The nurse is caring for a neonate with an anorectal malformation. The nurse notes that the infant has not passed any stool per rectum but the infant's urine contains meconium. The nurse can make which assumption?

Correct Answer: A

Rationale: The correct answer is A) The child likely has a high anorectal malformation. In anorectal malformations, the location of the abnormal connection between the rectum and urinary tract determines the level of the malformation. When a neonate does not pass stool per rectum but has meconium in the urine, it suggests a high anorectal malformation where the rectum is not properly connected to the anus. This condition often requires surgical intervention, including a colostomy to divert stool and a subsequent repair. Option B) The child likely has a low anorectal malformation is incorrect because the scenario described indicates a high anorectal malformation, not a low one. Option C) The child will not need a colostomy is incorrect because high anorectal malformations often require a colostomy to manage stool output before definitive repair. Option D) This malformation will be corrected with a nonoperative rectal pull-through is incorrect as high anorectal malformations typically require surgical correction rather than nonoperative interventions. Understanding anorectal malformations in neonates is crucial for pediatric nurses as early identification and appropriate management are vital for the child's long-term outcomes and quality of life. Nurses must be aware of the different types of anorectal malformations and their implications to provide optimal care and support to these vulnerable patients and their families.

Correct Answer: B

Rationale: Rationale: The correct answer is B) To relieve your child's itching (pruritus). Cholestyramine is a medication commonly used in pediatric patients with biliary atresia to help alleviate itching, a common symptom due to the accumulation of bile salts in the bloodstream. By binding to these bile salts, cholestyramine reduces their absorption and subsequently decreases pruritus, improving the infant's comfort and quality of life. Option A) To lower your child's cholesterol is incorrect because cholestyramine is not primarily used for reducing cholesterol levels in this scenario. While it can impact cholesterol levels, its main purpose in biliary atresia is to manage pruritus. Option C) To help your child gain weight is incorrect as cholestyramine does not directly impact weight gain. Weight gain in infants with biliary atresia is more related to ensuring adequate nutrition and managing complications of the disease. Option D) To help feedings be absorbed in a more efficient manner is incorrect because cholestyramine does not enhance the absorption of feedings. Its role is specifically targeted at bile salt binding and relieving pruritus in conditions like biliary atresia. Educational Context: Understanding the rationale behind using cholestyramine in pediatric patients with biliary atresia is crucial for nurses caring for these infants. By knowing the specific purpose of this medication, nurses can educate parents effectively about its benefits and help manage their child's symptoms more comprehensively. This knowledge also aids in providing holistic care and addressing parental concerns, ultimately improving the overall care experience for the infant and their family.

Correct Answer: B

Rationale: The correct answer is B) "We will call the physician if the stools change in consistency." This answer is correct because after surgery for a low imperforate anus, monitoring stool consistency is crucial. Changes in stool consistency can indicate complications or the need for further medical intervention. By calling the physician when such changes occur, the parents are demonstrating proper understanding of post-operative care and the need for prompt medical attention if there are any concerns. Option A is incorrect because using an oral thermometer is not related to the surgical procedure for a low imperforate anus. Rectal thermometers should not be used in this case to avoid causing injury to the surgical site. Option C is incorrect because surgery for a low imperforate anus does not usually impact toilet-training abilities in the long term. With appropriate medical care and interventions, children can often achieve normal bowel control as they grow. Option D is incorrect because while some temporary changes in urine and stool patterns may occur post-surgery, the presence of stool in the urine would generally warrant medical evaluation rather than being considered usual. From an educational perspective, this question highlights the importance of providing clear and accurate discharge instructions to parents of infants undergoing surgical procedures. It emphasizes the need for parents to be vigilant about monitoring their child's condition post-surgery and seeking medical advice promptly if any concerning symptoms arise. It also underscores the role of healthcare professionals in ensuring that parents are well-informed and prepared to care for their child at home following a surgical intervention.

Correct Answer: D

Rationale: The correct answer is D: Offer your child 1/2 ounce of Pedialyte every 10 minutes. If vomiting continues, keep the child NPO for a while, then restart fluids slowly. This response is the best choice because it provides a balanced approach to managing the situation. Offering Pedialyte helps prevent dehydration and provides essential electrolytes. The small, frequent amounts help reduce the likelihood of further vomiting. If vomiting persists, the instruction to keep the child NPO (nothing by mouth) allows the stomach to rest before slowly reintroducing fluids. Option A is incorrect because giving plain water can worsen dehydration due to the lack of electrolytes. Option B is incorrect as restricting feeding can lead to further dehydration and inadequate nutrition for the baby. Option C is also incorrect as withholding fluids for 24 hours can lead to dehydration and is not recommended, especially for infants. In an educational context, this question highlights the importance of assessing and managing vomiting in infants to prevent dehydration. It emphasizes the need for proper fluid and electrolyte replacement strategies in pediatric patients, especially in cases of acute gastrointestinal disturbances. Understanding these principles is crucial for nurses caring for pediatric patients to ensure optimal outcomes and prevent complications.

Correct Answer: A

Rationale: The best response for managing a 4-year-old's constipation is option A: "Add 2 ounces of apple or pear juice to your child's diet to help loosen the stool." This is the correct choice because apple and pear juices contain sorbitol, a natural sugar alcohol that can help soften and loosen stools, aiding in relieving constipation in children. Option B is incorrect because while fresh fruits like apples and bananas are good sources of fiber which can help with constipation, the specific recommendation of apple or pear juice in option A is more effective in this scenario. Option C, encouraging the child to drink more fluids, is a general recommendation for overall health but may not directly address the constipation concern as effectively as the sorbitol in apple or pear juice. Option D, suggesting to decrease bulky foods like whole-grain breads and rice, is not ideal as fiber from whole grains is typically beneficial for preventing constipation. In an educational context, it's important for nurses to understand the specific dietary recommendations for managing pediatric GI disorders like constipation to provide effective and evidence-based care to young patients. By knowing the properties of different foods and their effects on digestion, nurses can offer tailored advice to parents seeking help for their child's gastrointestinal issues.