Pediatric Gastrointestinal disorders

55. A cardinal sign of Hirschsprungs Disease in neonates is: 1. A thin abdomen. 2. Constipation since birth. 3. Dry, pebble-like stools. 4. Crying every time the neonate is fed

ANS: 2 Feedback 1. The abdomen becomes obtunded because of the collection of stool in the colon. 2. Constipation is present because of the collection of stool in a particular portion of the colon. 3. The stool is thin and ribbon-like in appearance. 4. The neonate tends to vomit after eating because the food cannot move through the digestive tract.

14. Gastroesophageal reflux should be treated when a child or infant exhibits all of the following except: 1. When a baby spits up frequently. 2. If a baby develops a chronic cough or pneumonia. 3. When a baby has excessive irritability after meals. 4. When a child has a persistent sore throat without illness.

ANS: 1 Feedback 1. All babies spit up, but can have reflux that needs treatment. 2. Infants or children with respiratory symptoms should be treated. 3. Infants or children with excessive irritability should be treated. 4. Infants or children with persistent sore throat should be treated, as this makes eating difficult and will affect nutrition.

54. A child with issues of constipation should include which of the following foods in his/her diet to facilitate defecation? 1. Skittles 2. Apples 3. White bread 4. Grilled chicken breast

ANS: 2 Feedback 1. A candy may increase constipation because of the sodium content. 2. Apples will increase the amount of fiber, thus making the bowel act to defecate. 3. White bread lacks fiber and is not effective for constipation. 4. Chicken breasts lack the fiber that is needed for the defecation.

27. A 7 year old with acute diarrhea and mild dehydration is being given oral rehydration. The childs mother calls the clinic nurse because he is also occasionally vomiting. The nurse should recommend which of the following? 1. Bring the child to the hospital as soon as possible for IV fluids 2. Alternate between oral rehydration and soda pop 3. Continue giving the oral rehydration in small amounts 4. Do not allow the child to drink anything for the next eight hours, then restart fluids if the vomiting has stopped.

ANS: 3 Feedback 1. Because this is acute and only occasional vomiting, the child can be taken care of at home with close monitoring. 2. Soda has sodium and can contribute to the electrolyte imbalance. 3. Small amounts of fluids will decrease the urge to vomit because it is not filling the entire stomach, and the hydration will help the electrolytes find balance. 4. Waiting eight hours can further the dehydration and cause more issues with vomiting because the electrolyte imbalance is not being addressed.

43. A child with unresolved pyloric stenosis may exhibit signs of: 1. Crying. 2. Irritability. 3. Poor weight gain. 4. Tachycardia.

ANS: 3 Feedback 1. The baby may cry because he/she is hungry, but this is not the major, long-term issue. 2. The baby may be irritable because he/she is hungry, but this is not the major, long-term issue 3. Poor weight gain is a major, long-term issue that needs to be resolved quickly so that there are no neurological effects. 4. Tachycardia is not common with long-term pyloric stenosis issues.

Necrotizing enterocolitis is caused by infection or ischemia, causing decreased oxygenation to the bowel as well as tissue death. True or False

True 1. Infections cause decreased oxygenation to the bowel, which causes damage and necrosis with tissue death.

11. Which of the following statements about gastroschisis and omphalocele is true? 1. Only omphalocele has a malrotation. 2. Omphalocele contain stomach and intestines within a sac of amnion and is associated with anomalies. 3. Gastroschisis opens to the left of the umbilical cord, contains the liver, and is associated with anomalies. 4. 1 and 2

ANS: 2 Feedback 1. Both defects are associated with malrotation. 2. Omphalocele may have the stomach and intestines, as well as other GI organs, and is covered by a sac that may rupture in utero. Both defects are associated with malrotation. 3. Gastroschisis arises to the right of the umbilical cord and has the stomach and intestines, but rarely the liver. It is also rarely associated with other anomalies. 4. Both defects are associated with malrotation. Omphalocele may have the stomach and intestines, as well as other GI organs, and is covered by a sac that may rupture in utero.

76. Triple therapy has been prescribed for a 13 year old with peptic ulcer disease. Identify the medications that are part of the therapy Select all that apply. 1. Polyethylene Glycol 2. Omeprazole 3. Prevacid 4. Pantoprazole 5. Ranitidine

ANS: 2, 3 Feedback 1. This medication is otherwise known as Mirlax and is not used for peptic ulcers. 2. A common treatment for peptic ulcers 3. An over-the-counter treatment for peptic ulcers 4. Used for gastroesophageal reflux, not peptic ulcers 5. Used for gastroesophageal reflux, not peptic ulcers

8. Treatment for a child with cystic fibrosis with gastrointestinal symptoms may include: 1. Pancreatic enzymes. 2. Fat-soluble vitamins. 3. No immunizations. 4. 1 and 2.

ANS: 4 Feedback 1. A child with cystic fibrosis will require replacement pancreatic enzymes. 2. A child with cystic fibrosis will require fat-soluble vitamins for proper growth and nutrition. 3. Regular immunizations are recommended. 4. More than one answer applies.

59. Which of the following conditions is often associated with severe diarrhea of gastroenteritis? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

ANS: 1 Feedback1.The body is in an acidic state and because of the electrolyte imbalance in the GI tract, it is metabolic acidosis.2.Alkalosis is not occurring because of the lack of fluid.3.The condition is not affecting the respiratory tract.4.The condition is not affecting the respiratory tract.

53. A child has been prescribed to use Senna to help reduce constipation. The nurse should include which of the following in her teaching? 1. Senna can be used long term. 2. Increasing the amount of fluid intake will be important to help Senna work effectively. 3. Senna should be used after an enema has been given. 4. Senna should also be used with milk of magnesium to improve the outcomes.

ANS: 2 Feedback1.Senna should only be taken short term so that the bowel does not come to depend on the medication for defecation.2.Fluid is important to help loosen stool and help Senna create the need for defecation.3.Senna should be used prior to the use of an enema to try to defecate as much as possible in the least invasive manner possible.4.Senna and Milk of Magnesium should not be used at the same time.

What are important teaching points for a patient with ulcerative colitis? Select all that apply. 1. Stress reduction techniques, such as relaxation 2. Report any illness to the gastroenterologist for possible medication adjustment. 3. The child only needs appointments when the symptoms occur. 4. Importance of the regular medication use and possible side effects 5. Teach about the proper cleansing material.

ANS: 1, 2, 3 Feedback 1. Stress reduction may help to decrease some exacerbations of the disease. 2. Medication would need adjustment if the child becomes ill. 3. A child with ulcerative colitis needs to have regular follow-up visits, whether symptomatic or not. 4. A child with ulcerative colitis needs to have regular follow-up visits, whether symptomatic or not. Medication would need adjustment if the child becomes ill. The parents and child need to know about the medications and the side effects to report. Stress reduction may help to decrease some exacerbations of the disease. 5. Cleansing the area will not decrease the occurrence of exacerbation.

70. Diagnostic testing for hepatitis should include: 1. CBC. 2. Hepatitis B surface antigen. 3. Hemoglobin and hematocrit. 4. Liver antibodies.

ANS: 2 Feedback 1. A CBC will not give an indication of Hepatitis. 2. Testing for the Hepatitis antigen is needed to be able to make a diagnosis. 3. Hemoglobin and hematocrit do not give a diagnosis for Hepatitis. 4. Liver antibodies may indicate liver damage, but not Hepatitis.

1. What is being assessed when auscultating the gastrointestinal system? 1. Changes in the abdominal appearance 2. Presence or absence of bowel sounds 3. Distension as well as spleen and liver size 4. Presence of a hernia

ANS: 2 Feedback 1. A visual inspection is done or this. 2. Auscultation allows the examiner to assess the bowel sounds and assess for any changes that may occur in the bowel sounds due to a GI problem. 3. Palpation assesses the distension and size. 4. Presence of a hernia is detected with palpation and a visual inspection.

