GI Practice Qs
The parents of a 4-week-old report that their infant has forceful vomiting but seems very hungry immediately after vomiting. Upon further questioning, the nurse notifies the physician of the findings and pyloric stenosis is suspected. The nurse prepares the parents for the possibility of which diagnostic procedures and treatment? Select all that apply A. surgical repair B. pyloric ultrasound C. physical examination of the abdomen D. upper GI series E. CT scan
A,B,C,D Frequently, a diagnosis is made with the client history and palpation of a hard, moveable "olive" mass in the right upper quadrant. If no mass is palpated, the most common diagnostic procedure is a pyloric ultrasound. An upper GI series is sometimes performed, but this test is much more invasive than an ultrasound. Surgical repair is necessary. A CT scan is not warranted.
A nurse is teaching a patient of an infant about gastrointestinal reflux disease. Which of the following should the nurse include in the teaching? (Select-all-that-apply) A. Offer frequent feedings B. Thicken formula with rice cereal C. Use a bottle with one-way valve. D. Position baby upright after feedings. E. Use a wide-based nipple for feedings.
A,B,D These are appropriate measures to prevent reflux events by reducing the amount of vomiting episodes after eating. C and E are measures to take for infants who have cleft lip and palate.
A nurse is assessing an infant who has hypertrophic pyloric stenosis. Which of the following manifestations should the nurse expect? (Select all that apply) A. Projectile vomiting B. Dry mucus membranes C. Currant jelly stool D. Sausage-shaped abdominal mass E. Constant hunger
A,B,E A client who has pyloric stenosis would have projectile vomiting (classic symptom), dry mucus membranes (due to dehydration), and constant hunger. Currant jelly stool and sausage-shaped abdominal mass are findings in intussuception.
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? A. Take a stool culture B. Administer antibiotic therapy C. Administer IV potassium D. Feed the child a cracker
A Treatment of severe diarrhea focuses on regulating electrolyte and fluid balance by initiating a temporary rest for the gastrointestinal tract, oral or IV rehydration therapy, and discovering the organism responsible for the diarrhea. All children with severe diarrhea or diarrhea that persists longer than 24 hours should have a stool culture taken to determine if bacteria are causing the diarrhea; if so, a definite antibiotic therapy can be prescribed. Because a side effect of many antibiotics is diarrhea, antibiotics should not routinely be used to treat diarrhea without an identifiable bacterial cause. Before the initial IV fluid is changed to a potassium solution, be certain the infant or child has voided—proof that the kidneys are functioning; in this case, the child is not voiding yet. The child should not be fed a cracker, as the gastrointestinal tract should be rested until the diarrhea stops.
A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition? A. Air enema B. Endoscopic retrograde cholangiopancreatography C. Surgery D. Upper endoscopy
A Air 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.
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? A. "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." B. "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." C. "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." D. "I will be sure to note this in your child's chart so it is something we will continue to monitor in future visits."
A The mother is describing common symptoms of an inguinal hernia. It may be possible to visualize the mass, but often the mass is seen only during crying or straining, making it difficult to actually identify in the clinic setting. It is important to notify the physician so treatment can be initiated.
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. GI tract obstruction C. intussusception D. gastroesophageal reflux
A 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.
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? A. pyloric stenosis B. peptic ulcer disease C. gastroesophageal reflux D. appendicitis
A 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 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.
A 2-year-old male patient was brought to the clinician with the complaints of nasal speech, difficulty eating, difficulty swallowing with liquids and foods often coming out of the nose, and chronic ear infections. On examination, there was a split in the roof of the mouth that did not affect the appearance of the face. What is the ideal age for surgical intervention in this case? A. 4 months B. 10 to 12 months C. 2 years D. 5 years
B A cleft palate can be corrected by surgery, usually performed between 10 and 12 months of age. Cleft palate repair before the beginning of the speech is a priority. Even with repair, the possibility of a speech impairment exists. Postoperative care in these patients requires measures to protect the surgical site from trauma.
