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

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Diarrhea. Diarrhea can lead to metabolic acidosis with a normal anion gap due to the loss of bicarbonate in the stool, leading to an increase in chloride. This results in an acidosis with a normal anion gap because the lost bicarbonate is replaced by chloride. A) Diabetic ketoacidosis causes an increased anion gap metabolic acidosis due to the accumulation of ketones in the blood. C) Salicylate poisoning leads to an increased anion gap metabolic acidosis by directly affecting acid-base balance. D) Renal failure causes a normal anion gap metabolic acidosis due to the inability of the kidneys to excrete acid effectively. In an educational context, understanding the causes of metabolic acidosis is crucial for pediatric nurses to provide effective care to pediatric patients. Knowing the specific differences between the various causes helps nurses in assessing and managing acid-base disorders in children. This knowledge is vital for providing safe and efficient care to pediatric patients with metabolic acidosis.

Correct Answer: D

Rationale: In pediatric nursing, understanding the indications and contraindications for gastric lavage is crucial for providing safe and effective care to children in emergency situations. Gastric lavage, the process of flushing out the stomach, is used in cases of certain poison ingestions. The correct answer, option D (All of the above), is the appropriate choice as all the listed conditions are contraindications for gastric lavage. Option A, Glasgow Coma Scale 5, indicates severe neurological impairment, making the child unable to protect their airway during the procedure, which can lead to aspiration and further complications. Option B, kerosene ingestion, is a petroleum-based product that can cause lung injury if aspirated during the lavage procedure. Option C, ingestion of corrosives, can cause damage to the esophagus, and lavage can further exacerbate the injury by increasing contact with the corrosive substance. Educationally, it is important for pediatric nurses to recognize when gastric lavage is contraindicated to prevent harm to the child. Understanding these contraindications helps nurses make informed decisions and provide appropriate care in poisoning emergencies. By knowing the specific scenarios in which gastric lavage should not be performed, nurses can advocate for alternative treatments and ensure the safety and well-being of their pediatric patients.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) 10. The Glasgow Coma Scale (GCS) is used to assess the level of consciousness in patients with head injuries. It is composed of three components: eye opening response, verbal response, and motor response. Each component is scored, and the total score indicates the level of consciousness. For a 4-year-old patient who opens eyes to a painful stimulus, is confused, and withdraws from pain, the GCS score would be as follows: - Eye opening response: 2 - Verbal response: 5 (confused) - Motor response: 3 (withdraws from pain) Total GCS score = 2 + 5 + 3 = 10 Option A) 8 is incorrect because it would indicate a lower level of consciousness which is not consistent with the patient's presentation. Option C) 11 is incorrect as well because the patient's responses do not align with a GCS score of 11. Option D) 13 is also incorrect as it would indicate a higher level of consciousness than what is described in the scenario. In a pediatric nursing context, understanding and correctly interpreting the Glasgow Coma Scale is crucial for assessing and managing head-injured patients. It helps healthcare providers to communicate effectively about the patient's level of consciousness and to monitor changes over time. This knowledge is essential for providing appropriate and timely interventions to optimize patient outcomes.

Correct Answer: B

Rationale: In the management of hyperkalemia, it is crucial to understand the appropriate lines of treatment to prevent serious complications. The correct answer, B) Beta blockers, is not a typical treatment for hyperkalemia. Beta blockers do not directly impact potassium levels in the body and are not indicated for managing hyperkalemia. A) Calcium gluconate IV is used to stabilize cardiac cell membranes in severe hyperkalemia to prevent cardiac arrhythmias. C) Sodium bicarbonate is used in cases of metabolic acidosis associated with hyperkalemia to help shift potassium into cells. D) Sodium polystyrene sulfonate (Kayexalate) is a cation-exchange resin that helps remove potassium from the body through the gastrointestinal tract. Educationally, understanding the treatment options for hyperkalemia is vital for pediatric nurses to provide safe and effective care to pediatric patients. Nurses must be able to recognize the signs and symptoms of hyperkalemia and implement appropriate interventions promptly to prevent life-threatening complications. It is important to continuously update knowledge on pediatric pharmacology and treatment guidelines to ensure optimal patient outcomes.

Correct Answer: A

Rationale: In this scenario, the most informative diagnostic test explaining the underlying etiology of the patient's presentation is option A) Chromosomal breakage test. This test is crucial in identifying genetic disorders such as Fanconi anemia which presents with physical anomalies like microcephaly, absent thumb, and other congenital malformations. Option B) Hemoglobin electrophoresis is used to diagnose various types of anemia, not genetic disorders like Fanconi anemia. Option C) Schilling test is used to assess vitamin B12 absorption, which is not relevant 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. Educationally, understanding the significance of the Chromosomal breakage test highlights the importance of genetic testing in diagnosing complex conditions in pediatric patients. It also emphasizes the need for a comprehensive approach to investigating rare genetic disorders that may present with a combination of physical anomalies. This case underscores the role of diagnostic tests in pediatric nursing practice and the importance of considering genetic factors in the differential diagnosis of pediatric patients with multiple congenital anomalies.