The most common gastrointestinal manifestation that may occur in up to 80% of children with Henoch-Schonlein purpura (HSP) is

Correct Answer: A

Rationale: In Henoch-Schonlein purpura (HSP), the most common gastrointestinal manifestation occurring in up to 80% of affected children is abdominal pain and ileus. This is because HSP is a systemic vasculitis that affects small blood vessels, including those in the gastrointestinal tract. Abdominal pain and ileus result from the inflammation and damage to these blood vessels, leading to bowel wall edema and impaired peristalsis. Option B, diarrhea, is less common in HSP compared to abdominal pain and ileus. While gastrointestinal symptoms like vomiting (Option C) may occur in some cases of HSP, they are not as prevalent as abdominal pain and ileus. Paralytic ileus (Option D) is a severe form of ileus that involves a lack of bowel motility due to nerve or muscle damage, which is not a typical manifestation of HSP. Educationally, understanding the common gastrointestinal manifestations of HSP is crucial for pediatric nurses to recognize and manage symptoms promptly. This knowledge helps in providing appropriate care, monitoring for complications like bowel obstruction, and educating both the child and their caregivers about the condition. By grasping these nuances, healthcare professionals can enhance the quality of care provided to children with HSP.

Correct Answer: A

Rationale: In this scenario, the most common possible cause of the 15-month-old child's symptoms (failure to thrive, diarrhea, and fatty stool) is malabsorption (Option A). Malabsorption refers to the inability of the digestive system to properly absorb nutrients from food, leading to nutritional deficiencies and symptoms like those described. Option A is the correct answer because the symptoms of failure to thrive, diarrhea, and fatty stool are classic signs of malabsorption in children. Malabsorption can be due to various conditions such as cystic fibrosis, celiac disease, or short bowel syndrome, which can affect nutrient absorption and result in poor growth and gastrointestinal issues. Option B (intestinal parasites) is less likely in this case as the symptoms described are more indicative of a chronic condition like malabsorption rather than an acute parasitic infection. While intestinal parasites can cause diarrhea and malabsorption, they are not as common a cause in this context. Option C (milk protein intolerance) could present with similar symptoms, but it would typically lead to more immediate gastrointestinal reactions like vomiting and abdominal pain rather than chronic failure to thrive and fatty stool. Option D (pancreatic insufficiency) could also lead to malabsorption due to inadequate enzyme production for digestion, but it is less common in young children and typically presents with other symptoms like steatorrhea (fatty stools) and weight loss. Educationally, understanding the differential diagnosis of failure to thrive in children is crucial for pediatric nurses. Recognizing the signs and symptoms of malabsorption and knowing the common causes can aid in timely diagnosis and appropriate management to improve the child's nutritional status and overall health.

Correct Answer: D

Rationale: In this scenario, the most appropriate step is to intubate the trachea and provide positive-pressure ventilation (Option D). This is because the infant is presenting with significant respiratory distress, as evidenced by hypotonia, cyanosis, apnea, and bradycardia. Intubation allows for a secure airway and the delivery of oxygen and positive-pressure ventilation to support the infant's breathing. Stimulating the infant to breathe (Option A) may not be effective in this case, as the infant is already hypotonic and apneic, indicating a more severe respiratory compromise. Administering epinephrine (Option B) is not the initial intervention for respiratory distress in a newborn. Positive-pressure bag-and-mask ventilation (Option C) could be considered if intubation is not immediately feasible, but given the severity of the infant's condition, intubation for definitive airway management is the most appropriate next step. From an educational perspective, understanding the importance of prompt and appropriate interventions in neonatal resuscitation is crucial for healthcare providers working in labor and delivery settings. Recognizing the signs of respiratory distress in a newborn and knowing the steps to secure the airway and provide ventilation can significantly impact outcomes in these critical situations. Practicing skills such as neonatal intubation and ventilation techniques through simulation and hands-on training can help healthcare providers feel more confident and competent in managing such emergencies.

Correct Answer: C

Rationale: The correct answer is C) A systematic method to assess the newborn at birth. The Apgar score is a quick assessment tool used by healthcare providers to evaluate a newborn's physical condition immediately after birth. It helps determine if the baby needs any immediate medical attention or intervention. The score is based on five criteria: heart rate, respiratory effort, muscle tone, reflex irritability, and color. Each criterion is scored from 0 to 2, and the total score ranges from 0 to 10. Option A) A predictor of future development quotients is incorrect because the Apgar score does not predict a child's future development. It is solely a snapshot of the newborn's immediate condition at birth. Option B) A predictor of cerebral palsy is incorrect because the Apgar score does not predict specific long-term outcomes like cerebral palsy. It is a tool for immediate assessment and intervention, not for long-term prognostication. Option D) A predictor of neonatal survival is incorrect because while a low Apgar score may indicate a need for medical intervention to support the newborn's survival, it is not a definitive predictor of survival outcomes. In an educational context, understanding the Apgar score is crucial for pediatric nurses as it guides their initial assessment and care of newborns. It helps them prioritize interventions and communicate effectively with other members of the healthcare team. By mastering the Apgar scoring system, nurses can contribute to improving outcomes for newborns in the critical moments following birth.

Correct Answer: B

Rationale: In this scenario, the most likely problem the patient is experiencing at one month of age with significant pallor, tachycardia, and a new heart murmur is ductal dependent congenital heart disease (Option B). Ductal dependent congenital heart disease refers to a group of heart defects where blood flow to the body is dependent on the patent ductus arteriosus (PDA) remaining open. In this case, the closure of the ductus arteriosus after birth could lead to decreased blood flow to the body, causing symptoms like pallor, tachycardia, and a heart murmur. Late-onset neonatal sepsis (Option A) is less likely in this case because the symptoms described are more indicative of a cardiac issue rather than an infectious process. Hemolysis (Option C) would typically present with jaundice and anemia, which are not prominent in this case. Myocarditis (Option D) is less likely given the absence of symptoms like fever, chest pain, or respiratory distress typically associated with this condition. Educationally, understanding the pathophysiology of ductal dependent congenital heart disease is crucial for pediatric nurses as early detection and intervention are vital in managing such cases. Recognizing the clinical manifestations and differentiating them from other conditions is essential for providing timely and appropriate care to these vulnerable patients.