NURS 224 - Exam 1 - Chapters 5, 16, 23

Ch. 5 18. A nurse is assisting a child with inflammatory bowel disease to choose items from the dietary menu. Which dietary item should be avoided because it is high in residue? a. Eggs b. Cheese c. Grapes d. Jello

ANS: C Fruits with skins or seeds should be avoided because they are high in residue. Cooked or canned fruits and vegetables without skins are allowed. Eggs, cheese, and Jello would be allowed on a low residue diet.

Ch. 23 3. The mother of a child with cognitive impairment calls the nurse because her son has been gagging and drooling all morning. The nurse suspects foreign body ingestion. What physiologic occurrence is most likely responsible for the presenting signs? a. Gastrointestinal perforation may have occurred. b. The object may have been aspirated. c. The object may be lodged in the esophagus. d. The object may be embedded in the stomach wall.

ANS: C Gagging and drooling may be signs of esophageal obstruction. The child is unable to swallow saliva, which contributes to the drooling. Signs of gastrointestinal (GI) perforation include chest or abdominal pain and evidence of bleeding in the GI tract. If the object was aspirated, the child would most likely have coughing, choking, inability to speak, or difficulty breathing. If the object was embedded in the stomach wall, it would not result in symptoms of gagging and drooling.

Ch. 23 32. The nurse is caring for an infant who had surgical repair of a tracheoesophageal fistula 24 hours ago. Gastrostomy feedings have not been started. What do nursing actions related to the gastrostomy tube include? a. Keep the tube clamped. b. Suction the tube as needed. c. Leave the tube open to gravity drainage. d. Lower the tube to a point below the level of the stomach.

ANS: C In the immediate postoperative period, the gastrostomy tube is open to gravity drainage. This usually is continued until the infant is able to tolerate feedings. The tube is unclamped in the postoperative period to allow for the drainage of secretions and air. Gastrostomy tubes are not suctioned on an as-needed basis. They may be connected to low suction to facilitate drainage of secretions. Lowering the tube to a point below the level of the stomach would create too much pressure.

Ch. 16 15. Parents of a preschool child ask the nurse, What can we do to prepare our child for kindergarten? In response, the nurse should include which critical factor in preparing a child for kindergarten entry? a. The childs ability to sit still b. The childs sense of learned helplessness c. The parents interactions and responsiveness to the child d. Attending a preschool program

ANS: C Interactions between the parent and child are an important factor in the development of academic competence. Parent encouragement and support maximize a childs potential. The childs ability to sit still is important to learning; however, parental responsiveness and involvement are more important factors. Learned helplessness is the result of a child feeling that he or she has no effect on the environment and his or her actions do not matter. Parents who are actively involved in a supportive learning environment will demonstrate a more positive approach to learning. Preschool and day care programs can supplement the developmental opportunities provided by parents at home, but they are not critical in preparing a child for entering kindergarten.

Ch. 5 3. The postoperative care plan for an infant with surgical repair of a cleft lip includes which intervention? a. A clear liquid diet for 72 hours b. Nasogastric feedings until the sutures are removed c. Elbow restraints to keep the infants fingers away from the mouth d. Rinsing the mouth after every feeding

ANS: C Keeping the infants hands away from the incision reduces potential complications at the surgical site. The infants diet is advanced from clear liquid to soft foods within 48 hours of surgery. After surgery, the infant can resume preoperative feeding techniques. Rinsing the mouth after feeding is an inappropriate intervention. Feeding a small amount of water after feedings will help keep the mouth clean. A cleft lip repair site should be cleansed with a wet sterile cotton swab after feedings.

Ch. 5 23. Which stool characteristic should the nurse expect to assess with a child diagnosed with intussusception? a. Ribbon-like stools b. Hard stools positive for guaiac c. Currant jelly stools d. Loose, foul-smelling stools

ANS: C Pressure on the bowel from obstruction leads to passage of currant jelly stools. Ribbon-like stools are characteristic of Hirschsprungs disease. With intussusception, passage of bloody mucus stools occurs. Stools will not be hard. Loose, foul-smelling stools may indicate infectious gastroenteritis.

Ch. 5 9. Which information does the nurse include when teaching the parents of a 5-week-old infant about pyloromyotomy? a. The infant will be in the hospital for a week. b. The surgical procedure is routine and no big deal. c. The prognosis for complete correction with surgery is good. d. They will need to ask the physician about home care nursing.

ANS: C Pyloromyotomy is the definitive treatment for pyloric stenosis. Prognosis is good with few complications. These comments reassure parents. The infant will remain in the hospital for a day or two postoperatively. Although the prognosis for surgical correction is good, telling the parents that surgery is no big deal minimizes the infants condition. Home care nursing is not necessary after pyloromyotomy.

Ch. 5 8. What is the most important information to be included in the discharge planning for an infant with gastroesophageal reflux? a. Teach the parents to position the infant on the left side. b. Reinforce the parents knowledge of the infants developmental needs. c. Teach the parents how to do infant cardiopulmonary resuscitation (CPR). d. Have the parents keep an accurate record of intake and output.

ANS: C Risk of aspiration is a priority nursing diagnosis for the infant with gastroesophageal reflux. The parents must be taught infant CPR. Correct positioning minimizes aspiration. The correct position for the infant is on the right side after feeding and supine for sleeping. Knowledge of developmental needs should be included in discharge planning for all hospitalized infants but is not the most important in this case. Keeping a record of intake and output is not a priority and may not be necessary.

Ch. 23 14. When caring for a child with probable appendicitis, the nurse should be alert to recognize which sign or symptom as a manifestation of perforation? a. Anorexia b. Bradycardia c. Sudden relief from pain d. Decreased abdominal distention

ANS: C Signs of peritonitis, in addition to fever, include sudden relief from pain after perforation. Anorexia is already a clinical manifestation of appendicitis. Tachycardia, not bradycardia, is a manifestation of peritonitis. Abdominal distention usually increases in addition to an increase in pain (usually diffuse and accompanied by rigid guarding of the abdomen).

Ch. 23 15. The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. What intervention is appropriate to relieve the abdominal discomfort during the evaluation? a. Place in the Trendelenburg position. b. Apply moist heat to the abdomen. c. Allow the child to assume a position of comfort. d. Administer a saline enema to cleanse the bowel.

ANS: C 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. If appendicitis is a possibility, administering laxative or enemas or applying heat to the area is dangerous. Such measures stimulate bowel motility and increase the risk of perforation.

Ch. 5 37. Which goal has the highest priority for a child with malabsorption associated with lactose intolerance? a. The child will experience no abdominal spasms. b. The child will not experience constipation associated with malabsorption syndrome. c. The child will not experience diarrhea associated with malabsorption syndrome. d. The child will receive adequate nutrition as evidenced by a weight gain of 1 kg/day.

ANS: C The highest priority goal is that the child will not experience diarrhea associated with malabsorption syndrome; this goal is correct for a child with malabsorption associated with lactose intolerance. A child usually has abdominal cramping, pain, and distention rather than spasms. The child usually has diarrhea, not constipation. One kilogram a day is too much weight gain with no time parameters.

Ch. 5 21. What is an appropriate statement for the nurse to make to parents of a child who has had a barium enema to correct an intussusception? a. I will call the physician when the baby passes his first stool. b. I am going to dilate the anal sphincter with a gloved finger to help the baby pass the barium. c. I would like you to save all the soiled diapers so I can inspect them. d. Add cereal to the babys formula to help him pass the barium.

