A nurse is planning care for multiple children on a pediatric unit who have gastroesophageal reflux. Which of the following children requires a revision to their plan of care?

A 14-year-old child who eats small but frequent meals throughout the day

A 16-year-old child who takes their proton pump inhibitor 30 min before meals

A 6-year-old child who underwent a Nissen fundoplication and is tolerating a full liquid diet

A 4-month-old child who is experiencing weight loss

Answer and Explanation

The Correct Answer is D

A. A 14-year-old child who eats small but frequent meals throughout the day: This is an appropriate intervention for gastroesophageal reflux, as smaller, more frequent meals reduce gastric distention and minimize reflux episodes. No revision to the plan of care is needed for this child.

B. A 16-year-old child who takes their proton pump inhibitor 30 min before meals: Administering proton pump inhibitors before meals is correct because these medications are most effective when taken prior to food intake, allowing for optimal acid suppression. The current plan aligns with best practice.

C. A 6-year-old child who underwent a Nissen fundoplication and is tolerating a full liquid diet: Progressing to a full liquid diet after Nissen fundoplication is appropriate and indicates the child is tolerating postoperative dietary advancement. The plan of care is appropriate and requires no changes.

D. A 4-month-old child who is experiencing weight loss: Weight loss in an infant with gastroesophageal reflux is concerning and indicates inadequate nutrition or complications. The plan of care should be revised to address feeding adequacy, possible medical interventions, and close monitoring of growth and hydration status.

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Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A,B"},"C":{"answers":"B"},"D":{"answers":"B"}}

Explanation

Rationale

• Genitourinary findings: Intermittent sensations of "squeezing or spasm" in the bladder or urinary tract are typical in multiple sclerosis due to autonomic nervous system involvement and demyelination affecting bladder control. These symptoms are less common in ALS, which primarily affects motor neurons without early autonomic involvement.

• Report about gait: Episodes of leg weakness and balance issues can occur in both ALS and MS. ALS causes progressive motor weakness affecting gait due to upper and lower motor neuron degeneration. MS can cause intermittent gait disturbances from demyelination in the central nervous system, often with exacerbations and remissions.

• Vision disturbance: Intermittent double vision is consistent with MS, reflecting demyelination of cranial nerves or the optic pathways. Visual symptoms, including diplopia or optic neuritis, are hallmark early signs of MS. ALS typically does not involve vision, making this symptom specific to MS.

• Energy level: Fatigue lasting more than 4 months aligns with MS, which frequently causes persistent fatigue due to both neurological dysfunction and immune-mediated inflammation. ALS may lead to fatigue later in disease progression, but early chronic fatigue is more characteristic of MS.

A. Furosemide B. Spironolactone C. Metoprolol D. Atorvastatin

Correct Answer is B

Explanation

A. Furosemide: Furosemide is a loop diuretic that promotes potassium excretion. It does not need to be withheld for a mildly elevated potassium level; in fact, it may help lower potassium levels in hyperkalemia.

B. Spironolactone: Spironolactone is a potassium-sparing diuretic that can increase serum potassium. With a level of 5.2 mEq/L, administering spironolactone could worsen hyperkalemia and increase the risk of cardiac complications, so the dose should be withheld and the provider notified.

C. Metoprolol: Metoprolol, a beta-blocker, does not typically raise potassium levels significantly. While beta-blockers can slightly affect potassium, withholding is not indicated solely based on a potassium level of 5.2 mEq/L.

D. Atorvastatin: Atorvastatin, a lipid-lowering agent, has no effect on serum potassium levels and does not need to be withheld in this situation. It can be continued safely.

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A nurse is planning care for multiple children on a pediatric unit who have gastroesophageal reflux. Which of the following children requires a revision to their plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A,B"},"C":{"answers":"B"},"D":{"answers":"B"}}

Explanation

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Correct Answer is B

Explanation

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