GI Study Questions

A preschooler with a history of cleft palate repair comes to the clinic for a routine well-child checkup. To determine if this child is experiencing a long-term effect of cleft palate, which question should the nurse ask? 1. "Was the child recently treated for pneumonia?" 2. "Does the child play with an imaginary friend?" 3. "Is the child unresponsive when given directions?" 4. "Has the child had any difficulty swallowing food?"

3 Rationale: Unresponsiveness may be an indication of hearing loss. A child who has a history of cleft palate should be routinely checked for hearing loss. Pneumonia and dysphagia are unrelated to cleft palate after repair. Having an imaginary friend is normal behavior for a preschool child. Many preschoolers with vivid imaginations have imaginary friends.

A child is diagnosed with Hirschsprung's disease. The nurse is teaching the parents about the cause of the disease. Which statement, if made by the parent, supports that teaching was successful? 1."Special cells are not present in the rectum, which caused the disease." 2."The protein part of wheat, barley, rye, and oats is not being digested fully." 3."The disease occurs from increased bowel motility that leads to spasm and pain." 4."The disease occurs because of inability to tolerate sugar found in dairy products."

1

The nurse has been assigned to care for a neonate just delivered who has gastroschisis. Which concern should the nurse address in the client's plan of care? 1.Infection 2.Poor body image 3.Decreased urinary elimination 4.Cracking oral mucous membranes

1

The nurse is caring for a 1-year-old child after cleft palate repair. On completion of feeding, the nurse should plan for which appropriate nursing action? 1. Rinsing the mouth with water 2. Cleaning the mouth with diluted hydrogen peroxide 3. Using a soft lemon and glycerin swab to clean the mouth 4. Using cotton swabs saturated with half-strength povidone-iodine to clean the mouth

1

The nurse is reviewing the laboratory test results for an infant suspected of having hypertrophic pyloric stenosis. The nurse should expect to note which value as the most likely laboratory finding in this infant? 1. Blood pH of 7.50 2. Blood pH of 7.35 3. Blood bicarbonate of 22 mEq/L (22 mmol/L) 4. Blood bicarbonate of 27 mEq/L (27 mmol/L)

1 Rationale: Laboratory findings in an infant with hypertrophic pyloric stenosis include metabolic alkalosis due to vomiting. These include increased blood pH and bicarbonate level, decreased serum potassium and sodium levels, and a decreased chloride level. The normal pH is 7.35 to 7.45. The normal bicarbonate is 21 to 28 mEq/L (21 to 28 mmol/L).

The nurse is caring for an infant after repair of an inguinal hernia. Which of these assessment findings indicates that the surgical repair was effective? 1.A clean, dry incision 2.Abdominal distension 3.An adequate flow of urine 4.Absence of inguinal swelling with crying

4 Rationale: With an inguinal hernia, inguinal swelling occurs when the infant cries or strains. Absence of this swelling would indicate resolution of this problem. A clean, dry incision refers to absence of wound infection after surgery. Abdominal distension indicates a continuing gastrointestinal problem. The flow of urine is not specific to an inguinal hernia.

The nurse is providing instructions to the parents of a child with a hernia regarding measures that will promote reducing the hernia. The nurse determines that the parents understand care for their child if they make which statement? 1."We will encourage our child to cough every few hours on a daily basis." 2."We will make sure that our child participates in physical activity every day." 3."We will provide comfort measures to reduce any crying periods by our child." 4."We will be sure to give our child a Fleet enema every day to prevent constipation."

3

The clinic nurse reviews the record of an infant and notes that the primary health care provider (PHCP) has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which sign most likely led the mother to seek health care for the infant? 1. Diarrhea 2. Projectile vomiting 3. Regurgitation of feedings 4. Foul-smelling ribbon-like stools

4

The parents of a child with a cleft palate are concerned and ask the nurse when the palate will be repaired. The nurse should plan to base the response on which information about cleft palate repair? 1. A cleft palate cannot be repaired in children. 2. Repair usually is performed by age 8 weeks. 3. Repair usually is performed by 2 months of age. 4. Repair usually is performed between 6 months and 2 years.

