Pediatric Nursing MCQ Quiz - Objective Question with Answer for Pediatric Nursing - Download Free PDF

• Play therapy is a psychotherapeutic approach specifically designed for children to help them express their emotions, thoughts, and experiences through play activities rather than verbal communication. This is particularly beneficial for children who prefer solitary activities or have difficulty expressing themselves verbally.
• Children who engage in solitary activities may use play as a safe and non-threatening medium to explore their emotions, work through their challenges, and develop social and emotional skills.
• The therapist observes the child's play behavior, interacts when appropriate, and uses these interactions to address the child's emotional and psychological needs in a supportive manner.
• Play therapy is effective in addressing a variety of issues, including anxiety, trauma, behavioral problems, and difficulty in social interaction, making it ideal for children who prefer being alone.

• Rationale: Family therapy focuses on improving communication, relationships, and dynamics within a family unit. While it can be beneficial for addressing family-wide issues, it is not specifically tailored to children who prefer solitary activities or struggle with individual emotional expression.

• Rationale: Art therapy involves using creative expression, such as drawing, painting, or sculpting, to explore emotions and experiences. While it can help children express themselves, it may not engage solitary children as effectively as play therapy, which uses a broader range of interactive activities tailored to their natural preferences.

• Rationale: CBT is a structured, goal-oriented form of therapy that focuses on identifying and changing negative thought patterns and behaviors. While it is highly effective for older children and adults, it relies heavily on verbal communication and cognitive skills, which may not be suitable for younger children or those who prefer solitary activities.

• Rationale: In the given question, there is no fifth option provided, so it does not apply to this explanation.

• Play therapy is the most suitable option for children who prefer being alone and engage in solitary activities. It provides a non-verbal, safe, and engaging way for children to express themselves and address emotional or psychological challenges.

• Severe stunting is a critical indicator of chronic malnutrition in children, which results from prolonged nutritional deficiencies or recurrent illnesses during early growth and development.
• According to the World Health Organization (WHO) standards, severe stunting is classified when a child’s height-for-age Z-score (HAZ) is less than -3. This means the child’s height is significantly below the median height for their age and sex, as per the WHO Child Growth Standards.
• The Z-score compares a child’s height to a reference population, with a score of 0 representing the median. A Z-score less than -3 indicates a child is in the lowest 0.13% of the population for height, suggesting severe growth retardation.

• Rationale: This Z-score range represents moderate stunting, not severe stunting. While children with HAZ less than -2 are still considered malnourished, their growth deficit is less severe than those with HAZ less than -3.

• Rationale: A Z-score less than -1 does not indicate stunting. It may suggest a slight deviation from the median height, but it does not fall into the categories of moderate or severe stunting.

• Rationale: This range represents children who are slightly below average for height but do not meet the threshold for stunting (moderate or severe). These children may not be classified as malnourished but could still benefit from monitoring.

• Stunting is a significant public health concern, as it is associated with impaired cognitive and physical development, reduced productivity, and increased risk of chronic diseases in adulthood.
• Addressing stunting involves improving maternal nutrition, ensuring adequate infant and young child feeding practices, providing access to healthcare, and addressing underlying factors such as poverty and food insecurity.
• WHO recommends monitoring height-for-age Z-scores as part of regular child health assessments to identify and address stunting early.

• Hypertrophic Pyloric Stenosis (HPS) is a condition in infants where the pylorus (the opening from the stomach to the small intestine) becomes abnormally thickened, leading to obstruction of gastric emptying.
• Projectile non-bilious vomiting is the cardinal sign of HPS. This occurs because the thickened pylorus prevents food from moving from the stomach to the intestines. Vomiting is non-bilious because the obstruction is proximal to the duodenum, where bile would normally be mixed with gastric contents.
• Metabolic alkalosis is a common symptom of HPS. Repeated vomiting leads to loss of stomach acid (hydrochloric acid), resulting in an imbalance in acid-base levels and causing alkalosis.
• Other associated symptoms include visible gastric peristalsis (wave-like stomach movements) and failure to thrive due to inadequate nutrition intake.

