anticipating potential challenges, individualizing care plans, and providing appropriate support to patients and their families throughout the treatment process. By differentiating between these factors, nurses can contribute to improved patient outcomes and quality of care in pediatric oncology settings.

Correct Answer: D

Rationale: In the case of a 2-year-old with an asymptomatic right flank mass suspected to be a Wilms tumor, the least likely investigation to be performed is a biopsy of the mass (Option D). This is because in pediatric oncology, especially when dealing with suspected Wilms tumor, biopsies are generally avoided due to the risk of tumor spillage and seeding. A plain abdominal radiography (Option A) is less likely to provide detailed information compared to a CT scan of the abdomen (Option B) which is preferred for evaluating the extent of the tumor. A CT scan of the chest (Option C) is important to assess for metastasis, a common occurrence in Wilms tumor. Educationally, understanding the appropriate diagnostic approach in pediatric oncology is crucial for nurses caring for children with suspected malignancies. It is essential to grasp the rationale behind choosing specific investigations to ensure accurate diagnosis and appropriate management without compromising the child's well-being.

Correct Answer: D

Rationale: In the context of pediatric emergency nursing, understanding Kasabach-Merritt syndrome is crucial for providing effective care to pediatric patients. Kasabach-Merritt syndrome is a rare condition characterized by profound thrombocytopenia, microangiopathic hemolytic anemia, and coagulopathy. The correct answer, D) association with infantile hemangiomas, is the exception because Kasabach-Merritt syndrome is actually associated with kaposiform hemangioendotheliomas, not infantile hemangiomas. Thrombocytopenia in Kasabach-Merritt syndrome results from platelet consumption within the vascular tumor, leading to bleeding tendencies. Microangiopathic hemolytic anemia occurs due to red blood cell damage as they pass through the abnormal vasculature. Coagulopathy is also a common feature, manifesting as prolonged clotting times and increased risk of bleeding. Educationally, recognizing the distinguishing features of Kasabach-Merritt syndrome is essential for timely diagnosis and management in pediatric emergency settings. By understanding the correct association and the pathophysiology of this syndrome, nurses can intervene promptly to prevent life-threatening complications such as severe bleeding or disseminated intravascular coagulation. This knowledge empowers pediatric nurses to advocate for appropriate treatment strategies and collaborate effectively with the interprofessional team to optimize patient outcomes.

Correct Answer: D

Rationale: The correct answer is D) the majority of affected boys can be successfully retreated, and the survival rate is good. This statement is crucial to mention to the parents because it provides them with hope and reassurance during a challenging time. It emphasizes that relapse is not uncommon in ALL but that there are effective treatment options available, and the prognosis is positive. Option A is incorrect because while testicular relapse can occur in boys with ALL, it does not happen in the majority of cases. Option B is incorrect as it describes a specific symptom of testicular relapse rather than providing overall information on prognosis. Option C is incorrect because while ultrasonography may be used in the diagnosis, it is not the only method, and the statement does not address the treatment or survival rate, which is important for parents to know. From an educational perspective, providing accurate and reassuring information to parents of pediatric patients is essential in helping them understand the situation, make informed decisions, and cope effectively with the challenges ahead. It is crucial to balance honesty about the condition with hope and optimism about the available treatments and outcomes.