The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which sign of this disorder documented?
Ribbon-like stools
Profuse projectile vomiting
Bright red blood and mucus in the stools
Watery diarrhea
The Correct Answer is C
A. Ribbon-like stools
Explanation: Ribbon-like or pencil-thin stools are associated with conditions affecting the rectum, such as colorectal cancer, but they are not a typical sign of intussusception.
B. Profuse projectile vomiting
Explanation: Profuse projectile vomiting is not a typical sign of intussusception. Vomiting may occur, but it is not the primary characteristic feature.
C. Bright red blood and mucus in the stools
Explanation:
Intussusception is a condition in which one part of the intestine slides into another, causing a blockage. One of the classic signs of intussusception is the presence of "currant jelly" stools, which are characterized by a mixture of bright red blood and mucus in the stools. This occurs due to the compression of the blood vessels in the intestine, leading to bleeding and mucosal discharge.
D. Watery diarrhea
Explanation: Watery diarrhea is not a typical sign of intussusception. The condition is more commonly associated with abdominal pain, vomiting, and the characteristic "currant jelly" stools.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. "I'll check my child's temperature."
Explanation: Monitoring the child's temperature is a general indicator of well-being and can help identify signs of infection or other postoperative concerns.
B. "I'll give medication so that my child will be comfortable."
Explanation: Administering prescribed medication for comfort is a suitable practice to manage postoperative pain or discomfort.
C. "I'll check my child's voiding to be sure there's no problem."
Explanation:
After an orchiopexy procedure, checking voiding may not be directly related to the surgical intervention. Orchiopexy is a procedure to correct cryptorchidism, which involves repositioning an undescended testicle into the scrotum. While monitoring for general signs of well-being is important, specifically checking voiding might not be directly relevant to the surgical recovery process.
D. "I'll let my child decide when to return to play activities."
Explanation: Allowing the child to gradually resume play activities based on their comfort and recovery is a reasonable approach, considering individual variations in recovery times.
Correct Answer is A
Explanation
A. Orthopnea
Explanation:
Orthopnea refers to difficulty breathing that occurs when lying flat. In heart failure, fluid may accumulate in the lungs, leading to respiratory distress when the child is in a supine position. Orthopnea is a common symptom of heart failure in both adults and children.
B. Bradycardia
Explanation: Bradycardia (slow heart rate) is not a typical finding in heart failure. Heart failure often leads to compensatory mechanisms, including an increased heart rate (tachycardia), to maintain cardiac output.
C. Weight loss
Explanation: Weight loss is not a typical finding in heart failure. In fact, heart failure in children may lead to fluid retention and weight gain rather than weight loss.
D. Increased urine output
Explanation: Heart failure in toddlers is more likely to be associated with decreased urine output rather than increased urine output. Reduced cardiac output can result in decreased blood flow to the kidneys, leading to decreased urine production and potential fluid retention. Increased urine output is not a characteristic finding in heart failure.
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