NURS 155 Exam 2 Success Questions Chapter 8 GI

46. The nurse is caring for a 7-week-old scheduled for a pyloromyotomy in 24 hours. Which of the following would the nurse expect to find in the plan of care? 1. Keep infant NPO; begin intravenous fluids at maintenance. 2. Keep infant NPO; begin intravenous fluids at maintenance; place NGT to low wall suction. 3. Obtain serum electrolytes; keep infant NPO; do not attempt to pass NGT due to obstruction from pylorus. 4. Offer infant small frequent feedings; keep NPO 6 to 8 hours before surgery.

2. In addition to giving fluids intra- venously and keeping the infant NPO, an NGT is placed to decompress the stomach.

37. The nurse is caring for an 18-month-old infant whose cleft palate was repaired 12 hours ago. Which of the following should be included in the plan of care? 1. Allow the infant to have familiar items of comfort such as a favorite stuffed animal and a pacifier. 2. Once liquids have been tolerated, encourage a bland diet such as soup, Jell-O, and saltine crackers. 3. Administer pain medication on a regular schedule, as opposed to an as-needed schedule. 4. Use a Yankauer suction catheter on the infant's mouth to decrease the risk of aspiration of oral secretions.

3. Pain medication should be administered regularly to avoid crying, which places stress on the suture line.

12. The nurse is reviewing the discharge instructions of a child diagnosed with encopresis. Which of the following instructions should the nurse question? 1. Limit the intake of milk. 2. Encourage positive reinforcement for appropriate toileting habits. 3. Obtain a complete dietary log. 4. Follow up with a child psychologist or psychiatrist.

2. Positive reinforcement is encouraged. The use of negative reinforcement is discouraged, however, as it may cause the child to attempt to be controlling by holding on to the stool.

39. The nurse is in the room while a mother of a newborn is feeding her infant for the first time. The baby immediately begins coughing and choking. The nurse notes that the baby is extremely cyanotic. Which of the following should be the nurse's immediate action? 1. Call the physician, and inform the physician of the situation. 2. Have the mother stop feeding the infant, and observe to see if the choking episode resolves on its own. 3. Immediately determine the infant's oxygen saturation, and have the mother stop feeding the infant. 4. Take the infant from the mother, and administer blow-by oxygen while obtaining the infant's oxygen saturation.

4. The infant should be taken from the mother and placed in the crib where the nurse can assess the baby. Oxygen should be administered immediately, and vital signs should be obtained.

34. The parents of a newborn diagnosed with a cleft lip and palate ask the nurse when their child's lip and palate will most likely be repaired. Select the nurse's best response. 1. "The palate and the lip are usually repaired in the first few weeks of life so that the baby can grow and gain weight." 2. "The palate and the lip are usually not repaired until the baby is approximately 6 months old so that the mouth has had enough time to grow." 3. "The lip is repaired in the first few months of life, but the palate is not usually repaired until the child is 3 years old." 4. "The lip is repaired in the first few weeks of life, but the palate is not usually re- paired until the child is 18 months old."

4. The lip is repaired in the first few weeks of life, but the palate is not usually repaired until the child is 18 months old.

21. The nurse is caring for a 10-year-old who is being evaluated for possible appendicitis. The child has been complaining of nausea and sharp abdominal pain in the right lower quadrant. An abdominal ultrasound is scheduled, and a blood count has been obtained. The child vomits, finds the pain relieved, and calls the nurse. Which of the following should be the nurse's next action? 1. Cancel the ultrasound, and obtain an order for oral Zofran. 2. Cancel the ultrasound, and prepare to administer an intravenous bolus. 3. Prepare for the probable discharge of the patient. 4. Immediately notify the physician of the child's status.

4. The physician should be notified immediately, as a sudden change or loss of pain often indicates a perforated appendix.

