Peds GI and Resp edit 2

A nurse is caring for an infant who has a tracheoesophageal fistula. Which of the following findings should the nurse expect? A. Coughing B. Apnea C. Sunken abdomen D. Cyanosis E. Frothy saliva

A, B, D, E

A parent calls a clinic and reports to a nurse that his 2-month-old infant is hungry more than usual but is projectile vomiting immediately after eating. Which of the following responses should the nurse make? A. "Bring your baby in to the clinic today." B. "Burp your baby more frequently during feedings." C. "Give your infant an oral rehydration solution." D. "Try switching to a different formula."

A. "Bring your baby in to the clinic today." Projectile vomiting followed by hunger are characteristic of pyloric stenosis. The infant needs to be examined in the clinic by a provider as soon as possible.

A nurse is providing teaching to the parent of an infant who has gastroesophageal reflux. Which of the following statements by the parent indicates an understanding of the teaching? A. "I will keep my baby in an upright position after feedings." B. "My baby's formula can be thickened with oatmeal." C. "I will have to feed my baby formula rather than breast milk." D. "I should position my baby side-lying during sleep."

A. "I will keep my baby in an upright position after feedings." The infant should be maintained in an upright position for 1 hr after feedings.

A nurse is providing teaching to a parent of a child who has Hirschsprung disease and is scheduled for initial surgery. Which of the following statements by the parent indicates an understanding of the teaching? A. "I'm glad that my child's ostomy is only temporary." B. "I'm glad my child will have normal bowel movements now." C. "I want to learn how to use my child's feeding tube as soon as possible." D. "I want to learn how to empty my child's urinary catheter bag."

A. "I'm glad that my child's ostomy is only temporary." Hirschsprung disease is also known as aganglionic megacolon and is characterized by an area of the large intestine without nerve innervation. The child will probably require two surgeries over an 18- to 24-month period before normal bowel function is obtained. The initial surgery creates an ostomy, which relieves the obstructed area and allows the bowel distal to the ostomy to rest.

A nurse is caring for a school-aged child who has a systemic disorder and is receiving antibiotics, immunosuppresants, and corticosteroids. Both of the child's parents have a smoking history. The child reports soreness in his mouth and refuses to eat. Inspection of his mouth reveals a white, milky plaque that does not come off with rubbing. The nurse should suspect which of the following conditions? A. Candidiasis B. Dermatitis C. Herpes simplex D. Squamous cell carcinoma

A. Candidiasis Manifestations of oral candidiasis include white patches that adhere to the inner cheeks, tongue, and palate that are painful and can cause the child to refuse to eat.

A nurse is caring for a 2-month-old infant who is postoperative following repair of a cleft lip and palate. The provider prescribes restraints. The nurse should apply which of the following types of restraints for this infant? A. Elbow B. Mummy C. Wrist D. Jacket

A. Elbow It is essential to apply elbow restraints immediately after surgery to keep the infant from rubbing the operative site. The nurse should remove the restraints periodically to inspect the skin and allow the infant arm exercise.

A nurse is caring for a 2-month-old infant who is postoperative following surgical repair of a cleft lip. Which of the following actions should the nurse take? A. Encourage the parents to rock the infant. B. Offer the infant a pacifier. C. Administer ibuprofen as needed for pain. D. Position the infant on her abdomen.

A. Encourage the parents to rock the infant. A rocking motion will calm and soothe the infant. Additionally, involving the parents in the infant's care can reduce feelings of helplessness.

A nurse is caring for a child who is admitted with suspected acute appendicitis. Which of the following manifestations should indicate to the nurse that the child's appendix is perforated? A. Sudden decrease in abdominal pain B. Absent Rovsing's sign C. Flaccid abdomen D. Low-grade fever

A. Sudden decrease in abdominal pain A sudden decrease in abdominal pain should indicate to the nurse that the appendix might be ruptured. If the appendix ruptures, the pain can disappear for a short period and the client might feel suddenly better. However, once peritonitis sets in, the pain returns and can spread into the whole abdomen.

A nurse is caring for a child who has otitis media. Which of the following assessment findings should the nurse expect? A. Tugging on the affected ear lobe B. Clear drainage from the affected ear C. Pain when manipulating the affected ear lobe D. Erythema and edema of the affected ear

A. Tugging on the affected ear lobe Otitis media is a middle ear infection. Expected findings include fever, purulent drainage (if the tympanic membrane is ruptured), and pain, demonstrated by the child tugging at the ear.

