Chapter 22 The Child with Gastrointestinal Dysfunction Hockenberry

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 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 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. Inhibits hydrogen ion pump in parietal cells 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.

Which diet is most appropriate for the child with celiac disease? 1. Salt-free 2. Low-gluten 3. Phenylalanine-free 4. High-calorie, low-protein, low-fat

2. Low-gluten Celiac disease is characterized by intolerance of gluten, the protein found in wheat, barley, rye, and oats. A low-gluten diet is indicated for life. The diet for a child with celiac disease does not have to be salt free. A low-phenylalanine diet is indicated in phenylketonuria. The diet of a child with celiac disease should be high in calories and protein and low in fat in addition to the low-gluten requirement.

A 2-month-old breastfed infant is receiving oral rehydration solution for acute diarrhea. What instructions should the nurse give the mother about breastfeeding? 1. To continue breastfeeding 2. To supplement breastfeeding with water 3. To stop breastfeeding until the diarrhea has ceased for 24 hours 4. To express breast milk and dilute it with sterile water before feedings

1. To continue breastfeeding

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. Tracheoesophageal fistula

What is an appropriate breakfast for the hospitalized child who has celiac disease? 1. Eggs, turkey bacon, fruit 2. Cheerios, low-fat milk, fruit 3. Pancakes, eggs, turkey bacon 4. Eggs, turkey bacon, toast, low-sugar orange juice

1. Eggs, turkey bacon, fruit

What factors contribute to infants' having a greater and more rapid water loss than adults? Select all that apply. 1. Infants lose a large amount of fluid at birth. 2. Infants are less likely than adults to become febrile. 3. Infants maintain more extracellular fluid than do adults. 4. Infants have the same amount of intracellular fluid as adults. 5. Infants with acute illnesses retain extracellular fluid more than adults do.

1. Infants lose a large amount of fluid at birth. 3. Infants maintain more extracellular fluid than do adults.

What does management of the child with a peptic ulcer often include? 1. Proton pump inhibitors 2. Milk at frequent intervals 3. Coping with stress and adjusting to chronic illness 4. Antacids 1 and 3 hours before meals and at bedtime

1. Proton pump inhibitors

A school-age child with acute diarrhea and mild dehydration is being given oral rehydration solution (ORS). The child's mother calls the clinic nurse because the child is also occasionally vomiting. What should the nurse recommend? 1. Alternating ORS and carbonated drinks 2. Continuing to give ORS frequently in small amounts. 3. Bringing the child to the hospital for intravenous fluids 4. Instituting nothing-by-mouth status for the child for 8 hours and resuming ORS if the vomiting subsides

2. Continuing to give ORS frequently in small amounts.

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. Spitting up 4. Failure to thrive 5. Excessive crying and arching of the back

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. Liver transplantation may be needed eventually.

The nurse is caring for an infant with celiac disease. Why does the nurse expect the child to be prescribed a wheat-free diet at all times? 1. To avoid constipation 2. To avoid formation of fecalith 3. To prevent villous atrophy 4. To prevent fecal impaction

3. To prevent villous atrophy Celiac disease is a permanent intestinal intolerance to dietary wheat gliadin and is related to proteins. It produces mucosal lesions and villous atrophy in the small bowel. Villous atrophy leads to malabsorption caused by the reduced absorptive surface area. The child has chronic diarrhea, not constipation, after the introduction of gluten-containing wheat products. Appendicitis is caused by obstruction of the lumen of the appendix, usually by hardened fecal material or fecalith. Chronic stool-withholding behavior may cause the rectal vault to become distended over time, leading to fecal impaction.

What should the nurse teach the parents about caring for the infant with gastroesophageal reflux (GER)? 1. Place the infant supine after feeding. 2. Feed the infant just before bedtime. 3. Place the infant on the side to sleep. 4. Avoid vigorous play after feedings.

4. Avoid vigorous play after feedings.

Constipation has recently become a problem for a school-age boy who just started attending a new school. What is the most likely cause of his constipation? 1. Puberty 2. Allergies 3. High-fiber diet 4. Fear of using bathrooms at school

4. Fear of using bathrooms at school

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. Provide cheek support when feeding.