51. An infant is brought to the emergency department with the following clinical signs: poor skin turgor, weight loss, lethargy, tachycardia, and tachypnea. This is suggestive of which of the following? 1. Sodium excess 2. Water depletion 3. Potassium Excess 4. Fluid overload

ANS: 2 Feedback 1. An infant with sodium excess would have weight gain because of fluid retention as well as a doughy skin turgor. 2. The weight loss and poor skin turgor indicate the lack of fluid in the body. The high heart and respiratory rates are because the blood is thicker, making the heart and lungs work harder. 3. The infant is not exhibiting cardiac arrhythmias that are part of hyperkalemia. 4. The infant would have increased weight, a doughy skin turgor, and a sluggish pulse if fluid overload was occurring.

62. A child with a known diagnosis of biliary atresia is not able to absorb: 1. Minerals. 2. Fat-soluble vitamins. 3. Calcium. 4. Sodium.

ANS: 2 Feedback 1. The childs body can absorb minerals without difficulty. 2. The childs body cannot absorb enough fat-soluble vitamins and may need supplementation. 3. The childs body can absorb the adequate amount of calcium. 4. The childs body can absorb the adequate amount of sodium.

24. A neonate has been taken to the nursery because of a cyanotic event while feeding due to choking. As the baby lies on the warmer bed, he/she is noted to have froth around the mouth. The priority action by the nurse would be to: 1. Assess vital signs. 2. Use suction to remove the secretions. 3. Hold the neonate in an upright position. 4. Feed the neonate.

ANS: 2 Feedback 1. Vital signs will need to be taken prior to informing the doctor, but is not the priority at this time. 2. Suctioning the secretions to maintain an open airway is the priority at this time. 3. Holding the neonate upright will force secretions down because of gravity and increase the risk for aspiration. 4. Feeding the neonate could increase the risk for aspiration. The child needs an evaluation before feedings are continued.

9. Symptoms of Biliary Atresia would include which of the following? 1. Prolonged jaundice (appearing for longer than two weeks) 2. Elevated direct bilirubin (greater than 20 percent of the total bilirubin measurement) 3. Very dark stools 4. 1 and 2

ANS: 4 Feedback 1. Biliary Atresia causes prolonged jaundice, lasting well past two weeks. 2. The direct bilirubin remains elevated and is always greater than 20% of the total bilirubin measurement. 3. Stools become light and urine becomes dark. 4. Biliary Atresia causes a prolonged jaundice, lasting well past two weeks. The direct bilirubin remains elevated and is always greater than 20% of the total bilirubin measurement.

3. When teaching the family about a gluten-free diet, what are the recommendations for the family about diet? 1. Many gluten-free products are available, so it is important to read labels. 2. Participation in a support group may help with identifying stores that carry gluten-free food. 3. Communion wafers contain gluten and may need to be avoided. 4. All of the above.

ANS: 4 Feedback 1. Reading labels will help identify food that can cause difficulty, as well as make the family aware of foods that the child will not tolerate. 2. Support groups are excellent resources for information about gluten-free foods and stores in the area that carry these products. 3. Speaking with the clergy may be important due to the gluten in communion wafers. 4. All are important factors for teaching about a gluten-free diet.

Laser lithotripsy is the safest treatment for children with gallstones. True or False

Because of the size of children, lithotripsy is not a chosen method of treatment.

A cause of elevated bilirubin in a newborn is related to an abnormality in the pancreas. True or False

Biliary atresia may cause elevated bilirubin due to the abnormality in the biliary tree, which can cause liver damage. The liver may be damaged and need eventual transplantation.

2. Which of the following symptoms may be found in Celiac Disease? 1. Abdominal pain with bloating 2. Weight gain with very skinny extremities 3. Small, hard stools 4. Normal growth

ANS: 1 Feedback 1. The most common complaint of celiac patients is abdominal bloating that is usually painful. 2. Patients with this disorder usually appear skinny with thin extremities. 3. Patients with this disorder tend to have diarrhea and foul smelling stools. 4. This can affect growth because of villi damage due to gluten intolerance.

67. Long-term goals for education for a child with cystic fibrosis should consist of: 1. Taking enzyme medication before bed. 2. Only receiving immunizations when healthy. 3. Learning foods that do not need to have enzyme therapy applied. 4. Not mixing enzymes with soft acidic foods.

ANS: 3 Feedback 1. The enzyme medication should be taken with meals throughout the day. 2. Immunizations should be received when scheduled. 3. Certain foods do not need the enzyme therapy applied because they already have the needed enzymes for digestion. 4. Enzymes can be mixed with acidic foods and not cause harm to the child.

41. A new baby has been diagnosed with gastroesophageal reflux. As the nurse is feeding the baby, she notes that the baby is twisting and arching. The nurse knows that the baby is exhibiting: 1. Torsion. 2. Flexion. 3. Sandifers Syndrome. 4. Hashimoto Disease.

ANS: 3 Feedback 1. Torsion is the twisting of the gut. 2. Flexion is the extension of the body. The baby is arching. 3. The infant is exhibiting Sandifers Syndrome with the twisting and arching. 4. Hashimoto Disease is a thyroid disorder.

37. A common sign of an infant having a peptic ulcer is: 1. Abdominal distension. 2. Frequent stools. 3. Anorexia. 4. Gastritis.

ANS: 1 Feedback 1. This is a common sign of peptic ulcer disease. 2. This is seen in Crohns disease. 3. The infant will want to eat and can digest foods, so they do not have a wasted appearance. 4. The infant will not have inflammation of the GI tract.

10. The main complication of neonatal jaundice is: 1. Lack of voiding and stooling. 2. Bilirubin encephalopathy. 3. The need to immediately stop breastfeeding. 4. Increased risk of infection

ANS: 2 Feedback 1. Jaundice does not affect voiding and stooling, but lack of voiding and stooling may increase the jaundice level. 2. Bilirubin encephalopathy can cause hypotonia, opisthotonic posturing, and brain damage at high levels of jaundice, which make early intervention important. 3. Moms may continue to breastfeed if the baby is jaundiced, but may sometimes need to supplement if intake or output is poor. 4. Babies with an infection may have a higher jaundice level, but jaundice does not cause the infection.

12. When caring for a newborn with an abdominal wall defect at birth, it is important to do all of the following except: 1. Wrap and support the defect to prevent rupture. 2. Start immediate feedings to support nutrition. 3. Insert an orogastric tube to decompress the stomach. 4. Provide parenteral nutrition.

ANS: 2 Feedback 1. Keeping the defect moist and supported helps to prevent a rupture. 2. Feeding will distend the abdomen and could cause damage. 3. An orogastric tube will help keep the stomach decompressed and help prevent a rupture. 4. Parenteral nutrition is needed for caloric intake and growth.

47. Megan is caring for a neonate. Megan assesses the possibility of necrotizing enterocolitis (NEC) because the premie is exhibiting the generalized assessment of: 1. Hypertonia, tachycardia, and metabolic alkalosis. 2. Abdominal distention, temperature instability, and bloody stools. 3. Hypertension, apnea, and ruddy skin color. 4. No residual feedings and increased urinary output.

ANS: 2 Feedback 1. Metabolic alkalosis cannot be seen in a generalized assessment. 2. These are the cardinal signs of a neonate with a generalized assessment of necrotizing enterocolitis. 3. Hypotension usually occurs, along with the neonate appearing gray or pale in color. 4. Feedings will have a high residual and a decreased urinary output when necrotizing enterocolitis is developing.

7. The first symptom in an infant of the gastrointestinal manifestation of cystic fibrosis is: 1. Constipation. 2. Meconium ileus. 3. Rapid weight gain. 4. Inability to breastfeed.

ANS: 2 Feedback 1. Newborns with cystic fibrosis fail to pass meconium in the first 48 hours. 2. Newborns with cystic fibrosis fail to pass meconium in the first 48 hours and develop meconium ileus. That may be followed by diarrhea and poor weight gain. 3. Rapid weight loss may occur due to diarrhea and poor weight gain. 4. Mothers of children with cystic fibrosis are encouraged to breastfeed because children with cystic fibrosis can breastfeed.

42. A previously healthy 3-week-old baby has been admitted to the pediatric unit for pyloric stenosis. On admission, what would the nurse anticipate being told? 1. History of watery stools 2. History of projectile vomiting 3. History of increased stools 4. History of vomiting with large amount of bile

ANS: 2 Feedback 1. Normal stools are present with pyloric stenosis. 2. The projectile vomiting is an indication that the pyloric sphincter is not holding the stomach contents in properly. 3. The infant may have decreased stools. 4. The vomiting consists of formula/milk that appears similar to what was in the bottle.

