Ch 20 - GI
A 4-month-old has had a fever, vomiting, and loose watery stools every few hours for 2 days. The mother calls the physician's office and asks the nurse what she should do. Which response by the nurse is most appropriate? a) "Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." b) "Give a clear pediatric electrolyte replacement for the next few hours, then call back to report on how your child is doing." c) "Continue breastfeeding as you have been doing. The fluid from the breast milk is important to maintain fluid balance." d) "Do not give the child anything to drink for 4 hours. If the fever goes down and the loose stools stop, you can resume breastfeeding."
"Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." Infants are comprised of a high percentage of fluid that can be lost very quickly when vomiting, fever, and diarrhea are all present. This infant needs to be seen by the physician based on her age and symptoms; hospitalization may be necessary for intravenous rehydration depending upon her status when assessed.
The nurse is caring for a 2-year-old boy with an umbilical hernia and is teaching the mother about this condition. Which response from the mother indicates a need for further teaching? a) "I can tape a quarter over the hernia to reduce it." b) "My son could have some appearance-related self-esteem issues." c) "I need to watch for pain, tenderness, or redness." d) "Incarceration is rare, but it can occur."
"I can tape a quarter over the hernia to reduce it." The use of home remedies to reduce an umbilical hernia should be discouraged because of the risk of bowel strangulation. The mother needs to be aware that strangulation can occur, but it is rare with an umbilical hernia. Pain, tenderness, or redness indicates incarceration, which although rare with umbilical hernias, can occur. She needs to understand the signs of strangulation and understand that some children have self-esteem issues related to the large protrusion of the unrepaired umbilical hernia. Physical needs of the child have priority over any types of potential psychosocial issues. Self-esteem issues may arise due to a large protrusion of an unrepaired umbilical hernia.
The nurse is providing instructions to the parents of a 10-year-old boy who has undergone a barium swallow/upper and lower GI for suspected inflammatory bowel disease. Which of the following instructions is most important? a) "Your child might have lighter stools for the next few days." b) "Your child could have diarrhea for several days afterward." c) "It is very important to drink lots of water and fluids after the test is finished." d) "Please be aware of any signs of infection."
"It is very important to drink lots of water and fluids after the test is finished." It is very important to encourage large amounts of water/fluids after this test to avoid barium-induced constipation. It is also important to tell the parents about a possible change in stool color, but the fluids are most important. This procedure is unlikely to cause an infection. Diarrhea is usually not a problem after this examination.
The nurse is caring for a 4-year-old with oral vesicles and ulcers from herpangina. The child is refusing fluids due to the pain and the mother is concerned about his hydration status. Which of the suggestions would be most appropriate? a) "Offer 'magic mouthwash' followed by a popsicle." b) "Encourage him to have some soda." c) "Try some Anbesol or Kank-A." d) "Offer him some orange juice."
"Offer 'magic mouthwash' followed by a popsicle." Children are more likely to cooperate with interventions if play is involved. "Magic" analgesic mouthwash followed by a popsicle is most likely to alleviate some pain and then provide hydration. Soda should be avoided because it can cause stinging and burning. Orange juice should be avoided because it can cause stinging and burning. Anbesol might be helpful but it will likely be difficult to apply. Additionally, oral analgesics are often necessary.
A nurse caring for Paulo, an infant born with a cleft palate, notices that the parents rarely interact with their child. The nurse overhears the mother telling her husband that she "feels like crying" every time she looks at their son. What would be the best response from the nurse? a) "Keep in mind that your son's condition is not life-threatening and can be corrected eventually." b) "I sense you could use more information on caring for a cleft palate. Would you be interested in meeting with other parents who have dealt with this?" c) "Your son needs you right now. You should put your negative feelings about his condition aside for his sake." d) "Many infants are born with this condition. Your son's palate is not nearly as bad as some cases."
"I sense you could use more information on caring for a cleft palate. Would you be interested in meeting with other parents who have dealt with this?" The nurse should support the family's adjustment to a child's condition by demonstrating an accepting, caring attitude toward the child and family and providing the parents with opportunities and support for normal infant-parent interactions.
