Chapter 42

A child is experiencing an acute exacerbation of Crohn disease for which she is prescribed prednisone. The nurse teaches the parents and child about this medication. Which statement by the parents indicates that the teaching was successful? "She might lose some weight initially." "This drug helps to control the abdominal cramping." "We might notice some of the medication in her stool." "We should not stop this medication abruptly."

"We should not stop this medication abruptly."

The nurse is taking a health history of a 2-year-old girl presenting with a sudden onset of severe vomiting. Which description would suggest an obstruction? Effortless vomiting Bloody vomiting Projectile vomiting Bilious vomiting

Bilious vomiting

A 10-year-old male presents with low-grade fever, nausea, and abdominal pain. The nurse examining him suspects appendicitis and checks for rebound tenderness in what quadrant? Upper left Upper right Lower left Lower right

Lower right

An adolescent has hepatitis B. What would be the most important nursing action? Strict enforcement of standard precautions Strict calculation of caloric and vitamin B intake Close observation to detect cerebral hallucinations Conscientious collection of stool for ova and parasites

Strict enforcement of standard precautions

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

Tenting of skin

The nurse completes a 1-month-old's feeding and sits the infant up to burp. The infant vomits back the feeding. Which is the nurse's primary concern? stunted growth aspiration nutritional deficiency stomach irritation

aspiration

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? fever clear lung sounds report of a headache no joint swelling

fever

A 12-year-old boy has just undergone a liver transplantation and is recovering. After performing a fingerstick puncture and assessing the results, the nurse administers a 10% solution of dextrose IV. What is the correct rationale for this intervention? Prevention of T-cell rejection of the transplanted liver Prevention of hypoglycemia Maintenance of electrolyte balance Reduction of hypertension

Prevention of hypoglycemia

The nurse is caring for a 6-month-old infant who was admitted to the emergency department 24 hours ago with signs of severe diarrhea. The infant's rectal temperature is 104°F (40°C), with weak and rapid pulse and respirations. The skin is pale and cool. The child is on IV rehydration therapy, but the diarrhea is persisting. The infant has not voided since being admitted. Which is the priority nursing intervention? Administer antibiotic therapy Feed the child a cracker Administer IV potassium Take a stool culture

Take a stool culture

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? GI tract obstruction intussusception acute upper GI bleeding gastroesophageal reflux

acute upper GI bleeding

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? "Infants this age commonly spit up." "Do not worry; you are just feeding your infant too much." "Your child might have an allergy." "Thicken the formula by adding oat cereal."

"Infants this age commonly spit up."

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 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." "I have a lot of diarrhea every day because of how my small intestine is damaged." "I have to be careful because I am prone to not absorbing nutrients."

"I have to be careful because I am prone to not absorbing nutrients."

The nurse is providing discharge teaching regarding oral fluid rehydration to a mother who brought her child to the clinic because of vomiting over the past 2 days. The child is mildly dehydrated. Which comments by the mother indicated learning occurred? "My child can drink milk if he feels like it to help in rehydration." "Solutions like Pedialyte are not necessary for mild dehydration." "I should not give my child any fluids for 1 to 2 hours after an episode of vomiting." "I should be sure my child receives 50 to 100 ml/kg of oral rehydration solution (ORS) over 4 hours." "Oral rehydration solutions (ORS) are good sources of fluids for rehydration."

"I should not give my child any fluids for 1 to 2 hours after an episode of vomiting." "I should be sure my child receives 50 to 100 ml/kg of oral rehydration solution (ORS) over 4 hours." "Oral rehydration solutions (ORS) are good sources of fluids for rehydration."

The student nurse is caring for a child with the nursing diagnosis "Risk for fluid volume deficit related to inadequate oral intake." Which statement by the student would indicate a need for further education by the nursing instructor? "I will weigh her every morning at the same time." "I will make sure there is plenty of orange juice available. It's her favorite juice." "I will teach her mother to give her small drinks frequently." "I will monitor her IV line to help maintain her fluid volume."

"I will make sure there is plenty of orange juice available. It's her favorite juice."

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? "The treatment for the disorder will be a surgical procedure." "Your child will be treated with oral iron preparations to correct the anemia." "We will give enemas until clear and then teach you how to do these at home." "Your child will receive counseling so the underlying concerns will be addressed."

"The treatment for the disorder will be a surgical procedure."

The nurse is preparing a client for surgery and the client asks, "What does it mean when they say they are going to reduce my abdominal hernia?" Which response by the nurse is most appropriate? "The health care provider will remove about half of the herniated contents during the procedure." "If you do not understand this, I need to cancel your surgery and have the health care provider come back." "All this means is that the herniated intestines are twisted and edematous, which is why you need surgery." "This means the hernia contents will be manipulated back into your peritoneal cavity during surgery."

"This means the hernia contents will be manipulated back into your peritoneal cavity during surgery."

