Nursing Elites

1. What is the appropriate therapeutic management for children with Hirschsprung disease?

• A. daily enemas
• B. low-fiber diet
• C. permanent colostomy
• D. surgical removal of the affected section of bowel

Correct answer: D

Rationale: The correct answer is D: surgical removal of the affected section of bowel. Hirschsprung disease is characterized by a segment of the colon lacking nerve cells, leading to obstruction. The definitive treatment involves surgically removing the affected segment, followed by a pull-through procedure to restore normal bowel continuity. Daily enemas (choice A) are not the primary treatment for Hirschsprung disease. While dietary adjustments may be advised, a low-fiber diet (choice B) alone is not curative for this condition. A permanent colostomy (choice C) is considered a last resort if surgical interventions fail or in severe cases, but it is not the initial therapeutic approach for managing Hirschsprung disease.

2. Following corrective surgery for hypertrophic pyloric stenosis (HPS), an infant is returned to the pediatric unit with an IV infusion in place. What is the priority nursing action?

• A. Apply adequate restraints.
• B. Administer a mild sedative.
• C. Assess the IV site for infiltration.
• D. Attach the nasogastric tube to wall suction.

Correct answer: C

Rationale: The priority nursing action after a corrective surgery for hypertrophic pyloric stenosis (HPS) is to assess the IV site for infiltration. This is crucial to ensure proper fluid administration and prevent complications such as extravasation or infiltration. Applying restraints (Choice A) is not indicated in this scenario and can compromise the infant's comfort and safety. Administering a mild sedative (Choice B) is not necessary and should only be done based on specific clinical indications. Attaching the nasogastric tube to wall suction (Choice D) may be important for certain conditions but is not the priority immediately post-surgery; assessing the IV site is more urgent to prevent potential complications related to IV therapy.

3. A 4-year-old child is admitted to the hospital with a diagnosis of epiglottitis. What is the priority nursing intervention?

• A. Administer antibiotics
• B. Provide humidified oxygen
• C. Keep the child NPO
• D. Position the child upright

Correct answer: C

Rationale: The priority nursing intervention for a 4-year-old child admitted with epiglottitis is to keep the child NPO (nothing by mouth). This is crucial to prevent further airway compromise due to the inflamed epiglottis. Administering antibiotics may be necessary but is not the priority at this moment. Providing humidified oxygen can support oxygenation but does not address the immediate risk of airway obstruction. Positioning the child upright may help with breathing but does not address the risk of aspiration. Keeping the child NPO is essential to maintain a patent airway and prevent complications associated with epiglottitis.

4. A child with a diagnosis of cystic fibrosis is admitted to the hospital. What is the priority nursing intervention?

• A. Administering pancreatic enzymes
• B. Providing respiratory therapy
• C. Providing nutritional support
• D. Encouraging physical activity

Correct answer: A

Rationale: The correct answer is administering pancreatic enzymes. In cystic fibrosis, there is a deficiency in pancreatic enzymes, leading to poor digestion and malabsorption of nutrients. Administering pancreatic enzymes is essential to ensure proper digestion and absorption of nutrients. Providing respiratory therapy and nutritional support are important aspects of care for a child with cystic fibrosis, but addressing the pancreatic enzyme deficiency takes priority in this scenario. Encouraging physical activity is beneficial for overall health but is not the priority intervention in this case.

5. The parents of a 6-week-old infant who was born without an immune system ask a nurse why their baby is still so healthy. How should the nurse reply?

• A. Exposure to pathogens during this time can be limited.
• B. Some antibodies are produced by the infant’s colonic bacteria.
• C. Antibodies are passively received from the mother through the placenta and breast milk.
• D. Fewer antibodies are produced by the fetal thymus during the eighth and ninth months of gestation.

Correct answer: C

Rationale: The correct answer is C. Infants receive passive immunity through antibodies from the mother during pregnancy and breastfeeding, which protect them initially. Choice A is incorrect because a 6-week-old infant born without an immune system would not be able to limit exposure to pathogens effectively. Choice B is incorrect as antibodies produced by colonic bacteria are not a significant source of immunity in infants. Choice D is incorrect as the fetal thymus primarily plays a role in T cell development rather than antibody production during gestation.

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