You are discussing physical child abuse with medical students; you state that fractures are common presentation and those that should raise suspicion for abuse include fractures that are unexplained, occurring in young, non-ambulatory children, or involve multiple bones. Of the following, the site of the fracture that is LESS specific for abuse is

Correct Answer: D

Rationale: Fractures of the vertebrae are less specific for abuse compared to other sites like ribs, scapula, or skull, which are more characteristic of inflicted trauma.

Correct Answer: C

Rationale: Frequent oral care is important for overall oral health and cleanliness, but it will not directly help correct the patient's fluid imbalance. The patient's condition likely requires direct fluid replacement to address the fluid loss and restore balance. A, B, and D are focused on fluid replacement strategies which are more crucial in correcting the patient's condition. Offering a large amount of oral fluid intake to replace lost fluids, giving enteral or parenteral fluid, and giving small volumes of fluid at frequent intervals are all appropriate measures that can help correct the patient's condition by addressing the underlying fluid imbalance.

Correct Answer: D

Rationale: Wilms tumor can grow very quickly, so a lump that was not evident previously may become noticeable in a short period.

Correct Answer: D

Rationale: Pyloric stenosis is a condition in infants where there is a tightening of the muscle at the outlet of the stomach, causing obstruction of food passage into the small intestine. One of the hallmark symptoms of pyloric stenosis is projectile vomiting, in which the vomit is forceful and shoots out a significant distance. This distinguishes it from regular regurgitation or spitting up, which are more common in infants for other reasons. Nurse Nancy would likely note this symptom while assessing a child with pyloric stenosis.

Correct Answer: C

Rationale: In a first-time generalized seizure, an immediate EEG and starting anticonvulsant therapy is prudent to prevent recurrence, especially if the EEG shows epileptiform activity.