The nurse is collecting data on a 2 ½-year-old child admitted with a diagnosis of gastroenteritis. When interviewing the caregivers, which question is most important for the nurse to ask? a) "What foods has your child eaten during the last few days." b) "How many times a day does your child urinate?" c) "Tell me about the types of stools you child has been having." d) "How long has your child been toilet trained?"
"Tell me about the types of stools you child has been having." For the child with gastroenteritis, the interview with the family caregiver must include specific information about the history of bowel patterns and the onset of diarrheal stools, with details on number and type of stools per day. Recent eating patterns, if the child is toilet trained, and how many times a day the child urinates are important questions, but the highest priority is gathering data regarding the stools and stool pattern.
A physician recommends a gastrostomy for a 4-year-old client with an obstruction. The parents ask the certified wound, ostomy, and continence nurse (CWOCN) what the surgery entails. What is the nurse's best response? a) "The surgery will create an opening to the small intestine." b) "The surgery creates an opening between the stomach and abdominal wall." c) "The surgery will create an opening to the large intestine." d) "The surgery is performed to create an opening between the esophagus and the neck."
"The surgery creates an opening between the stomach and abdominal wall." Ostomies can be created at various sites in the GI tract, depending on the child's clinical condition. A gastrostomy provides an opening between the stomach and the abdominal wall, and an esophagostomy communicates between the esophagus and an external site on the neck. Ostomies may be created at various sites in the small intestine (e.g., jejunostomy, ileostomy) or in the large intestine (e.g., colostomy).
The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis? a) "The treatment for the disorder will be a surgical procedure." b) "Your child will receive counseling so the underlying concerns will be addressed." c) "Your child will be treated with oral iron preparations to correct the anemia." d) "We will give enemas until clear and then teach you how to do these at home."
"The treatment for the disorder will be a surgical procedure." Treatment of congenital aganglionic megacolon involves surgery with the ultimate resection of the aganglionic portion of the bowel. Chronic anemia may be present, but iron will not correct the disorder. Enemas may be given to initially achieve bowel elimination, but they will not treat the disorder. Differentiation must be made between this condition and psychogenic megacolon because of coercive toileting or other emotional problems. The child with aganglionic megacolon does not withhold stools or defecate in inappropriate places, and no soiling occurs.
The nurse is caring for a 13-year-old girl with suspected autoimmune hepatitis. The girl inquires about the testing required to evaluate the condition. How should the nurse respond? a) "You will most likely have viral studies." b) "You will most likely be tested for ammonia levels." c) "You will most likely have an ultrasound evaluation." d) "You will most likely have a blood test to check for certain antibodies."
"You will most likely have a blood test to check for certain antibodies." Anti-nuclear antibodies are one of the diagnostic tests performed to diagnose autoimmune hepatitis. Ultrasound is to assess for liver or spleen abnormalities. Viral studies are performed to screen for viral causes of hepatitis. Ammonia levels may be ordered if hepatic encephalopathy is suspected.
The nurse is conducting a physical examination of an 18-month-old with suspected intussusception. Which finding would the nurse identify as the hallmark of this condition? a) Perianal skin tags b) A sausage-shaped mass in the upper midabdomen c) Abdominal pain and guarding d) Skin tenting
A sausage-shaped mass in the upper midabdomen A sausage-shaped mass in the upper midabdomen is the hallmark of intussusception. Perianal skin tags are highly suspicious of Crohn disease. Abdominal pain and guarding are also common with intussusception but are seen with many other conditions. Tenting would indicate dehydration.
A mother brings her 3-year-old son to the ER and tells the triage nurse that he has been vomiting blood. A medical history determines that the 3-year-old has no history of GI disturbances and his only symptoms are a slightly elevated fever and vomiting bright red blood. Based on these symptoms, what condition might the nurse suspect? a) Acute upper GI bleeding b) Gastroesophageal reflux c) GI tract obstruction d) Intussusception
Acute upper GI bleeding Vomiting bright red blood indicates acute upper GI bleeding. Emesis containing brown, foul-smelling stool indicates GI obstruction. Stool with red blood and mucus is associated with intussusception. Bleeding is not generally indicative of gastroesophageal reflux.