23. The nurse is caring for an 8-year-old who has just returned to the pediatric unit after an appendectomy for a ruptured appendix. Which of the following is the best position for the child?1. Semi-Fowler. 2. Prone. 3. Right side-lying. 4. Left side-lying.

3. The right side-lying position promotes comfort and allows the peritoneal cavity to drain.

36. The nurse is caring for a 4-month-old who has just had an isolated cleft lip repaired. Select the best position for the child in the immediate postoperative period. 1. Right side-lying. 2. Left side-lying. 3. Supine. 4. Prone.

3. The supine position is preferred because there is decreased risk of the infant rubbing the suture line.

38. The nurse is caring for a newborn with esophageal atresia. When reviewing the mother's history, the nurse would expect to find which of the following? 1. A history of maternal polyhydramnios. 2. A pregnancy that lasted more than 38 weeks. 3. A history of poor nutrition during pregnancy. 4. A history of alcohol consumption during pregnancy.

1. Maternal polyhydramnios is present because the infant cannot swallow and absorb the amniotic fluid in utero.

48. The nurse is caring for a 5-month-old infant with a diagnosis of intussusception. The infant has periods of irritability during which the knees are brought to chest and the infant cries, alternating with periods of lethargy. Vital signs are stable and within age-appropriate limits. The physician elects to give an enema. The parents ask the purpose of is the enema. Select the nurse's most appropriate response. 1. "The enema will confirm the diagnosis. If the test result is positive, your child will need to have surgery to correct the intussusception." 2. "The enema will confirm the diagnosis. Although very unlikely, the enema may also help fix the intussusception so that your child will not immediately need surgery." 3. "The enema will help confirm diagnosis and has a good chance of fixing the intussusception." 4. "The enema will help confirm the diagnosis and may temporarily fix the intussusception. If the bowel returns to normal, there is a strong likelihood that the intussusception will recur."

3. In most cases of intussusception in young children, an enema is successful in reducing the intussusception.

10. The parents of a 4-year-old ask the nurse how to manage their child's constipation. Select the nurse's best response. 1. "Add 2 ounces of apple or pear juice to the child's diet." 2. "Be sure your child eats a lot of fresh fruit such as apples and bananas." 3. "Encourage your child to drink more fluids." 4. "Decrease bulky foods such as whole-grain breads and rice."

3. Increasing fluid consumption helps to decrease the hardness of the stool.

45. The nurse is caring for an 8-week-old infant being evaluated for pyloric stenosis. Which of the following statements made by the parents would be typical of a child with this diagnosis? 1. "The baby is a very fussy eater and just does not want to eat." 2. "The baby tends to have a very forceful vomiting episode approximately 30 minutes after most feedings." 3. "The baby is always hungry." 4. "The baby is happy in spite of getting really upset on spitting up."

3. Infants with pyloric stenosis are always hungry and often appear malnourished.

19. The nurse is caring for a 4-month-old with GER. The infant is due to receive Reglan (metoclopramide). Based on the medication's mechanism of action, when should this medication be administered? 1. Immediately before a feeding. 2. 30 minutes after the feeding. 3. 30 minutes before the feeding. 4. At bedtime.

3. Reglan increases gastric emptying and should be administered 30 minutes before a feeding.

49. A nurse working in an emergency room of a large pediatric hospital receives a transfer call from a reporting nurse at a local community hospital. The nurse will soon receive a 4-month-old who has been diagnosed with an intussusception. The infant is described as very lethargic with the following vital signs, T 101.8°F (38.7°C), HR 181, BP 68/38. The reporting nurse states the infant's abdomen is very rigid. Which of the following is the most appropriate action for the receiving nurse? 1. Prepare to accompany the infant to a computed tomography scan to confirm the diagnosis. 2. Prepare to accompany the infant to the radiology department for a reducing enema. 3. Prepare to start a second intravenous line to administer fluids and antibiotics. 4. Prepare to get the infant ready for immediate surgical correction.

