Prep U CH 42

A 9-year-old child has undergone a temporary colostomy in the ascending colon several days ago. The nurse has just completed discharge teaching to the child and the parents. Which statements by the child or parents warrants additional instruction from the nurse?

"It is important to change the pouch and skin appliance every other day to decrease the risk of problems with the skin." "We will need to use an antimicrobial soap to cleanse the area around the stoma in order to prevent any skin infection."

The nurse is caring for a 4-year-old with oral vesicles and ulcers from herpangina. The child is refusing fluids due to the pain and the mother is concerned about his hydration status. Which of the suggestions would be most appropriate?

"Offer 'magic mouthwash' followed by a popsicle."

The student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply.

"Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "The only treatment for celiac disease is a strict gluten-free diet." "Gluten is found in most wheat products, rye, barley and possibly oats."

The nurse is collecting data on a 2-year-old child admitted with a diagnosis of gastroenteritis. When interviewing the caregivers, which question is most important for the nurse to ask?

"Tell me about the types of stools your child has been having."

A physician recommends a gastrostomy for a 4-year-old client with an obstruction. The parents ask the certified wound, ostomy, and continence nurse (CWOCN) what the surgery entails. What is the nurse's best response?

"The surgery creates an opening between the stomach and abdominal wall."

The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis?

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

The nurse is preparing a client for surgery and the client asks, "What does it mean when they say they are going to reduce my abdominal hernia?" Which response by the nurse is most appropriate?

"This means the hernia contents will be manipulated back into your peritoneal cavity during surgery."

The nurse is caring for a newborn diagnosed with imperforate anus following delivery. The physician has discussed the treatment options and prognosis with the parents. The nurse is talking with the parents and determines that learning has occurred when the parents make which statement?

"We are worried that our child may have other congenital problems that we aren't aware of."

The nurse is caring for a 13-year-old girl with suspected autoimmune hepatitis. The girl inquires about the testing required to evaluate the condition. How should the nurse respond?

"You will most likely have a blood test to check for certain antibodies."

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

1230

The nurse is doing dietary teaching with the caregivers of a child diagnosed with idiopathic celiac disease. What food will the nurse recommend as an appropriate diet choice?

Bananas

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which foods would be permitted in the diet of the child with celiac syndrome? Select all that apply.

Bananas Skim milk Applesauce

The nurse is administering an enteral feeding to a child with a gastrostomy tube (G-tube). Which action will the nurse take when administering a prescribed feeding through the client's G-tube?

Check for gastric residual before starting feeding.

The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis?

Hard, moveable "olive-like mass" in the upper right quadrant

Testing is being performed to confirm the presence of Meckel diverticulum. Which findings are consistent with this condition? Select all that apply.

Hemoglobin 9.4 g/dL Stool test reveals occult blood.

A neonatal nurse teaches students how to recognize gastrointestinal disorders in infants. The nurse tells the students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease?

Hirschsprung disease

The nurse is caring for a child with a diagnosis of pyloric stenosis during the preoperative phase of the child's treatment. What is the highest priority at this time?

Improving hydration

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of gastroesophageal reflux?

In this disorder the sphincter that leads into the stomach is relaxed.

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

Lower right

The nurse is preparing to perform ostomy care on a pediatric client. The nurse has explained the procedure to the child and caregiver. Place the remaining steps of the procedure in the order the nurse will complete them. Use all options.

Obtain and set up equipment. Remove the old pouch. Assess the stoma and surrounding skin. Clean the stoma and skin as needed, allowing it to dry thoroughly. Measure the stoma. Mark the new pouch backing, and cut the new backing to size. Apply the new pouch.

A mother calls the doctor's office and tells the nurse that she is concerned because her 4-month-old keeps "spitting up" with every feeding. What would indicate that the child is regurgitating as opposed to vomiting?

Only occurs with feeding

The emergency department nurse is assessing a child who has presented with a 2-day history of nausea and vomiting with pain that is isolated to the right upper quadrant of the abdomen. Which action is most appropriate?

Prepare the child for admission to the hospital

In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention?

Prepare the infant for surgery.

A 12-year-old boy has just undergone a liver transplantation and is recovering. After performing a fingerstick puncture and assessing the results, the nurse administers a 10% solution of dextrose IV. What is the correct rationale for this intervention?

Prevention of hypoglycemia

An adolescent has hepatitis B. What would be the most important nursing action?

Strict enforcement of standard precautions

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

Take a stool culture

The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration?

