Which assessment finding would the nurse expect in an infant with Hirschsprung's disease?

Constipation with foul-smelling, ribbon-like stool.

"Currant jelly" stool.

Passage of foul-smelling, fatty stools.

Mucoid, bloody diarrhea.

Answer and Explanation

The Correct Answer is A

A. This is the correct answer. Hirschsprung's disease causes a lack of nerve cells in the colon, leading to difficulty with bowel movement. The result is constipation and the passage of small, ribbon-like stools due to the narrowed areas of the colon. The stool can also be foul-smelling.

B. "Currant jelly" stool is typically associated with intussusception, not Hirschsprung's disease. This stool appears red and mucus-like and suggests a bowel obstruction or infection.

C. Foul-smelling, fatty stools (steatorrhea) are characteristic of malabsorption disorders like cystic fibrosis, not Hirschsprung's disease.

D. Mucoid, bloody diarrhea is more common in conditions like infectious colitis or inflammatory bowel disease, not Hirschsprung's disease.

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Correct Answer is C

Explanation

A. The nurse monitors the child's vital signs every 2 to 4 hours is appropriate. Regular monitoring of vital signs is important in children with neutropenia to detect early signs of infection or sepsis.

B. The nurse carefully washes his/her hands before and after providing care is appropriate. Hand hygiene is critical in preventing the transmission of infection, especially in neutropenic patients who are at high risk of infections.

C. The child has been placed in a semi-private room requires further education. A child with a neutrophil count of 225 is at significant risk of infection, and placing the child in a semi-private room increases the risk of exposure to pathogens. The child should be placed in a private room to minimize exposure to infectious agents.

D. The nurse assesses the child for clinical signs of an infection is appropriate. Vigilant monitoring for infection is essential in neutropenic patients, as they are more susceptible to infections.

A. Administer antipyretic therapy B. Place the child in a lateral Sims position C. Place the child on droplet precautions D. Reduce all environmental stimuli

Correct Answer is C

Explanation

A. Administer antipyretic therapy is appropriate to help reduce fever, but it is not the first priority. The child’s vital signs indicate a high fever and signs of possible meningitis, and intervention to prevent further complications or the spread of infection should take precedence.

B. Place the child in a lateral Sims position is unnecessary in this case. A lateral Sims position is typically used to prevent aspiration during vomiting, but it is not the priority for this child. The focus should be on infection control and stabilizing the child’s condition.

C. Place the child on droplet precautions is the correct priority. The child is showing signs of possible bacterial meningitis, which is a highly contagious infection. Droplet precautions are necessary to prevent transmission of the infection to other individuals.

D. Reduce all environmental stimuli may be helpful for a child with a neurological condition, but it is not the first priority in this case. The priority is preventing the spread of infection while further stabilizing the child’s condition.

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Which assessment finding would the nurse expect in an infant with Hirschsprung's disease?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A child has been admitted to the pediatric unit. Her absolute neutrophil count is 225 and the child has been placed in neutropenic isolation. Which action by a nurse indicates that the nurse requires further education? (Select all that apply)

Correct Answer is C

Explanation

Correct Answer is C

Explanation

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