The nurse is interviewing the parents of a 6-year-old who has been experiencing constipation. Which could be a causative factor? (Select all that apply.)

Correct Answer: D

Rationale: In pediatric gastrointestinal assessment, constipation is a common concern that requires a comprehensive understanding of potential causative factors. In this scenario, selecting all the options (A, B, and C) as causative factors for constipation in a 6-year-old child is the correct choice. - A) Hypothyroidism: Hypothyroidism can lead to decreased metabolic rate and affect gastrointestinal motility, potentially causing constipation in children. - B) Muscular dystrophy: Muscular weakness and impaired coordination of bowel movements associated with muscular dystrophy can contribute to constipation. - C) Myelomeningocele: Children with myelomeningocele often have neurological issues affecting bowel function, leading to constipation. Educationally, understanding these causative factors helps nurses in conducting thorough assessments, formulating appropriate care plans, and providing necessary interventions to manage constipation effectively in pediatric patients. By grasping the relationship between underlying conditions and gastrointestinal symptoms, nurses can promote optimal health outcomes for children experiencing constipation.

Correct Answer: A

Rationale: The correct answer is A) The body's response to gluten damages the intestinal mucosa and villi, leading to malabsorption of nutrients. This response is correct because in celiac disease, an autoimmune reaction to gluten damages the lining of the small intestine, specifically the villi responsible for nutrient absorption. This damage impairs the intestine's ability to absorb essential nutrients like vitamins, minerals, and other macronutrients, leading to malabsorption and potential nutrient deficiencies in children. Option B is incorrect as it inaccurately states that consuming gluten creates special cells called villi, which is not true. Villi are already present in the intestine and are damaged due to the autoimmune response in celiac disease. Option C is incorrect because gluten does not cause the intestine to become more porous but instead damages the mucosa and villi. Retaining fat-soluble vitamins and leading to toxicity is not a direct consequence of celiac disease. Option D is incorrect as it describes a different condition where mucosal cells are damaged, leading to issues with water absorption and constipation, which is not characteristic of celiac disease. In an educational context, it is crucial for healthcare providers to understand the pathophysiology of celiac disease to effectively educate parents and patients on the importance of dietary changes. By explaining the direct impact of gluten on the intestinal mucosa and villi, nurses can emphasize the necessity of adhering to a strict gluten-free diet to manage celiac disease and prevent long-term complications associated with malabsorption.

Correct Answer: B

Rationale: In this scenario, option B is the correct answer, indicating the child who can be discharged without further evaluation. A child who had a relapse of one diarrhea episode after restarting a normal diet is likely experiencing a mild, self-limiting gastrointestinal upset that does not require further medical intervention. Option A should not be discharged as bloody diarrhea in a child, especially after watery diarrhea, raises concerns for potential serious bacterial infection like Shigella or E. coli. Option C is concerning due to the combination of vomiting, diarrhea, and decreased urine output, which can indicate dehydration and potentially severe illness. Option D is also worrisome as the child has had several episodes of diarrhea after a camping trip, raising the possibility of infectious gastroenteritis requiring further evaluation. From an educational perspective, understanding the difference between mild self-limiting gastrointestinal issues and more serious conditions requiring medical attention is crucial for healthcare providers working with pediatric patients. Recognizing red flags such as bloody diarrhea, persistent vomiting, decreased urine output, and recent travel history helps in making appropriate decisions for patient care and safety.

Correct Answer: A

Rationale: The best position for an 8-year-old who has just returned to the pediatric unit after an appendectomy for a ruptured appendix is A) Right side-lying. This position helps to minimize the risk of complications post-surgery. Placing the child on the right side can reduce the pressure on the surgical site, decreasing the likelihood of disrupting the healing process. It also aids in preventing accidental pressure on the incision site, promoting comfort and facilitating proper drainage. Choosing the other options can be detrimental in this scenario. B) Semi-Fowler position may exert pressure on the abdominal area, leading to discomfort and potential complications. C) Placing the child prone is contraindicated after an appendectomy, as it can strain the surgical site and inhibit proper healing. D) Left side-lying can also increase pressure on the surgical area, potentially causing pain and compromising recovery. From an educational perspective, understanding the rationale behind positioning post-appendectomy is crucial for pediatric nurses and healthcare providers. By knowing the optimal position for the child, healthcare professionals can ensure the best possible outcomes for their young patients post-surgery. This knowledge is essential for providing safe and effective care in pediatric units, emphasizing the importance of evidence-based practices in pediatric gastrointestinal assessment and management.

Correct Answer: C

Rationale: In this scenario, the correct immediate action for the nurse when a newborn begins to cough, choke, and become cyanotic while feeding is option C - take the infant from the mother, place the infant in the crib for assessment, and immediately obtain the oxygen saturation while administering blow-by oxygen. This option is the most appropriate because it addresses the critical situation of a newborn struggling to breathe and potentially experiencing respiratory distress. Placing the infant in a safe environment for assessment and providing oxygen support are essential steps to ensure the infant's airway is clear and oxygenation is maintained. Option A is not the immediate action needed as it delays direct intervention by involving the physician first. Option B is risky as it assumes the choking episode will resolve on its own, which can be dangerous and potentially life-threatening in this situation. Option D is not safe as it disregards the infant's distress and continues feeding, which can exacerbate the respiratory compromise. Educationally, this scenario highlights the importance of rapid assessment and action in pediatric emergencies, especially those involving airway compromise. Nurses must be prepared to intervene promptly to ensure the safety and well-being of pediatric patients in critical situations like this one.