Ch 22 GI

An infant is found to have malrotation of the intestine. What is the therapeutic management to reverse this condition? 1 Surgery to remove the affected area 2 Holding feedings until bowel sounds are present in all four quadrants 3 Nothing-by-mouth status until the intestine rotates back into normal position 4 Beginning breastfeeding to help the intestine rotate back into normal position

1 Surgery to remove the affected area is the treatment for malrotation of the intestine. Nothing-by-mouth (NPO) status will not cause the intestine to rotate back into normal position. Breastfeeding will not help the intestine rotate back into normal position. Holding feedings until bowel sounds are present in all four quadrants will not cause the intestines to rotate back into normal position.

The nurse is aware of the need to maintain water balance in infants. Which infants would the nurse expect to have an increased need for water replacement? Select all that apply. 1 The infant in the radiant warmer 2 An infant with oliguric renal failure 3 The infant with congestive heart failure 4 An infant receiving phototherapy 5 The febrile infant who is vomiting

1, 4, 5 (I guessed 1, 2, 4, 5) A radiant warmer, phototherapy, and fever cause water loss through the skin due to evaporation. The febrile infant may also lose water due to vomiting. The infant with oliguric renal failure has decreased urine output and therefore a reduced need for water. The infant with congestive heart failure experiences lethargy and failure to excrete water; therefore this infant will have a decreased need for water replacement.

What does the nurse recognize as a nursing intervention that is contraindicated for children, especially infants with acute diarrhea? 1 Bathing 2 BRAT diet 3 Breastfeeding 4 Rehydration solution

2 A nursing intervention known as the BRAT diet (bananas, rice, applesauce, and toast or tea) that used to be offered for dehydration is now contraindicated in children, especially infants with acute diarrhea, because it is of little nutritional value. Bathing is not contraindicated. Breastfeeding is not contraindicated if it is established. Rehydration solution is the treatment of choice and therefore not contraindicated.

An 8-week-old infant is brought to the clinic. The infant's parents tell the nurse that the baby was thriving and doing well with only a mild amount of jaundice at birth but report that over the past several days the baby has become increasingly irritable and has started passing dark yellow urine and is having difficulty gaining weight. The nurse notices jaundice in the baby's sclerae. With what condition are these clinical manifestations associated? 1 Liver disease 2 Biliary atresia 3 Acute hepatitis 4 Peptic ulcer disease

2 Biliary atresia is associated with worsening of jaundice, especially in the sclerae; dark-yellow urine; difficulty gaining weight; and irritability in babies who were once thriving. Peptic ulcer disease, liver disease, and acute hepatitis have other presentations.

The nurse is caring for a child who had an appendectomy following a ruptured appendix and peritonitis. Which intervention does the nurse perform first for the child with risk for infection? 1 Listen for bowel sounds and bowel activity. 2 Monitor wound status, integrity, and type of dressing. 3 Maintain nasogastric (NG) tube gastric decompression. 4 Monitor temperature, blood pressure, and pulse oximeter.

2 Postoperative care for a child with a ruptured appendix and peritonitis requires thorough care. The first action is to monitor the wound status, integrity, and type of dressing to detect infection and plan interventions. The nurse should then monitor vital signs such as temperature, blood pressure, and pulse oximeter to detect fever or hemodynamic instability. The child should have nothing by mouth (NPO) while receiving IV fluids to prevent dehydration. The NG tube is kept on low continuous gastric decompression until there is evidence of intestinal activity. This prevents nausea and vomiting; it also promotes drainage of gastrointestinal secretions and acid. The nurse should evaluate bowel sounds and function by listening to bowel sounds and observing for other signs of bowel activity.

What manifestation in the infant does the nurse associate with hypertrophic pyloric stenosis? 1 Abdominal pain 2 Projectile vomiting 3 Edema at the extremities 4 Distended lower abdomen

2 The infant with hypertrophic pyloric stenosis has projectile vomiting, a sign of obstruction. Vomit may be ejected 3 to 4 feet from the infant when in a side-lying position or 1 foot or more when in a supine position. The infant does not have abdominal pain, except for discomfort due to hunger. The infant is hungry and shows signs of dehydration. There is no edema at the extremities. The infant has a distended upper abdomen as a result of gas and fluid above the level of the obstruction.

