gi practice questions
A mother calls the clinic nurse about her 4-year-old son who has acute diarrhea. She has been giving him the antidiarrheal drug loperamide (Imodium A-D). The nurse's response should be based on what knowledge about this drug? a. Not indicated b. Indicated because it slows intestinal motility c. Indicated because it decreases diarrhea d. Indicated because it decreases fluid and electrolyte losses
ANS: A Antidiarrheal medications are not recommended for the treatment of acute infectious diarrhea. These medications have adverse effects and toxicity, such as worsening of the diarrhea because of slowing of motility and ileus, or a decrease in diarrhea with continuing fluid losses and dehydration. Antidiarrheal medications are not recommended in infants and small children.
A four year old who has just had her appendix out, wakes up with her mother at the bedside. Which of the following comments would be most developmentally appropriate: a. "When you feel better your friends can come visit you" b. "There is a big band-aid where the doctors fixed your belly pain" c. "You will be able to return to preschool really soon" d. "Let's close the curtain while I look at your tummy'
ANS: B A four year old would not be as concerned with friends visiting or privacy. Returning to school may not be "really soon". Four year olds are concerned with body integrity. Telling her there is a big band-aid covering the area will alleviate fears of "things leaking out".
Parents call the clinic and report that their toddler has had acute diarrhea for 24 hours. The nurse should further ask the parents if the toddler has which associated factor that is causing the acute diarrhea? a. Celiac disease b. Antibiotic therapy c. Immunodeficiency d. Protein malnutrition
ANS: B Acute diarrhea is a sudden increase in frequency and change in consistency of stools and may be associated with antibiotic therapy. Celiac disease is a problem with gluten intolerance and may cause chronic diarrhea if not identified and managed appropriately. Immunodeficiency would occur with chronic diarrhea. Protein malnutrition or kwashiorkor causes chronic diarrhea from lowered resistance to infection.
The nurse is caring for a newborn with suspected TEF. When offered the first feeding, the infant became cyanotic and the plan of care? a. Allow the mother to feed Pedialyte slowly in a monitored area, stopping all feedings six hours before surgery b. Begin IV fluids and IV antibiotics c. Admit to the ICU and immediately place on 100% oxygen d. Allow parents to visit in the PICU, but not hold unitl immediately before surgery
ANS: B Oral feedings are immediately stopped when a child is suspected of having TEF. An IV is started and fluids are administered to prevent dehydration. IV antibiotics are started to prevent and treat pneumonia that is caused from aspiration. Unless the newborn's oxygen saturations drop, 100% oxygen is not required. Oxygen is delivered at the lowest amount to keep oxygen saturations above 94%. Parents are encouraged to stay in the ICU and hold the infant as much as possible.
Which of the following assessments would you expect to find when caring for the child with pyloric stenosis? a. Projectile vomiting of bile-tinged emesis b. Visible peristaltic waves c. Metabolic acidosis d. Non-projectile vomiting
ANS: B Pyloric stenosis is the narrowing of the pyloric sphincter at the outlet of the stomach. Infants do not have signs in the first few days of life. As the pylorous narrows causing obstruction of the pyloric sphincter, the infant has clinical manifestations including: projectile vomiting of non-bilious vomitus, visible peristaltic waves across the epigastrum, signs of malnutrition and dehydration. Infants present with markedly abnormal electrolytes with signs of metabolic alkalosis revealing an increased pH and bicarbonate levels.
A one day old neonate is suspected to have tracheoesophageal fistula. Which nursing intervention is most appropriate for this infant?a. Avoiding suctioning unless cyanosis occurs b. Elevating the head of the bed/crib and giving nothing by mouth c. Elevating the neonate's head for 1 hour after feedings d. Giving the neonate only glucose water for the first 24 hours
ANS: B The chid with TEF is at risk for aspiration and respiratory distress due to communication between the esophagus and the trachea. The child should be NPO and should have the head of the bed elevated. Suction equipment is necessary to handle excess secretions. Ventilation equipment is indicated due to risk for respiratory distress.
The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. Which is appropriate to relieve the abdominal discomfort? a. Place in Trendelenburg position .b. Allow to assume position of comfort. c. Apply moist heat to the abdomen. d. Administer a saline enema to cleanse bowel.