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? A. "If you do not understand this, I need to cancel your surgery and have the health care provider come back." B. "This means the hernia contents will be manipulated back into your peritoneal cavity during surgery." C. "The health care provider will remove about half of the herniated contents during the procedure." D. "All this means is that the herniated intestines are twisted and edematous, which is why you need surgery."
B A hernia in the abdominal region is considered reducible when its contents are easily manipulated back through the inguinal ring into the peritoneal cavity. The nurse would reinforce this education, already provided by the primary health care provider when the surgery was explained, to the client. It is not necessary to cancel surgery when the nurse can provide education to the client. Reducing does not mean the intestines are twisted and edematous. Nor does it mean half of the contents will be removed.
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. hernia B. esophageal atresia (EA) C. pyloric stenosis D. cleft palate
B A maternal history of polyhydramnios is usually present in one-third of cases of EA and in some cases of tracheoesophageal fistula (TEF).
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. "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." B. "Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." C. "Give a clear pediatric electrolyte replacement for the next few hours, then call back to report on how your child is doing." D. "Continue breastfeeding as you have been doing. The fluid from the breast milk is important to maintain fluid balance."
B An infant's body comprises 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 child with gastrointestinal concerns. What statement by the parent would indicate a need for the nurse to further assess the child for constipation? A. "My child eats vegetables and fresh fruit, but does not like beans." B. "My child has such large bowl movements that it clogs the toilet." C. "My child does not have liquid stool or leak liquid stools that I am aware of." D. "My child only has a bowel movement about four times a week."
B Constipation may manifest by bowel movements that are large enough to clog the toilet, fewer bowel movements than normal, and bowel movements that are hard and pellet-like. Constipation is not likely if the child eats fruits and vegetables, even when beans are not incorporated into the child's diet. Passage of liquid stools can be a sign of constipation (encopresis)
The nurse is caring for a child admitted with pyloric stenosis. Which clinical manifestation would likely have been noted in the child with this diagnosis? A. Severe abdominal pain B. Projectile vomiting C. Frequent urination D. Explosive diarrhea
B During the first weeks of life, the infant with pyloric stenosis often eats well and gains weight and then starts vomiting occasionally after meals. Within a few days the vomiting increases in frequency and force, becoming projectile. The child may have constipation, and peristaltic waves may be seen in the abdomen, but the child does not appear in severe pain. Urine output is decreased and urination is infrequent.
A nurse is caring for an infant who has a non-communicating hydrocele. Which of the following actions should the nurse take? A. Prepare the client for a surgery. B. Explain to the parents that the issue will self-resolve. C. Retract the foreskin and cleanse several times a day. D. Refer the family to genetic counseling.
B Non-communicating hydrocele is fluid in the scrotum and resolves spontaneously in the majority of the cases; the actions listed in other options are unnecessary and may be detrimental.
The nurse is caring for an infant. The infant's mother asks the nurse, "What did the doctor mean when he said she may have regurgitation?" What response by the nurse is appropriate? A. "Regurgitation is not normal in infants. She will need more testing to see what is causing this." B. "Regurgitation is the backflow of stomach contents up into the esophagus or mouth." C. "Regurgitation is when an infant can't tolerate their formula. You will need to switch." D. "Regurgitation is just another term for vomiting. All infants vomit some."
B Regurgitation is the backflow of stomach contents up into the esophagus and/or oral cavity. The muscle tone of the lower esophageal sphincter is not fully developed until age 1 month, so infants younger than 1 month of age frequently regurgitate after feedings. Many children younger than 1 year of age continue to regurgitate for several months, but this usually disappears with age.
The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration? A. Blood pressure of 80/42 mm Hg B. Tenting of skin C. Soft and flat fontanels (fontanelles) D. Pale and slightly dry mucosa
B Tenting of skin is an indicator of severe dehydration. Soft and flat fontanels (fontanelles) indicate mild dehydration. Pale and slightly dry mucosa indicates mild or moderate dehydration. Blood pressure of 80/42 mm Hg is a normal finding for an infant.
