Measles is a highly contagious viral illness that can cause severe complications in children, especially in those who are malnourished or vitamin A–deficient. Vitamin A supplementation has been shown to significantly reduce measles-related morbidity and mortality by enhancing immune function, supporting epithelial integrity, and reducing the risk of severe complications like pneumonia and blindness.

Rationale for correct answer:

D. Measles virus can cause severe respiratory and systemic illness. Vitamin A deficiency worsens outcomes by impairing immune defenses and tissue repair. WHO and UNICEF recommend high-dose vitamin A for all children diagnosed with measles to reduce severity and fatality rates.

Rationale for incorrect answers:

A. Pertussis caused by Bordetella pertussis, it affects the respiratory tract but does not benefit from vitamin A supplementation in terms of morbidity or mortality reduction.

B. Varicella caused by the varicella-zoster virus, this usually has a mild course in healthy children and does not require vitamin A supplementation.

C. Rubella caused by the rubella virus, it is typically mild in children; prevention is via vaccination, and vitamin A is not part of management.

Take home points

• Measles can cause severe complications such as pneumonia, diarrhea, and blindness, particularly in vitamin A–deficient children.
• WHO recommends administering vitamin A to all children with measles to reduce morbidity and mortality.
• Early recognition and supportive care, including nutritional support, are essential in measles management.

Peanut allergy is an IgE-mediated hypersensitivity reaction that can occur within minutes of exposure. Early manifestations result from histamine and other inflammatory mediators causing respiratory, gastrointestinal, skin, and cardiovascular symptoms. Recognizing these early signs is critical to prevent progression to life-threatening anaphylaxis.

Rationale for correct answers:

A. Wheezing caused by bronchospasm and airway inflammation due to histamine release in an allergic reaction.

C. Trouble breathing result from airway swelling, bronchoconstriction, and laryngeal edema which may cause dyspnea and stridor, signaling early respiratory compromise.

E. Urticaria are raised, itchy hives are a classic skin manifestation of IgE-mediated allergic reactions.

Rationale for incorrect answer:

B. Gastrointestinal symptoms such as nausea, vomiting, or abdominal pain can occur as a late symptom unlike respiratory symptoms such as dyspnea.

C. Headache is not a typical early manifestation of peanut allergy. While headaches may occur later from hypoxia or hypotension in severe reactions, they are not an early sign.

Take home points

• Early symptoms of peanut allergy can involve the skin, respiratory tract, and gastrointestinal tract.
• Rapid recognition and prompt administration of epinephrine are critical to preventing progression to anaphylaxis.
• Education of caregivers and children on allergen avoidance and emergency action plans is essential.

Cow’s milk protein allergy (CMPA) is an immune-mediated reaction to proteins such as casein and whey found in cow’s milk. Management involves eliminating cow’s milk protein from the diet and replacing it with a safe, nutritionally adequate alternative. Hydrolyzed formulas contain proteins broken down into smaller peptides, reducing allergenicity. Soy formula may be used in some cases for infants older than 6 months if tolerated.

Rationale for correct answer:

B. Extensively hydrolyzed formulas such as soy milk or a hydrolyzed formula are first-line for most infants with CMPA, as they minimize allergic reactions while providing complete nutrition. Soy formulas may be used in children over 6 months if there is no soy protein allergy.

Rationale for incorrect answers:

A. Goat’s milk is not recommended because it contains proteins similar to those in cow’s milk, which can trigger cross-reactivity.

C. Whole milk still contains cow’s milk proteins and would worsen symptoms.

D. Evaporated milk is derived from cow’s milk and therefore not safe for CMPA. It is also nutritionally inappropriate for infants without proper fortification.

Take home points

• CMPA requires strict elimination of all cow’s milk proteins from the diet.
• Extensively hydrolyzed formulas are preferred; amino acid–based formulas are used in severe or refractory cases.
• Soy formula may be considered for older infants if no soy sensitivity exists.

Sudden infant death syndrome (SIDS) is the sudden, unexplained death of an apparently healthy infant, typically during sleep. Certain practices significantly reduce the risk by improving airway patency, lowering arousal thresholds, and supporting immune protection.

Rationale for correct answer:

D. Supine sleeping position keeps the airway clear and reduces the risk of suffocation compared to prone or side positions. Breastfeeding is associated with a lower incidence of SIDS, possibly due to immune benefits and improved arousability from sleep. Vaccination may reduce SIDS risk by preventing infections that could contribute to sudden death.

Rationale for incorrect answers:

A. Side sleeping position, breastfeeding, updated childhood immunization status: Side sleeping is unstable and increases the risk of rolling into a prone position.

B. Supine sleeping position, breastfeeding, soft bedding: Soft bedding increases suffocation and entrapment risk.

C. Prone sleeping position, exposure to maternal tobacco use, updated childhood immunization status: Prone sleeping and tobacco exposure are strong SIDS risk factors.

