NR-328 Pediatric Nursing - Set 3 - Part 3

Correct Answer: Hirschsprung disease with a distal aganglionic segment

Ninety percent of healthy newborns stool within two days. Absent meconium with distension, feeding refusal and bilious vomiting points to an aganglionic distal segment that cannot relax, and it must be reported. Option b is incorrect because failure to stool by two days is never brushed off as normal. That newborn is the highest risk infant on the unit and needs evaluation for obstruction. Option c is incorrect because that defect announces itself with drooling, frothy secretions and choking at the very first feeding. A catheter also stops in the upper pouch, none of which is described here. Option d is incorrect because that obstruction surfaces around one month with milky projectile emesis, not on the second day of life. Its vomit never contains bile, and meconium passes on schedule.

Correct Answer: The immature nephron cannot concentrate urine yet

Renal concentrating ability stays immature until roughly age two, so the infant nephron keeps excreting dilute urine while the body needs to conserve water. Dilute urine here reflects immaturity, not adequate hydration. Option a is incorrect because sodium retention would produce scant, concentrated urine with a high specific gravity. The picture described is the opposite, and it points to a nephron that cannot yet do that work. Option b is incorrect because renal compensation for acidosis works through bicarbonate reclamation and acid excretion, a process measured in days. It changes the acid load of the urine, leaving the water concentration untouched. Option c is incorrect because frequency describes how often voiding happens, not how much solute each void carries. A dehydrated infant usually voids less often, and counting wet diapers would show that pattern clearly.

Correct Answer: Offer oral rehydration solution in small amounts

Oral rehydration solution is the first line treatment for mild and moderate losses. Small frequent sips let glucose and sodium move together across an inflamed gut, and vomiting does not rule the approach out. Option a is incorrect because intravenous therapy is held for severe loss, shock, relentless vomiting or a child who cannot drink. Sticking an alert toddler who is still making urine adds pain and cost. Option b is incorrect because loperamide and similar drugs are avoided in young children. Slowing the bowel traps organisms and toxins inside it, and ileus, toxic megacolon or worsening infection can follow. Option d is incorrect because prolonged clear liquids starve the child and the healing mucosa. Age appropriate food and milk resume early, since the restrictive approach taught years ago lengthens the illness.

Correct Answer: The infection has reached the kidney tissue

High fever with chills, vomiting and costovertebral tenderness signals pyelonephritis rather than simple cystitis. Kidney involvement in a young child threatens permanent scarring, so the provider is told promptly and therapy is escalated. Option b is incorrect because glomerular inflammation arrives one to two weeks after a strep illness and brings cola coloured urine with hypertension. Fever, chills and flank tenderness describe bacterial invasion of kidney tissue instead. Option c is incorrect because stopping medication early usually produces returning burning and frequency, not rigors and flank pain. Adherence still deserves review, yet the immediate concern is where this infection has travelled inside the urinary tract. Option d is incorrect because drug hypersensitivity presents with rash, itching, facial swelling or wheeze. None of those appear here, and localised tenderness above the kidney is an infectious sign that no allergic reaction explains.

Correct Answer: Notify the provider so circumcision is deferred

The foreskin is the graft tissue the surgeon needs to rebuild the urethra, so circumcision is held until repair. The nurse alerts the provider and teaches the mother why the plan changes. Option a is incorrect because removing the foreskin destroys the tissue needed for reconstruction. Every newborn is inspected before the procedure, and a meatus sitting anywhere other than the tip stops the circumcision. Option c is incorrect because a ventrally placed meatus is an intact structural variation, not an open wound. Dressings serve no purpose here, and the infant voids normally through that opening until surgical repair. Option d is incorrect because feeding continues on the usual schedule for a healthy newborn. Withholding milk offers no benefit, and repair is scheduled months later, generally between six and eighteen months of age.

Correct Answer: Removing the lead source from the home

Removing the source is the priority in lead exposure, because chelation without remediation lets the level climb again. Environmental investigation, wet mopping, hand washing and a diet rich in iron and calcium follow. Option a is incorrect because chelation is generally held for much higher levels, around forty-five micrograms per deciliter. Treating this child with a drug while the paint stays in place would accomplish very little. Option b is incorrect because an elevated fingerstick result must be confirmed by a venous draw rather than simply repeated later. Retesting has a role in follow-up, though it does nothing about the exposure. Option c is incorrect because nutrition matters through specific nutrients rather than a general supplement. Iron and calcium deficiency increase how much swallowed lead the gut absorbs, so counseling targets those two along with vitamin C.

Correct Answer: Monthly self-examination will still be needed as a teenager

Bringing the testis down reduces but never erases the raised cancer risk, so the adolescent learns monthly testicular self-examination. That habit is the follow up parents most need to hear about now. Option b is incorrect because surgery protects remaining function rather than guaranteeing it. Fertility problems still affect a share of these boys, more so when both sides were involved, and no operation reverses damage already done. Option c is incorrect because the malignancy risk stays elevated for life even after a well timed repair. Telling parents the danger vanishes would remove the whole reason for lifelong self-examination teaching. Option d is incorrect because straddle toys and rough activity are restricted for the period the surgeon specifies. Returning to vigorous play within days can pull on the fixation sutures and undo the placement in the scrotum.

Correct Answer: Muscle weakness with abdominal distention

Low potassium weakens skeletal and smooth muscle, so the nurse finds weakness, sluggish reflexes and an ileus with a distended abdomen. Shallow respirations and arrhythmias follow if the deficit deepens. Option a is incorrect because tall tented T waves with QRS widening belong to hyperkalemia, the opposite disturbance. This child's tracing would instead show flattened T waves, prominent U waves and a lengthened interval. Option b is incorrect because flaccid paralysis with a slow heart rate marks a rising potassium level in kidney failure or crush injury. Diarrhea drains potassium out of the body rather than trapping it. Option c is incorrect because carpopedal spasm and a twitching cheek on tapping the facial nerve point to low calcium. Those neuromuscular signs answer a different electrolyte question than the one this value raises.

Correct Answer: Hypertrophic pyloric stenosis

Non bilious projectile vomiting in a hungry infant of about five weeks is the pyloric stenosis picture. The obstruction sits above the bile duct, so emesis stays milky and the infant refeeds eagerly. Option a is incorrect because that defect declares itself at the very first feeding with coughing, choking and cyanosis, not weeks later. Drooling and frothy secretions dominate, and the infant never feeds well enough to vomit repeatedly. Option c is incorrect because telescoping bowel brings screaming spells with knees drawn up and calm stretches between them. Its vomiting turns bilious and stools carry blood and mucus, none of which appears here. Option d is incorrect because aganglionic bowel shows itself as delayed meconium, distension and ribbon like stools rather than forceful emesis. A hungry infant gaining nothing from feeds points instead to a gastric outlet blockage.

Correct Answer: The first child has nephrotic syndrome and the second glomerulonephritis

Heavy protein with almost no blood is the nephrotic pattern, while modest protein with marked haematuria is nephritic. Protein dominance points to a permeability defect, blood dominance to glomerular inflammation. Option a is incorrect because the two dipsticks describe opposite processes. One glomerulus is leaking protein through damaged filtration barriers, the other is inflamed and bleeding, and treatment for each differs completely. Option b is incorrect because it reverses the two patterns. Massive proteinuria of three to four plus defines nephrotic syndrome, and red blood cell casts with gross bleeding mark the inflammatory nephritic picture instead. Option d is incorrect because protein and blood escaping into urine come from the filtering unit itself. Bladder infection produces white cells and bacteria, not the heavy protein loss and casts seen with glomerular damage.