Nokea
The most common site for temperature in a 2-year-old is
- A. Axillary
- B. Oral
- C. Rectal
- D. Temporal
Correct Answer: A
Rationale: Axillary A is safest for toddlers, per document p34, 4.
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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 3-month-old infant presents with tachypnea and poor feeding. Chest x-ray shows cardiomegaly and pulmonary edema. Most likely diagnosis is:
- A. Pneumonia
- B. Congestive heart failure
- C. Bronchiolitis
- D. Cystic fibrosis
Correct Answer: B
Rationale: CHF shows cardiomegaly and edema, per AHA. A, C-E differ.
Vitamin B1 deficiency causes
- A. Beriberi
- B. Mumps
- C. Pellagra
- D. Scurvy
Correct Answer: A
Rationale: Beriberi A results from B1 deficiency, per document p14, 8.
A 3-month-old infant presents with poor feeding and hypotonia. MRI shows periventricular leukomalacia. Most likely diagnosis is:
- A. Hypoxic-ischemic encephalopathy
- B. Congenital infection
- C. Metabolic disorder
- D. Trauma
Correct Answer: A
Rationale: HIE causes leukomalacia, per AAP. B-E differ.