A nurse is assessing a 6-week-old child for progressive weight loss and projectile vomiting. The nurse suspects pyloric stenosis. What other assessment finding should be expected?

The child accepts a feeding after vomiting

Sausage shaped upper abdominal mass

Jelly- like consistency stools

Severe pain in the abdomen

Answer and Explanation

The Correct Answer is A

A.   Pyloric stenosis typically causes projectile vomiting shortly after feedings. After vomiting, the infant may still appear hungry and may want to feed again. This is because the blockage prevents food from entering the small intestine, causing the infant to feel hungry soon after vomiting.
B.   One of the classic physical findings of pyloric stenosis is a palpable "olive-shaped" mass in the upper abdomen, which is usually located in the right upper quadrant. This mass is the enlarged pyloric muscle.
C.   Jelly-like stools are more characteristic of intussusception, not pyloric stenosis.
D.   While the child may show signs of discomfort or irritability due to hunger, severe pain in the abdomen is not a hallmark of pyloric stenosis.

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Correct Answer is D

Explanation

A. Although pain management is an important aspect of post-operative care, opioid use such as codeine is generally avoided in children due to the risk of respiratory depression and other side effects. Non- opioid pain relievers are preferred for post-tonsillectomy care.
B. While it is important for the child to stay hydrated after a tonsillectomy, using a straw can increase the risk of trauma to the surgical site, leading to bleeding. The nurse should encourage sipping liquids carefully without using a straw.
C. Blowing the nose after a tonsillectomy can cause pressure that may disrupt the healing tissue, increasing the risk of bleeding. This action should be avoided in the post-operative period.
D. Bleeding is a significant concern after a tonsillectomy, especially in the first 24 hours. Frequent swallowing may indicate that the child is swallowing blood, and bright red emesis (vomiting) may also signal active bleeding. Monitoring for signs of bleeding is the nursing priority, as it can be life- threatening if not addressed promptly.

A. Normal feeding and swallowing B. Sunken abdomen C. Excessive drooling D. Respiratory distress E. Coughing or choking during feeding

Correct Answer is ["C","D","E"]

Explanation

A. Normal feeding and swallowing would not be expected in a newborn with TEF, as they typically have difficulty feeding and may choke or cough.
B. Sunken abdomen is not a typical finding for TEF.
C. Excessive drooling is a common symptom due to the inability to swallow saliva properly.
D. Respiratory distress is a hallmark sign of TEF, as the fistula can lead to aspiration and breathing difficulties.
E. Coughing or choking during feeding is another classic sign of TEF due to the abnormal connection between the esophagus and the trachea.

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A nurse is assessing a 6-week-old child for progressive weight loss and projectile vomiting. The nurse suspects pyloric stenosis. What other assessment finding should be expected?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a child post-operative tonsillectomy, what is the nursing priority when providing post-operative care?

Correct Answer is D

Explanation

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Correct Answer is ["C","D","E"]

Explanation

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