Take home points

• Place infants on their backs to sleep, on a firm surface, with no loose bedding or soft objects.
• Encourage breastfeeding and keep vaccinations up to date.
• Avoid smoke exposure, overheating, and unsafe sleep environments to reduce SIDS risk.

Night terrors are a type of parasomnia that typically occur in children aged 3–7 years during non-REM sleep. They are usually self-limiting and not remembered by the child. Management focuses on safety, reassurance, and maintaining good sleep hygiene, not on stimulating activities or co-sleeping.

Rationale for correct answers:
C. Watching TV before bedtime can stimulate the child and worsen sleep disturbances. Understanding “what is real” does not prevent night terrors.
E. Co-sleeping can disrupt sleep cycles and is not recommended as a treatment for night terrors. It may also increase safety risks, particularly in younger children.

Rationale for incorrect answers

A. This statement is true since most children outgrow night terrors by late childhood.

B. Getting into a specific routine is helpful and can be calming to my son is consistent bedtime routines improve sleep quality.

D. Helping the child with sleep by giving him his favorite stuffed animal or using a night-light is acceptable comfort measures that promote a sense of security without interfering with sleep.

Take home points

• Night terrors usually resolve without intervention as the child matures.
• Maintain a calm, consistent bedtime routine and ensure a safe environment.
• Avoid stimulating activities, screen time before bed, and unnecessary co-sleeping.

In suspected pediatric ingestion of potentially cardiotoxic medication such as digoxin, beta-blockers, or calcium channel blockers, rapid assessment and stabilization take priority. Emergency interventions depend on the type of drug, time since ingestion, and clinical status.

Rationale for correct answers:
D. This scenario suggests a possible cardiac medication ingestion such as digoxin, beta-blockers, calcium channel blockers, all of which can cause life-threatening bradycardia, hypotension, arrhythmias, and altered mental status. In pediatric poisoning, airway, breathing, and circulation (ABCs) are the top priorities. Continuous vital sign and neurological assessments allow early detection of deterioration. Cardiac and respiratory support may be required, including supplemental oxygen, IV access, and possible advanced life support measures.

Rationale for incorrect answers:

A. The majority of medications having a specific antidote is false since most medications do not have specific antidotes, and treatment is supportive or involves decontamination methods.

B. Gastric lavage is rarely used today due to risk of aspiration and limited benefit, and is usually only considered within 1 hour of ingestion in life-threatening cases.

C. Activated charcoal should be mixed with water, not milk or juice, as these may reduce its effectiveness. It is used selectively based on drug type and presentation time.

Take home points

• In pediatric poisonings, stabilization of airway, breathing, and circulation comes before any decontamination efforts.
• Many ingestions, including cardiac medications, can cause rapid clinical deterioration.
• Antidotes are rare; most treatment is supportive.
• Activated charcoal should be used appropriately and never with milk or juice.

Lead exposure in children can occur from multiple sources, especially in environments with deteriorating lead-based paint, contaminated dust, or renovations that release lead particles. Any history suggesting possible exposure warrants follow-up regardless of age.

Rationale for correct answers:

A. The child goes daily to the older home of a babysitter: Older homes (built before 1978 in the U.S.) are more likely to have lead-based paint and contaminated dust.

B. One of the child’s playmates in the neighborhood has lead poisoning: Shared environments or similar exposures increase risk, even if the child lives in a different home.

C. Although living in a newer neighborhood, one of the child’s playmates’ homes is being renovated: Renovations in older homes can release lead dust, posing a risk to visiting children.

Rationale for incorrect answers:
D. The child is out of the danger age range for screening (1 to 2 years old), so screening is not needed: While routine screening is most common at ages 1–2, older children with risk factors should also be screened.
E. Past BLL was 12, so no follow-up is needed at this time: A blood lead level (BLL) of 12 µg/dL is above the CDC reference value (currently C.5 µg/dL) and requires follow-up, environmental investigation, and monitoring until levels decrease.

Take home points

• Lead screening should be based on risk factors, not just age.
• Any suspected exposure, through older homes, renovations, or contact with affected individuals, warrants evaluation.
• Even mild elevations in BLL require intervention to prevent long-term neurodevelopmental harm.

Child abuse refers to any intentional harm or mistreatment of a child under the age of 18. It can occur in various forms and often involves someone the child knows and trusts, such as a parent, caregiver, teacher, or family member.

Rationale for correct answer:

B. Reporting the case in which the abuse is suspected to the local authorities is the nurse’s primary legal duty. Reporting must be done immediately upon suspicion; proof is not required. Failure to report can result in legal consequences for the nurse.

Rationale for incorrect answers:

A. Assisting the family in identifying resources for support is important for long-term care, but not the immediate legal priority when abuse is suspected.

