The nurse is assessing a 3-month-old during a well-baby visit. Which of the following findings would warrant the nurse to recommend that the baby have an ultrasound for a possible diagnosis of developmental dysplasia of the hip (DDH)?

Correct Answer: B

Rationale: Developmental dysplasia of the hip (DDH) is a condition where the hip joint does not develop normally. It is important to detect DDH early in infants as it can lead to long-term hip problems. One of the key physical exam findings that may suggest DDH is unequal knee heights when the infant's legs are flexed. This is known as the Galeazzi sign, and it can indicate hip dysplasia or dislocation. Therefore, if a nurse observes this finding during an assessment of a 3-month-old infant, it would warrant recommending an ultrasound to further evaluate for possible DDH. Bilateral plantar flexion, bilateral polydactyly, and a positive Babinski test are not typically associated with DDH.

Correct Answer: D

Rationale: Children with acute lymphocytic leukemia commonly present with a combination of symptoms which can include fatigability, persistent fever of unknown cause, and a tendency to bruise easily. Fatigue is a common complaint in children with leukemia due to anemia caused by decreased production of healthy red blood cells. Persistent fevers can be a sign of infection, anemia, or other complications related to leukemia. Additionally, children with leukemia may have a low platelet count, leading to easy bruising or bleeding tendencies. Therefore, all of the characteristics mentioned in the options are correct for a child with acute lymphocytic leukemia.

Correct Answer: D

Rationale: The protrusion of the frontal fontanelle in a child can be a concerning sign and can be seen in various conditions such as meningitis, hydrocephalus, and subdural hematoma. In meningitis, the inflammation of the meninges can lead to increased intracranial pressure, which may cause the fontanelle to bulge. Hydrocephalus, which is the buildup of fluid in the brain, can also result in the fontanelle being more pronounced. Additionally, a subdural hematoma, which is a collection of blood between the brain and its outermost covering, can lead to pressure on the brain and consequent fontanelle protrusion. Therefore, all the provided choices (A, B, C) are correct as they can lead to the protrusion of the frontal fontanelle in a child.

Correct Answer: C

Rationale: Rectal temperatures are not recommended in newborns because they can potentially cause perforation of the rectal mucosa. Newborns have fragile, delicate tissues in the rectal area, and the insertion of a rectal thermometer may lead to injury or damage to the mucosal lining. It is important to exercise caution and use alternative methods for taking temperatures in newborns to avoid any harm or discomfort.

Correct Answer: B

Rationale: The current recommendations for hepatitis B (HBV) vaccine state that the first dose should be administered between ages 12 and 15 months. The vaccine series typically consists of three doses, with the second dose administered 1-2 months after the first dose, and the third dose given at least 8 weeks after the second dose. This schedule is recommended by the Centers for Disease Control and Prevention (CDC) to provide optimal protection against the hepatitis B virus. Starting the vaccine series at 12-15 months ensures that the child's immune system is mature enough to respond effectively to the vaccine and generate lasting immunity.