ANS: B The child should be allowed to take a position of comfort, usually with the legs flexed. The Trendelenburg position will not help with the discomfort. In any instance in which appendicitis is a possibility, there is a danger in administering a laxative or enemas or applying heat to the area. Such measures stimulate bowel motility and increase the risk of perforation.
You are caring for a 3 year old admitted with diarrhea and dehydration. She is NPO for bowel rest. She has an order for IV maintenance fluids. Her weight is 13 kg. You calculate her IV fluid rate to be approximately: a. 52 ml/hr b. 46 ml/hr c. 36 ml/hr d. 26 ml/hr
ANS: B The formula to calculate maintenance fluids is 100 ml/kg for the first 10 kg of body weight + 50 ml/kg for the second 10 kg of body weight and 20 ml/kg for the remaining kg of body weight.
A mother who intended to breastfeed has given birth to an infant with a cleft palate. What nursing interventions should be included? a. Giving medication to suppress lactation. b. Encouraging and helping mother to breastfeed. c. Teaching mother to feed breast milk by gavage. d. Recommending use of a breast pump to maintain lactation until infant can suck.
ANS: B The mother who wishes to breastfeed may need encouragement and support because the defect does present some logistical issues. The nipple must be positioned and stabilized well back in the infant's oral cavity so that the tongue action facilitates milk expression. Because breastfeeding is an option, if the mother wishes to breastfeed, medications should not be given to suppress lactation. Because breastfeeding can usually be accomplished, gavage feedings are not indicated. The suction required to stimulate milk, absent initially, may be useful before nursing to stimulate the let-down reflex.
A mother asks f it matters when they give their infant the prescribed ranitidine. Which of the following is the nurse's best response? a. "Since ranitidine is an antacid it doesn't matter when you give it." b. "It would be easiest to give it with feeding." c. "It would be best to give the medication 30 minutes before feeding." d. "It would be best to give the medication 30 minutes after feeding."
ANS: C Antacids reduce esophagitis by decreasing the amount of acid present in the stomach contents. It is most effective when given 30 minutes prior to a feeding.
The nurse is providing dietary teaching for the parents of a child with celiac disease. This child should avoid: a. Vegetables b. Fruits c. Prepared puddings d. Rice
ANS: C Celiac disease is a gluten induced enteropathy caused by an insenstivity to gluten found in wheat. Gluten is contained in wheat, rye, barley and oats. Substitutions include corn, rice and millet. Thickeners used in prepared puddings, malted milkshakes and ice cream contain gluten and therfore should be avoided.
An infant is brought to the emergency department with dehydration. Which physical assessment finding does the nurse expect? a. Weight gain b. Bradycardia c. Poor skin turgor d. Brisk capillary refill
ANS: C Clinical manifestations of dehydration include poor skin turgor, weight loss, lethargy, and tachycardia. The infant would have prolonged capillary refill, not brisk.
Constipation has recently become a problem for a school-age girl. She is healthy except for seasonal allergies that are being treated with antihistamines. What should the nurse suspect caused the constipation? a. Diet b. Allergies c. Antihistamines d. Emotional factors
ANS: C Constipation may be associated with drugs such as antihistamines, antacids, diuretics, opioids, antiepileptics, and iron. Because this is the only known change in her habits, the addition of antihistamines is most likely the cause of the diarrhea. With a change in bowel habits, the role of any recently prescribed medications should be assessed.
Which is used to treat moderate to severe inflammatory bowel disease? a. Antacids b. Antibiotics c. Corticosteroids d. Antidiarrheal medications
ANS: C Corticosteroids, such as prednisone and prednisolone, are used in short bursts to suppress the inflammatory response in inflammatory bowel disease. Antacids and antidiarrheal medications are not drugs of choice in the treatment of inflammatory bowel disease. Antibiotics may be used as an adjunctive therapy to treat complications.
Which statement best characterizes hepatitis A? a. Incubation period is 6 weeks to 6 months .b. Principal mode of transmission is through the parenteral route. c. Onset is usually rapid and acute. d. There is a persistent carrier state.
ANS: C Hepatitis A is the most common form of acute hepatitis in most parts of the world. It is characterized by a rapid and acute onset. The incubation period is approximately 3 weeks for hepatitis A, and the principal mode of transmission for it is the fecal-oral route. Hepatitis A does not have a carrier state.
