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Bobby, a 9-Year-Old Caucasian Boy, Is Being Seen for a Health

question 36

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Bobby, a 9-year-old Caucasian boy, is being seen for a health physical. His physical exam revealed a normal BMI with an increase in height of an inch and a half in the past year. His skin was noted to be pale, and his eyelid mucosae were white. His mother's chief complaint is that Bobby is often lethargic at school and has been reprimanded for failing to pay attention. He dropped out of soccer when the practices became too physically demanding, and since then, he spends several hours each night watching TV and playing video games. He gets very little exercise. Bobby states that he would like to play soccer next year but that he "didn't feel like it" this year. Though his mom says he is always willing to go to bed when asked, he seems irritable and withdrawn. The nurse practitioner obtains his diet history, using MyPlate to ask about food groups he usually eats: Grains Group: Prefers refined grains, such as Chex, Rice Krispies, and Frosted Flakes for breakfast with milk. Prefers white bread, bagels, crackers, and pretzels. The only whole grain he eats is microwave popcorn.
Vegetables Group: Favorite is French fries. Eats canned vegetables such as canned green beans and corn. At school, enjoys cream of tomato soup. Likes lettuce and tomato on his School Lunch tacos, but if he had his choice, he would not choose a salad or side vegetable.
Fruits Group: Likes apples, grapes, bananas, canned fruit, and fruit juice.
Milk Group: Regularly consumes two 8-ounce cups of 2% milk or whole chocolate milk per day. Likes grilled cheese sandwiches, string cheese, and ice cream.
Protein Foods Group: Favorites are chicken nuggets, bacon, breakfast sausage, and fish sticks. At school, likes peanut butter and jelly sandwiches, but otherwise does not like nuts, seeds, or legumes.
Discretionary kcalories: Eats candy and cookies and drinks soda every day; drinks iced tea occasionally with his School Lunch instead of milk. He puts ketchup on "everything."
Bobby's diet is low in iron, vitamin D, and fiber and he eats too many foods that contain added sugars. What test can the nurse practitioner perform that would most likely determine if Bobby has an iron deficit in his blood?

Definitions:

Nonbenzodiazepine

A class of psychoactive drugs used to treat sleep disorders, differing chemically and pharmacologically from benzodiazepines.

Melatonin Agonist

A type of medication or substance that mimics the action of melatonin, a hormone that regulates sleep-wake cycles.

Quiet Activities

Quiet activities refer to actions or tasks that do not produce much noise, often used to promote calmness and relaxation.

Reading

The action or skill of reading written or printed material.