A nurse is collecting data from an infant. Which of the following is a clinical manifestation of pyloric stenosis?
Projectile vomiting after feedings
Absent bowel sounds
Increased sodium level
Golf ball-size mass over the left quadrant
The Correct Answer is A
A. Projectile vomiting after feedings: Projectile vomiting after feedings, especially occurring a short time after feeding, is a classic sign of pyloric stenosis due to obstruction at the pylorus.
B. Absent bowel sounds: Absent bowel sounds may occur in more advanced cases of bowel obstruction but are not specific to pyloric stenosis.
C. Increased sodium level: Increased sodium level is not typically associated with pyloric stenosis.
D. Golf ball-size mass over the left quadrant: A palpable mass in the left quadrant is not a typical finding in pyloric stenosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","D"]
Explanation
A. Change diapers frequently. Frequent diaper changes reduce prolonged contact with moisture, decreasing the risk of dermatitis.
B. Allow the buttocks to air-dry. Air-drying helps to keep the skin dry and allows it to heal, preventing further irritation.
C. Use commercial baby wipes that are free of alcohol and fragrances to cleanse the area. Alcohol and fragrance-free wipes minimize further irritation to the sensitive skin.
D. Apply zinc oxide ointment to the affected area. Zinc oxide creates a protective barrier that helps heal and protect the skin from moisture and irritants.
E. Apply talcum powder with every diaper change. Talcum powder is not recommended as it can be inhaled by the infant and may cause respiratory issues.
Correct Answer is D
Explanation
A. "I'm tired and want to take a nap." Common in sick children and not necessarily concerning in this context.
B. "I am scared and I want to go home." Emotional response, typical in children facing surgery.
C. "I am hungry and thirsty." Normal sensations and not indicative of the severity of the condition.
D. "My belly doesn't hurt anymore." This statement suggests potential rupture or perforation of the appendix, which can lead to peritonitis and is a surgical emergency. A sudden relief of pain can indicate a worsening condition rather than improvement.
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