NURS 405 Ch. 42 (Ricci) (through ML 7)

The nurse is talking with a woman in her second trimester of pregnancy who has been diagnosed with polyhydramnios. The physician has ordered an ultrasound be performed to check for the presence of esophageal atresia. Which statement by the woman indicates an understanding of the relationship between these conditions? A. "Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup." B. "Reductions in amniotic fluid are associated with the development of esophageal atresia." C. "Enzymes in amniotic fluid can cause the development of esophageal atresia." D. "Babies with esophageal atresia produce an excessive amount of amniotic fluid."

A. "Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup." Review the maternal history for polyhydramnios. Often this is the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. Esophageal atresia is an underlying cause of polyhydramnios.

The nurse has performed client education for a 15-year-old boy with Crohn disease and his parents regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning has occurred? A. "I have to be careful because I am prone to not absorbing nutrients." B. "It's unusual for someone my age to get Crohn disease." C. "I have a lot of diarrhea every day because of how my small intestine is damaged." D. "I may end up with a colectomy because the disease is continuous from the beginning to the end of my intestines."

A. "I have to be careful because I am prone to not absorbing nutrients." Crohn disease typically affects the small intestine more than the large intestine and its onset is between the ages of 10 to 20 years. The cobblestone lesions in the small intestine prevent absorption of nutrients that normally occurs. The diarrhea is not directly related to the cobblestone lesions, and ulcerative colitis is characterized by the disease affecting the intestine(s) in a continuous pattern.

The nurse is caring for an infant recently diagnosed with oral candidiasis (thrush) who has been prescribed nystatin. Which statement by the infant's mother would suggest a need for further education? A. "I will add the nystatin to her bottle four times per day." B. "I will use a cotton tipped applicator to apply the medication to her mouth." C. "I will make sure to clean all of her toys before I give them to her." D. "I will watch for diaper rash."

A. "I will add the nystatin to her bottle four times per day." Administer nystatin suspension four times per day following feeding, not mixed in the bottle, to allow the medication to remain in contact with the lesions. In the younger infant, apply nystatin to the lesions with a cotton-tipped applicator. Infants and young children often mouth their toys, so it is important to clean them appropriately. Explain to parents of infants with oral candidiasis (thrush) the importance of reporting diaper rash because fungal infections in the diaper area often occur concomitantly with thrush and also need to be treated.

The mother of a young child who has been treated for a bacterial urinary tract infection tells the nurse her daughter has a white thick covering over her tongue. The mother states that she "has tried everything to get it off my child's tongue." How should the nurse respond? A. "It's not unusual for a fungal infection to occur while taking an antibiotic for an infection. I will let your primary care provider know so we can get it treated." B. "It is likely an infection was caused by the antibiotic for the urinary tract infection. I am sure a different antibiotic will help it." C. "That is a common side effect after taking an antibiotic. It will go away after the antibiotic is out of the system." D. "Have you tried using a toothbrush to get it off?"

A. "It's not unusual for a fungal infection to occur while taking an antibiotic for an infection. I will let your primary care provider know so we can get it treated." Oral candidiasis (thrush) is a fungal infection that can occur on the tongue while on an antibiotic for an unrelated bacterial infection. The antibiotic destroys normal flora, which allows the fungal infection to occur. Thrush requires an antifungal agent, such as nystatin liquid, to destroy the infection. Additional antibiotics will not help since it is a fungal infection.

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac disease. The caregivers make the following statements. Which statement indicates a need for further teaching regarding the dietary restrictions for the child with celiac disease? A. "She loves hot dogs, and we always cut hers up into small pieces." B. "I have learned to make my own bread with no gluten." C. "The soup we eat at our house is all made from scratch." D. "Even though milk and pudding are good for her, we don't give her those foods."

A. "She loves hot dogs, and we always cut hers up into small pieces." Commercially canned creamed soups, cold cuts, frankfurters, and pudding mixes generally contain wheat products and should not be included in the diet of the child with celiac syndrome. This caregiver needs further teaching regarding giving her child hot dogs, even if they are cut into small pieces. The other choices show an understanding of the dietary restrictions.

The student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply. A. "The only treatment for celiac disease is a strict gluten-free diet." B. "Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." C. "Most children with celiac disease are diagnosed within the first year of life." D. "Gluten is found in most wheat products, rye, barley and possibly oats." E. "The entire family will need to eat a gluten-free diet."

A. "The only treatment for celiac disease is a strict gluten-free diet." B. "Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." D. "Gluten is found in most wheat products, rye, barley and possibly oats." Celiac disease is an immunologic disorder in which gluten causes damage to the small intestine. The only treatment currently is consuming a gluten-free diet. While the child needs to have a gluten-free diet, the rest of the family does not. Most children present by the age of 2 for evaluation. Symptoms of celiac disease include diarrhea, constipation, steatorrhea, weight loss, poor muscle tone, anemia and dental disorders. Gluten is found in most grains, like wheat, rye, barley and possibly oats.

The nurse is providing care to a child who has had an appendectomy for a perforated appendix. The nurse would anticipate intravenous antibiotic therapy for how long? A. 7 to 14 days B. 3 to 5 days C. 1 to 3 days D. 5 to 7 days

A. 7 to 14 days The child with a perforated appendix requires 7 to 14 days of intravenous antibiotic therapy. If the child has a suppurative or gangrenous appendix that was not perforated, 2 to 3 days of antibiotics would be most likely ordered.

The nurse is caring for a teenager diagnosed with acute pancreatitis. Which order would the nurse question? A. PO pain management B. serum amylase levels C. nasogastric tube placed to suction D. NPO

A. PO pain management Maintain NPO status and nasogastric tube suction and patency. Administer intravenous fluids to keep the child hydrated and correct any alterations in fluid and electrolyte balance. Pain management is crucial in children with pancreatitis; due to NPO status, medications are typically prescribed intravenously. Serial monitoring of serum amylase levels will determine when oral feeding may be restarted.