Which vaccine is now recommended for the immunization of all newborns? a. Hepatitis A vaccine b. Hepatitis B vaccine c. Hepatitis C vaccine d. Hepatitis A, B, and C vaccines
ANS: C Hepatitis A is the most common form of acute hepatitis in most parts of the world. It is characterized by a rapid and acute onset. The incubation period is approximately 3 weeks for hepatitis A, and the principal mode of transmission for it is the fecal-oral route. Hepatitis A does not have a carrier state.
The nurse is caring for a two year old diagnosed with biliary atresia. When reviewing the child's history the nurse would expect to find: a. Pale urine b. Black, tarry stools c. Poor weight gain d. Bluish tint to the sclera
ANS: C In biliary atresia the unconjugated bilirubin is trapped within the liver as it is unable to pass to the intestines. The buildup of bilirubin eventually leads to liver failure. Symptoms of biliary atresia include jaundice, dark urine, light stools and yellow sclera. The child typically has failure to thrive and does not gain weight.
A three month old infant who is receiving tube feeds due to a temporary malformation of the GI system is admitted to the pediatric floor. Which of the following should the nurse encourage the mother to do during feedings? a. Sing or play music that is calm during feedings b. Stroke the child's head and talk softly during the feedings c. Give a pacifier during the feedings d. Encourage the infant to sleep during the feedings
ANS: C It is important for an infant receiving tube feedings to have episodes of nonnutritive sucking. If offered concurrently with a feeding, sucking and mouth stimulation is associated with a positive contented feeding. Studies have also linked increased growth and development with nonnutritive sucking. While it is important for the other to interact and be present with her infant, nonnutritive sucking has a very positive overall effect. It is not necessary to encourage the infant to sleep during feedings.
The nurse is explaining to a parent how to care for a school-age child with vomiting associated with a viral illness. Which action should the nurse include? a. Avoid carbohydrate-containing liquids .b. Give nothing by mouth for 24 hours. c. Brush teeth or rinse mouth after vomiting. d. Give plain water until vomiting ceases for at least 24 hours.
ANS: C It is important to emphasize the need for the child to brush the teeth or rinse the mouth after vomiting to dilute the hydrochloric acid that comes in contact with the teeth. Ad libitum administration of glucose-electrolyte solution to an alert child will help restore water and electrolytes satisfactorily. It is important to include carbohydrate to spare body protein and avoid ketosis.
When developing a postoperative plan of care for an infant scheduled for cleft lip repair, the nurse should assign highest priority to which intervention? a. Comforting the child as quickly as possible b. Maintaining the child in a prone position c. Restraining the child's arms at all times using elbow restraints d. Avoid disturbing any crusts that form on the suture line
ANS: C Nursing interventions following a cleft lip repair focus on monitoring for respiratory distress and maintaining an intact suture line. The infant should be placed on the back for sleeping and the infant's arms should be kept away from his mouth which can be accomplished using elbow restraints. The greatest danger post-operatively after cleft lip or cleft palate repair is rupture of the suture lines.
3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. The nurse should recognize that preparing this child psychologically is: a. not necessary because of child's age. b. not necessary because colostomy is temporary. c. necessary because it will be an adjustment. d. necessary because the child must deal with a negative body image.
ANS: C The child's age dictates the type and extent of psychological preparation. When a colostomy is performed, the child who is at least preschool age is told about the procedure and what to expect in concrete terms, with the use of visual aids. It is necessary to prepare a 3-year-old child for procedures. The preschooler is not yet concerned with body image.
Which observation made of the exposed abdomen is most indicative of pyloric stenosis? a. Abdominal rigidity b. Substernal retraction c. Palpable olive-like mass d. Marked distention of lower abdomen
ANS: C The diagnosis of pyloric stenosis is often made after the history and physical examination. The olive-like mass is easily palpated when the stomach is empty, the infant is quiet, and the abdominal muscles are relaxed. Abdominal rigidity and substernal retraction are usually not present. The upper abdomen, not lower abdomen, is distended.
