Which should be included in the plan of care for a 14-month-old whose cleft palate was repaired 12 hours ago? (Select all that apply.)

Correct Answer: A

Rationale: The correct answer is A) Allow the infant to have familiar items of comfort (e.g., favorite stuffed animal) and a 'sippy' cup. Rationale: After cleft palate repair, it is essential to provide comfort to the child as they may be irritable due to postoperative pain and discomfort. Allowing familiar items like a stuffed animal and a 'sippy' cup can provide emotional support and familiarity, which can help in reducing anxiety and promoting healing. Option B is incorrect because immediately after cleft palate repair, the child should not be given solid foods like soup, Jell-O, or saltine crackers. It is crucial to start with clear fluids and gradually progress to soft, easily digestible foods as tolerated. Option C is incorrect as elbow restraints are typically used postoperatively to prevent the child from touching or traumatizing the surgical site. They should only be removed as per the surgeon's instructions. Option D is incorrect because using a Yankauer suction catheter in the mouth can disrupt the healing process and increase the risk of trauma to the surgical site. Suctioning should be done cautiously and as per the healthcare provider's orders to prevent complications. Educational Context: Understanding the specific care needs of a child after cleft palate repair is crucial for pediatric nurses. Providing appropriate postoperative care, including comfort measures and diet modifications, is essential to ensure optimal recovery and prevent complications. Nurses must be knowledgeable about the correct interventions to promote the child's comfort and well-being during the postoperative period.

Correct Answer: A

Rationale: In pediatric gastrointestinal disorders, understanding the absorption sites of essential nutrients like Vitamin B12 and bile salts is crucial for effective management. The correct answer is A) distal ileum. The distal ileum is the primary site for the absorption of Vitamin B12 and bile salts. Vitamin B12 binds to intrinsic factor in the stomach and is absorbed in the distal ileum. Bile salts, produced by the liver and stored in the gallbladder, aid in the absorption of fats and fat-soluble vitamins, including Vitamin B12, primarily in the distal ileum. Option B) duodenum is incorrect because while the duodenum is involved in the initial stages of digestion and absorption of some nutrients, it is not the primary site for absorption of Vitamin B12 and bile salts. Option C) proximal jejunum is incorrect as it is mainly involved in the absorption of carbohydrates and proteins, not Vitamin B12 and bile salts. Option D) colon is incorrect as it is primarily responsible for water and electrolyte absorption, not for the absorption of Vitamin B12 and bile salts. Educationally, understanding these absorption sites is essential for nurses and healthcare providers caring for pediatric patients with gastrointestinal disorders. Knowing where these nutrients are absorbed helps in assessing and managing nutritional deficiencies and gastrointestinal issues effectively.

Correct Answer: B

Rationale: In newborns with congenital chloride diarrhea, the most common laboratory finding is hyperchloremia. This occurs because chloride is lost in large amounts in the stool, leading to an excess of chloride in the blood. This results in hyperchloremic metabolic acidosis due to the loss of bicarbonate in the stool, which is not reabsorbed. Metabolic alkalosis (Option A) is less likely because the loss of chloride and bicarbonate in the stool leads to an acidotic state rather than alkalosis. Hyperkalemia (Option C) and hypernatremia (Option D) are less likely because they are not typically seen in congenital chloride diarrhea. Hyperchloremia is the hallmark finding in this condition due to the excessive loss of chloride in the stool. Educationally, understanding the pathophysiology behind laboratory findings in pediatric gastrointestinal disorders is crucial for nurses and healthcare professionals caring for these patients. Recognizing the significance of hyperchloremia in congenital chloride diarrhea can aid in prompt diagnosis and appropriate management to prevent severe complications associated with electrolyte imbalances in newborns.

Correct Answer: A

Rationale: The correct answer is A) azithromycin for the first-line treatment of children with Vibrio cholera due to its efficacy and safety profile in this population. Azithromycin is a macrolide antibiotic that is effective against Vibrio cholera and is well-tolerated in pediatric patients. It is often preferred over other antibiotics due to its broad spectrum of activity and minimal side effects. Option B) ciprofloxacin is not the first-line treatment for Vibrio cholera in children because of concerns about its safety profile, especially in young patients. Ciprofloxacin is associated with potential adverse effects on growing cartilage and should be avoided in pediatric populations whenever possible. Option C) doxycycline is not recommended for children with Vibrio cholera as it can cause permanent discoloration of teeth and is contraindicated in pediatric patients under the age of 8 years due to its effects on bone growth and development. Option D) ampicillin is not the first-line treatment for Vibrio cholera as this bacterium is often resistant to penicillin-based antibiotics. Using ampicillin as a treatment could be ineffective and potentially worsen the infection by promoting antibiotic resistance. In an educational context, understanding the appropriate first-line treatment for pediatric gastrointestinal infections like Vibrio cholera is crucial for nurses and healthcare providers working with children. By knowing the most effective and safe treatment options, healthcare professionals can ensure better outcomes for pediatric patients with gastrointestinal disorders and prevent potential complications associated with inappropriate antibiotic use.

Correct Answer: D

Rationale: In pediatric gastrointestinal disorders, like diarrhea, enteral feeding plays a crucial role in aiding recovery. Choosing the right foods is essential to prevent exacerbating the condition. In this case, the correct answer is D) juices. While juices are often seen as a source of hydration, they should be avoided during diarrhea as they can worsen the symptoms due to their high sugar content and osmolarity, which can draw water into the intestines and worsen diarrhea. Regarding the other options: A) Rice and B) Potatoes are generally well-tolerated and recommended during diarrhea as they are easily digestible and provide energy. C) Lean meats can also be a good source of protein for children, but in some cases, they may be harder to digest compared to other options like rice or potatoes. It is essential for healthcare professionals, especially those preparing for the NCLEX exam, to understand the nuances of dietary management in pediatric gastrointestinal disorders. By avoiding high-sugar beverages like juices during diarrhea, healthcare providers can help promote faster recovery and prevent complications. This knowledge is crucial in providing safe and effective care to pediatric patients with gastrointestinal issues.