Pediatric Success: Gastrointestinal Disorders
The nurse is caring for a 4-month-old with GER. The infant is due to receive omeprazole (Prilosec). Based on the medication's mechanism of action, when should this medication be administered?
60 minutes before the feeding.
The nurse is working in the pediatric clinic and is seeing many children with diarrhea. Which of the following children can most likely be discharged without further evaluation?
A 3-year-old who had a relapse of one diarrhea episode after restarting a normal diet.
The parents of a 6-year-old being evaluated for appendicitis tell the nurse the physician diagnosed their child as having a positive Rovsing sign. They ask the nurse what this means. Select the nurse's best response.
"A positive Rovsing sign means the child feels pain in the right side of the abdomen when the left side is palpated."
The nurse is caring for an 8-week-old male who has just been diagnosed with Hirschsprung disease. The parents ask what they should expect. Select the nurse's best response.
"Although your child will require surgery, there are different ways to manage the disease, depending on how much of your child's bowel is involved."
The parent of a newborn asks, "Will my baby spit out the formula if it is too hot or too cold?" Select the nurse's best response.
"Your baby is too young to be physically capable of spitting out fluids and will automatically swallow anything."
The nurse is conducting an in-service lecture on NEC to a group of colleagues. The nurse knows that she needs to provide more education when one of the participants states which of the following?
"NEC occurs only in preemies and low-birth-weight infants."
The nurse is caring for a newborn with esophageal atresia. When reviewing the mother's history, the nurse would expect to find which of the following?
A history of maternal polyhydramnios.
The nurse receives a call from the parent of a 10-month-old who has vomited three times in the past 8 hours. The parent describes the baby as playful and wanting to drink. The parent asks the nurse what to give the child. Select the nurse's best response.
"Give your child 1/2 oz of Pedialyte. If vomiting continues, wait a half hour, and then give half of what you previously gave."
The nurse is giving discharge instructions to the parents of a 1-month-old infant with tracheoesophageal atresia. The infant is being discharged with a GT. The nurse knows that the parents understand the discharge teaching when the mother states:
"I will clean the area around the GT with soap and water every day."
The nurse is administering Prilosec to a 3-month-old with GER. The child's parents ask the nurse how the medication works. Select the nurse's best response.
"Prilosec decreases stomach acid, so it will not be as irritating when your child spits up."
A 4-month-old is brought to the pediatric clinic. The infant has had vomiting and diarrhea for 24 hours. The infant's anterior fontanel is sunken. The child is irritable, and the nurse notes that the infant does not produce tears when he cries. Which of the following tasks will help confirm the diagnosis of dehydration?
Analysis of serum electrolytes.
The nurse in the pediatric clinic is providing instructions to the parents of a 2-year-old child who has just been diagnosed with acute hepatitis. Which of the following would be an appropriate activity for the nurse to recommend?
Playing with puzzles in bed.
Which of the following manifestations suggests that an infant is developing NEC?
The infant has bloody diarrhea
The nurse is caring for an infant with biliary atresia. The parents ask why the child is receiving cholestyramine. Select the nurse's best response.
To relieve your child's itching.
An expectant mother asks the nurse if her new baby will likely have an umbilical hernia. The nurse bases the response on which of the following?
Umbilical hernias occur more often in premature infants.
The nurse is caring for an infant newly diagnosed with Hirschsprung disease. Which of the following does the nurse understand about this infant's condition? SAT 1. There is a lack of peristalsis in the large intestine and an accumulation of bowel contents, leading to abdominal distention. 2. There is excessive peristalsis throughout the intestine, resulting in abdominal distention. 3. There is a small bowel obstruction leading to ribbon-like stools. 4. There is inflammation throughout the large intestine, leading to the accumulation of intestinal contents and abdominal distention. 5. There is an accumulation of bowel contents, leading to non-passage of stools.
There is a lack of peristalsis in the large intestine and an accumulation of bowel contents, leading to abdominal distention. There is an accumulation of bowel contents, leading to non-passage of stools.
The nurse is caring for an infant with pyloric stenosis. The parents ask if any future children will likely have pyloric stenosis. Select the nurse's best response.
"Pyloric stenosis can run in families. It is more common among males."
The nurse is caring for a 4-week-old infant with biliary atresia. Which of the following manifestations would the nurse expect to see?
