A child is brought to the pediatric clinic because he has been vomiting for the past 2 days. What acid-base imbalance would the nurse expect to occur from this persistent vomiting?

Choice A reason: Kwashiorkor, a protein-energy malnutrition, causes hypoalbuminemia, reducing oncotic pressure and leading to fluid leakage into tissues, particularly the abdomen, causing edema. This is a hallmark sign, reflecting severe protein deficiency, impairing liver albumin synthesis and causing ascites, commonly observed in children with this condition.

Choice B reason: Thick, oily hair is not characteristic of kwashiorkor, which causes thin, brittle hair due to protein deficiency impairing keratin synthesis. Hair may appear discolored or sparse, but not thick or oily. Edema and growth issues are more typical, making this an incorrect finding for kwashiorkor.

Choice C reason: Hyperactivity is not associated with kwashiorkor, which causes lethargy due to severe protein-energy deficiency, reducing metabolic capacity and energy levels. Children appear apathetic, not hyperactive. Edema and slowed growth are hallmark signs, making hyperactivity an incorrect manifestation of this malnutrition condition.

Choice D reason: Slowed growth is a hallmark of kwashiorkor, as protein deficiency impairs tissue synthesis and growth hormone function, leading to stunting. Inadequate amino acids hinder cell division and muscle development, making growth retardation a common finding in affected children, reflecting the disease’s impact on development.

Choice E reason: A white streak in hair (flag sign) occurs in kwashiorkor due to intermittent protein deficiency, disrupting melanin and keratin synthesis during hair growth. This results in alternating bands of discolored hair, a classic sign of malnutrition, reflecting periods of inadequate protein intake in affected children.

Choice A reason: Pinworms (Enterobius vermicularis) are diagnosed via the Scotch tape test, performed in the early morning, when females lay eggs perianally. Tape collects eggs, visible microscopically, confirming infection. This method targets the parasite’s nocturnal egg-laying cycle, ensuring high sensitivity for detecting pinworms in children with perianal itching.

Choice B reason: Stool examination is less effective for pinworm diagnosis, as eggs are laid perianally, not in feces. Obtaining stool at sleep hours is impractical and low-yield. The Scotch tape test directly samples perianal eggs, making stool analysis an incorrect and less reliable method for confirming pinworm infection.

Choice C reason: Blood antigen levels are not used for pinworm diagnosis, as Enterobius vermicularis does not elicit a detectable systemic immune response. Diagnosis relies on visualizing eggs or worms perianally via the Scotch tape test. Blood tests are irrelevant, making this an incorrect diagnostic approach for pinworms.

Choice D reason: Seeing worms in the stool is rare in pinworm infection, as females lay eggs perianally, not in the intestinal lumen. The Scotch tape test is the standard, targeting perianal eggs. Visualizing worms is unreliable and non-specific, making this an incorrect method for diagnosing pinworms in children.