The nurse is to obtain a stool specimen from a 4-year-old child who has very liquid stool. The child is ambulatory but weak. Which collection method would be most effective for the nurse to use? a) Apply a urine bag to the anal area. b) Have the child defecate into a container in the toilet. c) Use a clean bedpan to collect the specimen. d) Use a tongue blade to scrape a specimen from a diaper.
Apply a urine bag to the anal area. With very liquid stool, applying a urine bag to the anal area is most effective in collecting the specimen. Using a tongue blade to scrape a specimen from a diaper would be appropriate if the stool is formed. However, putting a diaper on a 4-year-old would be demeaning. Defecating into a collection container that sits at the back of the toilet would be more appropriate for an older child who is ambulatory. A bedpan would be appropriate if the child was bedridden.
The nurse observes the interactions of parents with their infant who was born with a cleft lip. The mother is attempting to feed the baby, but does not make eye contact. The father is watching television with his back turned to the mother and baby. What psychosocial nursing intervention would be most helpful to this family? a) Explain to the parents that surgical intervention will fix the defect in the baby's lip. b) Refer the family to a social worker or mental health practitioner. c) Teach the mother the appropriate technique for breast-feeding an infant with cleft lip. d) Ask the parents if they have any questions regarding the care of their child.
Ask the parents if they have any questions regarding the care of their child. The family's emotional response to the birth of a child with cleft lip, palate, or both may range from grief to anger to denial. The nurse should encourage the parents to express their feelings and provide the parents with opportunities and support for normal infant-parent interactions.
The nurse is doing dietary teaching with the caregivers of a child diagnosed with idiopathic celiac disease. Of the following foods, which would most likely be appropriate in the child's diet? a) Oatmeal b) Toast c) Bananas d) Potatoes
Bananas The young child should be started on a starch-free, low-fat diet. Bananas contain invert sugar and are usually well tolerated. Products that contain wheat, rye, or oats should be excluded.
A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition? a) Surgery b) Barium enema c) Endoscopic retrograde cholangiopancreatography d) Upper endoscopy
Barium enema A barium enema is successful in reducing a large percentage of intussusception cases. Other cases are reduced surgically. Upper endoscopy is used to visualize the upper gastrointestinal tract from the mouth to the upper jejunum. Endoscopic retrograde cholangiopancreatography is used to view the hepatobiliary system.
A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason? a) Confirm pancreatitis b) Determine esophageal contractility c) Evaluate gastric pH d) Detect Helicobacter pylori
Detect Helicobacter pylori Urea breath test is used to detect the presence of H. pylori in the exhaled breath. This test does not evaluate gastric pH. Serum amylase and lipase levels are used to confirm pancreatitis. Esophageal manometry is used to evaluate esophageal contractile activity and effectiveness.
The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child? a) Severe constipation with occasional ribbon-like stools b) Effortless vomiting just after the child has eaten c) Bouts of diarrhea with failure to gain weight d) Forceful vomiting followed by the child being eager to eat again
Effortless vomiting just after the child has eaten Almost immediately after feeding, the child with gastroesophageal reflux vomits the contents of the stomach. The vomiting is effortless, not projectile in nature.
A nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. What GI condition might this history precipitate? a) Pyloric stenosis b) Cleft palate c) Esophageal atresia (EA) d) Hernia
Esophageal atresia (EA) A maternal history of polyhydramnios is usually present in one-third of cases of EA and in some cases of tracheoesophageal fistula (TEF).
The pH of blood is normally slightly acidic, ranging from 6.85 to 6.95. a) True b) False
False The pH of blood is normally slightly alkaline, ranging from 7.35 to 7.45.
