Which of the following causes metabolic acidosis with a normal anion gap?

Correct Answer: B

Rationale: In the context of pediatric nursing, understanding the causes of metabolic acidosis is crucial for providing quality care to children. In this question, the correct answer is B) Diarrhea, which can lead to metabolic acidosis with a normal anion gap. Diarrhea causes the loss of bicarbonate-rich fluid from the body, leading to an increase in chloride concentration in the blood. This results in a normal anion gap metabolic acidosis due to the loss of bicarbonate without a corresponding increase in anions. Option A) Diabetic ketoacidosis causes an increased anion gap metabolic acidosis due to the accumulation of ketones in the blood. Option C) Salicylate poisoning leads to an increased anion gap metabolic acidosis from the presence of salicylates. Option D) Renal failure can cause a normal or increased anion gap metabolic acidosis, depending on the underlying cause. Educationally, understanding these different etiologies of metabolic acidosis is essential for nurses caring for pediatric patients. Recognizing the specific causes helps in accurate assessment, diagnosis, and treatment planning for children presenting with acid-base imbalances. This knowledge also underlines the importance of a thorough patient history, physical examination, and diagnostic tests in pediatric nursing practice.

Correct Answer: D

Rationale: In pediatric nursing, understanding the indications and contraindications for gastric lavage is crucial for safe and effective patient care. In this scenario, the correct answer is D) All of the above - Glasgow Coma Scale 5, kerosene ingestion, and ingestion of corrosives are all contraindications for gastric lavage in pediatrics. Gastric lavage is contraindicated in patients with a Glasgow Coma Scale of 5 because they are at a high risk of aspiration due to their decreased level of consciousness. Kerosene ingestion can lead to lipid pneumonia if aspirated during lavage, making it a contraindication. Ingestion of corrosives can cause further damage to the esophagus and stomach if lavage is attempted. Educationally, it is important for pediatric nurses to understand these contraindications to avoid causing harm to the patient. Knowledge of when not to perform gastric lavage is just as critical as knowing when it is indicated. This information helps nurses make informed decisions based on the specific needs and condition of the pediatric patient in their care.

Correct Answer: B

Rationale: In this case, the correct answer is B) 10. The Glasgow Coma Scale (GCS) is used to assess the level of consciousness in patients, especially those with head injuries. A GCS score of 10 indicates that the patient is opening their eyes in response to pain, is confused, and withdrawing from painful stimuli. Option A) 8 would indicate a more severe level of impairment as it suggests a lower level of consciousness compared to the patient's described state of confusion and withdrawal from pain. Option C) 11 would indicate a higher level of consciousness as the patient is withdrawing from pain, suggesting an appropriate response to stimuli, which is not the case in this scenario. Option D) 13 would indicate a near-normal level of consciousness with appropriate responses to stimuli, which does not align with the patient's presentation of confusion and withdrawal from pain. Understanding the GCS is crucial in pediatric nursing as it helps in assessing and monitoring the neurological status of children, especially those with head injuries. It allows healthcare providers to quickly evaluate the severity of the injury and provide appropriate treatment. This knowledge is essential for pediatric nurses to deliver safe and effective care to their young patients.

Correct Answer: B

Rationale: In the context of pediatric nursing, understanding the management of hyperkalemia is crucial for providing safe and effective care to pediatric patients. In this scenario, the correct answer is B) Beta blockers. Beta blockers are not a primary treatment for hyperkalemia. Instead, they are contraindicated in the management of hyperkalemia as they can further increase potassium levels by inhibiting beta-2 receptors, which play a role in potassium uptake by cells. Therefore, giving beta blockers to a patient with hyperkalemia can exacerbate the condition. A) Calcium gluconate IV is a correct treatment for hyperkalemia as it stabilizes the cardiac membrane potential in the setting of elevated potassium levels. C) Sodium bicarbonate can help shift potassium into cells temporarily, thereby reducing serum potassium levels. D) Sodium polystyrene sulfonate (Kayexalate) is a cation exchange resin that binds potassium in the gastrointestinal tract and facilitates its excretion. Educationally, understanding the appropriate treatments for hyperkalemia is essential for nurses working with pediatric patients, as untreated hyperkalemia can lead to life-threatening cardiac arrhythmias. Nurses need to be familiar with the actions of different medications used in hyperkalemia treatment to provide prompt and effective care to pediatric patients in critical situations.

Correct Answer: A

Rationale: The correct answer is option A) Chromosomal breakage test for this patient presenting with microcephaly, microphthalmia, absent thumb, ectopic kidney, and recurrent epistaxis. These clinical manifestations are indicative of a rare genetic disorder called Fanconi anemia, characterized by chromosomal instability leading to breakage and increased risk of malignancies. Option B) Hemoglobin electrophoresis is used to diagnose hemoglobinopathies like sickle cell disease, not relevant to this patient's presentation. Option C) Schilling test is used to assess vitamin B12 absorption, not related to the symptoms described. Option D) Osmotic fragility test is used to diagnose conditions like hereditary spherocytosis, which does not align with the patient's symptoms. In an educational context, understanding the rationale behind diagnostic testing based on presenting symptoms is crucial in pediatric nursing. Recognizing the pattern of anomalies and linking them to specific genetic disorders is essential for early diagnosis and appropriate management of pediatric patients with rare conditions like Fanconi anemia. This case highlights the importance of a comprehensive assessment and knowledge of diagnostic tests in pediatric nursing practice.