The drug that is LEAST effective for the treatment of chronic renal disease occurring in 1-2% of children with Henoch-Schonlein purpura (HSP) is

Correct Answer: A

Rationale: In the context of pediatric nursing and the treatment of chronic renal disease in children with Henoch-Schonlein purpura (HSP), the correct answer is A) prednisolone. Prednisolone is the least effective in this scenario because it is a corticosteroid used primarily for its anti-inflammatory properties. In chronic renal disease associated with HSP, the main treatment goal is to manage inflammation and prevent renal damage. Prednisolone alone may not adequately address the underlying renal pathology in these cases. Option B) azathioprine is an immunosuppressant that can be used in chronic renal disease to dampen the immune response and reduce inflammation. It is often considered in cases where corticosteroids alone are not sufficient. Option C) cyclophosphamide is a potent immunosuppressant used in severe cases of autoimmune diseases to suppress the immune system's activity. While it can be effective in certain conditions, it comes with significant side effects and is typically reserved for more aggressive disease processes. Option D) cyclosporine is another immunosuppressant that is sometimes used in renal diseases to modulate the immune response. It is not the least effective in this context but may have more potential side effects compared to other options. Educationally, understanding the rationale behind the choice of medication in pediatric patients with chronic renal disease associated with HSP is crucial for nursing practice. It is essential to consider the mechanism of action, potential side effects, and overall effectiveness of each medication to provide safe and evidence-based care to these vulnerable patients.

Correct Answer: B

Rationale: In pediatric nursing, failure to thrive is a serious concern requiring prompt intervention. The correct answer, B) 4 weeks, is the most appropriate indication for hospitalization if outpatient management has failed. This timeline allows for close monitoring and intervention to address the underlying causes of failure to thrive promptly. Option A) 1-2 weeks is too short a period to assess the effectiveness of outpatient management and implement necessary interventions. Hospitalization may be premature within this timeframe and may not allow for an adequate response to treatment. Options C) 2-3 months and D) 4 months are excessively long periods to wait before considering hospitalization. Prolonging hospitalization in these cases could lead to further deterioration in the child's condition and delay essential interventions. Educationally, understanding the appropriate timing for hospitalization in cases of failure to thrive is crucial for pediatric nurses to provide optimal care for these vulnerable patients. By recognizing the signs indicating the need for hospitalization, nurses can intervene early, prevent complications, and improve outcomes for children with failure to thrive.

Correct Answer: D

Rationale: The correct answer is D) ABO incompatibility with continued hemolysis. In this case, the infant's ABO blood group is different from the mother's, which can lead to hemolysis of the infant's red blood cells. This condition presents with symptoms such as pallor, apathy, and jaundice due to increased bilirubin levels from the breakdown of red blood cells. The systolic ejection murmur and tachycardia are signs of increased cardiac output in response to anemia. Option A) Anemia of chronic disease is unlikely in a neonate without a history of chronic illness. Option B) Cholestasis secondary to neonatal hepatitis typically presents with jaundice but not severe anemia and heart murmur. Option C) Hereditary spherocytosis would present with a different clinical picture, such as jaundice without hemolysis. Understanding neonatal conditions like ABO incompatibility is crucial for pediatric nurses as they care for newborns. Recognizing the signs and symptoms of hemolytic disease of the newborn allows for prompt treatment to prevent complications such as kernicterus. Nurses play a vital role in monitoring and managing neonatal jaundice, ensuring positive outcomes for infants.

Correct Answer: D

Rationale: The correct answer is D) Administration of local anesthetic into the fetal scalp. In this scenario, the baby is presenting with signs of perinatal depression, which can be caused by various factors such as birth asphyxia. Administration of local anesthetic into the fetal scalp, while a common practice during instrumental vaginal deliveries, would not directly cause the baby to present with symptoms of perinatal depression. Option A) Prolapsed umbilical cord could lead to fetal hypoxia and subsequent perinatal depression due to compromised blood flow to the baby. Option B) Central nervous system trauma during delivery can also result in perinatal depression. Option C) Administration of morphine to the mother can lead to respiratory depression in the newborn if the drug crosses the placenta. Educationally, understanding the causes of perinatal depression and its management is crucial for pediatric nurses to provide timely and appropriate interventions to stabilize a newborn's condition. It highlights the importance of recognizing potential risk factors during labor and delivery and being prepared to address them promptly to ensure optimal outcomes for both the mother and the newborn.

Correct Answer: D

Rationale: In this question, the correct answer is D) Gilbert disease. Direct-reacting hyperbilirubinemia on the 5th day of life is suggestive of liver pathology. Gilbert disease is characterized by unconjugated hyperbilirubinemia, not direct-reacting hyperbilirubinemia. A) Cystic fibrosis and B) Galactosemia are metabolic disorders that can present with direct hyperbilirubinemia due to liver involvement. C) Neonatal hepatitis is a common cause of direct-reacting hyperbilirubinemia in newborns. Understanding the differential diagnoses of neonatal jaundice is crucial in pediatric nursing. Different etiologies require specific interventions and treatments. Recognizing the characteristics of various conditions aids in prompt diagnosis and appropriate management, ultimately improving patient outcomes. It is essential for nurses to be able to differentiate between different causes of neonatal jaundice to provide optimal care to newborns.