4. Intussusception with peritonitis is a surgical emergency, so preparing the infant for surgery is the nurse's top priority.

53. The parents of a child being evaluated for celiac disease ask the nurse why it is important to make dietary changes. Select the nurse's best response. 1. "The body's response to gluten causes damage to the mucosal cells in the intestine, leading to absorption problems." 2. "When the child with celiac disease consumes anything containing gluten, the body responds by creating specials cells called villi, which leads to more diarrhea." 3. "The body's response to gluten causes the intestine to become more porous and hang on to more of the fat-soluble vitamins, leading to vitamin toxicity." 4. "The body's response to gluten causes damage to the mucosal cells, leading to malabsorbtion of water and hard, constipated stools."

1. The inability to digest protein leads to an accumulation of an amino acid that is toxic to the mucosal cells and villi, leading to absorption problems.

47. The nurse receives a call from the mother of a 6-month-old who describes her child as sleepy and fussy. She states that her infant vomited once this morning and had two episodes of diarrhea. The last episode contained mucus and a small amount of blood. She asks the nurse what she should do. Select the nurse's best response. 1. "Your infant will need to have some tests in the emergency room to determine if anything serious is going on." 2. "Try feeding your infant in about 30 minutes; in the event of repeat vomiting, bring the infant to the emergency room for some tests and intravenous rehydration." 3. "Many infants display these symptoms when they develop an allergy to the formula they are receiving; try switching to a soy-based formula." 4. "Do not worry about the blood and mucus in the stool; it is not unusual for infants to have blood in their stools because their intestines are more sensitive."

1. The infant is displaying signs of intussusception. This is an emergency that needs to be evaluated to prevent ischemia and perforation.

13. The nurse is caring for an infant diagnosed with Hirschsprung disease. The mother states she is pregnant with a male and wants to know if her new baby will likely have the disorder. Select the nurse's best response. 1. "Genetics play a small role in Hirschsprung disease, so there is a chance the baby will develop it as well." 2. "There is no evidence to support a genetic link, so it is very unlikely the baby will also have it." 3. "It is rarely seen in boys, so it is not likely your new baby will have Hirschsprung disease." 4. "Hirschsprung disease is seen only in girls, so your new baby will not be at risk."

1. There is a genetic component to Hirschsprung disease, so any future siblings are also at risk.

40. The nurse is caring for a newborn who has just been diagnosed with tracheoesophageal atresia and is scheduled for surgery. Which of the following should the nurse expect to do in the preoperative period? 1. Keep the child in a monitored crib, obtain frequent vital signs, and allow the parents to visit but not hold their infant. 2. Administer intravenous fluids and antibiotics. 3. Place the infant on 100% oxygen via a non-rebreather mask. 4. Have the mother feed the infant slowly in a monitored area, stopping all feedings 4 to 6 hours before surgery.

2. Intravenous fluids are administered to prevent dehydration because the infant is NPO. Intravenous antibiotics are ad- ministered to prevent pneumonia be- cause aspiration of secretions is likely.

35. The nurse is caring for a newborn with a cleft lip and palate. The mother states, "I will not be able to breastfeed my baby." Select the nurse's best response. 1. "It sounds like you are feeling discouraged. Would you like to talk about it?" 2. "Sometimes breastfeeding is still an option for babies with a cleft lip and palate. Would you like more information?" 3. "Although breastfeeding is not an option, you have the option of pumping your milk and then feeding it to your baby with a special nipple." 4. "We usually discourage breastfeeding babies with cleft lip and palate as it puts them at an increased risk for aspiration."

2. Some mothers are able to breastfeed their infants who have a cleft lip and palate. The breast can help fill in the cleft and help the infant create suction.