Abdominal distention, enlarged liver, enlarged spleen, clay-colored stool, and tea-colored urine.
The nurse is caring for a 3-month-old male who is being evaluated for possible Hirschsprung disease. His parents call the nurse and state that his diaper contains a large amount of mucus and bloody diarrhea. The nurse notes that the infant is irritable and his abdomen appears very distended. Which of the following should be the nurse's next action?
Immediately obtain all vital signs with a quick head-to-toe assessment.
The nurse is caring for a 3-year-old undergoing evaluation for celiac disease. Which of the following would the nurse expect to be included in the child's diagnostic workup?
Obtain stool samples and prepare a child for a jejunal biopsy.
The nurse is caring for an infant who has been diagnosed with SBS. The parents of the infant ask how the disease will affect their child. Select the nurse's best response.
"Because your child has a shorter intestine than most, your child will not be able to absorb all the nutrients and vitamins in food and will need to get nutrients in alternative ways."
The parents of a 4-year-old ask the nurse how to manage their child's constipation. Select the nurse's best response.
"Encourage your child to drink more fluids."
The nurse is caring for a 9-month-old with diarrhea secondary to rotavirus. The child has not vomited and is mildly dehydrated. The nurse is sending the child home. Which of the following is likely to be included in the discharge teaching?
Continue breastfeeding per routine.
The nurse is caring for a 5-year-old who has just returned from having an appendectomy. Which of the following is the optimal way to manage pain?
Morphine is administered through a PCA pump.
The nurse is caring for an infant diagnosed with Hirschsprung disease. The mother states she is pregnant with a male and wants to know if her new baby will likely have the disorder. Select the nurse's best response.
"Genetics play a small role in Hirschsprung disease, so there is a chance the baby will develop it as well."
The nurse is caring for a 6-year-old with hepatitis. The child is hungry and wants to eat dinner. Which of the following foods should be offered?
A tuna sandwich on whole wheat bread and a cup of skim milk.
A 4-month-old female is brought to the emergency department with severe dehydration. Her heart rate is 198, and her blood pressure is 68/38. The infant's anterior fontanel is sunken. The nurse notes that the infant does not cry when the intravenous line is inserted. The child's parents state that she has not "held anything down" in 18 hours. The nurse obtained a finger-stick blood sugar of 94. Which of the following would the nurse expect to do immediately?
Administer a bolus of normal saline.
The nurse is caring for a 4-month-old who has just had an isolated cleft lip repaired. Select the best position for the child in the immediate postoperative period.
Supine.
The nurse is providing discharge teaching to the parents of an infant with an umbilical hernia. Which of the following should be included in the plan of care?
If the hernia appears to be more swollen or tender, seek medical care immediately.
The nurse is caring for a 3-year-old who had an appendectomy 2 days ago. When taking the child's temperature, the nurse notes that the child has a fever of 101.8°F (38.8°C). The nurse notes the child's breath sounds are slightly diminished in the right lower lobe. Which of the following actions is most appropriate for this patient?
Encourage the child to blow bubbles.
The nurse is caring for a 6-year-old in the early stages of acute hepatitis. Which of the following manifestations should the nurse expect to find?
Nausea, vomiting, and generalized malaise.
The nurse received a 4-month-old who had been diagnosed with an intussusception. The infant is described as very lethargic with the following vital signs, T 101.8°F (38.7°C), HR 181, BP 68/38. The reporting nurse states the infant's abdomen is very rigid. Which of the following is the most appropriate action for the receiving nurse?
Prepare to get the infant ready for immediate surgical correction.
The nurse is caring for an 8-year-old who has just returned to the pediatric unit after an appendectomy for a ruptured appendix. Which of the following is the best position for the child?
Right side-lying.
The mother of a newborn asks the nurse why she has to nurse so frequently. The nurse replies using which of the following principles?
The newborn's stomach capacity is small, and peristalsis is more rapid than in older children.
The nurse is caring for an 8-week-old infant being evaluated for pyloric stenosis. Which of the following statements made by the parents would be typical of a child with this diagnosis?
"The baby is always hungry."
The parents of a child being evaluated for celiac disease ask the nurse why it is important to make dietary changes. Select the nurse's best response.
"The body's response to gluten causes damage to the mucosal cells in the intestine, leading to absorption problems."