• HPS typically presents in infants between 2-6 weeks of age and is more common in males. Diagnosis is confirmed using ultrasound imaging, which reveals the thickened pyloric muscle.
• Treatment involves surgical intervention, specifically a pyloromyotomy, which relieves the obstruction by splitting the thickened pyloric muscle.

• Rationale: Bilious vomiting (vomit containing bile) indicates an obstruction distal to the duodenum, not proximal as seen in HPS. Diarrhea is not a typical symptom of HPS, as the obstruction prevents food from reaching the intestines.

• Rationale: Bloody stools and abdominal distension are more characteristic of conditions like intussusception or necrotizing enterocolitis. These symptoms are not associated with HPS.

• Rationale: While dehydration may occur due to fluid loss from vomiting, constipation is not a defining feature of HPS. The primary symptom is vomiting, not bowel movement abnormalities.

• Projectile non-bilious vomiting and metabolic alkalosis are the hallmark signs and symptoms of Hypertrophic Pyloric Stenosis. Early recognition and surgical treatment are crucial for preventing complications and ensuring recovery.

• Kangaroo Mother Care (KMC) is a method of care for preterm or low birth weight infants. It involves skin-to-skin contact between the mother (or caregiver) and the infant, and it is known to provide significant benefits for the baby's growth, development, and overall health.
• KMC should ideally be continued until the infant reaches a weight of around 2500 grams. At this weight, the baby is considered to have achieved a sufficient level of maturity and growth to maintain body temperature, immunity, and other physiological functions without the need for constant skin-to-skin contact.
• The practice of KMC helps in regulating the infant's body temperature, promoting breastfeeding, improving bonding between the mother and child, and reducing the risk of infections. These benefits are particularly important for preterm infants, who are more vulnerable to complications.

• Rationale: While KMC can be initiated for infants weighing as little as 1500 grams or even less, discontinuing KMC at this weight would be premature. At 1500 grams, the infant's physiological systems are still underdeveloped, and they continue to benefit significantly from KMC.

• Rationale: Although some benefits of KMC may be achieved by the time the baby reaches 2000 grams, it is still recommended to continue KMC until the baby reaches 2500 grams. This ensures the baby has achieved more stability in terms of thermoregulation and immunity.

• Rationale: KMC is typically not required to be continued until 3000 grams. By this weight, the infant would have reached a level of maturity and growth where the benefits of KMC, such as thermoregulation and immunity support, are no longer as critical.

• KMC is a highly beneficial practice for preterm or low birth weight infants, helping to improve their growth, health, and overall outcomes. The recommended weight to discontinue KMC is around 2500 grams, as this indicates the infant has achieved sufficient stability and maturity.
• Continuing KMC until this weight ensures that the baby receives the maximum possible benefits, including better thermoregulation, reduced infection risk, and enhanced bonding with the caregiver.

• Pyloric stenosis is a condition where the pylorus (the opening between the stomach and the small intestine) becomes narrowed, obstructing the passage of food. It often presents in infants with symptoms such as projectile vomiting, leading to the loss of stomach contents, which are rich in hydrochloric acid (HCl).
• The persistent vomiting in pyloric stenosis results in the loss of HCl, which is a crucial component of stomach acid. This leads to a decrease in hydrogen ion concentration (H+) in the blood, causing the pH to rise, and subsequently resulting in metabolic alkalosis.
• Additionally, the vomiting leads to dehydration and a decrease in circulating blood volume. This triggers the renin-angiotensin-aldosterone system (RAAS), which promotes sodium reabsorption and potassium excretion in the kidneys. The loss of potassium further contributes to the alkalosis.

• Metabolic alkalosis is characterized by an elevated blood pH (>7.45) and an increase in serum bicarbonate levels. This condition is commonly associated with excessive vomiting, diuretic use, and overuse of antacids.
• Clinical symptoms may include lethargy, irritability, muscle cramps, and, in severe cases, arrhythmias due to electrolyte imbalances.
• Management of metabolic alkalosis typically involves addressing the underlying cause (e.g., correcting the pyloric stenosis via surgical intervention) and replenishing lost electrolytes, such as potassium and chloride.

