A nurse is reinforcing teaching with a parent of a 1 month old infant who is to undergo the initial surgery to treat Hirschsprung’s disease. Which of the following statements should indicate to the nurse that the parent understands the goal of the surgery.
“The operation will straighten out the kink in then intestine.”
“I want to learn how to use the feeding tube as soon as possible.”
“I’m glad my child will have bowel movements now.”
“I’m glad that the ostomy is only temporary.”
The Correct Answer is D
A. "The operation will straighten out the kink in the intestine.": Hirschsprung’s disease involves a lack of nerve cells in the colon, not a physical kink.
B. "I want to learn how to use the feeding tube as soon as possible.": Feeding tubes are not a standard part of treatment for Hirschsprung’s disease.
C. "I’m glad my child will have bowel movements now.": While the surgery will help bowel function, the initial goal is creating an ostomy to divert stool.
D. "I’m glad that the ostomy is only temporary.": The initial surgery often involves a temporary ostomy to allow the colon to heal before definitive repair.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Assess fluid balance: Although assessment is important, rehydration takes priority to address the acute loss of fluids and electrolytes.
B. Maintain fluid therapy: Fluid therapy maintenance is secondary to initiating rehydration.
C. Introduce a regular diet: Diet modification is less critical than rehydration in the acute phase.
D. Rehydrate: Rehydration addresses the immediate risk of dehydration and electrolyte imbalance caused by severe diarrhea.
Correct Answer is B
Explanation
A. Sodium 142 mEq/L: This is within the normal range for sodium (135–145 mEq/L) and does not indicate an immediate threat.
B. Potassium 2.5 mEq/L: This is critically low (normal range is 3.5–5.0 mEq/L), and hypokalemia can cause life-threatening cardiac arrhythmias.
C. Urine specific gravity 1.025: Although elevated, it is not as critical as severe hypokalemia.
D. Blood glucose 110 mg/dL: This is a normal glucose level and not a priority.
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