ANS: C The nurse needs to inspect diapers after a barium enema because it is important to document the passage of barium and note the characteristics of the stool. The physician does not need to be notified when the infant passes the first stool. Dilating the anal sphincter is not appropriate for the child after a barium enema. After reduction, the infant is given clear liquids and the diet is gradually increased.

Ch. 23 10. A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. What recommendation should the nurse include in teaching this parent? a. Surgical therapy is indicated. b. Place in prone position for sleep after feeding. c. Thicken feedings and enlarge the nipple hole. d. Reduce the frequency of feeding by encouraging larger volumes of formula.

ANS: C Thickened feedings decrease the childs crying and increase the caloric density of the feeding. Although it does not decrease the pH, the number and volume of emesis are reduced. Surgical therapy is reserved for children who have failed to respond to medical therapy or who have an anatomic abnormality. The prone position is not recommended because of the risk of sudden infant death syndrome. Smaller, more frequent feedings are more effective than less frequent, larger volumes of formula.

Ch. 23 31. The nurse is caring for a neonate with a suspected tracheoesophageal fistula. What should nursing care include? a. Feed glucose water only. b. Elevate the patients head for feedings. c. Raise the patients head and give nothing by mouth. d. Avoid suctioning unless the infant is cyanotic.

ANS: C When a newborn is suspected of having a tracheoesophageal fistula, the most desirable position is supine with the head elevated on an inclined plane of at least 30 degrees. It is imperative that any source of aspiration be removed at once; oral feedings are withheld. The oral pharynx should be kept clear of secretions by oral suctioning. This is to prevent the cyanosis that is usually the result of laryngospasm caused by overflow of saliva into the larynx.

Ch. 5 33. The nurse caring for a child with suspected appendicitis should question which physician prescriptions? a. Keep patient NPO. b. Start IV of D5/0.45 normal saline at 60 mL/hr. c. Apply K-pad to abdomen prn for pain. d. Obtain CBC on admission to the nursing unit.

ANS: C A K-pad (moist heat device) is contraindicated for suspected appendicitis because it may contribute to the rupture of the appendix. NPO status is appropriate for the potential appendectomy client. An IV is appropriate both as a preoperative intervention and to compensate for the short-term NPO status. Because appendicitis is frequently reflected in an elevated WBC, laboratory data are needed.

Ch. 23 9. A child has a nasogastric (NG) tube after surgery for Hirschsprung disease. What is the purpose of the NG tube? a. Prevent spread of infection. b. Monitor electrolyte balance. c. Prevent abdominal distention. d. Maintain accurate record of output.

ANS: C The NG tube is placed to suction out gastrointestinal secretions and prevent abdominal distention. The NG tube would not affect infection. Electrolyte content of the NG drainage can be monitored. Without the NG tube, there would be no drainage. After the NG tube is placed, it is important to maintain an accurate record of intake and output. This is not the reason for placement of the tube.

Ch. 5 26. A child is admitted to the pediatric floor for appendicitis. Which assessment finding will the nurse monitor that indicates the appendix has ruptured? a. Abdominal pain shifts from the left to the right side. b. Vomiting and diarrhea become more intense. c. Elevated temperature decreases to normal. d. Abdominal pain is relieved.

ANS: D Abdominal pain is relieved when appendix rupture occurs. Pain in the right lower quadrant is suggestive of appendicitis. Abdominal pain does not shift from one side to the other. The child with appendicitis may have vomiting and diarrhea. A rupture does not intensify symptoms. Because peritonitis is associated with a ruptured appendix, the temperature would be elevated in the presence of infection.

Ch. 16 3. Which is the priority concern in developing a teaching plan for the parents of a 15-month-old child? a. Toilet training guidelines b. Guidelines for weaning children from bottles c. Instructions on preschool readiness d. Instructions on a home safety assessment

ANS: D Accidents are the major cause of death in children, including deaths caused by ingestion of poisonous materials. Home and environmental safety assessments are priorities in this age group because of toddlers increased mobility, which puts them at greater risk in an unsafe environment. Although it is appropriate to give parents of a 15-month-old child toilet training guidelines, the child is not usually ready for toilet training, so it is not the priority teaching intervention. Parents of a 15-month-old child should have been advised to begin weaning from the breast or bottle at 6 to 12 months of age. Educating a parent about preschool readiness is important and can occur later in the parents educational process. The priority teaching intervention for the parents of a 15- month-old child is the importance of a safe environment.

Ch. 5 11. What should the nurse teach a school-age child and his parents about the management of ulcer disease? a. Eat a bland, low-fiber diet in small frequent meals. b. Eat three balanced meals a day with no snacking between meals. c. The child needs to eat alone to avoid stress. d. Do not give antacids 1 hour before or after antiulcer medications.

ANS: D Antacids can interfere with antiulcer medication if given less than 1 hour before or after antiulcer medications. A bland diet is not indicated for ulcer disease. The diet should be a regular diet that is low in caffeine, and the child should eat a meal or snack every 2 to 3 hours. Eating alone is not indicated.

Ch. 5 39. What should the nurse stress in a teaching plan for the mother of an 11-year-old boy with ulcerative colitis? a. Preventing the spread of illness to others b. Nutritional guidance and preventing constipation c. Teaching daily use of enemas d. Coping with stress and adjusting to a chronic illness

ANS: D Coping with the stress of a chronic illness and the clinical manifestations associated with ulcerative colitis (diarrhea, pain) are important teaching foci. Ulcerative colitis is not infectious. Although nutritional guidance is a priority teaching focus, diarrhea is a problem with ulcerative colitis, not constipation. Teaching daily use of enemas is not part of the therapeutic plan of care.

Ch. 16 14. What do parents of preschool children need to understand about discipline? a. Both parents and the child should agree on the method of discipline. b. Discipline should involve some physical restriction. c. The method of discipline should be consistent with the discipline methods of the childs peers. d. Discipline should include positive reinforcement of desired behaviors.

ANS: D Effective discipline strategies should involve a comprehensive approach that includes consideration of the parentchild relationship, reinforcement of desired behaviors, and consequences for negative behaviors. Discipline does not need to be agreed on by the child. Both parents should be in agreement so the discipline is consistently applied. Discipline does not necessarily need to include physical restriction and does not need to be consistent with that of the childs peers.

Ch. 5 41. Careful hand washing before and after contact can prevent the spread of _____ in day care and school settings. a. irritable bowel syndrome b. ulcerative colitis c. hepatic cirrhosis d. hepatitis A

ANS: D Hepatitis A is spread person to person, by the fecal-oral route and through contaminated food or water. Good hand washing is critical in preventing its spread. The virus can survive on contaminated objects for weeks. Irritable bowel syndrome is the result of increased intestinal motility and is not contagious. Ulcerative colitis and cirrhosis are not infectious.

Ch. 5 30. Which nursing diagnosis has the highest priority for the child with celiac disease? a. Pain related to chronic constipation b. Altered growth and development related to obesity c. Fluid volume excess related to celiac crisis d. Imbalanced nutrition: Less than body requirements related to malabsorption

ANS: D Imbalanced nutrition: Less than body requirements related to malabsorption is the highest priority nursing diagnosis because celiac disease causes gluten enteropathy, a malabsorption condition. The pain associated with celiac disease is associated with diarrhea, not constipation. Celiac disease causes altered growth and development associated with malnutrition, not obesity. Celiac crisis causes fluid volume deficit.

Ch. 23 20. A child with pyloric stenosis is having excessive vomiting. The nurse should assess for what potential complication? a. Hyperkalemia b. Hyperchloremia c. Metabolic acidosis d. Metabolic alkalosis

ANS: D Infants with excessive vomiting are prone to metabolic alkalosis from the loss of hydrogen ions. Potassium and chloride ions are lost with vomiting. Metabolic alkalosis, not acidosis, is likely.

