A nurse is assessing a newborn. Which of the following should the nurse understand is a clinical manifestation of pyloric stenosis?
Projectile vomiting after feedings.
Absent bowel sounds.
Increased sodium levels.
Golf ball-sized mass over the left quadrant.
The Correct Answer is A
Choice A rationale
Projectile vomiting after feedings is a classic symptom of pyloric stenosis. This occurs because the enlarged pyloric muscle obstructs the passage of food from the stomach to the small intestine.
Choice B rationale
Absent bowel sounds are not typically associated with pyloric stenosis. While this condition affects the gastrointestinal tract, it does not typically cause a complete absence of bowel sounds.
Choice C rationale
Increased sodium levels are not a typical finding in a newborn with pyloric stenosis. In fact, these infants may have low sodium levels due to vomiting.
Choice D rationale
A golf ball-sized mass over the left quadrant is not a typical finding in a newborn with pyloric stenosis. The classic physical examination finding in pyloric stenosis is a palpable “olive-like” mass in the right upper quadrant of the abdomen.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
An ectopic pregnancy, where the fertilized egg attaches outside the uterus, often presents with unilateral, cramp-like abdominal pain. This is because as the fertilized egg grows in an area where it cannot survive, it can cause irritation and bleeding, leading to pain. This pain is often one-sided or unilateral and can vary from mild to severe. It’s one of the key symptoms that can suggest an ectopic pregnancy in the early weeks of gestation.
Choice B rationale
Severe nausea and vomiting are not typically the primary symptoms associated with an ectopic pregnancy. While nausea can be a symptom of early pregnancy, severe nausea and vomiting alone without other symptoms would not necessarily indicate an ectopic pregnancy.
Choice C rationale
Uterine enlargement greater than expected for gestational age is not a symptom of an ectopic pregnancy. In fact, because the pregnancy is not in the uterus, the size of the uterus may not correlate with the expected size at the given gestational age.
Choice D rationale
While vaginal bleeding can occur in an ectopic pregnancy, it is not typically a large amount. The bleeding is often lighter than normal menstrual bleeding and may be associated with a change in color of the vaginal discharge.
Correct Answer is A
Explanation
Choice A rationale
Applying lotion to the newborn’s skin during phototherapy is not recommended. Lotion can block the light from reaching the skin and reduce the effectiveness of the treatment.
Choice B rationale
Covering the newborn’s eyes with a mask during phototherapy is a standard practice. This is done to protect the newborn’s eyes from the intense light used in phototherapy.
Choice C rationale
An increase in stool frequency is expected during phototherapy. This is because phototherapy helps to break down bilirubin, which is then excreted in the stool.
Choice D rationale
A pink rash on the newborn’s trunk does not require intervention during phototherapy. It could be a common newborn rash that will resolve on its own.
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