A newborn with a repaired gastroschisis is transferred to the pediatric unit after several days in the pediatric intensive care unit. The infant is receiving parenteral nutrition and continuous enteral feedings. To maintain normal growth and development of the infant, which action should the nurse include in plan of care?

Ensure placement of the enteral tube with an abdominal x-ray.

Speak to the healthcare provider about instituting physical therapy.

Offer a pacifier for non-nutritive sucking.

Use sterile technique during feedings.

Answer and Explanation

The Correct Answer is C

A. Ensure placement of the enteral tube with an abdominal x-ray: Verifying enteral tube placement is essential for safety, but it is not related to maintaining the newborn's growth and development. Tube placement should already have been verified prior to initiating feedings.

B. Speak to the healthcare provider about instituting physical therapy: Physical therapy may be beneficial for infants with specific motor delays, but it is not a routine intervention for all infants recovering from gastroschisis.

C. Offer a pacifier for non-nutritive sucking: Non-nutritive sucking (e.g., using a pacifier) is crucial for the growth and development of newborns, especially those unable to feed orally. It helps promote oral-motor development, soothes the infant, and lays the foundation for transitioning to oral feeding. This is particularly important for an infant receiving parenteral or enteral nutrition to ensure they develop the skills and comfort needed for future oral feeding.

D. Use sterile technique during feedings: Clean technique is generally sufficient or routine enteral feedings unless there is a specific indication for sterility (e.g., immunocompromised clients). Further, this does not directly support growth and development.

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Correct Answer is D

Explanation

A. Normal gait can be expected with appropriate management and treatment for clubfoot. With early and effective intervention, many children with clubfoot can achieve a normal gait.

B. Growth and development are not typically delayed as a long-term outcome of clubfoot when it is appropriately managed. The goal of treatment is to achieve normal foot development and function.

C. While heredity can play a role in clubfoot, it is not typically a sole determinant of the outcome. The success of treatment primarily depends on the timeliness and effectiveness of the interventions.

D Correction will require serial casting.

Unilateral clubfoot is a congenital deformity of the foot that can often be effectively managed with non-surgical interventions. Serial casting is a common and successful approach used to gradually correct the deformity. Parents should be informed that serial casting is likely to be a part of the treatment plan for their child's clubfoot.

Therefore, it is essential to educate parents that correction of unilateral clubfoot will likely require serial casting and that with appropriate treatment, the child can achieve a normal gait and experience normal growth and development.

A. Olive-size mass in the epigastric area. B. Stool that consists of mucus and blood. C. Rebound tenderness in the left lower abdominal quadrant. D. Frequent burping accompanied by poor feeding

Correct Answer is A

Explanation

Projectile vomiting in a 5-week-old infant can be indicative of a condition known as pyloric stenosis. Pyloric stenosis is a narrowing of the pylorus, the opening from the stomach to the small intestine. It results in delayed gastric emptying, leading to the forceful, projectile vomiting observed after feedings.

A. An olive-size mass in the epigastric area is a characteristic finding in infants with pyloric stenosis. The hypertrophied pyloric muscle feels like an olive and is often palpable in the upper abdomen.

B. Stool that consists of mucus and blood is not a typical finding associated with pyloric stenosis. This symptom is more suggestive of gastrointestinal issues like infectious colitis or other conditions unrelated to pyloric stenosis.

C. Rebound tenderness in the left lower abdominal quadrant is not a common finding in infants with pyloric stenosis. Rebound tenderness is typically associated with conditions like appendicitis in a different part of the abdomen.

D. Frequent burping accompanied by poor feeding can be a sign of discomfort but is not a specific indicator of pyloric stenosis. Projectile vomiting is a more distinctive symptom associated with this condition.

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Naxlex Comprehensive Predictor Exams

The nurse is caring for an infant with unilateral clubfoot. Which information should the nurse include in parent education about long-term outcomes?

Correct Answer is D

Explanation

The nurse is caring for a 5-week-old infant presenting with a history of projectile vomiting after feedings. Which additional finding should the nurse expect to assess?

Correct Answer is A

Explanation

The mother of an 11-year-old boy who has juvenile idiopathic arthritis tells the nurse, "I really don't want my son to become dependent on pain medication, so I only allow him to take it when he is really hurting." Which information is most important for the nurse to provide this mother?

A male adolescent arrives at the clinic and reports intense pain in the testicular area that occurred during football practice at high school. The nurse observes the scrotum and identifies significant erythema and swelling. Which action should the nurse take?

An infant born 2 days ago has not passed a meconium stool and begins to vomit bilious secretions. Which action should the nurse take first?

The nurse is assessing a child with acute glomerulonephritis who presents to the clinic with increased fatigue, facial puffiness, decreased appetite. The child's urine sample is dark yellow in color. Which additional finding should the nurse report to the healthcare provider?