4

The nurse admits a child to the hospital with a diagnosis of pyloric stenosis. On assessment, which data would the nurse expect to obtain when asking the parent about the child's symptoms? 1.Watery diarrhea 2.Projectile vomiting 3.Increased urine output 4.Vomiting large amounts of bile

2

The nurse provides home care instructions to the mother of a child who had a cleft palate repair 4 days ago. Which statement by the mother indicates the need for further instruction? 1."I will use a short nipple on the bottle." 2."I need to buy some straws for drinking." 3."I can give my child the pacifier in 2 weeks." 4."I may give my baby food mixed with water."

2 Rationale: The mother needs to be instructed that straws, pacifiers, spoons, and fingers must be kept away from the child's mouth for 7 to 10 days. Additionally, the mother should be advised to avoid taking an oral temperature. The remaining options are accurate measures to implement after cleft palate repair.

The nurse is collecting data on an infant with a diagnosis of suspected Hirschsprung's disease. Which question to the mother will mostspecifically elicit information regarding this disorder? 1. "Does your infant have diarrhea?" 2. "Is your infant constantly vomiting?" 3. "Does your infant constantly spit up feedings?" 4. "Does your infant have foul-smelling, ribbon-like stools?"

4

An infant has just returned to the nursing unit after surgical repair of a cleft lip on the right side. The nurse should place the infant in which best position at this time? 1.Prone position 2.On the stomach 3.Left lateral position 4.Right lateral position

3

The nurse is preparing an infant for surgery to treat Hirschsprung's disease. Which assessment finding is priority to identify and treat? 1.Vomiting and irritability 2.Malnourishment and lethargy 3.Abdominal distension and tenderness 4.Decreased blood pressure and tachycardia

4 Rationale: Nursing care management includes assessing for signs of enterocolitis, shock, fluid and electrolyte problems, and signs of bowel perforation. While all of the answer options are concerning, low blood pressure and tachycardia are signs of shock. Shock results in decreased perfusion and oxygenation to major organs and is the priority of care.

A child is suspected of suffering from intussusception. The nurse should be alert to which clinical manifestation of this condition? 1. Tender, distended abdomen 2. Presence of fecal incontinence 3. Incomplete development of the anus 4. Infrequent and difficult passage of dry stools

1

The nurse is assigned to care for a child who is scheduled for an appendectomy. Select the prescriptions that the nurse anticipates will be prescribed. Select all that apply. 1.Initiate an IV line. 2.Maintain an NPO status. 3.Administer a Fleet enema. 4.Administer intravenous antibiotics. 5.Administer preoperative medications. 6.Place a heating pad on the abdomen to decrease pain.

1,2,4,5

The nurse is caring for a child who was brought to the clinic complaining of severe abdominal pain and is suspected of having acute appendicitis. The child is lying on the examining table with the knees pulled up toward the chest. What is the priority nursing action? 1. Collect urine sample for urinalysis. 2. Perform a pain assessment using the FACES scale. 3. Prepare the child for magnetic resonance imaging. 4. Notify primary health care provider of white blood cell count above 10,000 mm3 (10 × 109/L).

2

The nurse is providing discharge instructions to the mother of a child who had a cleft palate repair. Which statement should the nurse make to the mother? 1."You should use a plastic spoon to feed the child." 2."You need to use an orthodontic nipple on the child's bottle." 3."You can allow the child to use a pacifier but only for 30 minutes at a time." 4."You need to monitor the child's temperature for signs of infection using an oral thermometer."

2 Rationale: An orthodontic nipple should be placed on the child's bottle, and the mother should be instructed to give the child baby food or baby food mixed with water. The mother should be instructed that straws, pacifiers, spoons, or fingers must be kept away from the child's mouth for 7 to 10 days after surgery. A pacifier should not be used for at least 2 weeks following the surgical repair. Additionally, the mother should be advised to avoid taking oral temperatures.