A father brings Jacob, age 2, to the health clinic with complaints of diarrhea, vomiting, and abdominal pain. The father tells the nurse that he is a single parent and Jacob is enrolled in a local daycare center. Based on this information, what gastrointestinal condition might the nurse suspect? a) Appendicitis b) Pancreatitis c) Gastroenteritis d) Hirschsprung disease
Gastroenteritis Outbreaks of gastroenteritis routinely occur in day care centers, schools, institutions for the handicapped, and other places where overcrowding is prevalent and hygiene is inadequate. Typical signs and symptoms include diarrhea, nausea, vomiting, and abdominal pain.
A father brings Jacob, age 2, to the health clinic with complaints of diarrhea, vomiting, and abdominal pain. The father tells the nurse that he is a single parent and Jacob is enrolled in a local daycare center. Based on this information, what gastrointestinal condition might the nurse suspect? a) Gastroenteritis b) Appendicitis c) Hirschsprung disease d) Pancreatitis
Gastroenteritis Outbreaks of gastroenteritis routinely occur in day care centers, schools, institutions for the handicapped, and other places where overcrowding is prevalent and hygiene is inadequate. Typical signs and symptoms include diarrhea, nausea, vomiting, and abdominal pain.
A 2-month-old boy is admitted to the emergency room with severe diarrhea. Intravenous fluid is prescribed for him. Before adding potassium to this solution, which assessment would you record? a) He has voided. b) He cries with tears. c) He "attunes" to a music box. d) His hands are restrained.
He has voided. With severe diarrhea, kidney function may fail. It is important to document that kidney function is intact before adding potassium to prevent hyperkalemia.
A neonatal nurse teaches students how to recognize gastrointestinal disorders in infants. The nurse tells the students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease? a) Hirschsprung disease b) Short bowel syndrome (SBS) c) Ulcerative colitis (UC) d) Gastroenteritis
Hirschsprung disease The nurse should suspect Hirschsprung disease when the newborn does not pass meconium in the first 24 hours after birth, and has bilious vomiting or abdominal distention and feeding intolerance with bilious aspirates and vomiting. Typical signs and symptoms of gastroenteritis include diarrhea, nausea, vomiting, and abdominal pain. The characteristic GI manifestation of UC is bloody diarrhea accompanied by crampy, typically left-sided lower abdominal pain. Clinical manifestations of untreated SBS include profuse watery diarrhea, malabsorption, and failure to thrive.
A 10-year-old girl with an intestinal virus has been vomiting and has become dehydrated. She says she is mildly thirsty, her skin turgor is poor, and her skin is dry and cool. Her serum sodium level is normal. The nurse recognizes that she has which type of dehydration? a) Acidotic b) Hypertonic c) Isotonic d) Hypotonic
Isotonic Signs and symptoms of isotonic dehydration include the following: mild thirst; poor skin turgor; dry, cool skin; decreased urine output; irritability; and a normal sodium level. Signs and symptoms of hypotonic dehydration include the following: moderate thirst; very poor skin turgor; clammy, cool skin; decreased urine output; lethargy; and a reduced sodium level. Signs and symptoms of hypertonic dehydration include the following: extreme thirst; moderate skin turgor; warm skin; decreased urine output; extreme lethargy; and an increased sodium level. Acidotic is not a type of dehydration.
A nurse reads the medical history of a client who is scheduled for a hernia repair that is termed "reducible." What best describes this type of hernia? a) The herniated intestines are twisted and edematous. b) Its contents can be easily manipulated back into the peritoneal cavity. c) Intestinal obstruction and ischemia may occur. d) The abdominal contents have become trapped.
Its contents can be easily manipulated back into the peritoneal cavity. A hernia in the abdominal region is considered reducible when its contents are easily manipulated back into the peritoneal cavity. An incarcerated hernia occurs when the abdominal contents become trapped and difficult to reduce. A strangulated hernia occurs when the herniated intestines become twisted and edematous compromising blood flow. Intestinal obstruction and ischemia may occur.
