When a 2-week-old infant is seen for irritability, poor appetite, and rapid head growth with observable distended scalp veins, the nurse recognizes these signs as indicative of which disorder?
Cerebral palsy
Syndrome of inappropriate antidiuretic hormone (SIADH)
Hydrocephalus
Reye's syndrome
The Correct Answer is C
Hydrocephalus refers to a condition characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain. In infants, hydrocephalus can cause the head to enlarge rapidly as a result of the increased pressure exerted by the accumulating fluid. This is known as "rapid head growth." The increased intracranial pressure canlead to irritability and poor appetite in infants.
The distended scalp veins are another common sign of hydrocephalus. As the fluid accumulates, it puts pressure on theblood vessels in the brain, causing the veins in the scalp to become more visible and distended.
Cerebral palsy in (option A) is incorrect because is a neurological disorder that affects body movement and musclecoordination, but it does not typically present with rapid head growth or distended scalp veins.
Syndrome of inappropriate antidiuretic hormone (SIADH) in (option B) is incorrect because it is a condition characterized by excessive secretion of antidiuretic hormone, leading to fluid imbalance, but it does not usually cause rapid head growth or distended scalp veins. Reye's syndrome (D) is a rare condition that primarily affects the liver and brain, and it does not typically present with rapid head growth or distended scalp veins.
Therefore, based on the signs described, hydrocephalus (C) is the most likely disorder in this case. It is important to seekmedical attention promptly for a proper diagnosis and appropriate management of hydrocephalus in infants.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The best response for the nurse to give a parent regarding contacting the physician about an
infant with diarrhea is option B. In infants, dehydration can occur quickly, and a decrease in
urine output is an important indicator of fluid imbalance. Not having a wet diaper for 6 hours
can be a sign of inadequate fluid intake or excessive fluid loss, which warrants contacting the
paediatrician for further assessment and guidance.
"Call the doctor immediately if the infant has a temperature greater than 100° F,"in (option
A) is incorrect because it is not directly related to the concern of diarrhea. While a high fever
can be a sign of an underlying infection, it is not the primary concern in this case.
"The paediatrician should be contacted if the infant has two loose stools in an 8-hour
period,” in (option B) is incorrect because it may not necessarily require immediate medical
attention. While increased frequency of stools can be concerning, the absence of urine output
is a more critical indicator of dehydration.
"Notify the paediatrician if the infant naps more than 2 hours," in (option D) is incorrect
because it is unrelated to the concern of diarrhea and dehydration.
Correct Answer is D
Explanation
The first sign of pubertal change seen with boys is testicular enlargement. This is known as testicular or scrotal growth and is one of the earliest physical signs of puberty in boys. Testicular enlargement is followed by other changes such as the growth of pubic hair, penile growth, voice deepening, and facial hair growth.
voice deepening in (option A) is incorrect because it, typically occurs after testicular enlargement and is associated with the growth and development of the larynx during puberty.
scrotal enlargement in (option B) is incorrect because it, may occur simultaneously or shortly after testicular enlargement as part of overall genital growth during puberty.
, facial hair growth in (option C) is incorrect because it, is a later sign of pubertal development in boys and typically occurs after the initial testicular enlargement and growth of pubic hair.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today