Parents bring their child to the emergency department and tell the nurse that the child has been complaining of colicky abdominal pain located in the lower right quadrant of the abdomen. The nurse suspects that the child has which disorder? 1.Peritonitis 2.Appendicitis 3.Intussusception 4.Hirschsprung's disease

2 Rationale: The most common symptom of appendicitis is a colicky, periumbilical, or lower abdominal pain located in the right quadrant. Peritonitis is a complication that can follow organ perforation or intestinal obstruction. The classic signs and symptoms of intussusception are acute, colicky abdominal pain and currant jelly-like stools. Clinical manifestations of Hirschsprung's disease include constipation, abdominal distension, and ribbon-like, foul-smelling stools.

A child is hospitalized because of persistent vomiting. The nurse should monitor the child closely for which problem? 1.Diarrhea 2.Metabolic acidosis 3.Metabolic alkalosis 4.Hyperactive bowel sounds

3

The parents of a newborn with a cleft lip are concerned and ask the nurse when the lip will be repaired. With which statement should the nurse respond? 1. Cleft lip cannot be repaired. 2. Cleft-lip repair is usually performed by 6 months of age. 3. Cleft-lip repair is usually performed during the first months of life. 4. Cleft-lip repair is usually performed between 6 months and 2 years.

3

The mother of a child with an umbilical hernia calls the clinic and reports to the nurse that the child has been vomiting and is complaining of pain in the abdominal area. Which instruction to the mother is most appropriate? 1. Administer acetaminophen. 2. Keep the child on clear liquids. 3. Contact the primary health care provider. 4. Apply an ice pack to the abdomen.

3 Rationale: Vomiting, pain, and irreducible mass at the umbilicus are signs of a strangulated hernia. The parents should be instructed to contact the primary health care provider immediately if strangulation is suspected. The remaining options are incorrect, can cause harm to the child, and delay emergency treatment measures that are required.

A 1-year-old child is diagnosed with intussusception, and the mother of the child asks the student nurse to describe the disorder. Which statement by the student nurse indicates correct understanding of this disorder? 1."It is an acute bowel obstruction." 2."It is a condition that causes an acute inflammatory process in the bowel." 3."It is a condition in which a distal segment of the bowel prolapses into a proximal segment of the bowel." 4."It is a condition in which a proximal segment of the bowel prolapses into a distal segment of the bowel."

4

The nurse provides feeding instructions to a parent of an infant diagnosed with gastroesophageal reflux disease. Which instruction should the nurse give to the parent to assist in reducing the episodes of emesis? 1.Provide less frequent, larger feedings. 2.Burp the infant less frequently during feedings. 3.Thin the feedings by adding water to the formula. 4.Thicken the feedings by adding rice cereal to the formula.

4

An infant is seen in the primary health care provider's office for complaints of projectile vomiting after feeding. Findings indicate that the child is fussy and is gaining weight but seems never to get enough to eat. Pyloric stenosis is suspected. Which prescription would the nurse anticipate having the highest priority in the care of this child? 1. Monitor intake and output. 2. Administer predigested formula. 3. Administer omeprazole before feeding. 4. Prepare the family for surgery for the child.

4 Rationale: Infants with projectile vomiting after feeding that are fussy should be suspected of pyloric stenosis. The treatment for this diagnosis is surgery. The other options are treatment measures that may be prescribed for gastroesophageal reflux.

The nurse is reviewing the plan of care for a child with a diagnosis of suspected appendicitis. The nurse would question which intervention if noted in the plan of care? 1. Taking the child's temperature with an oral thermometer 2. Applying a heating pad to abdomen to promote pain relief 3. Palpating between the right anterior superior iliac crest and umbilicus 4. Obtaining blood for complete blood count while starting an intravenous line

2

The nurse in the hospital is giving at-home feeding instructions to a family whose child is being discharged after being born with a cleft lip. Which statement by the mother would indicate that further teaching is indicated? 1. "I am so glad that I am able to breast-feed my baby." 2. "I must always feed my baby with a syringe and not use a nipple." 3. "I will feed my baby while sitting in a chair and holding her more upright." 4. "I will burp my baby very frequently so that she does not swallow a lot of air."