The nurse is administering an enteral feeding to a child with a gastrostomy tube (G-tube). Which action will the nurse take when administering a prescribed feeding through the client's G-tube? A. Position the client with the head of the bed at a 20° angle. B. Check for gastric residual before starting feeding. C. Use a syringe plunger to administer the feeding. D. After feeding, flush the tube with a small amount of saline and leave the G-tube open for 2 minutes.
B The nurse should check for gastric residual before starting feeding by gently aspirating from the tube with a syringe or positioning the tube below the level of the stomach with only the barrel of the syringe attached. The client should be positioned with his or her head elevated 30° to 45° and the formula should be allowed to flow with gravity, not plunged unless the tube is clogged. After feeding, the nurse should flush the tube with a small amount of water, unless contraindicated, and leave the G-tube open for 5 to 10 minutes after feeding to allow for escape of air.
The nurse is discussing the treatment of congenital aganglionic megacolon (Hirschsprung's disease) with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis? A. "Your child will be treated with oral iron preparations to correct the anemia." B. "The treatment for the disorder will be a surgical procedure." C. "We will give enemas until clear and then teach you how to do these at home." D. "Your child will receive counseling so the underlying concerns will be addressed."
B 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.
A school-aged child is brought to the emergency room with severe abdominal pain. The nurse performs a physical assessment. Which assessment parameters indicate appendicitis? Select all that apply. A. Distended abdomen with unperforated appendicitis B. Hypoactive bowel sounds with perforation C. Low-grade fever, nausea, anorexia, and vomiting D. Normal to hyperactive bowel sounds early E. Rebound tenderness present with palpation in the left upper quadrant F. Irritation and pain in the right lower quadrant
B,C,D,F 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.
An infant was noted at his 18-month well visit to have a steady decline in his weight percentile measurement from previous visits. His height and head circumference had continued to trend normally. Due to concerns about the etiology of his poor weight gain, the patient was admitted to the hospital for further evaluation. Lab evaluation at the time was unremarkable. During his hospitalization, the patient demonstrated that he could consume the recommended amount of daily calories by mouth, and he was gaining weight at the time of discharge one week ago. He presents to the outpatient clinic today for a follow-up weight check. He is well appearing, but the exam is notable for a 0.5 kg weight loss from his discharge weight last week. What is the best next step in management? A. Readmit the patient to the hospital B. Dismiss the weight loss, as it is probably related to difference in scale calibration C. Determine what barriers are preventing appropriate caloric intake at home. D. Prescribe a high-caloric toddler formula in addition to the patient's regular diet.
C At its core, FTT is related to inadequate calories to support age-appropriate weight gain. Based on the patient's response, the patient likely has an inorganic cause of FTT. This patient was able to gain weight and consume appropriate calories as an inpatient making other organic causes of his failure to thrive unlikely. Determining why he could not sustain the same caloric intake at home must be addressed. The patient gained weight adequately while in the hospital with a regular diet alone. Additional high-calorie supplements are unnecessary and may mask a more significant underlying etiology for his decreased caloric intake in the home setting. While differences in scale calibration can contribute to variance in measurements, this should be a diagnosis of exclusion, especially in the setting of known poor weight gain.
A patient is scheduled for appendectomy at noon. While performing your morning assessment, you note that the patient has a fever of 103.8 'F and rates abdominal pain 9 on 1-10. In addition, the abdomen is distended and the patient states, "I was feeling better last night but it seems the pain has become worst." The patient is having tachycardia and tachypnea. Based on the scenario, what do you suspect the patient is experiencing? A. Pulmonary embolism B. Colon Fistulae C. Peritonitis D. Hemorrhage
C Based on the patient's presenting symptoms, the patient is most likely experiencing peritonitis because the appendix has ruptured. The key clues in this scenario are the classic signs and symptoms of peritonitis (tachycardia, tachypnea, high temperature, and abdominal pain/distension) along with the patient's statement that they were feeling better last night (hence probably the time the appendix ruptured) which periodically relieved the pain at the appendix but allowed for the contents of the appendix to leak into the peritoneal cavity, eventually leading to peritonitis.
