A nurse is caring for a school-age child admitted for suspected Hirschsprung's disease.
Which provider order should the nurse querry
Insert a nasogastric tube for decompression of abdomen.
NPO status and initiate IV fluids.
Monitor abdominal girth every 4 hours.
Administer a large-volume liquid enema.
The Correct Answer is D
Choice A rationale
Inserting a nasogastric tube for decompression of the abdomen is a standard intervention for suspected Hirschsprung's disease, which is characterized by a lack of ganglion cells in a segment of the colon, leading to impaired motility and potential bowel obstruction. Decompression helps relieve abdominal distension and pressure.
Choice B rationale
NPO status and initiating IV fluids are appropriate initial management for a child with suspected Hirschsprung's disease to rest the bowel and maintain hydration and electrolyte balance while further diagnostic tests are performed.
Choice C rationale
Monitoring abdominal girth every 4 hours is essential to assess for increasing abdominal distension, which can indicate worsening obstruction in Hirschsprung's disease. An increasing girth would warrant further investigation and intervention.
Choice D rationale
Administering a large-volume liquid enema is contraindicated in suspected Hirschsprung's disease. Due to the aganglionic segment's impaired motility, the enema fluid may not be expelled and could lead to fluid overload or bowel perforation. Diagnostic enemas using contrast are performed under controlled conditions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Oral contraceptive pills primarily work by suppressing ovulation and thinning the uterine lining, leading to lighter and less painful periods. While effective for dysmenorrhea, they are not typically the first-line treatment for a 12-year-old experiencing recent onset, as other less hormonally impactful options are usually tried first.
Choice B rationale
Increasing dairy intake primarily impacts bone health due to its calcium content. While calcium plays a role in muscle function, there is no strong scientific evidence directly linking increased dairy consumption to the reduction of menstrual pain caused by prostaglandins and uterine contractions in dysmenorrhea.
Choice C rationale
Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen inhibit the production of prostaglandins, which are key mediators of inflammation and pain. During menstruation, the uterus releases prostaglandins, causing contractions and pain. By blocking prostaglandin synthesis, NSAIDs effectively reduce the intensity of menstrual cramps. The medical term for severe pain during menstruation is dysmenorrhea.
Choice D rationale
Applying a heating pad to the abdomen provides localized warmth, which can help to relax the smooth muscles of the uterus and increase blood flow. This can offer symptomatic relief from menstrual cramps by reducing muscle spasms and alleviating discomfort, but it does not address the underlying physiological cause of dysmenorrhea.
Correct Answer is A
Explanation
Choice A rationale
Lethargy, or excessive drowsiness and lack of energy, can be a sign of dehydration, electrolyte imbalance, or even bowel perforation in a child with intussusception. These are serious complications that require immediate medical attention. Normal temperature range is 36.5°C to 37.5°C (97.7°F to 99.5°F).
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