Persistence of unconjugated hyperbilirubinemia at levels >20 mg/dL after the 1st wk of life in the absence of hemolysis should suggest

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Crigler-Najjar type I. Crigler-Najjar syndrome is a rare, autosomal recessive genetic disorder characterized by a deficiency of the enzyme uridine diphosphate glucuronosyltransferase (UGT). This enzyme is responsible for conjugating bilirubin, which is necessary for its excretion from the body. In Crigler-Najjar type I, there is a complete absence of UGT activity, leading to severe unconjugated hyperbilirubinemia. Now, let's discuss why the other options are not the correct answers: A) Galactosemia: Galactosemia is a disorder of galactose metabolism, which can also present with jaundice. However, the persistence of unconjugated hyperbilirubinemia in the absence of hemolysis is not a typical feature of galactosemia. B) Tyrosinemia: Tyrosinemia is a metabolic disorder that affects the breakdown of tyrosine. While it can also present with jaundice, it is not typically associated with unconjugated hyperbilirubinemia as seen in this case. C) Alpha-1 Antitrypsin deficiency: This is a genetic disorder that can lead to liver disease. While it can cause jaundice, it is not specifically associated with unconjugated hyperbilirubinemia. Educational Context: Understanding the different causes of hyperbilirubinemia in infants is crucial for healthcare providers, especially for nurses preparing for the NCLEX exam. Recognizing the specific characteristics of Crigler-Najjar syndrome, such as the persistent unconjugated hyperbilirubinemia in the absence of hemolysis, can help in making accurate clinical assessments and providing appropriate care for infants with this rare disorder. This knowledge is essential for early detection, diagnosis, and management of pediatric gastrointestinal disorders in clinical practice.

Correct Answer: D

Rationale: HBV, or Hepatitis B Virus, is primarily spread through contact with infected blood or body fluids. Sharing needles, as in option D, is a high-risk behavior for HBV transmission due to direct blood contact. Kissing (option A) and hugging (option B) do not typically transmit HBV unless there are open sores or blood present. Sharing utensils (option C) can potentially transmit the virus if there is blood on the utensil, but it is a less common mode of transmission compared to direct blood contact via needle sharing. In an educational context, understanding how HBV is transmitted is crucial for healthcare professionals, especially when dealing with pediatric patients who may be more vulnerable to infections. By knowing the modes of transmission, healthcare providers can educate families on preventive measures to protect children from contracting HBV. This question reinforces the importance of safe practices and highlights the significance of infection control in pediatric care.

Correct Answer: D

Rationale: In this question, the correct answer is D) ceftriaxone. Ceftriaxone is associated with the development of biliary sludge or cholelithiasis in pediatric patients. This adverse effect is linked to the calcium salt formation in the gallbladder due to the breakdown of ceftriaxone into calcium complexes. This process can lead to the precipitation of calcium bilirubinate crystals, resulting in biliary sludge or gallstones. A) cefotaxime and B) meropenem are not typically associated with the formation of biliary sludge or cholelithiasis in pediatric patients. Vancomycin (C) is not known to cause this specific adverse effect. Educationally, it is important for healthcare providers to be aware of the potential side effects of medications commonly used in pediatric populations. Understanding the risks associated with certain antibiotics can help in making informed decisions when prescribing medications to children, ensuring their safety and well-being. It also highlights the importance of monitoring for adverse effects and considering alternative treatment options when necessary.

Correct Answer: A

Rationale: In this question, the correct answer is A) perforation of the appendix. Acute secondary peritonitis commonly follows the entry of enteric bacteria into the peritoneal cavity through a necrotic defect in the viscus, with the most common source being a perforated appendix. Rationale: Perforation of the appendix can lead to the release of fecal material and bacteria into the peritoneal cavity, causing peritonitis. The appendix is a common site for infection and inflammation, and if left untreated, it can rupture, leading to serious complications. Why the other options are incorrect: B) Rupture of a Meckel diverticulum is less common than appendiceal perforation as a cause of peritonitis. C) Intussusception is the telescoping of one part of the intestine into another and is not typically associated with peritonitis. D) Necrotizing enterocolitis is a condition primarily seen in premature infants and is not a common cause of peritonitis in the context described in the question. Educational context: Understanding the common causes of acute secondary peritonitis is crucial for healthcare professionals, especially those working with pediatric patients. Recognizing the signs and symptoms of peritonitis, along with its common etiologies, is essential for prompt diagnosis and treatment to prevent serious complications. This knowledge is particularly important in emergency and pediatric healthcare settings where timely intervention can be life-saving.