The emergency department nurse is assessing a child who has presented with a 2-day history of nausea and vomiting with pain that is isolated to the right upper quadrant of the abdomen. Which action is most appropriate? A. Prepare the child for admission to the hospital. B. Encourage fluid intake. C. Assess the child's usual urinary voiding pattern. D. Administer antacids as ordered.

A. Prepare the child for admission to the hospital. The child's presentation is consistent with cholecystitis, which necessitates surgery in most cases. The child should be kept NPO and antacids are of no benefit. Genitourinary involvement is atypical.

An adolescent has hepatitis B. What would be the most important nursing action? A. Strict enforcement of standard precautions B. Strict calculation of caloric and vitamin B intake C. Close observation to detect cerebral hallucinations D. Conscientious collection of stool for ova and parasites

A. Strict enforcement of standard precautions Hepatitis B is spread through IV drug use, sex, contaminated blood and perinatally. The treatment is rest, hydration, and nutrition. Hospitalization is required if there is vomiting, dehydration, elevated bleeding times and mental status changes. The adolescent should be taught about good hygiene, safe sex practices, careful handwashing and blood/bodily fluid contact precautions. Using standard precautions of gloves and good handwashing will help prevent spread of the disease. Ova and parasites are not present with hepatitis B. A good diet with adequate protein and vitamins will help the body heal, so these should not be restricted. The nurse observes for mental status changes. These can occur as a complication, but preventing spread of the disease is the nursing priority.

Which assessment finding would suggest that a child's postoperative feeding schedule following pyloric stenosis surgery should be slowed? A. Vomiting B. Flatulence C. Semiformed bowel movements D. Falling asleep at each feeding

A. Vomiting Vomiting after a feeding suggests the pyloric valve is not yet able to accommodate feedings well, possibly from edema. Flatulence and semi-formed stools would be positive signs that motility is active and digestion is occurring. Falling asleep is a sign that the child is full and satisfied.

The health care provider prescribes an abdominal radiograph for a newborn to check for Hirschsprung disease. The nurse examines the newborn and finds which symptoms that are indicative of this disease? Select all that apply. A. abdominal distention B. presence of a fistula C. bilious vomiting D. enterocolitis E. absence of stool in the rectum F. displaced anus

A. abdominal distention C. bilious vomiting D. enterocolitis E. absence of stool in the rectum Hirschsprung disease is a movement disorder of the intestinal tract. The ganglion are missing, which causes inadequate motility. The nurse should suspect Hirschsprung disease when the newborn does not pass meconium in the first 24 hours after birth and has bilious vomiting or has abdominal distention, feeding intolerance with bilious aspirates, and vomiting. In anorectal malformations, the anus is absent or displaced and the presence of a fistula may be noted when gas or stool is expelled from the urethra or vagina.

A mother brings her 3-year-old son to the ER and tells the triage nurse that he has been vomiting blood. A medical history determines that the 3-year-old has no history of GI disturbances and his only symptoms are a slightly elevated fever and vomiting bright red blood. Based on these symptoms, what condition might the nurse suspect? A. acute upper GI bleeding B. intussusception C. GI tract obstruction D. gastroesophageal reflux

A. acute upper GI bleeding Vomiting bright red blood indicates acute upper GI bleeding. Emesis containing brown, foul-smelling stool indicates GI obstruction. Stool with red blood and mucus is associated with intussusception. Bleeding is not generally indicative of gastroesophageal reflux.

A child is hospitalized with dehydration as a result of rotavirus. When reviewing the plan of treatment, what can the nurse anticipate will be included? Select all that apply. A. daily weight assessment B. antibiotic therapy C. IV fluid administration D. monitor of intake and output E. antidiarrheal agents

A. daily weight assessment C. IV fluid administration D. monitor of intake and output Rotavirus is viral in nature. Antibiotic therapy is not used in the care and treatment of a viral infection. Antidiarrhea medications are not utilized as they are not effective. Intake and output will be observed. Daily weight will aid in the determination of hydration status. IV fluids may be indicated in the rehydration process.

An 18-month-old infant is brought to the emergency department with flu-like symptoms. The infant is diagnosed with pneumonia secondary to aspiration of stomach contents. The nurse explains to the parents that pneumonia is a condition that often occurs secondary to: A. gastroesophageal reflux disease. B. inflammatory bowel disease. C. cystic fibrosis. D. Hirschsprung disease.

A. gastroesophageal reflux disease. Gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus. These refluxed contents may be aspirated into the lungs. The child with gastroesophageal reflux disease may present with the physical findings of pneumonia or GER-induced asthma. GER may cause apnea or an apparent life-threatening event in the younger infant. Pneumonia can occur in children with cystic fibrosis, but the child would need to have the cystic fibrosis diagnosis first. Hirschsprung and inflammatory bowel diseases are diseases of the gastrointestinal tract that do not present with respiratory symptoms.

The parent reports that the health care provider said that the infant had a hernia but cannot remember which type. When recalling what the health care provider said, the parent said that a surgeon will repair it soon and there is no problem with the testes. Which hernia type is anticipated? A. inguinal hernia B. hiatal hernia C. umbilical hernia D. diaphragmatic hernia

A. inguinal hernia An inguinal hernia occurs primarily in males and allows the intestine to slip into the inguinal canal, resulting in swelling. If the intestine becomes trapped and circulation is impaired, surgery is indicated within a short period of time. The diaphragmatic hernia has implications with the respiratory system. An umbilical hernia typically spontaneously closes by age 3. A hiatal hernia produces digestive issues.

