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

• It is normal for newborns to lose weight in the first few days of life. This physiological weight loss occurs due to the loss of excess fluid accumulated during pregnancy and birth.
• Typically, newborns may lose about 5-10% of their birth weight by day 3-5 of life. This weight is generally regained by the end of the second week as feeding patterns stabilize and the baby grows.
• The nurse reassuring the mother that this is normal helps alleviate her concerns and provides emotional support during this critical period of adjustment for both mother and baby.
• This reassurance also encourages the mother to continue focusing on feeding and bonding with the baby rather than worrying unnecessarily about weight loss.

• Breastfed babies may lose slightly more weight compared to formula-fed babies due to the natural learning curve of breastfeeding, but this is still within the normal range.
• Monitoring the baby's hydration status, urine output, and overall activity is important during this period to ensure the baby is thriving despite the weight loss.

• Rationale: While it is crucial to assess the newborn for anomalies if there are other concerning symptoms (e.g., lethargy, poor feeding, or dehydration), weight loss alone on day 3 is typically physiological and does not warrant immediate clinical investigation unless it exceeds the normal range (more than 10% of birth weight).

• Rationale: Increasing feeding frequency may be helpful in some cases, but it is not the primary response to normal newborn weight loss. Feeding should be encouraged as per the baby's hunger cues, and undue pressure on the mother to feed excessively may lead to stress or frustration.

• Rationale: Weight loss within the normal range does not require immediate medical intervention. Informing the doctor may be necessary if the weight loss exceeds 10% of the birth weight or if there are other concerning signs, but this is not the case for normal physiological weight loss.

• The correct response to a mother's concern about normal newborn weight loss is to reassure her that this is normal, provide education about physiological weight loss, and encourage her to focus on regular feeding and bonding with the baby.
• Other options may be applicable in specific cases with abnormal weight loss or additional symptoms, but they are not appropriate for normal physiological newborn weight loss.

• Phototherapy is a treatment commonly used for neonatal hyperbilirubinemia, which occurs due to elevated bilirubin levels in the blood. It helps in breaking down excess bilirubin in the skin using light exposure, preventing complications like kernicterus (brain damage).
• During phototherapy, it is crucial to protect sensitive areas of the baby's body from potential damage caused by prolonged light exposure. The eyes are particularly vulnerable, as phototherapy light can harm the retina. Therefore, the baby's eyes must be covered with protective patches or shields.
• The genital area is another sensitive region that must be covered to avoid tissue irritation or damage during phototherapy. Prolonged exposure to light can lead to skin irritation or damage in this area.
• Covering these regions ensures that the phototherapy treatment is both effective and safe for the newborn.

• Rationale: While the eyes need protection during phototherapy, the abdomen does not require covering as it is not particularly vulnerable to tissue damage from light exposure. Covering the abdomen unnecessarily could reduce the effectiveness of the treatment by limiting light exposure to areas where bilirubin is present.

• Rationale: The extremities (arms and legs) do not require covering during phototherapy. Exposing these areas to light is essential for effective treatment, as bilirubin is distributed throughout the skin. Covering the extremities would hinder the therapeutic process.

• Rationale: While the genital area does require protection, the abdomen does not need covering during phototherapy. Covering the abdomen would interfere with the light's ability to break down bilirubin in that region, reducing the effectiveness of the treatment.

• The correct approach during phototherapy is to cover the baby's eyes and genital area to prevent tissue damage while allowing maximum light exposure to other parts of the body to effectively reduce bilirubin levels. This ensures the treatment is both safe and effective.

• Vitamin K plays a crucial role in the process of blood clotting (coagulation). Without sufficient levels of Vitamin K, the body cannot produce certain clotting factors that are necessary to prevent bleeding.
• Newborns are at risk for Vitamin K deficiency because they are born with low levels of Vitamin K. This is due to limited placental transfer of Vitamin K during pregnancy and the lack of gut bacteria in the newborn's intestines to produce it naturally.
• Administering Vitamin K to newborns helps to prevent a rare but serious condition called Vitamin K Deficiency Bleeding (VKDB), which can cause uncontrolled bleeding in the brain or other parts of the body.
• Vitamin K is typically given as an injection shortly after birth to ensure the baby has adequate levels for proper blood clotting until their gut bacteria begin producing it naturally.

• Rationale: While Vitamin K is synthesized by gut bacteria in older children and adults, it does not directly play a role in the process of gut maturation. Newborns lack sufficient gut bacteria at birth, which is why they cannot produce Vitamin K on their own initially.

• Rationale: Vitamin K is unrelated to the immunization process. Immunizations involve stimulating the immune system to develop immunity against specific diseases, which is not influenced by Vitamin K levels.

• Rationale: Vitamin K does not play a direct role in brain growth or development. Brain growth is influenced by other factors such as adequate nutrition, oxygen supply, and essential nutrients like DHA and iron.

