The outward sign of cell damage in malnutrition is

Correct Answer: D

Rationale: In malnutrition, the outward sign of cell damage is wasting (Option D). Wasting refers to the severe loss of muscle and fat tissue due to inadequate nutrient intake. This is a characteristic feature of protein-energy malnutrition. Option A, edema, is the accumulation of fluid in tissues and occurs in conditions like kwashiorkor, which is a form of severe acute malnutrition characterized by edema. However, edema is not the primary outward sign of cell damage in malnutrition. Option B, hepatomegaly, refers to an enlarged liver and can be seen in conditions like liver disease or infection. While liver damage can occur in malnutrition, hepatomegaly is not the most prominent outward sign of cell damage in this context. Option C, facial appearance, can be affected in malnutrition, leading to a gaunt or sunken appearance. However, this is more of a general physical manifestation and not a direct sign of cell damage. Understanding these distinctions is crucial in pediatric nursing practice, especially when assessing and managing malnourished children. Recognizing wasting as a sign of severe malnutrition can prompt timely interventions to address nutritional deficiencies and prevent further complications.

Correct Answer: A

Rationale: In refeeding syndrome, when a malnourished individual undergoes rapid refeeding, there is a shift from fat to carbohydrate metabolism, leading to increased insulin secretion and subsequent intracellular uptake of electrolytes. This shift can result in hypophosphatemia, which is the main cause of thrombocytopenia in refeeding syndrome. Option A, hypophosphatemia, is correct because low serum phosphate levels can lead to impaired platelet function and decreased platelet count, causing thrombocytopenia in refeeding syndrome. Option B, hypokalemia, is incorrect because while electrolyte imbalances like hypokalemia can occur in refeeding syndrome, they are not the primary cause of thrombocytopenia in this condition. Option C, hypomagnesemia, is incorrect as well. Although magnesium deficiency can contribute to cardiac arrhythmias in refeeding syndrome, it is not the main factor leading to thrombocytopenia. Option D, thiamine deficiency, is also incorrect. Thiamine deficiency can result in Wernicke's encephalopathy in malnourished individuals, but it is not directly linked to thrombocytopenia in refeeding syndrome. Understanding the pathophysiology of refeeding syndrome and its impact on electrolyte balance and organ function is crucial for nurses and healthcare providers caring for malnourished pediatric patients. Recognizing the role of hypophosphatemia in thrombocytopenia can guide appropriate monitoring and treatment strategies to prevent complications in these vulnerable populations.

Correct Answer: C

Rationale: The most likely diagnosis for this case is C) Hepatic abscess. Hepatic abscess presents with right upper quadrant pain, fever, hepatomegaly, and often a history of recent abdominal illness or travel to endemic areas. In this case, the patient's symptoms, physical exam findings, and recent travel to Mexico align with a hepatic abscess diagnosis, especially given the history of receiving over-the-counter medication for gastrointestinal symptoms. A) Giardiasis is less likely in this case as it typically presents with diarrhea, bloating, and flatulence, not with the symptoms described in the scenario. B) Hepatitis would typically present with jaundice, which is not present in this patient, making it a less likely diagnosis. D) Cholangitis usually presents with right upper quadrant pain, fever, and jaundice, which are not all present in this case. Educationally, this question highlights the importance of considering travel history, medication use, and specific symptomatology in diagnosing gastrointestinal conditions. It also emphasizes the need for a thorough understanding of different pathologies that can present with similar symptoms to make accurate differential diagnoses in clinical practice.

Correct Answer: C

Rationale: The correct answer is C) Adrenogenital syndrome. This condition typically presents in infancy with symptoms such as recurrent vomiting, dehydration, hyponatremia, hyperkalemia, and metabolic acidosis. The electrolyte imbalances seen in the patient (low potassium, high bicarbonate) are indicative of this syndrome, caused by a defect in cortisol biosynthesis leading to increased adrenal androgen production. Option A) Duodenal stenosis typically presents with bilious vomiting and is unlikely in this case as the emesis is nonbilious. Option B) Annular pancreas would present with duodenal obstruction and symptoms of bilious vomiting, which are not seen in this patient. Option D) Galactosemia would present with symptoms related to galactose metabolism such as jaundice, liver dysfunction, and coagulopathy, which are not evident in this case. Educationally, understanding the clinical presentation and key laboratory findings of various pediatric gastrointestinal disorders is crucial for nurses preparing for the NCLEX exam as it helps in accurate diagnosis and management of these conditions in pediatric patients. It also highlights the importance of recognizing electrolyte imbalances and metabolic disturbances in infants to provide timely and appropriate interventions.

Correct Answer: B

Rationale: The correct answer is B) Biliary atresia. Biliary atresia is the most common indication for pediatric liver transplantation. This condition involves the obstruction or absence of the bile ducts that drain bile from the liver, leading to liver damage and failure if left untreated. Option A) Neonatal hepatitis is a broad term for liver inflammation in newborns and is not as common an indication for liver transplantation as biliary atresia. Option C) Metabolic liver disease refers to a group of inherited disorders that affect the liver's ability to function properly. While these conditions can be severe, they are not as prevalent as biliary atresia in necessitating liver transplantation in pediatric patients. Option D) Fulminant hepatic failure is a rapid and severe deterioration of liver function, often requiring urgent medical intervention. While this is a serious condition, biliary atresia remains the most common indication for pediatric liver transplantation. Understanding the most common indications for pediatric liver transplantation is crucial for healthcare providers working in pediatric gastroenterology and transplant services. It highlights the importance of early diagnosis and intervention in conditions like biliary atresia to prevent irreversible liver damage and improve outcomes for young patients.