Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A 3-week-old infant is brought to the emergency department with a history of forceful, projectile vomiting after feedings and signs of weight loss. On assessment, the nurse palpates a small, olive-shaped mass in the upper abdomen. Which condition does this clinical picture most likely indicate?
A. Intussusception
Intussusception is incorrect because this condition typically presents with intermittent abdominal pain, drawing up of the legs, and “currant jelly” stools caused by blood and mucus. Vomiting may occur, but the presence of a palpable olive-shaped mass and projectile vomiting is not characteristic.
B. Pyloric stenosis
Pyloric stenosis is correct. Pyloric stenosis occurs when the pyloric muscle hypertrophies, causing gastric outlet obstruction. It usually presents in infants around 3–6 weeks of age with forceful, projectile vomiting immediately after feedings, signs of weight loss or poor weight gain, dehydration, and a palpable, firm, olive-shaped mass in the right upper abdomen. Vomiting is non-bilious because the obstruction is proximal to the duodenum.
C. A. Gastroesophageal reflux (GER)
Gastroesophageal reflux (GER) is incorrect because GER typically causes spitting up or regurgitation, which is usually non-forceful and not associated with an olive-shaped mass or significant weight loss. GER is common in infants and often resolves spontaneously.
D. Hirschsprung's disease
Hirschsprung's disease is incorrect because it presents with chronic constipation, abdominal distension, and delayed passage of meconium in the newborn period. Projectile vomiting and a palpable pyloric mass are not typical features.
This question is an excerpt from Nurse Dive's nursing test bank - Ati dmmsn 650 OB/Pediatrics Proctored Exams. Take the full exam now
Full Explanation
A. Intussusception is incorrect because this condition typically presents with intermittent abdominal pain, drawing up of the legs, and “currant jelly” stools caused by blood and mucus. Vomiting may occur, but the presence of a palpable olive-shaped mass and projectile vomiting is not characteristic.
B. Pyloric stenosis is correct. Pyloric stenosis occurs when the pyloric muscle hypertrophies, causing gastric outlet obstruction. It usually presents in infants around 3–6 weeks of age with forceful, projectile vomiting immediately after feedings, signs of weight loss or poor weight gain, dehydration, and a palpable, firm, olive-shaped mass in the right upper abdomen. Vomiting is non-bilious because the obstruction is proximal to the duodenum.
C. Gastroesophageal reflux (GER) is incorrect because GER typically causes spitting up or regurgitation, which is usually non-forceful and not associated with an olive-shaped mass or significant weight loss. GER is common in infants and often resolves spontaneously.
D. Hirschsprung's disease is incorrect because it presents with chronic constipation, abdominal distension, and delayed passage of meconium in the newborn period. Projectile vomiting and a palpable pyloric mass are not typical features.
Similar Questions
Which of the following is a key difference between Hodgkin's lymphoma (HL) and Non-Hodgkin's lymphoma (NHL) in children?
A. Non-Hodgkin's lymphoma is more commonly associated with painless, enlarged lymph nodes than Hodgkin's lymphoma
Non-Hodgkin's lymphoma is more commonly associated with painless, enlarged lymph nodes than Hodgkin's lymphoma is incorrect because both HL and NHL can present with painless lymphadenopathy, so this is not a distinguishing feature.
B. Hodgkin's lymphoma presents with a more aggressive course than Non-Hodgkin's lymphoma
Hodgkin's lymphoma presents with a more aggressive course than Non-Hodgkin's lymphoma is incorrect because, in children, Non-Hodgkin’s lymphoma generally has a more aggressive and rapid course compared with Hodgkin’s lymphoma, which usually progresses more slowly.
C. Non-Hodgkin's lymphoma typically involves the reed-Sternberg cells
Non-Hodgkin's lymphoma typically involves the Reed-Sternberg cells is incorrect because Reed-Sternberg cells are characteristic of Hodgkin’s lymphoma, not Non-Hodgkin’s lymphoma. Their presence is a key diagnostic feature of HL.
D. Hodgkin's lymphoma usually has a more predictable and localized spread than Non-Hodgkin's lymphoma
Hodgkin's lymphoma usually has a more predictable and localized spread than Non-Hodgkin's lymphoma is correct. Hodgkin’s lymphoma tends to spread in a contiguous, orderly fashion from one lymph node group to another, often starting in cervical or supraclavicular nodes. Non-Hodgkin’s lymphoma, in contrast, tends to spread more diffusely and rapidly, involving extranodal sites such as the gastrointestinal tract, mediastinum, and bone marrow.
Full Explanation
A. Non-Hodgkin's lymphoma is more commonly associated with painless, enlarged lymph nodes than Hodgkin's lymphoma is incorrect because both HL and NHL can present with painless lymphadenopathy, so this is not a distinguishing feature.
B. Hodgkin's lymphoma presents with a more aggressive course than Non-Hodgkin's lymphoma is incorrect because, in children, Non-Hodgkin’s lymphoma generally has a more aggressive and rapid course compared with Hodgkin’s lymphoma, which usually progresses more slowly.
C. Non-Hodgkin's lymphoma typically involves the Reed-Sternberg cells is incorrect because Reed-Sternberg cells are characteristic of Hodgkin’s lymphoma, not Non-Hodgkin’s lymphoma. Their presence is a key diagnostic feature of HL.