56. The family of a child with suspected Hirschsprungs Disease is asking the nurse about the preparation for confirming the diagnosis. The nurse should explain which of the following procedures to the family? 1. A barium enema 2. A rectal biopsy 3. A transabdominal ultrasound 4. A bronchoscope

ANS: 2 Feedback 1. Not advised because there is blockage in the colon 2. Will indicate if Hirschsprungs Disease is present 3. Does not provide a clear view of the diseased tissue 4. The test looks at the lungs, not the intestines.

32. A child that is exhibiting signs of appendicitis will have: 1. Pain after internal rotation of a flexed thigh. 2. Rebound pain on the left quadrant. 3. A high fever. 4. Acute pain episodes for 3 to 4 days in a row.

ANS: 1 Feedback 1. Rotation of the leg may cause pain in a child with appendicitis. 2. Rebound pain happens in the left quadrant. 3. A high fever is usually not noted in appendicitis until rupture occurs. 4. Acute pain is short in duration.

6. Gallstones are occurring more often in children. Which of the following is not true about treatment for children with gallstones? 1. Surgery is always the treatment for gallstones. 2. Infants do not need treatment. 3. Crohns patients may have an ERCP, only without surgery. 4. Laser lithotripsy may be an effective option.

ANS: 1 Feedback 1. Surgery is not the only treatment for gallstones. 2. Infants usually resolve gallstones on their own. 3. Children with Crohns disease need a functioning gallbladder, and an ERCP may help them retain the gallbladder while removing the stones. 4. Laser lithotripsy has been found to be an effective treatment and is being used in children as an alternative treatment.

64. A common medication that is used for children with Fatty Liver disease is: 1. Metformin. 2. Vitamin C. 3. Prilosec. 4. Probiotics.

ANS: 1 Feedback 1. Metformin helps reverse the effects of Fatty Liver Disease on the body. 2. Vitamin C can be absorbed by the body through foods and does not need to have a supplement. 3. Prilosec is not a medication used to treat Fatty Liver Disease. 4. Probiotics are used for the intestinal tract, not Fatty Liver Disease.

29. Comfort care for a neonate with a new diagnosis of tracheoesophageal fistula would consist of all of the following except: 1. Holding the neonate. 2. Swaddling the neonate. 3. Nonnutritive sucking on a pacifier. 4. Placing sucrose on a pacifier for the baby to have nonnutritive sucking.

ANS: 4 Feedback 1. Neonates are comforted when being held. 2. Swaddling helps a neonate find his/her boundaries and allows for him/her to feel comfort. 3. The sucking is a normal reaction and soothes the newborn. 4. The neonate should remain NPO to prevent chances for aspiration.

52. A preschooler that is being potty trained is refusing to have bowel movements. The mother brought the child to the clinic because now the child has constipation. The nurse speaks to the mother about behavior modification efforts to have the preschooler defecate. All of the following may help except: 1. Rewarding the child for defecating in the toilet. 2. Identifying when the child usually defecated prior to potty training, then attempting to use the toilet at that time. 3. Create regular times to use the potty, especially 5 to 10 minutes after a meal. 4. Rewarding the child for defecating in a diaper, then trying to retrain using the toilet.

ANS: 4 Feedback 1. Incentives for defecation may be the reason some children will have success because the urge for a treat is important to the child. 2. Timing can help create a known pattern so that the child understands the expectations at particular times throughout the day. 3. Food that is consumed helps to put pressure on the bowel, which may lead to defecation if the child does not have to hold it. 4. Reverting back to diapers may make the child refuse to use a toilet because of the convenience.

23. Intestinal obstruction can be caused by an Intussusception or a Volvulus. What are the important points to know about these conditions? 1. Intussusception and Volvulus are both immediately treated with surgery. 2. Intussusception cannot be reduced with a barium enema. 3. Both conditions present with continuous pain. 4. Both Intussusception and Volvulus may first be present with bilious vomiting.

ANS: 4 Feedback 1. Intussusception may be reduced with a barium enema or air insufflations. 2. Intussusception may be reduced with a barium enema or air insufflation, saving the baby from a surgical intervention. 3. Because of Malrotation, the conditions result in cramping pains. 4. Volvulus is always treated with surgery. Both conditions may have bilious vomiting as the presenting symptom. The pain in Volvulus is continuous; it may be intermittent with increasing frequency in an Intussusception.

4. Appendicitis may have abdominal pain as a symptom. Where does the abdominal pain occur? 1. Left upper quadrant 2. Right lower quadrant 3. Periumbilical 4. 2 and 3 only

ANS: 4 Feedback 1. Pain usually is not in the upper left quadrant. 2. Advances to the right lower quadrant 3. Begins in the periumbilical area 4. Pain usually is not in the upper left quadrant. It begins in the periumbilical area.

15. What are symptoms that may indicate an inguinal hernia? 1. Right lower quadrant pain with rebound tenderness 2. A feeling of weakness or pressure in the groin 3. The lack of a hydrocele in a newborn 4. Pain after internal rotation of a flexed thigh

ANS: 2 Feedback 1. Right lower quadrant pain with rebound and pain with internal rotation are indicative of an appendicitis. 2. Weakness and pressure in the groin area is common. 3. An infant with hydroceles should be examined for possible inguinal hernias. 4. Pain with an internal rotation of flexed thigh is not a sign of a hernia.

38. The mother of a teen with Irritable Bowel Syndrome is asking what types of food should be part of his diet. Identify a food that would be appropriate for the teen. 1. Wheat Chex cereal 2. Hamburger 3. Spinach 4. Peaches

ANS: 1 Feedback 1. High fiber should be part of the diet to help with bowel movements. 2. A hamburger does not provide the needed fiber content for bowel movements. The protein can be irritating to the stomach. 3. The spinach does not have the high fiber content needed. 4. The peaches do not have the high fiber content needed.

17. What does an Irritable Bowel Syndrome (IBS) patient need to know to help reduce his/her symptoms? 1. Keep a food diary to identify triggers for symptoms 2. Decrease the amount of fiber in his/her diet 3. Fewer larger meals may reduce incidence of symptoms 4. Avoid supplements, such as fiber supplements or probiotics

ANS: 1 Feedback 1. IBS patients should keep a food diary to identify the foods that aggravate their condition. 2. IBS patients should also increase the amount of fiber in their diet. 3. IBS patients should eat more frequent, smaller meals. 4. Fiber and probiotic supplements are encouraged.

The nurse is admitting an infant who is 3 months of age. The parents sought medical attention when the infant began passing pale-colored stools that are nearly white. The infant had been diagnosed with biliary atresia at birth and underwent corrective surgery. For which treatment will the nurse prepare the parents? 1. A liver transplant 2. A second corrective surgery 3. Initiating comfort care 4. Focusing on diet therapy

ANS 1 1 This is correct. If initial surgery for biliary atresia is not successful, then a liver transplant may be indicated. The occurrence of pale, gray, or white stools is an indication the condition is still present. 2 This is incorrect. A second surgery for biliary atresia is not planned if the first surgery is not successful. 3 This is incorrect. The infant will receive active and corrective medical care. Comfort care will be initiated if the condition worsens and/or a liver is not available for transplant. 4 This is incorrect. At this point, the infant's condition is considered seriously ill; nutrition needs are likely to be met by a means other than oral intake.

12. The nurse is preparing teaching materials for an adolescent patient recently diagnosed with nonalcoholic fatty liver disease (NAFLD). The adolescent initially presented with right upper quadrant pain, obesity, and hepatomegaly. Which teaching will the nurse initially present? 1. Review lifestyle changes and diet modification with the adolescent. 2. Explain the care that is provided in the event acute liver failure occurs. 3. Discuss feelings the adolescent has related to the disease diagnosis. 4. Begin to introduce the probability for a liver transplant later in life.

ANS 1 1 This is correct. Initially, the nurse will present information about the dietary and lifestyle changes necessary to prevent worsening of the condition. The nurse will emphasize the danger of rapid weight loss and the benefits of regular exercise. 2 This is incorrect. At this point in time, there is no reason to explain care for a condition that does not exist and may not occur. 3 This is incorrect. It is always appropriate to discuss a patient's feelings related to a diagnosis; however, this intervention will be interwoven through all patient teachings. 4 This is incorrect. At this point in time, there is no reason to explain care for a condition that does not exist and may not occur.