C. Documenting the child’s physical assessment findings accurately and thoroughly is essential for supporting the case, but documentation alone does not fulfill the legal reporting requirement.

D. Referring the family to the hospital support group may be helpful later but is not a legal mandate in the acute setting of suspected abuse.

Take home points

• Nurses must report suspected child abuse promptly; investigation is not the nurse’s role.
• Accurate documentation and cooperation with authorities support the legal process.
• The child’s safety takes priority over all other considerations in suspected abuse cases.

Childhood obesity results from a combination of behavioral, environmental, and socioeconomic factors that influence caloric intake and energy expenditure. Early identification of risk factors is essential for prevention.

Rationale for correct answers:

A. Reduced physical activity decreases energy expenditure, contributing to a positive energy balance and weight gain.

B. Low socioeconomic status is often associated with limited access to healthy foods, safe play areas, and healthcare, increasing obesity risk.

C. Use of food as a positive reinforcement of desired behaviors encourages emotional eating patterns and overconsumption of calorie-dense foods.

D. Consumption of energy-dense foods and drinks, such as high-calorie, nutrient-poor foods and sugar-sweetened beverages contribute significantly to excess caloric intake.

Rationale for incorrect answer:
E. Positive self-esteem is not a risk factor for childhood obesity. In fact, children with obesity often experience low self-esteem due to stigma and body image concerns.

Take home points

• Childhood obesity is multifactorial, involving lifestyle, socioeconomic, and behavioral influences.
• Prevention strategies should focus on promoting physical activity, balanced nutrition, and healthy coping mechanisms.
• Avoid using food as a behavioral reward to prevent unhealthy eating habits.

Chronic abdominal pain in children may be due to functional gastrointestinal disorders or underlying organic pathology. Chronic pain is generally defined as pain lasting ≥1 month that interferes with daily activities, or pain associated with alarming features such as gastrointestinal bleeding, persistent diarrhea, weight loss, or abnormal physical findings.

Rationale for correct answers:

A. An 11-year-old boy with a 1-month history of generalized periumbilical pain: This description is a classic presentation of functional abdominal pain. The pain is generalized and centered around the navel, and there are no other "red flag" symptoms like fever, weight loss, or specific location of pain. While it's chronic, lasting over a month, the nature of the pain does not strongly suggest an organic cause.

C. A 12-year-old girl with a 6-week history of constipation: Constipation lasting several weeks may indicate an underlying gastrointestinal disorder and requires further evaluation.

D. A 6-year-old boy with 1 month of diarrhea and a rectal fistula: Presence of a rectal fistula is an alarming sign suggestive of Crohn’s disease or other inflammatory bowel disease, necessitating prompt diagnostic workup.

Rationale for incorrect answer:
B. An 8-year-old girl with a 1-week history of right lower quadrant pain: This is acute rather than chronic abdominal pain; the priority would be to evaluate for acute appendicitis or other emergent causes rather than chronic pain workup.

Take home points

• Chronic abdominal pain workup is indicated when symptoms are persistent (weeks to months) or when there are red flag signs such as weight loss, gastrointestinal bleeding, persistent diarrhea, or abnormal examination findings.
• Conditions like inflammatory bowel disease, celiac disease, and chronic constipation are common organic causes.
• Acute localized pain requires urgent evaluation for surgical causes, not chronic pain assessment.

Attention-deficit/hyperactivity disorder (ADHD) is best managed with structured routines, clear and concise communication, and consistent expectations. Misunderstandings about learning strategies or avoiding structure can hinder progress.

Rationale for correct answers:

A. Children with ADHD often have difficulty sustaining attention during lengthy verbal explanations. They benefit more from short, clear instructions, visual aids, and step-by-step guidance.

D. Structure and clear rules actually help children with ADHD. Avoiding rules or reducing structure can worsen symptoms.

Rationale for incorrect answers:
B. Proving the child with a consistent schedule for homework and activities helps him be organized structured routines improve focus and reduce forgetfulness.
C. Stimulant medications can affect appetite and growth, requiring frequent monitoring of the child’s growth.
E. Family counseling is appropriate and can help with coping strategies, stress reduction, and family support.

Take home points

• Children with ADHD benefit from structured environments, clear rules, and short, focused instructions.
• Both medical management and behavioral strategies are important.

Family counseling and collaboration with teachers support the child’s overall progress

Enuresis is involuntary urination beyond the age of expected bladder control, most commonly nocturnal. It is typically benign and often resolves spontaneously, but supportive strategies and sometimes pharmacologic therapy are used when it persists.

Rationale for correct answers:

A. Enuresis, particularly nocturnal enuresis (bed-wetting), is often related to a developmental delay in the nervous system's ability to coordinate bladder control during sleep. It is not caused by a serious disease and usually resolves on its own over time.

