Which child may need extra fluids to prevent dehydration? (Select all that apply.)

Correct Answer: D

Rationale: In this scenario, the correct answer is D) 13-year-old who has just started her menses. During menstruation, females may experience increased fluid loss due to blood loss, which can put them at risk for dehydration. Providing extra fluids during this time can help maintain hydration levels. Option A) 7-day-old receiving phototherapy typically needs strict fluid management due to the risk of fluid overload, making extra fluids not recommended in this case. Option B) A 6-month-old with newly diagnosed pyloric stenosis may experience vomiting, leading to fluid loss; however, the priority in this situation is to address the underlying condition and ensure adequate intake rather than just increasing fluids. Option C) A 2-year-old with pneumonia may also be at risk for dehydration due to fever and increased respiratory rate, but the focus of care would be on treating the pneumonia and ensuring adequate hydration rather than just providing extra fluids. Educationally, it is essential for pediatric healthcare providers to understand the specific needs of children in different clinical situations to provide individualized care. Understanding the factors that can contribute to dehydration in children, such as increased fluid loss during menstruation in adolescents, is crucial for effective nursing interventions to prevent complications related to dehydration.

Correct Answer: D

Rationale: In managing gastroesophageal reflux (GER) in a 2-month-old, the nurse should include holding the infant in an upright position for 30 minutes following a feeding (Option D) in the plan of care. This position helps prevent the reflux of stomach contents into the esophagus by utilizing gravity to aid digestion and reduce regurgitation. Option A is incorrect because placing the infant in an infant seat immediately after feedings can actually increase intra-abdominal pressure, worsening GER symptoms. Option B is also incorrect as placing the infant in the prone position after feeding increases the risk of aspiration. Option C is incorrect because while it is true that most infants outgrow GER by the first year of life, it is important to provide symptomatic relief and support to the infant and parents in the meantime. Educational context: Understanding the correct positioning after feeding is crucial in managing GER in infants and can significantly impact their comfort and reduce symptoms. Nurses play a key role in educating parents on appropriate interventions to alleviate GER symptoms and improve the overall well-being of the infant.

Correct Answer: D

Rationale: In abetalipoproteinemia, a rare genetic disorder affecting lipid metabolism, the correct answer is D) normal intellectual development. This is because abetalipoproteinemia primarily affects lipid transport, leading to very low plasma levels of cholesterol (option B) and triglycerides (option C). Acanthocytes (spur cells) are also commonly seen in the peripheral blood smear of individuals with abetalipoproteinemia (option A). The incorrect options (A, B, C) are manifestations commonly associated with abetalipoproteinemia due to the inability to properly transport lipids for absorption and metabolism. Acanthocytes result from alterations in lipid composition of the red blood cell membrane. Extremely low levels of cholesterol and triglycerides are characteristic features of this condition as these lipids are typically transported in lipoproteins that are deficient in individuals with abetalipoproteinemia. Educationally, understanding the pathophysiology and clinical manifestations of abetalipoproteinemia is crucial for pediatric gastrointestinal nursing interventions. It helps nurses recognize key signs and symptoms, provide appropriate care, and educate patients and families on dietary modifications and lipid supplementation to manage the condition effectively. The emphasis on intellectual development being normal in abetalipoproteinemia highlights the specific nature of the disorder's impact on lipid metabolism without affecting cognitive function.

Correct Answer: D

Rationale: In pediatric gastrointestinal nursing, understanding congenital disorders associated with exocrine pancreatic insufficiency is crucial for providing effective care. The correct answer to the question is D) cystic fibrosis. Cystic fibrosis is the most common congenital disorder linked to exocrine pancreatic insufficiency. This genetic condition affects the production of a protein that results in thick, sticky mucus in various organs, including the pancreas, leading to pancreatic insufficiency. Option A) Shwachman Diamond syndrome is a rare genetic disorder that primarily affects the bone marrow and pancreas, leading to pancreatic insufficiency as well. However, it is not as common as cystic fibrosis in causing exocrine pancreatic insufficiency. Option B) Johanson-Blizzard syndrome is another rare genetic disorder characterized by pancreatic insufficiency, intellectual disability, and other physical abnormalities. While it can also present with pancreatic insufficiency, it is not as prevalent as cystic fibrosis. Option C) Pearson bone marrow syndrome is a mitochondrial disorder that primarily affects blood cell production and does not commonly present with exocrine pancreatic insufficiency. Educationally, knowing the most common congenital disorder associated with exocrine pancreatic insufficiency helps nurses prioritize care interventions, such as enzyme replacement therapy, nutritional support, and monitoring for complications like malabsorption. Understanding the differences between these congenital disorders aids in accurate assessment and tailored nursing interventions for pediatric patients with gastrointestinal conditions.

Correct Answer: A

Rationale: In the context of pediatric gastrointestinal nursing interventions, understanding the etiology of gastroenteritis outbreaks is crucial for effective management. Direct person-to-person contact outbreaks of gastroenteritis are commonly caused by Shigella. Shigella is highly contagious and can spread rapidly through poor hygiene practices, making person-to-person transmission a significant concern in pediatric settings. Shigella is known for causing severe watery diarrhea, fever, and abdominal cramps, particularly in young children. Its ability to survive in various environments and low infectious dose make it a key culprit in outbreaks involving direct contact. Salmonella, on the other hand, is typically associated with foodborne outbreaks rather than direct person-to-person transmission. Rotavirus is a leading cause of viral gastroenteritis in children but is primarily spread through fecal-oral route rather than direct contact. Clostridium difficile is more commonly linked to healthcare-associated infections rather than direct person-to-person outbreaks. Educationally, emphasizing the modes of transmission of different pathogens causing gastroenteritis helps nurses and healthcare providers implement appropriate infection control measures to prevent and manage outbreaks effectively. Understanding the specific characteristics of each pathogen aids in targeted interventions and reduces the risk of transmission in pediatric populations.