2 Rationale: Infants with a cleft lip are fed using a special nipple. Therefore, although all the interventions relate to feeding, option 2 should be clarified with the family because if they fed the baby using a syringe, the child's oral needs for sucking will not be met. Breast-feeding is always an option and should be done unless the child is having difficulty. Most children with a small cleft lip can be breast-fed. Newborns should be burped frequently and fed in a somewhat upright position. These interventions are applicable to the child with a cleft lip as well.

The nurse is reviewing the laboratory results for an infant with suspected hypertrophic pyloric stenosis. What should the nurse expect to note as the most likely finding in this infant? 1.Metabolic acidosis 2.Metabolic alkalosis 3.Respiratory acidosis 4.Respiratory alkalosis

2 Rationale: Laboratory findings in an infant with hypertrophic pyloric stenosis include metabolic alkalosis as a result of the vomiting that occurs in this disorder. Additional findings include decreased serum potassium and sodium levels, increased pH and bicarbonate levels, and decreased chloride level. The remaining options are incorrect.

A 12-year-old girl is admitted to the hospital with suspected appendicitis. What nursing interventions should be implemented preoperatively? 1. Applying a heating pad for 5-minute intervals as prescribed 2. Administering acetaminophen as needed for pain, as prescribed 3. Placing the adolescent in a fetal position, side-lying with legs drawn up to chest 4. Inserting a nasogastric tube and attaching it to low intermittent suction; measuring drainage as prescribed

3 Rationale: A client with appendicitis is more comfortable when lying in what is traditionally known as the fetal position, with the legs drawn up toward the chest. This flexed positioning assists in decreasing the pain that comes with appendicitis by decreasing the pressure on the abdominal area. A heating pad is contraindicated because heat can lead to a ruptured appendix. Pain medications are not given to the client with acute appendicitis because they may mask the symptoms that accompany a ruptured appendix. A nasogastric tube may be necessary postoperatively for gastric decompression or preoperatively if perforation occurs. There are no data in the question that support perforation.

An emergency department nurse is performing an assessment on a child with a suspected diagnosis of intussusception. Which assessment question for the parents will elicit the most specific data related to this disorder? 1."Does the child have any food allergies?" 2."What do the bowel movements look like?" 3."Has the child eaten any food in the last 24 hours?" 4."Can you describe the type of pain that the child is experiencing?"

4

The nurse is developing a plan of care for a 5-week-old infant being admitted with hypertrophic pyloric stenosis who is scheduled for pyloromyotomy. In the preoperative period, the nurse should place the infant in which bestposition? 1. In an infant seat placed in the crib 2. Prone with the head of the bed elevated 3. Supine with the head at a 90-degree angle 4. Supine with the head of the bed at a 15-degree angle

1 Rationale: In the preoperative period, the infant is positioned with the head of the bed elevated to reduce the risk of aspiration. To assist a 5-week-old to maintain this position, it is best to place the infant in an infant seat. If placed in a crib without an infant seat, towel or blanket rolls should be placed around the head of the infant to maintain this position. A 15-degree angle is too low, while a 90-degree angle is too high for a 5-week-old to maintain the position.

A 2-year-old child with acute diarrhea has been diagnosed with mild dehydration. Which rehydration methods would the nurse expect the primary health care provider to prescribe? 1. Increase intake of water with a diet high in carbohydrates. 2. Consume oral rehydration fluid, advancing to a regular diet. 3. Begin fluid replacement immediately with intravenous fluids. 4. Begin a diet of bananas, rice, apples, pears, and toast with juice.