B. A significant number of children will stop bed-wetting without any specific intervention, which supports the "self-limiting" aspect of the condition. While the exact percentage can vary slightly in different studies, this figure is a good general approximation.

D. Desmopressin acetate (DDAVP) is a common and effective medical treatment for nocturnal enuresis. It works as an antidiuretic hormone, concentrating urine and decreasing the amount produced by the kidneys at night. This reduces the pressure on the bladder and lowers the likelihood of bed-wetting.

Rationale for incorrect answers:

C. The formula for estimating normal bladder capacity is indeed a child's age plus 2, not D. So, for a 6-year-old, the approximate bladder capacity is 8 ounces (240 ml). The calculation in the statement is incorrect, as 10 ounces is closer to 300 ml, not 600 ml. This makes the entire statement factually incorrect.

E. While enuresis is typically not a sign of a serious emotional disturbance, it is not a form of "willful misbehavior." The child is not doing it on purpose. Teaching parents that it's a behavioral issue can lead to punishment, shaming, and emotional distress for the child, which can in turn worsen the enuresis.

Take home points

• Enuresis is usually a developmental delay in bladder control, not misbehavior.
• Most cases resolve with time; reassurance and support are essential.
• Behavioral interventions, bladder training, and sometimes medications like desmopressin can be helpful.

A varicocele is an abnormal dilatation of the pampiniform plexus veins in the spermatic cord, often leading to increased scrotal temperature, oxidative stress, and impaired spermatogenesis. Early detection and surgical repair (varicocelectomy) can significantly improve sperm parameters and fertility outcomes.

Rationale for correct answer:
C. Idiopathic varicocele is strongly linked to male infertility. It disrupts testicular temperature regulation and damages sperm DNA. Surgical or embolization correction can restore fertility in many cases.

Rationale for incorrect answers:

A. Paraphimosis is a urologic emergency caused by retracted foreskin that cannot be returned to its normal position; may cause pain, swelling, and vascular compromise, but it is not a common cause of infertility.

B. While severe trauma of the penis can impair sexual function, it is less common and usually not the leading treatable cause of male infertility.

C. Epididymitis is the inflammation of the epididymis, often due to infection, may cause infertility if scarring occurs, but it is not as common a cause as varicocele.

Take home points

• Varicocele is the leading treatable cause of male infertility, often detected during adolescence or early adulthood.
• It is typically asymptomatic but may present with scrotal heaviness or a “bag of worms” texture on exam.
• Treatment improves sperm quality and chances of conception.
• Early evaluation of male infertility should include physical examination and scrotal ultrasound when indicated.

Anorexia nervosa is a serious eating disorder and mental health condition characterized by extreme restriction of food intake, an intense fear of gaining weight, and a distorted body image, even when the individual is underweight.

Rationale for correct answer:
B. Serum potassium of B.6 mEq/L: Normal potassium range is C.5–E.0 mEq/L. A level this low is dangerous because it destabilizes cardiac electrical activity, potentially leading to ventricular arrhythmias such as ventricular tachycardia or fibrillation. In the context of anorexia nervosa, hypokalemia is often related to malnutrition, vomiting, laxative abuse, or diuretic misuse. Immediate IV potassium replacement and cardiac monitoring are required.

Rationale for incorrect answers:

A. Serum sodium of 149 mEq/L: Mild hypernatremia can cause neurological symptoms if severe or acute, but this is not as immediately life-threatening as severe hypokalemia. Correction should be gradual to avoid cerebral edema.

C. Hemoglobin of F.8 mg/dL: This indicates significant anemia, but unless there is active bleeding or hemodynamic instability, it is not as immediately fatal as a severe electrolyte imbalance affecting the heart.

D. Arterial pH of G.30: This indicates mild metabolic acidosis. It is important to address underlying cause, but not as immediately dangerous as hypokalemia in this scenario.

Take home points

• Severe hypokalemia is a medical emergency due to its risk for life-threatening arrhythmias.
• In eating disorders, electrolyte imbalances are common and must be monitored closely during acute care and refeeding.
• Potassium correction should be done promptly but cautiously, with continuous cardiac monitoring.

While anemia, hypernatremia, and mild acidosis require management, they typically do not pose the same immediate cardiac arrest risk as profound hypokalemia

High-risk substance use behaviors in adolescents indicate patterns that can lead to acute harm, dependency, or long-term health consequences. While experimentation may occur in adolescence, certain patterns signal significant concern, especially when they involve repeated binge drinking, combining substances, or signs of dependence.

Rationale for correct answers:
B. An adolescent binging on alcohol every weekend: Recurrent binge drinking is associated with alcohol poisoning, risky behaviors, accidents, and the development of alcohol use disorder.
C. An adolescent using prescription drugs along with alcohol: Combining substances, particularly central nervous system depressants (e.g., opioids, benzodiazepines) with alcohol, greatly increases the risk of respiratory depression, overdose, and death.
D. An adolescent reports feeling jittery until she drinks some alcohol: This suggests the presence of alcohol withdrawal symptoms, indicating physical dependence, which is a serious and urgent health concern.

