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 D
Explanation
Rationale:
A. Dry mouth is expected postoperatively, especially if the child is not drinking adequate fluids, but it is not a sign of a complication.
B. Mild to moderate pain is expected after a tonsillectomy and should be managed with analgesics.
C. Dried flecks of blood in oral secretions can be normal immediately after surgery, but active bleeding would be concerning.
D. Frequent swallowing is a sign of possible postoperative bleeding, which is a serious complication that requires immediate evaluation and intervention.
Correct Answer is D
Explanation
Rationale:
A. Barrier creams should not be washed off with each diaper change; they should be left intact to protect the skin.
B. Cloth diapers can sometimes exacerbate diaper dermatitis due to moisture retention; disposable diapers may be better at wicking moisture away from the skin.
C. Talcum powder is not recommended due to the risk of inhalation, which can cause respiratory issues in infants.
D. Exposing the excoriated area to air frequently allows the skin to dry out, reducing moisture and irritation, which is beneficial in managing diaper dermatitis.