A term infant presents at four weeks after birth with pale stools and dark urine. The mother claims that the infant was doing fine until recently and has developed a yellowish skin color as well. Physical examination reveals distended abdomen with liver enlargement. Blood work reveals elevated bilirubin and liver enzymes. Imaging studies reveal blockage of the bile duct. What is the ideal treatment for this patient? A. Liver transplantation B. Percutaneous drainage C. Kasai procedure (Roux-en-Y hepatoportoenterostomy) D. Steroids
C Biliary atresia is defined as an obstructive cholangiopathy, the etiology of which is unclear and causes obstruction to the bile flow. It typically presents in neonates, usually at 2 to 8 weeks of age, with jaundice, dark urine and pale stools. Physical examination may reveal hepatomegaly, splenomegaly, ascites, and other signs of portal hypertension. The standard treatment is surgical, which is Roux-en-Y hepatic portoenterostomy or Kasai procedure, and if the procedure fails or cirrhosis is far advanced, a liver transplant is considered. Steroids may be used as adjuncts to enhance biliary drainage after the surgery.
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? A. "I have a lot of diarrhea every day because of how my small intestine is damaged." B. "It's unusual for someone my age to get Crohn disease." C. "I have to be careful because I am prone to not absorbing nutrients." D."I may end up with a colectomy because the disease is continuous from the beginning to the end of my intestines."
C Crohn disease typically affects the small intestine more than the large intestine and its onset is between the ages of 10 to 20 years. The cobblestone lesions in the small intestine prevent absorption of nutrients that normally occurs (Image of cobblestone lesions in the small intestine)
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? A. "How many times a day does your child urinate?" B. "How long has your child been toilet trained?" C. "Tell me about the types of stools your child has been having." D. "What foods has your child eaten during the last few days?"
C 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 the number and type of stools per day. Recent eating patterns, determining 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.
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: A. cystic fibrosis. B. inflammatory bowel disease. C. gastroesophageal reflux disease. D. Hirschsprung disease.
C Gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus. These refluxed contents may be aspirated into the lungs. The child with gastroesophageal reflux disease may present with the physical findings of pneumonia or GER-induced asthma. GER may cause apnea or an apparent life-threatening event in the younger infant.
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. There are recurrent paroxysmal bouts of abdominal pain. B. A partial or complete intestinal obstruction occurs. C. In this disorder the sphincter that leads into the stomach is relaxed. D. A thickened, elongated muscle causes an obstruction at the end of the stomach.
C Gastroesophageal reflux (GER) occurs when the sphincter in the lower portion of the esophagus, which leads into the stomach, is relaxed and allows gastric contents to be regurgitated back into the esophagus.
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? A. "Thicken the formula by adding oat cereal." B. "Do not worry; you are just feeding your infant too much." C. "Infants this age commonly spit up." D. "Your child might have an allergy."
C In infants younger than 1 month of age, the lower esophageal sphincter is not fully developed. Therefore, infants younger than 1 month of age frequently regurgitate after feedings. Many children younger than 1 year of age continue to regurgitate for several months, but this usually disappears with age. Adding oat cereal to the infant formula should only be done when medically indicated and under the recommendation of a health care provider.
A 17 year old patient is admitted with suspected appendicitis. The patient states he is having pain around the umbilicus that extends into the lower part of his abdomen. In addition, he says that the pain is worst on the right lower quadrant. The patient points to his abdomen at a location which is about a one-third distance between the anterior superior iliac spine and umbilicus. This area is known as what? A. Rovsing's Point B. Hamman's Point C. McBurney's Point D. Murphy's Point
C This is known as McBurney's Point and is a classic sign and symptom in patients with appendicitis.
