A nurse in an acute care facility is caring for a toddler.

Exhibits

For each assessment finding below, click to specify if the assessment finding is consistent with Crohn's disease, appendicitis, or intussusception. Each finding may support more than 1 disease process.

Pain rating

Vomiting

Stool

Temperature

Abdominal findings

Answer and Explanation

The Correct Answer is {"A":{"answers":"C"},"B":{"answers":"B,C"},"C":{"answers":"A,C"},"D":{"answers":"B"},"E":{"answers":"C"}}

Pain rating: Severe, intermittent abdominal pain where the child draws their knees to the chest and then returns to normal behavior is a classic symptom of intussusception. Neither Crohn’s disease nor appendicitis typically presents with this pattern, appendicitis pain is usually constant and worsening, while Crohn’s pain is chronic and non-episodic.
Vomiting: Vomiting in intussusception is common and often non-bilious in early stages, aligning with the child's light-colored emesis. Vomiting also occurs in appendicitis, especially in the early stages. However, it is not a prominent or early symptom of Crohn’s disease unless obstruction is present.
Stool: The presence of blood and mucus in the stool ("currant jelly stool") is strongly associated with intussusception and may also occur in Crohn’s disease during flares due to colonic inflammation. Appendicitis does not typically cause bloody or mucoid stools, making this finding inconsistent with that diagnosis.
Temperature: A temperature of 37.4°C is within normal limits, appendicitis however may present with low grade fever. The absence of fever at this time limits its diagnostic value in this case.
Abdominal findings: A distended abdomen with hypoactive bowel sounds and a palpable sausage-shaped mass in the right upper quadrant is highly indicative of intussusception. These findings are not characteristic of appendicitis, which usually involves RLQ pain, or Crohn’s, which rarely presents with a discrete palpable mass.

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Correct Answer is A

Explanation

A. Turn off oxygen sources. After ensuring the client is safe, the priority is to reduce the risk of fire spreading, and oxygen greatly increases flammability. Turning off oxygen is a critical safety measure to prevent rapid combustion.
B. Put out the fire with an extinguisher. While extinguishing the fire is important, it should only be attempted if safe to do so and after addressing immediate dangers, such as oxygen sources and client safety.
C. Close the fire doors on the unit. This is part of containment under the RACE protocol (Rescue, Alarm, Contain, Extinguish), but it is not the first priority after rescue when oxygen is actively feeding the fire.
D. Notify the facility operator. This step corresponds to the "Alarm" phase of RACE and is essential for initiating the emergency response. However, it follows immediately after ensuring client safety and environmental hazard reduction, like turning off oxygen.

A. "I will use a communication board to assess the client's needs." B. “I will collaborate with a speech therapist about the client's plan of care." C. "I will use indirect lighting in the client's room." D. “I will use a loud tone of voice when speaking with the client.” E. None F. None

Correct Answer is A

Explanation

A. "I will use a communication board to assess the client's needs." This demonstrates appropriate use of assistive tools tailored for individuals with visual impairments. Communication boards can include tactile or auditory features, allowing clients to express needs effectively without relying on vision.
B. “I will collaborate with a speech therapist about the client's plan of care." While speech therapy may be helpful in some situations, it is not directly related to communication strategies for a client with visual impairment unless there is a concurrent speech or language issue.
C. "I will use indirect lighting in the client's room." Indirect lighting can reduce glare, which may help clients with partial vision, but this action does not address communication needs or strategies specific to visual impairment.
D. “I will use a loud tone of voice when speaking with the client.” Clients with visual impairments do not necessarily have hearing impairments. Raising the voice unnecessarily can be perceived as patronizing or inappropriate unless hearing loss is also present.

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A nurse in an acute care facility is caring for a toddler. Exhibits For each assessment finding below, click to specify if the assessment finding is consistent with Crohn's disease, appendicitis, or intussusception. Each finding may support more than 1 disease process.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is A

Explanation

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A nurse in an acute care facility is caring for a toddler.

Exhibits

For each assessment finding below, click to specify if the assessment finding is consistent with Crohn's disease, appendicitis, or intussusception. Each finding may support more than 1 disease process.