In USA, the newly arrived international adoptees are subjected to many lab tests. All the following tests need to be repeated after 3-6 months after arrival EXCEPT

Correct Answer: D

Rationale: The rationale is that tuberculin skin tests (TST) may give false-negative results immediately after arrival due to factors like recent travel stress or malnutrition. Therefore, repeating the test after 3-6 months ensures more accurate results. The other tests are generally required to be repeated for ongoing monitoring.

Correct Answer: A

Rationale: In this scenario, the correct Apgar score for the infant is 7. The Apgar score is a quick assessment tool used to evaluate a newborn's physical condition at one minute and five minutes after birth. It consists of five components: heart rate, respiratory effort, muscle tone, reflex irritability, and color. For the given infant: - Pulse rate: at least 100 beats per minute (2 points) - Cyanotic hands and feet indicate some central cyanosis (1 point) - Good muscle tone and a strong cry and grimace suggest good reflex irritability (2 points) - However, the infant may lose 1 point for color if they are cyanotic (blue) in the extremities. So, the Apgar score calculation would be 2 + 1 + 2 - 1 = 4 + 3 = 7. Option B) 8 would be incorrect because cyanosis in the extremities would lead to a deduction in the color component, resulting in a score of 7, not 8. Option C) 9 would also be incorrect as the presence of cyanosis in the extremities would still lead to a slight deduction in the color component, making the score 7, not 9. Educationally, understanding the Apgar score is crucial for healthcare providers working with newborns to quickly assess their well-being and determine if immediate interventions are needed. It helps in identifying infants who may require additional support or monitoring after birth. Interpreting Apgar scores correctly is essential for providing appropriate care and support to newborns during a critical period of transition.

Correct Answer: C

Rationale: The correct answer is C) Renal ultrasonography. In this case, the patient presents with multiple congenital anomalies including a ventricular septal defect, cleft lip and palate, and imperforate anus. Renal ultrasonography is not necessary in the initial workup of these specific conditions. A) A karyotype analysis would be appropriate to check for any chromosomal abnormalities that may be associated with multiple congenital anomalies. B) TORCH titer is important to rule out infections such as toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus which can cause congenital defects. D) Ultrasonography of the brain can help in assessing for any structural abnormalities in the brain that could be associated with the other congenital anomalies present. Educationally, understanding the rationale behind selecting appropriate laboratory tests based on the clinical presentation is crucial in pediatric nursing practice. It helps in providing comprehensive care and early interventions for newborns with complex medical conditions.

Correct Answer: A

Rationale: In this scenario, the most likely diagnosis is Stage I hypoxic ischemic encephalopathy (HIE). Apgar scores of 9 and 9 at 1 and 5 minutes indicate good initial adaptation to extrauterine life. However, the clinical presentation of hyperalertness, hyperactive deep tendon reflexes, and mydriasis suggests central nervous system irritability, which is consistent with Stage I HIE. Option A is correct because Stage I HIE typically manifests with central nervous system signs such as irritability and hyperreflexia. Options B, C, and D are incorrect because they represent more severe stages of HIE or a different condition like kernicterus, which is characterized by bilirubin-induced brain damage, not the acute hypoxic insult seen in this case. Educationally, understanding the progression of HIE stages is crucial for pediatric nurses and nurse practitioners. Recognizing subtle neurological signs and symptoms can lead to early intervention and prevention of further brain injury in neonates. This knowledge is essential for providing safe and effective care to infants at risk for HIE.

Correct Answer: D

Rationale: In this question from a Pediatric NCLEX Practice Quiz, the correct answer is D) Graft-versus-host disease. Late complications of Rhesus sensitization hyperbilirubinemia include transient aregenerative anemia, direct-reacting hyperbilirubinemia, and hypoglycemia. Graft-versus-host disease is not typically associated with Rhesus sensitization hyperbilirubinemia and its treatment. Educationally, understanding the late complications of Rhesus sensitization hyperbilirubinemia is crucial for pediatric healthcare providers. This knowledge helps in recognizing and managing potential complications in infants with this condition, ensuring optimal care and outcomes. By knowing which complications are commonly associated and which are not, healthcare professionals can provide more effective and targeted care to pediatric patients.