Nokea
When explaining to the parents of a child with a hydrocele about the possible cause of the condition, the nurse bases this explanation on the interpretation that a hydrocele is most likely the result of which condition?
- A. Blockage in the inguinal canal that allows fluid to accumulate in epididymis and ductus deferens.
- B. Failure of the upper part of the processus vaginalis to atrophy, allowing accumulation of fluid in the testicle and the peritoneal cavity.
- C. A patent processus vaginalis that results in the collection of fluid along the spermatic cord or tunica vaginalis of the testicle.
- D. An obliterated processus vaginalis that allows fluid to accumulate in the scrotal sac.
Correct Answer: C
Rationale: Patent processus vaginalis leads to fluid collection.
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Which of the following would indicate that an infant with a tracheoesophageal fistula (TEF) needs suctioning?
- A. Brassy cough.
- B. Substernal retractions.
- C. Decreased activity level.
- D. Increased respiratory rate.
Correct Answer: B
Rationale: Substernal retractions indicate respiratory distress, often due to mucus accumulation in TEF, necessitating suctioning.
A 2-year-old child returns to the clinic after completing a 10-day course of amoxicillin prescribed to relieve an infection in his right ear. After completing the medication, the child has become fussy and has a low-grade fever. On physical examination, his right tympanic membrane is bulging and he is tugging at his ear. The nurse should:
- A. Suggest to the mother that a decongestant be used.
- B. Tell the mother the health care provider will probably repeat the 10-day course of amoxicillin.
- C. Suggest that the child should see an ear, nose, and throat specialist for myringotomy tubes.
- D. Report the assessment to the health care provider with the probability that another antibiotic will be used for a 10-day course.
Correct Answer: D
Rationale: Persistent symptoms like fussiness, fever, a bulging tympanic membrane, and ear tugging after completing amoxicillin suggest treatment failure, possibly due to resistant bacteria. The nurse should report these findings to the health care provider, who may prescribe a different antibiotic for another 10-day course.
A child with celiac disease is at risk for which complication if the diet is not followed?
- A. Renal failure.
- B. Intestinal lymphoma.
- C. Pulmonary fibrosis.
- D. Cardiomyopathy.
Correct Answer: B
Rationale: Untreated celiac disease increases the risk of intestinal lymphoma due to chronic inflammation. Renal, pulmonary, or cardiac complications are not directly associated.
The physician is able to reduce an infant's hernia and schedules the infant for a herniorrhaphy in 2 days. The mother asks the nurse why the surgery is not performed now. Which of the following responses indicates that the nurse understands the rationale for delaying the surgery?
- A. Delaying the surgery ensures that your infant will receive the proper preoperative preparation.
- B. The infant can take nothing by mouth for at least 24 hours before the surgery.
- C. Waiting these 2 days helps to allow any edema and inflammation in the area to subside.
- D. Your infant needs to wear a truss for at least 24 hours before any surgery can be attempted.
Correct Answer: C
Rationale: Delaying surgery allows edema and inflammation to decrease, improving surgical outcomes.
When teaching the parents of an infant how to perform back slaps to dislodge a foreign body, which of the following should the nurse tell the parents to use to deliver the blows?
- A. Palm of the hand.
- B. Heel of the hand.
- C. Fingertips.
- D. Entire hand.
Correct Answer: B
Rationale: The heel of the hand is used to deliver back slaps in infants to effectively dislodge a foreign body without causing injury.