Peds GI/GU (Exam 2)

Which child can be discharged without further evaluation? A. A 2 y/o who has had 24 hrs of watery diarrhea that has changed to bloody diarrhea in the past 12 hrs B. A 3 y/o who had a relapse of one diarrhea episode for 2 days and has decreased urine output C. A 6 y/o who has been having vomiting and diarrhea for 2 days and has decreased urine output D. A 10 y/o who has just returned from a scout camping trip and has had several episodes of diarrhea

B

Which needs to be present to diagnose HUS? A. Increased red blood cells with a low reticulocyte count, increased platelet count, and renal failure. B. Decreased red blood cells with a high reticulocyte count, decreased platelet count, and renal failure. C. Increased red blood cells with a high reticulocyte count, increased platelet count, and renal failure. D. Decreased red blood cells with a low reticulocyte count, decreased platelet count, and renal failure.

B

The nurse is caring for an infant diagnosed with Hirschsprung disease. The mother states she is pregnant with a boy and wants to know if her new baby will likely have the disorder. Which is the nurse's best response? A. "Genetics play a small role in Hirschsprung disease, so there is a chance the baby will develop it as well." B. "There is no evidence to support a genetic link, so it is very unlikely the baby will also have it." C. "It is rarely seen in boys, so it is not likely your new baby will have Hirschsprung disease" D. "Hirschsprung disease is seen only in girls, so your new baby will not be at risk."

A

The nurse is caring for a 4 month old who has just had an isolated cleft lip repaired. Select the best option for the child in the immediate post-op period. A. Right side-lying B. Left side-lying C. Supine D. Prone

C

A parent asks the nurse how to prevent the child from having nephrotic syndrome again. What is the nurse's best response? A. "It is very rare for a child to have a relapse after having fully recovered" B. "Unfortunately, many children have cycles of relapse, and there is very little that can be done to prevent it" C. "Your child is much less likely to get sick again if sodium is decreased in the diet" D. "Try to keep your child away from sick children because relapses have been associated with infectious illnesses"

D

The nurse is caring for an infant diagnosed with Hirschsprung disease. The parents ask what to expect. Select the best response. A. Most children are placed on stool softeners to help with constipation until it resolves B. A permanent colostomy will be necessary for stool diversion C. Daily bowel regimens will be needed to manage bowel habits for his lifetime D. Your child will most likely require surgery

D

What should the nurse teach a group of girls and parents about the importance of preventing UTIs? A. Avoiding constipation has no effect on the occurrence of UTIs B. After urinating, always wipe from back to front to prevent fecal contamination C. Hygiene is an important preventative measure and can be accomplished with frequent tub baths D. Increased fluids will help prevent and treat UTIs

D

The parents of a 4 y/o ask the nurse how to manage their child's constipation. Select the nurse's best response. A. "Add 2 oz of apple or pear juice to the child's diet" B. "Be sure your child eats a lot of fresh fruit such as apples and bananas" C. "Encourage your child to drink more fluids" D. "Decrease bulky foods such as whole-grain breads and brown rice"

C

The nurse is caring for a newborn with hypospadias. His parents ask if circumcision is an option. Which is the nurse's best response? A. "Circumcision is a fading practice and is now contraindicated in most children" B. "Circumcision in children with hypospadias is recommended because it helps prevent infection" C. "Circumcision is an option, but it can not be done at this time" D. "Circumcision can never be performed in a child with hypospadias"

C

The nurse is caring for an infant with pyloric stenosis. The parent asks if any future children will likely have pyloric stenosis. Which is the nurse's best response? A. "You seem worried; would you like to discuss your concerns?" B. "It is very rare for a family to have more than one child with pyloric stenosis" C. "Pyloric stenosis can run in families. It is more common among males" D. "Although there can be a genetic link, it is very unusual for girls to have pyloric stenosis"

C

Which would the nurse most likely find in the history of a child with hemolytic uremic syndrome (HUS)? Select all that apply. A. Frequent UTIs and possible VUR B. Vomiting and diarrhea before admission C. Bee sting and localized edema of the site for 3 days D. Previously healthy with no signs of illness E. Anorexia and bruising

