A 2-year-old has weight at the 3rd percentile and height at the 50th percentile. Which additional physical exam finding would most suggest an organic (medical) cause of failure to thrive?

A quantity that gives the direction of a thermodynamic process is

In a coal-fired power plant, high pressure steam turns the turbines which then turns the generator. 

A 5-year-old presents with a second episode of nephrotic syndrome. Which historical finding is most relevant to the current evaluation?

A 4-year-old receiving IV vancomycin develops diffuse flushing, erythema, and pruritus over the face, neck, and upper chest during infusion. Blood pressure and heart rate remain stable. Which intervention is most appropriate?

A 15-year-old with obesity is admitted for an unrelated illness. Which psychosocial risk is most important to screen for during the hospitalization?

An 8-year-old with known Crohn disease presents with crampy abdominal pain, bloody diarrhea, and 4 lb weight loss over 2 weeks. Which physical examination finding most suggests active disease flare?

A nurse is caring for a client whose cultural beliefs emphasize the use of traditional healers. The client states they prefer to use herbal remedies instead of prescribed medication. What is the nurse’s best response?

A 4-year-old presents with a sandpaper-like rash, flushed face with circumoral pallor, and pharyngitis. Which additional physical exam finding would confirm a diagnosis of scarlet fever?

A 5-year-old in septic shock has received 60 mL/kg of isotonic crystalloid fluid. Blood pressure remains critically low (MAP 38 mmHg). Which is the most appropriate next pharmacologic intervention?