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? A. Appendicitis B. Pancreatitis C. Gastroenteritis D. Hirschsprung disease
C 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.
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? A. Encourage fluid intake. B. Administer antacids as ordered. C. Prepare the child for admission to the hospital. D. Assess the child's usual urinary voiding pattern.
C The child's presentation is consistent with cholecystitis, which necessitates surgery in most cases. The child should be kept NPO and antacids are of no benefit. Genitourinary involvement is atypical.
What occurs in the gastrointestinal system of the child with Hirschsprung disease? A. There is an invagination or telescoping of one portion of the bowel into a distal portion. B. There is a partial or complete mechanical obstruction in the intestine. C. There is a relaxed sphincter in the lower portion of the esophagus. D. There is a severe narrowing of the lumen of the pylorus.
B Congenital aganglionic megacolon, also called Hirschsprung disease, is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin.
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? A. Upper right B. Upper left C. Lower left D. Lower right
D With appendicitis, percussion reveals irritation and pain in the right lower quadrant. Rebound tenderness present with palpation in the right lower quadrant is referred to as the McBurney point, an area of tenderness 1.5 to 2 inches (3.8 to 5 cm) in from the right anterior superior iliac spine along a line extending to the umbilicus.
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? A. 1 to 3 days B. 3 to 5 days C. 7 to 14 days D. 5 to 7 days
C The child with a perforated appendix requires 7 to 14 days of intravenous antibiotic therapy. If the child has a suppurative or gangrenous appendix that was not perforated, 2 to 3 days of antibiotics would be most likely ordered.
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: A. severe diarrhea. B. steatorrhea. C. currant jelly stools. D. projectile stools.
B Celiac disease is an immunologic response to gluten, which causes damage to the small intestine. Steatorrhea (fatty stools) is a classic symptom of celiac disease. Symptoms also include abdominal distention or bloating, constipation, and nutritional deficiencies. Currant jelly stools are a sign of intussusception. Projectile vomiting is a sign of pyloric stenosis. Severe diarrhea could be caused by a bacteria or virus. Projectile stools represent severe diarrhea.
A nurse is caring for a child who has Hirschsprung's disease. Which of the following actions should the nurse take? A. Encourage a high-fiber, low-protein, low-calorie diet. B. Prepare the family for surgery. C. Place an NG tube for decompression. D. Initiate bed rest.
B A client with Hirschsprung's disease requires a surgery to remove the affected segment of the intestine. Preparing family for the surgery is an appropriate action for the nurse to take.
The labor and delivery nurse is caring for a mother who has demonstrated polyhydramnios upon delivery. The newborn displays copious, frothy bubbles of mucus in the mouth and nose, as well as drooling. The nurse is concerned that the infant has what disorder? A. esophageal atresia B. hiatal hernia C. gastroschisis D. omphalocele
A Esophageal atresia refers to a congenitally interrupted esophagus where the proximal and distal ends do not communicate; the upper esophageal segment ends in a blind pouch and the lower segment ends a variable distance above the diaphragm. Polyhydramnios is often the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation.
A nurse reviews the record of an infant who is seen in the clinic. The nurse notes that a diagnosis of esophageal atresia with tracheoesophageal fistula (TEF) is suspected. The nurse expects to note which most likely clinical manifestation of this condition in the medical record? A. Incessant crying B. Coughing at nighttime C. Choking with feedings D. Severe projectile vomiting
C Any child who exhibits the "3 Cs"—coughing and choking during feedings and unexplained cyanosis—should be suspected of having TEF
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. Gastroenteritis B. Hirschsprung disease C. Short bowel syndrome (SBS) D. Ulcerative colitis (UC)
B 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 13-day-old premature neonate, born at 30 weeks gestation develops poor feeding, abdominal distention, and bloody stools. The mother reports that the patient has just begun bottle feeding. Abdominal radiography shows small amounts of air within the bowel wall. Which of the following is pertinent to the further findings? A. Midgut volvulus B. Necrotizing enterocolitis C. Intussusception
B The signs and symptoms of necrotizing enterocolitis are highly variable, nonspecific, and subtle. Parents often report decreased activity and fatigue. They may also report gastrointestinal symptoms such as decreased appetite, vomiting, diarrhea, and increasing abdominal girth. Patients may also experience blood in the stool. As the disease progresses, tissue shows ischemia, followed by necrosis, and ultimately perforation. Perforation may lead to pneumatosis intestinalis or air within the intestine wall (picture). In perforation, the peritoneal cavity becomes contaminated with bacteria and bowel content, leading to peritonitis.
