A nurse is caring for a 3-day-old newborn and suspects Hirschsprung disease. What finding best supports the nurse's concern?
The infant has passed several tar-like stools.
The infant has not gained weight and has stooled once.
The infant has not stooled.
The infant has passed hard, pellet-like stools.
The Correct Answer is C
Rationale:
A. Passing tar-like stools is normal for newborns within the first few days of life and does not indicate Hirschsprung disease.
B. Limited stooling and poor weight gain may suggest feeding issues but are not as indicative of Hirschsprung disease as the absence of stool.
C. The absence of stool (failure to pass meconium within 24-48 hours) is a classic sign of Hirschsprung disease, a condition where the absence of ganglion cells in the intestines leads to a blockage.
D. Passing hard, pellet-like stools may indicate constipation but is not specific to Hirschsprung disease, especially in a newborn.
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Correct Answer is B
Explanation
Rationale:
A. Mild illnesses like nasopharyngitis (a common cold) do not typically contraindicate vaccination, so there is no need to delay immunization.
B. It is essential to evaluate for allergies to vaccine components, such as gelatin or neomycin, which could contraindicate the administration of the varicella vaccine.
C. The first dose of the varicella vaccine is recommended at 12-15 months of age, not at 4 years of age, so it is appropriate to administer it during this well-check.
D. The varicella vaccine is administered subcutaneously, not intramuscularly, so this is not the correct route for administration.
Correct Answer is A
Explanation
Rationale:
A. Bradycardia, constipation, and hypotonia are common symptoms associated with congenital hypothyroidism due to the reduced metabolism that results from decreased thyroid hormone levels.
B. Elevated serum T3 and T4 would not be expected in congenital hypothyroidism; these levels are typically low.
C. Tachycardia, diarrhea, and tremors are more indicative of hyperthyroidism, not hypothyroidism.
D. In congenital hypothyroidism, the thyroid-stimulating hormone (TSH) is typically elevated as the body attempts to stimulate the thyroid gland to produce more hormones.