• Rationale: Respiratory acidosis occurs when there is hypoventilation or impaired gas exchange in the lungs, leading to an accumulation of carbon dioxide (CO2). This condition is unrelated to vomiting or pyloric stenosis, as the primary issue is metabolic, not respiratory.

• Rationale: Respiratory alkalosis is caused by hyperventilation, which leads to excessive exhalation of CO2 and an increase in blood pH. This condition is unrelated to the loss of stomach acid due to vomiting, as the primary issue in pyloric stenosis is metabolic, not respiratory.

• Rationale: Metabolic acidosis occurs due to an accumulation of acid or a loss of bicarbonate in the body (e.g., in diarrhea or kidney failure). In pyloric stenosis, however, the loss of acid through vomiting leads to alkalosis rather than acidosis.

• The prolonged vomiting associated with pyloric stenosis results in metabolic alkalosis due to the loss of hydrochloric acid and subsequent electrolyte imbalances. Understanding the pathophysiology of this condition is critical for proper diagnosis and treatment.

Concept:

• Breast milk : Produced by the mammary glands of the lactating mother.
• Used to provide nutrition to the infant.
• Colostrum -> Provides important nutrients and elements of innate immunity to the infant -> Maternal antibodies.

Explanation:

• Breast milk can be stored at room temperature for 4 hours.
• Breast milk storage bags and food - grade containers -> Used to store breast milk.
• The storage time in a refrigerator is 4 days.
• Need -> Can be fed to the baby -> When he is hungry.

• The recommended compression-to-ventilation ratio for neonatal resuscitation is 3:1. This means that for every three chest compressions, one ventilation (breath) should be given.
• This ratio is designed to optimize both circulation and ventilation in the critical moments of neonatal resuscitation.
• The higher frequency of compressions relative to ventilations helps to ensure adequate cardiac output and perfusion, which is critical for the survival of a neonate in distress.
• This ratio is based on the specific physiological needs of neonates, who generally require more frequent ventilation support than older children and adults during resuscitation.

• Rationale: A 1:1 ratio would provide insufficient compressions relative to ventilations and does not meet the standard guidelines for neonatal resuscitation.

• Rationale: A 1:2 ratio is not recommended for neonates and would similarly provide an inappropriate balance of compressions and ventilations.

• Rationale: This ratio would be too heavily weighted toward compressions and provide insufficient ventilations for a neonate in distress.

• The correct compression-to-ventilation ratio for neonatal resuscitation is 3:1. This ratio ensures the appropriate balance of chest compressions and ventilations to support the physiological needs of neonates during resuscitation.

Concept:-

Examination of the newborn:

Complete physical examination should be done within 24 hours after birth. Including the following:

1. Vital signs
2. Physical examination
3. Neurological examination
4. Estimation of gestation age  

Newborn examination:

Concept:

• Birth weight of baby quadruples from 2 to 2 1/2 years of age (based on weight at birth).
• A newborn's normal weight is between 2.5 and 3.5 kg. If the weight of the baby is slightly more than 3.5 kg it is considered to be normal. If the baby weighs less than 2.5 kg, then the baby is said to have a low birth weight.

Additional Information

• The weight of newborn babies usually doubles by about 5 months of age. 
• Birth weight of the baby triples by 12 months of age.
• Height doubles between 3 and 4 years old.

Explanation:-

• The height doubles between the age of 4 years old. 

Additional Information

• Neonatal Height triples by 13 years old (based on height at birth).
• Physical growth is especially very fast during the first 2 years. Usually, an infant's birth weight generally doubles within 5 months and triples by the infant's first birthday.
• Also baby grows between 10 and 12 inches in length (or height), and the baby's proportions change during the first 2 years.
• A baby's length is measured usually from the top of their head to the bottom of one of their heels. It's the same as their height, but height is measured standing up, whereas length is measured when the baby is lying down.
• The average length at birth for a full-term baby is 19 to 20 inches or 50 cm.

Explanation

• Dehydration occurs when an infant or child loses so much body fluid that they are not able to maintain ordinary function. 
• Dehydration may happen because of vomiting, diarrhoea, fever or not drinking enough water. 

