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?
AMaintain the child on nothing-by-mouth (NPO) status.
BApply a warm compress to the right lower quadrant.
CAdminister the prescribed opioid analgesic for pain relief.
DInsert a nasogastric tube for gastric decompression.
Show the answer and why the others fail
Answer: A. Maintain the child on nothing-by-mouth (NPO) status.
A — correct
Maintaining NPO status is the priority to prevent pulmonary aspiration of gastric contents during anesthesia, a critical safety measure before appendectomy.
B
Applying a warm compress is contraindicated because it increases blood flow and inflammation, which can worsen the condition and increase the risk of complications.
C
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.
D
Routine nasogastric tube insertion is not indicated for appendicitis unless significant vomiting or abdominal distention is present; it is not the priority intervention.
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?
AAdminister an antiemetic to control vomiting.
BInitiate intravenous fluids and monitor serum electrolytes.
CPrepare the infant for immediate surgical correction.
DInsert a nasogastric tube for gastric decompression.
Show the answer and why the others fail
Answer: B. Initiate intravenous fluids and monitor serum electrolytes.
A
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.
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
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.
D
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.
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?
AAbdominal distension with rigidity
BTemperature of 38.2°C (100.8°F)
CPassage of a small amount of bloody mucus
DAbsent bowel sounds on auscultation
Show the answer and why the others fail
Answer: A. Abdominal distension with rigidity
A — correct
Abdominal distension with rigidity suggests peritonitis or perforation, which contraindicates pneumatic reduction due to the risk of further leakage and sepsis.
B
Mild fever can accompany intussusception and is not a contraindication to pneumatic reduction.
C
Bloody mucus is a typical finding in intussusception and does not contraindicate reduction; it reflects the underlying pathology.
D
Absent bowel sounds are common in intussusception due to obstruction but do not contraindicate pneumatic reduction.
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?
ACover the exposed bowel with warm, sterile, saline-soaked gauze and wrap with plastic.
BInsert a nasogastric tube and connect to low intermittent suction.
CAdminister intravenous broad-spectrum antibiotics as prescribed.
DPosition the infant supine with legs extended and secure the defect with a dry dressing.
Show the answer and why the others fail
Answer: A. Cover the exposed bowel with warm, sterile, saline-soaked gauze and wrap with plastic.
A — 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.
B
Gastrointestinal decompression is necessary to prevent distension and vomiting, but it is performed after the defect is covered and the infant is stabilized.
C
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.
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?
AAdminister a prescribed laxative to relieve possible constipation.
BEncourage increased oral fluid intake to prevent dehydration.
CInstruct the parents and staff to avoid palpating the abdomen.
DApply a warm compress to the abdomen to promote comfort.
Show the answer and why the others fail
Answer: C. Instruct the parents and staff to avoid palpating the abdomen.
A
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.
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 — 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.
D
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.
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.
CAdminister the prescribed antipyretic to reduce fever.
DObtain a stool culture to identify the causative organism.
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
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.
D
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.
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?
AInitiate intravenous broad-spectrum antibiotics to prevent aspiration pneumonia.
BPass a nasogastric tube to confirm the diagnosis and decompress the stomach.
CAdminister oxygen via face mask and place the infant in Trendelenburg position.
DKeep the infant NPO, elevate the head, and provide continuous suction of the blind esophageal pouch.
Show the answer and why the others fail
Answer: D. Keep the infant NPO, elevate the head, and provide continuous suction of the blind esophageal pouch.
A
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.
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
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.
D — 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.
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.