The caregiver of a child diagnosed with celiac disease tells the nurse that the child has large amounts of bulky stools and what looks like fat in the stools. The clinical manifestation this caregiver is describing is: A. steatorrhea. B. projectile stools. C. currant jelly stools. D. severe diarrhea.

A. steatorrhea. Celiac disease is an immunologic response to gluten, which causes damage to the small intestine. Steatorrhea (fatty stools) is a classic symptom of celiac disease. Symptoms also include abdominal distention or bloating, constipation, and nutritional deficiencies. Currant jelly stools are a sign of intussusception. Projectile vomiting is a sign of pyloric stenosis. Severe diarrhea could be caused by a bacteria or virus. Projectile stools represent severe diarrhea.

A nurse caring for an infant born with a cleft palate notices that the parents rarely interact with their child. The nurse overhears the mother telling her spouse that she "feels like crying" every time she looks at their infant. What would be the best response from the nurse? A. "Your infant needs you right now. You should put your negative feelings about the condition aside for your infant's sake." B. "I sense you could use more information on caring for a cleft palate. Would you be interested in meeting with other parents who have dealt with this?" C. "Keep in mind that your infant's condition is not life-threatening and can be corrected eventually." D. "Many infants are born with this condition. Your infant's palate is not nearly as bad as some cases."

B. "I sense you could use more information on caring for a cleft palate. Would you be interested in meeting with other parents who have dealt with this?" For many parents, having their infant born with a cleft lip or palate is overwhelming and to some even appalling. The nurse can support the parents by acknowledging their normal feelings of guilt, anger, and sadness. The nurse should support the family's adjustment to an infant's condition by demonstrating an accepting, caring attitude toward the child and family and providing the parents with opportunities and support for normal infant-parent interactions. Many parents need additional support outside the hospital or during surgical repairs. Parent-to-parent support groups are available and parents should be given information about to how to contact a local group. It may be difficult for a parent to bond with an infant who the parent feels is not perfect and those feeling cannot be easily dismissed. It does not matter if the defect is not life-threatening; it is still important to the parents and requires much skill to repair and heal. Stating this is being judgmental.

A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition? A. Endoscopic retrograde cholangiopancreatography B. Barium enema C. Upper endoscopy D. Surgery

B. Barium enema A barium enema is successful in reducing a large percentage of intussusception cases. Other cases are reduced surgically. Upper endoscopy is used to visualize the upper gastrointestinal tract from the mouth to the upper jejunum. Endoscopic retrograde cholangiopancreatography is used to view the hepatobiliary system.

A child presents with intermittent abdominal pain, severe anorexia, and diarrhea. The child's height and weight are significantly behind standards for age. There is skin breakdown in the anal region. The nurse explains that this presentation is consistent with which diagnosis? A. Hirschsprung disease B. Crohn disease C. ulcerative colitis D. food poisoning

B. Crohn disease Intermittent abdominal pain, anorexia, diarrhea, growth delays, and perianal lesions are characteristic of Crohn disease. In ulcerative colitis, the pain is continuous with bloody diarrhea, but anorexia, weight loss, and growth delay are mild. Food poisoning is an acute condition and may result in weight loss but not growth delays. In Hirschsprung disease the bowel lacks nerve innervation, so it lacks motility and fecal output.

A preschooler has celiac disease. The parent is preparing a gluten-free diet. The nurse knows that the parent understands the diet when the parent prepares which breakfast foods? A. Cheerios (oat cereal) and skim milk B. Eggs and orange juice C. Rye toast and peanut butter D. Wheat toast and grape jelly

B. Eggs and orange juice Celiac disease is an immunological disorder in which gluten causes damage to the small intestines. Gluten is commonly found in grains. Children with celiac disease cannot digest the protein in common grains, such as wheat, rye, and oats. Providing foods with rye, wheat, and oats would cause the child to develop symptoms and worsen the situation.

A neonatal nurse teaches students how to recognize gastrointestinal disorders in infants. The nurse tells the students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease? A. Gastroenteritis B. Hirschsprung disease C. Ulcerative colitis (UC) D. Short bowel syndrome (SBS)

B. Hirschsprung disease The nurse should suspect Hirschsprung disease when the newborn does not pass meconium in the first 24 hours after birth, and has bilious vomiting or abdominal distention and feeding intolerance with bilious aspirates and vomiting. Typical signs and symptoms of gastroenteritis include diarrhea, nausea, vomiting, and abdominal pain. The characteristic GI manifestation of UC is bloody diarrhea accompanied by crampy, typically left-sided lower abdominal pain. Clinical manifestations of untreated SBS include profuse watery diarrhea, malabsorption, and failure to thrive.

An infant brought to the emergency department has been vomiting for 2 days. The nurse assesses the infant and finds sunken fontanels (fontanelles), tenting skin, dry mucus membranes and no urine output for 12 hours. Which intervention(s) will the nurse complete as first-line care for this infant? Select all that apply. A. Begin maintenance IV fluids. B. Insert a peripheral IV. C. Administer a prescribed IV fluid bolus. D. Start oral rehydration. E. Administer an antiemetic.

B. Insert a peripheral IV. C. Administer a prescribed IV fluid bolus. E. Administer an antiemetic. This infant is showing signs of severe dehydration. These symptoms include sunken fontanels (fontanelles), tenting of the skin, dry mucus membranes, delayed capillary refill, an increased heart rate and a urine output of less than 1ml/kg/hr. The nurse will need to insert a peripheral IV and begin the prescribed bolus IV infusion. After the bolus has been completed, the infant would need to be reassessed for urine output and symptom improvement. The health care provider would then prescribe another IV bolus or begin maintenance IV fluids. Antiemetics can be prescribed if necessary. Oral rehydration is used for mild or moderate dehydration.

