7 original SNLE questions on pediatric surgical, each with an explanation for all four options. Part of Maternal-Child Nursing, worth 30% of the Saudi Nursing Licensure Examination.
Q01 / 07medium0 correct
Maternal-Child Nursingmediumq057
A 10-year-old boy is admitted to the pediatric unit with a 12-hour history of periumbilical pain that has migrated to the right lower quadrant, accompanied by nausea and a low-grade fever of 38.1°C (100.6°F). The nurse notes rebound tenderness and guarding on palpation. The healthcare provider suspects acute appendicitis and plans for an appendectomy. Which of the following is the priority nursing intervention at this time?
All 7 questions
Every question below, with the reasoning for all four options. Try to answer before you open one.
Pediatric surgical · medium
A 10-year-old boy is admitted to the pediatric unit with a 12-hour history of periumbilical pain that has migrated to the right lower quadrant, accompanied by nausea and a low-grade fever of 38.1°C (100.6°F). The nurse notes rebound tenderness and guarding on palpation. The healthcare provider suspects acute appendicitis and plans for an appendectomy. Which of the following is the priority nursing intervention at this time?
AAdminister the prescribed opioid analgesic for pain relief.
BInsert a nasogastric tube for gastric decompression.
CApply a warm compress to the right lower quadrant.
DMaintain the child on nothing-by-mouth (NPO) status.
Show the answer and why the others fail
Answer: D. Maintain the child on nothing-by-mouth (NPO) status.
A
While early opioid analgesia is safe and does not mask clinical signs, maintaining NPO status is the immediate priority to reduce aspiration risk before surgery.
B
Routine nasogastric tube insertion is not indicated for appendicitis unless significant vomiting or abdominal distention is present; it is not the priority intervention.
C
Applying a warm compress is contraindicated because it increases blood flow and inflammation, which can worsen the condition and increase the risk of complications.
D — correct
Maintaining NPO status is the priority to prevent pulmonary aspiration of gastric contents during anesthesia, a critical safety measure before appendectomy.
TakeawayIn suspected appendicitis requiring surgery, the priority nursing intervention is to maintain NPO status to reduce aspiration risk. Early opioid analgesia is safe and does not mask clinical signs, but NPO status takes precedence. Heat application is contraindicated because it increases inflammation and may worsen the condition.
Pediatric surgical · medium
A 4-week-old male infant is brought to the emergency department with a 3-day history of progressively forceful vomiting after every feeding. The vomitus is non-bilious. The infant appears hungry after vomiting and has lost 200 grams since birth. On examination, a small, firm, movable mass is palpated in the right upper quadrant. Which of the following is the priority nursing intervention before surgery?
APrepare the infant for immediate surgical correction.
BInitiate intravenous fluids and monitor serum electrolytes.
CInsert a nasogastric tube for gastric decompression.
DAdminister an antiemetic to control vomiting.
Show the answer and why the others fail
Answer: B. Initiate intravenous fluids and monitor serum electrolytes.
A
Surgery is the definitive treatment, but it is not performed immediately. The infant must first be stabilized with fluid and electrolyte replacement to reduce anesthesia risk.
B — correct
The infant's history of projectile vomiting suggests hypertrophic pyloric stenosis, leading to dehydration and hypochloremic metabolic alkalosis. The priority is to correct these imbalances before surgery to ensure safe anesthesia and recovery.
C
Nasogastric decompression may be used to relieve gastric distension, but it is not the highest priority. Fluid and electrolyte correction takes precedence to stabilize the infant for surgery.
D
Antiemetics are ineffective in pyloric stenosis because vomiting is due to mechanical obstruction, not a central cause. This does not address the underlying fluid and electrolyte deficits.
TakeawayPreoperative correction of dehydration and electrolyte imbalances is critical in infants with pyloric stenosis to ensure safe anesthesia and surgery.
Pediatric surgical · medium
A 9-month-old infant is admitted with sudden episodes of crying, drawing up the knees, and vomiting. The stool is mixed with blood and mucus. The healthcare provider suspects intussusception and orders a pneumatic (air) enema for reduction. Which assessment finding should prompt the nurse to withhold the procedure and notify the provider immediately?
AAbsent bowel sounds on auscultation
BPassage of a small amount of bloody mucus
CTemperature of 38.2°C (100.8°F)
DAbdominal distension with rigidity
Show the answer and why the others fail
Answer: D. Abdominal distension with rigidity
A
Absent bowel sounds are common in intussusception due to obstruction but do not contraindicate pneumatic reduction.
B
Bloody mucus is a typical finding in intussusception and does not contraindicate reduction; it reflects the underlying pathology.
C
Mild fever can accompany intussusception and is not a contraindication to pneumatic reduction.
D — correct
Abdominal distension with rigidity suggests peritonitis or perforation, which contraindicates pneumatic reduction due to the risk of further leakage and sepsis.
TakeawaySigns of peritonitis (rigidity, distension, rebound tenderness) contraindicate pneumatic reduction of intussusception because of the high risk of perforation; immediate surgical consultation is required.
Pediatric surgical · medium
A newborn is admitted to the neonatal intensive care unit with a prenatally diagnosed gastroschisis. The defect is to the right of the umbilical cord, and a large portion of the bowel is exposed. Which nursing action is the priority?
AAdminister intravenous broad-spectrum antibiotics as prescribed.
BCover the exposed bowel with warm, sterile, saline-soaked gauze and wrap with plastic.
CInsert a nasogastric tube and connect to low intermittent suction.
DPosition the infant supine with legs extended and secure the defect with a dry dressing.
Show the answer and why the others fail
Answer: B. Cover the exposed bowel with warm, sterile, saline-soaked gauze and wrap with plastic.
