A child has been diagnosed with Hirschsprung's disease. Which of the following findings would the nurse expect the parents to report in the child's history? Select all that apply.
Ribbon-like stools.
Distended abdomen.
Chronic constipation.
Black and tarry stools.
Correct Answer : A,B,C
Choice A rationale:
Ribbon-like stools are a classic sign of Hirschsprung's disease, indicating narrowed or obstructed bowel segments due to the absence of ganglion cells in the intestine's muscular layers.
Choice B rationale:
A distended abdomen is common in Hirschsprung's disease due to the accumulation of stool and gas in the narrowed segments of the intestine.
Choice C rationale:
Chronic constipation is a result of the dysfunctional intestinal motility caused by Hirschsprung's disease. The absence of ganglion cells leads to a lack of peristalsis and difficulty passing stools.
Choice D rationale:
Black and tarry stools are indicative of upper gastrointestinal bleeding, often caused by conditions like peptic ulcers. This finding is not directly related to Hirschsprung's disease.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Failing to regularly wash their hands after eating may contribute to the transmission of various infections, but it's not specifically related to pinworms.
Choice B rationale:
Failing to adequately wipe themselves after toileting can lead to the transfer of pinworm eggs from the anal area to the fingers and under the nails. This behavior increases the risk of ingesting the eggs through hand-to-mouth contact, which can perpetuate the pinworm infection cycle.
Choice C rationale:
Sharing clothing with friends might facilitate the transmission of certain infections like lice or fungal infections, but it's not a common mode of transmission for pinworms.
Choice D rationale:
Engaging in frequent hand-to-mouth activity might increase the risk of ingesting pinworm eggs, but the eggs are more likely to be present on the hands due to inadequate wiping after toileting.
Correct Answer is B
Explanation
Choice A rationale:
The identification band falling off the patient's leg is a documentation concern and doesn't require immediate action unless the patient is at risk of wandering or abduction.
Choice B rationale:
IV fluids should be changed every 24 hours to prevent bacterial growth and infection. Using fluids that are 48 hours old increases the risk of introducing infection to the patient.
Choice C rationale:
The crib rails being halfway up is not an immediate concern unless the child is at risk of falling or climbing out of the crib.
Choice D rationale:
Damp bed linen can be addressed during the next bedding change. It may not require immediate action unless the patient's skin integrity is at risk.
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