The hematocrit of the patient in Question 46 is 29%, and the vital signs are stable. The next appropriate test is

Correct Answer: A

Rationale: The next appropriate test for a patient with a hematocrit of 29% and stable vital signs would be an upper gastrointestinal endoscopy. This test is indicated to evaluate for sources of chronic gastrointestinal bleeding, such as peptic ulcers, esophagitis, or gastritis, which could be contributing to the patient's low hematocrit. Option B, ESR (erythrocyte sedimentation rate), is a nonspecific test used to detect inflammation in the body and is not the most appropriate test in this scenario where a specific cause of bleeding needs to be identified. Option C, angiography, is an invasive test used to visualize blood vessels and is not typically the initial investigation for a patient with a low hematocrit and stable vital signs. Option D, Meckel scan, is used to detect the presence of a Meckel's diverticulum, a congenital outpouching of the small intestine that can cause gastrointestinal bleeding. However, an upper gastrointestinal endoscopy would be more appropriate as the first step in evaluating this patient's condition. In an educational context, understanding the rationale behind selecting the appropriate diagnostic test is crucial in providing safe and effective patient care. It is important for nurses to have a solid foundation in clinical decision-making to ensure the best outcomes for their patients.

Correct Answer: D

Rationale: In this question, the correct answer is D) Sweet syndrome. The presence of aphthous-like lesions is associated with various conditions, but not with Sweet syndrome. A) Inflammatory bowel disease (IBD) is associated with oral ulcers, including aphthous-like lesions due to the inflammatory nature of the disease affecting the gastrointestinal tract. B) Behçet disease is a systemic vasculitis that can cause oral ulcers resembling aphthous ulcers, along with other symptoms such as genital ulcers and uveitis. C) Gluten-sensitive enteropathy, also known as celiac disease, can present with aphthous-like lesions in the oral cavity due to the immune response triggered by gluten ingestion in genetically predisposed individuals. Educational context: Understanding the different presentations of gastrointestinal conditions in pediatric patients is crucial for nurses preparing for the NCLEX exam. Recognizing the unique oral manifestations associated with various diseases helps in early identification and appropriate management. It is essential to differentiate between conditions like Sweet syndrome, which typically presents with skin lesions, and those that manifest with oral ulcers like aphthous-like lesions.

Correct Answer: C

Rationale: In this question, the correct answer is C) hyperthyroidism. Explanation: Advanced dentition in terms of eruption for age and sex is a common manifestation of hyperthyroidism. Thyroid hormone plays a crucial role in the development of teeth, and increased levels can lead to accelerated dental development. Why others are wrong: A) Nutritional disturbances are more likely to cause delayed dentition rather than advanced dentition. B) Hypopituitarism is associated with growth and developmental delays, not advanced dentition. D) Cleidocranial dysplasia is a genetic disorder characterized by delayed eruption of teeth, not advanced dentition. Educational context: Understanding the relationship between different medical conditions and their manifestations in pediatric patients is essential for nurses preparing for the NCLEX exam. This question highlights the importance of recognizing the dental manifestations of hyperthyroidism in children, which can help in early identification and management of the condition. Remembering these associations can aid in providing comprehensive care to pediatric patients with various health issues.

Correct Answer: B

Rationale: In infants, the most common symptom of gastroesophageal reflux disease (GERD) is regurgitation, making option B the correct answer. Infants with GERD often spit up or regurgitate their food, which occurs due to the backflow of stomach contents into the esophagus. This regurgitation can be frequent and may be forceful, leading to discomfort and irritability in the infant. Option A, excessive crying, is a common symptom seen in infants with GERD but is usually a secondary symptom resulting from the discomfort caused by regurgitation rather than the primary symptom. Option C, failure to thrive, can be a consequence of untreated GERD over time but is not typically the initial presenting symptom. Option D, abnormal posturing, is not a common symptom of GERD in infants. From an educational perspective, understanding the primary symptoms of GERD in infants is crucial for healthcare providers working with pediatric populations. Recognizing these symptoms early can lead to prompt diagnosis and appropriate management, improving the infant's quality of life and preventing potential complications associated with untreated GERD. Educating caregivers about the signs and symptoms of GERD in infants can also help in early identification and intervention, promoting better outcomes for these vulnerable patients.

Correct Answer: C

Rationale: In this question, the correct answer is option C: Meckel's diverticulum is approximately 2 inches in length. Meckel's diverticulum is a common congenital abnormality of the gastrointestinal tract that results from incomplete closure of the vitelline duct during embryonic development. The "rule of twos" commonly associated with Meckel's diverticulum includes its occurrence in approximately 2% of the population, its location at around 2 feet proximal to the ileocecal valve, and its length of about 2 inches. Option A is incorrect because Meckel's diverticulum is found in about 2% of the population, which aligns with the rule of twos. Option B is incorrect as it should be 2 feet distal to the ileocecal valve, not proximal. Option D is incorrect because Meckel's diverticulum is actually more common in males than females. Understanding Meckel's diverticulum is crucial for nurses, especially those preparing for the NCLEX exam, as it is a common topic in pediatric gastrointestinal disorders. Knowing the key characteristics, such as its dimensions and location, helps in early identification and appropriate management of complications associated with this condition. This question reinforces the importance of recalling specific details and applying them correctly in a clinical context.