Nokea
A three year old child is brought to hospital by his step mother with a 2 month history of diarrhea, poor feeding and progressive leg swelling. He also has wounds on his legs and perineum. His weight is $7 \mathrm{~kg}$. When you examine him you find he is in shock and has kwashiorkor. What is your differential diagnosis?
- A. Kwashiorkor, child abuse
- B. Celiac disease, cystic fibrosis
- C. Congestive heart failure, nephrotic syndrome
- D. Tuberculosis, HIV
Correct Answer: A
Rationale: Kwashiorkor (edema, low weight) and child abuse (cigarette burns, multiple wounds) fit the clinical picture of malnutrition and trauma.
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A two month old infant is brought to the clinic for the first immunization against DPT. The nurse should administer the vaccine via what route?
- A. Oral.
- B. Intramuscular
- C. Subcutaneous
- D. Intradermal
Correct Answer: B
Rationale: The DPT vaccine is administered intramuscularly for effective absorption.
Regarding the scenario in the question above, when would you reassess the APGAR?
- A. 2 minutes after the previous APGAR assessment
- B. 15 minutes after the previous APGAR assessment
- C. 5 minutes after the previous APGAR assessment
- D. No reassessment of the APGAR score is needed.
Correct Answer: C
Rationale: Standard practice is to reassess the APGAR score at 5-minute intervals after the initial 1-minute score, typically at 5 minutes, and again at 10 minutes if needed.
A mother is anxious about her ability to breastfeed after her child is born because of her small breast size. What would be an important point to teach this mother?
- A. Milk is produced in ducts and lobules regardless of breast size.
- B. Supplementing breastfeeding with formula allows the infant to receive adequate nutrition.
- C. Breast size can be increased with exercise.
- D. Drinking extra milk during pregnancy allows breasts to produce adequate amounts of milk.
Correct Answer: A
Rationale: Breast size does not influence the ability to secrete milk.
A couple just learned they are expecting their first child and are curious if they are having a boy or a girl. At what point of development can the couple first expect to see the sex of their child on ultrasound?
- A. 4 weeks gestational age
- B. 6 weeks gestational age
- C. 10 weeks gestational age
- D. 16 weeks gestational age
Correct Answer: C
Rationale: The fetal period begins at the ninth week, and by the tenth week the external genitalia are visible to ultrasound examination.
When discussing normal infant growth and development with parents, which of the following toys would the nurse suggest as most appropriate for an 8-month-old?
- A. Push-pull toys
- B. Rattle
- C. Large blocks
- D. Mobile
Correct Answer: C
Rationale: Because the 8-month-old is refining his gross motor skills, being able to sit unsupported and also improving his fine motor skills, probably capable of making hand-to-hand transfers, large blocks would be the most appropriate toy selection.