A nurse in a clinic is assessing a 7-month-old infant. Which of the following indicates a need for further evaluation?

Choice A: An ostomy is a surgical opening in the abdomen that allows stool to pass out of the body. A child who has Hirschsprung disease, which is a condition that causes a blockage of the large intestine due to a lack of nerve cells, may need an ostomy to relieve the obstruction and prevent complications. The ostomy is usually temporary and can be reversed after the affected part of the intestine is removed or repaired. This statement indicates an understanding of the teaching, as the parent knows that the ostomy is not permanent.

Choice B: A urinary catheter is a tube that drains urine from the bladder. A child who has Hirschsprung disease does not need a urinary catheter, as their condition does not affect their urinary system. This statement indicates a lack of understanding of the teaching, as the parent is confused about the type of surgery or device that their child will have.

Choice C: A feeding tube is a tube that delivers nutrition directly into the stomach or small intestine. A child who has Hirschsprung disease may need a feeding tube if they have severe malnutrition, dehydration, or infection due to their condition. However, this is not always necessary and depends on the individual case and the surgeon's preference.
This statement indicates a lack of understanding of the teaching, as the parent assumes that their child will need a feeding tube without knowing the specific plan.

Choice D: A child who has Hirschsprung disease will not have normal bowel movements after the initial surgery, as they will still have an ostomy that bypasses their large intestine. They will need another surgery to reconnect their intestine and restore their bowel function. This statement indicates a lack of understanding of the teaching, as the parent has unrealistic expectations about the outcome of the surgery.

Choice A reason: This choice is incorrect because the loss of a parent is not the priority risk factor for suicide completion. Loss of a parent is a stressful life event that may cause grief, depression, or anxiety in an adolescent, but it does not necessarily increase the risk of suicide completion. However, the loss of a parent may be associated with other risk factors such as low self-esteem, poor coping skills, or social isolation, which can contribute to suicidal ideation or behavior.
Choice B reason: This choice is incorrect because a history of substance abuse is not the priority risk factor for suicide completion. History of substance abuse is a behavioral problem that may impair the judgment, mood, or impulse control of an adolescent, but it does not necessarily increase the risk of suicide completion. However, a history of substance abuse may be associated with other risk factors such as mental illness, family conflict, or legal trouble, which can contribute to suicidal ideation or behavior.
Choice C reason: This choice is correct because a previous suicide attempt is the priority risk factor for suicide completion. Previous suicide attempt is a clear indicator of suicidal intent and capability, and it increases the likelihood of future attempts and completion. According to the American Foundation for Suicide Prevention (AFSP), about 40% of people who die by suicide have a history of previous attempts. Therefore, assessing and addressing previous suicide attempts is essential to prevent further harm and save lives.
Choice D reason: This choice is incorrect because active psychiatric disorder is not the priority risk factor for suicide completion. Active psychiatric disorder is a mental health condition that may affect the thoughts, feelings, or behaviors of an adolescent, but it does not necessarily increase the risk of suicide completion. However, active psychiatric disorder may be associated with other risk factors such as hopelessness, helplessness, or isolation, which can contribute to suicidal ideation or behavior.