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A 2-year-old boy presents with fever and a vesicular rash in the mouth. Most likely diagnosis is:
- A. Measles
- B. Herpangina
- C. Hand-foot-mouth disease
- D. Chickenpox
Correct Answer: C
Rationale: HFMD features fever and oral vesicles, per CDC. A, B, D, E differ in distribution.
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In administering vitamin K to the infant shortly after birth, the nurse understands that vitamin K is
- A. Synthesized by the kidneys
- B. Not initially synthesized because of sterile bowel at birth
- C. Given to enhance lung function
- D. Produced by the liver immediately
Correct Answer: B
Rationale: Not initially synthesized because of sterile bowel at birth B explains the need for vitamin K to prevent hemorrhagic disease, per document .
An adolescent who is brought to the emergency department (ED) by his parents has the following symptoms: periumbilical pain that peaks at 4-hour intervals followed by right lower quadrant pain, which is followed by vomiting. Based on these data, which condition does the nurse suspect?
- A. Meckel's diverticulum
- B. Omphalitis
- C. Appendicitis
- D. Ulcerative colitis
Correct Answer: C
Rationale: Periumbilical pain shifting to the right lower quadrant (McBurney’s point) with vomiting is characteristic of appendicitis . Meckel’s diverticulum may cause bleeding, omphalitis is umbilical infection, and ulcerative colitis involves chronic diarrhea, not acute localized pain.
A child is diagnosed with hypoalbuminemia. Her total serum calcium level is normal. Most likely associated finding that may be missed is:
- A. Hypocalcemia
- B. Hypercalcuria
- C. Hypomagnesemia
- D. Hypercalcemia
Correct Answer: D
Rationale: Hypoalbuminemia lowers bound calcium; a normal total calcium suggests hypercalcemia in ionized form, often missed (UpToDate). A-C, E don’t fit.
What type of diet is recommended for the menopausal woman?
- A. Low-fat, high-fiber, and soy diet
- B. High-carbohydrate, low-fat diet
- C. Low-salt, high-fiber, low-protein diet
- D. Low-fat, low-carbohydrate, high-protein
Correct Answer: A
Rationale: A low-fat, high-fiber, and soy diet (A) helps manage menopausal symptoms via phytoestrogens and heart health. Other options (B, C, D) lack soy’s specific benefits. Document: 'A low-fat, high-fiber, and soy diet… [is used for] managing menopausal symptoms.'
What is the most likely cause of her pancreatitis?
- A. Bile duct adenoma
- B. Choledochal cyst
- C. Neonatal sclerosing cholangitis
- D. Sphincter of Oddi dysfunction
Correct Answer: B
Rationale: A 2-year-old with acute abdominal pain and pancreatitis, with ultrasound showing a significantly dilated common bile duct tapering distally and dilated intrahepatic ducts, suggests a structural anomaly. Choledochal cyst (Choice B) is a congenital dilatation of the bile ducts, often presenting in young children with pancreatitis, jaundice, or abdominal pain due to bile stasis or obstruction. Bile duct adenoma (Choice A) is a benign tumor, rare in children, and typically asymptomatic unless obstructive, which doesn’t align with the ultrasound findings. Neonatal sclerosing cholangitis (Choice C) is a rare progressive disease usually presenting in infancy with cholestasis, not typically acute pancreatitis or this ultrasound pattern. Sphincter of Oddi dysfunction (Choice D) causes biliary or pancreatic obstruction in adults but is uncommon in children and lacks the structural ductal dilatation seen here. Thus, Choledochal cyst is the most likely cause.