A nurse is planning care for an adolescent following the repair of the Meckel diverticulum. Which of the following actions should the nurse include in the plan of care?
Teach the client about ostomy care.
Administer total parenteral nutrition.
Initiate long-term antibiotic therapy.
Maintain an NG tube for decompression.
The Correct Answer is D
A. Teaching the client about ostomy care is unnecessary because surgical repair of Meckel diverticulum does not typically require an ostomy.
B. Administering total parenteral nutrition (TPN) is not routinely required postoperatively unless there are significant complications affecting digestion.
C. Initiating long-term antibiotic therapy is not standard post-surgical care for Meckel diverticulum repair; antibiotics are usually given short-term to prevent infection.
D. Maintaining an NG tube for decompression is appropriate because postoperative bowel rest is needed to prevent distension and reduce the risk of complications such as ileus.
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Related Questions
Correct Answer is D
Explanation
A. Negative doll's eye reflex (also known as oculocephalic reflex) is a normal finding in infants. It is a reflexive movement of the eyes in the opposite direction of the head
movement.
B. A sunken anterior fontanel can indicate dehydration, which is a concern. However, in a 2-month-old with heart failure, a high heart rate (tachycardia) may indicate worsening of the heart failure and needs to be addressed promptly.
C. A potassium level of 5.1 mEq/L is within the normal range for infants. While electrolyte balance is important, it is not the priority in this situation.
D. This is the correct answer. A heart rate of 162/min in a 2-month-old infant with heart failure is elevated and requires immediate attention. It may indicate worsening heart
failure or an adverse reaction to the medication (furosemide) being administered. The nurse should assess the infant's condition, notify the healthcare provider, and intervene as necessary.
Correct Answer is B
Explanation
A. Increased self-esteem is a positive aspect of development, but it may not be a consistent characteristic during early adolescence. Self-esteem can fluctuate based on various factors.
B. Mood swings are common during early adolescence due to hormonal changes and the emotional challenges that come with this stage of development. It's important for parents to be understanding and supportive during this time.
C. The growth rate during early adolescence may vary from person to person, but it generally accelerates rather than decelerates. This period is associated with rapid physical growth, known as the adolescent growth spurt.
D. Emotional separation from parents is a normal part of adolescent development, but it tends to become more prominent in later adolescence rather than early adolescence. During early adolescence, there may be a mix of seeking independence and still relying on parental support and guidance.
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