The parents of a newborn diagnosed with a cleft lip and palate ask the nurse when their child's lip and palate will most likely be repaired. Select the nurse's best response.
"The lip is repaired in the first few weeks of life, but the palate is not usually repaired until the child is 18 months old."
The nurse is providing discharge instructions to the parents of an infant who has had surgery to open a low imperforate anus. The nurse knows that the discharge instructions have been understood when the child's parents say which of the following?
"We will call the physician if the stools change in consistency."
The nurse is caring for a 3-month-old infant who has SBS and has been receiving TPN. The parents ask if their child will ever be able to eat. Select the nurse's best response.
"We will start feeding your child soon so that the bowel continues to receive stimulation."
The nurse receives a call from the mother of a 6-month-old who describes her child as sleepy and fussy. She states that her infant vomited once this morning and had two episodes of diarrhea. The last episode contained mucus and a small amount of blood. She asks the nurse what she should do. Select the nurse's best response.
"Your infant will need to have some tests in the emergency room to determine if anything serious is going on."
The nurse is caring for a 14-year-old with celiac disease. The nurse knows that the patient understands the diet instructions by ordering which of the following meals?
Cheese, banana slices, rice cakes, and whole milk.
The nurse is interviewing the parents of a 6-year-old who has been experiencing constipation. Which of the following could be a causative factor? Select all that apply. 1. Hypothyroidism. 2. Muscular dystrophy. 3. Myelomeningocele. 4. Drink a lot of milk. 5. Active in sports
1, 2, 3, 4. 1. Hypothyroidism. 2. Muscular dystrophy. 3. Myelomeningocele. 4. Drink a lot of milk.
The nurse is caring for a 5-month-old infant with a diagnosis of intussusception. The infant has periods of irritability during which the knees are brought to the chest and the infant cries, alternating with periods of lethargy. Vital signs are stable and within age-appropriate limits. The physician elects to give an enema. The parents ask about the purpose of the enema. Select the nurse's most appropriate response.
"The enema will help confirm the diagnosis and has a good chance of fixing the intussusception."
The nurse is providing discharge instructions to the parents of a 10-year-old who had an appendectomy for a ruptured appendix 5 days ago. The nurse knows that further education is required when the child's parent states: SAT
"We will wait 2 weeks before allowing our child to return to sports." "We will call the pediatrician's office if we notice any drainage around the wound."
The nurse is about to receive a 4-year-old from the recovery room after an appendectomy for a non-ruptured appendix. The parents have not seen the child since the surgery and ask what to expect. Select the nurse's best response.
"Your child will be very sleepy and will have an intravenous line in the hand. If your child needs pain medication. we will give it intravenously.
The nurse is caring for a newborn with a cleft lip and palate. The mother states, "I will not be able to breastfeed my baby." Select the nurse's best response.
"Sometimes breastfeeding is still an option for babies with a cleft lip and palate. Would you like more information?"
The nurse is caring for a newborn with an anorectal malformation and has had a colostomy placed. The nurse knows that more education is needed when the infant's parent states which of the following?
"I will keep a bag attached to avoid the contents of the small intestine coming in contact with the baby's skin."
The nurse in the pediatric clinic receives a call from the parent of a 5-year-old and states that the child has been having diarrhea for 24 hours. The parent explains that the child vomited twice 2 hours ago and now claims to be thirsty. The parent asks what to offer the child because the child is refusing Pedialyte. Select the nurse's most appropriate response.
"Pedialyte is the best thing for your child. Allow your child some choice in the way to take it. Try offering small amounts in a spoon, medicine cup, or syringe."
Which of the following children may need extra fluids to prevent dehydration? Select all that apply. 1. A 7-day-old receiving phototherapy. 2. A 6-month-old with newly diagnosed pyloric stenosis. 3. A 2-year-old with pneumonia. 4. A 13-year-old who has just started her menses. 5. A 2-year-old with full-thickness burns to the chest, back, and abdomen.
A 7-day-old receiving phototherapy. A 6-month-old with newly diagnosed pyloric stenosis. A 2-year-old with pneumonia. A 2-year-old with full-thickness burns to the chest, back, and abdomen.
The nurse is caring for an infant with biliary atresia who is scheduled for a Kasai procedure. Which of the following is an accurate description of this surgery?
A palliative procedure in which a bile duct is attached to a loop of bowel to assist with bile drainage.
