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rationale:
Abdominal rigidity and pain on palpation are not typical signs of pyloric stenosis. Pyloric stenosis usually presents with non-bilious projectile vomiting, a palpable olive-shaped mass in the upper abdomen, and signs of dehydration.

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Visible peristalsis and weight loss are consistent with pyloric stenosis. The visible peristalsis occurs as the infant tries to force the stomach contents through the narrowed pyloric sphincter. Weight loss is a result of poor feeding and vomiting.

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Distention of the lower abdomen and constipation are not typical findings in pyloric stenosis. Constipation suggests a lower gastrointestinal issue, while pyloric stenosis primarily affects the upper gastrointestinal tract.

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Notifying the physician when weight gain exceeds more than 20 g/day might be too late for intervention. Daily weight monitoring is essential to detect trends and intervene promptly to manage excess fluid volume.

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Placing the infant in a car seat to minimize movement is not directly related to managing excess fluid volume in congestive heart failure. It is essential for safety during transportation but does not address the nursing diagnosis.

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Administering digoxin as ordered by the physician is a medical intervention for congestive heart failure. While important, the nursing diagnosis is related to excess fluid volume, and the focus should be on nursing interventions such as monitoring daily weights.

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Kimberly and Amanda sharing clay to each make things represents cooperative play, not parallel play. Cooperative play involves interaction and collaboration between children, whereas parallel play involves children playing side by side without interacting.

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Adam playing a board game with Kyle, Steven, and Erich represents cooperative play, not parallel play. Cooperative play involves shared activities and collaboration, while parallel play involves independent activities in proximity to others.

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Danielle playing with a music box on her mother's lap is an example of solitary play, where a child plays alone without regard to others. Solitary play is common in younger children and is different from parallel play.

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Self-monitoring of blood glucose is not recommended primarily because it is a less expensive method of testing. The main reasons for self-monitoring include empowering the child to manage their diabetes, allowing for more frequent monitoring without hospital visits, and facilitating prompt adjustments in insulin or dietary intake.

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Self-monitoring of blood glucose can be quite accurate if done correctly. Accuracy depends on proper technique, calibration of the glucometer, and regular maintenance. It is comparable to laboratory testing when performed accurately.

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While parental involvement is essential, self-monitoring of blood glucose is primarily about empowering the child to manage their diabetes. Parents play a supportive role in educating and supervising, but the child's active involvement is crucial for long-term management.

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Pulmonary stenosis is characterized by a systolic ejection murmur best heard at the upper left sternal border. It does not typically produce a continuous machinery-like murmur. Pulmonary stenosis results from narrowing at the pulmonary valve, obstructing blood flow from the right ventricle to the pulmonary artery.

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Ventricular septal defect (VSD) typically produces a harsh holosystolic murmur heard best at the lower left sternal border. VSD is a hole in the septum separating the ventricles, allowing blood to flow from the higher-pressure left ventricle to the lower-pressure right ventricle.

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Coarctation of the aorta causes a murmur due to increased blood flow across the aortic valve. However, this murmur is not continuous and is usually systolic and best heard in the back over the left scapula.

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Abdominal respirations do not directly predispose toddlers to frequent infections such as otitis media, tonsillitis, and upper respiratory tract infections. Abdominal respirations are a normal breathing pattern in toddlers, transitioning from the diaphragmatic breathing seen in infants. This change is due to the toddler's increased chest wall compliance and stronger intercostal muscles, facilitating more efficient breathing.

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Slower pulse and respiratory rates in toddlers compared to infants are part of normal physiological development. Toddler's heart rates range from 70 to 110 beats per minute, and respiratory rates range from 20 to 30 breaths per minute. These rates are considered normal for toddlers and do not predispose them to frequent infections.

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Toddlers do have less efficient defense mechanisms than infants, making them more susceptible to infections. This is due to the immature immune system in toddlers, which is still developing and learning to respond to various pathogens. However, this choice is not the most important factor predisposing toddlers to frequent infections; other factors play a more significant role.

