Exhibits

The nurse obtains the bottle of acetaminophen pictured below. How many mL of acetaminophen does the nurse administer? (Round to the 10ths if needed)

Rationale:

• Nutrition: Millie’s intake of 5–6 cups of low-fat milk per day significantly exceeds the recommended 2 cups for toddlers. High milk intake suppresses appetite for nutrient-dense foods, worsening her picky eating and risking iron-deficiency anemia. Because it directly affects growth and development, nutrition becomes the priority teaching need.
• Excessive milk intake: Drinking this much milk can displace iron-rich solids, creating micronutrient deficits and contributing to poor weight progression if continued. Excess milk can also cause constipation and limit overall diet variety in young children. This factor presents the most immediate risk and therefore requires primary intervention.
• Language: Millie’s use of two-word phrases is developmentally appropriate for age 2, even though she is not yet forming full sentences. Sentence formation typically matures between ages 2½ and 3, making this delay mild and expected in many toddlers.
• Not using complete sentences: Toddlers commonly have uneven language development, and sentence construction often emerges later in the third year. This pattern does not impair Millie’s daily functioning or pose a health threat. Because the concern is mild and age-appropriate, it does not outweigh the need to address excessive milk intake.
• Motor skills: Millie walks, runs, kicks a ball, and climbs stairs with help—all well within expected developmental ranges for a 2-year-old. Fine motor tasks such as switching from a palmar grasp to a mature tripod grasp do not emerge until closer to age 3. These findings do not require urgent correction.
• Holding pencil in fist and needing help to walk up stairs: A fist grasp is the normal toddler way of holding writing tools, and alternating feet on stairs often develops after age 3. These abilities reflect early-stage coordination that continues to mature gradually. They do not signal a developmental risk.
• Behavior: Saying “no,” imitating adults, and having 2–3 tantrums per week are classic expressions of toddler autonomy. These behaviors demonstrate normal emotional development and do not indicate dysregulation that threatens health or safety.
• Having a tantrum 2–3 times per week: Tantrums at this frequency fall squarely within expected toddler patterns as they manage frustration and communication limits. They usually decrease as language improves and routines stabilize. Because they represent normal development, they are not the primary concern.

Rationale:

A. Elevated systolic blood pressure in the upper extremities and elevated systolic blood pressure in the lower extremities: Uniformly elevated blood pressure in both upper and lower extremities does not indicate coarctation of the aorta. This pattern may suggest systemic hypertension but not a localized obstruction of the aorta.

B. Elevated systolic blood pressure in the upper extremities and low systolic blood pressure in the lower extremities: This is characteristic of coarctation of the aorta, where narrowing of the aortic arch causes obstruction to blood flow to the lower extremities. The upper extremities receive blood before the narrowing, resulting in higher pressures compared with the legs.

C. Low systolic blood pressure in the upper extremities and low systolic blood pressure in the lower extremities: Low pressures in all extremities suggest generalized hypotension or poor cardiac output rather than a localized structural defect like coarctation of the aorta.

D. Low systolic blood pressure in the upper extremities and elevated systolic blood pressure in the lower extremities: This pattern is not consistent with coarctation of the aorta. Elevated lower extremity pressure with low upper extremity pressure may indicate other rare circulatory anomalies but is not typical for this condition.