A child has a nasogastric (NG) tube after surgery for acute appendicitis. What is the purpose of the NG tube? 1 Maintain electrolyte balance 2 Prevent abdominal distention 3 Prevent the spread of infection 4 Maintain an accurate record of output

2 The nasogastric (NG) tube is used to maintain gastric decompression until intestinal activity returns. The NG tube may adversely affect electrolyte balance by removing stomach secretions. NG drainage is one part of the child's output. The nurse needs to include the NG drainage with other output. There is no relationship between the NG tube and prevention of the spread of infection.

A patient with gastrointestinal Helicobacter pylori is prescribed triple-drug therapy of bismuth, clarithromycin, and metronidazole as first-line treatment. Which condition does the nurse expect to be present in the patient? 1 Acute appendicitis 2 Peptic ulcer disease 3 Meckel diverticulum 4 Hirschsprung disease

2 The triple-drug therapy bismuth, clarithromycin, and metronidazole should be given as a first-line treatment for the patient with gastrointestinal H. pylori infection. This infection of H. pylori results in peptic ulcer disease. Acute appendicitis is an inflammation of theappendix, effectively treated by surgical removal of the appendix. Meckel diverticulum is a bulge in the small intestine treated with the surgical removal of the diverticulum. Hirschsprung disease is a gastrointestinal dysfunction, treated effectively with a resection of the diseased portion of the bowel.

The nurse is caring for a child with a peptic ulcer, who has been prescribed omeprazole. What is the effect of this drug on the child? 1 Protects the ulcerated mucosal layer 2 Inhibits hydrogen ion pump in parietal cells 3 Neutralizes gastric acid 4 Inhibits the growth of microorganisms

2 (I guessed 1) Proton pump inhibitors (PPIs), such as omeprazole, inhibit the hydrogen ion pump in the parietal cells, thus blocking the production of gastric acid. Sucralfate is an aluminum-containing agent that forms a protective barrier over the ulcerated mucosa to protect against acid and pepsin. Antacids are beneficial preparations that neutralize gastric acid. Bismuth compounds are sometimes prescribed for the relief of ulcers, but they are used less frequently than PPIs. These compounds inhibit the growth of microorganisms.

A nurse is caring for a 6-month-old infant who has been brought to the clinic with a moderate fever and foul-smelling watery stools for the past 2 days. What is the most common cause of diarrhea in children of this age group? 1 Shigella 2 Rotavirus 3 Salmonella 4 Escherichia coli

2 (I guessed 3) Rotavirus is the most common cause of diarrhea in children younger than 5 years of age; infants between 6 and 12 months are the most vulnerable. Signs and symptoms include mild to moderate fever and vomiting followed by onset of foul-smelling watery stools. Escherichia coli infection results in watery diarrhea and severe abdominal cramping. Salmonella infection results in nausea, vomiting, colicky abdominal pain, bloody diarrhea, and fever. Shigella infection results in fever, fatigue, anorexia, and crampy abdominal pain preceding watery or bloody diarrhea.

An infant with neurologic impairment and delay is receiving several medications, including a proton pump inhibitor. Which of these medications are proton pump inhibitors? Select all that apply. 1 Ranitidine 2 Omeprazole 3 Pantoprazole 4 Glycopyrrolate 5 Bethanechol

2, 3 Omeprazole (Prilosec) and Pantoprazole (Protonix) are proton pump inhibitors that block the action of acid-producing cells. Ranitidine (Zantac) is a histamine-2 (H2) receptor blocker, not a proton pump inhibitor. Ranitidine (Zantac) inhibits the action of histamine at the H2receptor site in the stomach, resulting in the inhibition of gastric acid secretion. Glycopyrrolate (Robinul) is an anticholinergic agent that is used to inhibit excessive salivation. Bethanechol (Urecholine) is a prokinetic drug; its use remains controversial.

