Five pediatrics questions with answers
Cover the key. Write the first action. Then open the rationale and name why the other choices fail.
Question 1
What should be included in the teaching plan for parents of an infant diagnosed with phenylketonuria (PKU)?
- A. Mental retardation occurs if PKU is untreated.
- B. Testing for PKU is done immediately after birth.
- C. Treatment for PKU includes lifelong dietary management.
- D. PKU is transmitted by an autosomal recessive gene.
Show answer and rationale
Correct answer: A — Mental retardation occurs if PKU is untreated.
The correct answer is A: 'Mental retardation occurs if PKU is untreated.' Phenylketonuria (PKU) is a metabolic disorder that, if left untreated with dietary management, can lead to severe mental retardation due to the accumulation of phenylalanine. It is crucial for parents to understand the potential consequences of untreated PKU to emphasize the importance of early and consistent treatment. Choice B is incorrect because testing for PKU is typically done through newborn screening shortly after birth, not immediately. Choice C is incorrect as treatment for PKU primarily involves strict dietary management that restricts phenylalanine intake, not lifelong medications. Choice D is incorrect as PKU is inherited in an autosomal recessive pattern, meaning that both parents must pass on a mutated gene for the disorder to manifest.
Question 2
A nurse is working with an active labor patient who is in preterm labor and has been designated as high risk. The patient is very apprehensive and asks the nurse, “Is everything going to be all right?†The nurse replies, “Yes, everything will be okay.†Following delivery via an emergency cesarean birth, the newborn undergoes resuscitation and does not survive. The patient is distraught over the outcome and blames the nurse for telling her that everything would be okay. Which ethical principle did the nurse violate?
- A. Autonomy N R I G B.C M U S N T O
- B. Fidelity
- C. Beneficence
- D. Accountability
Show answer and rationale
Correct answer: C — Beneficence
The correct answer is C: Beneficence. The nurse violated the ethical principle of beneficence by providing false reassurance to the patient, leading to unrealistic expectations and potential harm. Beneficence is about acting in the best interest of the patient and ensuring their well-being. By misleading the patient, the nurse failed to uphold this principle.
A: Autonomy is the right of the patient to make their own decisions. The nurse did not directly violate the patient's autonomy in this scenario.
B: Fidelity is about being faithful to commitments and promises. The nurse did not violate fidelity, as there was no explicit promise made that was broken.
D: Accountability is about taking responsibility for one's actions. While accountability is important, it is not the primary ethical principle violated in this case.
Question 3
In which condition is breastfeeding contraindicated?
- A. Triplet birth
- B. Flat or inverted nipples
- C. Human immunodeficiency virus infection
- D. Inactive, previously treated tuberculosis
Show answer and rationale
Correct answer: C — Human immunodeficiency virus infection
The correct answer is C: Human immunodeficiency virus infection. Breastfeeding is contraindicated in this condition due to the risk of vertical transmission of the virus to the infant through breast milk. HIV can be present in breast milk, increasing the risk of infection to the baby. This is supported by guidelines from organizations such as WHO.
Choices A, B, and D are incorrect:
A: Triplet birth is not a contraindication for breastfeeding; it may require additional support but is not a direct contraindication.
B: Flat or inverted nipples may pose initial challenges but can be addressed with proper latch techniques or the use of aids like nipple shields.
D: Inactive, previously treated tuberculosis does not contraindicate breastfeeding as long as the mother has completed treatment and is not actively infectious.
Question 4
Congenital heart defects have traditionally been divided into acyanotic or cyanotic defects. Based on the nurse's knowledge of congenital heart defects, this system in clinical practice is
- A. helpful because it explains the hemodynamics involved
- B. helpful because children with cyanotic defects are easily identified
- C. problematic because cyanosis is rarely present in children
- D. problematic because children with acyanotic heart defects may develop cyanosis
Show answer and rationale
Correct answer: D — problematic because children with acyanotic heart defects may develop cyanosis
The classification system of congenital heart defects into acyanotic or cyanotic defects is problematic because children with acyanotic heart defects may develop cyanosis, complicating the differentiation. Cyanosis can occur in some acyanotic defects due to various reasons such as right-to-left shunting or decreased pulmonary blood flow, making the classification based solely on cyanosis misleading. Choice A is incorrect because while the classification may involve hemodynamics, the main issue lies in the potential for acyanotic defects to develop cyanosis. Choice B is incorrect as the ease of identifying children with cyanotic defects does not address the main problem with the classification system. Choice C is also incorrect as the presence of cyanosis is not the only factor determining the classification's validity.
Question 5
A 13-year-old girl tells the nurse at the pediatric clinic that she took a pregnancy test and it was positive. She adds that her grandfather, with whom she, her younger sisters, and her mother live, has repeatedly molested her for the past 3 years. When the nurse asks the girl if she has told this to anyone, she replies, 'Yes, but my mother doesn't believe me.' Legally, who should the nurse notify?
- A. Police regarding a potential sex crime
- B. Health care provider to confirm the pregnancy
- C. Child Protective Services for immediate intervention
- D. The girl's mother about the positive pregnancy test result
Show answer and rationale
Correct answer: C — Child Protective Services for immediate intervention
In cases of child abuse and ongoing molestation, as described in the scenario, the primary concern is the safety and well-being of the child. Child Protective Services should be notified immediately for intervention to protect the girl and other children in the household from further harm. The police may be involved later to investigate the criminal aspect of the abuse. Notifying the healthcare provider solely to confirm the pregnancy or informing the girl's mother about the positive test result does not address the urgent need for intervention and protection from abuse. Child Protective Services are trained to handle such cases and provide the necessary support and protection for the child and other vulnerable individuals in the family. Immediate action is crucial to ensure the girl's safety and prevent further harm.