A nurse is caring for a child who has influenza. The nurse should identify that which of the following statements by the parent indicates the child has an increased risk for Reye syndrome? A. "I give my child ibuprofen when his muscles are aching." B. "I am encouraging my child to drink grapefruit juice." C. "I give my child aspirin to reduce his fever." D. "I am leaving a humidifier on in my child's room when he naps."

C. "I give my child aspirin to reduce his fever." The administration of aspirin for fever associated with a viral illness increases the child's risk for Reye syndrome. Reye syndrome is a metabolic encephalopathy with manifestations of cerebral edema and fatty changes in the liver.

A nurse is planning care for a 10-month-old infant who is 8 hr postoperative following cleft palate repair. Which of the following interventions should the nurse include in the infant's plan of care? A. Feed the infant with a spoon for 48 hr. B. Apply and release elbow restraints every hour. C. Keep the infant supine. D. Suction the mouth with an oral suction tube.

B. Apply and release elbow restraints every hour. It is essential to apply elbow restraints after surgery to keep the infant from placing her hands in and around her mouth. The nurse should remove them periodically to inspect the skin and allow the infant to exercise her arms.

A nurse is caring for an infant who has gastroesophageal reflux. The nurse should place the infant in which of the following positions following feedings? A. Place the infant in a prone position. B. Place the infant in an infant seat. C. Place the infant on his left side. D. Place the infant on his right side.

B. Place the infant in an infant seat. An infant seat provides elevation and decreases the risk of aspiration.

A nurse is caring for a child who has pertussis. The child's parent asks the nurse what the common name for this disease is. The nurse should respond with which of the following common names? A. Chickenpox B. Whooping cough C. Mumps D. Fifth disease

B. Whooping cough Whooping cough is the common name for pertussis

A nurse is caring for a toddler who is 24 hour postoperative following a cleft palate repair. Which of the following actions should the nurse take? A. Offer fluids through a straw. B. Apply bilateral wrist restraints. C. Administer opioids for pain. D. Implement a soft diet.

C. Administer opioids for pain. Administering opioids for pain is an appropriate action by the nurse. Opioids control pain in the immediate postoperative period are followed by administration of acetaminophen PRN.

A nurse in a pediatric clinic is caring for a child who has iron deficiency anemia and a new prescription for ferrous sulfate tablets. Which of the following instructions should the nurse provide the parents regarding administration of this medication? A. Give with a 240 mL (8 oz) glass of milk. B. Administer at mealtimes. C. Give with orange juice D. Administer at bedtime

C. Give with orange juice Citrus fruit or juice aids absorption of this medication.

A nurse is caring for a 6-week-old infant who has a pyloric stenosis. Which of the following clinical manifestations should the nurse expect? A. Red currant jelly stools B. Distended neck veins C. Projectile vomiting D. Ridged abdomen

C. Projectile vomiting Pyloric stenosis is a narrowing of the pylorus, the outlet from the stomach to the small intestine. The narrowing does not allow for emptying of the stomach contents. Vomiting, which is usually mild at first, becomes more forceful and progresses to projectile vomiting.

A nurse is caring for a child who has otitis media with effusion. The nurse should identify that which of the following manifestations indicates a tympanic membrane rupture? A. Green-blue discharge in the ear canal B. Increased temperature C. Sudden pain relief D. Popping sensation when swallowing

C. Sudden pain relief Accumulation of exudate caused by otitis media with effusion increases pressure behind the tympanic membrane. The pressure releases when the tympanic membrane ruptures, which results in sudden pain relief.

A nurse is caring for a child who has suspected appendicitis. Which of the following provider prescriptions should the nurse clarify? A. Maintain NPO status. B. Monitor oral temperature every 4 hr. C. Medicate the client for pain every 4 hr as needed. D. Administer sodium biphosphate/sodium phosphate.

D. Administer sodium biphosphate/sodium phosphate. Enemas and laxatives are contraindicated because they increase the volume in the bowel and can cause the inflamed appendix to rupture, increasing the risk for peritonitis.

A nurse is caring for a child who has acute gastroenteritis but is able to tolerate oral fluids. The nurse should anticipate providing which of the following types of fluid? A. Broth B. Water C. Diluted apple juice D. Oral rehydration solution

D. Oral rehydration solution Oral rehydration solution is the fluid of choice for infants and children who have dehydration due to diarrhea.