A 10-year-old is being evaluated for possible appendicitis and complains of nausea and sharp abdominal pain in the right lower quadrant. An abdominal ultrasound is scheduled, and a blood count has been obtained. The child vomits, finds the pain relieved, and calls the nurse. Which should be the nurse's next action?

Correct Answer: D

Rationale: In this scenario, the correct action for the nurse is to immediately notify the physician of the child's status (Option D). This is crucial because the child's symptoms of nausea and sharp abdominal pain, followed by vomiting and pain relief, could indicate a potential appendicitis which may require urgent medical attention or surgical intervention. By notifying the physician promptly, further evaluation and appropriate treatment can be initiated without delay, ensuring the child's well-being and safety. Option A is incorrect because while addressing the nausea with Zofran is important, it should not take precedence over informing the physician about the child's condition. Option B is also incorrect as administering an intravenous bolus without consulting the physician first could be unnecessary or even harmful. Option C is incorrect as the child's symptoms warrant further evaluation rather than immediate discharge. This scenario provides a valuable educational context for healthcare professionals to understand the critical importance of timely communication and collaboration in pediatric care, especially when dealing with potentially serious conditions like appendicitis. It underscores the significance of clinical judgment, prioritization, and effective communication in ensuring optimal patient outcomes.

Correct Answer: D

Rationale: In this scenario, the correct answer to question is D) Give clear liquid diet as tolerated. The rationale behind questioning this order is that clear liquid diet is not appropriate for a child with moderate dehydration. A child with vomiting, diarrhea, and signs of dehydration needs IV fluids to restore electrolyte balance and hydration status before advancing to oral intake. Clear liquid diet may worsen dehydration and electrolyte imbalances in this case. Option A is correct because administering a saline bolus is crucial to rehydrate the child and correct the electrolyte imbalances. Option B is also appropriate as rechecking serum electrolytes helps in monitoring the child's response to treatment. Option C is correct as it outlines the appropriate maintenance fluid therapy after the initial saline bolus. In an educational context, it is essential for nurses to understand the appropriate management of pediatric dehydration, including the use of IV fluids before advancing to oral intake. This scenario highlights the importance of recognizing the severity of dehydration and implementing appropriate interventions to prevent complications. Nurses need to be vigilant in questioning orders that may not align with evidence-based practice in pediatric care.

Correct Answer: C

Rationale: In caring for a 4-month-old with gastroesophageal reflux (GER) who is prescribed Zantac (ranitidine), administering the medication 30 minutes before the feeding (Option C) is the correct choice. Ranitidine is a histamine-2 receptor antagonist that works by decreasing stomach acid production, thereby reducing reflux symptoms. By giving it before a feeding, it allows the medication to be absorbed and take effect before the infant consumes food, optimizing its efficacy in controlling acid reflux during feeding times. Option A (immediately before a feeding) is incorrect as there may not be enough time for the medication to start working effectively before the feeding, potentially leading to inadequate symptom relief. Option B (30 minutes after the feeding) is also incorrect as the medication needs to be in the system prior to food intake to prevent reflux symptoms. Option D (at bedtime) is not ideal for this scenario as the goal is to manage reflux during feeding times when symptoms are typically more pronounced. Educationally, understanding the timing of medication administration in relation to feeding schedules is crucial in pediatric nursing. This knowledge ensures the optimal therapeutic effect of the medication and enhances patient outcomes. By grasping the rationale behind the timing of Zantac administration, nurses can provide safe and effective care for infants with GER, promoting their comfort and well-being.

Correct Answer: A

Rationale: The correct answer is A) The child likely has a high anorectal malformation. In anorectal malformations, the location of the abnormal connection between the rectum and urinary tract determines the level of the malformation. When a neonate does not pass stool per rectum but has meconium in the urine, it suggests a high anorectal malformation where the rectum is not properly connected to the anus. This condition often requires surgical intervention, including a colostomy to divert stool and a subsequent repair. Option B) The child likely has a low anorectal malformation is incorrect because the scenario described indicates a high anorectal malformation, not a low one. Option C) The child will not need a colostomy is incorrect because high anorectal malformations often require a colostomy to manage stool output before definitive repair. Option D) This malformation will be corrected with a nonoperative rectal pull-through is incorrect as high anorectal malformations typically require surgical correction rather than nonoperative interventions. Understanding anorectal malformations in neonates is crucial for pediatric nurses as early identification and appropriate management are vital for the child's long-term outcomes and quality of life. Nurses must be aware of the different types of anorectal malformations and their implications to provide optimal care and support to these vulnerable patients and their families.

Correct Answer: B

Rationale: In this scenario, option B is the correct answer because it describes a classic symptom of pyloric stenosis in infants, which is forceful vomiting around 30 minutes after feeding. This is due to the narrowing of the pylorus, leading to projectile vomiting. Option A is incorrect because pyloric stenosis typically presents with projectile vomiting, not just fussiness with feeding. Option C is incorrect as continuous feeding after vomiting exacerbates the condition and is not a typical parent response. Option D is also incorrect because a baby with pyloric stenosis would not be described as happy after vomiting forcefully. Educationally, understanding the typical presentation of pediatric GI disorders like pyloric stenosis is crucial for nurses to provide timely and accurate care. Recognizing these symptoms early can lead to prompt diagnosis and intervention, improving outcomes for the infant. Nursing education should focus on differentiating between normal and abnormal findings in pediatric patients to ensure appropriate care and management.