Ch. 23 21. What term describes invagination of one segment of bowel within another? 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. Atresia is the absence or closure of a natural opening in the body. Stenosis is a narrowing or constriction of the diameter of a bodily passage or orifice. Herniation is the protrusion of an organ or part through connective tissue or through a wall of the cavity in which it is normally enclosed.

Ch. 5 17. Which intervention should be included in the nurses plan of care for a 7-year-old child with encopresis who has cleared the initial impaction? a. Have the child sit on the toilet 30 minutes when he gets up in the morning and at bedtime. b. Increase sugar in the childs diet to promote bowel elimination. c. Use a Fleet enema daily. d. Give the child a choice of beverage to mix with a laxative.

ANS: D Offering realistic choices is helpful in meeting the school-age childs sense of control. To facilitate bowel elimination, the child should sit on the toilet for 5 to 10 minutes after breakfast and dinner. Decreasing the amount of sugar in the diet will help keep stools soft. Daily Fleet enemas can result in hypernatremia and hyperphosphatemia and are used only during periods of fecal impaction.

Ch. 23 13. What clinical manifestation should 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. Colicky, cramping, abdominal pain around the umbilicus

ANS: D Pain is the cardinal feature. It is initially generalized, usually periumbilical. The pain becomes constant and may shift to the right lower quadrant. Rebound tenderness is not a reliable sign and is extremely painful to the child. Bright or dark red rectal bleeding and abdominal pain that is relieved by eating are not signs of acute appendicitis.

Ch. 16 9. Which assessment finding in a preschooler would suggest the need for further investigation? a. The child is able to dress independently. b. The child rides a tricycle. c. The child has an imaginary friend. d. The child has a 2-pound weight gain in 12 months.

ANS: D Preschool children gain an average of 5 pounds a year. A gain of only 2 pounds is less than half of the expected weight gain and should be investigated. A preschool child should be able to dress independently and be able to ride a tricycle. Imaginary friends are common for preschoolers.

Ch. 5 36. A 7-year-old child is admitted to the hospital with severe abdominal pain, bloody currant jelly diarrhea, and fever. What is his probable diagnosis? a. Hirschsprungs disease b. Celiac disease c. Ruptured appendix d. Intussusception

ANS: D Severe abdominal pain, bloody currant jelly diarrhea, and fever are common clinical manifestations of intussusception. Hirschsprungs disease usually manifests as bowel obstruction. Severe abdominal pain, bloody currant jelly diarrhea, and fever are not common symptoms of celiac disease. Although a child with a ruptured appendix will probably be febrile, the other symptoms are not indicative of a ruptured appendix.

Ch. 16 10. Which is the most appropriate action for the nurse to take when telling a preschool child about an upcoming procedure? a. Explain all the information in detail to the child. b. Speak loudly and clearly to the child. c. Inform the parents of the procedure and ask them to tell the child. d. Use symbolic play to explain the procedure.

ANS: D Symbolic play is important for emotional development because it allows the child to work through distressing feelings and can be therapeutic. It is inappropriate to give a preschooler all the information in detail. The child needs to understand what is going to happen to him without explicit details of the procedure. Speaking in clear sentences with simple words is important, but the conversation should be conducted at a nonthreatening normal sound level. The nurse has the most knowledge and best ability for explaining the procedure to the child; however, the parents can be an important resource when explaining the procedure.

Ch. 23 34. A child who has just had definitive repair of a high rectal malformation is to be discharged. What should the nurse address in the discharge preparation of this family? a. Safe administration of daily enemas b. Necessity of firm stools to keep suture line clean c. Bowel training beginning as soon as the child returns home d. Changes in stooling patterns to report to the practitioner

ANS: D The parents are taught to notify the practitioner if any signs of an anal stricture or other complications develop. Constipation is avoided because a firm stool will place strain on the suture line. Daily enemas are contraindicated after surgical repair of a rectal malformation. Fiber and stool softeners are often given to keep stools soft and avoid tension on the suture line. The child needs to recover from the surgical procedure. Then bowel training may begin, depending on the childs developmental and physiologic readiness.

Ch. 16 12. Which is helpful to tell a mother who is concerned about preventing sleep problems in her preschool child? 1. Have the child always sleep in a quiet, darkened room. 2. Provide high-carbohydrate snacks before bedtime. 3. Communicate with the childs daytime caretaker to encourage a longer nap. 4. Use a nightlight in the childs room.

ANS: D The preschooler has a great imagination. Sounds and shadows can have a negative effect on sleeping behavior. Nightlights provide the child with the ability to visualize the environment and decrease the fear felt in a dark room. A dark, quiet room may be scary to a preschooler. High- carbohydrate snacks increase energy and do not promote relaxation. Taking a longer nap during the day will not cause the child to sleep longer at night. A child who has slept for a long time at the babysitters may not be ready to sleep again.

Ch. 5 38. What would be an appropriate meal for a school-age child with celiac disease? a. Baked chicken and cornbread b. Hot dog and bun c. Bean with barley soup and rice cakes d. Cheeseburger on rye bread

ANS: A Children with celiac disease must eliminate all wheat, rye, barley, oats, and hydrolyzed vegetable proteins from their diet. Cornbread does not contain glutens. Most buns, barley, and rye bread contain glutens.

Ch. 5 7. The nurse admits an infant with vomiting and the diagnosis of hypertrophic pyloric stenosis. Which metabolic alteration should the nurse plan to assess for with this infant? a. Metabolic alkalosis b. Metabolic acidosis c. Respiratory acidosis d. Respiratory alkalosis

ANS: A Frequent projectile vomiting, characteristic of pyloric stenosis, results in a loss of nonvolatile acids that decreases hydrogen ion concentration. This results in an excess of bicarbonate that increases arterial pH above 7.45 (metabolic alkalosis). Metabolic acidosis, respiratory acidosis, and respiratory alkalosis do not result from vomiting.

Ch. 5 19. What is an expected outcome for the child with irritable bowel disease? a. Decreasing symptoms b. Adherence to a low-fiber diet c. Increasing milk products in the diet d. Adapting the lifestyle to the lifelong problems

ANS: A Management of irritable bowel disease is aimed at identifying and decreasing exposure to triggers and decreasing bowel spasms, which will decrease symptoms. Management includes maintenance of a healthy, well-balanced, moderate-fiber, lower-fat diet. A moderate amount of fiber in the diet is indicated for the child with irritable bowel disease. No modification in dairy products is necessary unless the child is lactose intolerant. Irritable bowel syndrome is typically self-limiting and resolves by age 20 years.

Ch. 23 6. What statement best describes Hirschsprung disease? a. The colon has an aganglionic segment. b. It results in frequent evacuation of solids, liquid, and gas. c. The neonate passes excessive amounts of meconium. d. It results in excessive peristaltic movements within the gastrointestinal tract.

ANS: A Mechanical obstruction in the colon results from a lack of innervation. In most cases, the aganglionic segment includes the rectum and some portion of the distal colon. There is decreased evacuation of the large intestine secondary to the aganglionic segment. Liquid stool may ooze around the blockage. The obstruction does not affect meconium production. The infant may not be able to pass the meconium stool. There is decreased movement in the colon.

Ch. 5 40. An infant with Hirschsprungs disease has a temporary colostomy. Which statement by the infants mother indicates she understands how to care for the infants colostomy at home? a. I need to be careful to check the skin around the colostomy for breakdown and be sure I keep it clean. b. Ill call my home health nurse if the colostomy bag needs to be changed. c. Ill call the doctor if I notice that the colostomy stoma is pink. d. Ill have my mother help me with the care of the colostomy.

