A mother brings her 3-year-old daughter to the emergency department because the child has been vomiting and having diarrhea for the past 36 hours. When assessing this child'stemperature, which method would be least appropriate?

Tympanic

Oral

Axillary

Rectal

Answer and Explanation

The Correct Answer is D

A. TympaniC. Tympanic temperature measurement using an ear thermometer is a convenient and accurate method for assessing temperature in children, including toddlers.

B. Oral: Oral temperature measurement using a digital thermometer placed under the tongue is a commonly used method for children who can cooperate with the procedure and keep the

thermometer in their mouth.

C. Axillary: Axillary temperature measurement using a thermometer placed in the armpit is a non-invasive method suitable for children who cannot cooperate with oral or tympanic

measurements or when rectal measurement is contraindicated.

D. Rectal: Rectal temperature measurement is generally considered the most accurate method for assessing temperature in infants and young children, especially when accuracy is critical.

However, it may be less appropriate in the emergency department setting due to its invasive nature and potential discomfort for the child, especially in cases of diarrhea or vomiting where rectal temperature measurement may be difficult or impractical.

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Correct Answer is D

Explanation

A. Administer at mealtimes: While iron supplements can be given with meals to reduce gastrointestinal upset, they are typically better absorbed on an empty stomach. Therefore, giving them at mealtimes may not optimize absorption.

B. Administer at bedtimE. Administering iron supplements at bedtime is not typically recommended unless specifically instructed by a healthcare provider.

C. Give with a 240 mL (8 oz) glass of milk: Milk can decrease the absorption of iron due to its calcium content, so giving iron supplements with milk is not recommended.

D. Give with orange juicE. Vitamin C enhances iron absorption, so giving iron supplements with orange juice is a common practice to improve absorption.

A. Increased intracranial pressure B. Dehydration C. Overhydration D. These are normal findings

Correct Answer is D

Explanation

A. Increased intracranial pressurE. Pulsation and bulging of the fontanel may be signs of

increased intracranial pressure in infants. However, it is important to differentiate between normal fontanel characteristics and abnormal signs of elevated intracranial pressure. In this case, the pulsation and bulging are likely normal responses to crying and changes in intracranial pressure during the newborn period.

B. Dehydration: Dehydration typically presents with sunken fontanels rather than pulsation and bulging. Dehydration is a serious condition that requires prompt assessment and intervention, but it is not indicated by the findings described in the scenario.

C. Overhydration: Overhydration is not typically associated with pulsation and bulging of the fontanel. Overhydration may lead to fluid overload and edema but does not directly affect fontanel characteristics.

D. These are normal findings: Pulsation and brief bulging of the fontanel in response to crying are considered normal findings in newborns. Fontanels allow for the flexibility of the skull bones during childbirth and provide space for brain growth during infancy. Pulsation and bulging may occur temporarily during crying or changes in intracranial pressure and are not necessarily

indicative of pathology.

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A mother brings her 3-year-old daughter to the emergency department because the child has been vomiting and having diarrhea for the past 36 hours. When assessing this child'stemperature, which method would be least appropriate?

Nursing Test Bank

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Correct Answer is D

Explanation

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Correct Answer is D

Explanation

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