What test should NOT be included in evaluating a symptomatic toddler for autistic spectrum disorders?

Correct Answer: D

Rationale: In evaluating a symptomatic toddler for autistic spectrum disorders, the test that should NOT be included is a Woods lamp examination, making option D the correct answer. A Woods lamp is used to detect certain skin conditions like fungal infections or pigment changes, and it is not a standard diagnostic tool for evaluating autism spectrum disorders. Physical examination (option A) is essential to assess the overall health and developmental milestones of the child. Hearing tests (option B) are crucial to rule out any hearing impairments that might be affecting the child's communication skills. A brain CT scan (option C) may be ordered to evaluate any structural abnormalities in the brain, which can sometimes be associated with certain developmental disorders but is not typically used as a primary tool for diagnosing autism spectrum disorders. In the context of pediatric nursing, it is important to prioritize evidence-based assessment tools and diagnostic tests that are relevant to the specific condition being evaluated. Understanding the rationale behind choosing or excluding certain tests is crucial for providing optimal care to pediatric patients.

Correct Answer: B

Rationale: The correct answer is B) behavioral instruction to parents and follow-up. Breath-holding spells are typically benign in nature and self-limiting. They are usually triggered by emotional upset or frustration in young children. Therefore, reassurance is the most appropriate response as it helps alleviate parental anxiety and stress. Ordering an MRI brain (option C) is unnecessary for a child with classic breath-holding spells as they have a typical presentation and do not require neuroimaging. Similarly, ordering an ECG (option D) is not indicated in this case as breath-holding spells are not cardiac in nature. Educationally, it is important for healthcare providers to have a good understanding of common pediatric conditions such as breath-holding spells to provide appropriate care and guidance to parents. By recognizing the typical presentation and course of these spells, unnecessary investigations and interventions can be avoided, leading to better patient outcomes and cost-effective care.

Correct Answer: D

Rationale: Rationale: The correct answer is D) pediatrician concern. This is because pediatricians are trained to identify signs and symptoms of ASD during routine well-child visits. Therefore, if a pediatrician has concerns about a child potentially having ASD, it is a significant red flag that should not be ignored. Option A) sibling with ASD is a valid concern as there is a genetic component to ASD, increasing the likelihood of a sibling also being diagnosed. Option B) playmate concern is relevant as peers and playmates may notice social or behavioral differences in a child that could indicate ASD. Option C) parental concern is important since parents are often the first to notice atypical behaviors or developmental delays in their child. In an educational context, it is crucial for healthcare providers and educators to be aware of the various signs and symptoms of ASD to facilitate early detection and intervention. Understanding the red flags associated with ASD can lead to timely diagnosis and appropriate support services for children and their families. Collaboration between healthcare providers, educators, and families is essential in providing comprehensive care for children with ASD.

Correct Answer: D

Rationale: In pediatric nursing, understanding the significance of fontanelles is crucial as they provide insight into an infant's neurological status. The correct answer, D) Russell-Silver syndrome, is not associated with a large anterior fontanel. This condition is characterized by growth failure and distinctive facial features, but not by fontanel abnormalities. A) Congenital rubella syndrome is associated with a large anterior fontanel due to the impact of the rubella virus on the developing fetus. B) Hypophosphatasia is a genetic disorder that can cause skeletal abnormalities, including a large fontanel. C) Apert syndrome is a genetic disorder that affects skull development, leading to a large fontanel among other craniofacial abnormalities. Educationally, this question emphasizes the importance of recognizing clinical manifestations associated with different pediatric disorders. Understanding these associations aids in timely diagnosis and appropriate management of conditions affecting infants and children. Pediatric nurses must be able to recognize abnormal findings like fontanel size to provide comprehensive care to pediatric patients.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) dexamethasone. Dexamethasone, a corticosteroid, is known to potentially cause pyloric stenosis in premature infants due to its impact on muscle tone and motility in the digestive system. Pyloric stenosis is a condition where the muscle at the base of the stomach thickens, leading to a blockage in the opening to the small intestine. Now, let's address why the other options are incorrect: A) Intravenous vitamin E: Vitamin E supplementation is not associated with pyloric stenosis in premature infants. It is generally considered safe and essential for premature infants' health. B) Indomethacin: While indomethacin is a nonsteroidal anti-inflammatory drug commonly used to treat patent ductus arteriosus in premature infants, it is not linked to causing pyloric stenosis. C) Enteric gentamicin: Gentamicin, an antibiotic, is not known to cause pyloric stenosis in premature infants. Its route of administration and mechanism of action do not typically lead to this condition. Educational Context: Understanding the potential adverse effects of medications on premature infants is crucial for pediatric nurses. By knowing which drugs can lead to complications like pyloric stenosis, nurses can make informed decisions when administering medications to this vulnerable population. This knowledge ensures safe and effective care for premature infants in neonatal settings.