You are examining a 12-year-old female adolescent with a small nevus in the thigh; the mother is concerned regarding the future development of melanoma. All the following findings raise suspicion of melanoma EXCEPT

Correct Answer: E

Rationale: In this scenario, the correct answer is option E, none of the findings raise suspicion of melanoma. This question assesses the student's understanding of the characteristics of melanoma in pediatric patients. Explanation: A) An enlarging nevus is concerning as it can be a sign of melanoma. Melanomas often grow in size over time. B) Changing colors in a nevus can be indicative of melanoma. Variegated colors are a warning sign. C) Irregular margins are a classic feature of melanoma. Well-defined borders are typical of benign nevi. D) A nevus that easily bleeds can be a sign of melanoma, as melanomas are prone to bleeding due to their abnormal blood supply. Educational context: It is crucial for pediatric nurses to recognize the signs of potential skin malignancies like melanoma in children. Understanding the specific characteristics of melanoma helps in early detection and intervention, leading to better outcomes for patients. Nurses play a key role in educating parents about monitoring moles and seeking medical evaluation if concerning changes are noted. This question reinforces the importance of vigilance and knowledge in pediatric dermatological assessments.

Correct Answer: D

Rationale: In this scenario, the correct answer is option D) fluid overload or pulmonary edema. When caring for a pediatric patient with septic shock and administering fluid resuscitation, the nurse should monitor for signs of fluid overload, which can lead to pulmonary edema. This is a potential complication of rapid fluid administration in patients with septic shock. Pulmonary edema presents with symptoms such as respiratory distress, crackles on lung auscultation, and increased work of breathing. Option A) a heart rate of 50 beats/min is not directly related to fluid overload or pulmonary edema. In septic shock, tachycardia is a common finding due to the body's response to infection. Option B) a temperature of 102°F (38.9°C) is indicative of an ongoing infection and inflammatory response, which are expected in septic shock. It is not a specific sign of fluid overload. Option C) reports of leg pain could indicate muscle pain, joint issues, or poor perfusion, but it is not a typical sign of fluid overload or pulmonary edema. Educationally, this question highlights the importance of recognizing potential complications of fluid resuscitation in pediatric patients with septic shock. It emphasizes the need for close monitoring and assessment to detect early signs of fluid overload, which can impact the patient's respiratory status and overall outcome. Nurses must be vigilant in assessing for both desired effects and potential adverse reactions to interventions such as fluid resuscitation in critically ill pediatric patients.

Correct Answer: A

Rationale: Rationale: The correct answer is A) visual-motor coordination. At 22 months, children are in the early stages of development and are starting to explore and engage in activities that require coordination between their visual perception and motor skills. Building a tower involves looking at the blocks, planning how to stack them, and then using their hands to carry out the action. This process demonstrates the integration of visual information with physical movements, which is known as visual-motor coordination. Option B) using visual and motor skills in combination is similar to the correct answer, but it lacks the specificity of the term "coordination," which is crucial in understanding the complexity of the task for a toddler. Option C) gross and fine motor coordination is not entirely accurate in this context. While building a tower does involve both gross (large muscle movements) and fine (small muscle movements) motor skills, the key aspect being tested in this question is the coordination between visual input and motor output. Option D) symbolic thought is not relevant to the task of building a tower with blocks for a 22-month-old child. Symbolic thought typically develops later in childhood and involves the ability to understand and use symbols to represent objects or ideas. Educational Context: Understanding the developmental milestones and skills required at different ages is essential for pediatric nurses to provide appropriate care and support to children and their families. By recognizing the significance of visual-motor coordination in activities like building a tower, nurses can assess a child's developmental progress and intervene if there are any concerns or delays. This knowledge also informs nurses on how to engage children in play activities that promote their physical and cognitive development.

Correct Answer: B

Rationale: In pediatric nursing, understanding child development milestones is crucial for providing effective care. The question pertains to object permanence, a key concept in Piaget's theory of cognitive development. The correct answer is B) 9 months. At this age, infants develop object permanence, realizing that objects continue to exist even when out of sight. They actively search for hidden objects, demonstrating cognitive growth. Option A) 7 months is incorrect as infants at this age do not yet typically exhibit full object permanence. Option C) 11 months is also incorrect as by this age, most children have already developed object permanence skills. Option D) 13 months is incorrect as children typically master object permanence around 8-12 months, so at 13 months, they should have already achieved this milestone. Educationally, understanding developmental milestones helps nurses assess children's growth, plan interventions, and educate caregivers about age-appropriate behaviors. This knowledge is essential for providing holistic care that considers not only physical but also cognitive and emotional development in pediatric patients.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) behavioral insomnia of childhood. This condition is characterized by difficulty falling asleep and/or staying asleep. In the case of the 4-year-old boy, his refusal to go to bed and remaining active are indicative of behavioral insomnia. This type of insomnia is often linked to poor sleep habits, parental influence, or learned behavior. Option A) thyrotoxicosis is unlikely in this case as it is a condition involving an overactive thyroid gland, leading to symptoms such as weight loss, heat intolerance, and fatigue, rather than solely difficulty sleeping. Option B) ADHD (Attention-Deficit/Hyperactivity Disorder) can present with hyperactivity and impulsivity, but the primary issue is not related to difficulty falling asleep. Children with ADHD may have sleep problems, but the behavior described is more indicative of behavioral insomnia. Option D) sleep-onset association disorder is a condition where a child associates falling asleep with certain conditions or objects. While this could contribute to difficulty falling asleep, the scenario described is more aligned with behavioral insomnia where the child actively resists going to bed. Educationally, understanding common pediatric sleep disorders is crucial for healthcare providers working with children and families. Recognizing the signs and symptoms of different disorders helps in accurate diagnosis and appropriate intervention. Behavioral interventions and sleep hygiene practices are key in managing behavioral insomnia in children, emphasizing the importance of establishing healthy bedtime routines.