Which description of stool is characteristic of intussusception?
Loose, foul-smelling stools.
Ribbon-like stools.
Hard stools positive for guaiac.
"Currant jelly" stools.
The Correct Answer is D
The correct answer is choice D. "Currant jelly" stools.
Choice A rationale:
Loose, foul-smelling stools are not characteristic of intussusception. Intussusception is a condition in which a part of the intestine invaginates into another part, causing obstruction. This obstruction often leads to "currant jelly" stools, which are composed of mucus, blood, and sloughed intestinal tissue. Loose stools might be associated with other gastrointestinal issues but are not a hallmark of intussusception.
Choice B rationale:
Ribbon-like stools are characteristic of intussusception. When a section of the intestine telescopes into another section, it can cause the stool to be squeezed into a ribbon-like shape as it passes through the narrowed portion. This description aligns with the pathophysiology of intussusception.
Choice C rationale:
Hard stools positive for guaiac indicate the presence of blood in the stool, but this finding is not specific to intussusception. Guaiac testing detects occult blood, which could be present in various gastrointestinal conditions, including bleeding ulcers or diverticulitis, and not exclusively in intussusception.
Choice D rationale:
"Currant jelly" stools are characteristic of intussusception. As mentioned earlier, these stools are the result of the obstruction and subsequent damage to the intestinal lining, leading to the presence of blood, mucus, and sloughed tissue. This description is a classic sign of intussusception and should raise suspicion for this condition.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
The correct answer is choice A. The cuff bladder covers 50% to 66% of the length of the upper arm.
Choice A rationale:
Selecting a blood pressure cuff with a bladder that covers 50% to 66% of the length of the upper arm is the appropriate criterion for determining the cuff size for a 2-year-old boy. This range ensures accurate blood pressure measurement by ensuring a proper fit on the arm. If the cuff bladder is too small or too large, it can result in inaccurate readings.
Choice B rationale:
The label "toddler" on the cuff might be helpful in identifying the intended age group, but it doesn't provide precise measurements for cuff sizing. Relying solely on a label might not account for variations in arm sizes within the toddler age group.
Choice C rationale:
The cuff bladder width being 40% of the circumference of the upper arm might not be as accurate as the length-based criterion. A cuff that fits the arm's length is more critical in ensuring proper inflation and accurate blood pressure measurement.
Choice D rationale:
The cuff bladder length covering 80% to 100% of the circumference of the upper arm might result in an excessively large cuff for a 2-year-old, which can lead to inaccurate readings. Length-based sizing is more appropriate for accuracy in this scenario.
Correct Answer is D
Explanation
Answer is: d. Apply direct pressure above the catheterization site.
Explanation: The first action should be to apply direct pressure above the catheterization site to help control the bleeding and minimize blood loss. This will also give the nurse time to prepare additional interventions or supplies if necessary.
Choice a. is wrong because placing the child in the Trendelenburg position is not an appropriate initial nursing action in this scenario. This position can increase intracranial pressure and is typically used for patients experiencing shock or hypotension.
Choice b. is wrong because applying a new bandage with more pressure might be a subsequent action, but the priority is to apply direct pressure to slow down the bleeding.
Choice c. is wrong because notifying the physician is important, but the nurse should first take immediate action to control the bleeding and minimize potential harm to the patient.
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