• Vitamin K is primarily given to newborns to support the coagulation of blood and prevent Vitamin K Deficiency Bleeding (VKDB). It does not contribute to gut maturation, immunization processes, or brain growth.

• Athlete's Foot, medically known as Tinea Pedis, is a fungal infection caused by dermatophytes. These fungi thrive in warm, moist environments such as locker rooms, showers, and sweaty shoes, making the feet vulnerable to infection.
• This condition primarily affects the soles of the feet and the skin between the toes, leading to symptoms such as scaliness, itching, redness, and cracking of the skin. If left untreated, it can progress to more severe infections.
• It is highly contagious and can spread through direct contact with contaminated surfaces or objects. Preventive measures include maintaining good foot hygiene, keeping feet dry, wearing breathable footwear, and avoiding sharing personal items like towels and socks.
• Treatment typically involves antifungal medications, either topical creams or oral drugs, depending on the severity of the infection. Over-the-counter antifungal creams like clotrimazole or terbinafine are commonly used.
• In severe or recurrent cases, consultation with a healthcare provider is recommended for proper diagnosis and advanced treatment options.

• Rationale: Paronychia is a bacterial or fungal infection of the skin around the nails, often caused by injury or excessive moisture. It does not affect the soles or the skin between the toes, distinguishing it from Athlete's Foot.
• Symptoms include redness, swelling, and pain around the nail, sometimes accompanied by pus formation. Treatment involves antibiotics or antifungal medications, depending on the cause.

• Rationale: Corns are thickened layers of skin that develop due to repeated pressure or friction, often on the toes or feet. They are not caused by fungal infections and do not exhibit symptoms like itching, redness, or cracking of the skin.
• Treatment involves reducing pressure on the affected area, using protective pads, or visiting a podiatrist for removal.

• Rationale: Calluses are similar to corns but cover larger areas of skin, usually on the soles of the feet. They result from prolonged pressure or friction and are not related to fungal infections.
• Treatment includes moisturizing the area, using pumice stones to reduce thickness, and wearing comfortable footwear to prevent recurrence.

• Athlete's Foot is the only condition among the given options caused by a fungal infection and characterized by scaliness, cracking, and irritation of the skin on the sole and between the toes. Preventive measures and appropriate treatment are crucial to managing this common and contagious condition.

The correct answer is less than 2500g or 2.5Kg.

Key Points

• Low birth weight (LBW) in infants is defined by the World Health Organization (WHO) as a birth weight of less than 2500 grams (2.5 kg), irrespective of gestational age.
• This classification is important as low birth weight is associated with higher risks of neonatal mortality, morbidity, and long-term health issues.
• Globally, an estimated 15-20% of all births result in low birth weight infants, with the majority occurring in developing countries.
• Key factors contributing to low birth weight include premature birth (before 37 weeks of gestation) and intrauterine growth restriction (IUGR), which can result from maternal health issues, malnutrition, or other complications.
• Programs such as maternal nutritional support and antenatal care are critical in addressing and reducing incidences of low birth weight.

Additional Information

• World Health Organization (WHO) Definition:
  • Low birth weight is defined as a weight of less than 2500 grams (5.5 pounds) measured within the first hour of life.
  • This definition is globally recognized for monitoring and assessing infant health outcomes.
• Impact of Low Birth Weight:
  • LBW infants are at higher risk of developing infections, malnutrition, and delayed developmental milestones.
  • In adulthood, they are more prone to non-communicable diseases such as diabetes, hypertension, and cardiovascular conditions.
• Causes of Low Birth Weight:
  • Prematurity: Birth before 37 weeks of gestation often results in lower birth weight.
  • Intrauterine Growth Restriction (IUGR): Poor growth of the fetus due to maternal health, nutritional deficiencies, or placental issues.
  • Other causes include maternal infections, multiple pregnancies (twins/triplets), and lifestyle factors like smoking or substance abuse.
• Prevention and Management:
  • Adequate maternal nutrition, regular antenatal care, and early detection of complications are essential for reducing LBW rates.
  • Kangaroo Mother Care (KMC) is an effective method to provide warmth and promote weight gain in LBW infants.
  • Supplementary feeding and monitoring of growth are crucial for ensuring long-term health of LBW infants.

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:-

• Vitamin C, also known as ascorbic acid, is a water-soluble nutrient that plays a vital role in most of a baby's bodily functions.
• To maintain a healthy immune system it is necessary to increase the absorption of iron and produce collagen, which is the most abundant protein in the human body.
• Vitamin C is an essential nutrient, which means a baby's body cannot make it on its own. Therefore, they get it from the foods they eat every day.
• Vitamin C is a vital nutrient that supports immunity and collagen production. It also acts as an antioxidant which babies need 30-40 mg of vitamin C per day depending on their age.