A parent brings the 2-week-old infant to the office because the infant has been experiencing gastroesophageal reflux over the past week. Which intervention(s) should the nurse recommend to the parent at this point? Select all that apply. A. If breastfeeding, switch to feeding the infant formula. B. Keep the infant upright by holding them and/or elevating the head of the crib after feeding. C. Feed the infant while holding the infant in an upright position. D. Consult the heath care provider regarding having botulinum toxin injected into the lower esophageal sphincter. E. Feed the infant a formula thickened with rice cereal. F. Consult a pediatric surgeon regarding having a myotomy procedure performed.

B. Keep the infant upright by holding them and/or elevating the head of the crib after feeding. C. Feed the infant while holding the infant in an upright position. E. Feed the infant a formula thickened with rice cereal. The traditional treatment of gastroesophageal reflux in the infant is to feed a formula thickened with rice cereal (1 tbsp of cereal per 1 oz of formula or breast milk) while holding the infant in an upright position and then keeping the infant upright by holding them and/or elevating the head of the crib 30 degrees for 30 to 45 minutes after feeding so gravity can help prevent reflux. There is no need for the parent to switch from breastfeeding to formula-feeding. Injection of botulinum toxin into the lower esophageal sphincter and a myotomy procedure are interventions that would be considered only if the problem does not disappear with feeding solid food and maintaining the infant in a more upright position during and following feeding; these procedures would not be appropriate at this point.

The nurse is caring for a child admitted with congenital aganglionic megacolon. Which clinical manifestation would likely have been noted in the child with this diagnosis? A. Prolonged bleeding B. Persistent constipation C. Irregular breathing D. Chronic cough

B. Persistent constipation Congenital aganglionic megacolon, also called Hirschsprung disease, is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Prolonged bleeding is a manifestation of hemophilia. A chronic cough is noted in the child with cystic fibrosis. Irregular breathing occurs in children with seizures.

The nurse is caring for a child admitted with pyloric stenosis. Which clinical manifestation would likely have been noted in the child with this diagnosis? A. Explosive diarrhea B. Projectile vomiting C. Frequent urination D. Severe abdominal pain

B. Projectile vomiting During the first weeks of life, the infant with pyloric stenosis often eats well and gains weight and then starts vomiting occasionally after meals. Within a few days the vomiting increases in frequency and force, becoming projectile. The child may have constipation, and peristaltic waves may be seen in the abdomen, but the child does not appear in severe pain. Urine output is decreased and urination is infrequent.

An adolescent is diagnosed with hepatitis A. Which problem should be considered when planning care? A. The adolescent's urine will be dark and infectious. B. The adolescent will become fatigued easily. C. The adolescent will be very irritable and perhaps require sedation. D. Hypothermia is common.

B. The adolescent will become fatigued easily. Hepatitis A is transmitted via the oral-fecal route; it is water borne and often occurs in areas of poor sanitation. The adolescent with hepatitis A will exhibit flu-like symptoms, a headache, anorexia and fatigue. The urine is not infectious and fever may be present as opposed to hypothermia. Irritability is not one of the symptoms of hepatitis A. The client is usually lethargic or listless.

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which foods would be permitted in the diet of the child with celiac syndrome? Select all that apply. A. wheat bread B. applesauce C. bananas D. rye bread E. skim milk

B. applesauce C. bananas E. skim milk The child is usually started on a gluten-free, low-fat diet. Skim milk and bananas are usually well tolerated. Lean meats, puréed vegetables, and fruits are gradually added to the diet. Wheat, rye, and oats (unless specifically gluten free) are not included in the diet.

The labor and delivery nurse is caring for a mother who has demonstrated polyhydramnios upon delivery. The newborn displays copious, frothy bubbles of mucus in the mouth and nose, as well as drooling. The nurse is concerned that the infant has what disorder? A. omphalocele B. esophageal atresia C. gastroschisis D. hiatal hernia

B. esophageal atresia Esophageal atresia refers to a congenitally interrupted esophagus where the proximal and distal ends do not communicate; the upper esophageal segment ends in a blind pouch and the lower segment ends a variable distance above the diaphragm. Polyhydramnios is often the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. Omphalocele and gastroschisis are congenital anomalies of the anterior abdominal wall. Hiatal hernia involves a weakened diaphragm.

The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis? A. perianal fissures and skin tags B. hard, moveable "olive-like mass" in the upper right quadrant C. abdominal pain and irritability D. sausage-shaped mass in the upper mid abdomen

B. hard, moveable "olive-like mass" in the upper right quadrant A hard, moveable "olive-like mass" in the right upper quadrant is the hypertrophied pylorus. A sausage-shaped mass in the upper mid abdomen is the hallmark of intussusception. Perianal fissures and skin tags are typical with Crohn disease. Abdominal pain and irritability is common with pyloric stenosis but are seen with many other conditions.

A parent brings a 10-year-old child to the emergency room with reports of abdominal pain. The nurse performing a physical assessment notes the following symptoms: upper right quadrant pain that radiates to the back; fever; nausea; and abdominal distention. Which disease would the nurse suspect? A. ulcerative colitis B. pancreatitis C. Crohn disease D. appendicitis

B. pancreatitis The child admitted with the suspicion of pancreatitis typically reports acute onset of persistent abdominal pain. It can be mid-epigastric or periumbilical with radiation to the back or the chest. Nausea and vomiting, fever, tachycardia, hypotension, and jaundice may be present. Abdominal signs such as abdominal distention, decreased bowel sounds, rebound tenderness, and guarding also may be noted. Appendicitis pain and tenderness would be localized to the right lower quadrant. Crohn disease is a chronic bowel disorder causing frequent, recurring diarrhea. Ulcerative colitis is a chronic bowel disease affecting the large intestine and the rectum.

