When palpating the brachial, radial, and femoral pulses of a neonate, the nurse notes a difference in pulse amplitude between the femoral and radial pulses bilaterally. This difference suggests:

Correct Answer: B

Rationale: Coarctation of the aorta is a congenital heart defect in which there is a narrowing of the aorta leading to differential pulses in the upper and lower extremities. In neonates, this can manifest as weaker femoral pulses compared to radial pulses due to decreased blood flow to the lower body. This difference in pulse amplitude between the femoral and radial pulses bilaterally is a classic finding in coarctation of the aorta, making it the most likely cause in this scenario. Other conditions like patent ductus arteriosus, diminished cardiac output, or left to right shunting in the heart may not specifically present with this particular pulse amplitude difference.

Correct Answer: C

Rationale: The primary reason a type II diabetic does not usually develop diabetic ketoacidosis is that there is no sufficient insulin to prevent the breakdown of protein and fatty acids for metabolic needs. In type II diabetes, the body still produces some insulin, unlike in type I diabetes where there is a complete lack of insulin. However, the insulin that is produced in type II diabetes may not be enough to effectively lower blood sugar levels and prevent the breakdown of protein and fatty acids for energy. This imbalance can lead to high blood sugar levels, known as hyperglycemia, but not to the extent of causing diabetic ketoacidosis, which typically occurs in the absence of sufficient insulin to prevent the breakdown of fats into ketones.

Correct Answer: D

Rationale: The presence of polyps in the colon is a significant risk factor for developing colorectal cancer. Polyps are abnormal growths in the inner lining of the colon or rectum that can potentially become cancerous over time if left untreated. Therefore, if a client has a history of polyps, the nurse may suspect the possibility of colorectal cancer and should closely monitor the client for any signs or symptoms. While the other conditions listed may sometimes be associated with colorectal cancer, having a history of polyps is the most concerning in this context.

Correct Answer: A

Rationale: When caring for a child that has undergone a tonsillectomy, the nurse should observe for continuous swallowing. Continuous swallowing may indicate bleeding, and it is important to monitor for this postoperatively as it can be a sign of hemorrhage, which is a potential complication following a tonsillectomy. Encouraging the child to take sips of clear fluids can help in assessing if there is bleeding. Observing for any signs of bleeding, such as frequent swallowing, along with monitoring vital signs and overall assessment, is crucial during the initial postoperative period.

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.