Rationale for incorrect answers:

A. An adolescent using marijuana once to fit in with peers at a party: While any drug use in adolescents carries risk and should be addressed, a single reported use without evidence of ongoing pattern or dependence is less immediately concerning than the other scenarios. It still warrants discussion and prevention counseling, but it does not indicate the same acute risk level.

Take home points

• Binge drinking, polydrug use, and signs of withdrawal are red flags for substance use disorders in adolescents.
• Early identification and intervention are critical to prevent long-term addiction, injury, or death.
• Combining alcohol with prescription medications significantly increases overdose risk.
• Even “one-time” drug use should prompt education and monitoring, but ongoing harmful patterns require urgent intervention.

Positional plagiocephaly is a flattening of one side of an infant’s skull, often due to prolonged pressure on that area. Early interventions focus on repositioning strategies to relieve constant pressure and promote symmetrical skull growth.

Rationale for correct answers:
B. Placing the infant in a prone position when awake (approximately 15 min), also known as “tummy time,” strengthens neck and upper body muscles, reduces time spent with pressure on the back of the head, and promotes motor development.
C. Alternating the infant’s head position (side of head) when asleep changes the head orientation during supine sleep and helps distribute pressure evenly, reducing progression of flattening.

Rationale for incorrect answers:

A. Placing the infant to sleep in the prone position is unsafe and increases the risk of sudden infant death syndrome (SIDS). Infants should always sleep supine.

D. Having the infant wear a soft helmet for 23 to 24 hours a day is reserved for severe cases that do not improve with repositioning and is typically started after 6 months of age.

E. Prolonged use of infant seats increases pressure on the skull and can worsen plagiocephaly; not recommended for sleep.

Take home points

• Early positional changes and supervised tummy time are first-line interventions for positional plagiocephaly.
• Always maintain supine sleep position for SIDS prevention.
• Helmet therapy is a later option if conservative measures fail.

When caring for a child with suspected abuse, it is important to provide a safe, supportive, and nonjudgmental environment. Focusing on the child’s strengths and individual needs, rather than labeling them, helps build trust, supports recovery, and reduces shame and guilt.

Rationale for correct answer:

C. Treating the child as someone with a specific problem, not as an “abuse” victim fosters self-worth, reduces the stigma of abuse, and helps the child feel seen as more than the abuse they experienced.

Rationale for incorrect answers:

A. Assigning a variety of nurses to the child so that he can get to know and trust the whole staff is inappropriate since abused children benefit from consistent caregivers to build trust and feel secure.

B. Praising the child’s ability to minimize feelings of shame and guilt is inappropriate. Minimizing feelings may indicate denial or avoidance rather than healthy coping.

D. Over-questioning can feel intrusive and may cause the child to withdraw; interactions should be gentle, supportive, and at the child’s pace.

Take home points

• Consistency, safety, and nonjudgmental care are essential for children with suspected abuse.
• Avoid labeling or overwhelming the child with questions.
• Build trust and promote self-esteem while collaborating with the multidisciplinary team for support and protection.

Childhood depression is a mood disorder that can present similarly to adult depression but is often harder to detect due to developmental differences. It affects emotional well-being, cognitive function, social interaction, and can disrupt normal growth and development.

Rationale for correct answers:
B. Accurate identification of depression in children requires comprehensive history-taking, interviews, and observations from multiple sources, since symptoms can be subtle or masked.
D. Depressed children often show persistent negative thinking patterns, low self-esteem, hopelessness, and social withdrawal, which are key diagnostic clues.
E. Depression can be easily overlooked in school-age children because symptoms may be misattributed to “normal” childhood moodiness, yet it can significantly impair development if untreated.

Rationale for incorrect answers:

A. The manifestations of childhood depression are not often similar to adult depression. Children are more likely to exhibit irritability, somatic complaints such as headaches or stomachaches, social withdrawal, and academic decline. Overt sadness and despondency, which are classic signs of adult depression, may not be as prominent in children.

C. Many antidepressants require 2 to 4 weeks for full therapeutic effect not 4 to 6 weeks. The child and family should monitor the child for side effects of the specific prescribed drug.

Take home points

• Childhood depression is real but often underdiagnosed due to atypical presentation.
• Comprehensive assessment involving family, school, and healthcare providers is crucial.
• Persistent negative thought patterns and social withdrawal are key red flags.
• Early detection and intervention can prevent disruption of growth, development, and learning.

Pelvic Inflammatory Disease (PID) is an infection of the female upper genital tract, including the uterus, fallopian tubes, and ovaries. It is caused by organisms that ascend from the cervix to the upper genital tract, causing inflammation, scarring, and potential infertility.