ANS: A Preventing skin breakdown is a priority concern when caring for a colostomy. The mother should be taught the basics of colostomy care, including how to change the appliance. The colostomy stoma should be pink in color, not pale or discolored. There is no evidence that her mother knows how to care for a colostomy.

Ch. 16 2. Which toy is the most developmentally appropriate for an 18- to 24-month-old child? a. A push and pull toy b. Nesting blocks c. A bicycle with training wheels d. A computer

ANS: A Push and pull toys encourage large muscle activity and are appropriate for the child between 18 and 24 months of age. Nesting blocks are more appropriate for a 12- to 15-month-old child. A bicycle with training wheels is appropriate for a preschool or young school-age child. A computer can be appropriate as early as the preschool years.

Ch. 5 34. Which order should the nurse question when caring for a child after surgery for Hirschsprungs disease? a. Monitor rectal temperature every 4 hours and report an elevation greater than 38.5 C. b. Assess stools after surgery. c. Keep the child NPO until bowel sounds return. d. Maintain IV fluids at an ordered rate.

ANS: A Rectal temperatures should not be taken after this surgery. Rectal temperatures are generally not the route of choice for children because of the routes traumatic nature. Assessing stools after surgery is an appropriate intervention postoperatively. Stools should be soft and formed. Keeping the child NPO until bowel sounds return is an appropriate intervention postoperatively. Maintaining IV fluids at an ordered rate is an appropriate postoperative order.

Ch. 23 25. A child with acute gastrointestinal bleeding is admitted to the hospital. The nurse observes which sign or symptom as an early manifestation of shock? a. Restlessness b. Rapid capillary refill c. Increased temperature d. Increased blood pressure

ANS: A Restlessness is an indication of impending shock in a child. Capillary refill is slowed in shock. The child will feel cool. The blood pressure initially remains within the normal range and then declines.

Ch. 23 1. What test is used to screen for carbohydrate malabsorption? a. Stool pH b. Urine ketones c. C urea breath test d. ELISA stool assay

ANS: A The anticipated pH of a stool specimen is 7.0. A stool pH of less than 5.0 is indicative of carbohydrate malabsorption. The bacterial fermentation of carbohydrates in the colon produces short-chain fatty acids, which lower the stool pH. Urine ketones detect the presence of ketones in the urine, which indicates the use of alternative sources of energy to glucose. The C urea breath test measures the amount of carbon dioxide exhaled. It is used to determine the presence of Helicobacter pylori. ELISA (enzyme-linked immunosorbent assay) detects the presence of antigens and antibodies. It is not useful for disorders of metabolism.

Ch. 5 14. Which food choice by a parent of a 2-year-old child with celiac disease indicates a need for further teaching? a. Oatmeal b. Rice cake c. Corn muffin d. Meat patty

ANS: A The child with celiac disease is unable to fully digest gluten, the protein found in wheat, barley, rye, and oats. Oatmeal contains gluten and is not an appropriate food selection. Rice is an appropriate choice because it does not contain gluten. Corn is digestible because it does not contain gluten. Meats do not contain gluten and can be included in the diet of a child with celiac disease.

Ch. 23 5. A 2-year-old child has a chronic history of constipation and is brought to the clinic for evaluation. What should the therapeutic plan initially include? a. Bowel cleansing b. Dietary modification c. Structured toilet training d. Behavior modification

ANS: A The first step in the treatment of chronic constipation is to empty the bowel and allow the distended rectum to return to normal size. Dietary modification is an important part of the treatment. Increased fiber and fluids should be gradually added to the childs diet. A 2-year-old child is too young for structured toilet training. For an older child, a regular schedule for toileting should be established. Behavior modification is part of the overall treatment plan. The child practices releasing the anal sphincter and recognizing cues for defecation.

Ch. 5 22. Which is the best response for the nurse to make to parents who ask why their infant has a nasogastric tube to intermittent suction after abdominal surgery? a. The nasogastric tube decompresses the abdomen and decreases vomiting. b. We can keep a more accurate measure of intake and output with the nasogastric tube. c. The tube is used to decrease postoperative diarrhea. 4. Believe it or not, the nasogastric tube makes the baby more comfortable after surgery.

ANS: A The nasogastric tube provides decompression and decreases vomiting. A nursing responsibility when a patient has a nasogastric tube is measurement of accurate intake and output, but this is not why nasogastric tubes are inserted. Nasogastric tube placement does not decrease diarrhea. The presence of a nasogastric tube can be perceived as a discomfort by the patient.

Ch. 5 12. Which prescribed formula should the nurse plan to provide for an infant with lactose intolerance? a. Isomil b. Enfamil c. Similac d. Good Start

ANS: A The treatment for lactose intolerance is removal of lactose from the diet. Formulas that do not contain lactose (Isomil, Nursoy, Nutramigen, Prosobee, and other soy-based formulas) may be given to the infant suspected of having lactose intolerance. Enfamil, Similac, and Good Start are all milk-based formulas.

Ch. 5 31. The nurse notes on assessment that a 1-year-old child is underweight, with abdominal distention, thin legs and arms, and foul-smelling stools. The nurse suspects failure to thrive associated with which condition? a. Celiac disease b. Intussusception c. Irritable bowel syndrome d. Imperforate anus

ANS: A These are classic symptoms of celiac disease. Intussusception is not associated with failure to thrive or underweight, thin legs and arms, and foul-smelling stools. Stools are like currant jelly. Irritable bowel syndrome is characterized by diarrhea and pain, and the child does not typically have thin legs and arms. Imperforate anus is the incomplete development or absence of the anus in its normal position in the perineum. Symptoms are evident in early infancy.

Ch. 23 11. After surgery yesterday for gastroesophageal reflux, the nurse finds that the infant has somehow removed the nasogastric (NG) tube. What nursing action is most appropriate to perform at this time? a. Notify the practitioner. b. Insert the NG tube so feedings can be given. c. Replace the NG tube to maintain gastric decompression. d. Leave the NG tube out because it has probably been in long enough.

ANS: A When surgery is performed on the upper gastrointestinal tract, usually the surgical team replaces the NG tube because of potential injury to the operative site. The decision to replace the tube or leave it out is made by the surgical team. Replacing the tube is also usually done by the practitioner because of the surgical site.

Ch. 5 4. A nurse is teaching a group of parents about tracheoesophageal fistula. Which statement, made by the nurse, is accurate about tracheoesophageal fistula (TEF)? a. This defect results from an embryonal failure of the foregut to differentiate into the trachea and esophagus. b. It is a fistula between the esophagus and stomach that results in the oral intake being refluxed and aspirated. c. An extra connection between the esophagus and the trachea develops because of genetic abnormalities. d. The defect occurs in the second trimester of pregnancy.

ANS: A When the foregut does not differentiate into the trachea and esophagus during the fourth to fifth week of gestation, a TEF occurs. TEF is an abnormal connection between the esophagus and trachea. There is no connection between the trachea and esophagus in normal fetal development. Tracheoesophageal fistula occurs early in pregnancy during the fourth to fifth week of gestation.

