A nurse is collecting data from an infant who has Hirschsprung's disease. Which of the following manifestations should the nurse expect?
Abdominal distention.
Steatorrhea.
Blood-tinged emesis.
Dysphagia.
The Correct Answer is A
Abdominal distention. Choice A reason:
Abdominal distention is a common manifestation of Hirschsprung's disease in infants. This condition is characterized by the absence of ganglion cells in the distal segment of the colon, leading to a functional obstruction. The absence of ganglion cells causes the affected part of the colon to become narrow and unable to relax, resulting in a buildup of stool and gas, leading to abdominal distention.
Choice B reason:
Steatorrhea, which is the presence of fatty, bulky, and foul-smelling stools, is not typically associated with Hirschsprung's disease. This manifestation is more commonly seen in conditions affecting the pancreas, liver, or small intestine, where the digestion and absorption of fats are impaired.
Choice C reason:
Blood-tinged emesis (vomiting) is not a typical manifestation of Hirschsprung's disease. This symptom is more commonly associated with gastrointestinal bleeding, which can be caused by various factors such as ulcers, esophageal varices, or gastritis.
Choice D reason:
Dysphagia, which refers to difficulty swallowing, is also not a characteristic manifestation of Hirschsprung's disease. Dysphagia is more commonly seen in conditions affecting the esophagus or throat, such as esophageal strictures or neurological disorders affecting swallowing reflexes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C"]
Explanation
Choice A reason: The nurse should plan to ask the client to empty their bladder before performing Leopold maneuvers. The rationale behind this is to ensure that the client's bladder is empty to allow for better palpation of the uterus and fetal position. A full bladder can interfere with accurate assessment and may lead to incorrect findings during the examination.
Choice B reason:
The nurse should assist the client into a left-lateral position. This position is ideal for performing Leopold maneuvers because it helps to displace the uterus away from the vena cava, reducing the risk of supine hypotension syndrome. Moreover, the left-lateral position promotes optimal blood flow to the placenta, which is essential for the well-being of the fetus during the examination.
Choice C reason:
The nurse should apply an external fetal monitor to the client's abdomen after completing the Leopold maneuvers. The purpose of Leopold maneuvers is to determine the fetal position and presentation manually. Once this information is obtained, applying the external fetal monitor allows continuous monitoring of the fetal heart rate and uterine contractions to assess the baby's well-being and the progression of labor.
Choice D reason:
The nurse should not instruct the client to perform nipple stimulation when planning to assist with Leopold maneuvers. Nipple stimulation is a method to induce or augment labor, and it is not related to the process of assessing fetal position and presentation using Leopold maneuvers. It may lead to unnecessary contractions and confusion during the examination.
Correct Answer is D
Explanation
Choice A reason:
Insomnia may not be an expected finding in a school-age child with a newly diagnosed brain tumor. While sleep disturbances can occur due to various medical conditions, insomnia is not a common presenting symptom of brain tumors in this age group. Thus, it is less likely to be the correct answer.
Choice B reason:
A negative Babinski sign would actually be a normal finding in a school-age child. The Babinski sign is a neurological test that becomes positive in certain conditions, but a negative result is expected in a healthy child. Therefore, this finding is not indicative of a brain tumor and is not the correct choice.
Choice C reason:
Increased appetite is also an unlikely finding in a child with a newly diagnosed brain tumor. Brain tumors can lead to various neurological symptoms, but an increased appetite is not a characteristic feature. Thus, this choice is less likely to be correct.
Choice D reason:
Incoordination is a more expected finding in a school-age child with a newly diagnosed brain tumor. Brain tumors can affect motor skills and coordination due to their location and impact on the brain's functions. Children may experience difficulties with balance, coordination, and fine motor skills. Therefore, this choice is the most likely correct answer.
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