One of the following can cause thrombocytopenia with decreased megakaryocytes in bone marrow:

Correct Answer: B

Rationale: Thrombocytopenia refers to low platelet count, which can lead to increased risk of bleeding. In the context of decreased megakaryocytes in the bone marrow, the correct answer is B) Aplastic anemia. Aplastic anemia is a condition characterized by bone marrow failure, leading to decreased production of all blood cells, including platelets (megakaryocytes). This results in thrombocytopenia. A) ITP (Immune Thrombocytopenic Purpura) is an autoimmune disorder where the immune system destroys platelets, but it does not involve decreased megakaryocytes in the bone marrow. C) Hypersplenism is a condition where the spleen sequesters and destroys blood cells, including platelets, leading to thrombocytopenia. However, it does not involve decreased megakaryocytes in the bone marrow. D) DIC (Disseminated Intravascular Coagulation) is a disorder where widespread activation of coagulation leads to consumption of platelets and clotting factors, causing both bleeding and clotting. While DIC can cause thrombocytopenia, it is not typically associated with decreased megakaryocytes in the bone marrow. Educationally, understanding the pathophysiology of different conditions causing thrombocytopenia is crucial for pediatric nurses to make accurate assessments and provide appropriate interventions for pediatric patients with bleeding disorders. Recognizing the specific characteristics of each condition helps in early identification and management, leading to better outcomes for pediatric patients.

Correct Answer: A

Rationale: In pediatric nursing, understanding electrolyte imbalances is crucial for providing safe and effective care to children. Dilutional hyponatremia occurs when there is an excess of water relative to sodium in the body, leading to low sodium levels. The correct answer, option A) Heart failure, is associated with dilutional hyponatremia due to the release of antidiuretic hormone (ADH) in response to decreased cardiac output, resulting in water retention and dilution of sodium. Option B) Respiratory failure is not typically associated with dilutional hyponatremia as it does not directly impact sodium-water balance in the same way as heart failure. Option C) Nutritional edema is related to protein-calorie malnutrition and fluid retention but not specifically to dilutional hyponatremia. Option D) Inadequate breastfeeding in infants may lead to dehydration and hypernatremia, the opposite of dilutional hyponatremia. Educationally, nurses must understand the pathophysiology of conditions like dilutional hyponatremia to assess, intervene, and educate patients and families effectively. Recognizing the underlying causes of electrolyte imbalances is crucial for providing appropriate treatment and preventing complications in pediatric patients.

Correct Answer: B

Rationale: In the treatment of hypernatremia, the correct maximum accepted rate of drop of serum sodium per 24 hours is 12 mmol/L (option B). This rate is considered safe to prevent potential complications such as cerebral edema or osmotic demyelination syndrome (ODS). Option A (8 mmol/L) is too conservative of a decrease in serum sodium levels and may not effectively address the hypernatremia within an appropriate timeframe, potentially prolonging the patient's recovery. Option C (16 mmol/L) and option D (20 mmol/L) represent too rapid of a decrease in serum sodium levels, which can lead to serious neurological complications like ODS, especially in patients with chronic hypernatremia. In an educational context, understanding the appropriate rate of correction for electrolyte imbalances like hypernatremia is crucial for pediatric nurses to provide safe and effective care to their patients. Knowledge of the risks associated with correcting sodium levels too quickly or too slowly can help nurses make informed decisions in their clinical practice to ensure optimal patient outcomes.

Correct Answer: A

Rationale: In pediatric nursing, understanding physiological responses to serious illness is crucial for providing effective care. In the context of serious illness, the body often undergoes changes to compensate for the stress it is under. The correct answer is A) Blood pressure. When a child is seriously ill, their body typically responds by increasing their blood pressure to ensure adequate perfusion to vital organs. This is known as the body's compensatory mechanism to maintain circulation and oxygen delivery. Option B) Heart rate typically increases in response to serious illness as the body tries to pump more blood to meet increased demand for oxygen and nutrients. Option C) Respiratory rate often increases in serious illness to improve oxygen exchange and to help the body cope with the increased metabolic demands. Option D) Action of accessory respiratory muscles may increase in serious illness to aid in breathing when the primary respiratory muscles are fatigued or unable to meet the body's demands. Understanding these physiological responses is important for nurses caring for pediatric patients as it helps them recognize signs of deterioration or improvement in a child's condition. Monitoring vital signs like blood pressure, heart rate, respiratory rate, and respiratory muscle use are essential components of pediatric nursing care to ensure timely interventions and optimal outcomes for children with serious illnesses.

Correct Answer: B

Rationale: In pediatric nursing, understanding the features of shock is crucial for early identification and intervention. The correct answer is B) Tachycardia. In early (compensated) shock, the body attempts to maintain perfusion by increasing heart rate to improve cardiac output and maintain blood pressure. Tachycardia is a key compensatory mechanism to ensure vital organs receive adequate blood flow. Option A) Hypotension is incorrect because hypotension typically occurs in the later stage of shock when compensatory mechanisms fail. In early shock, blood pressure may remain within normal limits due to compensatory mechanisms such as tachycardia. Option C) Decreased level of consciousness is incorrect for early shock. Altered mental status is a late sign of shock when cerebral perfusion is compromised due to prolonged inadequate perfusion. Option D) Cold extremities are seen in late decompensated shock when peripheral vasoconstriction occurs to shunt blood to vital organs. In early shock, extremities may be cool but are usually warm due to compensatory mechanisms. Educationally, understanding the progression of shock helps nurses recognize early signs and intervene promptly. Teaching students the timing of clinical manifestations in shock aids in timely assessment and appropriate interventions to prevent further deterioration in pediatric patients. This knowledge is critical for providing safe and effective care in pediatric nursing practice.