The pediatric nurse in a clinic is mentoring a newly hired nurse who has no experience in pediatrics. The new nurse is performing a physical assessment on an infant who is 1 month of age. Which observation will prompt the nurse to discuss assessment skills with the new nurse? 1. The new nurse states, "How can I hear bowel sounds when he cries?" 2. The new nurse keeps the sleeping infant covered for parts of the assessment. 3. The new nurse performs all observations before physical assessment. 4. The new nurse informs the attending parent about the assessment actions.

ANS 1 1 This is correct. The new nurse needs to know that auscultation of the abdomen of an infant is performed prior to percussion and palpation in order to keep the infant quiet for auscultation. 2 This is incorrect. When the infant is sleeping, the new nurse is correct in keeping the infant partially covered for parts of the assessment. Auscultation of the abdomen can be performed while the infant is partially covered. 3 This is incorrect. The new nurse is correct to perform all inspection assessment before any physical assessment. 4 This is incorrect. The new nurse is correct in informing the parent about the assessment actions.

The nurse in a pediatric clinic is assessing an infant 2 months of age. The mother states, "He always spits up, but it has become so much worse. Vomit goes everywhere." Which additional assessment will help the nurse identify a possible diagnosis for the infant? 1. A hard mass is palpated in the mid-epigastrium. 2. Vomiting occurs both before and after eating. 3. Weight is normal even with frequent vomiting. 4. Normal skin turgor is noted over the sternum.

ANS 1 1 This is correct. Vomiting after eating that grows worse and evolves into projectile vomiting are signs of pyloric stenosis. If the nurse palpates the infant's mid-epigastrium and finds a pyloric mass, it is likely indicative of pyloric stenosis. This finding is called the olive sign. 2 This is incorrect. With pyloric stenosis, vomiting always occurs after eating. 3 This is incorrect. When an infant has pyloric stenosis, there is poor weight gain. 4 This is incorrect. A serious manifestation of pyloric stenosis is the development of dehydration and a decrease in serum chloride.

16. A neonate is born with a 6-cm omphalocele, in which the stomach and intestines are contained within a sac of amnio, peritoneum, and Wharton's jelly outside of the abdomen. For which additional anomalies will the nurse assess? Select all that apply. 1. Neural tube defects 2. Cardiac defects 3. Rupture of the sac 4. Herniation of the brainstem 5. Exstrophy of the urinary bladder

ANS 1,2,5 1. This is correct. Infants born with an omphalocele will commonly exhibit abnormalities such as neural tube defects. 2. This is correct. Infants born with an omphalocele will commonly exhibit abnormalities such as cardiac defects. 3. This is incorrect. With an omphalocele, the danger of a sac rupture is highest when the fetus is in utero. 4. This is incorrect. Herniation of the brain stem is not an abnormality associated with the presence of an omphalocele defect. 5. This is correct. Exstrophy of the urinary bladder (location outside the abdominal wall but not in the omphalocele) is a common abnormality associated with an omphalocele. If the omphalocele is large, the liver, spleen, gonads, and bladder may also be contained in the sac.

15. The nurse is collecting assessment information on a pediatric patient who is 13 years of age. The patient is at the clinic for recurrent gastrointestinal distress. Which questions are appropriate for the nurse to ask the patient? Select all that apply. 1. "Can you describe the pain you are having?" 2. "Do you ever have cramping or bloating?" 3. "Is there a family history of GI problems?" 4. "Do you have a history of previous illnesses?" 5. "Are there any changes at home or school?"

ANS 1,2,5 1. This is correct. At the age of 13 years, the patient is able to provide the nurse with an appropriate and accurate description of pain. 2. This is correct. At the age of 13 years, the patient is able to understand and provide the nurse with accurate information about cramping and bloating. 3. This is incorrect. The nurse should direct the question about family history to the parent. A complete genogram with at least three generations to show patterns of illness is helpful if possible. The patient is not likely to be a good source for this information. 4. This is incorrect. Most patients at the age of 13 years are not good historians regarding their medical history beyond the last year or two. The nurse needs to address this question to a parent. 5. This is correct. At the age of 13 years, the patient is the best person to consult about recent changes at home or school. The patient is likely to focus on personal concerns that are unknown to the parent.

17. The nurse in a neonatal nursery is mentoring a newly hired nurse. The new nurse expresses uncertainty about the facts of physiological and pathological jaundice. Which information does the nurse provide? Select all that apply. 1. In newborns, a low level of jaundice is normal. 2. Normal jaundice usually appears within a week of birth. 3. Immaturity of the liver prevents effective metabolization of bilirubin. 4. Greatest concern is when jaundice develops before the first 24 hours. 5. High levels of bilirubin cause hyperactivity and insatiable hunger.

ANS 1,3,4 1. This is correct. In newborns, a low level of jaundice is normal. 2. This is incorrect. Normal neonatal jaundice typically appears between the second and fifth days of life and clears with time. 3. This is correct. Neonatal jaundice is caused by the breakdown of red blood cells (which releases bilirubin into the blood) and the immaturity of the newborn's liver, which cannot effectively metabolize the bilirubin and prepare it for excretion into the urine. 4. This is correct. Concern of pathological jaundice exists if jaundice develops before the first 24 hours of life. 5. This is incorrect. A high level of bilirubin or hyperbilirubinemia may cause the infant to be sleepy and eat poorly, causing the jaundice level to rise.

20. A grandmother brings a toddler to a pediatric clinic and states, "I am worried that my grandchild is not getting adequate care." The nurse is able to verify the child is underweight for height and age. Which findings will cause the nurse to initiate additional assessment? Select all that apply. 1. The grandmother cannot provide an adequate feeding history. 2. The toddler's weight for height is less than the 20th percentile. 3. The toddler repeatedly asks if the nurse will get some food. 4. The toddler's evaluation at birth indicates prematurity. 5. The mother is a single parent and lives alone with the toddler.

ANS 1,3,4,5 1. This is correct. A feeding assessment is performed when a child exhibits a low body weight. The nurse needs a feeding history including calorie intake, feeding behaviors, frequency, and intake. If the grandmother cannot supply the information, the nurse will initiate additional assessment by seeking information from the mother. 2. This is incorrect. When a child's weight for height is less than the 10th percentile, the nurse will initiate additional assessment to rule out possible causes. 3. This is correct. When a toddler repeatedly asks the nurse for food, the nurse recognizes a behavior indicative of hunger. The nurse will further assess for information about when and what the toddler ate last. 4. This is correct. Prematurity may or may not be a cause of the toddler's current low weight. However, the nurse will need to further assess the prenatal, perinatal, neonatal, and postnatal health history. 5. This is correct. The nurse will perform additional assessment to ascertain the family and psychosocial environment of the toddler. Financial, educational, and mental health can all contribute to a failure to thrive condition.

19. A patient who is 17 years old comes to his health-care provider for a sports physical. The nurse's visual assessment places the patient in high percentiles for both weight and height. Which additional assessments does the nurse expect to be conducted for a complete health evaluation? Select all that apply. 1. Body mass index 2. Bedtime cortisol levels 3. Glucose levels after meals 4. Lipid profile 5. Thyroid-stimulating hormone level

ANS 1,4,5 1. This is correct. For a 17-year-old, the 50th percentiles for body mass index are 21.2. The patient's body mass index will be obtained for a comparison. 2. This is incorrect. Morning cortisol provides an indicator of obesity. Bedtime evaluation is performed at bedtime and is not an appropriate measurement. 3. This is incorrect. Fasting glucose levels are included in indicators of obesity; levels after eating are affected by the nutritional intake. 4. This is correct. A lipid profile provides information about circulating fats. 5. This is correct. The TSH provides an indicator of thyroid function, which affects growth.

18. The nurse in a pediatric clinic is performing a physical examination of a patient who is 8 years of age. The patient's weight is over the 95th percentile on the growth chart. The patient also expresses the presence of knee and abdominal pain. The patient's parent states, "He will outgrow it; all my boys start off like this." Which information does the nurse present to the parent? Select all that apply. 1. Obesity is related to the development of diabetes mellitus. 2. Being a social outcast can cause feelings of poor self-esteem. 3. Children with obesity are more likely to drop out of school. 4. There is a high risk for cardiac disease and hypertension. 5. Obesity adversely affects joint health and function.