The nurse is caring for an 18 month old who has moderate diarrhea. Which of the following should be included in the plan of care? a. Encourage the child to drink apple juice and sports drinks b. Have the child eat only bananas, rice, applesauce and toast (BRAT diet) c. Ensure that all diapers are weighed d. Keep NPO for 4-6 hours to see if the diarrhea subsides
ANS: C The hospitalized child with diarrhea should be placed on strict intake and output measures that include the weighing of diapers. Juices and sports drinks should be avoided as the sugar content tends to increase dehydration. The BRAT diet has been shown to lack adequate nutrition and is no longer recommended. It is not necessary for the child with diarrhea to be NPO.
The nurse is providing education to parents of a 6 week old infant diagnosed with gastroesophageal reflux (GER). Which of the following should the nurse include in her teaching plan? a. Although most children should be put on their backs to sleep, the infant should be placed on the side to avoid aspiration b. Feed in smaller amounts each feeding c. The time between feedings should be stretched out as much as possible to assure the stomach is fully empty. d. Decrease the caloric density of the feedings
ANS: C The hospitalized child with diarrhea should be placed on strict intake and output measures that include the weighing of diapers. Juices and sports drinks should be avoided as the sugar content tends to increase dehydration. The BRAT diet has been shown to lack adequate nutrition and is no longer recommended. It is not necessary for the child with diarrhea to be NPO.
A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with GER. What is the purpose of this medication? a. Prevent reflux b. Prevent hematemesis c. Reduce gastric acid production d. Increase gastric acid production
ANS: C The mechanism of action of histamine-receptor antagonists is to reduce the amount of acid present in gastric contents and perhaps prevent esophagitis. Preventing reflux or hematemesis and increasing gastric acid production are not the modes of action of histamine-receptor antagonists.
A nurse is conducting dietary teaching on high-fiber foods for parents of a child with constipation. Which foods should the nurse include as being high in fiber? (Select all that apply.) a. White rice b. Avocados c. Whole grain breads d. Bran pancakes e. Raw carrots
ANS: C, D, E High-fiber foods include whole grain breads, bran pancakes, and raw carrots. Unrefined (brown) rice is high in fiber, but white rice is not. Raw fruits, especially those with skins or seeds, other than ripe banana or avocado, are high in fiber.
A newborn infant is diagnosed with tracheoespohageal fistula (TEF). When reviewing the history, the nurse would expect to find which of the following? a. The infant tolerated feedings for a few days, then experienced projectile vomiting b. The child's mother stated that she barely looked pregnant and never needed to wear maternity clothes c. The infant continuously appeared hungry despite beign fed every 2 hours d. The infant appeared to have a lot of secretions and became cyanotic when fed
ANS: D
When caring for a 12 month old with diarrhea and metabolic acidosis, the nurse expects to see which of the? a. A reduced following white blood cell count b. A decreased platelet count c. Shallow respirations d. Tachypnea
ANS: D A child with metabolic acidosis will develop compensatory tachypnea to blow-off CO2, physiologic acid, and therefore reduce overall acidosis.
A 10 month old is admitted to the hospital with dehydration and metabolic acidosis. What is the most common cause of dehydration and acidosis in infants? a. Early introduction of solid foods b. Inadequate perianal hygiene c. Tachypnea d. Diarrhea
ANS: D Diarrhea is a common cause of metabolic acidosis among infants. The infant with diarrhea loses HCO3 in the stool and therefore develops metabolic acidosis.
What are the results of excessive vomiting in an infant with pyloric stenosis? a. Hyperchloremia b. Hypernatremia c. Metabolic acidosis d. Metabolic alkalosis
ANS: D Infants with excessive vomiting are prone to metabolic alkalosis from the loss of hydrogen ions. Chloride ions and sodium are lost with vomiting. Metabolic alkalosis, not acidosis, is likely.
The nurse in a pediatric clinic asks the mother to bring her baby in for evaluation. The nurse expects the baby will be evaluated for pyloric stenosis when the mother states the following: a. "My baby spits up a little about 45 minutes after eating." b. "My baby vomits right before I begin to give the next feeding." c. "When my baby vomits it is forceful and green." d. "My baby still wants to eat right after vomiting."
ANS: D Infants with pyloric stenosis typically vomiting within 30 minutes after feeding. Their vomitus can contain blood but not bile as the feeding does not advance beyond the pylorus. Infants remain hungry after vomiting and typically want to feed again.
