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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View Related questions
Correct Answer is A
Explanation
Rationale:
A. Hypertension (blood pressure of 136/92 mm Hg) in a child with acute pyelonephritis can indicate a severe condition that may lead to renal damage or worsening kidney function. Immediate intervention is necessary to manage high blood pressure and prevent complications.
B. A heart rate of 100 bpm is within normal limits for a 7-year-old and does not require immediate action.
C. Decreased urine output is concerning and needs monitoring, but hypertension is the more urgent issue.
D. Tea-colored urine suggests hematuria or concentrated urine, which is important but not as immediately life-threatening as high blood pressure.
Correct Answer is A
Explanation
Rationale:
A. An upper gastrointestinal series is commonly used to diagnose gastroesophageal reflux (GER), which can cause symptoms like spitting up and crying after feedings, leading to failure to thrive. This test helps visualize the esophagus, stomach, and duodenum for abnormalities.
B. A biopsy of the small intestine is typically done to diagnose celiac disease, which is less likely in this clinical scenario.
C. An ultrasound is used to diagnose pyloric stenosis, which presents with projectile vomiting and is less consistent with the described symptoms.
D. A lower gastrointestinal series is used to detect intestinal blockages, which are not suggested by the symptoms of spitting up and crying immediately after feeding.