Pediatrics NUR 335 Exam Questions

Correct Answer: B) Family history of respiratory disorders and siblings with respiratory distress or death.

The primary focus when evaluating neonatal respiratory distress includes family history of respiratory disorders and any history of siblings or family members with significant respiratory distress or death during the neonatal period. This information can help identify genetic conditions or recurrent respiratory issues in the family that might contribute to the neonate's condition.

Why Other Options are Wrong:

A) Maternal age and dietary habits during pregnancy.

While maternal history is important, the focus is on factors such as gestational age, infection, bleeding, and amniotic fluid status rather than just age and diet.

C) Neonatal birth weight and postnatal feeding history.

These may provide valuable information for overall health, but respiratory distress evaluation focuses more on prenatal history, such as maternal conditions, rather than postnatal feeding.

D) Number of prenatal ultrasounds and types of prenatal vitamins taken.

The evaluation of respiratory distress is more concerned with gestational age, infection, and other prenatal factors rather than the number of ultrasounds or the types of vitamins the mother took.

Summary:

When evaluating neonatal respiratory distress, the history primarily focuses on maternal and prenatal factors, including gestational age, maternal infections, amniotic fluid status, and family history of respiratory issues or neonatal deaths. This helps identify possible genetic causes or conditions that might contribute to the neonate’s condition.

Correct Answer: b) Hypospadias or epispadias

In boys, the penis should be examined for hypospadias (a condition where the urethra opens on the underside of the penis) or epispadias (where the urethra opens on the upper side of the penis). These conditions are important to identify early, as they may require surgical correction.

Why Other Options are Wrong:

a) Testicular size:

While testicular size is important in general, the specific concern mentioned in the question relates to the penis and conditions like hypospadias or epispadias, not testicular size.

c) Skin pigmentation:

Skin pigmentation is not the primary concern when assessing the penis in boys; the focus is on conditions like hypospadias and epispadias.

d) The presence of a hydrocele:

A hydrocele (fluid-filled sac around the testicle) can be present in newborns and infants, but the question specifically asks about conditions related to the penis, not the scrotum or testes.

Summary:

During a physical exam of boys, it's essential to check for conditions such as hypospadias and epispadias to ensure proper urinary function and to guide any potential treatment if required.

Correct Answer: A. Disruptive mood dysregulation disorder (DMDD).

The description of this 10-year-old girl with persistent irritability and recurrent temper outbursts that are grossly out of proportion to the situation, occurring approximately four times a week and affecting both home and school, is most consistent with Disruptive Mood Dysregulation Disorder (DMDD).

DMDD is characterized by:

Severe temper outbursts (verbal rages or physical aggression) that are out of proportion to the situation.

These outbursts occur on average 3 or more times per week.

Irritable or angry mood that is present between outbursts.

Symptoms must be present for at least 12 months and occur in at least two settings (e.g., home, school).

Onset occurs before the age of 10 years.

Why the Other Options are Incorrect:

B. Major depressive disorder (MDD):

While irritability can be a symptom of MDD in children, the key feature of MDD is the presence of depressed mood and loss of interest or pleasure in most activities, which are not mentioned in this case. Additionally, MDD does not typically involve the frequent temper outbursts seen in DMDD.

C. Persistent depressive disorder (dysthymia):

This disorder is characterized by a chronic low mood lasting for at least 2 years (with symptoms often less severe than MDD), but it does not include the recurrent temper outbursts that are seen in DMDD. Dysthymia also involves more pervasive symptoms of depression (e.g., low energy, low self-esteem) rather than irritability alone.

D. Premenstrual dysphoric disorder (PMDD): PMDD is a severe form of premenstrual syndrome (PMS), characterized by mood swings, irritability, and other physical symptoms that occur in the luteal phase of the menstrual cycle. Since this is a 10-year-old girl, PMDD is unlikely because menstruation is not typically expected at this age.

Summary:

The most likely diagnosis for this patient, based on her persistent irritability and frequent temper outbursts that are grossly out of proportion to the situation, is Disruptive Mood Dysregulation Disorder (DMDD). This condition typically presents in children before the age of 10 and is marked by frequent outbursts and a chronic irritable mood. Other mood disorders, like major depressive disorder or persistent depressive disorder, do not typically present with the same severity of irritability and temper outbursts.