Which type of diarrhea is associated with antibiotic therapy? 1. Acute diarrhea 2. Chronic diarrhea 3. Chronic nonspecific diarrhea 4. Intractable diarrhea of infancy

1. Acute diarrhea Acute diarrhea is associated with antibiotic therapy. Chronic diarrhea is associated with malabsorption syndromes. Chronic nonspecific diarrhea is associated with dietary indiscretions and food sensitivities. Intractable diarrhea of infancy is a syndrome that occurs in the first few months of life.

The nurse is providing nutritional counseling to a patient who presented with severe diarrhea, fistulas, weight loss, and severe growth retardation. Which statement by the patient indicates effective learning? 1. "I should consume a high-protein diet." 2. "It's OK to drink coffee sometimes." 3. "I should avoid high-calorie foods." 4. "I should avoid iron supplements."

1. "I should consume a high-protein diet." The patient who has severe diarrhea, fistulas, weight loss, and severe growth retardation more than likely has inflammatory bowel disease (IBD). A well-balanced, high-protein, high-calorie diet is recommended for children whose symptoms do not prohibit an adequate oral intake. Caffeine increases diarrhea so the nurse should instruct the patient to refrain from consuming coffee. This patient requires high-calorie food for proper growth. Supplementation with multivitamins, iron, and folic acid is recommended.

The nurse is caring for a child with hepatitis A. What is the main mode of transmission of this disease? 1. Fecal-oral route 2. Parenteral route 3. Breastfeeding 4. Transplacental blood

1. Fecal-oral route The main mode of transmission of hepatitis A is the fecal-oral route. This route spreads the virus (directly or indirectly) through the ingestion of contaminated foods, direct exposure to infected fecal material, or close contact with an infected person. Hepatitis B and C are transmitted parenterally, through exposure to blood and blood products. Most hepatitis B infection in children is acquired perinatally. Hepatitis B also spreads from the mother to the infant during breastfeeding, especially if the mother has cracked nipples. In addition, hepatitis B can be transmitted to the infant in the last trimester through transplacental blood.

Which factors would the nurse attribute to insensible fluid loss in an infant? Select all that apply. 1. Heat and humidity 2. Body temperature 3. Stool formation 4. Urine formation 5. Respiratory rate

1. Heat and humidity 2. Body temperature 5. Respiratory rate

An adolescent who has been consuming a low-sodium diet for a long period is at risk for: 1. Water excess 2. Hyponatremia 3. Hypernatremia 4. Water depletion

2. Hyponatremia

The nurse is caring for a child with Crohn disease (CD). What is a distinctive characteristic of CD? 1. Inflammation is limited to the distal colon and rectum. 2. Inflammation results in stiffening of the bowel wall. 3. The most dangerous form is toxic megacolon. 4. Rectal bleeding is common in these patients.

2. Inflammation results in stiffening of the bowel wall. CD is a form of inflammatory bowel disease. The inflammation may result in the stiffening of the bowel wall. Other manifestations include ulcerations, fibrosis, adhesions, stricture formation, and fistulas to other loops of bowel, bladder, vagina, or skin. Inflammation occurs in any part of the gastrointestinal tract from the mouth to the anus but most often affects the terminal ileum. In ulcerative colitis (UC), the inflammation is limited to the distal colon and rectum. The most dangerous form of severe colitis is toxic megacolon. Rectal bleeding due to inflammation and ulceration is common in patients with UC.

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. Projectile vomiting

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. Hypertrophic pyloric stenosis 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.

What should dietary management of a child with inflammatory bowel disease include? 1. High-fiber foods 2. Low-calorie foods 3. Low-protein foods 4. Vitamin supplements

4. Vitamin supplements

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. Prevent abdominal distention 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.

Which inflammatory bowel disease is characterized by inflammation limited to the colon and rectum? 1. Celiac disease 2. Crohn disease 3. Ulcerative colitis 4. Meckel diverticulum

3. Ulcerative colitis Ulcerative colitis is an inflammatory bowel disease that is characterized by inflammation limited to the colon and rectum. Celiac disease is a permanent intestinal intolerance to dietary wheat gliadin and related proteins that produces mucosal lesions in genetically susceptible individuals. Crohn disease is a chronic inflammatory process that may involve any part of the gastrointestinal tract, from mouth to anus. Meckel diverticulum is the most common congenital malformation of the gastrointestinal tract.