Ch. 23 19. What information should the nurse include when teaching an adolescent with Crohn disease (CD)? a. How to cope with stress and adjust to chronic illness b. Preparation for surgical treatment and cure of CD c. Nutritional guidance and prevention of constipation d. Prevention of spread of illness to others and principles of high-fiber diet

ANS: A CD is a chronic illness with a variable course and many potential complications. Guidance about living with chronic illness is essential for adolescents. Stress management techniques can help with exacerbations and possible limitations caused by the illness. At this time, there is no cure for CD. Surgical intervention may be indicated for complications that cannot be controlled by medical and nutritional therapy. Nutritional guidance is an essential part of management. Constipation is not usually an issue with CD. CD is not infectious, so transmission is not a concern. A low-fiber diet is indicated.

Ch. 16 1. Which play patterns does a 3-year-old child typically display? Select all that apply. a. Imaginary play b. Parallel play c. Cooperative play d. Structured play

ANS: A, B, C Children between the ages of 3 and 5 years enjoy parallel and associative play. Children learn to share and cooperate as they play in small groups. Play is often imitative, dramatic, and creative. Imaginary friends are common near the age of 3 years. Structured play is typical of school-age children.

Ch. 5 1. Which interventions should a nurse implement when caring for a child with hepatitis? Select all that apply. a. Provide a well-balanced low-fat diet. b. Schedule play time in the playroom with other children. c. Teach parents not to administer any over-the-counter medications. d. Arrange for home schooling as the child will not be able to return to school. e. Instruct parents on the importance of good hand washing.

ANS: A, C, E The child with hepatitis should be placed on a well-balanced low-fat diet. Parents should be taught to not give over-the-counter medications because of impaired liver function. Hand hygiene is the most important preventive measure for the spread of hepatitis. The child will be in contact isolation in the hospital so play time with other hospitalized children is not scheduled. The child will be on contact isolation for at least 1 week after the onset of jaundice, but after that period, will be allowed to return to school.

Ch. 5 1. Which is the best nursing response to a mother asking about the cause of her infants bilateral cleft lip? A. Did you have trouble with this pregnancy? B. Do you know of anyone in your or the fathers family born with cleft lip or palate problems? C. This defect is associated with intrauterine infection during the second trimester. D. Was your husband in the military and involved in chemical warfare?

ANS: B Cleft lip and palate result from embryonic failure resulting from multiple genetic and environmental factors. A genetic pattern or familial risk seems to exist. A troublesome pregnancy has not been associated with bilateral cleft lip. The defect occurred at approximately 6 to 8 weeks of gestation. Second-trimester intrauterine infection is not a known cause of bilateral cleft lip. Chemical warfare is not significantly associated with bilateral cleft lip and palate.

Ch. 5 32. A 10-year-old boy is admitted to the hospital with a diagnosis of appendicitis. He is nauseated, febrile, and complaining of severe abdominal pain radiating to the right lower quadrant. During a routine nursing check, he states that his stomach doesnt hurt anymore. The nurse should suspect that: a. he is anxious about surgery. b. his appendix has ruptured. c. he does not communicate effectively about pain. d. his nausea and vomiting have decreased, thereby relieving his abdominal pain.

ANS: B A classic symptom indicating appendix rupture is the sudden relief of pain. The boy may be anxious, but this will not cause his pain to disappear. There is no evidence to substantiate the assumption that he does not communicate effectively about pain. His nausea and vomiting have not decreased, nor will this affect his abdominal pain.

Ch. 5 28. What is an expected outcome for a 1-month-old infant with biliary atresia? a. Correction of the defect with the Kasai procedure b. Adequate nutrition and age-appropriate growth and development c. Increased blood pressure and adherence to a salt-free diet d. Adequate protein intake

ANS: B Adequate nutrition, preventing skin breakdown, adequate growth and development, and family education and support are expected outcomes in an infant with biliary atresia. The goal of the Kasai procedure is to allow for adequate growth until a transplant can be done. It is not a curative procedure. Although blood pressure typically is elevated, a modified salt diet is appropriate. Protein intake may need to be restricted to avoid hepatic encephalopathy.

Ch. 23 2. A toddlers mother calls the nurse because she thinks her son has swallowed a button type of battery. He has no signs of respiratory distress. The nurses response should be based on which premise? a. An emergency laparotomy is very likely. b. The location needs to be confirmed by radiographic examination. c. Surgery will be necessary if the battery has not passed in the stool in 48 hours. d. Careful observation is essential because an ingested battery cannot be accurately detected.

ANS: B Button batteries can cause severe damage if lodged in the esophagus. If both poles of the battery come in contact with the wall of the esophagus, acid burns, necrosis, and perforation can occur. If the battery is in the stomach, it will most likely be passed without incident. Surgery is not indicated. The battery is metallic and is readily seen on radiologic examination.

Ch. 16 7. Which statement by a mother of a toddler indicates a correct understanding of the use of discipline? a. I always include explanations and morals when I am disciplining my toddler. b. I always try to be consistent when disciplining the children, and I correct my children at the time they are misbehaving. c. I believe that discipline should be done by only one family member. d. My rule of thumb is no more than one spanking a day.

ANS: B Consistent and immediate discipline for toddlers is the most effective approach. Unless disciplined immediately, the toddler will have difficulty connecting the discipline with the behavior. The toddlers cognitive level of development precludes the use of explanations and morals as a part of discipline. Discipline for the toddler should be immediate; therefore, the family member caring for the child should provide discipline to the toddler when it is necessary. Discipline is required for unacceptable behavior, and the one-spanking-a-day rule contradicts the concept of a consistent response to inappropriate behavior. Additionally, spanking is an inappropriate method of disciplining a child.

Ch. 5 15. Which assessment finding should the nurse expect in an infant with Hirschsprungs disease? a. Currant jelly stools b. Constipation with passage of foul-smelling, ribbon-like stools c. Foul-smelling, fatty stools d. Diarrhea

ANS: B Constipation results from the absence of ganglion cells in the rectum and colon and is present since the neonatal period with passage of frequent foul-smelling, ribbon-like, or pellet-like stools. Currant jelly stools are associated with intussusception. Foul-smelling, fatty stools are associated with cystic fibrosis and celiac disease. Diarrhea is not typically associated with Hirschsprungs disease but may result from impaction.

Ch. 5 25. A nurse is conducting a teaching session to adolescents about Crohns disease. Which statement, made by the nurse, is the most accurate? a. Crohns disease is responsive to dietary modifications. b. Crohns disease can occur anywhere in the gastrointestinal tract. c. Edema usually accompanies this disease. d. Symptoms of Crohns disease usually disappear by late adolescence.

ANS: B Crohns disease can occur anywhere in the GI tract from the mouth to the anus and is most common in the terminal ileum. Maintaining a low-fiber, low-residue, and milk-free diet may give the child some relief; however, strict restrictions may not alleviate symptoms. Diarrhea and malabsorption from Crohns disease cause weight loss, anorexia, dehydration, and growth failure. Edema does not accompany this disease. Crohns disease is a long-term health problem. Symptoms do not typically disappear by adolescence.

Ch. 5 20. An infant has been admitted to the Neonatal Intensive Care Unit (NICU) with a congenital gastroschisis. Which intervention should the nurse perform first upon admission to the unit? a. Place the infant flat and prone. b. Cover the defect with sterile warm, moist gauze and wrap with plastic. c. Begin a gestational age assessment. d. Wrap the infant in a warm blanket and allow the father to hold the infant briefly.

ANS: B Gastroschisis is the protrusion of intraabdominal contents through a defect in the abdominal wall lateral to the umbilical ring. There is no peritoneal sac. The defect should be immediately wrapped in warm, moist, sterile gauze and covered with plastic to keep moist. The infant cannot be placed prone as more damage could occur to the defect. Movement of the infant should be minimized so gestational age assessment and parental holding would be done after the infant is stabilized.