A 9-month-old girl is brought to the emergency room with what appears to be bouts of intense abdominal pain 15 minutes apart in which she draws up her legs and cries, often accompanied by vomiting. In between the bouts, the child recovers and appears to be without symptoms. Blood is found in the stool. What condition should the nurse suspect in this case? Necrotizing enterocolitis Intussusception Short-bowel/short-gut syndrome Volvulus with malrotation

Intussusception

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

There is a partial or complete mechanical obstruction in the intestine.

The nurse is reviewing the history of a child who has chronic oral lesions. What risk factors does the nurse expect to find when reviewing the child's history? Select all that apply. history of anemia frequent bouts of constipation several episodes of tonsillitis severe malabsorption from a GI disorder recently finished the last chemotherapy treatment for leukemia

severe malabsorption from a GI disorder recently finished the last chemotherapy treatment for leukemia

An 18-month-old infant is brought to the emergency department with flu-like symptoms. The infant is diagnosed with pneumonia secondary to aspiration of stomach contents. The nurse explains to the parents that pneumonia is a condition that often occurs secondary to: inflammatory bowel disease. Hirschsprung disease. cystic fibrosis. gastroesophageal reflux disease.

gastroesophageal reflux disease.

A 3-month-old is admitted with severe diarrhea. Yesterday, the infant weighed 11 pounds (5 kg). Today, this infant weighs 9 pounds, 8 ounces (4.3 kg). Based on this information the nurse documents that the infant has: malabsorption syndrome. risk for fluid volume deficit. severe dehydration. failure to thrive.

severe dehydration.

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: severe diarrhea. currant jelly stools. projectile stools. steatorrhea.

steatorrhea.

The client calls the health care provider's office stating that her preschooler drank laundry detergent from under the sink. Which statement by the parent needs further instruction? "I will watch my child's breathing status and keep my child calm." "I will find out how much of the liquid my child drank." "I will call the Poison Control Center now." "I will use syrup of ipecac to get it out of my child's system."

"I will use syrup of ipecac to get it out of my child's system."

A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition? Endoscopic retrograde cholangiopancreatography Surgery Barium enema Upper endoscopy

Barium enema

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? Improving hydration Maintaining skin integrity Promoting comfort Preparing family for home care

Improving hydration

The nurse is talking with a woman in her second trimester of pregnancy who has been diagnosed with polyhydramnios. The physician has ordered an ultrasound be performed to check for the presence of esophageal atresia. Which statement by the woman indicates an understanding of the relationship between these conditions? "Enzymes in amniotic fluid can cause the development of esophageal atresia." "Reductions in amniotic fluid are associated with the development of esophageal atresia." "Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup." "Babies with esophageal atresia produce an excessive amount of amniotic fluid."

"Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup."

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? "Give a clear pediatric electrolyte replacement for the next few hours, then call back to report on how your child is doing." "Continue breastfeeding as you have been doing. The fluid from the breast milk is important to maintain fluid balance." "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."

"Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment."

The mother of an infant tells the nurse during a routine visit to the clinic that she often notices a bulging mass in the lower abdominal and groin area when her baby cries. She asks the nurse if this is normal. How should the nurse respond? "I will be sure to note this in your child's chart so it is something we will continue to monitor in future visits." "I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately." "The muscle wall of infants are not yet strong so it isn't unusual to see this happening when the baby is crying or straining." "I didn't notice any masses while I was assessing your infant. It may just appear they have a mass due to pressure in the abdomen when crying."

"I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately."

The nurse is caring for an infant recently diagnosed with oral candidiasis (thrush) who has been prescribed nystatin. Which statement by the infant's mother would suggest a need for further education? "I will use a cotton tipped applicator to apply the medication to her mouth." "I will add the nystatin to her bottle four times per day." "I will watch for diaper rash." "I will make sure to clean all of her toys before I give them to her."

"I will add the nystatin to her bottle four times per day."

The nurse is providing preoperative teaching for the parents of an 8-month-old child with Hirschsprung disease who will have two-stage surgery as treatment. Which statement by the parents demonstrates the need for further teaching? "After the surgery, we will slowly re-introduce easy-to-digest solids." "Our child will have a nasogastric tube for the first day after the surgery to receive nutrition." "Our child will have a colostomy from the first surgery and a second surgery to repair the bowel." "We will be able to resume breastfeeding about one day after the surgery."

"Our child will have a nasogastric tube for the first day after the surgery to receive nutrition."

The student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply. "The entire family will need to eat a gluten-free diet." "Gluten is found in most wheat products, rye, barley and possibly oats." "The only treatment for celiac disease is a strict gluten-free diet." "Most children with celiac disease are diagnosed within the first year of life." "Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders."

"Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "The only treatment for celiac disease is a strict gluten-free diet." "Gluten is found in most wheat products, rye, barley and possibly oats."