Some signs of dehydration in infants:

• Dry tongue and dry lips
• No tears when crying
• Depressed fontanelle
• Drowsiness
• Sunken eyes
• Dry and wrinkled skin
• Deep, rapid breathing
• Cool and blotchy hands and feel

 Important PointsDehydration can lead to serious complications, including:

• Heat injury
• Urinary and kidney problems
• Seizures
• Low blood volume shock (hypovolemic shock)

Additional Information ORT (Oral rehydration therapy) is the giving of fluid by mouth to prevent and/or correct the dehydration that is a result of diarrhoea.  As soon as diarrhoea begins, treatment using home remedies to prevent dehydration must be started. If adults or children have not been given extra drinks, or if in spite of this dehydration does occur, they must be treated with a special drink made with oral rehydration salts (ORS).

Dehydration can usually be treated at home, but severe cases may require hospitalization. Hospital care may include:

• Fluids are given intravenously (IV).
• Monitoring of electrolytes imbalance.
• Acetaminophen for fever.
• Rest.

Pneumonia: It is a lung infection caused by virus, bacteria and other micro-organisms.

causative organisms:

• Respiratory Syncytial Virus (most common); Streptococcus Aureus; Streptococcus Pneumoniae etc.

Clinical Manifestations:

• Tachypnea 
  • Respiratory Rate (RR) of 
    • RR > 60 breathes per minute in Neonate
    • RR > 50 bpm in infants 
    • RR > 40 bpm in children of 1 to 5 years of age
• Fever with chills
• Stridor i.e. horse noise on inspiration
• Grunting i.e. short and repetitve sound on expiration
• Nasal flaring
• In severe cases child may present with:
  • altered sensorium
  • Cynosis i.e. Spo2 < 90%

Diagnostic tests: 

• Blood test
• Sputum Culture
• Chest X ray
• Pulse Oximetry

Clinical Management: Broad spectrum antibiotics and symptomatic treatment

Booster Dose:

• Normal Respiratory Rate (RR)
  • Neonate:  30-60 breathes per minute (bpm)
  • Infants : 24-30 bpm
• Pneumonia is one of the leading cause of death among Children below the age of 5 years.
• Pneumonia can be prevented by immunization; adequate nutrition and modifying environmental factors.

Concept:

• Vitamin A is an over-the-counter vitamin that is naturally present in many foods.
• Vitamin A is important for normal vision, the immune system & reproduction.
• Vitamin A also helps the heart, lungs, kidneys and other organs work properly. 'There are two different types of Vitamin A, first preformed Vitamin A, is found in meat, poultry, fish, and dairy products.
• The second, Provitamin A, is found in fruits, vegetables & other plant-based products, most common type of provitamin is Beta-carotene.
• Vitamin A is available under the following different brand names: Retinol, Aquasol & Retinyl Palmitate.

Explanation:

• Vitamin A Supplementation Schedule  for Indian Children:
• Vitamin A ( 1st dose) at 9 completed months with measles- Rubella: 1 ml ( 1 lakh IU)  administered orally.
• Vitamin A ( 2nd dose) 16 to 18 months. Then one dose every 6 months up to the age of 5 years: 2ml ( 2lakh IU) is administered orally.

Additional Information

• The function of Vitamin A:
• Contributes to the production of retinal pigments.
• Required for the normal functioning of epithelial and glandular tissues.
• Supports growth, especially skeletal growth.
• It is anti-infective.
• Deficiency of Vitamin A leads to:
• Night blindness
• Conjunctival xerosis
• Bitot's spot
• Keratomalacia

Concept:

• Stunting is the impaired growth and development of the child.
• It is a disorder of malnutrition.

Explanation:

• Stunting -> low height-for-age.
• Causes:
  • Chronic or recurrent under-nutrition
  • Usually associated with poverty
  • Poor mental health and nutrition
  • Frequent illness and/or inappropriate feeding and care in early life.
• Stunting prevents children from reaching their physical and cognitive potential.
• Treatment:
  • Diet Planning
  • Antibiotics for infection
  • Anthelmintic drugs
  • Health education

Additional Information

• Rest of all options fall under underweight.
• An underweight person is a person whose body weight is considered too low to be healthy (BMI - less than 18.5).