Chapter 23

The nurse is providing care for a child who has been diagnosed with rickets. What is the nurse's priority intervention? administration of adequate vitamin D administration of thiamine supplements administration of a high-calorie diet increased protein intake

1

A nurse is caring for a client who has a slightly jaundiced appearance to the skin secondary to hepatitis. Which laboratory study(ies) does the nurse anticipate being elevated due to the presence of the symptoms? Select all that apply. aspartate aminotransferase (AST) serum bilirubin red blood cell count alkaline phosphatase (ALP) serum triglycerides

1,2,4

Nurses will need to teach the parents of the infant being treated for Hirschsprung disease (aganglionic megacolon) to: care for a temporary colostomy. thicken formula feedings. avoid use of a pacifier. carefully monitor heart rate.

A

A child with gastroenteritis has been unable to keep oral medication down. What nursing intervention would be appropriate for this client? Place the child on NPO status. Hold all medications until the vomiting stops. Request an intravenous form of the medication. Give an antiemetic prior to giving oral medications.

C

The nurse is caring for a child with a diagnosis of pyloric stenosis during the preoperative phase of the child's treatment. What is the highest priority at this time? Preparing family for home care Promoting comfort Maintaining skin integrity Improving hydration

d

Pyloric stenosis has been diagnosed in a 3-week-old male infant who has frequent vomiting after feedings. An important preoperative nursing intervention is: reducing vomiting by feeding small amounts of clear liquids or breast milk frequently. maintaining NPO status while restoring hydration and electrolyte balance. assessing the abdomen hourly for distention and bowel sounds. providing adequate pain control.

2

The parents of a boy diagnosed with Hirschsprung disease are anxious and fearful of the upcoming surgery. The mother states, "I'm worried about having to care for our son's ostomy." Which intervention would be most helpful for the parents? Explaining to them about the diagnosis and surgery. Having a wound, ostomy, and continence nurse meet with them. Reinforcing that the ostomy will be temporary. Teaching them about the medications used to slow stool output.

b

the nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis? sausage-shaped mass in the upper mid abdomen perianal fissures and skin tags abdominal pain and irritability hard, moveable "olive-like mass" in the upper right quadrant

d

The nurse is determining maintenance fluid requirements for a child who weighs 25 kg (55 lb). How much fluid would the child need per day? 1,560 ml 1,600 ml 1,650 ml 1,700 ml

1600

The caregiver of a child diagnosed with celiac disease tells the nurse that the child has large amounts of bulky stools and what looks like fat in the stools. The clinical manifestation this caregiver is describing is: steatorrhea. severe diarrhea. currant jelly stools. projectile stools.

A

The nurse recognizes that in the disorder referred to as rickets, the child has a lack of vitamin D. Because of the lack of vitamin D, the absorption of which of the following is decreased? calcium and phosphorus vitamin C and thiamine riboflavin and niacin iron and potassium

A

Hepatitis A is spread by which mode of transmission? Blood Fecal-oral Respiratory droplets Body fluids

B

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? Gastroenteritis Ulcerative colitis (UC) Hirschsprung disease Short bowel syndrome (SBS)

C

The nurse is caring for an infant recovering from surgery for pyloric stenosis. Which nursing diagnosis should the nurse use to guide care during the immediate postoperative period? Anxiety related to new feeding method used postoperatively Ineffective tissue perfusion related to pressure on heart chambers Excess fluid volume related to increased fluid intake prescribed postoperatively Risk for infection of incision line, related to disruption of skin barrier during surgery

D

The parents of a child diagnosed with celiac disease ask the nurse what types of food they can offer their child. What recommendation would the nurse include in the teaching plan? Frozen yogurt Rye bread Creamed spinach Fruit juice

Fruit juice

A parent brings a 2-year-old child to the health clinic with reports of diarrhea, vomiting, and abdominal pain. The father tells the nurse that he is a single parent and his child is enrolled in a local day care center. Based on this information, what gastrointestinal condition might the nurse suspect? Appendicitis Pancreatitis Gastroenteritis Hirschsprung disease

