A breastfeeding infant, screened for congenital hypothyroidism, is found to have low levels of thyroxine (T4) and high levels of thyroid stimulating hormone (TSH). Which is the best explanation for this finding?

The TSH is high because of the low production of T4 by the thyroid.

The thyroxine level is low because the TSH level is high.

The thyroid gland does not produce normal levels of thyroxine for several weeks after birth.

High thyroxine levels normally occur in breastfeeding infants.

Answer and Explanation

The Correct Answer is A

In a normal infant, T4 levels increase after birth due to stimulation by TSH from the pituitary gland. In this case, the T4 level is low and the TSH level is high, indicating that the thyroid gland is not producing enough T4 in response to TSH stimulation. This suggests that the infant may have congenital hypothyroidism, which requires prompt treatment to prevent developmental delays and other complications.

The low T4 level is not a direct cause of the high TSH level; rather, the high TSH level is a compensatory mechanism to increase T4 production. It is not normal for a breastfeeding infant to have high thyroxine levels. While the thyroid gland may take a few weeks to reach normal function after birth, the persistent low T4 and high TSH levels in this infant suggest a more serious issue.

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Correct Answer is A

Explanation

Children with autism spectrum disorder may have difficulty with sensory processing, social interactions, and communication, which can contribute to feeding difficulties and failure to thrive. Providing structured meal times is an important intervention to help establish a routine and promote consistency and predictability.

Structured meal times involve setting a specific time for meals and snacks, providing a calm and quiet environment, and limiting distractions. This can help the child focus on the task of eating and reduce sensory overload that may interfere with feeding. The nurse should also ensure that the child is seated comfortably and at an appropriate height for feeding.

Oﬀering food even if disinterested (B), incorporating play during meals (C), and allowing multiple food choices (D) are not necessarily helpful interventions for a toddler with autism spectrum disorder and failure to thrive. Oﬀering food when the child is not interested may reinforce negative feeding behaviors and can contribute to further feeding difficulties. Incorporating play during meals may distract the child from the task of eating and can be counterproductive. Allowing multiple food choices can be overwhelming for the child and may not promote a consistent and structured feeding routine.

Therefore, the nurse should prioritize providing structured meal times as an important intervention for promoting feeding and growth in a toddler with autism spectrum disorder and failure to thrive.

A. Repair should be done before the child is potty-trained. B. The urethral repair should be done after sexual maturity. C. Surgery should be done by one month to prevent bladder infections. D. Delaying the repair until school age reduces castration fears.

Correct Answer is A

Explanation

Answer: A

Rationale:

(A) Repair should be done before the child is potty-trained: Surgical correction of hypospadias is typically recommended before the child reaches the age of 18 months, ideally between 6 and 12 months. This timing ensures that the child has not yet developed any psychological awareness of the surgery and helps avoid complications during toilet training. Repair before potty training is important to prevent urinary dysfunction and psychosocial issues.

(B) The urethral repair should be done after sexual maturity: Delaying surgical repair until after sexual maturity is not recommended. Early repair is crucial to ensure normal urinary and sexual function, and delaying it could lead to complications such as difficulty with urination and psychological distress.

(C) Surgery should be done by one month to prevent bladder infections: While preventing urinary tract infections is important, performing surgery as early as one month is not typically necessary or recommended. The optimal timing is closer to 6 to 12 months of age when the child is more resilient to surgery but still before the developmental milestones of potty training.

(D) Delaying the repair until school age reduces castration fears: Delaying the surgery until school age can actually increase psychological stress and fear of castration. Early surgical correction is preferred to minimize psychological impact and to allow the child to develop normally without the need for complex explanations or fear of surgery later in life.

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A breastfeeding infant, screened for congenital hypothyroidism, is found to have low levels of thyroxine (T4) and high levels of thyroid stimulating hormone (TSH). Which is the best explanation for this finding?

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Naxlex Comprehensive Predictor Exams

The nurse is caring for a toddler with autism spectrum disorder and failure to thrive. Which intervention should the nurse implement?

Correct Answer is A

Explanation

The parents of a newborn infant with hypospadias are concerned about when the surgical correction should occur. Which information should the nurse provide?

Correct Answer is A

Explanation

The parents of a child with Wilms tumor ask the nurse why surgery is necessary before a biopsy is performed. Which information should the nurse provide?

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