Which menu choices for a child diagnosed with renal failure and experiencing hyperkalemia indicate the need for further instruction by the nurse?

Correct Answer: A

Rationale: In the context of a child with renal failure and hyperkalemia, the correct answer is A) Carrots and green, leafy vegetables. This is because carrots and green, leafy vegetables are high in potassium content, which can exacerbate hyperkalemia in these patients. Therefore, including these choices in the menu would not be appropriate and could worsen the child's condition. Option B) Spaghetti and meat sauce with breadsticks is a more suitable choice as pasta and breadsticks are lower in potassium compared to the other options provided. Option C) Hamburger on a bun and cherry gelatin also contain moderate amounts of potassium, but they are not as high as the incorrect option A. Option D) Chips, cold cuts, and canned foods are high in sodium and preservatives, which can be detrimental to a child with renal failure but do not directly contribute to hyperkalemia. In pediatric nursing, it is crucial to understand the dietary restrictions and considerations for children with specific health conditions like renal failure. Educating caregivers and patients about appropriate food choices is essential in managing their condition effectively and preventing complications such as hyperkalemia. By selecting appropriate menu options, nurses can contribute to the overall well-being and health outcomes of pediatric patients with renal issues.

Correct Answer: C

Rationale: In pediatric nursing, it is essential to understand the manifestations of various conditions to provide timely and appropriate care. In the case of Hirschsprung disease, the correct assessment data that would raise suspicion in a 3-year-old child is a history of chronic, progressive constipation and failure to gain weight (Option C). This is because Hirschsprung disease is a congenital disorder where there is a lack of nerve cells in the colon, leading to severe constipation. The absence of peristalsis in the affected segment results in a functional obstruction, causing chronic constipation, abdominal distention, and failure to thrive due to inadequate nutrient absorption. Option A (clay-colored stools and dark urine) is not indicative of Hirschsprung disease but may be seen in conditions affecting the liver or biliary system. Option B (history of early passage of meconium in the newborn period) is actually a normal finding and would not raise suspicion for Hirschsprung disease. Option D (continual bouts of foul-smelling diarrhea) is more suggestive of conditions like malabsorption disorders rather than Hirschsprung disease, which is characterized by constipation. Educationally, understanding the specific signs and symptoms of pediatric conditions like Hirschsprung disease is crucial for early identification and intervention. Nurses must be able to differentiate between various presentations to provide effective care and support to pediatric patients and their families. This knowledge helps in promoting early diagnosis, appropriate management, and improved outcomes for children with complex health needs.

Correct Answer: D

Rationale: In this scenario, the correct answer is option D, which involves applying a pillow against the abdomen to splint the incision site when coughing. This is the most appropriate intervention to address pain in a postoperative client with an appendectomy. Splinting the incision site with a pillow provides support and reduces the pressure on the surgical area, especially during activities like coughing which can increase pain post-surgery. This technique helps to minimize the discomfort associated with movement and promotes healing by reducing strain on the incision site. Option A, applying a warm, moist pack every 4 hours, is not recommended in this case as heat can increase blood flow to the area and potentially worsen inflammation, leading to increased pain and delayed healing. Option B, applying EMLA cream to the incision site prior to ambulation, is not necessary for pain management in this context as EMLA cream is a topical anesthetic primarily used for numbing the skin before certain procedures like IV insertions or minor skin surgeries. Option C, applying a cold, moist pack every 2 hours, is also not ideal post-appendectomy as cold therapy is more commonly used for acute injuries to reduce swelling and inflammation, rather than for postoperative pain management in this situation. Educationally, understanding the rationale behind pain management strategies post-surgery is crucial for pediatric nurses. It ensures safe and effective care for their young patients, promoting optimal recovery outcomes. By knowing when to utilize specific interventions like splinting the incision site, nurses can enhance their clinical skills and provide comprehensive care to pediatric clients undergoing surgical procedures.

Correct Answer: B

Rationale: In this case, the correct answer is B) Metabolic alkalosis. When a neonate with a diaphragmatic hernia is on nasogastric suction, excessive gastric drainage can lead to a loss of hydrochloric acid, resulting in metabolic alkalosis. This is the priority complication because it can have serious consequences on the neonate's overall health and well-being. Option A) Weight loss may occur as a result of gastric drainage, but it is not the priority concern compared to the acid-base imbalance that metabolic alkalosis presents. Option C) Dehydration is a possible complication due to fluid loss through gastric drainage; however, metabolic alkalosis takes precedence as it can have more immediate and severe effects on the neonate's physiological stability. Option D) Hyperbilirubinemia is not directly related to nasogastric suction or gastric drainage in this scenario and is therefore not the priority complication to address. Educationally, understanding the potential complications of nasogastric suction in neonates with specific conditions like diaphragmatic hernia is crucial for pediatric nurses. This knowledge enables them to anticipate, identify, and intervene promptly to prevent serious complications and provide optimal care for these vulnerable patients.

Correct Answer: D

Rationale: In this scenario, the 18-month-old child with tachypnea (rapid breathing) is at the highest risk for dehydration. Tachypnea can lead to increased respiratory rate, which can result in excessive loss of fluids through respiration, potentially causing dehydration. Option A, a 7-year-old child with migraine headaches, is less likely to be at high risk for dehydration unless vomiting is a significant symptom. Option B, a 4-year-old child with a broken arm, is not directly related to dehydration risk unless there are complicating factors like prolonged immobilization. Option C, a 2-year-old child with cellulitis of the left leg, might have localized infection but not necessarily higher dehydration risk unless it leads to systemic symptoms like fever and poor intake. In a pediatric nursing context, understanding the signs and symptoms of dehydration in children is crucial for appropriate assessment and intervention. It is essential to recognize high-risk factors like tachypnea in infants and young children, as they are more vulnerable to fluid imbalances due to their smaller body size and higher metabolic rate. Early identification and management of dehydration are vital in pediatric care to prevent complications and promote optimal health outcomes.