The treatment of choice in a child with intussusception who is not showing signs of sepsis or shock is hydrostatic reduction of telescoped bowel with an air or saline enema. True or False?
True
False
The Correct Answer is A
Choice A reason: This statement is correct, as hydrostatic reduction of telescoped bowel with an air or saline enema is the preferred treatment for intussusception, which is a condition where a segment of the intestine slides into another segment, causing obstruction, inflammation, and ischemia. The enema can help to push the invaginated bowel back to its normal position, relieve the obstruction, and restore the blood flow. The procedure is safe, effective, and minimally invasive, and can avoid the need for surgery.
Choice B reason: This statement is incorrect, as hydrostatic reduction of telescoped bowel with an air or saline enema is not a false statement, but a true one. The nurse should be aware of the indications, contraindications, and complications of this procedure, and monitor the child's vital signs, abdominal distension, bowel sounds, and stool output before, during, and after the enema. The nurse should also educate the parents about the signs and symptoms of recurrence, such as abdominal pain, vomiting, or bloody stools.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Increased stroke volume is not a correct answer as it means that the heart pumps more blood with each contraction. This would result in increased blood pressure and perfusion, not cool extremities, weak pulses, and low urine output.
Choice B reason: Cardiac arrhythmia is not a correct answer as it means that the heart beats irregularly or abnormally. This can cause palpitations, chest pain, or fainting, but not necessarily cool extremities, weak pulses, and low urine output.
Choice C reason: Decreased cardiac output is a correct answer as it means that the heart pumps less blood than the body needs. This can result from a ventricular septal defect, which causes blood to shunt from the left ventricle to the right ventricle, reducing the amount of oxygenated blood that reaches the tissues. This can cause cool extremities, weak pulses, and low urine output, as well as fatigue, poor growth, and shortness of breath.
Choice D reason: Cyanosis is not a correct answer as it means that the skin, lips, or nails turn blue due to low oxygen levels in the blood. This can occur in some cases of ventricular septal defect, especially if there is pulmonary hypertension or a reversal of the shunt. However, cyanosis is not a direct cause of cool extremities, weak pulses, and low urine output.
Correct Answer is D
Explanation
Choice A reason: This statement is incorrect, as aspirin is contraindicated in children under 18 years of age due to the risk of Reye syndrome, a rare but serious condition that affects the liver and brain. The nurse should use other methods to reduce the fever, such as acetaminophen, tepid sponge baths, or cooling blankets.
Choice B reason: This statement is incorrect, as hospital-acquired sepsis is unlikely in a 3-day-old infant, unless the infant was exposed to invasive procedures or devices, such as catheters, ventilators, or surgery. The nurse should consider other sources of infection, such as the maternal genital tract, the umbilical cord, or the skin.
Choice C reason: This statement is incorrect, as blood pressure is not an early indicator of sepsis, but a late sign of shock. The nurse should monitor the infant for other signs of sepsis, such as temperature instability, tachycardia, tachypnea, lethargy, poor feeding, irritability, or hypoglycemia.
Choice D reason: This statement is correct, as the most common cause of sepsis in neonates is vertical transmission from the mother during pregnancy, labor, or delivery. The nurse should obtain a history of the mother's prenatal care, infections, medications, or complications, and assess the infant for any congenital anomalies or risk factors.
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