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 group of students is reviewing information about the endocrine system in infants and children. The students demonstrate understanding of the information when they state:

• A. Endocrine glands begin developing during gestation.
• B. Endocrine glands are fully functional at birth.
• C. Infants may have difficulty regulating glucose and electrolytes.
• D. A child’s endocrine system plays a significant role in growth and development.

Correct answer: C

Rationale: The correct answer is C. Infants may have difficulty regulating glucose and electrolytes due to their immature endocrine systems. This can lead to issues such as hypoglycemia and electrolyte imbalances. Choice A is incorrect because endocrine glands actually begin developing early in gestation, not just in the third trimester. Choice B is incorrect as endocrine glands are not fully functional at birth; they continue to mature and develop after birth. Choice D is incorrect as a child's endocrine system has a significant impact on growth and development through the secretion of hormones that regulate various processes in the body, but it does not specifically address the difficulty in regulating glucose and electrolytes seen in infants.

3. A child with a diagnosis of nephrotic syndrome is being discharged. What dietary instructions should the nurse provide?

• A. Encourage a high-protein diet
• B. Avoid foods high in salt
• C. Encourage a low-sodium diet
• D. Encourage a low-protein diet

Correct answer: B

Rationale: For a child with nephrotic syndrome, it is crucial to avoid foods high in salt to manage symptoms and prevent complications. Excessive salt intake can lead to fluid retention and exacerbate edema, which are common issues in nephrotic syndrome. Encouraging a high-protein diet (Choice A) may put additional strain on the kidneys and worsen the condition. While protein restriction is sometimes needed, it is not the primary dietary concern in nephrotic syndrome. Similarly, a low-protein diet (Choice D) is not typically recommended as it may lead to malnutrition in children. Although a low-sodium diet (Choice C) may sound similar to avoiding foods high in salt, the emphasis should be on reducing salt intake specifically, rather than a generalized low-sodium approach.

4. An infant who has had diarrhea for 3 days is admitted in a lethargic state and is breathing rapidly. The parent states that the baby has been ingesting formula, although not as much as usual, and cannot understand the sudden change. What explanation should the nurse give the parent?

• A. Cellular metabolism is unstable in young children.
• B. The proportion of water in the body is less than in adults.
• C. Renal function is immature in children until they reach school age.
• D. The extracellular fluid requirement per unit of body weight is greater than in adults.

Correct answer: D

Rationale: The correct answer is D. Infants have a higher extracellular fluid requirement per unit of body weight, making them more susceptible to dehydration and electrolyte imbalances during illnesses such as diarrhea. Choice A is incorrect because cellular metabolism being unstable is not the primary explanation for the symptoms described. Choice B is incorrect as the proportion of water in the body alone does not fully explain the increased risk of dehydration in infants. Choice C is incorrect because while renal function is immature in children, it is not the most relevant factor in this scenario compared to the increased fluid requirements.

5. What behavior does the nurse anticipate when feeding a newborn with choanal atresia?

• A. Chokes during feeding
• B. Experiences swallowing challenges
• C. Lacks hunger cues
• D. Takes about half of the feeding

Correct answer: D

Rationale: When feeding a newborn with choanal atresia, the nurse can anticipate that the infant may take only part of the feeding before pausing for air. This is due to the fact that infants with choanal atresia struggle to breathe through their nose while feeding. Choice A is incorrect as choking typically involves a more severe airway obstruction. Choice B is incorrect because difficulty swallowing is not the primary concern in choanal atresia. Choice C is incorrect as the issue is not related to hunger cues but rather the physiological challenges associated with breathing while feeding.

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