Nokea
Parents have adopted a child with the diagnosis of kwashiorkor. What is most likely to be observed when assessing this child?
- A. Hyperactivity
- B. White streak in hair
- C. Edematous abdomen
- D. Slowed growth
- E. Thick, oily hair
Correct Answer: B,C,D
Rationale: Kwashiorkor presents with a white streak in hair (depigmentation), edematous abdomen, and slowed growth due to protein deficiency; the child is apathetic, with thin, dry hair.
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What would the nurse expect to find in a child admitted to the hospital for nonorganic failure to thrive?
- A. Cry to be picked up
- B. Be limp like a rag doll
- C. Be responsive to cuddling
- D. Weigh in the 10th percentile for age
Correct Answer: B
Rationale: Rag-doll limpness (hypotonia) is a characteristic finding in nonorganic failure to thrive, often with wariness of caregivers.
A child is brought into the ED with suspected appendicitis.
- A. Left lower quadrant pain
- B. Guarding
- C. Rebound tenderness
- D. Decreased C-reactive protein
- E. Pain on lifting thigh when supine
Correct Answer: B,C,E
Rationale: Guarding, rebound tenderness, and pain on thigh lifting are signs of appendicitis; pain is in the right lower quadrant, and C-reactive protein is elevated.
What will be the nurse's priority goal of the infant's care?
- A. Prevent fluid and electrolyte imbalance.
- B. Prevent nutritional deficiency.
- C. Prevent skin breakdown.
- D. Prevent malabsorption.
Correct Answer: A
Rationale: Preventing fluid and electrolyte imbalance is the priority in acute gastroenteritis to avoid life-threatening complications.
What does the nurse suspect based on this information?
- A. Pinworms
- B. Giardiasis
- C. Ringworm
- D. Roundworm
Correct Answer: A
Rationale: Anal itching and scratching are characteristic symptoms of pinworm infection.
What assessment(s) would lead a nurse to suspect Hirschsprung's disease in a 1-month-old infant?
- A. Ribbon-like stools
- B. Fever
- C. Failure to thrive
- D. Vomiting
- E. Diminished peristalsis
Correct Answer: A,B,C,D,E
Rationale: Ribbon-like stools, fever, failure to thrive, vomiting, and diminished peristalsis are all indicative of Hirschsprung's disease due to intestinal obstruction.