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An abnormal red reflex, especially if it is not uniform and brilliant, could indicate underlying eye conditions and would require referral to an ophthalmologist for further evaluation. However, in this scenario, the description provided indicates a normal finding, making this choice incorrect.

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A uniform red reflex does not suggest a possible visual defect that requires vision screening. A normal red reflex indicates the absence of significant visual abnormalities, making this choice incorrect.

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Small hemorrhages in the eye would not present as a brilliant, uniform red reflex. Hemorrhages typically appear as dark spots or patches and would be an abnormal finding requiring further evaluation. This choice is incorrect in the context of the described scenario.

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Adjusting the insulin dosage without proper medical guidance can be dangerous for a child with diabetes. Giving half the regular morning dose without considering the child's current blood glucose levels can lead to hypoglycemia, a potentially life-threatening condition. This choice is unsafe and incorrect.

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Substituting simple carbohydrates or calorie-containing liquids for solid foods might help maintain the child's blood glucose levels to some extent. However, it's crucial to ensure that the child's overall nutritional needs are met. In cases of illness, monitoring blood glucose levels and consulting with a healthcare provider are essential. This choice, while not the best option, could be a temporary measure if the child is not eating solid foods due to illness.

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Taking the child directly to the emergency department is not necessary if the child is only experiencing a minor illness and is not eating. However, if the child shows signs of severe dehydration, persistent vomiting, or other concerning symptoms, seeking medical attention promptly is crucial. In the absence of these severe symptoms, choice C is the most appropriate course of action.

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Soccer involves running, sudden stops, and potential collisions, which can increase the risk of injuries and bleeding in children with hemophilia. While moderate exercise is generally beneficial for individuals with hemophilia, activities with a high risk of trauma, like soccer, should be avoided to prevent bleeding episodes. Therefore, soccer is not the recommended sport for children with hemophilia.

rationale:
Basketball involves rapid movements, jumping, and physical contact, all of which can increase the risk of injuries and bleeding in children with hemophilia. Engaging in sports that involve frequent collisions or physical impact can lead to joint bleeds and other complications in individuals with hemophilia. Therefore, basketball is not the recommended sport for children with hemophilia.

rationale:
Football, similar to soccer and basketball, involves intense physical contact and rapid movements, making it a high-risk sport for children with hemophilia. Engaging in such activities significantly increases the likelihood of bleeding episodes and injuries. Therefore, football is not the recommended sport for children with hemophilia.

rationale:
Koplik's spots are small white or bluish-white spots with a red halo that appear inside the mouth on the buccal mucosa. They are a characteristic sign of measles (rubeola). Measles is a highly contagious viral infection characterized by fever, cough, runny nose, and a distinctive red rash. The presence of Koplik's spots is a specific diagnostic feature of measles, making choice A incorrect for this scenario.

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Chickenpox (varicella) presents with an itchy rash that progresses to fluid-filled blisters. However, Koplik's spots are not associated with chickenpox. Chickenpox is caused by the varicella-zoster virus and is characterized by a widespread rash, fever, and general discomfort. Koplik's spots are specific to measles and do not occur in chickenpox.

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Exanthema subitum, also known as roseola, is a viral illness that primarily affects infants and young children. It is characterized by high fever followed by a rash. However, Koplik's spots are not a feature of roseola. The rash in roseola appears after the fever subsides and is typically pink or red, differentiating it from the small white spots seen in measles.

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Fever as high as 40° C (104° F). Fever is not typically a common sign or symptom of chronic otitis media with effusion (OME). Chronic OME is characterized by the presence of fluid in the middle ear without signs of acute infection. While fever might occur in acute otitis media, it is not a typical feature of chronic OME.