Ch. 5 27. What is the most important action to prevent the spread of gastroenteritis in a daycare setting? a. Administering prophylactic medications to children and staff b. Frequent hand washing c. Having parents bring food from home d. Directing the staff to wear gloves at all times

ANS: B Hand washing is the most the important measure to prevent the spread of infectious diarrhea. Prophylactic medications are not helpful in preventing gastroenteritis. Bringing food from home will not prevent the spread of infectious diarrhea. Gloves should be worn when changing diapers, soiled clothing, or linens. They do not need to be worn for interactions that do not involve contact with secretions.

Ch. 23 28. The nurse is discussing home care with a mother whose 6-year-old child has hepatitis A. What information should the nurse include? a. Advise bed rest until 1 week after the icteric phase. b. Teach infection control measures to family members. c. Inform the mother that the child cannot return to school until 3 weeks after onset of jaundice. d. Reassure the mother that hepatitis A cannot be transmitted to other family members.

ANS: B Hand washing is the single most effective measure in preventing and controlling hepatitis. Hepatitis A can be transmitted through the fecaloral route. Family members must be taught preventive measures. Rest and quiet activities are essential and adjusted to the childs condition, but bed rest is not necessary. The child is not infectious 1 week after the onset of jaundice and may return to school as activity level allows.

Ch. 23 12. An adolescent with irritable bowel syndrome comes to see the school nurse. What information should the nurse share with the adolescent? a. A low-fiber diet is required. b. Stress management may be helpful. c. Milk products are a contributing factor. d. Pantoprazole (a proton pump inhibitor) is effective in treatment.

ANS: B Irritable bowel syndrome is believed to involve motor, autonomic, and psychologic factors. Stress management, environmental modification, and psychosocial intervention may reduce stress and gastrointestinal symptoms. A high-fiber diet with psyllium supplement is often beneficial. Milk products can exacerbate bowel problems caused by lactose intolerance. Antispasmodic drugs, antidiarrheal drugs, and simethicone are beneficial for some individuals. Proton pump inhibitors have no effect.

Ch. 23 24. Melena, the passage of black, tarry stools, suggests bleeding from which source? a. The perianal or rectal area b. The upper gastrointestinal (GI) tract c. The lower GI tract d. Hemorrhoids or anal fissures

ANS: B Melena is denatured blood from the upper GI tract or bleeding from the right colon. Blood from the perianal or rectal area, hemorrhoids, or lower GI tract would be bright red.

Ch. 16 6. Parents of a toddler ask the nurse when they should start toilet training. Which statement best addresses their concerns a. When the child is 18 months of age b. When the child exhibits signs of physical and psychological readiness c. When the child has been walking for 9 months d. When the child is able to sit on the potty for 10 to 15 minutes

ANS: B Neurological development is completed at approximately 18 months of age. Parents need to know that both physical and psychological readiness are necessary for toilet training to be successful. The child needs to demonstrate signs of bowel or bladder control before attempting toilet training. Waiting until 24 to 30 months of age makes the task easier; toddlers are less negative, more willing to control their sphincters, and want to please their parents. One of the physical signs of readiness for toilet training is that the child has been walking for 1 year. The ability to sit on the potty 10 to 15 minutes may demonstrate parental control rather than being a sign of developmental readiness for toilet training.

Ch. 5 16. Which would be an expected outcome for the parents of a child with encopresis? a. The parents will give the child an enema daily for 34 months. b. The parents will develop a plan to achieve control over incontinence. c. The parents will have the child launder soiled clothes. d. The parents will supply the child with a low-fiber diet.

ANS: B Parents of the child with encopresis often feel guilty and believe that encopresis is willful on the part of the child. The family functions effectively by openly discussing problems and developing a plan to achieve control over incontinence. Stool softeners or laxatives, along with dietary changes, are typically used to treat encopresis. Enemas are indicated when a fecal impaction is present. Having the child launder soiled clothes is a punishment and will increase the childs shame and embarrassment. The child should not be punished for an action that is not willful. Increasing fiber in the diet and fluid intake results in greater bulk in the stool, making it easier to pass.

Ch. 23 7. What procedure is most appropriate for assessment of an abdominal circumference related to a bowel obstruction? a. Measuring the abdomen after feedings b. Marking the point of measurement with a pen c. Measuring the circumference at the symphysis pubis d. Using a new tape measure with each assessment to ensure accuracy

ANS: B Pen marks on either side of the tape measure allow the nurse to measure the same spot on the childs abdomen at each assessment. The child most likely will be kept NPO (nothing by mouth) if a bowel obstruction is present. If the child is being fed, the assessment should be done before feedings. The symphysis pubis is too low. Usually the largest part of the abdomen is at the umbilicus. Leaving the tape measure in place reduces the trauma to the child.

Ch. 16 1. The mother of a 14-month-old child is concerned because the childs appetite has decreased. The best response for the nurse to make to the mother is: a. It is important for your toddler to eat three meals a day and nothing in between. b. It is not unusual for toddlers to eat less. c. Be sure to increase your childs milk consumption, which will improve nutrition. d. Giving your child a multivitamin supplement daily will increase your toddlers appetite.

ANS: B Physiologically, growth slows and appetite decreases during the toddler period. Toddlers need small, frequent meals. Nutritious selection throughout the day, rather than quantity, is more important with this age group. Milk consumption should not exceed 24 to 32 ounces daily. Increasing the amount of milk will only further decrease solid food intake. Supplemental vitamins are important for all children, but they do not increase appetite.

Ch. 16 11. In caring for a 4-year-old child with a diagnosis of suspected child abuse, which is the best nursing intervention? a. Avoid touching the child. b. Provide the child with play situations that allow for disclosure. c. Discourage the child from remembering the incident. d. Deny the suspected perpetrator visiting rights to the child.

ANS: B Play allows the child to disclose what happened to him or her without having to talk about the incident. Symbolic play is important for emotional development and it allows the child to work through distressing feelings. All children need to be touched. What is important is to tell the child in simple, clear terms what you are doing and why you are doing it. Nurses have the opportunity to teach children the normal, healthy boundaries of their bodies and what constitutes inappropriate behavior. If the child chooses to remember what happened, it is inappropriate to discourage it. It is important to listen to the child in a nonjudgmental way, allowing the child to discuss what happened, to make statements, or to ask questions. It is not the nurses role or responsibility to restrict visitors unless child safety is an issue. The child may be negatively affected if a caregiver, who may be the abuser, does not visit.

Ch. 23 4. What is a high-fiber food that the nurse should recommend for a child with chronic constipation? a. White rice b. Popcorn c. Fruit juice d. Ripe bananas

ANS: B Popcorn is a high-fiber food. Refined rice is not a significant source of fiber. Unrefined brown rice is a fiber source. Fruit juices are not a significant source of fiber. Raw fruits, especially those with skins and seeds, other than ripe bananas, have high fiber.

Ch. 23 17. One of the major differences in clinical presentation between Crohn disease (CD) and ulcerative colitis (UC) is that UC is more likely to cause which clinical manifestation? a. Pain b. Rectal bleeding c. Perianal lesions d. Growth retardation

ANS: B Rectal bleeding is more common in UC than CD. Pain, perianal lesions, and growth retardation are common manifestations of CD.

Ch. 5 2. Which nursing intervention is most helpful to parents of a neonate with bilateral cleft lip? a. Assure the parents that the correction will be immediate and uncomplicated. b. Show the parents before-and-after pictures of an infant whose cleft lip has been successfully repaired. c. Teach the parents about long-term enteral feedings. d. Refer the parents to a community agency that addresses this problem.