Gastroenteritis

In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention? Prepare the infant for surgery. Medicate the infant with analgesics. Change the infant's diet to one that is lactose-free. Assist in doing a barium enema procedure on the infant.

a

The nurse has performed client education for a 15-year-old boy with Crohn disease and his parents regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning has occurred? "I have to be careful because I am prone to not absorbing nutrients." "I have a lot of diarrhea every day because of how my small intestine is damaged." "I may end up with a colectomy because the disease is continuous from the beginning to the end of my intestines." "It's unusual for someone my age to get Crohn disease."

a

The nurse is caring for a 3-year-old with repeated diarrhea. The client is listless and clings to the parent. The nurse reviews the lab work, which reports a pH- 7.33, HCO3- 21, PaCO2- 42. Which would be documented? metabolic acidosis metabolic alkalosis high serum pH normal serum pH

a

Pyloric stenosis has been diagnosed in a 3-week-old male infant who has frequent vomiting after feedings. An important preoperative nursing intervention is: reducing vomiting by feeding small amounts of clear liquids or breast milk frequently. maintaining NPO status while restoring hydration and electrolyte balance. assessing the abdomen hourly for distention and bowel sounds. providing adequate pain control.

b

The nurse is collecting data on a 2-year-old child admitted with a diagnosis of gastroenteritis. When interviewing the caregivers, which question is most important for the nurse to ask? "How many times a day does your child urinate?" "How long has your child been toilet trained?" "Tell me about the types of stools your child has been having." "What foods has your child eaten during the last few days?"

c

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of gastroesophageal reflux? A partial or complete intestinal obstruction occurs. A thickened, elongated muscle causes an obstruction at the end of the stomach. There are recurrent paroxysmal bouts of abdominal pain. In this disorder the sphincter that leads into the stomach is relaxed.

d

The nurse is caring for a 12-year-old child with Crohn disease. What assessment finding will the nurse report to the health care provider when caring for the child? clear lung sounds fever no joint swelling report of a headache

fever

The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is: respiratory distress. painless rectal bleeding. dehydration. ischemia.

painless rectal bleeding

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 offers him a bottle. While he drinks, the nurse notes an olive-size lump in his right abdomen. Which condition should the nurse suspect in this child? pyloric stenosis peptic ulcer disease gastroesophageal reflux appendicitis

pyloric stenosis

Parents ask the nurse to explain why they should encourage their reluctant child to eat when the youngster is receiving total parenteral nutrition (TPN). What is the reason the nurse will provide? for prevention of liver damage to keep the digestive system healthy and functioning so that nausea can be avoided to prevent electrolyte imbalance

B

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 offers him a bottle. While he drinks, the nurse notes an olive-size lump in his right abdomen. Which condition should the nurse suspect in this child? pyloric stenosis peptic ulcer disease gastroesophageal reflux appendicitis

A

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? "You will most likely have a blood test to check for certain antibodies." "You will most likely have an ultrasound evaluation." "You will most likely have viral studies." "You will most likely be tested for ammonia levels."

A

When providing diaper care to an infant after pyloric stenosis surgery, which approach is indicated? Diapers should be folded so that the incision line is well covered to prevent infection. Diapers should be folded so that the incision line does not become contaminated. Diapers should not be used. Sterile diapers should be used.

b

The nurse is advising a group of new parents on how to care for their infant at home if the baby develops mild diarrhea. Which statement indicates that teaching has been effective? "I should offer milk after each episode of diarrhea." "I should take the baby's temperature and call my physician." "I could give Kaopectate as long as I follow the directions on the bottle." "I should offer Pedialyte after 1 hour and frequently thereafter to prevent dehydration."

d

The parent of a 3-week-old infant brings the infant in for an evaluation. During the visit, the parent tells the nurse that the infant is spitting up after feedings. Which response by the nurse would be most appropriate? "Thicken the formula by adding rice cereal." "Infants this age commonly spit up." "Your child might have an allergy." "Do not worry; you are just feeding your infant too much."