Answer: b) To check for spinal misalignment and asymmetry

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  Correct Answer: Children old enough to stand should be screened for scoliosis by observing posture, shoulder tip and scapular symmetry, torso list, and paraspinal asymmetry when children bend forward.

  
  


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  These signs help identify early indications of spinal curvature or abnormalities.

  
  

Why the other options are incorrect:

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  a) To assess for weight-bearing capacity: Scoliosis screening is focused on detecting spinal misalignment rather than evaluating weight-bearing capacity.

  
  

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  c) To monitor for abdominal growth: Abdominal growth is not a primary focus during scoliosis screening. The focus is on the spine and postural asymmetry.

  
  

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  d) To observe for muscular hypertrophy: Muscular hypertrophy would typically be observed in different contexts, such as in evaluating physical strength or muscle development, not in scoliosis screening.

  
  

Summary:

Scoliosis screening in children involves observing posture and symmetry to identify early signs of spinal misalignment, such as paraspinal asymmetry when bending forward, which is essential for early intervention.

Correct Answer: B) Spinal muscular atrophy

Spinal muscular atrophy (SMA) is a genetic disorder that affects the motor neurons in the spinal cord, leading to muscle weakness and atrophy. Unlike cerebral palsy, which is caused by brain damage, SMA primarily involves the spinal cord and motor neurons. It lacks signs of cerebral disease such as intellectual impairment or brain-related dysfunction. While SMA presents with muscle weakness and hypotonia, it doesn't typically cause the cognitive or cerebral deficits seen in CP.

Why Other Options are Wrong:

A) Lesch-Nyhan syndrome: Lesch-Nyhan syndrome is a genetic disorder caused by a deficiency in the enzyme hypoxanthine-guanine phosphoribosyltransferase (HGPRT). It leads to neurological and behavioral symptoms, including self-destructive behaviors, hyperuricemia, and motor dysfunction. Lesch-Nyhan syndrome does show signs of cerebral involvement, including motor symptoms similar to CP.

C) Tuberous sclerosis:

Tuberous sclerosis is a genetic disorder that causes benign tumors to form in various organs, including the brain. It can lead to neurological symptoms such as seizures, developmental delays, and autism spectrum disorders. It often shows cerebral involvement, and it can be confused with CP due to similar neurological symptoms.

D) von Hippel-Lindau disease:

Von Hippel-Lindau disease is a hereditary condition that causes tumors and cysts to form in various parts of the body, including the brain. Neurological manifestations such as headaches, vision problems, and ataxia may occur due to brain tumors, indicating cerebral involvement.

Summary:

When differentiating cerebral palsy from other disorders, spinal muscular atrophy (SMA) is unique in that it typically lacks signs of cerebral disease. SMA involves the motor neurons in the spinal cord, leading to muscle weakness but not cognitive or brain-related symptoms. On the other hand, conditions like Lesch-Nyhan syndrome, tuberous sclerosis, and von Hippel-Lindau disease can all present with neurological symptoms and involve the brain, thus showing signs of cerebral disease.

Correct Answer: B. A high-calorie diet.

Cystic fibrosis (CF) is a genetic disorder that affects multiple organs, primarily the lungs and digestive system.

In CF, the body has difficulty absorbing nutrients due to pancreatic insufficiency (the pancreas does not produce enough enzymes), which leads to poor digestion and malnutrition.

As a result, patients with CF often require a high-calorie diet to meet their increased energy needs, support growth, and maintain adequate weight. Additionally, high-fat and high-protein foods are typically recommended to compensate for nutrient malabsorption.

Why the Other Options are Incorrect:

A. A low-fat diet: A low-fat diet is not recommended for CF patients because fat is an important source of calories. Due to the malabsorption of fats, CF patients need higher amounts of dietary fat to ensure they receive adequate calories and nutrients.

C. Avoidance of breastfeeding in babies with cystic fibrosis: Breastfeeding is highly recommended for babies with cystic fibrosis. Breast milk provides essential nutrients, immune support, and benefits to infants with CF, helping to improve overall health and immunity. In fact, breastfeeding is encouraged in CF patients, and specialized CF nutrition plans can be introduced as needed.