ANS 1,4,5 1. This is correct. The child who is obese is at risk for developing diabetes mellitus, which is an associated condition. 2. This is incorrect. There is no specific information to support the statement that obese children will become a social outcast; however, obesity can negatively affect self-esteem. 3. This is incorrect. There is no specific information to support that obesity alone is a reason why a child will drop out of school. 4. This is correct. The obese child is at high risk for developing cardiac disease and/or hypertension, which can both cause serious and lifelong health problems. 5. This is correct. The patient is already experiencing knee pain. In addition, the patient is at risk for slipped capital femoral epiphysis, which can effect growth and function.

13. The nurse is providing care for a 2-month-old infant admitted to the hospital for testing because of a persistent low-grade fever. Laboratory tests and ultrasound of the abdomen confirm the presence of gallstones. Which procedure does the nurse expect to be prescribed for this infant? 1. Immediate preparation for abdominal surgery 2. Monitoring without surgical interventions 3. Endoscopic removal of stones and gallbladder 4. Placing the infant on low-fat, soy-based formula

ANS 2 1 This is incorrect. Gallbladder surgery, if necessary, is performed as an endoscopic procedure. 2 This is correct. Gallstones in infancy do not need removal unless symptomatic, because gallstones usually resolve spontaneously. The presence of a low-grade fever is indicative of inflammation. A symptomatic presentation would include jaundice and possibly vomiting. 3 This is incorrect. The expectation is that the gallstones resolve spontaneously; no surgical intervention is planned unless symptoms evolve or worsen. 4 This is incorrect. There is no indication that the infant's formula needs to be changed.

48. A toddler has been diagnosed with short bowel syndrome because of a past history of necrotizing enterocolitis. The nurse should encourage the parents to do all of the following except: 1. Give the child juice at least once a day to help with Vitamin C consumption. 2. Give enteral feedings. 3. Introduce solid food. 4. Keep follow-up appointments.

ANS: 1 Feedback 1. Juice may cause more diarrhea and should be avoided. 2. The child may need to have enteral feedings to increase the calorie content for growth because of the lack of absorption in the GI tract. 3. Solid food should be started slowly and be in higher calorie content because of the lack of absorption for the GI tract. 4. Appointments are needed to make sure the child is growing and receiving the proper nutritional content.

The nurse in a pediatric clinic is obtaining a health history on a child who is 9 years of age. The nurse learns the child exhibits a chronic cough, midsternal discomfort, and frequent sore throats without infection. Physical assessment indicates the child is on the 50th percentile on the height chart and on the 85th percentile for weight. Which recommendation does the nurse make? 1. Serve citrus juices instead of carbonated beverages. 2. Begin an age-appropriate weight loss program. 3. Initiate a practice of no eating or drinking after dinner. 4. Encourage lying on the left side after eating a meal.

ANS 2 1 This is incorrect. The child is exhibiting the symptoms of gastroesophageal reflux (GERD). The nurse will recommend avoidance of fatty foods, acidic foods (citrus juices, carbonated beverages, tomato products), and caffeine. 2 This is correct. When a child is on the 50th percentile in height and the 85th percentile for weight, the child is overweight. The nurse needs to recommend an age-appropriate weight loss program. 3 This is incorrect. The child with GERD needs to avoid food and drinks for 2 hours before bedtime. 4 This is incorrect. Lying on the left side after eating is likely to exacerbate the symptoms of GERD; the patient needs to remain upright after eating.

A parent brings an 18-month-old toddler to the pediatric emergency department for abdominal pain and stool mixed with blood and mucus. The pain is recurring three to four times an hour. Which intervention will the nurse initiate first? 1. Assess laboratory results. 2. Initiate intravenous access. 3. Maintain strict intake and output. 4. Prepare for ultrasound studies.

ANS 2 1 This is incorrect. The nurse strongly suspects intussusception because of the passage of stool mixed with blood and mucus. The nurse does assess laboratory results; however, this is not the nurse's first intervention. 2 This is correct. The nurse recognizes the existence of an emergency based on the toddler's presenting symptoms. The nurse will first initiate intravenous access in order to have a route established for medications and/or emergency interventions. 3 This is incorrect. The initial action by the nurse does not involve maintaining a strict intake and output. 4 This is incorrect. Once the toddler has an established IV, the nurse will initiate other interventions, such as preparations for ultrasound studies.

The nurse is providing care for an adolescent diagnosed with Crohn's disease. The nurse provides patient teaching regarding which manifestation of the condition? 1. Urgency to defecate 2. Possibility of oral aphthous ulcers 3. Episodic epigastric pain 4. Nocturnal awakening events

ANS 2 1 This is incorrect. Urgency to defecate is a manifestation of ulcerative colitis and not of Crohn's disease. 2 This is correct. Oral aphthous ulcers are canker sores, which are small, shallow lesions that develop on the soft tissues in the mouth or at the base of the gums. Unlike cold sores, canker sores do not occur on the surface of the lips and are not contagious. The condition is present in patients who have Crohn's disease, and information of the condition will be provided in patient teaching. 3 This is incorrect. Episodic epigastric pain is a manifestation of peptic ulcers and not of Crohn's disease. 4 This is incorrect. Nocturnal awakening events are a manifestation of peptic ulcers and not of Crohn's disease.

The nurse in a pediatric clinic is working with a preschool patient and a parent about managing the child's functional constipation. Which is the most important information for the nurse to share? 1. The child is allowed to select a reward for having a bowel movement. 2. The child is informed of the treatments for constipation and/or impaction. 3. Parental action is required for the onset of vomiting or severe abdominal pain. 4. The parents expect the child to sit on the toilet for a period of time each day.

ANS 3 1 This is incorrect. Rewards are great motivators for young children; however, the parent sets the award. Reward should be a privilege such as extra TV or video game time; no food awards should be given. This is important information but not the most important. 2 This is incorrect. Informing the child of the treatments for constipation and/or impaction will instill fear in the child and may compound the problem. 3 This is correct. The nurse needs to inform the parent of what actions to take if the child starts to vomit or has severe abdominal pain. Because the symptoms are indicative of a medical emergency, the caregiver should take the child to a medical facility for immediate evaluation. 4 This is incorrect. The nurse needs to provide information applicable to behavior modification. The child's condition is likely to improve with regular times for stooling, usually after meals, and sitting on the toilet for 5 to 10 minutes. However, this is not the most important information for the nurse to provide.

The nurse in a pediatric clinic is obtaining information about a 7-month-old infant with GI symptoms. The parent informs the nurse that bloating, flatulence, and foul-smelling stools occurred with the introduction of wheat cereal. Which additional information will cause the nurse to initiate emergency care? 1. Dental enamel defects of the teeth 2. Presence of dermatitis herpetiformis 3. Severe vomiting and diarrhea 4. Weight loss indicated by thinness of extremities

ANS 3 1 This is incorrect. The infant is exhibiting signs of celiac disease, which can manifest with dental enamel defects in the teeth. However, this would not be identifiable in a 7-month-old infant. 2 This is incorrect. Dermatitis herpetiformis is a blistering, pruritic skin rash on elbows, buttocks, or knees. The finding is more common in adults and does not occur in all cases. If the condition is present, it does not cause the nurse to initiate emergency care. 3 This is correct. If additional health information includes severe vomiting and diarrhea, the nurse will suspect dehydration; the manifestations together will cause the nurse to initiate emergency care. 4 This is incorrect. Weight loss, in which the infant may appear very skinny in the extremities but normal weight in the face, is not unexpected in an infant with celiac disease. This finding will be of concern but does not warrant initiating emergency care.

A neonate is born with gastroschisis. Which action will the nurse perform immediately? 1. Prepare the mother for a serious birth defect in the neonate. 2. Promote nonnutritive sucking to fulfill the neonate's needs. 3. Protect the defect with a nonadherent sterile saline dressing. 4. Place an orogastric tube to decompress the neonate's intestines.

