A school-age child in an emergency department has a 2-day history of nausea and vomiting and reports severe right lower quadrant pain. A nurse is preparing the child for an appendectomy. Which of the following statements by the child should the nurse find most concerning?

"My belly doesn't hurt anymore."

"I am hungry and thirsty."

"I'm tired and want to take a nap."

"I am scared and I want to go home."

Answer and Explanation

The Correct Answer is A

A. "My belly doesn't hurt anymore."

- This statement is concerning because sudden relief from severe right lower quadrant pain in a child with a history of nausea, vomiting, and suspected appendicitis may indicate a rupture or perforation of the appendix. When the appendix ruptures, there may be a temporary alleviation of pain due to the release of pressure. However, this situation is critical and requires immediate medical attention to prevent further complications such as peritonitis or sepsis.

B. "I am hungry and thirsty."

- While it's normal for a child to feel hungry and thirsty, especially if they have been experiencing nausea and vomiting, this statement is not necessarily concerning on its own. However, in the context of suspected appendicitis and severe right lower quadrant pain, it's important for the child to remain NPO (nothing by mouth) to prevent complications in case surgery is needed.

C. "I'm tired and want to take a nap."

- Feeling tired and wanting to rest is not uncommon, especially if the child has been experiencing discomfort or pain for a prolonged period. While this statement may indicate fatigue, it's not inherently concerning in the context of suspected appendicitis. However, it's important for the nurse to monitor the child's energy level and overall condition.

D. "I am scared and I want to go home."

- It's understandable for a child to feel scared or anxious, particularly when facing a medical procedure such as surgery. While this statement reflects the child's emotions, it doesn't necessarily indicate a change in their medical condition. However, it's important for the nurse to address the child's fears and provide emotional support while ensuring that the child receives appropriate medical care.

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Correct Answer is A

Explanation

A. Projectile vomiting

Projectile vomiting is a classic symptom of pyloric stenosis in infants. It typically occurs within 30 minutes of feeding and is forceful, often projecting several feet away from the infant. This occurs due to the obstruction at the pyloric sphincter, leading to the stomach forcefully emptying its contents.

B. Metabolic acidosis

Metabolic acidosis is not a typical finding associated with pyloric stenosis. Pyloric stenosis leads to vomiting, which can result in dehydration and electrolyte imbalances, but it typically does not cause metabolic acidosis directly.

C. Effortless regurgitation

Effortless regurgitation is not a characteristic finding of pyloric stenosis. In pyloric stenosis, vomiting is forceful and projectile, rather than a passive regurgitation of stomach contents.

D. Distended abdomen

A distended abdomen can be a finding in pyloric stenosis. The obstruction at the pyloric sphincter can lead to gastric retention, causing the stomach to become distended over time. However, it's important to note that not all infants with pyloric stenosis will present with a visibly distended abdomen.

A. Patches of baldness B. Blisters on the scalp C. Dry patches on the scalp D. Reports of scalp itchiness

Correct Answer is D

Explanation

A. Patches of baldness: Patches of baldness on the scalp could be indicative of conditions like alopecia areata, a disorder characterized by hair loss in patches. However, it is not a typical manifestation of pediculosis capitis, which primarily presents with scalp itchiness due to lice bites rather than hair loss.

B. Blisters on the scalp: Blisters on the scalp may suggest other conditions such as herpes simplex infection or contact dermatitis. While scratching from head lice infestation could lead to skin irritation, blisters are not a common presentation of pediculosis capitis.

C. Dry patches on the scalp: Dry patches on the scalp might be caused by conditions like seborrheic dermatitis or eczema. While scalp dryness can occur with pediculosis capitis due to irritation from scratching, it is not a specific symptom associated with head lice infestation.

D. Reports of scalp itchiness: Scalp itchiness is a hallmark symptom of pediculosis capitis. It occurs as a result of lice bites and the body's inflammatory response to their saliva. It is the most characteristic and common manifestation of head lice infestation and often prompts further examination for the presence of lice or their eggs (nits).

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A school-age child in an emergency department has a 2-day history of nausea and vomiting and reports severe right lower quadrant pain. A nurse is preparing the child for an appendectomy. Which of the following statements by the child should the nurse find most concerning?

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A nurse is caring for a 6-week-old infant admitted to the pediatric unit for evaluation of a suspected pyloric stenosis. Which of the following findings should the nurse expect?

Correct Answer is A

Explanation

A school nurse is completing routine health evaluations for school-age children. Which of the following manifestation should alert the nurse to the possibility of pediculosis capitis?

Correct Answer is D

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