A 2-year-old child has a chronic history of constipation and is brought to the clinic for evaluation. What should the therapeutic plan initially include?

Correct Answer: B

Rationale: In caring for a 2-year-old child with chronic constipation, the initial therapeutic plan should include dietary modification (Option B). This is the correct answer because dietary interventions play a crucial role in managing constipation in children. Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and promote regular bowel movements in young children. It is important to address dietary factors first before considering other interventions. Option A, bowel cleansing, is not appropriate as the initial step in managing chronic constipation in a child. Bowel cleansing procedures can be invasive and are typically reserved for specific situations under medical supervision. Option C, structured toilet training, may not be effective for a 2-year-old with chronic constipation. Toilet training is more relevant for addressing issues related to potty training readiness and may not directly address the underlying cause of constipation. Option D, behavior modification, is also not the initial step in managing chronic constipation in a child. While behavior modification strategies can be helpful in some cases, addressing dietary factors is typically the first line of treatment in pediatric constipation management. Educationally, understanding the importance of dietary modifications in managing constipation in children is essential for nursing care of pediatric patients. By prioritizing dietary interventions, nurses can help promote optimal bowel health and prevent complications associated with chronic constipation in young children.

Correct Answer: B

Rationale: The correct answer is B) Marking the point of measurement with a pen. This is the most appropriate procedure for assessing an abdominal circumference related to a bowel obstruction because marking the point of measurement with a pen ensures consistency in measuring the same location each time, allowing for accurate monitoring of changes in abdominal girth. In the context of a bowel obstruction, changes in abdominal circumference can indicate worsening or improvement of the condition, making precise measurements crucial for effective patient care. Option A) Measuring the abdomen after feedings is incorrect because abdominal measurements should ideally be taken before meals to minimize variations due to food intake. Option C) Measuring the circumference at the symphysis pubis is incorrect as it is not the standard location for assessing abdominal circumference related to a bowel obstruction. The point of measurement should be consistent and reproducible, typically around the umbilicus. Option D) Using a new tape measure with each assessment to ensure accuracy is unnecessary as long as the same tape measure is used consistently and the point of measurement is marked accurately. Replacing the tape measure for each assessment may not significantly impact measurement accuracy if the technique is standardized and reliable. In an educational context, understanding the correct procedure for assessing abdominal circumference in conditions like bowel obstruction is essential for nurses caring for pediatric patients. Accurate measurements can provide valuable information about a child's condition, guide treatment decisions, and help in monitoring progress or identifying complications. Nurses must be proficient in proper measurement techniques to deliver high-quality care and ensure patient safety.

Correct Answer: B

Rationale: The correct answer is B) It is essential because it will be an adjustment. When preparing a 3-year-old child with Hirschsprung disease for temporary colostomy surgery, it is crucial to help them understand and adapt to the upcoming changes. Children at this age are developing autonomy and may struggle with changes to their body and routine. Preparing the child emotionally and psychologically for the colostomy can help reduce anxiety, fear, and confusion. By providing age-appropriate information, reassurance, and emotional support, the nurse can help the child cope with the upcoming procedure and the temporary colostomy. Option A is incorrect because the child's age does not negate the need for preparation; all children, regardless of age, benefit from psychological preparation before surgery. Option C is incorrect because the temporary nature of the colostomy does not eliminate the need for emotional preparation. Option D is incorrect because while body image is important, the immediate focus should be on preparing the child for the upcoming surgery and the changes it will bring to their body. In an educational context, nurses must understand the developmental stage of the child and tailor their preparation strategies accordingly. Providing emotional support and age-appropriate information can help children cope with medical procedures and promote better outcomes.

Correct Answer: C

Rationale: The correct answer is C) Prevent abdominal distention. In the context of a child post-surgery for Hirschsprung disease, which is a condition affecting the large intestine, the NG tube serves to decompress the gastrointestinal system and prevent abdominal distention. Hirschsprung disease results in the inability of the colon to push stool toward the rectum, leading to a build-up of stool in the intestines. Option A) Prevent the spread of infection is incorrect as the primary purpose of an NG tube in this scenario is not related to infection control. Option B) Monitor electrolyte balance is also not the primary purpose of an NG tube in this specific situation. While electrolyte balance may be monitored in children with NG tubes for other reasons, it is not the main purpose post-surgery for Hirschsprung disease. Option D) Maintain accurate records of output is not the primary purpose of the NG tube in this case. While output may be measured and recorded, the main goal of the NG tube here is to prevent abdominal distention by removing gas and fluids from the gastrointestinal tract. Educationally, understanding the rationale behind the use of an NG tube in specific conditions like Hirschsprung disease is crucial for providing safe and effective care to pediatric patients. Nurses need to be knowledgeable about the purposes of different interventions to ensure optimal outcomes for their patients.