RN Pediatric Nursing (ATI)

Correct Answer: Intestinal obstruction.

Explanation:

The child is recovering from surgery for the removal of a Wilms tumor, and the nurse notes:

Abdominal pain, Distension, Absence of bowel sounds,Vomiting. These are classic signs of intestinal obstruction. After abdominal surgery, especially in the case of a tumor resection, there is an increased risk for adhesions, intestinal volvulus, or ileus (a temporary cessation of normal bowel function). The absence of bowel sounds indicates that the intestines are not functioning properly, and vomiting could be a result of bowel contents backing up due to the obstruction.

Why Other Options Are Wrong:

Abdominal peritonitis: This is a serious complication often associated with infection or perforation of the gastrointestinal tract. While it could cause abdominal pain and distension, it would likely present with fever, tachycardia, and signs of infection, which are not mentioned in this case.

Pyloric stenosis: This typically occurs in infants and is characterized by projectile vomiting and visible peristalsis. It is not a typical complication in a child recovering from surgery for Wilms tumor.

Infectious gastritis: This would typically cause symptoms like nausea, vomiting, epigastric pain, and possible fever, but it wouldn't typically lead to the absence of bowel sounds or significant distension, which are more indicative of obstruction.

Conclusion:

Given the clinical signs of abdominal pain, distension, absence of bowel sounds, and vomiting in a child post-surgery for Wilms tumor, intestinal obstruction is the most likely complication. This requires prompt assessment and intervention to prevent further complications.

Correct Answer: Strabismus.

Explanation:

Strabismus, also known as "crossed eyes," is a condition where the eyes do not align properly, often resulting in one eye turning in, out, up, or down while the other eye remains fixed. In many cases, strabismus leads to amblyopia (also known as "lazy eye"), where the brain favors the stronger eye, leading to poor vision in the weaker eye. To correct strabismus and amblyopia, visual stimulation is often provided to the weaker eye by patching the stronger eye. This encourages the brain to use the weaker eye and helps improve vision.

Why Other Options Are Wrong:

Myectopia: There is no common medical condition called "myectopia." You may have meant "myopia," which refers to nearsightedness. Myopia is a refractive error and is typically treated with corrective lenses, not patching.

Ophritis: Ophritis refers to inflammation of the eye, often caused by an infection. This condition is not treated by patching an eye but by addressing the underlying cause of the inflammation.

Anisometropia: Anisometropia is a condition in which there is a significant difference in the refractive error (e.g., nearsightedness or farsightedness) between the two eyes. While anisometropia may lead to amblyopia, it is typically corrected with glasses or contact lenses rather than patching the stronger eye.

Conclusion:

Patching the stronger eye to increase visual stimulation to the weaker eye is a common treatment for strabismus and associated amblyopia.

Correct Answer: The child swallows frequently.

Frequent swallowing in a child who has undergone a tonsillectomy is a priority finding because it can indicate bleeding at the surgical site. After a tonsillectomy, the child may swallow frequently to clear blood from their throat, which is a concerning sign of hemorrhage or postoperative bleeding. This condition requires immediate attention to prevent further complications such as severe blood loss or airway obstruction.

Why Other Options Are Wrong:

The child cries often:

Crying is common in the immediate postoperative period, especially in young children. It is a normal response to discomfort or pain, and while it should be addressed with appropriate pain management, it is not as urgent as frequent swallowing, which could indicate a life-threatening issue like bleeding.

The child refuses clear liquids:

It is normal for children to have a decreased appetite and reluctance to drink fluids after surgery, particularly due to the discomfort in the throat. While this may be concerning if it leads to dehydration, it is not as immediate a concern as frequent swallowing, which might signal bleeding or hemorrhage.

The child's throat pain increases:

An increase in throat pain after a tonsillectomy can be expected as part of the healing process. Although pain management should be administered, an increase in pain alone is not as urgent as frequent swallowing, which may suggest active bleeding requiring immediate intervention.

