# A nurse is assessing a 2-year-old toddler with suspected iron-deficiency anemia. Which assessment finding would be most indicative of this condition?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=542171  
> language: ko  
> subject: Adult Health

## 문제

A nurse is assessing a 2-year-old toddler with suspected iron-deficiency anemia. Which assessment finding would be most indicative of this condition?

## 보기

1. Bradycardia and hypertension
2. Jaundice and dark-colored urine
3. Petechiae and easy bruising
4. Pallor of conjunctiva and nail beds **✔ 정답**

**정답: 4**

## 해설

Pallor of conjunctiva and nail beds is most indicative of iron-deficiency anemia due to reduced hemoglobin and oxygen-carrying capacity. Other options are associated with different conditions like bradycardia/hypertension (cardiovascular issues), jaundice (liver or hemolytic disorders), or petechiae (bleeding disorders).

## 심화 해설

Understanding Iron-Deficiency Anemia in Toddlers

Iron-deficiency anemia (IDA) is the most common nutrient deficiency globally, with a particularly high prevalence in infants and preschool-aged children [3]. In toddlers, the etiology is frequently linked to inadequate dietary iron intake, and a classic culprit is excessive consumption of cow's milk [1][2][4]. While cow's milk is a staple in many early childhood diets, it is a poor source of bioavailable iron and can actively inhibit intestinal iron absorption, which increases the risk of deficiency [2]. The condition manifests through a spectrum of clinical signs resulting from reduced hemoglobin synthesis and subsequent decreased oxygen-carrying capacity of the blood.

Analysis of Assessment Findings

The most indicative assessment finding for IDA in this scenario is pallor of the conjunctiva and nail beds. This is a direct and classic clinical manifestation of anemia. When hemoglobin levels drop, the blood's oxygen content decreases, leading to a generalized paleness of vascularized tissues. The conjunctiva and nail beds are highly vascular areas where the skin or mucous membrane is thin, making pallor easily observable during a physical assessment. This finding is consistently reported in severe cases, as seen in a 16-month-old girl with a hemoglobin level of 2.6 g/dL who presented with marked conjunctival pallor [1].

To understand why the other options are less indicative, a pathophysiological comparison is helpful:

| Assessment Finding | Associated Condition | Pathophysiological Basis |
| --- | --- | --- |
| Pallor of conjunctiva and nail beds | Iron-Deficiency Anemia | Results directly from decreased hemoglobin and reduced oxygenated blood in peripheral capillaries and mucous membranes [1]. |
| Bradycardia and hypertension | Not typical of IDA | In early or moderate IDA, the body compensates with tachycardia, not bradycardia, to maintain cardiac output. Severe, chronic anemia can eventually lead to high-output heart failure, but hypertension is not a direct sign. |
| Jaundice and dark-colored urine | Hemolytic Anemia | These findings indicate excessive red blood cell destruction. Jaundice is from elevated unconjugated bilirubin, and dark urine is from hemoglobinuria. This is a hallmark of hemolytic processes, not nutritional deficiency. |
| Petechiae and easy bruising | Thrombocytopenia or Platelet Dysfunction | These are signs of impaired primary hemostasis, typically linked to a low platelet count or dysfunctional platelets. While severe IDA can sometimes cause a reactive thrombocytosis, it does not directly cause bleeding tendencies like petechiae or easy bruising. |

Clinical Reasoning and NCLEX Application

For the NCLEX-RN, it is crucial to connect the assessment finding directly to the underlying pathophysiology. In IDA, the body's iron stores are depleted, impairing heme synthesis and leading to the production of microcytic, hypochromic red blood cells [1]. The resulting anemia reduces the blood's oxygen-carrying capacity, and the physical manifestation you will most consistently observe is pallor. This is a key differentiator from anemias caused by hemolysis (jaundice) or bone marrow failure (petechiae from concurrent thrombocytopenia). The clinical picture is further supported by dietary history, where excessive cow's milk intake—a leading cause of dietary iron deficiency in young children due to its low iron content and interference with absorption—is a critical risk factor to identify during the nursing history [2][4].
References (research sources)

- [1]Severe Iron-Deficiency Anemia and Hypoalbuminemia Associated With Excessive Cow's Milk Intake Driven by a Strong Belief in the Health Benefits of Cow's Milk in a 16-Month-Old Girl: A Case Report.Case reportGotou T, Hagihara T, Wada Y, Hashimoto K, Nagashima F. (2026) · DOI: 10.7759/cureus.101657

- [2]Severe Iron Deficiency Anemia and Growth Faltering Associated With Excessive Cow's Milk Intake and Possible Celiac Disease in Indian Children: A Case Series.Case reportMujalda A, Mujalda J, Suman A, Gupta GK, Manisha M. (2026) · DOI: 10.7759/cureus.106283

- [3]Iron Deficiency Anemia in Infancy, Childhood, and Adolescence.Research articleAksu T, Ünal Ş. (2023) · DOI: 10.5152/turkarchpediatr.2023.23049

- [4]Pediatric Venous Sinus Thrombosis Secondary to Cow's Milk-Induced Iron-Deficiency Anemia.Research articleHooshmand SI, Sawalha A, Cierny M. (2025) · DOI: 10.7759/cureus.92394

## 임상 시나리오

Assessing Pallor in Pediatric AnemiaKey physical exam technique for suspected iron deficiency
Inspect the conjunctiva by gently pulling down the lower eyelid and the nail beds by applying gentle pressure. Pallor in these highly vascular areas is a classic, direct sign of reduced hemoglobin and is more reliable than skin tone alone.

Pallor is a late finding and indicates significant anemia. In toddlers, a common cause is excessive cow's milk intake (> 24 oz or 700 mL per day), which is low in iron and can cause microscopic GI bleeding.

CautionDo not confuse pallor with other findings. Jaundice suggests hemolysis, and petechiae suggests a platelet disorder. Tachycardia, not bradycardia, is the cardiovascular response to severe anemia.

## 핵심 개념

- **Iron-Deficiency Anemia** — A microcytic, hypochromic anemia caused by insufficient iron for hemoglobin synthesis, leading to decreased oxygen-carrying capacity.
- **Pallor** — Paleness of the skin or mucous membranes, a key physical sign of anemia best assessed in the conjunctivae, nail beds, and palms.
- **Conjunctival Pallor** — A sensitive indicator of severe anemia observed by gently pulling down the lower eyelid to inspect the inner mucous membrane.

## 같은 주제 문제

- [A nurse is assessing a 28-year-old female client who reports fatigue and weakness for the …](https://mymerci.kr/pages/nclex_q.php?qn_id=540773)
- [A nurse is assessing a 28-year-old female client with suspected iron-deficiency anemia. Wh…](https://mymerci.kr/pages/nclex_q.php?qn_id=540774)
- [A nurse is assessing a 65-year-old male client with iron-deficiency anemia. Which laborato…](https://mymerci.kr/pages/nclex_q.php?qn_id=540775)
- [A nurse is caring for a 28-year-old female client diagnosed with iron-deficiency anemia (h…](https://mymerci.kr/pages/nclex_q.php?qn_id=540776)
- [A nurse is caring for a client with iron-deficiency anemia. Which nursing intervention sho…](https://mymerci.kr/pages/nclex_q.php?qn_id=540777)
- [A nurse is assessing a 3-year-old child with suspected iron-deficiency anemia. Which asses…](https://mymerci.kr/pages/nclex_q.php?qn_id=542170)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._