The student nurse is caring for a child with the nursing diagnosis "Risk for fluid volume deficit related to inadequate oral intake." Which statement by the student would indicate a need for further education by the nursing instructor? A. "I will weigh her every morning at the same time." B. "I will teach her mother to give her small drinks frequently." C. "I will make sure there is plenty of orange juice available. It's her favorite juice." D. "I will monitor her IV line to help maintain her fluid volume."

C. "I will make sure there is plenty of orange juice available. It's her favorite juice." Proper interventions for children at risk for fluid volume deficit include maintaining IV line and administer IV fluid as ordered to maintain fluid volume. Offer small amounts of oral rehydration solution frequently to maintain fluid volume. Small amounts are usually well tolerated by children with diarrhea and vomiting. Avoid high-carbohydrate fluids such as Kool-Aid and fruit juice, as they are low in electrolytes, and increased simple carbohydrate consumption can decrease stool transit time. Daily weights are one of the best indicators of fluid volume status in children.

The nurse is caring for a 4-year-old with oral vesicles and ulcers from herpangina. The child is refusing fluids due to the pain and the mother is concerned about his hydration status. Which of the suggestions would be most appropriate? A. "Offer him some orange juice." B. "Encourage him to have some soda." C. "Offer 'magic mouthwash' followed by a popsicle." D. "Try some Anbesol or Kank-A."

C. "Offer 'magic mouthwash' followed by a popsicle." Children are more likely to cooperate with interventions if play is involved. "Magic" analgesic mouthwash followed by a popsicle is most likely to alleviate some pain and then provide hydration. Soda should be avoided because it can cause stinging and burning. Orange juice should be avoided because it can cause stinging and burning. Anbesol might be helpful but it will likely be difficult to apply. Additionally, oral analgesics are often necessary.

The nurse is caring for a 13-year-old girl with suspected autoimmune hepatitis. The girl inquires about the testing required to evaluate the condition. How should the nurse respond? A. "You will most likely be tested for ammonia levels." B. "You will most likely have viral studies." C. "You will most likely have a blood test to check for certain antibodies." D. "You will most likely have an ultrasound evaluation."

C. "You will most likely have a blood test to check for certain antibodies." Anti-nuclear antibodies are one of the diagnostic tests performed to diagnose autoimmune hepatitis. Ultrasound is performed to assess for liver or spleen abnormalities. Viral studies are performed to screen for viral causes of hepatitis. Ammonia levels may be ordered if hepatic encephalopathy is suspected.

The nurse is to obtain a stool specimen from a 4-year-old child who has very liquid stool. The child is ambulatory but weak. Which collection method would be most effective for the nurse to use? A. Have the child defecate into a container in the toilet. B. Use a tongue blade to scrape a specimen from a diaper. C. Apply a urine bag to the anal area. D. Use a clean bedpan to collect the specimen.

C. Apply a urine bag to the anal area. With very liquid stool, applying a urine bag to the anal area is most effective in collecting the specimen. Using a tongue blade to scrape a specimen from a diaper would be appropriate if the stool is formed. However, putting a diaper on a 4-year-old would be demeaning. Defecating into a collection container that sits at the back of the toilet would be more appropriate for an older child who is ambulatory. A bed pan would be appropriate if the child was bedridden.

A 9-month-old girl is brought to the emergency room with what appears to be bouts of intense abdominal pain 15 minutes apart in which she draws up her legs and cries, often accompanied by vomiting. In between the bouts, the child recovers and appears to be without symptoms. Blood is found in the stool. What condition should the nurse suspect in this case? A. Short-bowel/short-gut syndrome B. Necrotizing enterocolitis C. Intussusception D. Volvulus with malrotation

C. Intussusception Intussusception, the invagination of one portion of the intestine into another, usually occurs in the second half of the first year of life. Children with this disorder suddenly draw up their legs and cry as if they are in severe pain; they may vomit. After the peristaltic wave that caused the discomfort passes, they are symptom-free and play happily. In approximately 15 minutes, however, the same phenomenon of intense abdominal pain strikes again. After approximately 12 hours, blood appears in the stool and possibly in vomitus, described as a "currant jelly" appearance. Volvulus with malrotation and necrotizing enterocolitis typically occur in the first 6 months of life and do not match the symptoms described above. Short-bowel/short-gut syndrome typically occurs when a large portion of the intestine has been removed due to a previous disease or trauma.

In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention? A. Assist in insertion of a nasogastric (NG) tube. B. Assist in doing a barium enema procedure on the infant. C. Prepare the infant for surgery. D. Change the infant's diet to one that is lactose-free.

C. Prepare the infant for surgery. In pyloric stenosis, the thickened muscle of the pylorus causes gastric outlet obstruction. The treatment is a surgical correction called a pyloromyotomy. The condition is not related to lactose in the diet, so changing to lactose-free formula would not correct the condition. A barium enema would be used to diagnose intussusception. A nasogastric (NG) tube is inserted for gastric decompression in an infant with intussusception.

