Correct Answer: B

Rationale: It's not advisable to follow the directions on the aspirin bottle for her age and weight. Aspirin is not recommended for use in children due to the risk of Reye's syndrome, a rare but serious condition that can affect the liver and brain. This is the correct response. Acetaminophen is a safer alternative to aspirin for managing fever in children. While it's generally a good idea to administer medication with food to prevent stomach upset, this advice does not address the specific risks associated with giving aspirin to a toddler. Giving a toddler three baby aspirin every 4 hours is not recommended due to the risk of Reye's syndrome.

Correct Answer: D

Rationale: Bluish-green discharge from the ear canal is not a typical finding in otitis media. This could suggest a different condition, such as an external ear infection or a ruptured eardrum. Erythema and edema of the affected auricle (outer part of the ear) are not typical findings in otitis media. These symptoms are more commonly associated with conditions affecting the external ear, such as otitis externa. An increase in appetite is not typically associated with otitis media. In fact, children with otitis media may have a decreased appetite due to discomfort or pain while swallowing. Tugging on the affected ear lobe is a common sign of otitis media in infants and young children. This is often due to the pain and discomfort caused by the infection.

Correct Answer: 1170 mL

Rationale:
Step 1 is to convert all fluid intake to mL. Using the conversion factor 1 oz = 30 mL and 1 cup = 240 mL, we get: 1 cup of coffee = 240 mL, 4 oz of orange juice = 4 × 30 mL = 120 mL, 3 oz of water = 3 × 30 mL = 90 mL, 1 cup of flavored gelatin = 240 mL, 1 cup of tea = 240 mL, 5 oz of broth = 5 × 30 mL = 150 mL, 3 oz of water = 3 × 30 mL = 90 mL.
Step 2 is to add up all the mL values: 240 mL (coffee) + 120 mL (orange juice) + 90 mL (water) + 240 mL (gelatin) + 240 mL(tea) + 150 mL (broth) + 90 mL (water) = 1170 mL. So, the nurse should record a fluid intake of 1170 mL.

Correct Answer: A

Rationale: The goal of surgery for Hirschsprung disease is to remove the diseased section of the intestine and then pull the healthy portion of this organ down to the anus. This is typically achieved through a type of surgery called a pull-through procedure. In some cases, doctors recommend ostomy surgery of the bowel followed by a pull-through procedure. During ostomy surgery, surgeons create a stoma on a child's abdomen and connect the stoma to the large or small intestine. After ostomy surgery, waste will leave the child's body through the stoma. The stoma is usually temporary. In most cases, surgeons can later close the stoma and connect the healthy part of the intestine to the anus. Waste will move through the intestines, and stool will pass through the anus again.
Therefore, the statement 'I'm glad that the ostomy is only temporary' indicates understanding of the surgery's goal. The operation for Hirschsprung's disease does not involve straightening out a kink in the intestine. Instead, it involves removing the part of the large intestine that is missing nerve cells and then connecting the healthy part of the large intestine to the anus. The use of a feeding tube is not typically associated with the initial surgery for Hirschsprung's disease. The surgery involves removing the diseased section of the intestine and then pulling the healthy portion of this organ down to the anus. While the ultimate goal of the surgery is to enable normal bowel movements, it is important to note that about half of children may have ongoing problems after surgery. These problems may include constipation and, in some cases, other symptoms of intestinal obstruction, such as a swollen abdomen or vomiting.

Correct Answer: C

Rationale: Initiate isotonic fluids with 20 mEq/L potassium chloride. While it is important to maintain hydration in a child with acute gastroenteritis, initiating isotonic fluids with 20 mEq/L potassium chloride is not the first action a nurse should take. The child's hydration status and electrolyte balance need to be assessed first. The American Academy of Pediatrics recommends the use of isotonic solutions with adequate potassium chloride and dextrose for maintenance IV fluids in children. Collect a stool sample from the toddler Collecting a stool sample can help identify the cause of the gastroenteritis. However, this is not the first step. The stool sample collection should be done using a clean, dry toilet hat or plastic wrap. But before this, the child's hydration status needs to be assessed. Determine if the toddler is voiding The first action the nurse should take when using the nursing process is assessment.
Therefore, checking if the toddler is voiding is the priority. This will help assess the child's hydration status, which is critical in managing acute gastroenteritis. Request evaluation of the toddler's serum electrolytes Requesting an evaluation of the toddler's serum electrolytes is also important, but it's typically done after the initial assessment. Fluid and electrolyte derangement are the immediate causes that increase the mortality in diarrhea. However, before requesting this evaluation, the nurse should first determine if the toddler is voiding to assess the child's hydration status.