ANS 3 1 This is incorrect. The mother is likely to be aware of the defect before the neonate is born. The defect is initially picked up because of high AFP levels; the defect is then verified with ultrasound studies. Often, delivery is by cesarean. 2 This is incorrect. The neonate will be offered a pacifier to promote nonnutritive sucking. However, this intervention is not initiated immediately. 3 This is correct. Immediately after birth, the nurse will support and wrap the defect to prevent fluid loss and hypothermia. The nurse uses sterile normal saline with a nonadherent dressing. The neonate is placed under warmer to prevent heat loss through the opening/exposed contents. 4 This is incorrect. Immediately after birth, the nurse will not place an orogastric tube to decompress the intestine.

14. An adult female arrives in the emergency department following a spontaneous birth at home. The female indicates that no prenatal care has been received. Which assessment finding about the female causes the nurse greatest concern for the newborn? 1. A laboratory result reveals a positive hepatitis A anti-HAV-total. 2. The mother is emaciated and has indications of drug abuse. 3. The mother has no permanent address and denies having family. 4. A laboratory result reveals a positive hepatitis B e antigen (HBeAg).

ANS 4 1 This is incorrect. A positive hepatitis A anti-HAV-total, predominantly IgG, confirms previous exposure to hepatitis A, recovery, and immunity; it does not distinguish recent from past infection. Another finding causes greater concern for the newborn. 2 This is incorrect. The physical condition of the female coupled with evidence of drug abuse is of concern; however, there is one finding that will cause greater concern. 3 This is incorrect. Not having a permanent address and the denial of having family is a concern; however, another finding is of greater concern. 4 This is correct. A positive laboratory test for hepatitis B e antigen (HBeAg) causes the nurse greatest concern. The test is positive in blood only when the virus is present, and it can be passed to others. An HBeAg-positive mother indicates a 90% chance of the newborn acquiring the infection.

The nurse is informing a new mother of the concern about her newborn who is 36 hours old and has not passed any meconium. The nurse shares a suspicion of Hirschsprung's disease. The mother asks the nurse multiple questions about the condition. Which information will the nurse provide? 1. Retained meconium is a source of severe infection in newborns. 2. A positive diagnosis indicates the newborn is terminally ill. 3. The absence of nerves in the colon also indicates mobility issues. 4. The condition is congenital and causes blockage of the intestines.

ANS 4 1 This is incorrect. Retained meconium is not a source of severe infections in newborns. The inability to pass the meconium is the concern. 2 This is incorrect. Hirschsprung's disease, in itself, is not considered a terminal disease. 3 This is incorrect. The physical manifestation of Hirschsprung's disease is an absence of nerves in the bottom segment of the colon, which causes an intestinal blockage. 4 This is correct. Hirschsprung's disease is a congenital condition that causes blockage of the intestine because of a lack of nerves in the bottom segment of the colon. These nerves normally allow the muscles in the wall of the bowel to contract and move digested material toward the anus to be eliminated.

The NICU nurse is providing care for a neonate who presents with an overabundance of secretions that the neonate cannot manage. The nurse also identifies the neonate is anorectal and exhibits some limb deformity. Which assessment process will the nurse perform first? 1. Check whether there are deformities of the palate. 2. Check for choking after a feeding tube is passed. 3. Observe if cyanosis occurs during bottle feeding. 4. Determine the extent to which a feeding tube can be passed.

ANS 4 1 This is incorrect. The nurse is likely to recognize the symptoms of tracheoesophageal atresia, which does not commonly include palate deformities. 2 This is incorrect. The nurse will want to check if choking is initiated and/or continues after a feeding tube is passed, which can indicate the feeding tube is in the lungs. This is not the first assessment for tracheoesophageal atresia. 3 This is incorrect. With the lack of indications of tracheoesophageal atresia, feeding of the neonate may be attempted. The presence of cyanosis during feeding is an indication of the condition. Feeding is not performed first if tracheoesophageal atresia is suspected; the goal is to keep liquids out of the respiratory system. 4 This is correct. Because of the presence of anatomical and physiological manifestations, the nurse will attempt to assess for tracheoesophageal atresia. The first assessment is to determine the extent to which a feeding tube can be passed. Performing this assessment first will help prevent liquids from entering the respiratory system.

5. The most commonly used measure to diagnose obesity is: 1. Body mass index. 2. Ultrasound. 3. Weight measurement. 4. Cholesterol measurement.

ANS: 1 Feedback 1. Body mass index is the most commonly used measurement for diagnosing obesity. The CDC web site allows for the computation of body mass index for children and adults. 2. Ultrasounds do not assess obesity. 3. Weight measurements may be part of the diagnosis, but are not as definitive as the body mass index. 4. Cholesterol measurements may be part of the diagnosis, but are not as definitive as the body mass index.

16. What information should be taught to parents of children with peptic ulcers? 1. Stress reduction techniques, such as relaxation 2. Minimal consumption of food that may aggravate condition 3. Child may stop medication when symptoms are gone. 4. The child may use Motrin for headaches.

ANS: 1 Feedback 1. Children should use appropriate relaxation techniques to reduce stress. This may include visualization and hypnosis. 2. Children should learn the foods that may aggravate the condition and avoid foods that can cause aggravation. 3. The course of medication for an ulcer should be completed and not stopped prematurely because of symptom abatement. 4. NSAIDS should not be used by children with ulcers as it aggravates the condition.

18. Crohns disease may present with which of the following symptoms? 1. Right lower quadrant pain 2. Joint pain 3. Increased growth 4. Skin lesions

ANS: 1 Feedback 1. Crohns disease may mimic appendicitis with right lower quadrant pain. It is manifested by diarrhea, usually bloody, not constipation. 2. Joint pain is a symptom seen in ulcerative colitis, not Crohns disease. 3. Growth is slow due to malabsorption of nutrients 4. Skin lesions are a symptom usually seen in ulcerative colitis.

40. A 6 month old is exhibiting signs of gastroesophageal reflux. A nursing intervention to aid in decreasing pain would be: 1. Elevating the head of the bed 30 degrees. 2. Providing large amounts of formula every three hours. 3. Thinning formula so it decreases occurrences. 4. Keep the baby held upright for an hour after feedings.

ANS: 1 Feedback 1. Elevating the head of the bed will help take pressure off of the diaphragm. 2. Small amounts of food decrease the occurrence of gastroesophageal reflux. 3. Thinning formula decreases the calories needed and does not decrease the occurrence of gastroesophageal reflux. 4. Keeping a baby upright for an hour is not a realistic expectation.

13. What serologic tests in Hepatitis B would indicate the presence of a chronic infection? 1. Hepatitis B surface antigen (HBsAg) 2. Anti-HBe 3. Anti-HBc subtotal 4. HB surface antibody (anti-HBs Ag)

ANS: 1 Feedback 1. Hepatitis B surface antigen with AntiHBc total indicates a chronic infection. 2. HB surface antibody indicates recovery from an infection. 3. Anti-HBe indicates decreasing infectivity, and recovery from infection gives a total, not a subtotal. 4. HB surface antibody indicates recovery from an infection.

21. Hirschsprungs Disease may present with which of the following symptoms? 1. No meconium passage in the first 24 hours 2. Persistent diarrhea 3. Excellent weight gain with little stooling 4. Hard, pellet-like stools

ANS: 1 Feedback 1. Newborns with Hirschsprungs Disease may not pass meconium until well after the first 24 hours. The stools are thin and ribbon-like, and the child suffers from constipation. The child usually has poor weight gain. 2. The stools are thin and ribbon-like and the child suffers from constipation. 3. The child usually has poor weight gain. 4. The stools are thin and ribbon-like and the child suffers from constipation.

20. Treatment for constipation may be difficult. What is a strategy that may be included in the treatment of constipation? 1. Use of a reward system for successful toileting. 2. The child uses the toilet whenever he/she feels the urge. 3. Have the parents make a mental note about when the child uses the toilet. 4. None of the above are correct.

ANS: 1 Feedback 1. The child should have a record to keep track of taking his/her medication and his/her success with having a stool. 2. A child needs a regular schedule to sit on the toilet. He/she needs a regular time to sit on the toilet, usually twice a day, not just when the urge hits him/her. 3. The child should have a consistent reward system for successful toileting. He/she needs a regular time to sit on the toilet, usually twice a day, not just when the urge hits him/her. 4. One answer is correct.

