A child with severe gastroesophageal reflux disease (GERD) is scheduled for Nissen fundoplication. Postoperative nursing management should include (select all that apply):

Starting bolus feedings to stretch the stomach

Venting gastrostomy tube

Keeping child flat in bed to increase absorption of food

Observing for abdominal distension, flushing and hypotension which may indicate dumping syndrome

Answer and Explanation

Correct Answer : B,D

Choice A reason: Starting bolus feedings to stretch the stomach is not recommended for a child with Nissen fundoplication as it can cause increased pressure on the surgical site and lead to complications such as bleeding, perforation, or slippage of the wrap.

Choice B reason: Venting gastrostomy tube is a correct answer as it allows for the release of gas and fluids from the stomach and prevents gastric distension and discomfort. A gastrostomy tube is often placed during Nissen fundoplication to facilitate feeding and venting.

Choice C reason: Keeping child flat in bed to increase absorption of food is not advised for a child with Nissen fundoplication as it can increase the risk of aspiration and pneumonia. The child should be positioned at a 30-degree angle or higher after feeding to prevent reflux.

Choice D reason: Observing for abdominal distension, flushing and hypotension which may indicate dumping syndrome is a correct answer as it is a potential complication of Nissen fundoplication. Dumping syndrome occurs when food moves too quickly from the stomach to the small intestine, causing symptoms such as abdominal cramps, nausea, diarrhea, sweating, and dizziness.

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Correct Answer is A

Explanation

Choice A reason: This statement is correct, as hydrostatic reduction of telescoped bowel with an air or saline enema is the preferred treatment for intussusception, which is a condition where a segment of the intestine slides into another segment, causing obstruction, inflammation, and ischemia. The enema can help to push the invaginated bowel back to its normal position, relieve the obstruction, and restore the blood flow. The procedure is safe, effective, and minimally invasive, and can avoid the need for surgery.

Choice B reason: This statement is incorrect, as hydrostatic reduction of telescoped bowel with an air or saline enema is not a false statement, but a true one. The nurse should be aware of the indications, contraindications, and complications of this procedure, and monitor the child's vital signs, abdominal distension, bowel sounds, and stool output before, during, and after the enema. The nurse should also educate the parents about the signs and symptoms of recurrence, such as abdominal pain, vomiting, or bloody stools.

A. Increased stroke volume B. Cardiac arrhythmia C. Decreased cardiac output D. Cyanosis

Correct Answer is C

Explanation

Choice A reason: Increased stroke volume is not a correct answer as it means that the heart pumps more blood with each contraction. This would result in increased blood pressure and perfusion, not cool extremities, weak pulses, and low urine output.

Choice B reason: Cardiac arrhythmia is not a correct answer as it means that the heart beats irregularly or abnormally. This can cause palpitations, chest pain, or fainting, but not necessarily cool extremities, weak pulses, and low urine output.

Choice C reason: Decreased cardiac output is a correct answer as it means that the heart pumps less blood than the body needs. This can result from a ventricular septal defect, which causes blood to shunt from the left ventricle to the right ventricle, reducing the amount of oxygenated blood that reaches the tissues. This can cause cool extremities, weak pulses, and low urine output, as well as fatigue, poor growth, and shortness of breath.

Choice D reason: Cyanosis is not a correct answer as it means that the skin, lips, or nails turn blue due to low oxygen levels in the blood. This can occur in some cases of ventricular septal defect, especially if there is pulmonary hypertension or a reversal of the shunt. However, cyanosis is not a direct cause of cool extremities, weak pulses, and low urine output.

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A child with severe gastroesophageal reflux disease (GERD) is scheduled for Nissen fundoplication. Postoperative nursing management should include (select all that apply):

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The treatment of choice in a child with intussusception who is not showing signs of sepsis or shock is hydrostatic reduction of telescoped bowel with an air or saline enema. True or False?

Correct Answer is A

Explanation

A six-month-old infant is hospitalized for repair of a ventricular septal defect. As you are doing his physical exam, you note that the infant's extremities are cool, he has weak peripheral pulses, and his urine output is diminished. These clinical findings are suggestive of which of the following?

Correct Answer is C

Explanation

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