The nurse is caring for a 6-month-old infant who was admitted to the emergency department 24 hours ago with signs of severe diarrhea. The infant's rectal temperature is 104°F (40°C), with weak and rapid pulse and respirations. The skin is pale and cool. The child is on IV rehydration therapy, but the diarrhea is persisting. The infant has not voided since being admitted. Which is the priority nursing intervention? A. Administer IV potassium B. Feed the child a cracker C. Take a stool culture D. Administer antibiotic therapy

C. Take a stool culture Treatment of severe diarrhea focuses on regulating electrolyte and fluid balance by initiating a temporary rest for the gastrointestinal tract, oral or IV rehydration therapy, and discovering the organism responsible for the diarrhea. All children with severe diarrhea or diarrhea that persists longer than 24 hours should have a stool culture taken to determine if bacteria are causing the diarrhea; if so, a definite antibiotic therapy can be prescribed. Because a side effect of many antibiotics is diarrhea, antibiotics should not routinely be used to treat diarrhea without an identifiable bacterial cause. Before the initial IV fluid is changed to a potassium solution, be certain the infant or child has voided—proof that the kidneys are functioning; in this case, the child is not voiding yet. The child should not be fed a cracker, as the gastrointestinal tract should be rested until the diarrhea stops.

What occurs in the gastrointestinal system of the child with Hirschsprung disease? A. There is an invagination or telescoping of one portion of the bowel into a distal portion. B. There is a severe narrowing of the lumen of the pylorus. C. There is a partial or complete mechanical obstruction in the intestine. D. There is a relaxed sphincter in the lower portion of the esophagus.

C. There is a partial or complete mechanical obstruction in the intestine. Congenital aganglionic megacolon, also called Hirschsprung disease, is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. A narrowing of the lumen of the pylorus is associated with pyloric stenosis in young infants. The telescoping of the bowel is intussusception. The relaxed sphincter in the lower portion of the esophagus is related to gastrointestinal reflux disorder.

A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason? A. determine esophageal contractility B. confirm pancreatitis C. detect Helicobacter pylori D. evaluate gastric pH

C. detect Helicobacter pylori Urea breath test is used to detect the presence of H. pylori in the exhaled breath. This test does not evaluate gastric pH. Serum amylase and lipase levels are used to confirm pancreatitis. Esophageal manometry is used to evaluate esophageal contractile activity and effectiveness.

The parent reports that the health care provider said that the infant had a hernia but cannot remember which type. When recalling what the health care provider said, the parent said that a surgeon will repair it soon and there is no problem with the testes. Which hernia type is anticipated? A. diaphragmatic hernia B. umbilical hernia C. inguinal hernia D. hiatal hernia

C. inguinal hernia An inguinal hernia occurs primarily in males and allows the intestine to slip into the inguinal canal, resulting in swelling. If the intestine becomes trapped and circulation is impaired, surgery is indicated within a short period of time. The diaphragmatic hernia has implications with the respiratory system. An umbilical hernia typically spontaneously closes by age 3. A hiatal hernia produces digestive issues.

The nurse teaches a parent to differentiate between regurgitation and vomiting in the infant. The parent correctly states which characteristic of regurgitation? Select all that apply. A. followed by dry retching B. forceful expulsion of stomach contents C. occurs with feeding D. timing unrelated to feeding E. no appearance of distress

C. occurs with feeding E. no appearance of distress Regurgitation occurs with feeding; the infant does not exhibit signs of distress. Forceful expulsion of stomach contents that is followed by dry retching unrelated to feeding are characteristics of vomiting.

A 4-month-old has had a fever, vomiting, and loose watery stools every few hours for 2 days. The mother calls the physician's office and asks the nurse what she should do. Which response by the nurse is most appropriate? A. "Give a clear pediatric electrolyte replacement for the next few hours, then call back to report on how your child is doing." B. "Do not give the child anything to drink for 4 hours. If the fever goes down and the loose stools stop, you can resume breastfeeding." C. "Continue breastfeeding as you have been doing. The fluid from the breast milk is important to maintain fluid balance." D. "Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment."

D. "Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." An infant's body comprises a high percentage of fluid that can be lost very quickly when vomiting, fever, and diarrhea are all present. This infant needs to be seen by the physician based on her age and symptoms; hospitalization may be necessary for intravenous rehydration depending upon her status when assessed.

The nurse is teaching the mother of an infant with a temporary ileostomy about stoma care. What is the most important instruction to emphasize to the mother to avoid an emergency situation? A. "You may need adhesive remover to ease pouch removal." B. "You must be meticulous in caring for the surrounding skin." C. "Gather all of your supplies before you begin." D. "Call the doctor immediately if the stoma is not pink/red and moist."

D. "Call the doctor immediately if the stoma is not pink/red and moist." A healthy stoma is pink and moist. If the stoma is dry or pale, the mother must notify the health care provider immediately because it could indicate compromised circulation. Gathering supplies is important but would not be involved in avoiding an emergency situation. All of the other instructions are valid, but emphasizing the color of the healthy stoma is most important to avoid an emergency situation. Adhesive remover may be needed to ease pouch removal, but this action would not necessarily avoid an emergency situation. Meticulous skin care is important, but this action would not necessarily avoid an emergency situation.

The nurse is teaching the mother of a 5-year-old boy with a history of impaction how to administer enemas at home. Which response from the mother indicates a need for further teaching? A. "He should retain the solution for 5 to 10 minutes." B. "He will require 250 to 500 mL of enema solution." C. "I should wash my hands and then wear gloves." D. "I should position him on his abdomen with knees bent."

D. "I should position him on his abdomen with knees bent." A 5-year-old child should lie on his left side with his right leg flexed toward the chest. An infant or toddler is positioned on his abdomen. Using 250 to 500 mL of solution, washing hands and wearing gloves, and retaining the solution for 5 to 10 minutes are appropriate responses.

The parent of a 3-week-old infant brings the infant in for an evaluation. During the visit, the parent tells the nurse that the infant is spitting up after feedings. Which response by the nurse would be most appropriate? A. "Your child might have an allergy." B. "Thicken the formula by adding oat cereal." C. "Do not worry; you are just feeding your infant too much." D. "Infants this age commonly spit up."