The nurse is obtaining a history on a toddler with Hirschprung's Disease. She asks about bowel patterns and is not surprised when the child's mother states which of the following? a. "The stools are long and skinny" b. The stools occasionally have blood and mucus" c. "It is mostly large amounts of liquid diarrhea" d. The stools are small, hard balls that are white"
ANS: D Infants with pyloric stenosis typically vomiting within 30 minutes after feeding. Their vomitus can contain blood but not bile as the feeding does not advance beyond the pylorus. Infants remain hungry after vomiting and typically want to feed again.
What is invagination of one segment of bowel within another called?a. Atresia b. Stenosis c. Herniation d. Intussusception
ANS: D Intussusception occurs when a proximal section of the bowel telescopes into a more distal segment, pulling the mesentery with it. The mesentery is compressed and angled, resulting in lymphatic and venous obstruction. Invagination of one segment of bowel within another is the definition of intussusception, not atresia, stenosis, or herniation.
A three month old with biliary atresia is admitted to the pediatric floor. The mother asks why her infant is so irritable and restless. Which of the following is the nurse's best response? a. "The liver is enlarged and placing pressure on her abdomen causing pain. I will give her some pain medication." b. "Your baby is probably restless because of being confined to a crib and not being held and cuddled." c. "Your baby just needs more stimulation. Let's put a music toy in the crib." d. "Your baby may be feeling itchy. I can give some medication to help."
ANS: D It is common for children with biliary atresia to have extreme puritis from the build up of bile and irritation of nerve endings. It is treated with the administration of cholestyramine. Although the child with biliary atresia may have abdominal pain, puritis tends to cause the most discomfort. There is no reason not to hold the infant in this case.
Which clinical manifestation would be the most suggestive of acute appendicitis? a. Rebound tenderness b. Bright red or dark red rectal bleeding c. Abdominal pain that is relieved by eating d. Abdominal pain that is most intense at McBurney point
ANS: D Pain is the cardinal feature. It is initially generalized, usually periumbilical. The pain localizes to the right lower quadrant at McBurney point. Rebound tenderness is not a reliable sign and is extremely painful to the child. Bright red or dark red rectal bleeding and abdominal pain that is relieved by eating are not signs of acute appendicitis.
The nurse is providing education on cleft lip and palate to a group of nursing students. It is apparent that more education is needed when a student states that the infants are at risk for: a. Pneumonia b. Otitis media c. Altered bonding with parents d. Gastroesophageal reflux
ANS: D There is not an increased incidence of gastroesophageal reflux in children with cleft lip and palate. The open space in the mouth increases the risk of aspiration and subsequent pneumonia. There is an increased risk for otitis media as the cleft in palate allows fluid and microorganisms to easily enter into the ear canal. Because cleft lip and cleft palate are disfiguring defects, there can be an alteration in the way the parent bonds to and copes with their child.
What should be included in caring for the newborn with a cleft lip and palate before surgical repair? a. Gastrostomy feedings b. Keeping infant in near-horizontal position during feedings c. Allowing little or no sucking d. Providing satisfaction of sucking needs
ANS: D Using special or modified nipples for feeding techniques helps meet the infant's sucking needs. Gastrostomy feedings are usually not indicated. Feeding is best accomplished with the infant's head in an upright position. The child requires both nutritive and nonnutritive sucking.
child has an NG tube to continuous low intermittent suction. The physician's prescription is to replace the previous 4-hour NG output with a normal saline piggyback over a 2-hour period. The NG output for the previous 4 hours totaled 50 ml. What milliliter/hour rate should the nurse administer to replace normal saline piggyback? (Record your answer in a whole number.)
ANS:25 The previous total 4-hour output was 50 ml. To run the 50 ml over a 2-hour period, the nurse would divide 50 by 2 = 25. The normal saline replacement fluid would be run at 25 ml per hour.
The mother of an infant with cleft palate tells the nurse that she is so disappointed because she probably won't be able to nurse the baby. Which of the following is the nurse's best response? a. "Some mother's are still able to nurse their baby, have you tried yet? b. "I understand you are frustrated, let's talk about other ways to feel close to the baby." c. The risk of aspiration is too great, I know you want what is best for your baby." d. "It will be hard enough to feed with a bottle. I certainly wouldn't attempt to breastfeed."
