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 C
Explanation
Rationale:
A. Restricting fiber is not necessary; instead, administering vitamin C with iron can enhance absorption.
B. Iron supplements can cause dark stools, but not blood in the stools. Blood in the stools requires further investigation.
C. Routine monitoring of blood counts is crucial to assess the effectiveness of the iron supplementation and to adjust the dosage as needed.
D. Iron supplements are better absorbed on an empty stomach; taking them with meals can reduce their absorption.
Correct Answer is A
Explanation
Rationale:
A. Developmental dysplasia of the hip (DDH) often presents with a limited range of motion in the affected hip, particularly in abduction.
B. Asymmetry of the gluteal skinfolds, not symmetry, is a typical finding in DDH. This asymmetry is due to the improper alignment of the hip joint.
C. A positive Barlow test, where the hip can be dislocated by adduction and posterior pressure, is indicative of DDH. A negative Barlow test would suggest the absence of DDH.
D. A pale and cool leg is not a common finding in DDH. This would be more indicative of a circulatory problem, not hip dysplasia.