A nurse is caring for a child who has Hirschsprung disease. Which of the following findings should the nurse expect?
Ridged abdomen
Ribbonlike, foul-smelling stools
Projectile vomiting
Chronic hunger
The Correct Answer is B
A. Ridged abdomen - This finding is not typically associated with Hirschsprung disease. Instead, the abdomen may appear distended or bloated due to the accumulation of stool in the colon.
B. Ribbonlike, foul-smelling stools - This is a characteristic finding in Hirschsprung disease. Because the affected portion of the colon lacks nerve cells (ganglion cells) responsible for peristalsis, stool movement is impaired, leading to the passage of narrow, ribbonlike stools. These stools may also have a foul odor due to bacterial overgrowth in the affected area.
C. Projectile vomiting - Projectile vomiting is not a common finding in Hirschsprung disease. It is more commonly associated with conditions such as pyloric stenosis or gastroesophageal reflux.
D. Chronic hunger - Chronic hunger is not a typical finding in Hirschsprung disease. Instead, affected infants may experience feeding difficulties, constipation, and failure to thrive due to the obstruction of stool in the colon. They may also exhibit symptoms such as abdominal distention, vomiting, and refusal to feed.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Maintain seizure precautions:
While seizures can occur as a complication of bacterial meningitis, maintaining seizure precautions is not the nurse's priority at this stage. Prompt administration of antibiotics to address the underlying infection takes precedence over seizure precautions.
B. Document intake and output:
Documenting intake and output is an important nursing responsibility, but it is not the priority when a child is suspected of having bacterial meningitis. The immediate priority is to initiate antibiotic therapy to treat the infection and prevent further complications.
C. Administer antibiotics when available:
Administering antibiotics is the priority in the care of a child with suspected bacterial meningitis. Antibiotics are crucial for treating the infection and preventing its progression to reduce the risk of serious complications such as brain damage or death.
D. Reduce environmental stimuli:
While reducing environmental stimuli can help manage symptoms and discomfort in a child with bacterial meningitis, it is not the priority at this time. Initiating antibiotic therapy is essential to address the underlying infection, which takes precedence over environmental stimuli reduction.
Correct Answer is A
Explanation
A. Reports of exposure to a skin irritant:
This finding is consistent with contact dermatitis, as it typically occurs due to exposure to irritants or allergens. Therefore, it is an expected finding.
B. Elevated temperature:
Elevated temperature is not typically associated with contact dermatitis unless there is a secondary infection. It is not a typical finding in uncomplicated contact dermatitis.
C. Denial of pruritus:
Pruritus, or itching, is a common symptom of contact dermatitis. Clients with contact dermatitis often experience itching or discomfort in the affected area. Therefore, denial of pruritus would be an unexpected finding.
D. Reports of joint discomfort:
Joint discomfort is not typically associated with contact dermatitis. Contact dermatitis primarily affects the skin and does not usually involve the joints. Therefore, reports of joint discomfort would be an unexpected finding.
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