Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
What is the earliest clinical manifestation of biliary atresia?
A. Vomiting.
Vomiting can occur in biliary atresia due to the blockage of bile flow, but it is not the earliest clinical manifestation. Jaundice tends to precede vomiting and is a more characteristic early sign of biliary atresia.
B. Hepatomegaly.
Hepatomegaly (enlargement of the liver) is a common finding in biliary atresia, but it usually occurs after the onset of jaundice. Jaundice is an earlier and more specific manifestation of this condition.
C. Absence of stooling.
Absence of stooling is a sign that might occur in biliary atresia due to the obstructed bile flow, but it is not typically the earliest clinical manifestation. Jaundice is generally the first noticeable sign.
D. Jaundice.
Jaundice is the earliest clinical manifestation of biliary atresia. It is caused by the buildup of bilirubin in the blood due to impaired bile flow from the liver. The jaundice in biliary atresia is typically progressive and can be one of the key indicators for further evaluation and diagnosis.
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Full Explanation
The correct answer is Choice D: Jaundice.
Choice A rationale:
Vomiting can occur in biliary atresia due to the blockage of bile flow, but it is not the earliest clinical manifestation. Jaundice tends to precede vomiting and is a more characteristic early sign of biliary atresia.
Choice B rationale:
Hepatomegaly (enlargement of the liver) is a common finding in biliary atresia, but it usually occurs after the onset of jaundice. Jaundice is an earlier and more specific manifestation of this condition.
Choice C rationale:
Absence of stooling is a sign that might occur in biliary atresia due to the obstructed bile flow, but it is not typically the earliest clinical manifestation. Jaundice is generally the first noticeable sign.
Choice D rationale:
Jaundice is the earliest clinical manifestation of biliary atresia. It is caused by the buildup of bilirubin in the blood due to impaired bile flow from the liver. The jaundice in biliary atresia is typically progressive and can be one of the key indicators for further evaluation and diagnosis.
Similar Questions
What condition is characterized by a chronic inflammatory process that may involve any part of the gastrointestinal (GI) tract from mouth to anus?
A. Ulcerative colitis.
Ulcerative colitis is a chronic inflammatory disease that primarily affects the colon and rectum, causing continuous areas of inflammation and ulcers. It does not involve any part of the GI tract from mouth to anus as stated in the question.
B. Meckel's diverticulum.
Meckel's diverticulum is a congenital condition where a small pouch forms in the lower part of the small intestine. It is not characterized by a chronic inflammatory process involving various parts of the GI tract.
C. Crohn's disease.
Crohn's disease is a chronic inflammatory disorder that can affect any part of the gastrointestinal tract from mouth to anus. It commonly causes inflammation, ulceration, and narrowing of the affected segments of the intestines. This inflammation can lead to a range of symptoms including abdominal pain, diarrhea, and weight loss. The question accurately describes Crohn's disease.
D. Irritable bowel syndrome.
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain or discomfort and changes in bowel habits. It is not associated with chronic inflammatory processes or ulceration as seen in Crohn's disease.
Full Explanation
The correct answer is choice C. Crohn's disease.
Choice A rationale:
Ulcerative colitis is a chronic inflammatory disease that primarily affects the colon and rectum, causing continuous areas of inflammation and ulcers. It does not involve any part of the GI tract from mouth to anus as stated in the question.
Choice B rationale:
Meckel's diverticulum is a congenital condition where a small pouch forms in the lower part of the small intestine. It is not characterized by a chronic inflammatory process involving various parts of the GI tract.
Choice C rationale:
Crohn's disease is a chronic inflammatory disorder that can affect any part of the gastrointestinal tract from mouth to anus. It commonly causes inflammation, ulceration, and narrowing of the affected segments of the intestines. This inflammation can lead to a range of symptoms including abdominal pain, diarrhea, and weight loss. The question accurately describes Crohn's disease.
Choice D rationale:
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain or discomfort and changes in bowel habits. It is not associated with chronic inflammatory processes or ulceration as seen in Crohn's disease.
What is the primary purpose of prescribing a histamine receptor antagonist for an infant diagnosed with gastroesophageal reflux?
A. Prevent reflux.
Preventing reflux is not the primary purpose of prescribing a histamine receptor antagonist. Histamine receptor antagonists work by reducing gastric acid production, which in turn can help alleviate symptoms of gastroesophageal reflux disease (GERD). They do not directly prevent the physical reflux of stomach contents into the esophagus.
