Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal system.
Which findings would cause the nurse to suspect NEC?
Hypertonia, tachycardia, and metabolic alkalosis.
Hypertension, apnea, and ruddy skin color.
Abdominal distention, temperature instability, and bloody stools.
Scaphoid abdomen, no residual with feedings, and increased urinary output.
The Correct Answer is C
Choice A rationale
Hypertonia, tachycardia, and metabolic alkalosis are not associated with necrotizing enterocolitis (NEC). NEC is characterized by gastrointestinal symptoms and signs of systemic illness.
Choice B rationale
Hypertension, apnea, and ruddy skin color are not specific indicators of necrotizing enterocolitis (NEC). NEC primarily presents with gastrointestinal symptoms and systemic instability.
Choice C rationale
Abdominal distention, temperature instability, and bloody stools are classic signs of necrotizing enterocolitis (NEC). These symptoms indicate severe inflammation and potential bowel necrosis.
Choice D rationale
Scaphoid abdomen, no residual with feedings, and increased urinary output are not characteristic of necrotizing enterocolitis (NEC). NEC typically presents with abdominal distention and feeding intolerance. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Simply reassuring the parents does not provide them with actions they can take to support their baby's care. While reassurance is important, it must be paired with practical advice that empowers the parents and involves them in the baby's care.
Choice B rationale
Discharge teaching on SIDS prevention is essential but is premature for parents with a 24-week preemie in NICU. The immediate focus should be on supporting them with current care practices and preparing them for future involvement in their baby's daily needs.
Choice C rationale
Discussing diapering, skin, and umbilical cord care is important, but it is not the immediate priority in the NICU context. Parents need guidance on how to support their baby’s current complex care needs rather than routine newborn care at this stage.
Choice D rationale
Emphasizing the importance of pumping breast milk is the most appropriate action. Breast milk is crucial for the baby's nutrition and immune support once enteral feedings begin. This action empowers the parents to actively contribute to their baby's care and prepares for future needs. .
Correct Answer is B
Explanation
Choice A rationale
The Apgar score includes five criteria: heart rate, respiratory effort, muscle tone, reflex irritability, and color. Heart rate 60 scores 1, weak cry scores 1, partial flexion of extremities scores 1, weak suck scores 1, gray color scores 0. Total score: 4.
Choice B rationale
The Apgar score includes five criteria: heart rate, respiratory effort, muscle tone, reflex irritability, and color. Heart rate 60 scores 1, weak cry scores 1, partial flexion of extremities scores 1, weak suck scores 1, gray color scores 0. Total score: 4.
Choice C rationale
The Apgar score includes five criteria: heart rate, respiratory effort, muscle tone, reflex irritability, and color. Heart rate 60 scores 1, weak cry scores 1, partial flexion of extremities scores 1, weak suck scores 1, gray color scores 0. Total score: 4.
Choice D rationale
The Apgar score includes five criteria: heart rate, respiratory effort, muscle tone, reflex irritability, and color. Heart rate 60 scores 1, weak cry scores 1, partial flexion of extremities scores 1, weak suck scores 1, gray color scores 0. Total score: 4.
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