ANS: B Showing the parents pictures of successful lip repair promotes bonding and enhances coping ability. Correction is usually done around 4 weeks but may be done as early as 2 to 3 days after birth. The infant with a bilateral cleft lip can be fed orally using a compressible, longer nipple, and by making a larger hole in the nipple. Long-term enteral feedings are not usually indicated. A community agency referral is not appropriate at this time and may not be indicated long term.

Ch. 5 13. Which dietary foods high in calcium should the nurse encourage a lactose intolerant child to eat? a. Yogurt b. Green leafy vegetables c. Cheese d. Rice

ANS: B The child between 1 and 10 years requires a minimum of 800 milligrams of calcium daily. Because high-calcium dairy products containing lactose are restricted from the childs diet, alternate sources such as egg yolk, green leafy vegetables, dried beans, and cauliflower must be provided to prevent hypocalcemia. Yogurt and cheese contain lactose. Rice is not high in calcium.

Ch. 23 18. Nutritional management of the child with Crohn disease includes a diet that has which component? a. High fiber b. Increased protein c. Reduced calories d. Herbal supplements

ANS: B The child with Crohn disease often has growth failure. Nutritional support is planned to reduce ongoing losses and provide adequate energy and protein for healing. Fiber is mechanically hard to digest. Foods containing seeds may contribute to obstruction. A high-calorie diet is necessary to minimize growth failure. Herbal supplements should not be used unless discussed with the practitioner. Vitamin supplementation with folic acid, iron, and multivitamins is recommended.

Ch. 5 29. Which assessment findings would be significant for a child with cirrhosis? a. Weight loss b. Change in level of consciousness c. Soft, smooth skin d. Pallor and cyanosis

ANS: B The child with cirrhosis must be assessed for encephalopathy, which is characterized by a change in level of consciousness. Encephalopathy can result from a buildup of ammonia in the blood from the incomplete breakdown of protein. One complication of cirrhosis is ascites. The child needs to be assessed for increasing abdominal girth and edema. A child who is retaining fluid will not exhibit weight loss. Biliary obstruction can lead to intense pruritus. The skin will be irritated from frequent scratching. A skin assessment would likely reveal jaundice. Pallor and cyanosis are associated with a cardiac problem.

Ch. 23 8. A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. How should the nurse prepare this child? a. It is unnecessary because of childs age. b. It is essential because it will be an adjustment. c. Preparation is not needed because the colostomy is temporary. d. Preparation is important because the child needs to deal with negative body image.

ANS: B The childs age dictates the type and extent of psychologic preparation. When a colostomy is performed, it is necessary to prepare the child who is at least preschool age by telling him or her about the procedure and what to expect in concrete terms, with the use of visual aids. The preschooler is not yet concerned with body image.

Ch. 23 29. What therapeutic intervention provides the best chance of survival for a child with cirrhosis? a. Nutritional support b. Liver transplantation c. Blood component therapy d. Treatment with corticosteroids

ANS: B 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 reflects the failure of other medical and surgical measures to prevent or treat cirrhosis. Nutritional support is necessary for the child with cirrhosis, but it does not stop the progression of the disease. Blood components are indicated when the liver can no longer produce clotting factors. It is supportive therapy, not curative. Corticosteroids are not used in end-stage liver disease.

Ch. 16 5. A nurse is teaching parents of a toddler about language development. Which statement best identifies the characteristics of language development in a toddler? a. Language development skills slow during the toddler period. b. The toddler understands more than he or she can express. c. Most of the toddlers speech is not easily understood. d. The toddlers vocabulary contains approximately 600 words.

ANS: B The toddlers ability to understand language (receptive language) exceeds the childs ability to speak it (expressive language). Although language development varies in relationship to physical activity, language skills are rapidly accelerating by 15 to 24 months of age. By 2 years of age, 60% to 70% of the toddlers speech is understandable. The toddlers vocabulary contains approximately 300 or more words.

Ch. 23 35. The parents of a newborn with an umbilical hernia ask about treatment options. The nurses response should be based on which knowledge? a. Surgery is recommended as soon as possible. b. The defect usually resolves spontaneously by 3 to 5 years of age. c. Aggressive treatment is necessary to reduce its high mortality. d. Taping the abdomen to flatten the protrusion is sometimes helpful.

ANS: B The umbilical hernia usually resolves by ages 3 to 5 years of age without intervention. Umbilical hernias rarely become problematic. Incarceration, where the hernia is constricted and cannot be reduced manually, is rare. Umbilical hernias are not associated with a high mortality rate. Taping the abdomen flat does not help heal the hernia; it can cause skin irritation.

Ch. 23 27. What immunization is recommended for all newborns? a. Hepatitis A vaccine b. Hepatitis B vaccine c. Hepatitis C vaccine d. Hepatitis A, B, and C vaccines

ANS: B Universal vaccination for hepatitis B is recommended for all newborns. Hepatitis A vaccine is recommended for infants starting at 12 months. No vaccine is currently available for hepatitis C.

Ch. 23 16. What statement is most descriptive of Meckel diverticulum? a. It is acquired during childhood. b. Intestinal bleeding may be mild or profuse. c. It occurs more frequently in females than in males. d. Medical interventions are usually sufficient to treat the problem.

ANS: B Bloody stools are often a presenting sign of Meckel diverticulum. It is associated with mild to profuse intestinal bleeding. Meckel diverticulum is the most common congenital malformation of the gastrointestinal tract and is present in 1% to 4% of the general population. It is more common in males than in females. The standard therapy is surgical removal of the diverticulum.

Ch. 23 23. An infant with short bowel syndrome is receiving total parenteral nutrition (TPN). The practitioner has added continuous enteral feedings through a gastrostomy tube. The nurse recognizes this as important for which reason? a. Wean the infant from TPN the next day b. Stimulate adaptation of the small intestine c. Give additional nutrients that cannot be included in the TPN d. Provide parents with hope that the child is close to discharge

ANS: B Long-term survival without TPN depends on the small intestines ability to increase its absorptive capacity. Continuous enteral feedings facilitate the adaptation. TPN is indicated until the child is able to receive all nutrition via the enteral route. Before this is accomplished, the small intestine must adapt and increase in cell number and cell mass per villus column. TPN is formulated to meet the infants nutritional needs. Continuous enteral feedings through a gastrostomy tube is a positive sign, but the infants ability to tolerate increasing amounts of enteral nutrition is only one factor that determines readiness for discharge.

Ch. 16 13. Which statement is true about the care of the toddlers teeth? a. Because deciduous teeth are not permanent, they are not important to the child. b. Children can be encouraged to brush their teeth after the teeth have been thoroughly cleaned by the parent. c. Secondary tooth eruption begins at 4 to 5 years of age. d. Fluoride supplements can be discontinued when the secondary teeth erupt.

ANS: B Toddlers lack the manual dexterity to remove plaque adequately, so parents must assume this responsibility. Deciduous teeth are important because they maintain spacing and play an important role in the growth and development of the jaws and face and in speech development. Secondary teeth erupt at about 6 years of age. If the family does not live in an area in which fluoride is included in the water supply, fluoride supplements should be continued.

Ch. 23 26. What signs or symptoms are most commonly associated with the prodromal phase of acute viral hepatitis? a. Bruising and lethargy b. Anorexia and malaise c. Fatigability and jaundice d. Dark urine and pale stools

ANS: B Bruising and lethargy Anorexia and malaise Fatigability and jaundice Dark urine and pale stools The signs and symptoms most common in the prodromal phase are anorexia, malaise, lethargy, and easy fatigability. Bruising would not be an issue unless liver damage has occurred. Jaundice is a late sign and often does not occur in children. Dark urine and pale stools would occur during the onset of jaundice (icteric phase) if it occurs.