D. "Infants this age commonly spit up." In infants younger than 1 month of age, the lower esophageal sphincter is not fully developed. Therefore, infants younger than 1 month of age frequently regurgitate after feedings. Many children younger than 1 year of age continue to regurgitate for several months, but this usually disappears with age. Adding oat cereal to the infant formula should only be done when medically indicated and under the recommendation of a health care provider. The parent's report is not a cause for concern, so the health care provider does not need to be notified. Additional information would be needed to determine if the infant had an allergy. Although the infant's stomach capacity is small, telling the parent not to worry does not address the parent's concern, and telling the parent that he or she is feeding the child too much implies that he or she is doing something wrong.

A nurse is caring for a 6-year-old girl recently diagnosed with celiac disease and is discussing dietary restrictions with the girl's mother. Which response indicates a need for further teaching? A. "My daughter is eating more vegetables." B. "There is gluten hidden in unexpected foods." C. "There are many types of flour besides wheat." D. "My daughter can eat any kind of fruit."

D. "My daughter can eat any kind of fruit." While most fruits and fruit juices are allowed, the nurse needs to make sure the mother knows that some fruit pie fillings and dried fruit may contain gluten.

The nurse is collecting data on a 2-year-old child admitted with a diagnosis of gastroenteritis. When interviewing the caregivers, which question is most important for the nurse to ask? A. "How long has your child been toilet trained?" B. "How many times a day does your child urinate?" C. "What foods has your child eaten during the last few days?" D. "Tell me about the types of stools your child has been having."

D. "Tell me about the types of stools your child has been having." For the child with gastroenteritis, the interview with the family caregiver must include specific information about the history of bowel patterns and the onset of diarrheal stools, with details on the number and type of stools per day. Recent eating patterns, determining if the child is toilet trained, and how many times a day the child urinates are important questions, but the highest priority is gathering data regarding the stools and stool pattern.

The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis? A. "Your child will be treated with oral iron preparations to correct the anemia." B. "We will give enemas until clear and then teach you how to do these at home." C. "Your child will receive counseling so the underlying concerns will be addressed." D. "The treatment for the disorder will be a surgical procedure."

D. "The treatment for the disorder will be a surgical procedure."

The nurse is preparing a client for surgery and the client asks, "What does it mean when they say they are going to reduce my abdominal hernia?" Which response by the nurse is most appropriate? A. "If you do not understand this, I need to cancel your surgery and have the health care provider come back." B. "The health care provider will remove about half of the herniated contents during the procedure." C. "All this means is that the herniated intestines are twisted and edematous, which is why you need surgery." D. "This means the hernia contents will be manipulated back into your peritoneal cavity during surgery."

D. "This means the hernia contents will be manipulated back into your peritoneal cavity during surgery." A hernia in the abdominal region is considered reducible when its contents are easily manipulated back through the inguinal ring into the peritoneal cavity. The nurse would reinforce this education, already provided by the primary health care provider when the surgery was explained, to the client. It is not necessary to cancel surgery when the nurse can provide education to the client. Reducing does not mean the intestines are twisted and edematous. Nor does it mean half of the contents will be removed.

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurately related to the diagnosis of pyloric stenosis? A. There are recurrent paroxysmal bouts of abdominal pain. B. In this disorder the sphincter that leads into the stomach is relaxed. C. A partial or complete intestinal obstruction occurs. D. A thickened, elongated muscle causes an obstruction at the end of the stomach.

D. A thickened, elongated muscle causes an obstruction at the end of the stomach. Pyloric stenosis is characterized by hypertrophy of the circular muscle fibers of the pylorus, with a severe narrowing of its lumen. The pylorus is thickened to as much as twice its size, is elongated, and has a consistency resembling cartilage. As a result of this obstruction at the distal end of the stomach, the stomach becomes dilated. Congenital aganglionic megacolon is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Colic consists of recurrent paroxysmal bouts of abdominal pain. Gastroesophageal reflux (GER) occurs when the sphincter in the lower portion of the esophagus is relaxed and allows gastric contents to be regurgitated back into the esophagus.

The nurse is caring for a pediatric client with idiopathic celiac disease. Which meal will the nurse select for this client? A. Meatloaf, green beans, peanut butter cookie, and fat-free milk B. Ham and cheese sandwich, orange slices, chips, and whole milk C. Whole wheat pasta, meatballs, carrot sticks, apple, and water D. Baked salmon, potato slices, vanilla ice cream, and apple juice

D. Baked salmon, potato slices, vanilla ice cream, and apple juice Celiac disease is an autoimmune condition where contact with gluten causes a reaction from the body's immune system. Clients with celiac disease should be educated to eat a gluten-free diet to decrease symptoms and limit small intestine irritation. Gluten is a protein found in wheat, barley, and rye. Most commercially used flour contains wheat and should be avoided. The nurse would select foods such as meats/fish (salmon), fruits, vegetables (potatoes), and rice. Single flavor ice creams, such as chocolate, vanilla, and strawberry are gluten free, while cookies contain flour and should be avoided. Fruit juices, water, and milk are all gluten free. Meatloaf may contain oats; however, studies suggest oats are fine to consume, as long as the oats did not come into contact with wheat during processing. Reading the label would indicate if wheat was contacted. Sandwich bread and pastas contain gluten unless special gluten-free products are purchased or it is homemade. The nurse would not assume those items were gluten-free.

