The nurse has taught the parents of a school-aged child with a newly placed ventriculoperitoneal (VP) shunt to monitor for early signs of shunt malfunction. The nurse determines the parents understand the instructions if they understand they should notify the provider if the child develops which early manifestation?
Lethargy
Seizure activity
Rapid weight gain
Disinterest in attending school
The Correct Answer is A
Rationale:
A. Lethargy is an early sign of increased intracranial pressure (ICP) due to possible shunt malfunction and requires immediate medical attention.
B. Seizure activity can be a late sign of shunt malfunction and is also concerning but lethargy typically appears earlier.
C. Rapid weight gain is less directly related to shunt malfunction and more associated with conditions like hypothyroidism or edema.
D. Disinterest in school could suggest general malaise but is not a specific or early sign of shunt malfunction.
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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.
Correct Answer is B
Explanation
Rationale:
A. Intravenous fluids are generally not required if the child is alert and active with mild dehydration; oral rehydration is usually sufficient.
B. Oral rehydration solutions are appropriate for treating mild dehydration and should be given in small amounts frequently.
C. Chicken broth is not ideal for replacing electrolytes because it is low in electrolytes and high in sodium. Oral rehydration solutions are preferred.
D. A depressed soft spot (fontanel) is a sign of severe dehydration in infants. For a 4-year-old, signs of dehydration would include changes in urine output, thirst, or dry mucous membranes rather than a depressed fontanel.