A 4-month-old otherwise healthy male is brought by his mother for evaluation of a scrotal mass. The mother is unsure if the mass has been present since birth and is not sure if it has recently increased in size. The patient's familial history is unremarkable. Which finding on the exam would indicate no need for further workup? A. A firm, tender, palpable mass B. Transillumination of the mass with a penlight C. Increase of mass with crying D. A tender mass with scrotal edema and erythema
B Transillumination of the mass with a penlight is a reassuring finding demonstrating a hydrocele, since fluid will allow the light to pass through, whereas a solid mass would block the passage of light. If a mass if firm and tender, with signs of edema/erythema, further workup is needed to rule out testicular torsion or a neoplastic (cancerous) mass. Increase of mass with crying could suggest hernia, and additional testing, such as ultrasound, is needed to rule out abdominal organs protruding into the scrotum.
The student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply. A. "Most children with celiac disease are diagnosed within the first year of life." B. "The only treatment for celiac disease is a strict gluten-free diet." C. "Gluten is found in most wheat products, rye, barley and possibly oats." D. "Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." E. "The entire family will need to eat a gluten-free diet."
B,C,D Celiac disease is an immunologic disorder in which gluten causes damage to the small intestine. The only treatment currently is consuming a gluten-free diet. While the child needs to have a gluten-free diet, the rest of the family does not. Most children present by the age of 2 for evaluation. Symptoms of celiac disease include diarrhea, constipation, steatorrhea, weight loss, poor muscle tone, anemia and dental disorders. Gluten is found in most grains, like wheat, rye, barley and possibly oats.
A nurse is assigned to care for a child who is scheduled for an appendectomy. Which prescriptions does the nurse anticipate will be prescribed? Select all that apply. A. Administer a Fleet enema. B. Initiate an intravenous line. C. Maintain nothing-by-mouth status. D. Administer intravenous antibiotics. E. Administer preoperative medications. F. Place a heating pad on the abdomen to decrease pain.
B,C,D,E During the preoperative period, enemas or laxatives should not be administered. In addition, heat should not be applied to the abdomen. Any of these interventions can cause the rupture of the appendix and resultant peritonitis. Intravenous fluids would be started, and the child should receive nothing by mouth while awaiting surgery. Antibiotics are usually administered because of the risk of perforation. Preoperative medications are administered as prescribed.
The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis? A. abdominal pain and irritability B. sausage-shaped mass in the upper mid abdomen C. hard, moveable "olive-like mass" in the upper right quadrant D. perianal fissures and skin tags
C A hard, moveable "olive-like mass" in the right upper quadrant is the hypertrophied pylorus. A sausage-shaped mass in the upper mid abdomen is the hallmark of intussusception. Perianal fissures and skin tags are typical with Crohn disease. Abdominal pain and irritability is common with pyloric stenosis but are seen with many other conditions.
