Nokea
When caring for a child with probable appendicitis, the nurse should be alert to recognize which sign or symptom as a manifestation of perforation?
- A. Anorexia
- B. Bradycardia
- C. Sudden relief from pain
- D. Decreased abdominal distention
Correct Answer: C
Rationale: Sudden pain relief after perforation indicates peritonitis, a critical complication. Anorexia is a pre-existing appendicitis symptom, tachycardia (not bradycardia) accompanies peritonitis, and abdominal distention typically increases with perforation.
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What statement is most descriptive of Meckel diverticulum?
- A. It is acquired during childhood.
- B. Intestinal bleeding may be mild or profuse.
- C. It occurs more frequently in females than in males.
- D. Medical interventions are usually sufficient to treat the problem.
Correct Answer: B
Rationale: Meckel diverticulum often presents with mild to profuse intestinal bleeding due to its congenital nature. It?s present at birth, not acquired, is more common in males, and typically requires surgical removal, not just medical management.
What procedure is most appropriate for assessment of an abdominal circumference related to a bowel obstruction?
- A. Measuring the abdomen after feedings
- B. Marking the point of measurement with a pen
- C. Measuring the circumference at the symphysis pubis
- D. Using a new tape measure with each assessment to ensure accuracy
Correct Answer: B
Rationale: Marking the measurement point with a pen ensures consistent abdominal circumference assessment at the same location, typically the umbilicus. Measuring after feedings is inappropriate with NPO status, the symphysis pubis is too low, and a new tape measure is unnecessary.
Nutritional management of the child with Crohn disease includes a diet that has which component?
- A. High fiber
- B. Increased protein
- C. Reduced calories
- D. Herbal supplements
Correct Answer: B
Rationale: Increased protein in the diet supports healing and addresses growth failure in Crohn disease. High-fiber diets may cause obstruction, high-calorie diets are needed, and herbal supplements are not recommended without practitioner approval.
A 2-year-old child has a chronic history of constipation and is brought to the clinic for evaluation. What should the therapeutic plan initially include?
- A. Bowel cleansing
- B. Dietary modification
- C. Structured toilet training
- D. Behavior modification
Correct Answer: A
Rationale: Initial treatment for chronic constipation involves bowel cleansing to empty the distended rectum, allowing it to return to normal size. Dietary modification follows, structured toilet training is unsuitable for a 2-year-old, and behavior modification is part of ongoing management.
A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. What recommendation should the nurse include in teaching this parent?
- A. Surgical therapy is indicated.
- B. Place in prone position for sleep after feeding.
- C. Thicken feedings and enlarge the nipple hole.
- D. Reduce the frequency of feeding by encouraging larger volumes of formula.
Correct Answer: C
Rationale: Thickening feedings and enlarging the nipple hole reduces emesis volume and frequency by increasing caloric density and easing feeding. Surgery is for severe cases, prone positioning risks SIDS, and smaller, frequent feedings are better than larger volumes.