A newborn with hypospadias: The parents ask if circumcision is an option. Which is the nurse’s best response?

Correct Answer: C

Rationale: The best response for the nurse to provide to the parents of a newborn with hypospadias who inquire about circumcision is option C: Circumcision is an option, but it should be delayed because the foreskin may be needed for surgical repair. This response is correct because in cases of hypospadias, where the opening of the urethra is on the underside of the penis, the foreskin tissue may be required for reconstructive surgery to correct the condition. Delaying circumcision preserves this tissue and allows for potential future surgical interventions to be more effective. Option A is incorrect as circumcision is not contraindicated but rather may need to be delayed in this specific situation. Option B is incorrect because circumcision does not specifically prevent infection in the context of hypospadias. Option D is also incorrect as circumcision can be performed in children with hypospadias but may need to be timed appropriately based on the individual case. Educationally, it is important for nurses to understand the implications of different treatment options in pediatric genitourinary conditions like hypospadias. Providing accurate information to parents empowers them to make informed decisions regarding their child's care and fosters a trusting relationship between healthcare providers and families.

Correct Answer: A

Rationale: In testicular torsion, the correct answer is A) Twisting of the spermatic cord interrupts the blood supply. This is because testicular torsion involves the twisting of the spermatic cord, leading to a reduction or complete cessation of blood flow to the testicle. This lack of blood flow results in severe pain, swelling, and potential ischemic damage to the testicle. Option B) Swelling of the scrotum leads to displacement is incorrect because the swelling of the scrotum is a consequence of testicular torsion due to the interrupted blood supply, not the cause of the symptoms. Option C) Unmanaged undescended testes cause displacement is incorrect as undescended testes (cryptorchidism) refer to a condition where the testes fail to descend into the scrotum during development and are not directly related to testicular torsion. Option D) Microthrombi in the spermatic cord cause blockage is incorrect because testicular torsion is primarily a mechanical issue involving the twisting of the spermatic cord, not the formation of microthrombi. From an educational perspective, understanding the pathophysiology of testicular torsion is crucial for healthcare professionals, especially when dealing with pediatric patients. Recognizing the signs and symptoms of testicular torsion and understanding the urgent need for surgical intervention are essential to prevent testicular damage and preserve fertility in affected individuals.

Correct Answer: D

Rationale: The correct answer is D) Cluster care to allow the child uninterrupted sleep for healing before surgical repair. In the case of a newborn with bladder exstrophy and a malformed pelvis, the priority is to provide optimal conditions for healing before surgical intervention. Clustering care minimizes disruptions, allowing the newborn to rest and heal effectively. This approach promotes better outcomes and reduces the risk of complications associated with the condition. Option A is incorrect as simply changing the diaper frequently and assessing for skin breakdown does not address the primary concern of providing an optimal environment for healing. Option B is incorrect because keeping the exposed bladder open in a warm, dry environment can increase the risk of infection and does not prioritize the newborn's need for rest and healing. Option C is incorrect as offering formula for growth and fluid management is important but not the priority in this situation. The immediate focus should be on creating conditions that support healing and preparing the newborn for surgical repair. In an educational context, understanding the care priorities for newborns with genitourinary abnormalities is crucial for nursing practice, especially when preparing for the NCLEX exam. It highlights the importance of effective time management, prioritization, and providing holistic care to pediatric patients with complex health needs.

Correct Answer: D

Rationale: Encopresis is a condition characterized by repeated involuntary defecation in inappropriate places by a child over the age of 4 years. The correct answer to the question, "Which discharge instruction for a child with encopresis should the nurse question?" is D) Offer a diet high in protein. This answer is incorrect because a diet high in protein can actually exacerbate encopresis. Protein can be constipating, leading to harder stools and increased difficulty with bowel movements, which is counterproductive in managing encopresis. Option A) Limit milk intake is a recommended step because milk and dairy products can contribute to constipation in some children. Encouraging a balanced diet with adequate fiber intake is crucial in managing encopresis, making option B) Obtain a complete dietary log important. Option C) Follow up with a child psychologist is also essential as encopresis can have psychological components that may require professional intervention. Children with encopresis may experience emotional distress and may benefit from therapy or counseling. In an educational context, understanding the impact of diet on bowel function in children with encopresis is crucial for nursing practice. By selecting the appropriate dietary interventions and seeking psychological support when needed, nurses can provide comprehensive care to children with encopresis.

Correct Answer: A

Rationale: Biliary atresia is a serious pediatric condition where the bile ducts inside or outside the liver are blocked or absent, leading to bile buildup and liver damage. In a 4-week-old with biliary atresia, option A is the correct manifestation to expect. Abdominal distention occurs due to liver enlargement and ascites. The enlarged liver and spleen result from liver congestion. Clay-colored stool is indicative of obstructed bile flow, and tea-colored urine is a sign of conjugated hyperbilirubinemia. Option B is incorrect as it describes symptoms more indicative of a bleeding disorder or trauma, not specific to biliary atresia. Option C describes manifestations of a different condition, such as vitamin K deficiency or liver disease, but not specific to biliary atresia. Option D is incorrect because biliary atresia typically presents with symptoms early in life due to the rapid progression of liver damage if left untreated. Educationally, understanding the specific manifestations of biliary atresia is crucial for early identification and intervention to improve outcomes. Nurses caring for pediatric patients should be vigilant in assessing these symptoms and collaborating with healthcare providers for prompt diagnosis and treatment. Early recognition can lead to timely surgical intervention, such as a Kasai procedure, and potentially prevent the need for liver transplantation later in life.