What are some clinical manifestations of gastroesophageal reflux in infants? Select all that apply. 1 Heartburn 2 Spitting up 3 Chronic cough 4 Failure to thrive 5 Excessive crying and arching of the back

2, 4, 5 Clinical manifestations of gastroesophageal reflux in infants include spitting up, excessive crying and arching of the back, and failure to thrive. Heartburn and chronic cough are symptoms of gastroesophageal reflux in children, not infants.

A 3-month-old child presents with sudden acute abdominal pain. The child is having episodes of screaming and drawing knees to her chest followed by periods of comfort. The parent tells the nurse the child's stool looked like red jelly. What do these clinical manifestations suggest? 1 Omphalocele 2 Gastroschisis 3 Intussusception 4 Anorectal malformations

3 Acute abdominal pain followed by episodes of comfort accompanied with the passage of red jelly-like stools is the clinical manifestation of intussusception. An omphalocele is a birth defect in which the infant's intestine or other abdominal organs protrude through the abdominal wall. Gastroschisis is a birth defect in which an infant's intestines protrude from the body through a defect on one side of the umbilical cord. Anorectal malformations are birth defects in which the anus and rectum do not develop properly.

What should the nurse consider when providing support to a family whose infant has just been found to have biliary atresia? 1 Death usually occurs by 6 months of age. 2 The prognosis for full recovery is excellent. 3 Liver transplantation may be needed eventually. 4 Children with surgical correction live normal lives.

3 Approximately 80% to 90% of children with biliary atresia will require liver transplantation. When the condition is untreated, death usually occurs by 2 years of age. Long-term survival is possible with surgical intervention; liver transplantation is usually required for long-term survival. Even with surgical intervention most children progress to liver failure and require transplantation.

An 8-year-old child comes to the clinic with a history of constipation and malnourishment. Her parents say that her stools look like ribbons and smell strong. The nurse notes visible peristalsis and abdominal distension. With what condition are these clinical manifestations associated? 1 Dehydration 2 Constipation 3 Hirschsprung disease 4 Inflammatory bowel disease

3 Clinical signs of constipation, foul-smelling ribbon like stools, abdominal distention, visible peristalsis, an easily palpable fecal mass, and a malnourished, anemic appearance are all associated with Hirschsprung disease. These signs do not suggest dehydration, constipation, or inflammatory bowel disease.

What type of dehydration occurs when the electrolyte deficit exceeds the water deficit? 1 Isotonic 2 Moderate 3 Hypotonic 4 Hypertonic

3 Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic. Isotonic dehydration, the primary form of dehydration in children, occurs in conditions in which electrolyte and water deficits are present in approximately equal amounts. Moderate dehydration is a level of dehydration, not a type. Hypertonic dehydration results from water loss in excess of electrolyte loss and is usually caused by a proportionately larger loss of water or a larger intake of electrolytes.

The nurse reviews the medical record of a child with a cleft palate scheduled for surgery. Which finding suggests possible complications? 1 The child is 10 weeks old. 2 The child's weight is 10 pounds. 3 The child's hemoglobin content is 8 mg/dL. 4 The child's platelet count is 200,000 cells/mcL.

3 The rule of tens is followed before a child can undergo a cleft palate surgical repair. The hemoglobin level of the child at the time of surgery should be 10 mg/dL, so a low hemoglobin level may cause complications for the child. Following the rule of tens, the child should be at least 10 weeks old at the time of surgery, and the minimum weight of the child should be 10 pounds to reduce complications. The normal platelet count is 150,000 to 400,000 cells/mcL; this child has normal platelets and is not at risk for bleeding.

