Correct Answer: A

Rationale: A barium enema: A barium enema is both diagnostic and therapeutic for intussusception in many cases. It helps to diagnose the condition by visualizing the telescoped intestine and can also often reduce the intussusception by hydrostatic pressure. IV fluids until the spasms subside: IV fluids are important for managing dehydration and maintaining hydration but do not directly treat intussusception. Immediate surgery: Surgery may be necessary if non-operative reduction methods fail or if there are complications like bowel necrosis or perforation. However, it is not the first-line treatment choice. Gastric lavage: Gastric lavage (stomach pumping) is not indicated for the treatment of intussusception.

Correct Answer: A

Rationale: Have the child sit with her head tilted forward and hold pressure on her nose for 10 min. Tilting the head forward helps prevent blood from flowing down the throat and causing nausea or choking. Applying pressure to the nose for 10 minutes helps to stop the bleeding. Place the child in a sitting position and tilt her head back. Tilted head back can cause blood to flow down the throat and potentially cause aspiration or choking. It's not recommended in managing nosebleeds. Apply ice at the opening of the nares for 5 min and then re-check for bleeding. While cold compresses can help constrict blood vessels, direct pressure and maintaining a forward head position are more effective for stopping nosebleeds. Place the child in a supine position with a pillow under her head. Supine position can cause blood to flow down the throat and is not recommended in managing nosebleeds due to the risk of aspiration.

Correct Answer: C

Rationale: Wash bed linens in cold water. Washing bed linens in cold water is ineffective for killing pinworm eggs. Hot water should be used to properly sanitize linens and kill the eggs. Clean the bathroom with bleach solution. While cleaning the bathroom with bleach can help reduce contamination, it is not a primary or effective measure for preventing pinworm spread and reinfection in a household setting. Keep children's nails short. Keeping nails short reduces the likelihood of the child scratching the perianal area, where pinworm eggs are deposited, and then ingesting the eggs through hand-to-mouth contact. This helps prevent the spread and reinfection of pinworms. Dress child in loose-fitting underwear. Loose-fitting underwear does not specifically help in preventing the spread or reinfection of pinworms. Tight-fitting underwear may actually be better to prevent the spread of eggs to other surfaces.

Correct Answer: D

Rationale: Insulin is absorbed most rapidly when injected in the thigh. Insulin is actually absorbed most rapidly in the abdomen, not the thigh. Use cold insulin for injection to minimize site pain. Insulin should be at room temperature for injection to reduce discomfort and avoid altered absorption rates. Cold insulin can increase injection pain. Massage the site after injection to promote absorption. Massaging the injection site can cause unpredictable insulin absorption and is not recommended. Rotate the injection site to keep insulin levels consistent. Rotating the injection sites helps prevent lipodystrophy and ensures consistent insulin absorption. It helps maintain stable blood glucose levels.

Correct Answer: B,C,E

Rationale: A. Measure the infant's head circumference. Measuring head circumference is a standard part of routine well-child exams and growth monitoring, but it is not directly relevant to the current diagnosis of hypertrophic pyloric stenosis. The immediate clinical focus is on the gastrointestinal symptoms and associated dehydration. B. Weigh the infant. Weighing the infant is crucial for monitoring weight loss and assessing hydration status. Infants with hypertrophic pyloric stenosis are at risk of dehydration and malnutrition due to frequent, forceful vomiting. Regular weight checks help in evaluating the effectiveness of treatment and the nutritional status of the infant. C. Monitor intake and output. Monitoring intake and output is vital in this scenario to assess the infant's hydration status and kidney function. Given the forceful vomiting, there's a high risk of dehydration, as indicated by the dry mucous membranes, depressed fontanel, and reduced urine output. Accurate measurement helps guide fluid replacement therapy. D. Offer small frequent feedings of thickened liquids. Offering feedings, even of thickened liquids, is inappropriate in this situation because the infant requires surgical intervention for pyloric stenosis. Continued feeding may exacerbate vomiting and dehydration. Instead, the infant should be kept NPO (nothing by mouth) to prepare for surgery and prevent further complications. E. Evaluate serum electrolyte levels: Infants with hypertrophic pyloric stenosis often develop electrolyte imbalances such as hypokalemia, hypochloremia, and metabolic alkalosis due to prolonged vomiting. Evaluating serum electrolytes is essential to identify and correct these imbalances, which are critical to stabilizing the infant before surgical intervention. F. Plan to administer a plain water enema. A plain water enema is not indicated and is inappropriate for treating hypertrophic pyloric stenosis. The issue is not related to bowel movements or lower gastrointestinal obstruction, but rather to the pyloric sphincter in the stomach, which requires surgical correction. G. Implement contact precautions. Contact precautions are typically used to prevent the spread of infectious diseases. Hypertrophic pyloric stenosis is not an infectious condition but a structural anomaly. Thus, there is no need for contact precautions in this context.