Nokea
In pediatric patients, what is the primary concern with untreated vesicoureteral reflux (VUR)?
- A. Recurrent UTIs
- B. Chronic renal failure
- C. Hypertension
- D. Bladder dysfunction
Correct Answer: B
Rationale: The primary concern with untreated vesicoureteral reflux (VUR) in pediatric patients is chronic renal failure. Untreated VUR can lead to this complication due to recurrent urinary tract infections and kidney damage. While recurrent UTIs (Choice A) are a common consequence of VUR, the ultimate worry is the development of chronic renal failure. Hypertension (Choice C) may occur as a result of renal damage but is not the primary concern. Bladder dysfunction (Choice D) is not the most significant consequence of untreated VUR in terms of long-term outcomes compared to chronic renal failure.
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Which pediatric disorder is associated with a 'boot-shaped' heart on a chest x-ray?
- A. Tetralogy of Fallot
- B. Transposition of the great arteries
- C. Coarctation of the aorta
- D. Ventricular septal defect
Correct Answer: A
Rationale: The correct answer is A: Tetralogy of Fallot. Tetralogy of Fallot is often associated with a 'boot-shaped' heart appearance on a chest x-ray due to the characteristic heart anatomy in this condition. This appearance is caused by the combination of pulmonary stenosis, overriding aorta, ventricular septal defect, and right ventricular hypertrophy. Choice B, Transposition of the great arteries, is incorrect because it presents with a 'egg-on-a-string' appearance on x-ray due to the abnormal position of the aorta and pulmonary artery. Choice C, Coarctation of the aorta, typically presents with rib notching on x-ray. Choice D, Ventricular septal defect, does not produce the 'boot-shaped' heart appearance seen in Tetralogy of Fallot.
What is the most common cause of acute kidney injury in children?
- A. Dehydration
- B. Glomerulonephritis
- C. Hemolytic uremic syndrome
- D. Sepsis
Correct Answer: C
Rationale: Hemolytic uremic syndrome is the most common cause of acute kidney injury in children. While dehydration can lead to prerenal acute kidney injury, it is not the most common cause in children. Glomerulonephritis is a common cause of chronic kidney disease but not typically the most common cause of acute kidney injury in children. Sepsis can lead to acute kidney injury, but in children, hemolytic uremic syndrome is more prevalent.
What clinical manifestation should be the most suggestive of acute appendicitis?
- A. Rebound tenderness
- B. Bright red or dark red rectal bleeding
- C. Abdominal pain that is relieved by eating
- D. Colicky, cramping abdominal pain around the umbilicus
Correct Answer: D
Rationale: The correct answer is D: Colicky, cramping abdominal pain around the umbilicus. This type of pain is a common early sign of acute appendicitis. Rebound tenderness, choice A, is a later sign seen in the physical examination of a patient with appendicitis. Rectal bleeding, as described in choice B, is not typically associated with appendicitis. Abdominal pain that is relieved by eating, as mentioned in choice C, is more indicative of peptic ulcer disease rather than appendicitis.
What term describes the invagination of one segment of bowel within another?
- A. Atresia
- B. Stenosis
- C. Herniation
- D. Intussusception
Correct Answer: D
Rationale: Intussusception is the correct answer. It refers to the condition where one segment of the bowel folds into another, leading to an obstruction. Atresia (Choice A) is the absence or abnormal closure of a normal opening or tubular structure. Stenosis (Choice B) is the narrowing of a passage in the body. Herniation (Choice C) is the abnormal protrusion of an organ or tissue through a defect in its surrounding walls. Intussusception is a medical emergency commonly observed in infants and young children and necessitates prompt intervention to prevent severe complications.
The nurse observes that a newborn is having problems after birth. What should indicate a tracheoesophageal fistula?
- A. Jitteriness
- B. Meconium ileus
- C. Excessive frothy saliva
- D. Increased need for sleep
Correct Answer: C
Rationale: Excessive frothy saliva is a hallmark sign of tracheoesophageal fistula. The abnormal connection between the esophagus and trachea causes difficulty in swallowing, leading to an accumulation of saliva in the mouth. This symptom is crucial for early identification and management of tracheoesophageal fistula. Choices A, B, and D are incorrect as they are not specific indicators of tracheoesophageal fistula.