The nurse is caring for a child brought to the emergency department by a babysitter. The child needs an emergency appendectomy and the parents cannot be contacted. What would be the nurse's best response to this situation?

Have the primary care physician for the child sign the consent form.

Delay medical care until the child's next of kin can be contacted.

Document failed attempts to obtain consent to allow emergency care.

Have the babysitter sign the consent form even if she does not have signed papers to do so.

Answer and Explanation

The Correct Answer is C

A. Have the primary care physician for the child sign the consent form: The primary care physician cannot legally provide consent for an emergent surgical procedure unless they are acting as the attending surgeon with proper legal authority. This may delay care.

B. Delay medical care until the child's next of kin can be contacted: Delaying emergency surgery in a child with suspected appendicitis can lead to complications such as perforation, peritonitis, or sepsis. Immediate intervention takes priority over obtaining consent when parents are unreachable.

C. Document failed attempts to obtain consent to allow emergency care: In emergencies where life or health is at risk, care can proceed without parental consent under implied consent laws. Thorough documentation of attempts to reach the parents protects the healthcare team legally while allowing the child to receive timely, necessary care.

D. Have the babysitter sign the consent form even if she does not have signed papers to do so: A babysitter does not have legal authority to consent for surgery unless formally designated by a parent or legal guardian. Signing without proper authority could create legal and ethical issues.

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Correct Answer is B

Explanation

A. Sausage-shaped mass in the upper midabdomen: A sausage-shaped mass is more characteristic of intussusception rather than hypertrophic pyloric stenosis. Intussusception typically presents with intermittent abdominal pain, currant jelly stools, and a palpable tubular mass. Projectile vomiting without bile is not the classic presentation for this finding.

B. Hard, moveable, olive-shaped mass in the right upper quadrant: Hypertrophic pyloric stenosis classically presents with a firm, olive-shaped mass in the right upper quadrant or epigastric area. This mass represents the hypertrophied pyloric muscle and is most often palpated during feeding. Progressive, forceful projectile vomiting is a hallmark feature supporting this finding.

C. Tenderness over the McBurney point in the right lower quadrant: McBurney point tenderness is associated with acute appendicitis, which is rare in infants this young. Appendicitis presents with localized right lower quadrant pain, fever, and guarding rather than projectile vomiting.

D. Abdominal pain in the epigastric or umbilical region: Diffuse or localized abdominal pain is more typical of conditions such as gastroenteritis or early appendicitis. Infants with pyloric stenosis usually appear hungry after vomiting and do not typically demonstrate abdominal pain. The key finding is a palpable mass rather than pain.

A. Place the infant in the knee-chest position. B. start an IV for fluids. C. Prepare the infant for surgery D. Raise the head of the bed.

Correct Answer is A

Explanation

A. Place the infant in the knee-chest position: In a hypercyanotic (“Tet”) spell, placing the infant in a knee-chest position increases systemic vascular resistance, reduces right-to-left shunting, and improves pulmonary blood flow and oxygenation. Immediate positioning is a first-line emergency intervention.

B. Start an IV for fluids: Establishing IV access is important for administering medications and fluids, but it is secondary to immediate measures to relieve cyanosis and improve oxygenation during a Tet spell.

C. Prepare the infant for surgery: Surgical repair is definitive treatment for tetralogy of Fallot, but emergent stabilization takes priority before operative intervention can occur.

D. Raise the head of the bed: Elevating the head may aid comfort and respiratory mechanics in some conditions, but it does not address the acute pathophysiology of right-to-left shunting causing cyanosis during a Tet spell.

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The nurse is caring for a child brought to the emergency department by a babysitter. The child needs an emergency appendectomy and the parents cannot be contacted. What would be the nurse's best response to this situation?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is B

Explanation

An infant with tetralogy of Fallot becomes acutely cyanotic and hyperpneic. Which action should the nurse implement first?

Correct Answer is A

Explanation

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