Conclusion: The most critical finding is frequent swallowing, which could indicate bleeding at the surgical site and demands immediate medical attention to prevent further complications such as hemorrhage.

Correct Answer: Increased hematocrit

Diarrhea can lead to dehydration in infants, which can cause hemoconcentration. This means that the hematocrit (the percentage of red blood cells in the blood) may be elevated due to the loss of fluids and volume, while the blood becomes more concentrated. Thus, an increased hematocrit is an expected finding in an infant with dehydration caused by diarrhea.

Why Other Options are Wrong:

Bulging fontanel:

A bulging fontanel is more commonly associated with increased intracranial pressure, not dehydration. In dehydration, the fontanel is often sunken, reflecting the loss of fluid in the body.

Decreased heart rate:

Dehydration from diarrhea typically causes an increase in heart rate (tachycardia) as the body tries to compensate for fluid loss and maintain circulation. A decreased heart rate would not be expected in dehydration.

Polyuria:

Polyuria (excessive urine production) is not typically associated with dehydration. In fact, dehydration often leads to oliguria (reduced urine output) or anuria (absence of urine output), not an increase in urine production.

Conclusion:

The correct expected finding in a 3-month-old infant with diarrhea is an increased hematocrit due to dehydration. The other findings are inconsistent with dehydration.

Correct Answer:

Child's height and weight:

These measurements are commonly used to calculate medication dosages, especially in pediatric patients. Dosages are often based on weight (mg/kg) or weight adjusted for the child’s age.

Body surface area of child:

This is often the preferred method for calculating medication dosages in pediatrics, particularly for chemotherapy or high-risk medications, as it better correlates with metabolic needs than weight alone. Body surface area (BSA) can be calculated using formulas like the Mosteller formula.

Nomogram determined mathematical constant:

In some cases, nomograms or formulas specific to certain medications or conditions are used to determine the appropriate dosage based on the child's body surface area, weight, or height.

Why Other Options Are Wrong:

Adult dosage of medication: Adult dosages are not appropriate for pediatric patients because children metabolize medications differently, requiring adjustments to their dosages based on their size and developmental stage.

Average adult's body surface area: Using an adult's body surface area is not appropriate in pediatrics because children have smaller body surface areas and different pharmacokinetics that affect medication distribution.

Average pediatric dosage of medication: This is not a standardized measurement for every child, as dosages can vary significantly based on individual factors such as weight, age, and underlying health conditions. It is important to adjust based on specific measurements (e.g., weight, BSA) rather than a general pediatric dosage.

Correct Answer: Magnetic resonance imaging (MRI).

Explanation:

Magnetic resonance imaging (MRI) is the most sensitive imaging modality for detecting osteomyelitis, especially in the early stages. It provides detailed images of both bone and soft tissue and is highly effective in identifying areas of infection, inflammation, and bone marrow involvement, which are key indicators of osteomyelitis.

Why Other Options Are Wrong:

Radiography (X-ray):

X-rays are often the first imaging modality used to assess bone infections, but they are not sensitive enough to detect early osteomyelitis. X-rays may only show changes after significant bone destruction has occurred, which could delay diagnosis.

Fluoroscopy:

Fluoroscopy is a real-time X-ray used for guidance during procedures but is not typically used for diagnosing osteomyelitis or assessing bone infections. It does not provide the detailed imaging needed for detecting soft tissue involvement or early bone changes.

Computed tomography (CT):

CT scans provide good detail of bone structures but are not as sensitive as MRI in detecting early osteomyelitis or soft tissue changes related to infection. CT may be more useful in assessing complex bone fractures or abscess formation but not as optimal for soft tissue and early bone marrow involvement.

Conclusion:

MRI is the preferred imaging technique for early detection of osteomyelitis, particularly when the infection is non-responsive to antibiotics and involves soft tissue and bone marrow.

