Nursing Elites

1. How is the diagnosis of Hirschsprung disease confirmed in a 1-month-old infant admitted to the pediatric unit?

• A. Colonoscopy
• B. Rectal biopsy
• C. Multiple saline enemas
• D. Fiberoptic nasoenteric tube

Correct answer: B

Rationale: Rectal biopsy is the definitive diagnostic procedure for Hirschsprung disease in infants. It confirms the absence of ganglion cells in the affected bowel segment, which is characteristic of Hirschsprung disease. Colonoscopy (Choice A) is not typically used for confirmation as it may not provide a definitive result. Multiple saline enemas (Choice C) are utilized in the treatment of meconium ileus, a complication of cystic fibrosis, and not in the diagnosis of Hirschsprung disease. Fiberoptic nasoenteric tube (Choice D) is not a diagnostic tool for Hirschsprung disease; it is commonly used for gastrointestinal decompression or feeding purposes but does not confirm the diagnosis.

2. A premature infant with respiratory distress syndrome (RDS) receives artificial surfactant. How does the nurse explain surfactant therapy to the parents?

• A. Surfactant improves the ability of your baby’s lungs to exchange oxygen and carbon dioxide.
• B. The drug prevents your baby from requiring excessive sedation.
• C. Surfactant is used to reduce episodes of periodic apnea.
• D. Your baby needs this medication to combat a potential respiratory tract infection.

Correct answer: A

Rationale: The correct answer is A. Surfactant therapy is explained to parents as a treatment that enhances the lungs' ability to exchange oxygen and carbon dioxide. This is essential for premature infants with respiratory distress syndrome (RDS) as it helps improve their respiratory function. Choices B, C, and D are incorrect because surfactant therapy primarily focuses on addressing lung function and is not related to sedation, apnea reduction, or fighting respiratory tract infections.

3. A 7-year-old child has an altered mental status, high fever, and a generalized rash. You perform your assessment and initiate oxygen therapy. En route to the hospital, you should be most alert for:

• A. vomiting
• B. seizures
• C. combativeness
• D. respiratory distress

Correct answer: B

Rationale: In a pediatric patient presenting with altered mental status, high fever, and a generalized rash, seizures are a significant concern. Febrile seizures can occur in children with high fevers and may lead to further complications. It is crucial to monitor for seizures and be prepared to manage them promptly. Vomiting, combativeness, and respiratory distress are also important considerations in pediatric patients; however, given the clinical presentation described, seizures take priority as they are a common complication in this scenario.

4. The nurse is reviewing the laboratory test results of a child diagnosed with disseminated intravascular coagulation (DIC). What would the nurse interpret as indicative of this disorder?

• A. Shortened prothrombin time
• B. Increased fibrinogen level
• C. Positive fibrin split products
• D. Increased platelets

Correct answer: C

Rationale: Positive fibrin split products are indicative of disseminated intravascular coagulation (DIC). In DIC, there is widespread clotting and subsequent consumption of clotting factors, leading to the formation of fibrin split products. A shortened prothrombin time (Choice A) is not typically seen in DIC as it indicates faster clotting, which is opposite to the pathophysiology of DIC. An increased fibrinogen level (Choice B) may be observed in the early stages of DIC due to the compensatory increase in production, but it is not a definitive indicator. Increased platelets (Choice D) may be seen in the early stages of DIC due to the body's attempt to compensate for clot formation, but it is not a specific finding for DIC.

5. A 6-month-old infant is diagnosed with cystic fibrosis. What explanation should the nurse provide to the parents about this condition?

• A. It is a condition affecting the respiratory and digestive systems.
• B. It is an autoimmune disorder affecting multiple organs.
• C. It is a genetic disorder that can be managed with medication.
• D. It is a condition caused by prenatal exposure to toxins.

Correct answer: A

Rationale: The correct answer is A: 'It is a condition affecting the respiratory and digestive systems.' Cystic fibrosis is a genetic disorder that primarily affects the respiratory and digestive systems. It is caused by a defective gene that leads to the production of thick and sticky mucus in these organs. This mucus can clog airways in the lungs and block the ducts in the pancreas, affecting digestion. Choice B is incorrect because cystic fibrosis is not an autoimmune disorder; it is a genetic condition. Choice C is partially correct in that cystic fibrosis is a genetic disorder, but merely managing it with medication oversimplifies the comprehensive care needed for individuals with cystic fibrosis. Choice D is incorrect as cystic fibrosis is not caused by prenatal exposure to toxins but is a genetic condition inherited from parents.

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