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

Correct Answer: C

Rationale: Rationale: The correct answer is C) Circumcision is an option but should be delayed, as the foreskin may be needed for surgical repair. In the case of hypospadias, where the urethral meatus is located on the ventral side of the penis, surgical repair often involves using the foreskin tissue. Circumcision removes this potential tissue source, making it more challenging to perform corrective surgery later on. Option A is incorrect because circumcision is not contraindicated but should be delayed in this specific scenario. Option B is incorrect as circumcision for preventing infection is not the primary concern in this case. Option D is incorrect as circumcision can still be a consideration but timing is crucial in the context of hypospadias management. Educationally, this question highlights the importance of understanding specific considerations in pediatric urological conditions like hypospadias. It emphasizes the need for nurses to provide accurate information to parents based on the individual needs of the child, ensuring optimal outcomes for potential surgical interventions.

Correct Answer: C

Rationale: The correct answer is C) bruises over bony prominences. In pediatric patients, bruises over bony prominences are less likely to be suggestive of physical abuse because these areas are common sites for accidental bruising in active toddlers who are learning to walk and explore their environment. Bruises over bony prominences such as knees, shins, and elbows are often seen in toddlers due to frequent falls and bumps during play. Option A) bruises over the neck can be concerning for non-accidental trauma due to the location being a common site for inflicted injuries. Option B) looped extension cord marks on the body is a clear indicator of physical abuse, as looped cord marks are highly specific for abusive injuries. Option D) bruising of the torso can also raise suspicion for physical abuse, especially if the bruises are in various stages of healing or clustered in a pattern inconsistent with accidental trauma. In an educational context, it is crucial for healthcare providers, especially those working with pediatric patients, to be able to differentiate between accidental and non-accidental injuries. Understanding the common patterns of accidental bruising in children can help prevent misdiagnosis and ensure appropriate intervention and protection for at-risk children.

Correct Answer: A

Rationale: The plan of care to help limit the development of hyperbilirubinemia in the neonate should include monitoring for the passage of meconium each shift. Meconium passage indicates proper functioning of the gastrointestinal tract and normal elimination of bilirubin, which helps prevent its build-up and subsequent development of jaundice. Monitoring for meconium passage ensures that the baby is adequately processing and excreting bilirubin, reducing the risk of hyperbilirubinemia. It is a key aspect of managing neonatal jaundice and promoting the health of the newborn.

Correct Answer: D

Rationale: When administering an intramuscular (I.M.) injection to an infant, the nurse should use the vastus lateralis muscle. This is the preferred site for infants as it provides a large muscle mass and is less likely to damage nerves and blood vessels compared to other sites. The vastus lateralis is located on the thigh and is easily accessible for injections in infants. It is important to select the appropriate site for I.M. injections in infants to ensure proper medication absorption and minimize the risk of complications.

Correct Answer: C

Rationale: Iron deficiency anemia is characterized by a decreased mean corpuscular volume (MCV) due to the microcytic red blood cells that result from inadequate iron availability for hemoglobin synthesis. This leads to smaller red blood cells, which are reflected in a decreased MCV. Iron deficiency anemia would not typically result in an increased hemoglobin or normal hematocrit since the lack of iron impairs the production of red blood cells. Additionally, the total iron-binding capacity (TIBC) would usually be increased in iron deficiency anemia as the body attempts to compensate for the decreased iron levels by increasing its ability to bind and transport iron. Therefore, the nurse would expect a decreased mean corpuscular volume (MCV) in a child with iron deficiency anemia.