ANS: A In many cases the mother's breast helps to fill the cleft, allowing the infant to create suction in her mouth. The mother may just be assuming that breastfeeding is not an option. It is good to explore the mother's feelings but assessing whether she has attempted breastfeeding is the first step. Breastfeeding does not increase the risk of aspiration. It is best for the nurse not to point out potential difficulties.
The nurse is providing education about proper feeding of a two month old after a cleft lip repair. Which is the correct information to provide to parents about feeding their infant? a. Breast-feed or bottle-feed b. Use a cup c. Use a paper straw d. Use a medicine dropper
ANS: A Infants can be breastfed or bottle fed after cleft lip repair with careful attention to not put strain on the suture line and to maintain elbow restraints.
A toddler is brought to the emergency room with sudden onset of abdominal pain, vomiting, and stools that look like current jelly. To confirm intussusception, the nurse expects the doctor to order which of the following? a. A barium enema b. Suprapubic catheter insertion c. Nasogastric tube insertion d. Nasogastric tube insertion
ANS: A Intussusception is a telescoping or invagination of a bowel segment into itself. It's cause is not well-understood. Children typically present with signs of acute abdominal pain with drawing up of the knees to the chest. The classic symptom is current jelly-like stools. The diagnosis of intussusception is made based on the administration of a barium or water-soluble contrast with air pressure enema in order to reduce the invagination of the bowel segment. If the enema is unsuccessful, surgery is indicated to remove the gangrenous portion of the bowel.
A toddler is brought to the emergency department with sudden onset of abdominal pain, vomiting, and stools that look like red currant jelly. To confirm intussusception, the nurse expects the doctor to order which of the following tests? a. A barium enema b. Bloody diarrhea c. Anal fissures d. Abdominal distention
ANS: A Intussusception is a telescoping or invagination of a bowel segment into itself. Its cause is not well understood. Children typically present with signs of acute abdominal pain with drawing up of the knees to the chest. The classic symptom is currant like jelly stools. The diagnosis of intussusception is made based on the administration of a barium or water soluable contrast with air pressure enema in order to reduce the invagination of the bowel segment. If the enema is unsuccessful, surgery is indicated to remove the gangrenous portion of the bowel.
Which is a high-fiber food that the nurse should recommend for a child with chronic constipation? a. Raisins b. Pancakes c. Muffins d. Ripe bananas
ANS: A Raisins are a high-fiber food. Pancakes and muffins do not have significant fiber unless made with fruit or bran. Raw fruits, especially those with skins and seeds, other than ripe bananas, have high fiber.
Which is an important nursing consideration in the care of a child with celiac disease? a. Refer to a nutritionist for detailed dietary instructions and education. b. Help child and family understand that diet restrictions are usually only temporary. c. Teach proper hand washing and standard precautions to prevent disease transmission. d. Suggest ways to cope more effectively with stress to minimize symptoms.
ANS: A The main consideration is helping the child adhere to dietary management. Considerable time is spent explaining to the child and parents about the disease process, the specific role of gluten in aggravating the condition, and foods that must be restricted. Referral to a nutritionist would help in this process. The most severe symptoms usually occur in early childhood and adult life. Dietary avoidance of gluten should be lifelong. Celiac disease is not transmissible or stress related.
What offers the best chance of survival for a child with cirrhosis? a. Liver transplantation b. Treatment with corticosteroids c. Treatment with immune globulin d. Provision of nutritional support
ANS: A The only successful treatment for end-stage liver disease and liver failure may be liver transplantation, which has improved the prognosis for many children with cirrhosis. Liver transplantation has revolutionized the approach to cirrhosis. Liver failure and cirrhosis are indications for transplantation. Liver transplantation reflects the failure of other medical and surgical measures to prevent or treat cirrhosis.