A mother calls the doctor's office and tells the nurse that she is concerned because her 4-month-old keeps "spitting up" with every feeding. What would indicate that the child is regurgitating as opposed to vomiting? a) Is curdled and extremely sour smelling b) Continues until stomach is empty c) Is projected 1 ft away from infant d) Only occurs with feeding
Only occurs with feeding Regurgitation typically occurs only with feeding, runs out of the mouth with little force, smells barely sour and is only slightly curdled, appears to cause no pain or distress, occurs only once per feeding, and amounts to only about 1 to 2 tsp. Vomiting may occur at times other than feeding, is forceful and is typically projected 1 ft or more away from infant, is extremely sour smelling and curdled, is typically accompanied by crying, continues until the stomach is empty, and amounts to the full stomach contents.
The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is: a) Painless rectal bleeding b) Dehydration c) Ischemia d) Respiratory distress
Painless rectal bleeding With Meckel diverticulum, most symptomatic children present younger than age 2 years. Intermittent, painless rectal bleeding is the most common clinical manifestation of Meckel diverticulum. The blood is most often bright red or maroon and may be passed independent of stool due to ulceration at the junction of the ectopic tissue and the normal ileal mucosa.
A mother brings her 10-year-old son to the ER with complaints of abdominal pain. The nurse performing a physical assessment notes the following symptoms: upper right quadrant pain that radiates to the back; fever; nausea; and abdominal distention. Which disease would the nurse consider as a diagnosis? a) Ulcerative colitis b) Appendicitis c) Pancreatitis d) Crohn disease
Pancreatitis The child admitted with the suspicion of pancreatitis typically has a complaint of abdominal pain, either epigastric, upper left, or upper right quadrant pain that may radiate to the back. Nausea and vomiting, fever, tachycardia, hypotension, and jaundice may be present. Abdominal signs such as abdominal distention, decreased bowel sounds, rebound tenderness, and guarding also may be noted.
A 12-year-old boy has just undergone a liver transplantation and is recovering. After performing a finger stick puncture and assessing the results, the nurse administers a 10% solution of dextrose IV. What is the correct rationale for this intervention? a) Maintenance of electrolyte balance b) Prevention of T-cell rejection of the transplanted liver c) Reduction of hypertension d) Prevention of hypoglycemia
Prevention of hypoglycemia Hypoglycemia is a major danger following liver transplantation because glucose levels are regulated by the liver, and the transplanted organ may not function efficiently at first. Assess serum glucose levels hourly by finger stick puncture. A 10% solution of dextrose IV may be necessary to prevent hypoglycemia. Careful tissue matching before the transplantation is needed to reduce the possibility of stimulating T-cell rejection. Sodium, potassium, chloride, and calcium levels are evaluated approximately every 6 to 8 hours to be certain electrolyte balance is maintained, but potassium is rarely added to IV solutions because of the risk that renal failure has occurred. IV therapy with hypotensive agents such as hydralazine (Apresoline) and nitroprusside may be needed to reduce hypertension.
A mother is alarmed because her 6-week-old boy has begun vomiting almost immediately after every feeding. In the past week, the vomiting has grown more forceful, with the vomit projecting several feet from his mouth. He is always hungry again just after vomiting. At the physician's office, the nurse holds the child and gives him a bottle of water. While he drinks, she notes an olive-size lump in his right abdomen. Which condition should the nurse suspect in this child? a) Pyloric stenosis b) Peptic ulcer disease c) Gastroesophageal reflux d) Appendicitis
Pyloric stenosis With pyloric stenosis, at 4 to 6 weeks of age, infants typically begin to vomit almost immediately after each feeding. The vomiting grows increasingly forceful until it is projectile, possibly projecting as much as 3 to 4 feet. Infants are usually hungry immediately after vomiting because they are not nauseated. A definitive diagnosis can be made by watching the infant drink. If a pyloric stenosis is present, the sphincter feels round and firm, approximately the size of an olive in the right abdomen. Peptic ulcer disease in neonates usually presents with hematemesis (blood in vomitus) or melena (blood in the stool). Gastroesophageal reflux involves a small (1-2 tsp) volume and is not forceful. Appendicitis typically begins with anorexia for 12 to 24 hours; children do not eat and do not act like their usual selves. Nausea and vomiting may then occur, followed by diffuse abdominal pain.