Ch. 23 33. What should preoperative care of a newborn with an anorectal malformation include? a. Frequent suctioning b. Gastrointestinal decompression c. Feedings with sterile water only d. Supine position with head elevated

ANS: B Gastrointestinal decompression is an essential part of nursing care for a newborn with an anorectal malformation. This helps alleviate intraabdominal pressure until surgical intervention. Suctioning is not necessary for an infant with this type of anomaly. Feedings are not indicated until it is determined that the gastrointestinal tract is intact. Supine position with head elevated is indicated for infants with a tracheoesophageal fistula, not anorectal malformations.

Ch. 16 2. A nurse is planning care for a hospitalized toddler in the preoperational thinking stage. Which characteristics should the nurse expect in this stage? Select all that apply. a. Concrete thinking b. Egocentrism c. Animism d. Magical thought e. Ability to reason

ANS: B, C, D The characteristics of preoperational thinking that occur for the toddler include egocentrism (views everything in relation to self), animism (believes that inert objects are alive), and magical thought (believes that thinking something causes that event). Concrete thinking is seen in school age children and ability to reason is seen with adolescents.

Ch. 5 2. The nurse is providing home care instructions to the parents of an infant being discharged after repair of a bilateral cleft lip. Which instructions should the nurse include? Select all that apply. a. Acetaminophen (Tylenol) should not be given to your infant. b. Feed your infant in an upright position. c. Place your infant prone for a period of time each day. d. Burp your child frequently during feedings. e. Apply antibiotic ointment to the lip as prescribed.

ANS: B, D, E After cleft lip surgery the parents are taught to feed the infant in an upright position to decrease the chance of choking. The parents are taught to burp the infant frequently during feedings because excess air is often swallowed. Parents are taught to cleanse the suture line area with a cotton swab using a rolling motion and apply antibiotic ointment with the same technique. Tylenol is used for pain and the child should never be placed prone as that can damage the suture line.

Ch. 5 5. Which maternal assessment is related to the infants diagnosis of TEF? a. Maternal age more than 40 years b. First term pregnancy for the mother c. Maternal history of polyhydramnios d. Complicated pregnancy

ANS: C A maternal history of polyhydramnios is associated with TEF. Advanced maternal age is not a risk factor for TEF. The first term pregnancy is not a risk factor for an infant with TEF. Complicated pregnancy is not a risk factor for TEF.

Ch. 5 6. What clinical manifestation should a nurse should be alert for when a diagnosis of esophageal atresia is suspected? a. A radiograph in the prenatal period indicates abnormal development. b. It is visually identified at the time of delivery. c. A nasogastric tube fails to pass at birth. d. The infant has a low birth weight.

ANS: C Atresia is suspected when a nasogastric tube fails to pass 10 to 11 centimeters beyond the gum line. Abdominal radiographs will confirm the diagnosis. Prenatal radiographs do not provide a definitive diagnosis. The defect is not externally visible. Bronchoscopy and endoscopy can be used to identify this defect. Infants with esophageal atresia may have been born prematurely and with a low birth weight, but neither is suggestive of the presence of an esophageal atresia.

Ch. 23 22. A school-age child with celiac disease asks for guidance about snacks that will not exacerbate the disease. What snack should the nurse suggest? a. Pizza b. Pretzels c. Popcorn d. Oatmeal cookies

ANS: C Celiac disease symptoms result from ingestion of gluten. Corn and rice do not contain gluten. Popcorn or corn chips will not exacerbate the intestinal symptoms. Pizza and pretzels are usually made from wheat flour that contains gluten. Also, in the early stages of celiac disease, the child may be lactose intolerant. Oatmeal contains gluten.

Ch. 16 8. Which comment indicates that the mother of a toddler needs further teaching about dental care? a. We use well water so I give my toddler fluoride supplements. b. My toddler brushes his teeth with my help. c. My child will not need a dental checkup until his permanent teeth come in. d. I use a small nylon bristle brush for my toddlers teeth.

ANS: C Children should first see the dentist 6 months after the first primary tooth erupts and no later than age 30 months. Toddlers need fluoride supplements when they use a water supply that is not fluorinated. Toddlers need supervision with dental care. The parent should finish brushing areas not reached by the child. A small nylon bristle brush works best for cleaning toddlers teeth.

Ch. 16 4. What is the primary purpose of a transitional object? a. It helps the parents deal with the guilt they feel when they leave the child. b. It keeps the child quiet at bedtime. c. It is effective in decreasing anxiety in the toddler. d. It decreases negativism and tantrums in the toddler.

ANS: C Decreasing anxiety, particularly separation anxiety, is the function of a transitional object; it provides comfort to the toddler in stressful situations and helps make the transition from dependence to autonomy. A decrease in parental guilt (distress) is an indirect benefit of a transitional object. A transitional object may be part of a bedtime ritual, but it may not keep the child quiet at bedtime. A transitional object does not significantly affect negativity and tantrums, but it can comfort a child after tantrums.

Ch. 5 35. Which diagnosis has the highest priority for the child with irritable bowel syndrome? a. Alteration in nutrition: Less than body requirements related to malabsorption b. Altered growth and development related to inadequate nutrition c. Pain related to hyperperistalsis d. Constipation related to maldigestion

ANS: C Diffuse abdominal pain unrelated to activity or meals is a common clinical manifestation of irritable bowel syndrome. Normal physical growth and development usually occur with this disorder. Constipation may occur with irritable bowel syndrome, usually alternating with diarrhea.

Ch. 5 24. Which is a priority concern for a 14-year-old child with inflammatory bowel disease? a. Compliance with antidiarrheal medication therapy b. Long-term complications c. Dealing with the embarrassment and stress of diarrhea d. Home schooling

ANS: C Embarrassment and stress from chronic diarrhea are real concerns for the adolescent with inflammatory bowel disease. Antidiarrheal medications are not typically ordered for a child with inflammatory bowel disease. Long-term complications are not a priority concern for the adolescent with inflammatory bowel disease. Exacerbations may interfere with school attendance, but home schooling is not a usual consideration for the adolescent with inflammatory bowel disease.

Ch. 5 10. A nurse has admitted a child to the hospital with a diagnosis of rule out peptic ulcer disease. Which test will the nurse expect to be ordered to confirm the diagnosis of a peptic ulcer? a. A 24-hour dietary history b. A positive Hematest result on a stool sample c. A fiberoptic upper endoscopy d. An abdominal ultrasound

ANS: C Endoscopy provides direct visualization of the stomach lining and confirms the diagnosis of peptic ulcer. Dietary history may yield information suggestive of a peptic ulcer, but the diagnosis is confirmed through endoscopy. Blood in the stool indicates a gastrointestinal abnormality, but it does not conclusively confirm a diagnosis of peptic ulcer. An abdominal ultrasound is used to rule out other gastrointestinal alterations such as gallstones, tumor, or mechanical obstruction.

Ch. 23 30. The nurse observes that a newborn is having problems after birth. What should indicate a tracheoesophageal fistula? a. Jitteriness b. Meconium ileus c. Excessive frothy saliva d. Increased need for sleep

ANS: C Excessive frothy saliva is indicative of a tracheoesophageal fistula. The child is unable to swallow the secretions, so there are excessive amounts of saliva in the mouth. Jitteriness is associated with several disorders, including electrolyte imbalances. Meconium ileus is associated with cystic fibrosis. Increased need for sleep is not associated with a tracheoesophageal fistula.