Rationale for correct answers:
A. Neisseria gonorrhoeae is a major cause of PID, often producing purulent cervical discharge and easily spreading to the upper genital tract if untreated.
B. Chlamydia trachomatis is the most common bacterial cause of PID in the U.S., often asymptomatic initially, allowing silent progression and damage to reproductive organs.

Rationale for incorrect answers:
C. Treponema pallidum is the causative agent of syphilis. It causes systemic disease with distinct stages but is not a common cause of PID.
D. Human papillomavirus (HPV) causes genital warts and is linked to cervical cancer, but it does not cause PID.

Take home points

• In the U.S., PID is most often due to N. gonorrhoeae and C. trachomatis.
• Early detection and antibiotic treatment are crucial to prevent infertility, chronic pelvic pain, and ectopic pregnancy.
• Routine STI screening for sexually active individuals can significantly reduce PID risk.
• PID can be asymptomatic, so education on safe sexual practices is essential.

Self-harm (also known as nonsuicidal self-injury) involves deliberate injury to one’s body without suicidal intent, often as a coping mechanism for emotional distress. Warning signs may be behavioral, emotional, or environmental.

Rationale for correct answer:
D. Spending long periods of time in a locked bedroom or bathroom can indicate secrecy and an attempt to hide self-inflicted injuries. It is especially concerning if accompanied by mood changes, withdrawal from friends, or wearing long sleeves in warm weather.

Rationale for incorrect answers:

A. While multiple bruises on arms and legs may raise concern for abuse or injury, they are nonspecific and may occur from sports or accidental trauma. They are not a classic isolated indicator of self-harm.

B. Poor school performance may indicate depression, learning difficulties, or other psychosocial stressors, but it is not a specific warning sign of self-harm.

C. Finding tobacco products hidden in the adolescent’s room indicates risky behavior and possible substance use, but is not directly associated with self-harm behaviors.

Take home points

• Warning signs of self-harm include secretive behavior, isolation, wearing concealing clothing, and possessing sharp objects without explanation.
• Adolescents at risk should be assessed for depression, trauma history, and suicidal ideation.
• Early intervention, mental health referral, and supportive family involvement can prevent escalation.

Adolescents often test boundaries and may minimize the risks of alcohol use. The nurse’s priority is to open a nonjudgmental dialogue that encourages trust, allowing the teen to express herself while the nurse assesses the extent of use, underlying motivations, and associated risks.

Rationale for correct answer:
D. “It worries me that you’re drinking alcohol with friends.” This response expresses concern in a nonjudgmental way, communicates the nurse’s care for the teen’s well-being, and invites further discussion. It avoids lecturing or shaming, which could shut down conversation. This approach follows therapeutic communication principles.

Rationale for incorrect answers:

A. “You may think they’re lame, but they are still the law.” While factually correct, this is likely to sound authoritarian and could close off communication.

B. “I would like to know who your drinking friends are.” This may feel intrusive or accusatory to the adolescent and does not initially focus on her health and safety.

C. “I should call your parents about your behavior.” This is a threat rather than a therapeutic intervention and may cause the adolescent to withhold information in the future.

Take home points

• Effective communication with adolescents about risky behaviors requires a nonjudgmental, empathetic approach.
• Expressing concern for the adolescent’s health is more effective than threatening or lecturing.
• Building rapport increases the likelihood that the adolescent will share openly, enabling early intervention.

Suicide risk in adolescents may be indicated by sudden behavioral changes, preoccupation with death, and giving away prized possessions. These actions can reflect a sense of hopelessness or preparation for death. Recognizing these signs is critical for timely intervention.

Rationale for correct answers:

A. Has given away his favorite football jersey: Giving away valued possessions is a classic warning sign that an adolescent may be preparing for death.

D. Talks about actors and actresses who have recently died: Preoccupation with death, especially in conversation, may indicate suicidal thinking.

Rationale for incorrect answers:
B. Recently has started dating a new girlfriend: This is generally a positive social change and does not typically indicate suicidal intent.
C. Brags about his football team to his brother and sister: Positive interaction and pride are not indicators of suicidal ideation.
E. Has stated that he has decided to play baseball in the spring: Making future plans is often seen as a sign of hope and decreased suicide risk.

Take home points

• Warning signs of suicide include giving away possessions, withdrawing from others, and preoccupation with death.
• School nurses play a vital role in early identification and referral for mental health support.
• Any suspicion of suicidal intent warrants immediate assessment, safety planning, and involvement of mental health professionals.

When a child suddenly refuses to attend school, the cause may be academic struggles, social problems, anxiety, or other negative experiences. Understanding the child’s feelings in multiple areas of school life helps identify the root cause and guides appropriate intervention.