Constipation may be initially caused by psychological problems. a) True b) False
True Some children begin holding stool for psychological reasons. Once the process begins, however, the hardened stool, the anal fissures, and the pain on defecation soon occur, and what began for an emotional reason becomes a physical ailment. This is important to understand, because with these children, therapy involves both counseling to correct the initial problem and treatment of the physical symptoms.
A 6-month-old boy is diagnosed with pyloric stenosis. When you take a health history from his mother, which symptom would you expect to hear her describe? a) Refusal to eat b) Chronic diarrhea c) Vomiting immediately after feeding d) Vomiting about 2 hours after feeding
Vomiting immediately after feeding A narrowing of the pyloric valve leads to projectile vomiting soon after eating.
You care for a 12-year-old girl with Crohn disease. A primary assessment you would want to make when caring for her would be to note if: a) lung sounds are clear. b) her joints are not swollen. c) she has a headache. d) she has a temperature.
she has a temperature. Because Crohn disease leads to patches of inflammation in the bowel, the temperature increases if more patches become involved.
The adolescent has been diagnosed with gastroesophageal reflux disease (GERD). Which statements by the teen indicates that adequate learning has occurred? Select all that apply. a) "It sounds like the physician is reluctant to give me a prokinetic because of the side effects." b) "This famotidine may make me tired." c) "I should try to lie down right after I eat." d) "I will probably need a laxative because of the omeprazole." e) "The omeprazole could give me a headache."
• "It sounds like the physician is reluctant to give me a prokinetic because of the side effects." • "This famotidine may make me tired." • "The omeprazole could give me a headache." Famotidine may cause fatigue. Omeprazole can cause headaches. Prokinetics use may result in side effects involving the central nervous system. Omeprazole use more likely will result in diarrhea, not constipation. Children with GERD should not lie down after meals
A doctor orders an abdominal radiograph for a newborn to check for Hirschsprung disease. The nurse examines the infant and finds which symptoms that are indicative of this disease? Select all that apply. a) Absence of stool in the rectum b) Presence of a fistula c) Abdominal distention d) Bilious vomiting e) Enterocolitis f) Displaced anus
• Abdominal distention • Absence of stool in the rectum • Bilious vomiting • Enterocolitis The nurse should suspect Hirschsprung disease when the newborn does not pass meconium in the first 24 hours after birth and has bilious vomiting or has abdominal distention, feeding intolerance, with bilious aspirates and vomiting. In anorectal malformations the anus is absent or displaced and the presence of a fistula may be noted when gas or stool is expelled from the urethra or vagina
A doctor orders an abdominal radiograph for a newborn to check for Hirschsprung disease. The nurse examines the infant and finds which symptoms that are indicative of this disease? Select all that apply. a) Abdominal distention b) Presence of a fistula c) Bilious vomiting d) Enterocolitis e) Absence of stool in the rectum f) Displaced anus
• Abdominal distention • Absence of stool in the rectum • Enterocolitis • Bilious vomiting The nurse should suspect Hirschsprung disease when the newborn does not pass meconium in the first 24 hours after birth and has bilious vomiting or has abdominal distention, feeding intolerance, with bilious aspirates and vomiting. In anorectal malformations the anus is absent or displaced and the presence of a fistula may be noted when gas or stool is expelled from the urethra or vagina.
The nurse is assessing a child with suspected necrotizing enterocolitis. Which of the following would the nurse expect to find? Select all that apply. a) Bilious vomiting b) Hyperirritability c) Tachypnea d) Clay-colored stools e) Abdominal distention
• Abdominal distention • Bilious vomiting Assessment findings associated with necrotizing enterocolitis include abdominal distention and tenderness, bloody stools, feeding intolerance characterized by bilious vomiting, sepsis, lethargy, apnea, and shock.
