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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). What is the best explanation for this finding?
- A. The thyroxine level is low because the TSH level is high.
- B. High thyroxine levels normally occur in breastfeeding infants.
- C. The thyroid gland does not produce normal levels of thyroxine for several weeks after birth.
- D. The TSH is high because of the low production of T4 by the thyroid.
Correct Answer: D
Rationale: High TSH results from low T4 production, indicating congenital hypothyroidism.
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The nurse is evaluating a child with acute glomerulonephritis who presents at the clinic with increased fatigue, facial swelling, and decreased appetite. The child's urine sample is dark yellow. What additional finding should the nurse report to the healthcare provider?
- A. Blood pressure 88/50 mmHg
- B. Weight loss
- C. Maculopapular rash over the trunk of the body
- D. Positive rapid strep test of the oropharynx
Correct Answer: D
Rationale: A positive strep test indicates a recent infection, a common cause of glomerulonephritis, requiring reporting.
The parents of a child who is diagnosed with Wilm's tumor ask the nurse why surgery is necessary before a biopsy is performed. What information should the nurse provide?
- A. The surgery provides a visualization of other pathology and dysfunction of the kidney.
- B. Surgery is necessary to stage the tumor and determine metastasis to other sites.
- C. Metal clips are surgically applied at the tumor site for exact marking for radiation.
- D. Biopsy may rupture the encapsulated tumor and cause the cancer cells to spread.
Correct Answer: D
Rationale: Biopsy risks rupturing the tumor, potentially spreading cancer cells.
The nurse is evaluating a preschool-aged child who is presenting with symptoms of flank pain, dysuria, and a low-grade fever. What additional information should the nurse obtain from the parent to determine if the child might have a urinary tract infection?
- A. Frequency of urination
- B. Any recent changes in diet
- C. Presence of any unusual odors in the urine
- D. Any changes in the color of the urine
Correct Answer: A
Rationale: Increased urination frequency is a common UTI symptom in children, aiding diagnosis.
During a sports physical examination, a 15-year-old female expresses her desire for oral contraceptives. She mentions that she is sexually active and prefers not to inform her parents. What should be the nurse's course of action?
- A. Advise the client about the risks and benefits associated with oral contraceptives.
- B. Inform the client about how to obtain a variety of free oral contraceptives from the clinic.
- C. Encourage the client to discuss her contraceptive needs with her parents.
- D. Explain that parental consent is required to receive contraceptives.
Correct Answer: A
Rationale: Educating about risks and benefits respects autonomy and informs decision-making.
The nurse is assessing the growth and development of a 3-year-old child. Which speech and language skills should the nurse identify as normal developmental milestones for this child?
- A. Recognizes most letters and numbers
- B. Uses 1-word sentences
- C. Speaks in simple sentences with four or more words
- D. Uses gestures with 1 to 2-word sentences .
Correct Answer: C
Rationale: Simple sentences with four or more words are expected for a 3-year-old's language development.