You are examining an infant with multiple cutaneous hemangiomas; you suspect involvement of internal organs. The MOST common site of visceral involvement by hemangiomas is

Correct Answer: D

Rationale: Liver is the most common site of visceral involvement by hemangiomas.

Correct Answer: A

Rationale: Oxygen saturation above 90% is a discharge criterion from the PACU (Post-Anesthesia Care Unit) for a patient following surgery. This indicates that the patient is effectively exchanging oxygen and carbon dioxide, which is essential for proper respiratory function. Adequate oxygenation is crucial for the patient to be safely discharged from the PACU and transitioned to a regular hospital room or home. Monitoring oxygen saturation helps ensure that the patient's respiratory status is stable before leaving the PACU. If a patient's oxygen saturation is below 90%, further assessment and interventions may be necessary before discharge is considered.

Correct Answer: B

Rationale: During a Romberg test, the individual is asked to stand with feet together, arms at sides, and eyes closed. The tester then observes for swaying, losing balance, or arm drifting, which are signs of a positive Romberg test, indicating a potential issue with proprioception or vestibular function. Hypotension (choice A) refers to low blood pressure and is not directly assessed during a Romberg test. Sneezing and wheezing (choice C) are unrelated symptoms. Excessive cerumen in the outer ear (choice D) does not affect the results of a Romberg test focused on balance and proprioception.

Correct Answer: C

Rationale: Administering supplemental oxygen is the most appropriate nursing intervention to relieve tachycardia that may develop in a client with myocarditis from hypoxemia. Myocarditis can lead to decreased oxygen delivery to the tissues, which may result in tachycardia as the body tries to compensate for the lack of oxygen. Providing supplemental oxygen will help increase oxygen levels in the blood, improving tissue perfusion and thus reducing the tachycardia. This intervention aims to address the underlying cause of the tachycardia in this situation.

Correct Answer: C

Rationale: Secondary enuresis is the recurrence of incontinence in a child who had previously achieved bladder control.