36. A pediatric patient with ulcerative colitis is receiving long-term corticosteroid therapy. A side effect of this type of therapy can include all of the following except: 1. A higher than average heart rate. 2. Mood swings. 3. Easy bruising. 4. A moon face.

ANS: 1 Feedback 1. The heart rate is not affected by the long-term use. 2. Mood swings are apparent in children with long-term use. 3. Easily bruising occurs with long-term use. 4. The moon face is a side effect of long-term corticosteroid therapy.

45. The nurse has received orders for a 4 month old with a diagnosis of Volvulus. To provide comfort for the infant, the nurse should: 1. Encourage the mother to hold the infant and provide a pacifier. 2. Keep the infant swaddled tightly. 3. Place the infant in a prone position. 4. Assess the pain level of the infant using the FACES scale.

ANS: 1 Feedback 1. The holding will place the patient in a position to take pressure off of the abdomen, and the pacifier may help with decreasing the need for food. 2. Swaddling the baby may cause more distress because of the constriction around the abdomen. 3. The prone position will place too much pressure on the abdomen. 4. FACES is used for assessing pain, not providing a source of comfort.

44. The nurse is assessing an infant with a history of projectile vomiting. The nurse is palpating the abdomen and notes an olive sign in the upper abdomen. This is the cardinal sign of: 1. Pyloric stenosis. 2. GERD. 3. Intussusception. 4. Hirschsprungs disease.

ANS: 1 Feedback 1. The olive sign is the actual shape of the pyloric sphincter and the stomach meeting. 2. Palpation does not help diagnose GERD. 3. Intussusception is noted by a raised bowel in the lower abdomen. 4. Palpation for Hirschsprungs will note an obtunded abdomen, not the olive sign.

58. A neonate has been born with a known diagnosis of an omphalocele. The nurse should provide all of the following cares for the neonate except: 1. Swaddling the baby in blankets to keep body temperature stable. 2. Providing nonnutritive sucking. 3. Maintaining IV access for fluids. 4. Keeping the omphalocele moist and on a warmer bed to keep the body temperature stable.

ANS: 1 Feedback 1. The swaddling will introduce material onto the omphalocele and dry out the area, increasing the risk for infection. 2. Nonnutritive sucking will soothe the neonate. 3. IV access will be needed to maintain a fluid balance because of the NPO status. 4. Keeping the omphalocele moist and warm will help keep the body stable.

30. A family has just received the diagnosis of Celiac Disease for their 5-year-old son. The nurse knows that the family understands the teaching when the father states: 1. We will need to read labels, and anything with white flour should be avoided. 2. My child will not be able to participate in hockey anymore because of the diagnosis. 3. The family will need to change its eating out habits and only cook at home. 4. We will need to notify the school so that other children will not catch the disease.

ANS: 1 Feedback 1. White flour contains gluten, which is the allergy issue for Celiac Disease. 2. A child can participate in any sports with this disease. 3. The family will need to modify what is ordered when eating out. 4. Celiac Disease is not contagious.

What are practices for the preventing the transmission of Hepatitis B? Select all that apply. 1. Infants should receive the Hepatitis B series of immunizations at birth, and at 2, 3, 4 and 6 months. 2. All mothers should be tested for Hepatitis B during pregnancy. 3. Needle stick prevention should be emphasized. 4. Teach good handwashing to prevent oral fecal transmission. 5. Avoid food that is contaminated with Hepatitis B.

ANS: 1, 2, 3 Feedback 1. Immunization is a preventative practice. 2. Testing for pregnant mothers is a preventative practice. 3. Prevention of needle sticks is a preventative practice. 4. It is not transferred by the oral fecal route. 5. Hepatitis B is not spread through contaminated food.

63. A mother is being taught about the emergency situations for her child that has a diagnosis of biliary atresia. Emergency care should be provided if the child exhibits all of the following except: 1. Gray stools. 2. Jaundiced for 18 days. 3. Ruddy cheeks. 4. Pale skin.

ANS: 2 Feedback 1. Gray stools are a common characteristic of biliary atresia. 2. A child should not be jaundiced for this long. This symptom can indicate liver failure. 3. Ruddy cheeks are a common characteristic of biliary atresia. 4. Pale skin is a common characteristic of biliary atresia because of the liver function.

33. A 3-month-old infant has had surgery to repair an inguinal hernia. The nurse is giving discharge instructions for care of the surgical site. Instructions should include: 1. Cleansing the surgical site by placing the infant in a bathtub twice a day. 2. After each diaper change, check to make sure the area is clean and dry. 3. Apply a dressing to the area to keep it clean. 4. Remove the stitches in one week.

ANS: 2 Feedback 1. Placing the child in the bathtub may saturate the site and increase the risk for infection. 2. Keeping the site clean and dry will aid in healing without infection. 3. A dressing may keep the area moist and not facilitate healing. 4. The stitches may need to be removed by a health-care provider.

46. An infant with intussusception has returned to the pediatric unit from the operating room. The nurse should anticipate providing all of the following care except: 1. Maintaining an IV. 2. Starting gradual oral feedings right away. 3. Monitoring for pain. 4. Maintaining the nasogastric tube.

ANS: 2 Feedback 1. The infant will not be taking in large amounts of fluids, so IV fluid maintenance will be important. 2. The infants intestinal tract will need time to heal prior to starting feedings. 3. Pain management will be needed for healing. 4. The NG tube will help with draining gastric contents and air to decrease the risk for an upset stomach.

66. A child with cystic fibrosis is at risk for rectal prolapse because: 1. The body lacks enzymes to break down food. 2. Coughing attacks can weaken the muscle of the rectum. 3. Large bowel movements can cause the prolapse. 4. Of muscle atrophy throughout the body.

ANS: 2 Feedback 1. The lack of particular enzymes does not contribute to the prolapsed. 2. The coughing attacks cause muscle weakness in the rectum, thus causing a prolapse. 3. A child with cystic fibrosis may have larger bowel movements, but this does not cause the prolapse. 4. Muscle atrophy does not occur in the rectum, and thus is not the reason for the rectal prolapse.

59. A neonate is born with gastroschisis. The nurse should be the most concerned about which of the following when caring for the child? 1. Keeping the organs dry and warm 2. Assessing the organs to make sure that there is no vascular compromise 3. Starting oral feedings so that the stomach and intestines can start working 4. Maintaining an IV

ANS: 2 Feedback 1. The organs should be kept warm and as moist as possible to prevent drying, cracking, and increasing the risk for infection. 2. Vascular compromise is of concern, so positioning will be important. 3. The child will remain NPO until the gut can be further examined. 4. Maintaining IV access is needed, but not the top priority at this time.

35. A nurse working on a pediatric floor has three patients. Which patient should be seen first? 1. A four hour old post-op appendectomy with IV fluids and an antibiotic due 2. The child with abdominal pain and rectal bleeding with IV fluids. 3. An infant that had hernia repair surgery yesterday. 4. A family needing teaching about diet restrictions related to Celiac Disease

ANS: 2 Feedback 1. The patient is beyond the crucial two hour time frame after surgery. 2. This patient should be seen first because of the active bleeding. 3. The hernia repair assessment can be done at any time because the patient is not exhibiting risk factors. 4. Teaching can be done at various times throughout the childs inpatient stay and is not a top priority at this time.

50. A nurse taking care of a child with severe gastroenteritis knows that compensation for fluid loss will occur. What causes the compensation to occur? 1. Vasodilation of the peripheral vascular system increases the perfusion. 2. Fluid shifts from the interstitial space to the intravascular space 3. The renal-aldosterone system is activated. 4. The body reserves the fluid in the vasculature so that the heart does not have an increased workload.

ANS: 2 Feedback 1. Vasoconstriction can occur because of the lack of fluid. 2. The fluid shift occurs because the cells are dehydrated and want the fluid. 3. The renal-aldosterone system is not activated at this time. 4. The heart has an increased workload because the blood becomes thicker. The thickening occurs because of the lack of fluid.

68. A nurse has received orders to obtain laboratory tests for a child to rule out gallstones. The nurse should question which order? 1. CBC 2. Amylase 3. PT and PTT 4. Ultrasound

ANS: 3 Feedback 1. A CBC can indication infection within the body. 2. Amylase will indicate if the child can breakdown the carbohydrates in the body. 3. Gallstones do not cause clotting issues in the body. 4. An ultrasound can identify stones within the gallbladder, along with the size of the gallbladder.