A child with cirrhosis of the liver is admitted to the acute care facility in preparation for a liver transplant. When completing the physical examination, what would the nurse expect to assess? Select all that apply. a) Facial erythema b) Ascites c) Spider angiomas d) Fatty stools e) Jaundice
• Jaundice • Spider angiomas • Ascites Assessment findings associated with cirrhosis include jaundice, ascites, spider angiomas, and palmar erythema. Fatty stools are associated with celiac disease
12-year-old Hilary is brought to the emergency room by her parents with severe abdominal pain. The nurse performs a physical assessment to check for appendicitis. Which assessment parameters indicate appendicitis? Select all that apply. a) Rebound tenderness present with palpation in the left upper quadrant b) Normal to hyperactive bowel sounds early c) Distended abdomen with unperforated appendicitis d) Hypoactive bowel sounds with perforation e) Irritation and pain in the right lower quadrant f) Low-grade fever, nausea, anorexia, and vomiting
• Normal to hyperactive bowel sounds early • Hypoactive bowel sounds with perforation • Irritation and pain in the right lower quadrant • Low-grade fever, nausea, anorexia, and vomiting On auscultation, bowel sounds are normal to hyperactive early in the course of appendicitis but become hypoactive with perforation. Percussion reveals irritation and pain in the right lower quadrant. Rebound tenderness is present with palpation in the right lower quadrant. Low-grade fever, nausea, anorexia, and vomiting typically occur after the onset of abdominal pain. The abdomen appears flat with unperforated appendicitis, but abdominal distention may be present once perforation occurs.
A nurse manages the interdisciplinary care for a client with pancreatitis. What are recommended interventions for this condition? Select all that apply. a) Administering analgesics for pain b) Administering corticosteroids c) Providing glycemia control d) Positioning the client in a fetal position e) Keeping the child NPO to rest the pancreas f) Using a high-fat diet when lipase occurs
• Providing glycemia control • Positioning the client in a fetal position • Administering analgesics for pain • Keeping the child NPO to rest the pancreas The main interventions for pancreatitis are supportive, including administration of antibiotics; stress ulcer prophylaxis; pain relief by analgesic administration; managing fluids; glycemia control; using a low-fat diet when lipase occurs; positioning the child in the fetal position to minimize tension of the peritoneum; and keeping the child NPO to rest the pancreas.
The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which foods would be permitted in the diet of the child with celiac syndrome? Select all that apply. a) Corn flakes b) Bananas c) Oatmeal d) Applesauce e) Rye bread f) Skim milk
• Skim milk • Bananas • Applesauce The child is usually started on a gluten-free, low-fat diet. Skim milk, banana flakes, and bananas are usually well tolerated. Lean meats, puréed vegetables, and fruits are gradually added to the diet. Wheat, rye, oat products, corn flour, and cornmeal are not included in the diet.
The nurse caring for a patient with Crohn disease knows that long-term complications for this patient might include (select all that apply): a) Fistula b) Gallstones c) Stricture d) Short-bowel syndrome e) Intra-abdominal abscess formation f) Pancreatitis
• Stricture • Fistula • Intra-abdominal abscess formation • Short-bowel syndrome Crohn disease is a recurrent disease. Long-term complications may include stricture, fistula, and intra-abdominal abscess formation. Individuals with severe disease who require extensive resection of diseased bowel may be left with short bowel syndrome and long-term dependence on PN.
The newborn was diagnosed with esophageal atresia and a nasogastric tube was inserted. Which finding is most consistent with this condition? a) X-ray revealed that the nasogastric tube was coiled in the upper esophagus. b) The newborn's skin was very jaundiced. c) The newborn coughed excessively during attempts to feed. d) Coarse crackles were auscultated throughout all lung fields. e) The newborn's mouth was very dry.
• The newborn coughed excessively during attempts to feed. • Coarse crackles were auscultated throughout all lung fields. • X-ray revealed that the nasogastric tube was coiled in the upper esophagus. Newborns with esophageal atresia cough during attempts to feed, may have fluid in their lungs, and x-rays will show that nasogastric tubes just coil in the upper part of the esophagus because the esophagus does not extend to the stomach. They have increased salivation in their mouths and their skin may be dusky or cyanotic.
