A nurse is providing teaching to a parent of a child who has Hirschsprung disease is scheduled for initial surgery. Which of the following statements by the parent indicates an understanding of the teaching?
"I'm glad my child will have normal bowel movements now.
"I want to learn how to use my child's feeding tube as soon as possible
"I'm glad that my child's ostomy is only temporary
I want to learn how to empty my child's urinary catheter bag
The Correct Answer is C
Hirschsprung disease is a condition where nerve cells are missing from parts of the intestine, leading to problems with bowel movements. The treatment for Hirschsprung disease often involves surgery to remove the affected portion of the bowel and create a temporary ostomy (stoma). An ostomy is an opening in the abdominal wall through which waste material can pass into an external pouch, bypassing the affected section of the intestine.
The correct statement by the parent that indicates an understanding of the teaching is C. The parent is expressing relief that the ostomy is temporary, meaning it is not a permanent situation. This response indicates that the parent has been informed about the nature of the ostomy and its planned duration, which is an essential aspect of preoperative teaching.
Let's go through the other options and explain why they are not the best choices:
A. "I'm glad my child will have normal bowel movements now." This statement is not accurate because, after the initial surgery with the creation of a temporary ostomy, the child will not have normal bowel movements. The ostomy is created to bypass the affected part of the intestine, and the child's bowel movements will be directed through the ostomy until further surgery is performed to reconnect the intestine.
B. "I want to learn how to use my child's feeding tube as soon as possible." While learning how to use a feeding tube may be relevant for certain medical conditions, it is not specifically related to Hirschsprung disease or the planned initial surgery. Hirschsprung disease primarily affects the bowel and its function, not the child's ability to eat.
D. "I want to learn how to empty my child's urinary catheter bag." Hirschsprung disease does not directly impact the urinary system, so there is no specific reason for the parent to learn how to empty a urinary catheter bag in the context of this condition or the planned surgery.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A.Factor X is a clotting factor involved in the coagulation cascade. It is not directly related to preventing infections. While clotting factors are essential for hemostasis, they do not play a role in infection prevention.
B. Steroids can suppress the immune response, making the child more susceptible to infections. Therefore, they are not specifically administered to prevent infections
C. In a child with a sickle cell crisis who is hospitalized, preventing infections is crucial due to the increased risk of infections in this condition. Administering immunizations that the patient is scheduled for can help prevent certain infections.
Children with sickle cell disease are at a higher risk of bacterial infections, especially from encapsulated organisms like Streptococcus pneumoniae and Haemophilus influenzae. Vaccines can help protect against these pathogens and reduce the risk of serious infections.
Some of the recommended immunizations for children with sickle cell disease include:
Pneumococcal vaccine: This helps protect against infections caused by Streptococcus pneumoniae, which can cause severe respiratory and bloodstream infections.
Haemophilus influenzae type B (Hib) vaccine: This protects against infections caused by Haemophilus influenzae type B, which can lead to serious illnesses like pneumonia and meningitis.
Meningococcal vaccine: This protects against Neisseria meningitidis, which can cause meningitis and bloodstream infections.
Influenza vaccine: This annual vaccine helps protect against seasonal flu, which can be severe in children with sickle cell disease.
Administering these vaccines according to the recommended schedule helps provide protection against certain infections and can improve outcomes for children with sickle cell disease during hospitalization and beyond. The other options, Factor X, steroids, and PCA morphine, are not specific measures for preventing infections in a child with sickle cell crisis.
D.PCA (patient-controlled analgesia) morphine is used for pain management during a sickle cell crisis. It does not directly prevent infections.
Correct Answer is B
Explanation
In this scenario, the infant has a heart rate of 190/min and a fever of 40°C (104°F). Fever in infants can cause an increase in heart rate, which is a normal physiological response to elevated body temperature. Fever is the body's way of responding to an infection or illness, and it triggers various physiological changes, including an increase in heart rate. This helps the body to circulate blood and deliver immune cells to fight off the infection.
The other options are not accurate or relevant to the infant's current condition:
A. "This is within the expected range for your baby." - A heart rate of 190/min is above the normal expected range for a 2-month-old infant, which is typically between 120 to 160 beats per minute. This response would not address the elevated heart rate and fever.
C. "As your baby begins to fall asleep, his heart rate will decrease." - While heart rate may decrease during sleep, it does not explain the elevated heart rate and fever observed in this situation.
D. "Your baby's heart is beating fast in an attempt to cool down his body." - While tachycardia (fast heart rate) can be associated with increased metabolic demands during fever, the main reason for the increased heart rate in this case is the fever itself, not the body's attempt to cool down. Fever is a response to infection or illness and can cause an increase in heart rate as part of the body's normal immune response.
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