B, E

A 5 y/o is discharged from the hospital following the diagnosis of HUS. The child has been diarrhea free for 1 week and renal function has returned. The parent asks the nurse when the child can return to school. Which is the nurse's best response? A. "Immediately, as your child is no longer contagious" B. "It would be best to keep your child home for a few more weeks because the immune system is weak, and there could be a relapse of HUS" C. "Your child will be contagious for approximately another 10 days, so it is best to not allow a return just yet" D. "It would be best to keep your child home and monitor urinary output"

C

The nurse is interviewing the parents of a 6 y/o who has been experiencing constipation. Which could be a causative factor? Select all that apply. A. Hypothyroidism B. Muscular dystrophy C. Myelomeningocele D. Drinks a lot of milk E. Active in sports

A, B, C, D

Which should be included in the plan of care for a 14 month old whose cleft palate was repaired 12 hours ago? Select all that apply. A. Allow the infant to have familiar items of comfort such as a favorite stuffed animal and a "sippy" cup B. Once liquids have been tolerated, encourage a bland diet such as soup, jello, and saltine crackers C. Administer pain meds on a regular schedule, as opposed to an as-needed schedule D. Use a Yankauer suction catheter on the infant's mouth to decrease the risk of aspiration of oral secretions E. When discharged, remove elbow restraints

A, C

Which should the nurse include in the plan of care to decrease symptoms of GERD in a 2 month old? Select all that apply. A. Place the infant in an infant seat immediately after feedings B. Place the infant in the prone position immediately after feedings to decrease the risk of aspiration C. Encourage the parents not to worry because most infants outgrow GERD within the first year of life D. Encourage the parents to hold the infant in an upright position for 30 minutes following a feeding E. Suggest that the parents burp the infant after every 1-2 oz consumed

D, E

The parents of a child with glomerulonephritis ask how they will know their child is improving after they go home. Which are the nurse's best responses? Select all that apply. A. "Your child's urine output will increase, and the urine will become less tea-colored" B. "Your child will have more energy as lab tests become more normal" C. "Your child's appetite will decreased as urine output increases" D. "Your child's laboratory values will become more normal" E. "Your child's weight will increase as the urine becomes less tea-colored"

A, E

A child with HUS is very pale and lethargic. Stools have progressed from watery to bloody diarrhea. Blood work indicates low H&H levels. The child has not had any urine output in 24 hrs. The nurse expects administration of blood products and what else to be added to the plan of care? A. Initiation of dialysis B. Close observation of the child's hemodynamic status C. Diuretic therapy to force urinary output D. Monitoring urinary output

A

A 13 month old is discharged following repair of his epispadias. Which statement made by the parents indicates they understand the discharge teaching? A. "If a mucous plug forms in the urinary drainage tube, we will irrigate it gently to prevent a blockage" B. "If a mucous plug forms in the urinary drainage tube, we will allow it to pass on its own because this is a sign of healing" C. "We will make sure the dressing is loosely applied to increase the toddler's comfort" D. "If we notice any yellow drainage, we will know that everything is healing well"

A

A child had a UTI 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis revealed normal results. The child has had no other problems until this visit when the child was diagnosed with another UTI. Which is the most appropriate plan? A. Obtain a urinalysis and urine culture B. Evaluate for renal failure C. Admit to the pediatric unit D. Send home on an antibiotic E. Schedule a VCUG

A

Which child is at risk for developing glomerulonephritis? A. A 3 y/o who had impetigo 1 week ago B. A 5 y/o with a history of 5 UTIs in the previous year C. A 6 y/o with a new-onset type 1 diabetes D. A 10 y/o recovering from viral pneumonia

A

The clinical manifestations of nephrotic syndrome are due to which of the following? A. Chemical changes in the composition of the albumin B. Increased permeability of the glomeruli C. Obstruction of the capillaries of the glomeruli D. Loss of the kidneys' ability to excrete waste and concentrate urine

B

A school age child with acute post streptococcal glomerulonephritis who has a fluid restriction of 1,000 mL/day, which of the following fluids would the nurse consider as most appropriate for the child's condition and effective for preventing excessive thirst? A. Diet cola B. Ice chips C. Lemonade D. Water