69. When caring for a child with Hepatitis, it is important for the nurse to do all of the following except: 1. Use standard precautions. 2. Provide information for the family to receive the Hepatitis A and B vaccines. 3. Schedule immunizations. 4. Teach proper nutrition to attempt to keep the body as nourished as possible.

ANS: 3 Feedback 1. Standard precautions should be used with every patient. 2. Information empowers the family to play an active role in the childs health care. 3. The family will need to schedule the immunizations based on the health-care providers recommendations. 4. Nutrition will be important to maintain a healthy lifestyle.

25. An infant is brought to the emergency department with the following clinical manifestations: poor skin turgor, weight loss, lethargy, tachycardia, and tachypnea. This is suggestive of which of the following? 1. Water excess 2. Sodium excess 3. Water depletion 4. Potassium excess

ANS: 3 Feedback 1. Water excess would cause crackles in the lungs and a doughy skin turgor with weight gain. 2. Sodium excess would cause the child to have sunken eyes and gain weight. 3. Water depletion will cause these signs and symptoms. 4. Potassium excess will cause irregular heart rhythms and nausea.

77. A new nurse is assessing a 7 year old with a history of abdominal issues. The nurse knows that she should complete the assessment in which order? (Number the sequence.) __ Palpation __ Auscultation __ Percussion __ Visual

ANS: 3, 2, 4, 1

61. A mother is asking the nurse if her infant will be able to still breastfeed even though the infant is on phototherapy. Feedings for the infant: 1. Should be minimal while under phototherapy. 2. Should be done through a bottle because the baby will be too lethargic to breastfeed. 3. Should be stopped until the bilirubin levels have dropped into normal limits. 4. Should be frequent to promote bowel movements to rid the body of the bilirubin.

ANS: 4 Feedback 1 Feeding is important because the bilirubin binds to the fecal matter for excretion. 2. The baby can breastfeed even though the bilirubin level is elevated. 3. Feedings should continue because the bilirubin binds to the fecal matter for excretion. 4. Frequent feedings will help promote bowel movements. The bilirubin binds to the fecal matter for excretion.

65. A mother calls the clinic to ask which immunizations her child, who has cystic fibrosis, can have at the next checkup. Which statement would be an appropriate response from the nurse? 1. The immunization schedule will need to be altered. 2. Your child should not receive the Hepatitis series. 3. Your child should not receive the Polio vaccine. 4. Your child can receive all of the basic immunizations to help maintain immunity.

ANS: 4 Feedback 1. A child with cystic fibrosis can receive immunizations on the same schedule as any other child. 2. A child with cystic fibrosis should receive the Hepatitis series to help reduce the risk for contracting the disease. 3. The child can receive the vaccine because it is a basic immunization. 4. All basic immunizations should be given to a child with cystic fibrosis to maintain immunity.

60. A home care nurse is visiting a 5-day-old male infant for a scheduled follow-up appointment to ensure that he is responding to home phototherapy for treatment of jaundice. After completing a thorough assessment and obtaining a history from the parents, the nurse recognizes that this infant is in the first phase of encephalopathy when he exhibits: 1. A high-pitched cry when touched. 2. Severe muscle spasms. 3. Fever and seizures. 4. Hypotonia, lethargy, and a poor suck when feeding.

ANS: 4 Feedback 1. A high-pitched cry occurs in later phases of the encephalopathy. 2. Muscle spasms are not present with this diagnosis. 3. Fevers are rare in neonates with encephalopathy. The seizures can occur if the levels continue to climb. 4. Hypotonia, lethargy, and poor feedings are the first symptoms to occur in the first phase of encephalopathy caused by jaundice.

34. When palpating an inguinal hernia, a nurse would be concerned when feeling: 1. Crepitus. 2. Normal skin. 3. An edematous area surrounding the hernia. 4. A lump with erythema and edema.

ANS: 4 Feedback 1. Crepitus is not noted when palpating an inguinal hernia. 2. Normal skin will not be noted with an inguinal hernia. 3. The area will have edema along with erythema. 4. Erythema and edema would be cause for concern with an inguinal hernia. It may indicate strangulation of tissue or loss of circulation.

39. When assessing an emesis of an infant, it is important to note which of the following? 1. Curdled milk 2. Amount 3. The timing of the emesis 4. All of the above should be documented.

ANS: 4 Feedback 1. Curdled milk is an indication of the digestion process. 2. The amount can indicate the adoption of the previous intake. 3. The timing may indicate what the infant is doing to cause the emesis. 4. Curdled milk, amount, and timing can give indications as to how to treat the infants condition

57. The nurse is assessing a child with a history of Hirschsprungs Disease. The nurse should expect to have assessment findings of: 1. Frequent bloody stools. 2. Abdominal cramping and fecal soiling in the childs underwear. 3. A low hematocrit. 4. Thin, ribbon-like, foul smelling stool and a distended abdomen

ANS: 4 Feedback 1. Few stools occur with a child with this disease. 2. Abdominal cramping may occur, but the child is able to use the toilet. 3. There is no bleeding involved in the disease process, so a low hematocrit is rare. 4. The thin, ribbon-like stools occur because of the small passageway for stool to move through the affected area. The abdomen is distended because of the gas and fecal buildup in the affected area.

26. Clinical manifestations of sodium excess (hypernatremia) include which of the following? 1. Hyperreflexia 2. Abdominal cramps 3. Cardiac dysrhythmias 4. Dry, sticky mucous membranes

ANS: 4 Feedback 1. Hyperreflexia occurs with high magnesium levels. 2. Abdominal cramping may occur with high potassium levels. 3. Cardiac dysrhythmias will occur with hypercalcemia. 4. High sodium concentrations cause water loss and create dry, sticky mucous membranes

28. A newborn has been diagnosed with tracheoesophageal fistula. The nurse should ask for clarification of the doctors orders if the chart states to: 1. Place an IV for fluids and antibiotics. 2. Use an NG tube placed into the proximal pouch. 3. Take aspiration precautions. 4. Place the newborn in the prone position with his/her head elevated.

ANS: 4 Feedback 1. IV fluids will be needed to maintain electrolyte balance because the newborn will not be receiving oral feedings. 2. The NG will help drain any secretions in the pouch. 3. The newborn is at high risk for aspiration because of the lack of connection to the stomach. 4. The newborn should be in a supine position to prevent aspiration and allow for the secretions to drain.

31. An appendectomy has been performed on an 8-year-old boy. When the child arrives to the pediatric unit, the top nursing priority will be: 1. Measuring the childs urine output. 2. Making the parents comfortable in the room. 3. Starting the child on a liquid diet. 4. Monitoring for pain.

ANS: 4 Feedback 1. Kidney function will be assessed after the patient has adequate pain management. 2. The parents will need to be comfortable in the room, but this is not the top priority for the boy. 3. The child will remain NPO for a few hours after the surgery. 4. Pain management will be the top priority because of the surgical site.

22. What are recommended interventions for a patient with Fatty Liver Disease? 1. Rapid weight loss 2. Metformin administration 3. Group-based therapy 4. 2 and 3

ANS: 4 Feedback 1. Slow, measured weight loss is better than a rapid dropping of weight. 2. Metformin is an effective therapy for this condition. 3. Group-based therapy with the adolescent age group for weight loss as support during this process is beneficial and effective. 4. Group-based therapy with the adolescent age group for weight loss as support during this process is beneficial and effective. Slow, measured weight loss is better than a rapid dropping of weight. Metformin is an effective therapy for this condition

19. What is the recommended treatment for gastroenteritis? 1. Child should drink to thirst to replace fluids. 2. Child should take Imodium and Pepto-Bismol to stop diarrhea. 3. Mothers should stop breastfeeding until the illness is gone. 4. The child should have a bland diet for 24 hours after the vomiting stops, then return to a regular diet.

ANS: 4 Feedback 1. The child should only have small amounts of fluid, as large amounts may cause more vomiting. 2. Pepto-Bismol and Imodium should not be used for gastroenteritis in children. 3. Breastfeeding can continue even with gastroenteritis. 4. After vomiting stops and the child is tolerating fluids, then a bland diet is recommended with a return to regular diet in another 24 hours.