Nokea
Which assessment finding indicates ineffectiveness of treatment?
- A. Weight loss of 4 ounces
- B. Dry mucous membranes
- C. Decreased skin turgor
- D. Depressed fontanelle
Correct Answer: A
Rationale: Weight loss in an infant with gastroenteritis indicates ongoing dehydration, reflecting ineffective treatment.
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What is the most appropriate nursing action?
- A. Delay feeding the child for 6 hours.
- B. Offer regular formula thinned with water.
- C. Give small amounts of regular formula thickened with cereal.
- D. Allow 1 ounce of glucose water at frequent intervals.
Correct Answer: D
Rationale: Small, frequent glucose water feedings post-pyloric stenosis surgery support recovery while minimizing vomiting risk.
Which food would the nurse recommend to include in the child's diet?
- A. Cooked vegetables
- B. Pretzels
- C. Whole-grain cereal
- D. Yogurt
Correct Answer: C
Rationale: Whole-grain cereal, a high-roughage food, helps alleviate constipation by promoting bowel movements.
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.
What dietary modification would the nurse advise?
- A. Soft foods with rice, bananas, toast, and applesauce
- B. Small amounts of clear fluids such as gelatin
- C. An oral rehydrating solution, such as Pedialyte
- D. Chicken soup because it is high in sodium
Correct Answer: C
Rationale: An oral rehydrating solution like Pedialyte replaces fluids and electrolytes lost in mild diarrhea.
What is the treatment of choice for a child with intussusception?
- A. A barium enema
- B. Immediate surgery
- C. IV fluids until the spasms subside
- D. Gastric lavage
Correct Answer: A
Rationale: A barium enema can often reduce intussusception by 'un-telescoping' the bowel, avoiding surgery.