Rationale for correct answers:

A. His teacher: A negative relationship or fear of the teacher can cause school avoidance.

B. His performance in school: Struggling academically or feeling unsuccessful can trigger anxiety and refusal to attend.

C. His friends: Social isolation, bullying, or peer conflicts are common causes of school refusal.

D. His bus ride to school: Bullying or fear on the bus can make the child dread going to school.

Rationale for incorrect answers:
E. His lunches he eats at school: While food preferences may affect a child’s satisfaction with school, they are unlikely to be the primary cause of sudden refusal to attend unless related to broader social issues such as bullying in the cafeteria.

Take home points

• School refusal can be triggered by academic stress, social problems, anxiety, or bullying.
• Asking open-ended, nonjudgmental questions helps uncover the underlying cause.
• Early identification and collaboration between parents, teachers, and the school nurse can prevent prolonged absenteeism.

Discipline should be aimed at helping the child understand the consequences of their actions and encouraging moral development, rather than using physical punishment or unrelated restrictions. Logical consequences are most effective in promoting responsible behavior and reducing repeat offenses.

Rationale for correct answer:
C. Making the child return the candy to the owner is a natural and logical consequence directly related to the misbehavior. It teaches accountability, restitution, and respect for others’ property while allowing the child to experience the discomfort of facing the person they wronged.

Rationale for incorrect answers:

A. Spanking the child on the buttocks is physical punishment can promote fear or resentment rather than understanding, and it is discouraged by pediatric and mental health guidelines.

B. Grounding the child for one week may serve as a punishment, but it does not directly connect to the behavior or help the child learn how to correct it.

D. Preventing the child from eating dinner is inappropriate, unrelated to the behavior, and can be harmful to the child’s well-being.

Take home points

• Logical consequences such as returning stolen items are most effective in teaching moral responsibility.
• Discipline should be fair, consistent, and directly related to the behavior.
• Physical punishment and unrelated punitive measures are discouraged due to negative long-term effects on emotional and behavioral development.

Human Immunodeficiency Virus (HIV), a virus that attacks and weakens the body’s immune system by targeting CD4 cells. If left untreated, HIV can progress to AIDS (Acquired Immunodeficiency Syndrome), the most advanced stage of the infection.

Rationale for correct answer:
B. “This is good news, but I do want to remind you to continue to wear condoms when having intercourse.” This response acknowledges the adolescent’s feelings while emphasizing ongoing responsibility to protect himself and his partner from other STIs and potential HIV strain reinfection. It uses therapeutic communication and provides essential education.

Rationale for incorrect answers:

A. “I am happy for you. You must be happy not to have to worry about your disease anymore.” This is misleading because the adolescent still needs to manage his health and practice safe sex.

C. “Congratulations. Do you know whether or not your friend has any symptoms of AIDS?” This is not therapeutic; it shifts focus to the friend’s health rather than supporting the patient or reinforcing safe practices.

D. “What a wonderful surprise. Did you meet your friend at an HIV awareness party?” This is irrelevant to the key health teaching point and does not address safe behaviors.

Take home points

• Being HIV positive does not eliminate the need for consistent condom use.
• Condom use prevents transmission of other STIs and limits the risk of acquiring drug-resistant HIV strains.
• Nurses should combine empathy with education, acknowledging emotions while reinforcing health-protective behaviors.

Certain injury patterns, particularly burns or marks in unusual locations, are red flags for abuse. Burns on the torso, especially if they have a defined pattern or are inconsistent with the history given, are highly suspicious. Combined with the child’s refusal to seek comfort from the caregiver, this warrants mandatory reporting to child protective services.

Rationale for correct answer:
C. Burns on protected areas of the body such as the torso are uncommon from normal play and may indicate inflicted injury. This, paired with emotional withdrawal from the caregiver, strengthens concern for abuse.

Rationale for incorrect answers:

A. Bruises on his knees and elbows are common in active preschool children and typically result from accidental falls during play.

B. Bandaged laceration on his left calf is not in itself highly suspicious without an inconsistent explanation or unusual location.

D. Brown patches on his forehead could represent birthmarks, hyperpigmentation, or healed injuries, but are not necessarily indicative of abuse without other supporting findings.

Take home points

• Burns, especially in unusual or protected locations, are strong indicators of possible child abuse.
• Behavioral cues (e.g., refusing comfort from a caregiver) can support suspicion of maltreatment.
• Nurses are mandated reporters and must report suspected abuse to child protective services, even if not fully proven.

A BMI of 1F.6 kg/m² is significantly below the healthy range for a 16-year-old female (generally 18.5–2D.9 kg/m²). Low BMI may be due to an eating disorder such as anorexia nervosa, chronic illness, or malnutrition. Assessing body image perception is a key first step in identifying distorted self-image and guiding further evaluation.

Rationale for correct answer:
B. “How do you feel about your body?” This open-ended, nonjudgmental question helps the nurse explore the adolescent’s body image perception, which is central in diagnosing eating disorders. It fosters therapeutic communication and provides insight into whether there is body dysmorphia influencing eating habits.

