A nurse is collecting data from a child who has acute lead poisoning. Which of the following findings should the nurse expect?

Choice A reason: Switching formula does not address projectile vomiting followed by hunger, suggestive of pyloric stenosis, a mechanical obstruction. Changing formula may delay diagnosis and treatment, risking dehydration or malnutrition. Immediate clinical evaluation is needed to confirm the condition and plan surgical intervention, making this response inappropriate.

Choice B reason: Frequent burping reduces air in the stomach but does not address projectile vomiting from pyloric stenosis, caused by pyloric muscle hypertrophy. This symptom requires surgical evaluation, not feeding adjustments. Burping is ineffective, as the obstruction persists, making clinical evaluation the priority to prevent complications.

Choice C reason: Projectile vomiting with hunger in a 2-month-old suggests pyloric stenosis, requiring urgent clinical evaluation for diagnosis via ultrasound and surgical planning (pyloromyotomy). Prompt assessment prevents dehydration, electrolyte imbalances, and growth issues, making this the appropriate response to ensure timely intervention for this serious condition.

Choice D reason: Oral rehydration solution treats dehydration but does not address the underlying cause of projectile vomiting, likely pyloric stenosis. This delays definitive surgical treatment, risking worsening dehydration or malnutrition. Clinical evaluation is critical to confirm the diagnosis, making rehydration a secondary, not primary, response to the symptoms.

Choice A reason: Whole-wheat bread contains gluten, a protein harmful in celiac disease, causing villous atrophy and malabsorption in the small intestine. This triggers diarrhea, weight loss, and nutrient deficiencies. A gluten-free diet is essential, making a chicken sandwich on whole-wheat bread an inappropriate choice for a child with this condition.

Choice B reason: Pizza and chocolate cake typically contain wheat flour, a gluten source, which damages the intestinal mucosa in celiac disease, leading to inflammation and malabsorption. These foods exacerbate symptoms like diarrhea and abdominal pain, making them unsuitable for a child requiring a strict gluten-free diet to manage the condition.

Choice C reason: Corn tortillas and fresh fruit are naturally gluten-free, safe for celiac disease. Corn lacks the harmful proteins (gliadin) that trigger immune-mediated intestinal damage. Fresh fruit provides nutrients without gluten, supporting healing of the intestinal mucosa and preventing symptoms like diarrhea, making this the best dietary choice.

Choice D reason: Spaghetti and blueberry muffins are made with wheat flour, containing gluten, which causes intestinal villous atrophy in celiac disease. This leads to malabsorption, diarrhea, and growth issues. These foods are contraindicated, as a gluten-free diet is critical to prevent symptoms and promote intestinal healing in affected children.