B

The bladder capacity of a 3 y/o is approximately how much? A. 1.5 oz B. 3 oz C. 4 oz D. 5 oz

D

A recent history of which of the following would alert the nurse to suspect a UTI in a 1 y/o child who is exhibiting fever and fussiness? A. Nausea/vomitting B. Swollen lymph nodes C. Skin rash D. Back pain

A

The manifestations of HUS are due primarily to which event? A. The swollen lining of the small blood vessels damage the RBCs which are then removed by the spleen, leading to anemia B. There is a disturbance of the glomular basement membrane, allowing large proteins to pass through C. The RBC changes shape, causing it to obstruct microcirculation D. There is a depression in the production of all formed elements in the blood

A

The nurse receives a call from the mother of a 6 month old who describes her child as alternately sleepy and fussy. She states that her infant vomited once this morning and had 2 episodes of diarrhea. The last episode contained mucus and a small amount of blood. She asks the nurse what she should do. Which is the nurse's best response? A. "Your infant will need to have some tests in the ED to determined whether something serious is going on" B. "Try feeding your infant in about 30 minutes; in the event of repeat vomiting bring the infant to the ED for some tests and IV rehydration" C. "Many infants display these symptoms when they develop an allergy to the formula they are receiving; try switching to a soy-based formula" D. "Do not worry about the blood and mucus in the stool; is is not unusual for infants to have blood in their stools because of their intestines are more sensitive"

A

Which of the following statements by the mother of a toddler diagnosed with nephrotic syndrome indicates that the mother has understood the nurse's teaching about the disease? A. "My child really likes chips and bologna. I guess we'll have to find something else" B. "We'll have to encourage lots of liquids. Did you say about 4 liters every day?" C. "We worry about surgery. Do you think we should do direct donation of blood?" D. "We understand the need for antibiotics. I just wish the antibiotics could be given by mouth."

A

Which statement by a parent is most consistent with nephrotic syndrome? A. "My child missed 2 days of school last week because of a really bad cold" B. "After camping last week, my child's legs were covered in bug bites" C. "My child came home from school a week ago because of vomiting and stomach cramps" D. "We have a pet turtle, but no one washes their hands after playing with the turtle"

A

The nurse is caring for an infant newly diagnosed with Hirschsprung disease. What does the nurse understand about the infant's condition? Select all that apply. A. There is a lack of peristalsis in the large intestine and an accumulation of bowel contents, leading to abdominal distention B. There is an excessive peristalsis throughout the intestine, resulting in abdominal distention C. There is a small-bowel obstruction, leading to ribbon like stools D. There is inflammation throughout the large intestine, leading to accumulation of intestinal contents and abdominal distention E. There is an accumulation of bowel contents, leading to non-passage of stools

A, E

The nurse caring for a neonate with an anorectal malformation notes that the infant has not passed any stool per rectum but that the infant's urine contains meconium. The nurse can make which assumption? A. The child likely has a low anorectal malformation B. The child likely has a high anorectal malformation C. The child will not need a colostomy D. This malformation will be corrected with a nonoperative rectal pull-through

B

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." Which is the nurse's best response? A. "It sounds like you are feeling discouraged. Would you like to talk about it?" B. "Sometimes breastfeeding is still an option for babies with a cleft lip and palate. Would you like more information?" C. "Although breastfeeding is not an option, you can pump your milk and then feed it to your baby with a special nipple" D. "We usually discourage breastfeeding babies with cleft lip and palate as it puts them at an increased risk for aspiration"

B

The nurse is providing discharge instructions to parents of a 6 month old infant that just had a surgical repair to open a low imperforate anus. Which of the following statements by the parents would demonstrate understanding of discharge teaching? A. "We will use an oral thermometer because we cannot use a rectal one" B. "We will call the physician if the stools change in consistency or form" C. "Our infant will never be toilet trained" D. "We understand that it is not unusual for our infant's urine to contain stool"