Rationale for incorrect answers:

A. “Do you eat snacks between meals?” While it gathers dietary information, it is too narrow and does not address the psychological aspects that are critical in underweight adolescents.

C. “Let’s talk about foods that are high in calories.” Nutritional counseling may be important later, but it should not be the first approach before understanding the underlying cause and the adolescent’s readiness for change.

D. “It’s important for you to start to exercise each day.” This advice is inappropriate for someone already underweight and potentially malnourished; excessive exercise is often part of eating disorder pathology.

Take home points

• A low BMI in an adolescent warrants assessment for eating disorders, including questions about body image, eating patterns, and exercise habits.
• Therapeutic, open-ended questions help build trust and elicit meaningful responses.
• Management often requires a multidisciplinary approach including medical, nutritional, and mental health support.

Plagiocephaly (flat head syndrome) is a positional head shape deformity that can occur when infants spend too much time lying on their backs without repositioning. While back-sleeping is essential for SIDS prevention, supervised tummy time during the day helps strengthen neck muscles and reduce the risk of flat spots.

Rationale for correct answer:
D. Tummy time relieves constant pressure on the back of the head, promotes motor development, and strengthens the neck, shoulder, and arm muscles. It should always be supervised to ensure safety.

Rationale for incorrect answers:

A. Keeping the baby out of the sun for the first 6 months of life is related to skin protection, not plagiocephaly prevention.

B. While providing the baby with visually stimulating items to look at is beneficial for sensory development, this alone does not prevent head flattening.

C. Monitoring the numbers of stools and wet diapers the baby has in 24 hours is important for hydration and feeding assessment, not for preventing plagiocephaly.

Take home points

• Back to sleep, tummy to play: Infants should sleep on their backs but have daily supervised tummy time.
• Frequent repositioning and varying head positions during sleep can further reduce plagiocephaly risk.
• Early parental education helps balance safe sleep practices with healthy physical development.

At around age 4, children often develop vivid imaginations and may have fears of imaginary creatures. These fears are part of normal development and can be addressed through reassurance and simple coping strategies rather than dismissal or overindulgence.

Rationale for correct answer:
D. “Many children her age have night fears. If you look under her bed with her and give her a night light, she should go to bed more easily.” This response normalizes the behavior, reassures the parents, and offers practical steps such as checking under the bed and using a night light to help the child feel safe, thereby reducing bedtime anxiety.

Rationale for incorrect answers:

A. “That is pretty unusual. Has she ever been to the zoo? Maybe she saw an alligator there that frightened her.” This speculates about the origin of the fear without providing reassurance or strategies to address it.

B. “That is pretty unusual. Does she watch television? Maybe there was a story in the news about a child being attacked by an alligator?” This focuses on finding the cause rather than addressing the child’s current needs.

C. “Many children her age have night fears. If you give into her fears, though, she will continue to have night fears well into her school-age years.” This is dismissive and suggests avoiding comfort measures, which can increase anxiety and reduce trust.

Take home points

• Night fears are developmentally normal in preschoolers due to imagination growth.
• Reassurance, a calm bedtime routine, and comfort measures like a night light can help.
• Avoid dismissing or ridiculing the child’s fears; instead, address them with empathy and security-building actions.

Dental caries is the destruction of tooth enamel caused by acids produced by bacteria in the mouth. These acids result from the breakdown of sugars and starches left on teeth after eating. Over time, this leads to cavities in the teeth, which can deepen and cause pain, infection, or even tooth loss if untreated.

Rationale for correct answer:

C. Allowing a 13-month-old to fall asleep with a bottle of formula increases the risk of early childhood caries (also called baby bottle tooth decay) due to prolonged exposure of teeth to lactose sugars overnight. Switching to water at bedtime maintains the comfort of the bedtime bottle without the harmful sugar exposure.

Rationale for incorrect answers:

A. “I understand. Children this age often need something to soothe them when they are settling down to sleep.” This acknowledges need for comfort but ignores dental health risks. This misses the opportunity to educate parents about preventing tooth decay.

B. “I am not surprised that your child still drinks from a bottle before sleep, but does your child drink from a cup when she eats her meals during the day?” This focuses on daytime cup use which while important for developmental feeding milestones, it does not address the nighttime formula problem.

D. “I know how much babies love their formula, but once they reach one year of age they can start to drink cow’s milk.” This is correct for a child’s diet after age 1, but it does not address the risk of falling asleep with milk (formula or cow’s milk) in the bottle.

Take home points

• Bedtime bottles with milk or formula after tooth eruption can lead to severe dental decay.
• Water only at bedtime is safe and helps with weaning from bottles.
• By 12–14 months, children should transition primarily to cups for drinking, with bottles phased out to protect oral health and promote normal oral development.