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. A lot of mucus and blood are found in the stool. What condition should the nurse suspect in this case? A. Necrotizing enterocolitis B. Short-bowel/short-gut syndrome C. Intussusception D. Volvulus with malrotation
C Intussusception, the invagination of one portion of the intestine into another, usually occurs in the second half of the first year of life. Children with this disorder suddenly draw up their legs and cry as if they are in severe pain; they may vomit. After the peristaltic wave that caused the discomfort passes, they are symptom-free and play happily. In approximately 15 minutes, however, the same phenomenon of intense abdominal pain strikes again. After approximately 12 hours, blood appears in the stool and possibly in vomitus, described as a "currant jelly" appearance.
A 5-month-old male baby was brought to the clinician with the complaints of a nasal speaking voice, difficulty swallowing with liquids and foods often coming out of the nose, and recurrent discharge from the left ear. On examination, there was a split in the roof of the mouth that did not affect the appearance of the face. What is the ideal feeding position in this case? A. Standing B. Prone C. Sitting D. Lateral
C Sitting is the ideal position for an infant with cleft lip deformity. The sitting position has minimal risk of aspiration and leakage of the liquids into the nasal passages. Infants suffering from cleft palate deformity need to be burped repeatedly due to the swallowing of excessive air during feeding. Infants with cleft lip deformity should be fed with specially designed feeding bottles until the surgery is done to correct the defect.
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. "My son could have some appearance-related self-esteem issues." B. "I need to watch for pain, tenderness, or redness." C. "I can tape a quarter over the hernia to reduce it." D. "An incarcerated hernia is rare, but it can occur."
C The use of home remedies to reduce an umbilical hernia should be discouraged because of the risk of bowel strangulation (obstruction). The mother needs to be aware that strangulation can occur, but it is rare with an umbilical hernia. Pain, tenderness, or redness indicates an incarcerated hernia, 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 talking with a pregnant client about cleft lips and palates. The client has asked if these can be tested for. What information should be included in the nurse's response? Select all that apply. A. The nuchal translucency test can be used to screen for cleft lips and palates. B. There are no ways to determine the presence of cleft lips or palates prior to delivery. C. Most cleft lips and palates are found at delivery. D. Ultrasounds can be used to assess for these conditions. E. The quadruple marker test can be used to detect these conditions.
C, D Ultrasounds can be used to identify the presence of cleft lips or palates. Most, however, are found after birth. The quadruple screening test assesses for potential down syndrome and neuro tube defects. Nuchal translucency testing is used to assess for Down syndrome.
What other signs and symptoms are associated with appendicitis. SELECT-ALL-THAT-APPLY: A. Increased red blood Cells B. Patient has the desire to be positioned in the prone position to relieve pain C. Umbilical pain that extends in the right lower quadrant D. Abdominal rebound tenderness E. Abdominal Flaccidity
C,D These are classic signs and symptoms found in patients with appendicitis. Option A is wrong because the patient may have increased White blood cells, especially lymphocytes. Option B is wrong because the patient may have the desire to be in the fetal position (side-lying with the knees bent) to relieve the pain. The prone position would increase the pain. Option E is wrong because the patient would have abdominal RIGIDITY (not flaccidity).
The nurse is teaching the mother of an infant with a temporary ileostomy about stoma care. What is the most important instruction to emphasize to the mother to avoid an emergency situation? "You may need adhesive remover to ease pouch removal." "Gather all of your supplies before you begin." "You must be meticulous in caring for the surrounding skin." "Call the doctor immediately if the stoma is not pink/red and moist."
D A healthy stoma is pink and moist. If the stoma is dry or pale, the mother must notify the health care provider immediately because it could indicate compromised circulation. Gathering supplies is important but would not be involved in avoiding an emergency situation. All of the other instructions are valid, but emphasizing the color of the healthy stoma is most important to avoid an emergency situation.
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? A. report of a headache B. no joint swelling C. clear lung sounds D. fever
D Crohn disease may affect any area of the digestive tract. It causes acute and chronic inflammation. It may also cause abscesses and fistulas. Inflammation and abscesses can cause fever. An increasing temperature could be the manifestation of the inflammation worsening or the development of an abscess and subsequent infection. The progression of the disease will be reported to the health care provider.
