Which assessment finding should the nurse expect in an infant with Hirschsprung disease?
Constipation with passage of foul-smelling, ribbon-like stools
Diarrhea
Foul-smelling, fatty stools
"Currant jelly" stools
The Correct Answer is A
The assessment finding that the nurse should expect in an infant with Hirschsprung disease is option A, constipation with the passage of foul-smelling, ribbon-like stools. Hirschsprung disease is a congenital condition characterized by the absence of ganglion cells in the distal part of the colon, leading to functional obstruction. The affected segment of the colon lacks the normal peristaltic movements, resulting in an accumulation of faecal matter. The stools passed by infants with Hirschsprung disease are often constipated, and the narrow, ribbon- like appearance is a result of the narrowed segment of the colon.
diarrhea (option B) is incorrect because it, is not typically associated with Hirschsprung disease. Instead, the condition presents with constipation due to the obstructed bowel.
foul-smelling, fatty stools in (option C) is incorrect because it, is not characteristic of Hirschsprung disease. This finding may be associated with malabsorption disorders such as cystic fibrosis or celiac disease, but not specifically with Hirschsprung disease.
"currant jelly" stools in (option D) is incorrect because it, is a term commonly used to describe the stools seen in intussusception, which is a different condition involving the telescoping of one segment of the bowel into another. It is not an expected finding in Hirschsprung disease.
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Correct Answer is B
Explanation
The term used to describe an abnormally increased convex angulation in the curvature of the thoracic spine, which appears as a "hump back" or rounded upper back, is kyphosis.
Kyphosis refers to an excessive forward rounding or curvature of the thoracic spine, leading to a visible hump-like appearance. It can result from various causes, including poor posture, congenital abnormalities, osteoporosis, or certain medical conditions.
ankylosis in (option A), refers to the abnormal fusion or immobility of a joint, typically due to inflammation or injury.
Lordosis, in (option C) refers to an excessive inward curvature of the lower back, causing the abdomen and buttocks to protrude.
, scoliosis in (option D), refers to an abnormal sideways curvature of the spine, typically in an "S" or "C" shape. It is different from kyphosis, which primarily affects the thoracic spine and results in a rounded upper back.
Correct Answer is A
Explanation
A change in status that should alert the nurse to increased intracranial pressure (ICP) in a child with a head injury is confusion and altered mental status. As intracranial pressure increases, it can affect brain function and lead to neurological changes, including confusion, disorientation, irritability, decreased level of consciousness, or other alterations in mental status. These changes indicate that the brain is being compressed and compromised, and immediate intervention is required.
Option B, increased diastolic pressure with narrowing pulse pressure in (option B) is incorrect because it, can be a sign of increased ICP, but it is not specific to head injuries and can be influenced by other factors such as pain, anxiety, or systemic conditions. It is important to consider the overall hemodynamic status of the child and assess for additional signs and symptoms of increased ICP.
irregular, rapid heart rate in (option C), can be a sign of increased ICP, but it is not specific to head injuries and can be influenced by other factors such as pain, anxiety, or other medical conditions. Assessment of heart rate should be considered along with other signs and symptoms of increased ICP.
rapid, shallow breathing, in (option D) can be a sign of increased ICP, but it is not specific to head injuries and can be influenced by other factors such as pain, anxiety, or respiratory conditions. Respiratory assessment should be considered along with other signs and symptoms of increased ICP.
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