D. Hodgkin's lymphoma usually has a more predictable and localized spread than Non-Hodgkin's lymphoma is correct. Hodgkin’s lymphoma tends to spread in a contiguous, orderly fashion from one lymph node group to another, often starting in cervical or supraclavicular nodes. Non-Hodgkin’s lymphoma, in contrast, tends to spread more diffusely and rapidly, involving extranodal sites such as the gastrointestinal tract, mediastinum, and bone marrow.
A nurse is caring for a hospitalized child and family using a family-centered care approach. Which nursing action best demonstrates the principle that the family is the constant in the child's life?
A. Limiting family involvement to scheduled visiting hours
Limiting family involvement to scheduled visiting hours is incorrect because family-centered care promotes unrestricted or flexible family presence. Restricting involvement contradicts the idea that the family plays a continuous and central role in the child’s life.
B. Encouraging the family to follow unit routines without modification
Encouraging the family to follow unit routines without modification is incorrect because family-centered care values collaboration and flexibility. Care should be adapted to meet the needs of the child and family, not force the family to conform to rigid hospital routines.
C. Assuming the healthcare team is the primary source of support for the child
Assuming the healthcare team is the primary source of support for the child is incorrect because, in family-centered care, the family—not the healthcare team—is recognized as the primary and constant source of support, comfort, and advocacy for the child.
D. Involving the family in care planning and decision-making for the child
Involving the family in care planning and decision-making for the child is correct because it acknowledges that the family is the constant in the child’s life. This approach respects the family’s knowledge of the child, promotes collaboration, and supports continuity of care across healthcare settings.
Full Explanation
A. Limiting family involvement to scheduled visiting hours is incorrect because family-centered care promotes unrestricted or flexible family presence. Restricting involvement contradicts the idea that the family plays a continuous and central role in the child’s life.
B. Encouraging the family to follow unit routines without modification is incorrect because family-centered care values collaboration and flexibility. Care should be adapted to meet the needs of the child and family, not force the family to conform to rigid hospital routines.
C. Assuming the healthcare team is the primary source of support for the child is incorrect because, in family-centered care, the family—not the healthcare team—is recognized as the primary and constant source of support, comfort, and advocacy for the child.
D. Involving the family in care planning and decision-making for the child is correct because it acknowledges that the family is the constant in the child’s life. This approach respects the family’s knowledge of the child, promotes collaboration, and supports continuity of care across healthcare settings.
A 5-year-old child with cystic fibrosis (CF) is being seen for a follow-up visit. The parents report that the child has difficulty gaining weight despite a high- calorie diet and frequently experiences loose, fatty stools. The healthcare provider prescribes pancreatic enzyme replacement therapy (PERT) to assist with digestion. Which of the following statements best explains why children with CF require digestive enzymes?
A. CF causes thickened mucus that obstructs the pancreas, preventing the release of digestive enzymes
CF causes thickened mucus that obstructs the pancreas, preventing the release of digestive enzymes is correct because cystic fibrosis leads to thick, sticky secretions that block pancreatic ducts. This prevents digestive enzymes from reaching the small intestine, resulting in malabsorption of fats, proteins, and fat-soluble vitamins, which causes poor weight gain and steatorrhea (fatty stools).
B. Children with CF have an overproduction of digestive enzymes, leading to malabsorption
Children with CF have an overproduction of digestive enzymes, leading to malabsorption is incorrect because the problem in CF is insufficient delivery of enzymes to the intestine, not overproduction.
C. Digestive enzymes are needed to break down fat, which children with CF can digest more efficiently than carbohydrates
Digestive enzymes are needed to break down fat, which children with CF can digest more efficiently than carbohydrates is incorrect because children with CF have difficulty digesting fats due to lack of pancreatic enzymes. They do not digest fat more efficiently; instead, fat malabsorption is a hallmark of the disease.
D. Pancreatic enzyme replacement is only required when children develop diabetes, a common complication of CF
Pancreatic enzyme replacement is only required when children develop diabetes, a common complication of CF is incorrect because PERT is required due to exocrine pancreatic insufficiency, not diabetes. Diabetes in CF results from endocrine pancreatic dysfunction and is unrelated to the need for digestive enzymes.
Full Explanation
A. CF causes thickened mucus that obstructs the pancreas, preventing the release of digestive enzymes is correct because cystic fibrosis leads to thick, sticky secretions that block pancreatic ducts. This prevents digestive enzymes from reaching the small intestine, resulting in malabsorption of fats, proteins, and fat-soluble vitamins, which causes poor weight gain and steatorrhea (fatty stools).
B. Children with CF have an overproduction of digestive enzymes, leading to malabsorption is incorrect because the problem in CF is insufficient delivery of enzymes to the intestine, not overproduction.
C. Digestive enzymes are needed to break down fat, which children with CF can digest more efficiently than carbohydrates is incorrect because children with CF have difficulty digesting fats due to lack of pancreatic enzymes. They do not digest fat more efficiently; instead, fat malabsorption is a hallmark of the disease.
D. Pancreatic enzyme replacement is only required when children develop diabetes, a common complication of CF is incorrect because PERT is required due to exocrine pancreatic insufficiency, not diabetes. Diabetes in CF results from endocrine pancreatic dysfunction and is unrelated to the need for digestive enzymes.