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 long has your child been toilet trained?" "How many times a day does your child urinate?" "Tell me about the types of stools your child has been having." "What foods has your child eaten during the last few days?"

"Tell me about the types of stools your child has been having."

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? "The surgery creates an opening between the stomach and abdominal wall." "The surgery will create an opening to the large intestine." "The surgery will create an opening to the small intestine." "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."

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 be tested for ammonia levels." "You will most likely have an ultrasound evaluation." "You will most likely have viral studies." "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."

The nurse is providing care to a child who has had an appendectomy for a perforated appendix. The nurse would anticipate intravenous antibiotic therapy for how long? 1 to 3 days 7 to 14 days 3 to 5 days 5 to 7 days

7 to 14 days

The nurse is caring for a pediatric client with idiopathic celiac disease. Which meal will the nurse select for this client? Ham and cheese sandwich, orange slices, chips, and whole milk Baked salmon, potato slices, vanilla ice cream, and apple juice Whole wheat pasta, meatballs, carrot sticks, apple, and water Meatloaf, green beans, peanut butter cookie, and fat-free milk

Baked salmon, potato slices, vanilla ice cream, and apple juice

The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child? Effortless vomiting just after the child has eaten Severe constipation with occasional ribbon-like stools Forceful vomiting followed by the child being eager to eat again Bouts of diarrhea with failure to gain weight

Effortless vomiting just after the child has eaten

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

Hirschsprung disease

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.

In this disorder the sphincter that leads into the stomach is relaxed.

The emergency department nurse is assessing a child who has presented with a 2-day history of nausea and vomiting with pain that is isolated to the right upper quadrant of the abdomen. Which action is most appropriate? Assess the child's usual urinary voiding pattern. Prepare the child for admission to the hospital. Encourage fluid intake. Administer antacids as ordered.

Prepare the child for admission to the hospital.

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

Prepare the infant for surgery.

An adolescent is diagnosed with hepatitis A. Which problem should be considered when planning care? The adolescent's urine will be dark and infectious. The adolescent will become fatigued easily. Hypothermia is common. The adolescent will be very irritable and perhaps require sedation.

The adolescent will become fatigued easily.

A child has been diagnosed with pinworms. What home care instruction(s) will the nurse give the parent? Select all that apply. Wash the hands after toileting and before meals. Change the bedding and wash in hot water. Trim all nails short. Only one dosage of anthelmintic is needed. Restrict the child and siblings from sleeping in the same room. Encourage all family members to get treated with an anthelminthic.

Wash the hands after toileting and before meals. Change the bedding and wash in hot water. Trim all nails short. Encourage all family members to get treated with an anthelminthic.

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. bananas skim milk applesauce wheat bread rye bread

bananas skim milk applesauce

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? hernia esophageal atresia (EA) pyloric stenosis cleft palate

esophageal atresia (EA)

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

hard, moveable "olive-like mass" in the upper right quadrant

The nurse is reviewing the medical record of a child with a cleft lip and palate. When reviewing the child's history, what would the nurse identify as a risk factor for this condition? mother age 42 with pregnancy maternal use of acetaminophen in third trimester preterm birth history of hypoxia at birth

mother age 42 with pregnancy

Which type of nutrition does the nurse anticipate initiating when an infant with gastroenteritis and dehydration begins solid foods? oral rehydration solutions half strength infant formula the normal formula clear liquids

oral rehydration solutions

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

painless rectal bleeding.

A parent brings a 10-year-old child to the emergency room with reports 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 suspect? Crohn disease ulcerative colitis pancreatitis appendicitis

pancreatitis

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? appendicitis pyloric stenosis gastroesophageal reflux peptic ulcer disease

pyloric stenosis

Which congenital condition leads to the infant being hungry, irritable, losing weight, and rapidly becoming dehydrated with the potential of metabolic alkalosis? aganglionic megacolon intussusception pyloric stenosis colic

pyloric stenosis

A nurse is providing care to an 11-month-old infant diagnosed with intussusception. When assessing the appearance of the child's stool, the nurse expects to note which finding? loose, dark green stool hard, formed large brown stool clay-colored, watery stools red, currant jelly-like stool

red, currant jelly-like stool

A nurse prepares a menu for a client with Crohn disease. What is the focus of dietary management for this disease? Low fiber, low calorie Low calorie, high carbohydrate High calorie, high fiber High carbohydrate, high protein

High carbohydrate, high protein

The nurse is caring for a 6-month-old infant with diarrhea and dehydration. The parent is concerned because the infant has some patches on the tongue. Which feature indicates a geographic tongue? The patches are thick, white plaques on the tongue. There are also white patches on the erupted teeth. Some patches are light in color and other patches are dark in color. There are also plaques on the buccal mucosa.

Some patches are light in color and other patches are dark in color.

A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason? detect Helicobacter pylori evaluate gastric pH confirm pancreatitis determine esophageal contractility

detect Helicobacter pylori

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

Only occurs with feeding