2 Rationale: Mild dehydration is usually treated at home and consists of age-appropriate diet along with oral rehydration fluids. Bananas, rice, apples, pears, and toast with juice can be irritating to the gastrointestinal (GI) tract and does not provide the rehydration needed in a child who is dehydrated. Water does not provide electrolyte fluid replacement, a need during dehydration. Hospitalization and intravenous fluids are not required with mild dehydration.

A mother brings her 5-week-old infant to the health care clinic and tells the nurse that the child has been vomiting after meals. The mother reports that the vomiting is becoming more frequent and forceful. The nurse suspects pyloric stenosis and asks the mother which assessment question to elicit data specific to this condition? 1."Are the stools ribbon-like, and is the infant eating poorly?" 2."Does the infant suddenly become pale, begin to cry, and draw the legs up to the chest?" 3."Does the vomit contain sour, undigested food without bile, and is the infant constipated?" 4."Does the infant cry loudly and continuously during the evening hours but nurses or takes formula well?"

3

The nurse is reviewing the primary health care provider's documentation in the record of a child admitted with a diagnosis of intussusception. The nurse expects to note that the primary health care provider has documented which manifestation? 1. Scleral jaundice 2. Projectile vomiting 3. Currant jelly-like stools 4. Pale-colored and hard stools

3

The nurse reviews the record of a newborn infant and notes that a diagnosis of esophageal atresia with tracheoesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record? 1.Incessant crying 2.Coughing at nighttime 3.Choking with feedings 4.Severe projectile vomiting

3

A 3-year-old child is seen in the health care clinic, and a diagnosis of encopresis is made. The nurse expects to provide teaching about which client problem? 1. Odor 2. Nausea 3. Malaise 4. Diarrhea

1 Rationale: Encopresis is the repeated voluntary or involuntary passage of feces of normal or near-normal consistency in places not appropriate for that purpose according to the individual's own sociocultural setting. Signs include evidence of soiled clothing, scratching or rubbing the anal area because of irritation, fecal odor without apparent awareness by the child, and social withdrawal.

An infant is seen in the primary health care provider's office for complaints of frequent vomiting and spitting up after feedings. Findings indicate that the infant is not gaining weight, and gastroesophageal reflux is suspected. Which would the nurse anticipate being prescribed initially in the care of this child? 1. Administer omeprazole before feeding. 2. Place infant in prone position after each feeding. 3. Instruct parents to keep a log of feedings and any reflux present. 4. Administer predigested formula and feed small, frequent feedings.

4 Rationale: For infants with frequent vomiting and spitting up, the diagnosis of gastroesophageal reflux should be considered. The initial action is to alter the formula to a predigested formula and feed small, frequent feedings. After the formula is changed, the family will be instructed to keep a log of feedings and any reflux with the new formula. Medication is not started until after the formula is changed. A prone position increases the risk of reflux and thus aspiration.

The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which sign of this disorder documented? 1.Watery diarrhea 2.Ribbon-like stools 3.Profuse projectile vomiting 4.Bright red blood and mucus in the stools

4 - currant jelly like stools

The nurse is preparing to care for an infant who has esophageal atresia with tracheoesophageal fistula. Surgery is scheduled to be performed in 1 hour. Intravenous fluids have been initiated, and a nasogastric (NG) tube has been inserted by the primary health care provider. The nurse plans care, knowing that which intervention is of highest priority during this preoperative period? 1. Monitor the temperature. 2. Monitor the blood pressure 3. Reposition the infant frequently. 4. Aspirate the NG tube every 5 to 10 minutes.

4 Rationale: Esophageal atresia with tracheoesophageal fistula represents a critical neonatal surgical emergency. While the infant is awaiting transfer to surgery, management centers on prevention of aspiration. The infant is kept supine or prone with the head of the bed elevated to decrease the chance that gastric secretions will enter the lungs. Intravenous fluids are essential. An NG tube must be in place and aspirated every 5 to 10 minutes to keep the proximal pouch clear of secretions. Monitoring the temperature and monitoring blood pressure are standard nursing interventions.