A 7-year-old is being seen in the pediatric clinic. The child is diagnosed with chronic constipation and has been unresponsive to dietary and activity changes. Which of the following pharmacological measures is most appropriate?
A stool softener.
The nurse is caring for a newborn who has just been diagnosed with tracheoesophageal atresia and is scheduled for surgery. Which of the following should the nurse expect to do in the preoperative period?
Administer intravenous fluids and antibiotics.
The nurse is caring for a 2-year-old child who was admitted to the pediatric unit for moderate dehydration due to vomiting and diarrhea. The child is noted to be restless, with periods of irritability. The child is afebrile with a heart rate of 148 and a blood pressure of 90/42. Baseline laboratory tests reveal the following: Na 152, Cl 119, and glucose 115. The parents state that the child has not urinated in 12 hours. After establishing a saline lock, the nurse reviews the physician's orders. Which of the following orders should the nurse question?
After the saline bolus, begin maintenance fluids of D5 1/4 NS with 10 mEq KCl/L.
The nurse is caring for a 14-month-old infant whose cleft palate was repaired 12 hours ago. Which of the following should be included in the plan of care? SAT 1. Allow the infant to have familiar items of comfort such as a favorite stuffed animal and a pacifier. 2. Once liquids have been tolerated, encourage a bland diet such as soup, Jell-O, and saltine crackers. 3. Administer pain medication on a regular schedule, as opposed to an as-needed schedule. 4. Use a Yankauer suction catheter on the infant's mouth to decrease the risk of aspiration of oral secretions. 5. When discharged remove elbow restrains.
Allow the infant to have familiar items of comfort such as a favorite stuffed animal and a sippy cup Administer pain medication on a regular schedule, as opposed to an as-needed schedule.
The nurse knows that this Nissen fundoplication involves which of the following?
The fundus of the stomach is wrapped around the inferior esophagus, mimicking a cardiac sphincter.
The nurse is reviewing the discharge instructions of a child diagnosed with encopresis. Which of the following instructions should the nurse question? SAT 1. Limit the intake of milk. 2. Encourage positive reinforcement for appropriate toileting habits. 3. Obtain a complete dietary log. 4. Follow up with a child psychologist or psychiatrist 5. after dinner have the child sit on the toilet for 10min.
Encourage positive reinforcement for appropriate toileting habits. Follow up with a child psychologist or psychiatrist
Which of the following should the nurse include in the plan of care to decrease the symptoms of GER? SAT 1. Place the infant in an infant seat immediately after feeding. 2. Place the infant in the prone position immediately after feeding to decrease the risk of aspiration. 3. Encourage the parents not to worry because most infants outgrow GER within the first year of life. 4. Encourage the parents to hold the infant in an upright position for 30 minutes following a feeding. 5. suggest the parents burp the infants after every 1-2 oz consumed
Encourage the parents to hold the infant in an upright position for 30 minutes following a feeding. suggest the parents burp the infants after every 1-2 oz consumed
The nurse is caring for a 10-year-old who is being evaluated for possible appendicitis. The child has been complaining of nausea and sharp abdominal pain in the right lower quadrant. An abdominal ultrasound is scheduled, and a blood count has been obtained. The child vomits, finds the pain relieved, and calls the nurse. Which of the following should be the nurse's next action?
Immediately notify the physician of the child's status.
The nurse is caring for a 7-week-old scheduled for a pyloromyotomy in 24 hours. Which of the following would the nurse expect to find in the plan of care?
Keep infant NPO; begin intravenous fluids at maintenance; place NGT to low wall suction.
The nurse is caring for a 1-month-old term infant who experienced an anoxic episode at birth. The health-care team suspects that the infant is developing NEC. Which of the following would the nurse expect to be included in the plan of care?
Prepare to administer antibiotics intravenously.
The nurse is in the room while a mother of a newborn is feeding her infant for the first time. The baby immediately begins coughing and choking. The nurse notes that the baby is extremely cyanotic. Which of the following should be the nurse's immediate action?
Take the infant from the mother, and administer blow-by oxygen while obtaining the infant's oxygen saturation.
The nurse is caring for a neonate with an anorectal malformation. The nurse notes that the infant has not passed any stool per rectum but that the infant's urine contains meconium. The nurse can make which of the following assumptions?
The child likely has a high anorectal malformation.