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. BRAT diet 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.

What information should the nurse include when teaching an adolescent with Crohn's disease? 1. Nutritional guidance and prevention of constipation 2. How to cope with stress and adjust to chronic illness 3. How to preventing the spread of illness to others and nutritional guidance 4. How to adjust to chronic illness and prevent the spread of illness to others

2. How to cope with stress and adjust to chronic illness

The nurse is teaching a 2-year-old's parent about necessary dietary restrictions needed to manage celiac disease. Which statement made by the parent indicates effective learning? 1. "I should include oats in my child's breakfast daily." 2. "I should provide rye bread in my child's daily diet." 3. "I should provide a bowl of rice in my child's lunch and dinner." 4. "I should include two slices of wheat bread in my child's daily diet."

3. "I should provide a bowl of rice in my child's lunch and dinner."

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. Hirschsprung disease 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 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.

Which factor predisposes an infant to fluid imbalances? 1. Lower metabolic rate 2. Decreased surface area 3. Immature kidney function 4. Decreased daily exchange of extracellular fluid

3. Immature kidney function The infant's kidneys are unable to concentrate or dilute urine, to conserve or excrete sodium, or to acidify urine. The infant has a proportionally greater body surface area than an adult, permitting greater insensible water loss. The infant also has a higher metabolic rate and an increased amount of extracellular fluid. Approximately 60% of fluid loss is from the extracellular space.

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. Intussusception 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.

Infection with which bacterial pathogen that results in acute diarrhea has the highest incidence in infants? 1. Giardia 2. Shigella 3. Salmonella 4. Campylobacter

3. Salmonella Salmonella infection has the highest occurrence in infants; Giardia and Shigella infections have the highest incidence among toddlers. Campylobacter infection has a bimodal presentation that is highest in children younger than 12 months of age, with a second rise in incidence between the ages of 15 and 19 years.

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 child's hemoglobin content is 8 mg/dL. 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.

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

The nurse is discussing home care with the mother of a 6-year-old child with hepatitis A. What should the discharge teaching plan include? 1. Teaching infection-control measures to family members 2. The importance of bedrest until 1 week after the icteric phase 3. The need for the child not to return to school until 3 weeks after the icteric phase 4. Reassurance for the mother that hepatitis A cannot be transmitted to other family members

1. Teaching infection-control measures to family members Hepatitis A is a contagious disease that is transmitted by way of the fecal-oral route. The nurse should teach infection-control measures to family members. Hepatitis A does not usually have an icteric phase and often is subclinical. The period of communicability for hepatitis A is the latter half of the incubation period to 1 week after the onset of clinical illness; therefore the child may return to school after that time frame. Because hepatitis A is infectious through the fecal-oral route, family members may be susceptible to the disease if they fail to institute proper infection-control measures.

Which statement best describes Hirschsprung disease? 1. The colon has an aganglionic segment. 2. It results in frequent evacuation of solids, liquids, and gas. 3. There is a passage of excessive amounts of meconium in the neonate. 4. It results in excessive peristaltic movements within the gastrointestinal tract.

1. The colon has an aganglionic segment. Hirschsprung disease is a mechanical obstruction caused by a lack of motility (peristalsis) of a segment of the intestine that lacks ganglionic cells; therefore it is referred to as aganglionic megacolon. Hirschsprung disease is associated with a neonate's inability to pass meconium or an older child's inability to pass feces. The infant or child with Hirschsprung disease will be seen with constipation or the passage of ribbonlike stools.

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. An excessive amount of frothy saliva in the mouth 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 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. Peptic ulcer disease 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.

What should the nurse teach the parents about reducing the risk for transmitting bacteria via food? 1. Keep food out of the refrigerator for 3 hours before cooking. 2. Wash hands with hot, soapy water after contact with raw meat. 3. Cook all dishes made with ground meat until pale pink inside. 4. Wash vegetables that cannot be peeled in running water.

2. Wash hands with hot, soapy water after contact with raw meat.