The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child? A. Forceful vomiting followed by the child being eager to eat again B. Bouts of diarrhea with failure to gain weight C. Severe constipation with occasional ribbon-like stools D. Effortless vomiting just after the child has eaten

D. Effortless vomiting just after the child has eaten The child with GER usually gains weight and feeds well. It must be determined if there are underlying symptoms or complications that might suggest GERD. In the child with GERD, almost immediately after feeding, the child vomits the contents of the stomach. The vomiting is effortless, not projectile in nature. The child with GERD is irritable and hungry, but may refuse to eat. Aspiration after vomiting may lead to respiratory concerns, such as apnea, wheezing, cough, and pneumonia. Failure to thrive and lack of normal weight gain occurs. Symptoms seen in the older child may include heartburn, nausea, epigastric pain, and difficulty swallowing. Forceful vomiting with the child wanting to eat shortly after vomiting is associated with pyloric stenosis. Severe constipation with ribbon-like stools would be indicative of Hirschsprung disease. Bouts of diarrhea with failure to gain weight is associated with Crohn disease.

A 10-year-old male presents with low-grade fever, nausea, and abdominal pain. The nurse examining him suspects appendicitis and checks for rebound tenderness in what quadrant? A. Lower left B. Upper right C. Upper left D. Lower right

D. Lower right With appendicitis, percussion reveals irritation and pain in the right lower quadrant. Rebound tenderness present with palpation in the right lower quadrant is referred to as the McBurney point, an area of tenderness 1.5 to 2 inches (3.8 to 5 cm) in from the right anterior superior iliac spine along a line extending to the umbilicus.

The nurse is caring for a 6-month-old infant with diarrhea and dehydration. The parent is concerned because the infant has some patches on the tongue. Which feature indicates a geographic tongue? A. The patches are thick, white plaques on the tongue. B. There are also white patches on the erupted teeth. C. There are also plaques on the buccal mucosa. D. Some patches are light in color and other patches are dark in color.

D. Some patches are light in color and other patches are dark in color. A geographic tongue is a benign, noncontagious condition characterized by a reduction in the filiform papillae. Oral candidiasis (thrush) is characterized by thick, white plaques that form on the tongue. With thrush, plaques also appear on the buccal mucosa and often occur concomitantly in the diaper area. There would not be any patches on the few teeth the infant may have by that age.

The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration? A. Soft and flat fontanels (fontanelles) B. Blood pressure of 80/42 mm Hg C. Pale and slightly dry mucosa D. Tenting of skin

D. Tenting of skin Tenting of skin is an indicator of severe dehydration. Soft and flat fontanels (fontanelles) indicate mild dehydration. Pale and slightly dry mucosa indicates mild or moderate dehydration. Blood pressure of 80/42 mm Hg is a normal finding for an infant.

A 6-week-old infant is diagnosed with pyloric stenosis. When taking a health history from the parent, which symptom would the nurse expect to hear described? A. Refusal to eat B. Chronic diarrhea C. Vomiting about 2 hours after feeding D. Vomiting immediately after feeding

D. Vomiting immediately after feeding With pyloric stenosis the circular muscle pylorus is hypertrophied. This thickness causes gastric outlet obstruction. The condition is seen in younger infants starting at 3 to 6 weeks of age. The infant has projectile nonbilious vomiting. It occurs directly after eating and is not related to the feeding position. The infant is hungry shortly after eating. There is weight loss and/or dehydration. The treatment is a pyloromyotomy to reduce the increased size and increase the opening. Diarrhea is not associated with the disorder.

The nurse is reviewing the medical record of a child with a cleft lip and palate. When reviewing the child's history, what would the nurse identify as a risk factor for this condition? A. maternal use of acetaminophen in third trimester B. preterm birth C. history of hypoxia at birth D. mother age 42 with pregnancy

D. mother age 42 with pregnancy Advanced maternal age is a risk factor for cleft lip and palate. Drugs such as anticonvulsants, steroids, and other medications during early pregnancy are considered risk factors. Acetaminophen is not associated with an increased risk for cleft lip and palate. Preterm birth is not a risk factor for the development of cleft lip and palate. Hypoxia or anoxia is a risk factor for the development of necrotizing enterocolitis.

The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is: A. respiratory distress. B. ischemia. C. dehydration. D. painless rectal bleeding.

D. painless rectal bleeding. With Meckel diverticulum, most symptomatic children present younger than age 2 years. Intermittent, painless rectal bleeding is the most common clinical manifestation of Meckel diverticulum. The blood is most often bright red or maroon and may be passed independent of stool due to ulceration at the junction of the ectopic tissue and the normal ileal mucosa.

The nurse is caring for a child with gastrointestinal concerns. What statement by the parent would indicate a need for the nurse to further assess the child for constipation? "My child eats vegetables and fresh fruit, but does not like beans." "My child only has a bowel movement about four times a week." "My child has such large bowl movements that it clogs the toilet." "My child does not have liquid stool or leak liquid stools that I am aware of."

"My child has such large bowl movements that it clogs the toilet." Constipation may manifest by bowel movements that are large enough to clog the toilet, fewer bowel movements than normal, and bowel movements that are hard and pellet-like. Constipation is not likely if the child eats fruits and vegetables, even when beans are not incorporated into the child's diet. Passage of liquid stools can be a sign of constipation.

The nurse is caring for a child prescribed vancomycin 15 mg/kg IV every 6 hours for peritonitis. The child weights 45 lb (20.5 kg). How many milligrams will the nurse administer to this child in 24 hours?

1230

The infant is listless with sunken fontanels (fontanelles) and has been diagnosed with dehydration. The infant is still producing at least 1 mL/kg each hour of urine. The infant weighs 13.2 lb (6 kg). At the minimum, how many milliliters of urine will the infant produce during the next 8-hour shift? Record your answer using a whole number.

48 Urine output should be calculated using weight in kilograms. 6 kg x 1 mL/kg = 6 mL/hour 6 mL x 8 hours = 48 mL/8-hour shift