27. The nurse is providing discharge instructions to the parents of a 10-year-old who had an appendectomy for a ruptured appendix 5 days ago. The nurse knows that further education is required when the child's parent states: 1. "We will wait a few days before allowing our child to return to school." 2. "We will wait 2 weeks before allowing our child to return to sports." 3. "We will call the pediatrician's office if we notice any drainage around the wound." 4. "We will encourage our child to go for walks every day."

27. The child should wait 6 weeks before returning to any strenuous activity.

55. The nurse is caring for a 3-year-old undergoing evaluation for celiac disease. Which of the following would the nurse expect to be included in the child's diagnostic workup? 1. Obtain complete blood count and serum electrolytes. 2. Obtain complete blood count and stool sample; keep child NPO. 3. Obtain stool sample and prepare child for jejunal biopsy. 4. Obtain complete blood count and serum electrolytes; monitor child's response to gluten-containing diet.

3. A stool sample for analysis of fat and a jejunal biopsy can confirm the diagnosis.

11. A 7-year-old is being seen in the pediatric clinic. The child is diagnosed with chronic constipation that has been unresponsive to dietary and activity changes. Which of the following pharmacological measures is most appropriate? 1. Natural supplements and herbs. 2. A stimulant laxative. 3. A stool softener. 4. Pharmacological measures are not used in pediatric constipation.

3. A stool softener is the drug of choice because it will lead to easier evacuation.

41. The nurse is giving discharge instructions to the parents of a 1-month-old infant with tracheoesophageal atresia. The infant is being discharged with a GT. The nurse knows that the parents understand the discharge teaching when the mother states: 1. "I will give my baby feedings through the GT but place liquid medications in the corner of the mouth to be absorbed." 2. "I will flush the GT with 2 ounces of water after each feeding to prevent the GT from clogging." 3. "I will clean the area around the GT with soap and water every day." 4. "I will place petroleum jelly around the GT if any redness develops."

3. The area around the GT should be cleaned with soap and water to prevent an infection.

54. The nurse is caring for a 14-year-old with celiac disease. The nurse knows that the patient understands the diet instructions by ordering which of the following meals? 1. Eggs, bacon, rye toast, and lactose-free milk. 2. Pancakes, orange juice, and sausage links. 3. Oat cereal, breakfast pastry, and nonfat skim milk. 4. Cheese, banana slices, rice cakes, and whole milk.

4. Cheese, banana slices, rice cakes, and whole milk do not contain gluten.

24. The nurse is about to receive a 4-year-old from the recovery room after an appendectomy for a non-ruptured appendix. The parents have not seen the child since the surgery and ask what to expect. Select the nurse's best response. 1. "Your child will be very sleepy, have an intravenous line in the hand, and have a nasal tube to help drain the stomach. If your child needs pain medication, it will be given intravenously." 2. "Your child will be very sleepy, have an intravenous line in the hand, and have white stockings to help prevent blood clots. If your child needs pain medication, we will give it intravenously or provide a liquid to swallow." 3. "Your child will be wide awake and will have an intravenous line in the hand. If your child needs pain medication, we will give it intravenously or provide a liquid to swallow." 4."Your child will be very sleepy and will have an intravenous line in the hand. If your child needs pain medication, we will give it intravenously."

4. In the immediate postoperative period, the child is usually sleepy but can be roused. The child usually has an intravenous line for hydration and pain medication.

16. The nurse is caring for an 8-week-old male who has just been diagnosed with Hirschsprung disease. The parents ask what they should expect. Select the nurse's best response. 1. "It is really an easy disease to manage. Most children are placed on stool softeners to help with constipation until the constipation resolves." 2. "A permanent stool diversion, called a colostomy, will be placed by the surgeon to bypass the narrowed area." 3. "Daily bowel irrigations will help your child maintain regular bowel habits." 4. "Although your child will require surgery, there are different ways to manage the disease, depending on how much of your child's bowel is involved."

4. The aganglionic portion needs to be removed. Although most children have a temporary colostomy placed, many infants are able to bypass the colostomy and have the bowel immediately reattached.