Correct Answer: Exercise intolerance

Exercise intolerance is a manifestation of heart failure in children, including those who have undergone surgery for tetralogy of Fallot. Heart failure in children can result from the heart's inability to pump blood effectively, leading to reduced oxygenation of tissues, which causes fatigue and difficulty with physical activity or exercise. The body demands more oxygen during exertion, but if the heart cannot meet that demand, the child may experience exercise intolerance.

Why Other Options Are Wrong:

Bradycardia:

Bradycardia (a slower-than-normal heart rate) is not a typical manifestation of heart failure. In fact, tachycardia (an abnormally high heart rate) is more common in heart failure because the heart attempts to compensate for its reduced pumping ability by increasing its rate. Bradycardia could occur in other conditions but is not a primary sign of heart failure.

Weight loss:

Weight loss is not a primary manifestation of heart failure. In fact, fluid retention and weight gain due to edema are more characteristic of heart failure. When the heart cannot pump efficiently, the body tends to retain fluid, leading to weight gain. Weight loss would typically be associated with other conditions, such as chronic illness or malnutrition.

Decreased respirations:

Decreased respirations would not typically be a manifestation of heart failure. In fact, heart failure often leads to increased respiratory effort and tachypnea (rapid breathing) due to fluid buildup in the lungs, which impairs gas exchange. Decreased respirations might be seen in situations like respiratory depression due to medications but not in heart failure.

Conclusion:

Exercise intolerance is the correct manifestation of heart failure in this scenario. The child’s heart struggles to meet the demands of physical activity, resulting in fatigue and difficulty exercising. The other options are less consistent with the typical signs of heart failure.

Correct Answer: Have a bulb syringe readily available to remove secretions.

Explanation:

Infants with respiratory infections are often unable to clear their airways effectively due to excessive secretions. A bulb syringe is an essential tool in this situation, as it can help suction secretions from the infant's nose and mouth. This ensures the infant maintains a clear airway, which is critical in managing respiratory distress or potential pneumonia. Ensuring the airway is clear is the top priority to prevent further complications.

Why Other Options are Wrong:

Give small, frequent feedings of fluids:

While hydration is important, especially during illness, the immediate concern for this infant is clearing the airway to ensure adequate breathing. The airway needs to be addressed first to prevent respiratory distress, and once the airway is clear, fluid intake can be managed.

Accurately chart observations regarding breath sounds:

Monitoring and documenting breath sounds are important for ongoing assessment of the infant’s condition, but this is not the immediate priority. Ensuring the infant’s airway is clear takes precedence to prevent respiratory compromise, which is a more urgent concern.

Encourage older siblings to visit:

Although emotional support can be beneficial, it should not take priority over the infant’s airway management. Additionally, visits from siblings could increase the risk of further exposure to infection if they have been in contact with other environments, making this option less appropriate in this scenario.

Correct Answer: Rigid family rules.

Explanation:

Rigid family rules are a contributing factor to the development of anorexia nervosa in adolescents. Families with strict, controlling, and inflexible rules often create environments where adolescents may feel a lack of control, leading them to seek control in other aspects of their lives, such as their eating habits. This can contribute to the development of eating disorders like anorexia nervosa.

Why Other Options Are Wrong:

Complaisant parenting:

Complaisant (or overly permissive) parenting is less directly linked to anorexia nervosa than rigid family rules. While permissive parenting can sometimes contribute to emotional issues, it's the overly controlling family environments that are more strongly associated with anorexia.

Peer pressure:

Peer pressure, while an important factor in body image concerns, is typically more influential in the onset of disorders like bulimia nervosa or binge eating disorder. However, rigid family rules create a more profound internal pressure that may lead to anorexia nervosa.

Dropping out of high school:

Dropping out of high school may cause stress and emotional issues, but it is not a recognized direct cause of anorexia nervosa. Family dynamics, including rigid rules, are much more influential.

Conclusion:

Rigid family rules, which create an environment of control and perfectionism, are a recognized contributing factor to anorexia nervosa in adolescents.