12 year old with inflammatory bowel disease (IBD) has recently developed mouth ulcers and arthritis in the joints. Which of the following is likely? a. The patient has Crohn's disease b. The patient has Ulcerative colitis c. It is impossible to determine the type of IBD, but it is likely there is a seconary inflammatory illness unrelated to IBD d. The medications used to treat IBD tend to cause mouth ulcers and arthritic pain
ANS: A These inflammatory signs are more closely linked to Crohn's disease and are not likely related to medication
nurse is planning preoperative care for a newborn with tracheoesophageal fistula (TEF). Which interventions should the nurse plan to implement? (Select all that apply.) a. Positioning with head elevated on a 30-degree plane b. Feedings through a gastrostomy tube c. Nasogastric tube to continuous low wall suction d. Suctioning with a Replogle tube passed orally to the end of the pouche. Gastrostomy tube to gravity drainage
ANS: A, D, E The most desirable position for a newborn who has TEF is supine (or sometimes prone) with the head elevated on an inclined plane of at least 30 degrees. This positioning minimizes the reflux of gastric secretions at the distal esophagus into the trachea and bronchi, especially when intra-abdominal pressure is elevated. It is imperative to immediately remove any secretions that can be aspirated. Until surgery, the blind pouch is kept empty by intermittent or continuous suction through an indwelling double-lumen or Replogle catheter passed orally or nasally to the end of the pouch. In some cases, a percutaneous gastrostomy tube is inserted and left open so that any air entering the stomach through the fistula can escape, thus minimizing the danger of gastric contents being regurgitated into the trachea. The gastrostomy tube is emptied by gravity drainage. Feedings through the gastrostomy tube and irrigations with fluid are contraindicated before surgery in an infant with a distal TEF. A nasogastric tube to low intermittent suctioning could not be accomplished because the esophagus ends in a blind pouch in TEF.
A 30 kg child who is admitted to the pediatric unit with dehydration. The child is currently NPO and is receiving IV fluids at maintenance. What is the hourly rate that the IV should be set at? a. 60 ml/hr b. 70 ml/hr c. 80 ml/hr d. 90 ml/hr
ANS: B
An infant with short bowel syndrome will be discharged home on total parenteral nutrition (TPN) and gastrostomy feedings. What should be included in the discharge teaching? a. Prepare family for impending death .b. Teach family signs of central venous catheter infection. c. Teach family how to calculate caloric needs. d. Secure TPN and gastrostomy tubing under diaper to lessen risk of dislodgment.
ANS: B During TPN therapy, care must be taken to minimize the risk of complications related to the central venous access device, such as catheter infections, occlusions, or accidental removal. This is an important part of family teaching. The prognosis for patients with short bowel syndrome depends in part on the length of residual small intestine. It has improved with advances in TPN. Although parents need to be taught about nutritional needs, the caloric needs and prescribed TPN and rate are the responsibility of the health care team. The tubes should not be placed under the diaper due to risk of infection.
The greatest post-operative danger from a cleft palate repair is: a. Pain b. Rupture of the suture lines c. Infection d. Dehydration
ANS: B Following cleft palate repair the nurse would assess for signs of bleeding such as increased swallowing and tachycardia, which would indicate rupture of the suture lines. Pain is expected and can be controlled. Infection is prevented through use of antibiotics and stringent rinsing of the mouth. Dehydration can happen but is not the greatest danger.
A newborn was admitted to the nursery with a complete bilateral cleft lip and palate. The physician explained the plan of therapy and its expected good results. However, the mother refuses to see or hold her baby. What is the initial therapeutic approach for the mother? a. Restating what the physician has told her about plastic surgery .b. Encouraging her to express her feelings. c. Emphasizing the normalcy of her baby and the baby's need for mothering. d. Recognizing that negative feelings toward the child continue throughout childhood.
ANS: B For parents, cleft lip and cleft palate deformities are particularly disturbing. The nurse must emphasize not only the infant's physical needs but also the parents' emotional needs. The mother needs to be able to express her feelings before she can accept her child. Although the nurse will restate what the physician has told the mother about plastic surgery, it is not part of the initial therapeutic approach. As the mother expresses her feelings, the nurse's actions should convey to the parents that the infant is a precious human being. The nurse emphasizes the child's normalcy and helps the mother recognize the child's uniqueness.
The nurse is providing discharge instructions to a 14 year old with ulcerative colitis. Which is the nurse's best advice concerning her diet? a. "You'll know what to eat by how your body responds. Keeping a journal is always a good idea." b. "It is recommended that you eat high protein, high calorie, and low fat foods." c. "It is recommended that you eat high protein, high fat foods." d. "That is a good question. I will have the dietician come talk to you."