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Severe pain in the ear. Severe pain in the ear is more commonly associated with acute otitis media rather than chronic otitis media with effusion. Chronic OME usually presents with a sensation of fullness or hearing loss in the affected ear due to the accumulation of fluid in the middle ear, but it does not cause severe ear pain.

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Nausea and vomiting. Nausea and vomiting are not typical signs or symptoms of chronic otitis media with effusion. These symptoms are more likely to occur in conditions affecting the inner ear or vestibular system, not in chronic OME.

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Cough. While a cough can be a side effect of inhaled steroids, it is not a significant concern compared to other potential risks. Long-term use of inhaled steroids can lead to slowed growth in children, making choice C the correct answer.

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Osteoporosis. Osteoporosis is a potential side effect of long-term use of inhaled steroids. These medications can affect bone density and increase the risk of osteoporosis, especially in individuals who are already at risk due to other factors such as age, gender, or family history.

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Cushing's syndrome. Cushing's syndrome is a rare but serious side effect of long-term steroid use. It is characterized by a collection of signs and symptoms caused by prolonged exposure to high levels of cortisol (a steroid hormone). While it's a potential risk, slowed growth is a more common concern in children taking long-term inhaled steroids.

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Inspiratory stridor. Inspiratory stridor, a high-pitched sound heard during inhalation, is a common symptom of acute epiglottitis. It is caused by the swelling and inflammation of the epiglottis, which can partially obstruct the airway and create a stridor sound during breathing.

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Sore throat. A sore throat is a common symptom of various respiratory tract infections, including acute epiglottitis. However, the use of a tongue depressor can worsen the swelling and potentially lead to complete airway obstruction, which is a more immediate concern.

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Respiratory tract infection. Acute epiglottitis itself is a severe respiratory tract infection, specifically involving the epiglottis. Using a tongue depressor might exacerbate the condition, leading to airway obstruction, but it is not the cause of the respiratory tract infection.

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Encourage food intake to maintain caloric needs. Encouraging food intake is essential to ensure the infant receives adequate nutrition. However, if the infant has a reduced appetite due to illness, it's important to offer easily digestible foods and fluids to prevent dehydration. Offering small, frequent meals or breast milk/formula feeds can help maintain caloric needs.

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Have the child wear heavy clothing to prevent chilling. It is not advisable to have the child wear heavy clothing, especially if they have a fever. Fever is the body's natural response to infection and helps in fighting off the illness. Overdressing the child can trap heat and worsen the fever. Instead, it's better to dress the child in lightweight, breathable clothing to promote heat dissipation.

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Give small amounts of favorite fluids frequently to prevent dehydration. Giving small amounts of favorite fluids frequently is a suitable nursing intervention for an infant with an upper respiratory tract infection and elevated temperature. It helps prevent dehydration, especially if the infant is not feeding well due to illness. Offering oral rehydration solutions or breast milk/formula in small, frequent amounts can maintain hydration status.

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Increasing the caloric density of the infant's formula may be necessary in certain situations, but it is not specific to managing heart failure. Heart failure in infants often leads to poor feeding, so increasing the amount of formula given at each feeding is more appropriate.

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Feeding the baby every 2 hours may be necessary for infants, but it is not directly related to managing heart failure. The crucial aspect in heart failure management is optimizing the nutritional intake, which may involve adjusting the amount of formula given to the infant.

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Placing a nasal oxygen cannula on the infant during and after each feeding might be necessary if the infant has respiratory distress, but it is not a general recommendation for all infants with heart failure. The focus should be on improving feeding to enhance caloric intake.

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Allowing the adolescent to make decisions about medication is essential for promoting autonomy, but it is not the priority in this situation. Addressing the immediate physical symptoms and discomfort takes precedence.

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Verbalizing the importance of monitoring for medication side effects is important for patient education, but it is not the priority in this scenario. Constipation can significantly impact the child's quality of life and needs prompt attention.

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Developing alternative educational goals is not relevant to the immediate physical symptoms presented in the question.

