Correct Answer: C

Rationale: While maintaining a saline-lock can be important for administering medications or fluids, it is not the priority action. The nurse's priority should be to assess the child's condition and intervene to prevent complications. A no-salt-added diet may be recommended for some children with acute glomerulonephritis to help manage fluid balance and blood pressure. However, this is not the priority action. The nurse's priority should be to assess the child's condition and intervene to prevent complications. This is the correct answer. Checking the child's weight daily is a priority action because weight changes can indicate fluid retention or loss, which can affect kidney function. Regular weight checks can help guide treatment decisions and monitor the effectiveness of interventions. Educating the parents about potential complications is important, but it is not the priority action. The nurse's priority should be to assess the child's condition and intervene to prevent complications.

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: A

Rationale: Activated charcoal is often used in the management of poisoning. It works by binding to the poison in the stomach and preventing it from being absorbed into the body. Osmotic diarrheal agents are not typically used in gastric lavage. These agents work by increasing the amount of water in the intestinal tract, which can stimulate bowel movements. Syrup of ipecac was once used to induce vomiting in cases of poisoning, but it is no longer recommended for use in poisoning cases. 0.9% sodium chloride, or normal saline, is a type of fluid that's often used in medical treatments, but it's not typically used in gastric lavage for poisoning.

Correct Answer: B

Rationale: Schedule the child for an abdominal ultrasound. While an ultrasound may be necessary for further diagnosis, it is not the immediate priority. The child's symptoms suggest a possible Wilms' tumor, a type of kidney cancer that primarily affects children. An ultrasound can help confirm this diagnosis, but it should not be the first action. Instruct the parent to avoid pressing on the abdominal area. This is the correct answer. If the child has a Wilms' tumor, pressing on the abdominal area could potentially cause the cancer to spread.
Therefore, it is crucial to avoid any unnecessary pressure on the abdomen until further medical evaluation can be performed. Determine if the child is having pain. While assessing for pain is an important part of nursing care, it is not the immediate priority in this situation. The child's symptoms need urgent medical attention, and assessing for pain will not provide the necessary information to guide immediate care. Obtain a urine specimen for a urinalysis. Although a urinalysis can provide valuable information about a patient's health, it is not the immediate priority in this situation. The child's symptoms suggest a possible Wilms' tumor, which requires immediate medical attention. A urinalysis may be part of the diagnostic process, but it should not be the first action taken.

Correct Answer: A

Rationale: Bending forward from the waist with the head and arms downward, also known as the Adams forward bend test, is the standard screening test for scoliosis.
Touching the chin to the chest and then looking up at the ceiling does not provide a view of the spine necessary for scoliosis screening. Lying prone on the examination table is not a standard position for scoliosis screening. Turning to the side and remaining in a relaxed position is not a standard position for scoliosis screening.