B

The nurse knows that Nissen fundoplication involves which of the following? A. The fundus of the stomach is wrapped around the inferior stomach, mimicking a lower esophageal sphincter B. The fundus of the stomach is wrapped around the inferior esophagus, mimicking a cardiac sphincter C. The fundus of the stomach is wrapped around the middle portion of the stomach, decreasing the capacity of the stomach D. The fundus of the stomach is dilated, decreasing the likelihood of reflux

B

The parent of a child with glomerulonephritis asks the nurse why the urine is such a funny color. Which is the nurse's best response? A. "It is not uncommon for the urine to be discolored when children are receiving steroid and BP meds" B. "There is blood in your child's urine that causes it to be tea-colored" C. "Your child's urine is very concentrated, so it appears to be discolored" D. "A ketogenic diet often causes the urine to be tea-colored"

B

The toddler with nephrotic syndrome responds to treatment and is ready to go home. When helping the family plan for home care, which of the following would the nurse include in the teaching? A. Administer pain meds as needed B. Keep the child away from others with an infection C. Notify the physician if there is an increase in the child's urine output D. Administer acetaminophen daily

B

The urinalysis of a toddler with nephrotic syndrome reveals +4 for protein. The nurse interprets this result as indicating which of the following? A. Decreased secretion of aldosterone B. Increased glomerular permeability C. Inhibited tubular reabsorption of sodium and water D. Loss of RBCs

B

The child with nephrotic syndrome has generalized edema. The skin appears stretched and areas of breakdown are noted over the bony prominences. The child has been receiving Lasix twice daily for several days. Which does the nurse expect to be included in the treatment plan to reduce edema? A. An increase in an amount and frequency of Lasix B. Addition of a second diuretic, such as mannitol C. Administration of IV albumin D. Elimination of all fluids and sodium from the child's diet

C

The mother of a newborn asks the nurse why the infant has to nurse so frequently. Which is the best response? A. Formula tends to be more calorically dense, and formula-fed babies require fewer feedings than breastfed babies B. The newborn's stomach capacity is small, and peristalsis is slow C. The newborn's stomach capacity is small and peristalsis is more rapid than in older children D. Breastfed babies tend to take longer to complete a feeding than a formula-fed baby

C

The nurse is caring for a 3 month old being evaluated for possible Hirschsprung disease. His parents call the nurse and show her his diaper containing a large amount of mucus and bloody diarrhea. The nurse notes that the infant is irritable and his abdomen appears very distended. Which should be the nurse's next action? A. Reassure the parents that this is an expected finding and non uncommon B. Call a code for a potential cardiac arrest and stay with the infant C. Immediately obtain all vital signs with a quick head-to-toe assessment D. Obtain a stool sample for occult blood

C

The nurse is caring for a 4 month old with GERD. The infant is due to receive rantadine (Zantac). Based on the medications mechanism of action, when should this medication be administered? A. Immediately before a feeding B. 30 minutes after the feeing C. 30 minutes before the feeding D. At bedtime

C

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 appropriate age limits. The HCP elects to give an enema. The parents ask the purpose of the enema. Which is the nurse's most appropriate response? A. "The enema will confirm the diagnosis. If the test result is positive, your child will need to have surgery to correct the intussusception" B. "The enema will confirm the diagnosis. Although very unlikely, the enema may also help fix the intussusception so that your child will not immediately need surgery" C. "The enema will help confirm the diagnosis and has a good chance of fixing the intussusception" D. "The enema will help confirm the diagnosis and may temporarily fix the intussusception. If the bowel returns to normal, there is a strong likelihood that the intussusception will recur"

C

The nurse is caring for a newborn with an anorectal malformation and a colostomy. The nurse knows that more education is needed when the parent states which of the following? A. "I will make sure the stoma is red" B. "There should not be any discharge or irritation around the outside of the stoma" C. "I will keep a bag attached to avoid the contents of the small intestine coming in contact with the baby's skin" D. "As my baby grows, a pattern will develop over time, and there should be predictable bowel movements"

C

The parents of a child hospitalized with nephrotic syndrome ask why the last blood test revealed elevated lipids. Which is the nurse's best response? A. "If your child had just eaten a fatty meal, the lipids may have been falsely elevated" B. "It's not unusual to se elevated lipids in children because of the dietary habits of today" C. "Because your child is losing so much protein, the liver is stimulated and makes more lipids" D. "Your child's blood is very concentrated because of the edema, so the lipids are falsely elevated"

