The nurse is caring for a newborn with a suspected diagnosis of imperforate anus. The nurse monitors the infant, knowing that which is a clinical manifestation associated with this disorder?

Sausage-shaped mass palpated in the upper right abdominal quadrant

The passage of currant jelly-like stools

Bile-stained fecal emesis

Failure to pass meconium stool in the first 24 hours after birth

Answer and Explanation

The Correct Answer is D

A. Sausage-shaped mass palpated in the upper right abdominal quadrant.
Explanation: A sausage-shaped mass in the upper right abdominal quadrant is more indicative of Hirschsprung's disease, not imperforate anus. In Hirschsprung's disease, there is a lack of ganglion cells in the rectum, leading to obstruction and a palpable mass.
B. The passage of currant jelly-like stools.
Explanation: The passage of currant jelly-like stools is characteristic of intussusception, a condition where one portion of the intestine telescopes into another. It is not associated with imperforate anus.
C. Bile-stained fecal emesis.
Explanation: Bile-stained fecal emesis suggests a possible intestinal obstruction or other gastrointestinal issue, but it is not a specific manifestation of imperforate anus. Imperforate anus is primarily characterized by the absence of a normal anal opening.
D. Failure to pass meconium stool in the first 24 hours after birth.
Explanation:
Imperforate anus refers to a congenital condition in which the opening to the anus is absent or improperly formed. One of the clinical manifestations is the failure to pass meconium stool within the first 24 hours after birth. Meconium is the thick, sticky, greenish-black substance that constitutes a newborn's first stools. The absence of meconium passage suggests a potential obstruction.

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Correct Answer is D

Explanation

A. "This shunting allows oxygenated and unoxygenated blood to mix."
Explanation: This statement is correct. In PDA, the shunting of blood between the aorta and pulmonary artery allows oxygenated and unoxygenated blood to mix, leading to decreased oxygen saturation in the systemic circulation.
B. "Blood is shunted to the right side of the heart."
Explanation: This statement is correct. In PDA, blood is shunted from the left side of the heart (aorta) to the right side of the heart (pulmonary artery).
C. "This shunting results in increased pulmonary blood flow."
Explanation: This statement is correct. PDA leads to increased pulmonary blood flow as a result of the shunting of blood from the aorta to the pulmonary artery.
D. "Blood is shunted to the left side of the heart."
Explanation:
A patent ductus arteriosus (PDA) is a congenital heart defect where the ductus arteriosus, a fetal blood vessel that normally closes shortly after birth, remains open. In PDA, blood is shunted from the aorta (left side of the heart) to the pulmonary artery (right side of the heart), resulting in increased pulmonary blood flow. Therefore, the correct statement is that "Blood is shunted to the right side of the heart."

A. "Has the child had any difficulty swallowing food?" B. "Does the child play with an imaginary friend?" C. "Does the child respond when called by name? D. "Was the child recently treated for pneumonia?

Correct Answer is A

Explanation

A. "Has the child had any difficulty swallowing food?"
Explanation:
One potential long-term effect of cleft palate repair is difficulty with swallowing or feeding. Cleft palate repair aims to improve the child's ability to eat and speak, but some children may continue to face challenges with swallowing or have a history of difficulty feeding.
B. "Does the child play with an imaginary friend?"
Explanation: Imaginary play is not specifically related to the long-term effects of cleft palate repair. This question does not provide information about the physical outcomes of the surgical repair.
C. "Does the child respond when called by name?"
Explanation: Responsiveness to being called by name is a general developmental question but does not specifically address the long-term effects of cleft palate repair.
D. "Was the child recently treated for pneumonia?"
Explanation: While respiratory issues can be associated with cleft palate, this question focuses on a recent event rather than the long-term effects. Asking about difficulty swallowing or feeding may provide more information about ongoing concerns related to the cleft palate repair.

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The nurse is caring for a newborn with a suspected diagnosis of imperforate anus. The nurse monitors the infant, knowing that which is a clinical manifestation associated with this disorder?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

A preschooler with a history of cleft palate repair comes to the clinic for a routine well-child checkup. To determine whether this child is experiencing a long-term effect of cleft palate, which question would the nurse ask the parent?

Correct Answer is A

Explanation

A nurse is caring for a child who is on a clear liquid diet. At lunch, the child consumed ½ cup of juice, 3 oz gelatin, 1 oz of an ice pop, and 20 mL ginger ale. How many mL should the nurse record as the child's fluid intake?

A nurse is preparing to measure an infant's vital signs. The nurse should use which of the following sites to assess a heart rate?

The nurse has provided discharge instructions to the parents of a 2-year-old child who underwent an orchiopexy to correct cryptorchidism, which statement by the parents indicates a need for further instruction?

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