A
Antibiotics are important to prevent infection but are not the immediate priority. The exposed bowel must first be protected from heat and fluid loss and contamination.
B — correct
The priority is to protect the exposed viscera from heat and moisture loss, trauma, and infection. A sterile saline dressing covered with plastic wrap or a bowel bag maintains a moist environment and reduces evaporative losses.
C
Gastrointestinal decompression is necessary to prevent distension and vomiting, but it is performed after the defect is covered and the infant is stabilized.
D
Supine positioning with legs extended can place tension on the mesentery and compromise blood flow. The infant should be positioned to minimize tension on the defect, and a dry dressing would adhere to the bowel and cause injury.
TakeawayIn gastroschisis, the immediate priority is to cover the exposed bowel with warm, sterile, saline-soaked gauze and plastic wrap to prevent heat and fluid loss and reduce infection risk.
Pediatric surgical · medium
A 3-year-old child is admitted to the pediatric unit with a firm, non-tender abdominal mass discovered by the parent. The nurse suspects Wilms tumor. Which of the following is the priority nursing action?
AApply a warm compress to the abdomen to promote comfort.
BEncourage increased oral fluid intake to prevent dehydration.
CAdminister a prescribed laxative to relieve possible constipation.
DInstruct the parents and staff to avoid palpating the abdomen.
Show the answer and why the others fail
Answer: D. Instruct the parents and staff to avoid palpating the abdomen.
A
Applying a warm compress involves touching and manipulating the abdomen, which could inadvertently palpate the mass and increase the risk of tumor rupture. The priority is to avoid any abdominal manipulation.
B
Hydration is a general nursing consideration but is not the priority. The primary safety action is to avoid palpation of the mass to prevent potential tumor rupture.
C
While constipation management may be needed, it is not the priority. The immediate concern is to prevent any abdominal manipulation that could disturb the tumor and cause rupture.
D — correct
Palpation of a suspected Wilms tumor can cause rupture of the tumor capsule, leading to seeding of malignant cells. Immediate verbal instruction to avoid palpation is a critical safety measure.
TakeawayIn a child with a suspected Wilms tumor, the priority nursing action is to prevent palpation of the abdomen to avoid tumor rupture and seeding of malignant cells. Instruct parents and staff to avoid touching the mass.
Pediatric surgical · medium
A 2-year-old child with a history of Hirschsprung disease who underwent a pull-through procedure 6 months ago is brought to the clinic. The mother reports the child has had a fever of 39°C, progressive abdominal distension, and foul-smelling, explosive diarrhea for the past 12 hours. The child appears lethargic. What is the priority nursing action?
AInsert a nasogastric tube to decompress the abdomen.
BNotify the physician immediately of the assessment findings.
CObtain a stool culture to identify the causative organism.
DAdminister the prescribed antipyretic to reduce fever.
Show the answer and why the others fail
Answer: B. Notify the physician immediately of the assessment findings.
A
Nasogastric decompression may be ordered, but it is not the nurse's independent priority action. The physician must be notified first to evaluate and direct appropriate interventions, which may include decompression, IV fluids, and antibiotics.
B — correct
The combination of fever, abdominal distension, explosive diarrhea, and lethargy in a child with Hirschsprung disease indicates possible enterocolitis, which can rapidly progress to sepsis and death. Prompt medical evaluation and treatment are critical.
C
While stool cultures may be part of the diagnostic workup, they are not the immediate priority. The child's clinical deterioration requires urgent medical assessment and intervention to prevent septic shock.
D
Fever management is important but not the priority; the child's presentation suggests Hirschsprung-associated enterocolitis, a life-threatening emergency that requires immediate physician notification for urgent intervention.
TakeawayHirschsprung-associated enterocolitis is a serious, potentially fatal complication that can occur even after corrective surgery. Signs include fever, abdominal distension, explosive diarrhea, and lethargy. The nurse must recognize these signs and notify the physician immediately for emergency management.
Pediatric surgical · medium
A term newborn develops excessive drooling, choking, and cyanosis with the first feeding. Esophageal atresia with tracheoesophageal fistula is suspected. Which nursing action is the priority?
AAdminister oxygen via face mask and place the infant in Trendelenburg position.
BPass a nasogastric tube to confirm the diagnosis and decompress the stomach.
CKeep the infant NPO, elevate the head, and provide continuous suction of the blind esophageal pouch.
DInitiate intravenous broad-spectrum antibiotics to prevent aspiration pneumonia.
Show the answer and why the others fail
Answer: C. Keep the infant NPO, elevate the head, and provide continuous suction of the blind esophageal pouch.
A
Oxygen may be needed if cyanosis persists, but the priority is to clear the airway and prevent further aspiration. Trendelenburg position increases the risk of gastric contents refluxing through the fistula into the lungs, worsening aspiration.
B
Passing a nasogastric tube is a diagnostic step, but it is not the initial nursing priority. Attempting to pass a tube may cause trauma, vagal stimulation, or aspiration, and the priority is to secure the airway and prevent aspiration before any diagnostic maneuvers.
C — correct
The immediate priority is to prevent aspiration of oral secretions and gastric reflux. Keeping the infant NPO, elevating the head, and inserting a catheter (e.g., Replogle tube) into the blind esophageal pouch for continuous low-pressure suction maintains a patent airway and minimizes aspiration risk.
D
Antibiotics may be prescribed later if aspiration pneumonia develops, but they are not the immediate priority. The first nursing action is to maintain a patent airway and prevent further aspiration of secretions.
TakeawayIn suspected esophageal atresia/tracheoesophageal fistula, the priority nursing intervention is to prevent aspiration by keeping the infant NPO, elevating the head, and providing continuous suction of the blind esophageal pouch (e.g., with a Replogle tube) to clear secretions and protect the airway.