C

Which child does not need a urinalysis to evaluate for a UTI? A. A 4 month old female presenting with a 2 day hx of fussiness and poor appetite; current vital signs are T-100.8, HR-120 B. A 4 y/o female who states "it hurts when I pee;" she has been urinating every 30 minutes; vital signs are WDL C. An 8 y/o male presenting with a finger laceration; mother states he had surgical re-implantation of his ureters 2 yrs ago D. A 12 y/o female complaining of pain to her lower right back; she denies any burning of frequency at this time; T-101.5

C

Which combination of signs is commonly associated with glomerulonephritis? A. Massive proteinuria, hematuria, decreased urinary output, and lethargy B. Mild proteinuria, increased urinary output, and lethargy C. Mild proteinuria, hematuria, decreased urinary output, and lethargy D. Massive proteinuria, decreased urinary output, and hypotension

C

Which finding requires immediate attention in a child with glomerulonephritis? A. Sleeping most of the day and being very "cranky" when awake; BP is 170/90/ B. Urine output is 190mL in an 8hr period and the color of coca-cola C. Complaining of a severe headache and photophobia D. Refusing breakfast and lunch stating he is "just not hungry"

C

Which laboratory results besides hematuria are most consistent with HUS? A. Massive proteinuria, elevated blood urea nitrogen, and creatinine B. Mild proteinuria, decreased blood urea nitrogen, and creatinine C. Mild proteinuria, increased blood urea nitrogen, and creatinine D. Massive proteinuria, decreased blood urea nitrogen, and creatinine

C

Which of the following statements by a parent would be typical of pyloric stenosis? A. He is a fussy eater and doesn't want to eat B. He has forceful vomiting 30-60 minutes after feeding C. He is always hungry D. He is happy and only gets upset when he spits up

C

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. Which is the nurse's best response? A. "It is really an easy disease to manage. Most children are placed on stool softeners to help with constipation until it resolves" B. "A permanent stool diversion called a colostomy will be placed by the surgeon to bypass the narrowed area" C. "Daily bowel irrigations will help your child maintain regular bowel habits" D. "Although your child will require surgery, there are different ways to manage the disease, depending on how much bowel is involved"

D

The nurse will soon receive a 4 month old who has been diagnosed with intussusception. The infant is described as very lethargic with the following vital signs: T-101.8F, HR-181, BP-68/38. The reporting nurse states that the infant's abdomen is very rigid. Which is the most appropriate action for the receiving nurse? A. Prepare to accompany the infant to a CT scan to confirm the diagnosis B. Prepare to accompany the infant to the radiology department for a reducing enema C. Prepare to start a second IV line to administer fluids and antibiotics D. Prepare to get the infant ready for immediate surgical correction

D

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. Which is the nurse's best response? A. "The palate and the lip are usually repaired in the first few weeks of life so that the baby can grow and gain weight" B. "The palate and the lip are usually not repaired until the baby is approximately 6 months old so that the mouth has had enough time to grow" C. "The lip is repaired in the first few months of life, but the palate is not usually repaired until the child is 3 years old" D. "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"

D

Which is the best way to obtain a urine sample in an 8 month old being evaluated for a UTI? A. Carefully cleanse the perineum from front to back and apply a self-adhesive urine collection bag to the perineum B. Insert an indwelling foley catheter, obtain the sample, and wait for results C. Place a sterile cotton ball in the diaper and immediately obtain the sample with a syringe after the first void D. Using a straight catheter, obtain the sample and immediately remove the catheter without waiting for the results of the urine sample

D

Which should be the nurse's immediate action when a newborn begins to cough and choke and becomes cyanotic while feeding? A. Inform the HCP of the situation B. Have the mother stop feeding the infant, and observe to see if the choking episode resolves on its own C. Immediately determine the infant's oxygen saturation and have the mother stop feeding the infant D. Take the infant from the mother and administer blow-by oxygen while obtaining the infant's oxygen saturation

D