The parents of a 1-month-old infant bring the child to the clinic because the infant has been projectile vomiting 30 minutes after feeding. The parent describes the vomit as stale milk. On assessment the nurse palpates an olivelike mass. What condition do these clinical manifestations characterize? 1 Gastroschisis 2 Hiatal hernia 3 Umbilical hernia 4 Hypertrophic pyloric stenosis

4 Clinical manifestations of hypertrophic pyloric stenosis (HPS) include projectile vomiting 30 to 60 minutes after feeding with vomitus that resembles stale milk. An olivelike mass can be palpated when the stomach is empty. Gastroschisis is protrusion of intraabdominal contents. Hiatal hernia presents with dysphagia, growth failure, vomiting, neck contortions, frequent respiratory problems, and bleeding. Umbilical hernia is noted on inspection and palpation of the abdomen.

The nurse assesses a neonate immediately after birth. What is one clinical sign/symptom of tracheoesophageal fistula? 1 Jaundice 2 Absence of sucking 3 Bile-stained vomitus 4 An excessive amount of frothy saliva in the mouth

4 Excessive salivation and drooling are indicative of tracheoesophageal fistulas. The child with a fistula has difficulty managing the secretions, which may cause choking, coughing, and cyanosis. Jaundice and bile-stained vomitus are not usually associated with tracheoesophageal fistula. The infant is able to suck with a tracheoesophageal fistula but is not able to manage the secretions.

A nurse caring for a neonate immediately after birth notices an excessive amount of frothy mucus coming from the child's nose and mouth. What condition does the nurse suspect? 1 Cleft lip 2 Cleft palate 3 Biliary atresia 4 Tracheoesophageal fistula

4 One common sign of a tracheoesophageal fistula is excessive frothy mucus coming from the nose and mouth immediately after birth. Biliary atresia manifests as jaundice, dark-yellow urine, and light-colored stools. Cleft lip and palate present with facial malformations.

When evaluating the extent of an infant's dehydration, the nurse should recognize which symptoms of severe dehydration? 1 Tachycardia, decreased tears, 5% weight loss 2 Normal pulse and blood pressure, intense thirst 3 Irritability, moderate thirst, normal eyes and fontanels 4 Tachycardia, parched mucous membranes, sunken eyes and fontanels

4 Symptoms of severe dehydration include tachycardia, parched mucous membranes, and sunken eyes and fontanels. In severe dehydration there is a 15% weight loss in infants, not 5%, although the infant will exhibit tachycardia and decreased tears. Tachycardia, orthostatic hypotension and shock, and intense thirst would be expected in an infant with severe dehydration. The infant would be extremely irritable, with sunken eyes and fontanels, if severely dehydrated.

What should the nurse teach the parents of an infant with cleft lip (CL) about feeding? 1 Avoid breastfeeding; provide bottle feeds. 2 Use bottles with a narrow base nipple. 3 Feed the infant in the supine position. 4 Provide cheek support when feeding.

4 The CL may interfere with an infant's ability to achieve an adequate anterior lip seal. The parent must provide support by squeezing the cheeks together to decrease the width of the cleft. This may be useful in improving the lip seal during feeding. An infant with CL has no difficulty in breastfeeding because the breast tissue conforms to the cleft. If bottle fed, the bottles must have a wide nipple base, such as a Playtex nurser or a NUK (orthodontic) nipple. The infant with cleft lip must be positioned in an upright position during feeding. The head must be supported by the caregiver's hand or cradled in the arm to allow gravity to assist with the flow of the liquid.

The nurse is caring for a 6-year-old child who has been brought to the clinic with constipation. The nurse recognizes that constipation may arise as a result of a variety of conditions. Which condition is most commonly associated with constipation? 1 Acute appendicitis 2 Meckel diverticulum 3 Gastroesophageal reflux 4 Hirschsprung disease (HD)

4 (I guessed 3) Hirschsprung disease (HD) is a congenital anomaly that results in mechanical obstruction from inadequate motility of part of the intestine. Acute appendicitis is associated with inflammation and peritonitis. Meckel diverticulum causes bleeding, obstruction, and inflammation of the gastric mucosa. Gastroesophageal reflux is associated with heartburn, abdominal pain, dysphasia, and chronic cough