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Gathering literature for the parents is a valuable resource, but it should come after assessing the parents' needs and readiness to learn. Providing information without considering the parents' emotional state and readiness may not be as effective.

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Securing a quiet place for teaching is important for minimizing distractions, but it is not the first action. Assessing the parents' readiness to learn comes before setting up the teaching environment.

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Discussing the plan with the nursing team is important for coordination, but it is not the first action. Assessing the parents' emotional state and readiness to learn guides the development of an effective teaching plan.

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The child's fever in Kawasaki disease is typically unresponsive to antibiotics. The disease primarily affects blood vessels and can lead to the development of coronary artery aneurysms. Antibiotics are not the mainstay of treatment for Kawasaki disease.

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Kawasaki disease does not primarily involve the joints. It is a systemic vasculitis that affects medium-sized arteries throughout the body, including the coronary arteries. Joint involvement is not a characteristic feature of this condition.

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Aspirin is actually a crucial part of the treatment for Kawasaki disease. High-dose aspirin therapy (80-100 mg/kg/day) is administered until the child is afebrile, then the dose is reduced and continued for several weeks to prevent blood clots and inflammation in the coronary arteries.

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It is not inappropriate because of the child's age. Simple magic tricks, especially those using familiar items like gauze, can capture the attention and cooperation of young children. Age-appropriate distractions can be highly effective in engaging pediatric patients during medical procedures.

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It is not too distracting when cooperation is important. Distractions, when used judiciously, can enhance cooperation during medical procedures. The key is to strike a balance between engaging the child and ensuring the procedure's effectiveness. A simple magic trick with gauze is generally not overly distracting and can be a helpful technique in pediatric nursing.

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Adequate time is important, but the appropriateness of the magic trick is not solely dependent on time. While having adequate time is beneficial for implementing creative approaches, the effectiveness of using a magic trick depends more on the nurse's skill, the child's response, and the overall context of the situation.

rationale:
Preventing the spread of illness to others is not the primary focus when teaching a mother about ulcerative colitis. Ulcerative colitis is a chronic inflammatory bowel disease and is not contagious. The primary focus of education should be related to managing the child's symptoms and improving their quality of life.

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Teaching daily use of enemas may be relevant in specific cases or during acute flare-ups, but it is not a general teaching point for all children with ulcerative colitis. Enema usage should be based on the healthcare provider's recommendation and tailored to the individual child's needs.

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Coping with stress and avoiding triggers is important in managing ulcerative colitis. Stress and certain triggers can exacerbate symptoms and lead to flare-ups. Teaching coping mechanisms and identifying triggers can help the child and their family manage the condition effectively.

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Bronchoscopy is not the essential test for diagnosing cystic fibrosis. Bronchoscopy is a procedure that allows the healthcare provider to visualize the airways and lungs but is not the primary test for cystic fibrosis diagnosis. Cystic fibrosis is primarily diagnosed through genetic testing and sweat chloride testing.

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Serum calcium levels are not specific to cystic fibrosis diagnosis. Serum calcium levels are typically used to assess calcium balance in the body and are not directly related to cystic fibrosis diagnosis.

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Urine creatinine levels are not specific to cystic fibrosis diagnosis. Urine creatinine levels are often used to assess kidney function and muscle breakdown but are not diagnostic for cystic fibrosis.

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The dosage prescribed for the child is 40 mg/kg/day, twice a day for 10 days. The child weighs 44 lbs, which is approximately 20 kg (1 lb = 0.45 kg). Therefore, the total daily dosage would be 40 mg/kg * 20 kg = 800 mg. This is split into two doses, so each dose would be 400 mg, not 400 mg per 5 ml as in the suspension.

rationale:
This choice is incorrect because it does not accurately calculate the dosage based on the child's weight and the prescribed dosage regimen.

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This choice is incorrect because it suggests a higher dose than what is prescribed. The correct dosage, based on the child's weight and prescription, is 800 mg per day, split into two doses of 400 mg each.