The MOST likely cause of a 4-year-old boy refusing to go to bed and remaining active is

Correct Answer: C

Rationale: In this scenario, the correct answer is C) behavioral insomnia of childhood. Behavioral insomnia of childhood is characterized by a child's refusal to go to bed, remaining active, and experiencing difficulty falling asleep. This behavior is often due to learned associations, parental responses, or environmental factors that disrupt the child's sleep routine. Option A) thyrotoxicosis is unlikely in this case as it is a medical condition involving an overactive thyroid gland, leading to symptoms such as hyperactivity, but it is not the primary cause of bedtime refusal. Option B) ADHD, while it can present with hyperactivity and difficulties with impulse control, is not the most likely cause in this context unless there are other consistent behavioral patterns and symptoms present. Option D) sleep-onset association disorder involves difficulty falling asleep without certain conditions or associations present, which is not the primary issue in this case. Educationally, understanding common childhood sleep disorders is essential for healthcare providers, parents, and educators to support children's healthy sleep habits. Recognizing the signs, symptoms, and appropriate management strategies for behavioral insomnia of childhood can help address sleep disturbances in children and promote overall well-being and development. It is crucial to consider behavioral and environmental factors when evaluating sleep issues in children to provide targeted interventions and support.

Correct Answer: D

Rationale: The correct answer is D) limit-setting behavioral insomnia of childhood. In pediatric patients, especially toddlers and young children, refusing to go to bed and remaining active can be indicative of limit-setting behavioral insomnia of childhood. This is a common behavioral issue where children resist bedtime as a way to assert their independence, seek attention, or due to inconsistent bedtime routines. They may engage in activities to delay sleep, such as playing or asking for additional bedtime routines. Option A) thyrotoxicosis is unlikely in this scenario as it typically presents with symptoms related to hyperthyroidism such as weight loss, heat intolerance, tremors, and palpitations, not just bedtime resistance. Option B) ADHD might present with hyperactivity and impulsivity, but bedtime resistance alone is not a characteristic symptom of ADHD. Option C) primary sleep disorder is a broad category that includes various sleep disorders like sleep apnea, parasomnias, or insomnia, but limit-setting behavioral insomnia of childhood is a specific behavioral issue within this spectrum. In an educational context, understanding common pediatric sleep disturbances like limit-setting behavioral insomnia of childhood is crucial for healthcare providers working with children and families. By recognizing the behavioral aspects of sleep disturbances, providers can offer appropriate guidance and interventions to improve sleep hygiene and establish consistent bedtime routines for children. It is important to differentiate between behavioral issues and medical conditions to provide effective management and support for both the child and the family.

Correct Answer: B

Rationale: The correct answer is B) 3 months. At 3 months of age, infants typically exhibit the described developmental milestones. They can move their head to track objects, lift their head off the table to a certain degree, smile responsively, and make cooing sounds. These are all typical behaviors seen in infants around the age of 3 months as they start to develop motor and social skills. Option A) 1 month is incorrect because at 1 month, infants are usually not able to lift their heads as described in the question. Option C) 6 months is incorrect as by 6 months, infants should be able to maintain a seated position, which is a more advanced milestone than described. Option D) 9 months is also incorrect as by 9 months, infants should have achieved more advanced milestones such as crawling or pulling to stand. Understanding typical developmental milestones in infants is crucial for healthcare providers working with pediatric populations. By recognizing age-appropriate behaviors and skills, healthcare providers can assess a child's growth and development, provide appropriate interventions if needed, and offer guidance to parents on what to expect at different stages. This knowledge helps in early identification of any developmental delays or concerns, leading to timely interventions and support for the child's optimal growth and development.

Correct Answer: C

Rationale: The correct response for the nurse to provide to the parents is option C: "Your son's respiratory rate is elevated; a normal rate for his age is 20-30 breaths per minute." This answer is correct because it addresses the vital sign that is outside the normal range for a 3-year-old child, which is the respiratory rate. Option A is incorrect because the blood pressure provided (100/52) is within the normal range for a 3-year-old child. Option B is incorrect because the temperature of 98.8°F is considered normal for a child and not elevated. Option D is incorrect because a heart rate of 90 beats per minute is within the normal range for a 3-year-old child. Educationally, it is important for parents to understand the normal vital signs for their child's age to be able to monitor their health at home and recognize any abnormalities. By explaining why a specific vital sign is elevated or within normal limits, parents can better understand what to look out for and when to seek medical attention for their child. This scenario also highlights the importance of accurate assessment and communication in pediatric nursing to provide appropriate information and reassurance to parents.

Correct Answer: B

Rationale: The correct answer is B) There is blood in your child's urine, which causes it to be tea-colored. This response is the best because glomerulonephritis is a condition that affects the kidneys' ability to filter waste from the blood, leading to the presence of blood in the urine, which causes the discoloration. It is crucial for the parent to understand this as it indicates a serious issue that needs medical attention. Option A is incorrect because while steroids and BP medications may have side effects, they do not directly cause tea-colored urine in the context of glomerulonephritis. Option C is incorrect as concentrated urine would typically appear darker yellow, not tea-colored. Option D is also incorrect as a ketogenic diet does not typically cause tea-colored urine unless there is an underlying kidney issue. In an educational context, it is important for healthcare providers to effectively communicate with parents about their child's condition to ensure understanding and adherence to treatment plans. Understanding the reasons behind symptoms like tea-colored urine can help parents better manage their child's health and seek appropriate medical care when needed.