ANS: B High protein, high calorie foods help to promote growth. High fat foods tend to cause irritability and cramping. Keeping a food diary and consulting with a dietician are appropriate but providing a general answer is incorrect. If the child is being discharged, seeing a dietician might not be possible.
A child is suspected of having Hirschprung's disease. The nurse would expect the child's history of present illness to include which of the following? a. Anemia, abdominal distention, fecal soiling b. Abdominal distention, constipation, foul smelling stools c. Bloody diarrhea, fever, vomiting d. Irritability, severe abdominal cramping, fecal soiling
ANS: B Hirschprung's disease is a congenital anomaly of decreased intestinal motility resulting in mechanical obstruction of the intestine. Clinical manifestations include vomiting, constipation, abdominal distention, and ribbon-like foul smelling stools. This condition is not associated with anemia, fecal soiling or bloody diarrhea.
What is the best description of pyloric stenosis? a. Dilation of the pylorus b. Hypertrophy of the pyloric muscle c. Hypotonicity of the pyloric muscle d. Reduction of tone in the pyloric muscle
ANS: B Hypertrophic pyloric stenosis occurs when the circumferential muscle of the pyloric sphincter becomes thickened, resulting in elongation and narrowing of the pyloric channel. Dilation of the pylorus, hypotonicity of the pyloric muscle, and reduction of tone in the pyloric muscle are not the definition of pyloric stenosis.
Enemas are ordered to empty the bowel preoperatively for a child with Hirschsprung disease. What enema solution should be used? a. Tap water b. Normal saline c. Oil retention d. Phosphate preparation
ANS: B Isotonic solutions should be used in children. Saline is the solution of choice. Plain water is not used. This is a hypotonic solution and can cause rapid fluid shift, resulting in fluid overload. Oil-retention enemas will not achieve the "until clear" result. Phosphate enemas are not advised for children because of the harsh action of the ingredients. The osmotic effects of the phosphate enema can result in diarrhea, which can lead to metabolic acidosis.
What is the most common assessment finding in a child with ulceratie colitis? a. Abdominal cramps b. Bloody diarrhea c. Anal fissures d. Abdominal distention
ANS: B Ulcerative colitis is one form of inflammatory bowel disease (IBD) involving symmetrical and contiguous bowel ulcers attacking the mucosa of the bowel wall in the large intestine. The edema and inflammation in the bowel leads to bloody diarrhea, weight loss, anorexia, nausea and vomiting.
Which is true concerning hepatitis B? (Select all that apply.) a. Hepatitis B cannot exist in carrier state. b. Hepatitis B can be prevented by HBV vaccine. c. Hepatitis B can be transferred to an infant of a breastfeeding mother. d. Onset of hepatitis B is insidious. e. Principal mode of transmission for hepatitis B is fecal-oral route. f. Immunity to hepatitis B occurs after one attack.
ANS: B, C, D, F The vaccine elicits the formation of an antibody to the hepatitis B surface antigen, which is protective against hepatitis B. Hepatitis B can be transferred to an infant of a breastfeeding mother, especially if the mother's nipples are cracked. The onset of hepatitis B is insidious. Immunity develops after one exposure to hepatitis B. Hepatitis B has a carrier state. The fecal-oral route is the principal mode of transmission for hepatitis A. Hepatitis B is transmitted through the parenteral route.
The nurse is preparing to care for an infant returning from pyloromyotomy surgery. Which prescribed orders should the nurse anticipate implementing? (Select all that apply.) a. NPO for 24 hours b. Administration of analgesics for pain c. Ice bag to the incisional area d. IV fluids continued until tolerating PO e. Clear liquids as the first feeding
ANS: B, D, E Feedings are usually instituted soon after a pyloromyotomy surgery, beginning with clear liquids and advancing to formula or breast milk as tolerated. IV fluids are administered until the infant is taking and retaining adequate amounts by mouth. Appropriate analgesics should be given around the clock because pain is continuous. Ice should not be applied to the incisional area as it vasoconstricts and would reduce circulation to the incisional area and impair healing.