B. Reduce gastric acid production.
The primary purpose of prescribing a histamine receptor antagonist for an infant diagnosed with gastroesophageal reflux is to reduce gastric acid production. Histamine stimulates acid secretion in the stomach, and these medications (e.g., ranitidine, famotidine) block histamine receptors on stomach cells, leading to decreased acid secretion. This helps reduce the acidity of stomach contents that could contribute to esophageal irritation in GERD.
C. Prevent hematemesis.
Preventing hematemesis (vomiting blood) is not a primary action of histamine receptor antagonists. While reducing gastric acid production might indirectly help prevent complications such as bleeding due to irritation and inflammation of the esophagus, it's not the main purpose of these medications.
D. Increase gastric acid production.
Increasing gastric acid production is the opposite of the intended effect of histamine receptor antagonists. These medications are specifically used to decrease gastric acid production and provide relief from conditions where excess acid is causing problems, such as GERD.
Full Explanation
The correct answer is choice B. Reduce gastric acid production.
Choice A rationale:
Preventing reflux is not the primary purpose of prescribing a histamine receptor antagonist. Histamine receptor antagonists work by reducing gastric acid production, which in turn can help alleviate symptoms of gastroesophageal reflux disease (GERD). They do not directly prevent the physical reflux of stomach contents into the esophagus.
Choice B rationale:
The primary purpose of prescribing a histamine receptor antagonist for an infant diagnosed with gastroesophageal reflux is to reduce gastric acid production. Histamine stimulates acid secretion in the stomach, and these medications (e.g., ranitidine, famotidine) block histamine receptors on stomach cells, leading to decreased acid secretion. This helps reduce the acidity of stomach contents that could contribute to esophageal irritation in GERD.
Choice C rationale:
Preventing hematemesis (vomiting blood) is not a primary action of histamine receptor antagonists. While reducing gastric acid production might indirectly help prevent complications such as bleeding due to irritation and inflammation of the esophagus, it's not the main purpose of these medications.
Choice D rationale:
Increasing gastric acid production is the opposite of the intended effect of histamine receptor antagonists. These medications are specifically used to decrease gastric acid production and provide relief from conditions where excess acid is causing problems, such as GERD.
The nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include? (Select all that apply.)
A. Decreased urinary output.
Decreased urinary output can be a sign of heart failure, especially in infants. In heart failure, the heart's ability to pump effectively can lead to decreased blood flow to the kidneys, resulting in decreased urine production.
B. Sweating (inappropriate).
Sweating (inappropriate) is a symptom of heart failure in infants. Infants with heart failure might sweat excessively, especially while feeding or crying, due to the effort required by the heart to pump blood effectively.
C. Warm flushed extremities.
Warm flushed extremities are not typically associated with heart failure in infants. In heart failure, extremities might actually become cool and pale due to poor circulation.
D. Anorexia.
Anorexia, or a lack of appetite, is a common sign in infants with heart failure. The increased effort required for feeding due to compromised cardiac function can lead to poor feeding and decreased appetite.
E. Weight loss.
Weight loss can occur in infants with heart failure due to inadequate caloric intake, difficulty with feeding, and increased metabolic demands associated with heart failure. However, it's not as specific a sign as decreased urinary output, sweating, and anorexia.
Full Explanation
The correct answers are choices A, B, and D.
Choice A rationale:
Decreased urinary output can be a sign of heart failure, especially in infants. In heart failure, the heart's ability to pump effectively can lead to decreased blood flow to the kidneys, resulting in decreased urine production.
Choice B rationale:
Sweating (inappropriate) is a symptom of heart failure in infants. Infants with heart failure might sweat excessively, especially while feeding or crying, due to the effort required by the heart to pump blood effectively.
Choice C rationale:
Warm flushed extremities are not typically associated with heart failure in infants. In heart failure, extremities might actually become cool and pale due to poor circulation.
Choice D rationale:
Anorexia, or a lack of appetite, is a common sign in infants with heart failure. The increased effort required for feeding due to compromised cardiac function can lead to poor feeding and decreased appetite.
Choice E rationale:
Weight loss can occur in infants with heart failure due to inadequate caloric intake, difficulty with feeding, and increased metabolic demands associated with heart failure. However, it's not as specific a sign as decreased urinary output, sweating, and anorexia.