You are treating a 10-month-old child with failure to thrive. Of the following, the minimal accepted catch-up weight gain is about

Correct Answer: B

Rationale: In pediatric nursing, failure to thrive is a critical issue that requires close monitoring and intervention. The correct answer, option B (20-30 gm/kg/day), is the minimal accepted catch-up weight gain for a 10-month-old child with failure to thrive. This rate of weight gain is considered appropriate for achieving catch-up growth without overloading the child's system. Option A (10 gm/kg/day) is too low for a child with failure to thrive to adequately catch up in weight gain. This rate may not provide sufficient nutritional support for the child's growth needs. Option C (40-50 gm/kg/day) and option D (60 gm/kg/day) are too high and could potentially lead to overfeeding, which may overwhelm the child's digestive system and cause other complications. Educationally, understanding the appropriate rate of weight gain in children with failure to thrive is crucial for pediatric nurses. It helps them tailor feeding plans to meet the specific needs of each child, promoting optimal growth and development. Monitoring weight gain closely and adjusting feeding strategies accordingly is essential in managing failure to thrive in pediatric patients.

Correct Answer: D

Rationale: The correct answer is D) Congenital myasthenia gravis. In this scenario, the patient's presentation of being limp with intact consciousness and lack of crying when toes are pinched is suggestive of a neuromuscular disorder affecting the skeletal muscles. Congenital myasthenia gravis is a rare genetic disorder that impairs the transmission of signals between nerves and muscles, leading to muscle weakness and fatigue. This condition can manifest in infancy with symptoms such as poor feeding, weak cry, and respiratory difficulties, which align with the patient's presentation in the question. Option A) Congenital botulism is incorrect because it typically presents with symptoms such as constipation, weak cry, poor feeding, and respiratory distress, but typically does not involve intact consciousness and awareness as seen in the patient. Option B) Narcotic overdose is unlikely in this case as it would typically result in respiratory depression, altered consciousness, and other signs of central nervous system depression, which are not evident in the scenario described. Option C) Transection of the spinal cord is unlikely given the patient's intact consciousness and awareness of the surroundings, which would not typically be present in such a severe spinal cord injury scenario. Educationally, understanding the differential diagnoses for a limp, non-crying infant after intubation and resuscitation is crucial for pediatric nurses. Recognizing the specific presentation of congenital myasthenia gravis in infants is important for prompt diagnosis and management to prevent complications and improve outcomes for these vulnerable patients. This case highlights the importance of thorough assessment, knowledge of pediatric conditions, and clinical reasoning skills in pediatric nursing practice.

Correct Answer: A

Rationale: In pediatric nursing, understanding hyperbilirubinemia in infants is crucial as it is a common condition that requires prompt assessment and management. In this scenario, the correct answer is A) Physiologic jaundice. Physiologic jaundice is a normal occurrence in newborns due to the immature liver's inability to efficiently process bilirubin. It typically appears after the first 24 hours of life, peaks around 3-5 days, and resolves within a week. It is considered a benign and self-limiting condition that does not require immediate intervention. Option B) Hypothyroidism is incorrect because hypothyroidism can present with jaundice due to decreased conjugation of bilirubin, but it usually occurs later in infancy and is not a common cause of jaundice in the first weeks of life. Option C) Pyloric stenosis is incorrect as it presents with non-bilious vomiting and failure to thrive, rather than jaundice. Option D) Biliary atresia is incorrect because it is a serious condition that presents with persistent jaundice, acholic stools, and hepatomegaly within the first few weeks of life, not at weeks of age as mentioned in the question. Educationally, understanding the differential diagnoses of hyperbilirubinemia in infants is essential for nurses to provide comprehensive care. Recognizing the differences between physiologic jaundice and pathological causes like hypothyroidism, pyloric stenosis, and biliary atresia helps in early identification and appropriate management of these conditions to prevent complications and ensure optimal outcomes for neonates.

Correct Answer: D

Rationale: In pediatric nursing, understanding the associations between psychiatric illnesses in childhood and their appropriate treatments is crucial for providing safe and effective care to young patients. In this case, the correct answer is D) Depression and atypical antipsychotic. Depression in children is typically not treated with atypical antipsychotics as first-line therapy. Antidepressants, psychotherapy, and lifestyle modifications are usually the primary modalities for managing childhood depression. Atypical antipsychotics are more commonly prescribed for conditions like schizophrenia or bipolar disorder in pediatric patients. A) ADHD and atomoxetine: Atomoxetine is a common medication used to treat ADHD by increasing the levels of norepinephrine in the brain. B) Anxiety and antidepressant: Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are often used to manage anxiety disorders in children. C) Psychosis and typical antipsychotic: Typical antipsychotics are prescribed for conditions like psychosis to help manage symptoms such as hallucinations or delusions. Educationally, it is important for pediatric nurses to have a solid understanding of psychiatric illnesses in children and the appropriate pharmacological treatments. This knowledge allows nurses to advocate for appropriate care, monitor for side effects, and educate patients and their families about the treatment plan. By understanding these associations, nurses can contribute to improved outcomes and quality of life for pediatric patients with psychiatric conditions.

Correct Answer: A

Rationale: In this scenario, the best action for a 6-year-old boy with school refusal is to refer him to a pediatric psychologist (Option A). This choice is correct because school refusal can stem from various underlying psychological issues such as anxiety, separation anxiety, or other emotional challenges. A pediatric psychologist is trained to assess and address these underlying causes through therapy and interventions tailored to the child's specific needs. Option B, starting a selective serotonin reuptake inhibitor, is not the best initial action without a comprehensive evaluation by a mental health professional. Medication should not be the first line of treatment for school refusal in a young child. Option C, assessing the home environment, is important but may not directly address the child's emotional struggles that are leading to school refusal. While environmental factors can play a role, a psychological evaluation is crucial. Option D, giving the child special attention from the teacher, is not the most appropriate response as it does not address the underlying reasons for the school refusal and may inadvertently reinforce the behavior. In an educational context, it is important for healthcare providers and educators to collaborate in understanding and addressing school refusal in children. By recognizing the psychological factors at play and involving the appropriate mental health professionals, we can provide holistic support to help the child overcome their challenges and thrive in the school environment.