D. A low-protein diet: A low-protein diet is not recommended for CF patients. They require sufficient protein to support growth, muscle mass, and overall health. Protein is crucial for tissue repair, immune function, and other body processes, which are particularly important in the context of CF.

Summary:

For patients with cystic fibrosis, a high-calorie diet (B) is recommended to compensate for the malabsorption of nutrients and to support growth and energy needs. A high-fat and high-protein diet is also necessary to meet nutritional requirements. Breastfeeding is encouraged, and low-fat or low-protein diets are not appropriate for CF patients.

Correct Answer: A. Constipation.

Nocturnal enuresis (bedwetting) can be influenced by various factors, and one of the most common contributing factors is constipation, as it can increase bladder irritability.

When the rectum is full of stool, it can put pressure on the bladder, reducing its capacity and causing urgency or incontinence. This can lead to episodes of bedwetting, especially at night.

Rationale for other options:

B. Diabetes insipidus:

Diabetes insipidus (DI) leads to excessive thirst and urination due to the kidneys' inability to concentrate urine. While it causes frequent urination, it does not specifically contribute to bladder irritability. In fact, children with DI typically urinate large amounts of dilute urine, which can result in polyuria but not directly increase bladder irritability. DI would more likely lead to daytime wetting rather than nocturnal enuresis.

C. Renal failure:

Renal failure can cause a variety of urinary symptoms, including fluid retention and changes in urination patterns, but it is not typically associated with bladder irritability that would lead to nocturnal enuresis. Chronic renal failure can cause metabolic changes and electrolyte imbalances, which might affect the kidneys' ability to concentrate urine, but it is less directly associated with increasing bladder irritability.

D. Sickle cell disease:

Sickle cell disease can lead to urinary symptoms like hematuria (blood in the urine) due to renal complications, but it is not commonly associated with bladder irritability in the way that constipation is. Sickle cell disease can affect kidney function and lead to various complications in the urinary system, but bladder irritability is not a hallmark of this disease.

Summary:

Constipation is the most common contributor to nocturnal enuresis by increasing bladder irritability. The pressure from stool in the rectum can reduce the bladder's capacity and cause urgency or incontinence. The other options listed (diabetes insipidus, renal failure, and sickle cell disease) do not typically contribute to increased bladder irritability leading to nocturnal enuresis.

Correct Answer: D) Painless, palpable abdominal mass

The most common and characteristic finding in a child with Wilms tumor is a painless, palpable abdominal mass. It is typically discovered during routine physical exams or when a caregiver notices an unusual bulge or swelling in the abdomen.

Why Other Options are Wrong

A) Abdominal pain (Incorrect):

While abdominal pain can occur in some cases, it is not the most common presenting symptom. Abdominal pain in Wilms tumor is usually not as prominent as the mass.

B) Hematuria (Incorrect):

Hematuria (blood in the urine) may be present in some cases of Wilms tumor but is not the most frequent finding. It occurs in a smaller percentage of patients compared to the abdominal mass.

C) Nausea and vomiting (Incorrect):

Nausea and vomiting can occur, particularly if the tumor causes obstruction or compression of nearby structures, but it is not the most frequent initial symptom of Wilms tumor.

Summary:

The most frequent finding in a patient with Wilms tumor is a painless, palpable abdominal mass. Other symptoms like abdominal pain, hematuria, nausea, and vomiting may occur but are less common and typically present later in the disease process. Early detection of the mass is crucial for initiating prompt treatment, leading to a better prognosis.

Correct answer: C) Monosomy

Monosomy refers to the loss of one chromosome from a pair, leading to a missing chromosome in the individual’s genetic makeup.

Why Other Options are Wrong:

A: Translocation is a structural abnormality where chromosomes or parts of chromosomes are rearranged.

B: Duplication is a structural abnormality where a portion of a chromosome is duplicated, leading to extra genetic material.

D: Deletion refers to a structural abnormality where part of a chromosome is missing.

Summary:

Numerical chromosomal abnormalities, like monosomy and trisomy, involve missing or extra chromosomes. The other options (translocation, duplication, and deletion) are examples of structural abnormalities.