2

The nurse is caring for an infant recovering from surgery for pyloric stenosis. Which nursing diagnosis should the nurse use to guide care during the immediate postoperative period? Anxiety related to new feeding method used postoperatively Ineffective tissue perfusion related to pressure on heart chambers Excess fluid volume related to increased fluid intake prescribed postoperatively Risk for infection of incision line, related to disruption of skin barrier during surgery

4

An infant brought to the emergency department has been vomiting for 2 days. The nurse assesses the infant and finds sunken fontanels (fontanelles), tenting skin, dry mucus membranes and no urine output for 12 hours. Which intervention(s) will the nurse complete as first-line care for this infant? Select all that apply. Insert a peripheral IV. Begin maintenance IV fluids. Start oral rehydration. Administer a prescribed IV fluid bolus. Administer an antiemetic.

1, 4,5

The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration? Pale and slightly dry mucosa Blood pressure of 80/42 mm Hg Tenting of skin Soft and flat fontanels (fontanelles)

C

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurately related to the diagnosis of colic? A partial or complete intestinal obstruction occurs. A thickened, elongated muscle causes an obstruction at the end of the stomach. There are recurrent paroxysmal bouts of abdominal pain. In this disorder the sphincter that leads into the stomach is relaxed.

C

The nurse is providing care to a child with an intussusception. The child has a bowel movement and the nurse inspects the stool. The nurse would most likely document the stool's appearance as having what quality? Greasy Clay-colored Currant jelly-like Bloody

Currant jelly-like

A 6-week-old infant is diagnosed with pyloric stenosis. When taking a health history from the parent, which symptom would the nurse expect to hear described? Refusal to eat Vomiting about 2 hours after feeding Chronic diarrhea Vomiting immediately after feeding

D

A child has presented to the clinic with diarrhea. The nurse should teach the parent to give which item to properly care for the child? milk salty soups salty crackers bananas

D

The nurse has developed a plan of care for a 12-month-old hospitalized with dehydration as a result of rotavirus. Which intervention would the nurse include in the plan of care? Encouraging consumption of fruit juice Offering Kool-Aid or popsicles as tolerated Encouraging milk products to boost caloric intake Maintaining the intravenous (IV) fluid rate as ordered

Maintaining the intravenous (IV) fluid rate as ordered

A child with gastroenteritis has been unable to keep oral medication down. What nursing intervention would be appropriate for this client? Place the child on NPO status. Hold all medications until the vomiting stops. Request an intravenous form of the medication. Give an antiemetic prior to giving oral medications.

Request an intravenous form of the medication.

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? Only occurs with feeding Is projected 1 ft away from infant Is curdled and extremely sour smelling Continues until stomach is empty

a

A nurse is caring for a 4-year-old child who has undergone surgery to repair a hernia. Which of the following is a priority nursing intervention for this client? assisting with early ambulation to facilitate peristalsis restricting fluids to prevent fluid and electrolyte imbalance encouraging shallow breathing to protect the incision using nonpharmacologic interventions for pain management to prevent constipation

a

What occurs in the gastrointestinal system of the child with Hirschsprung disease? There is a partial or complete mechanical obstruction in the intestine. There is a severe narrowing of the lumen of the pylorus. There is an invagination or telescoping of one portion of the bowel into a distal portion. There is a relaxed sphincter in the lower portion of the esophagus.

a

A mother is told that her child will receive total parenteral nutrition. She asks the nurse what this means. The nurse bases her response on knowledge that total parenteral nutrition is: daily IM injections of vitamins. nutrition through a nasogastric tube. administration of Ringer's lactate through a peripheral IV line. administration of fluids, electrolytes, amino acids, lipids, dextrose, and minerals through an IV.

administration of fluids, electrolytes, amino acids, lipids, dextrose, and minerals through an IV.

A neonatal nurse examines an infant born with a congenital diaphragmatic hernia (CDH). The nurse is prepared for what condition associated with CDH that generally occurs at birth or within the first few hours of life? intussusception malrotation anemia respiratory distress

respiratory distress