A child with a heart defect has been prescribed a maintenance dose of Lanoxin elixir at 0.07 mg/kg/day, divided into two doses.
The child weighs 19 pounds.
What is the maximum dose of medication the nurse should administer in each dose? T 0.3 mg.
Answer and explanation
The correct answer is Choice B, Choice C, Choice D.
Choice A rationale
A large bruise on the forehead of a 2-year-old could occur from accidental falls, which are common at this developmental stage due to increased mobility and decreased coordination. It does not necessarily suggest abuse unless accompanied by other suspicious findings.
Choice B rationale
Circular abrasions around the wrists are highly indicative of physical abuse as they suggest binding injuries. Restraining a child is neither acceptable nor normal, and such findings must be reported for further investigation by child protective services.
Choice C rationale
A burn on the palm of a 10-year-old’s hand raises concerns for abuse as accidental burns usually occur on accessible areas like arms or legs, not the palm. This pattern could indicate intentional infliction, requiring mandatory reporting to authorities.
Choice D rationale
Splash burns on the front torso in a 6-year-old are suspicious if inconsistent with the child’s developmental abilities or history provided by caregivers. Intentional scald burns often follow specific patterns, like splash marks, and must be reported for investigation.

Choice A rationale

A history of breast cancer is a contraindication for menopausal hormone therapy (HT) due to its potential to stimulate hormone receptor-positive cancer cells. Estrogen, a component of HT, may promote the growth of residual malignant cells. HT must be avoided to minimize the recurrence risk. Regular screening and alternative symptom management are recommended for these patients.

Choice B rationale

GERD management with proton pump inhibitors or H2 receptor antagonists does not contraindicate HT. These conditions are unrelated to hormone therapy risks or benefits. HT may even aid in esophageal mucosal protection in some menopausal women, but only under clinical evaluation.

Choice C rationale

Dermatitis, being a localized skin condition, has no direct correlation to HT contraindications. While some patients may report worsened symptoms with HT, it is not a standard exclusion criterion. Hormone therapy decisions should focus on systemic and oncological considerations rather than minor dermatologic history.

Choice D rationale

COPD, while a chronic respiratory condition, is not a standard contraindication for HT. Careful evaluation of cardiopulmonary status is necessary before initiating HT, as estrogen may influence thromboembolic risk, particularly in sedentary individuals, but it is not specifically contraindicated in COPD cases.

A. Formation of fingers, toes, and facial features

Correct Trimester: 1st Trimester (Conception – 13 weeks)
Explanation:
By the end of the 1st trimester, organogenesis (organ formation) is largely complete.

• Weeks 7–8: Limb buds appear and begin differentiating into arms and legs.

• Weeks 9–12: Fingers, toes, facial features (eyes, nose, lips, ears) become clearly defined.
  This is a critical period for congenital malformations if exposed to teratogens.

B. Fetus can hear and respond to external stimuli

Correct Trimester: 2nd Trimester (14–26 weeks)
Explanation:

• Around 18–20 weeks: The fetus develops the ability to hear sounds.

• External sounds can startle the fetus, and the heartbeat may change in response.

• Mother's voice and music can be recognized at this stage.

C. Increase in body fat reserves

Correct Trimester: 3rd Trimester (27–40 weeks)
Explanation:

• In the final trimester, especially after week 32, fat accumulates under the skin.

• This provides energy and helps with temperature regulation after birth.

• The fetus also gains the most weight during this period.

D. Brain develops most rapidly during this time

Correct Trimester: 3rd Trimester (27–40 weeks)
Explanation:

• Although brain development starts early, the most rapid growth occurs in the third trimester.

• There's a dramatic increase in brain volume, cortical folding, and neural connectivity.

• This trimester is essential for cognitive and motor development.

E. Gender can be determined

Correct Trimester: 2nd Trimester (14–26 weeks)
Explanation:

• By week 18–20, an ultrasound can reliably show external genitalia.

• The sex organs begin forming in the 1st trimester, but become distinct and visible by the 2nd trimester.

• This is when many parents find out the baby's gender via an anatomy scan.