During a routine examination of a 10-mo-old male infant, you find a white pupillary reflex of the right eye; the eye movements are normal. You suspect retinoblastoma. Of the following, the BEST confirmatory diagnostic evaluation of this infant is

Correct Answer: B

Rationale: The correct answer is B) examination under general anesthesia by an experienced ophthalmologist. This procedure is the best confirmatory diagnostic evaluation for retinoblastoma in a 10-month-old infant with a white pupillary reflex. Retinoblastoma is a rare and aggressive eye cancer that primarily affects young children. Diagnosis is often made through a comprehensive eye exam under anesthesia, allowing for a thorough evaluation of the retina to confirm the presence of tumors. This method provides a detailed view of the eye and allows for necessary interventions to be planned accordingly. Option A, indirect ophthalmoscopy with slit-lamp examination, may not provide an adequate view of the entire retina, especially in infants, leading to potential missed diagnoses. Orbital ultrasonography (Option C) may not be as definitive in confirming retinoblastoma as a direct examination. Brain MRI (Option D) is not the primary diagnostic tool for retinoblastoma as it focuses on the brain rather than the eye. In an educational context, understanding the importance of a thorough diagnostic evaluation in pediatric patients is crucial for early detection and intervention in conditions like retinoblastoma. By selecting the correct confirmatory diagnostic test, healthcare providers can ensure timely and appropriate management of the child's condition, ultimately leading to better outcomes and quality of life.

Correct Answer: D

Rationale: The correct answer is D) 26 weeks - face clearly recognizable. During the fetal period, facial features continue to develop and refine throughout pregnancy. By 26 weeks, the face is not yet fully developed and may not be clearly recognizable. This is why option D is false. Option A) 10 weeks - midgut returns to abdomen is true as around 10 weeks gestation, the midgut begins to return to the abdominal cavity as it completes its rotation. Option B) 12 weeks - external genitalia formed is true as by around 12 weeks, the external genitalia have formed, although they may not yet be fully developed or distinguishable as male or female. Option C) 24 weeks - surfactant production begun is true as by 24 weeks, the fetal lungs are developing surfactant, a substance necessary for proper lung function after birth. Understanding the timeline of fetal development is crucial in pediatric nursing as it helps in assessing the growth and development of the fetus, identifying any potential issues, and providing appropriate care and support to both the mother and the unborn child. Being familiar with these milestones aids in monitoring the progress of pregnancy and ensuring optimal outcomes for both the mother and the baby.

Correct Answer: B

Rationale: In pediatric nursing, understanding child development milestones is crucial for providing appropriate care. The correct answer is B) 30 months because at this age, a child typically demonstrates the ability to imitate construction of a gate with 2-4 parts, draw longer lines, and draw a person with 5 cubes. This reflects the child's cognitive and fine motor skills development at around 2.5 years old. Option A) 24 months is too young for this level of detail in drawing and construction skills. Option C) 48 months and Option D) 54 months are older ages where these skills would be expected to be mastered already, thus making them incorrect choices. Educationally, knowing these developmental milestones helps pediatric nurses assess children's growth and development, identify any potential delays or concerns early on, and provide interventions or support as needed. It also aids in guiding parents on what to expect and how to promote their child's development at home. Understanding these milestones enhances the quality of care provided to pediatric patients.

Correct Answer: C

Rationale: In this question, the correct answer is C) walk up and down stairs. A 2-year-old child typically has developed the gross motor skills necessary to walk up and down stairs with support. This milestone demonstrates coordination, balance, and strength in the lower limbs, which are crucial for stair climbing. Option A) heel-toe walk may not be fully developed at age 2 as it requires more refined motor skills and balance control. Option B) balancing on each foot for 6 seconds also requires a higher level of balance and coordination that is usually not expected in a 2-year-old child. Option D) balancing well on each foot is typically achieved at a later age due to the complexity of the task. Educationally, understanding the progression of gross motor skills in children is essential for pediatric nurses as it helps them assess development, identify delays, and provide appropriate interventions. Knowing these milestones can guide healthcare professionals in promoting optimal growth and development in children.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Plasma cholinesterase level. The symptoms described are indicative of organophosphate poisoning, commonly seen with exposure to insecticides like malathion. Testing plasma cholinesterase levels helps to confirm this diagnosis as organophosphates inhibit this enzyme. Option A) Blood-lead level is not relevant in this case as lead poisoning presents differently and is not associated with the symptoms described. Option B) 24-hour urine mercury level is also not appropriate as mercury poisoning typically presents differently and is not linked to insecticide exposure. Option D) Urine malathion level may seem relevant but testing for the actual insecticide level in urine is less accurate compared to assessing the biological impact through plasma cholinesterase levels. Educationally, understanding the specific manifestations of different poisonings, appropriate diagnostic tests, and their interpretation is crucial for pediatric nurses to provide timely and accurate care to poisoned children. This question highlights the importance of clinical judgment and knowledge in pediatric toxicology to ensure effective management and treatment.