The nurse is caring for a 5-month-old infant diagnosed with intussusception. The infant has periods of irritability with the knees drawn to the chest alternating with periods of lethargy; vital signs are stable. The physician elects to give an enema. The parents ask the purpose of the enema. Select the nurse's most appropriate response.

Correct Answer: C

Rationale: The correct answer is option C: "The enema will help confirm the diagnosis and has a good chance of reducing the intussusception." This response is the most appropriate because an enema is a common diagnostic and therapeutic intervention for intussusception in infants. The purpose of the enema in this case is to both confirm the diagnosis by visualizing the telescoping of the bowel loops and to potentially reduce the intussusception by hydrostatic pressure or air insufflation, thereby resolving the obstruction. Option A is incorrect because while an enema can confirm the diagnosis, it is not primarily used for this purpose and does not directly imply the need for surgery. Option B is incorrect because enemas are not typically used to fix intussusception definitively, and surgery is often required for resolution. Option D is incorrect as it suggests a more definitive resolution than enemas typically provide and does not accurately portray the likelihood of recurrence. Educationally, it is important for nurses to understand the rationale behind diagnostic and therapeutic interventions to provide accurate information to patients and their families, as well as to ensure safe and effective care for the pediatric population. Understanding the purpose and potential outcomes of procedures like enemas in the context of specific conditions like intussusception is crucial for pediatric nursing practice.

Correct Answer: D

Rationale: The correct answer is D: Although your child will require surgery, there are different ways to manage the disease depending on how much of the bowel is involved. Rationale: - Correct Answer Explanation: Hirschsprung disease is a congenital condition where nerve cells are missing in the colon, leading to bowel obstruction. Surgery is the primary treatment, and the extent of surgery depends on how much of the bowel is affected. Different surgical approaches may be used to manage the condition effectively. - Incorrect Answers Explanation: A) Option A is incorrect because Hirschsprung disease requires surgical intervention and stool softeners alone will not resolve the condition. B) Option B is incorrect as colostomy is not the first-line treatment for Hirschsprung disease. Surgery aims to remove the affected segment of the bowel and reestablish normal bowel function. C) Option C is incorrect as daily bowel irrigations are not the mainstay of treatment for Hirschsprung disease. Surgery is the definitive treatment. Educational Context: Understanding the management of Hirschsprung disease is crucial for pediatric nurses as they care for children with this condition. By knowing the appropriate interventions, nurses can educate parents effectively and provide optimal care to the child. Highlighting the importance of surgical management and individualized treatment plans based on the extent of bowel involvement helps nurses deliver comprehensive care and support to families facing this diagnosis.

Correct Answer: C

Rationale: The correct answer is option C: "Pyloric stenosis can run in families and is more common among males." This response is accurate because pyloric stenosis has been found to have a genetic component, with a higher incidence among males. Educating the parent about the familial nature of the condition is essential for them to understand the potential risk factors for their future children. Option A is incorrect because it does not directly address the parent's question about the likelihood of future children having pyloric stenosis. Option B is incorrect as it inaccurately states that it is very rare for more than one child in a family to have pyloric stenosis, which is not supported by evidence. Option D is incorrect because pyloric stenosis can affect both males and females, although it is more common in males. In an educational context, understanding the genetic predisposition for certain conditions can help families make informed decisions about their future and possibly take preventive measures. It also highlights the importance of obtaining accurate information from healthcare providers to address any concerns or misconceptions.

Correct Answer: B

Rationale: In this scenario, option B is the correct answer because if the hernia appears more swollen or tender, seeking immediate medical care is crucial to prevent complications like incarceration or strangulation. This is important information for parents to know to ensure timely intervention and prevent potential harm to the infant. Option A is incorrect because surgery for an umbilical hernia is usually not recommended before the age of 4-5 years unless complications arise. Option C is incorrect as placing a pressure dressing can be harmful and is not a recommended treatment for an umbilical hernia. Option D is incorrect because while there is a possibility of hernia recurrence after surgical repair, it is not described as a strong likelihood. Educationally, this question serves to reinforce the importance of parental education and early recognition of signs of complications related to umbilical hernias in infants. It highlights the significance of prompt medical attention in such situations to ensure the well-being of the child. By understanding these key points, nurses can effectively educate parents on appropriate care and response to umbilical hernias in infants.

Correct Answer: D

Rationale: The most appropriate action for the receiving nurse in this scenario is to prepare to get the infant ready for immediate surgical correction (Option D). Intussusception is a medical emergency where a part of the intestine folds into itself, leading to obstruction and compromised blood flow. The infant's presentation with lethargy, high fever, tachycardia, hypotension, and a rigid abdomen indicates a severe case requiring urgent surgical intervention to prevent complications like bowel perforation, sepsis, and even death. Option A (CT scan) is not the immediate priority as the infant's condition is critical and waiting for imaging could delay life-saving treatment. Option B (reducing enema) may be contraindicated if the bowel is perforated or compromised, as in this case. Starting a second IV line for fluids and antibiotics (Option C) is important but secondary to addressing the immediate surgical need to correct the intussusception. In an educational context, understanding the urgency of surgical intervention in cases of intussusception is crucial for nurses caring for pediatric patients. Recognizing the signs and symptoms of this condition and knowing the appropriate interventions can help prevent complications and ensure positive outcomes for the child. It highlights the importance of swift clinical judgment and prioritization in emergency situations.