Tenting of skin

An adolescent is diagnosed with hepatitis A. Which problem should be considered when planning care?

The adolescent will become fatigued easily.

The newborn was diagnosed with esophageal atresia and a nasogastric tube was inserted. Which findings are most consistent with this condition? Select all that apply.

The newborn coughed excessively during attempts to feed. Coarse crackles were auscultated throughout all lung fields. X-ray revealed that the nasogastric tube was coiled in the upper esophagus.

A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason?

detect Helicobacter pylori

A nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. What GI condition might this history precipitate?

esophageal atresia (EA)

The nurse is caring for a 12-year-old child with Crohn disease. What assessment finding will the nurse report to the health care provider when caring for the child?

fever

An 18-month-old infant is brought to the emergency department with flu-like symptoms. The infant is diagnosed with pneumonia secondary to aspiration of stomach contents. The nurse explains to the parents that pneumonia is a condition that often occurs secondary to:

gastroesophageal reflux disease.

The nurse is reviewing the medical record of a child with a cleft lip and palate. When reviewing the child's history, what would the nurse identify as a risk factor for this condition?

mother age 42 with pregnancy

Which body system is most sensitive to lead ingestion?

nervous system

The nurse teaches a parent to differentiate between regurgitation and vomiting in the infant. The parent correctly states which characteristic of regurgitation? Select all that apply.

no appearance of distress occurs with feeding

The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is:

painless rectal bleeding.

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

pancreatitis

The caregiver of a child diagnosed with celiac disease tells the nurse that the child has large amounts of bulky stools and what looks like fat in the stools. The clinical manifestation this caregiver is describing is:

steatorrhea.

The nurse is talking with a woman who is in her 2nd trimester of pregnancy who has been diagnosed with polyhydramnios. The physician has ordered an ultrasound be performed to check for the presence of esophageal atresia. Which statement by the woman indicates an understanding of the relationship between these conditions?

"Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup."

A 4-month-old has had a fever, vomiting, and loose watery stools every few hours for 2 days. The mother calls the physician's office and asks the nurse what she should do. Which response by the nurse is most appropriate?

"Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment."

The nurse is assessing a toddler and palpates a sausage-shaped mass in the upper midabdomen. When taking the toddler's history what question would the nurse ask the parent first?

"Has your toddler been having different colored stools?"

The nurse has performed client teaching to a 15-year-old boy with Crohn disease, and his parents, regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning occurred?

"I have to be careful because I am prone to not absorbing nutrients."

A nurse caring for an infant born with a cleft palate notices that the parents rarely interact with their child. The nurse overhears the mother telling her spouse that she "feels like crying" every time she looks at their infant. What would be the best response from the nurse?

"I sense you could use more information on caring for a cleft palate. Would you be interested in meeting with other parents who have dealt with this?"

The mother of an infant tells the nurse during a routine visit to the clinic that she often notices a bulging mass in the lower abdominal and groin area when her baby cries. She asks the nurse if this is normal. How should the nurse respond?

"I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately."

The nurse is caring for an infant recently diagnosed with thrush and was prescribed nystatin. Which statement by the infant's mother would suggest a need for further education?

"I will add the nystatin to her bottle four times per day."

The student nurse is caring for a child with the nursing diagnosis "Risk for fluid volume deficit related to inadequate oral intake". Which statement by the student would indicate a need for further education by the nursing instructor?

"I will make sure there is plenty of orange juice available. It's her favorite juice."

The client calls the health care provider's office stating that her preschooler drank laundry detergent from under the sink. Which statement by the parent needs further instruction?

"I will use syrup of ipecac to get it out of my child's system."

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurately related to the diagnosis of pyloric stenosis?

A thickened, elongated muscle causes an obstruction at the end of the stomach.

The nurse is providing care to a child who has had an appendectomy for a perforated appendix. The nurse would anticipate intravenous antibiotic therapy for how long?

7 to 14 days

A nurse is caring for a child hospitalized with acute pancreatitis. Which intervention(s) in the care plan would alert the nurse to clarify with the provider? Select all that apply.

Administer intravenous corticosteroids Discontinue intravenous fluids if nasogastric tube is present

The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child?

Effortless vomiting just after the child has eaten

A parent brings a 2-year-old child to the health clinic with reports of diarrhea, vomiting, and abdominal pain. The father tells the nurse that he is a single parent and his child is enrolled in a local day care center. Based on this information, what gastrointestinal condition might the nurse suspect?

Gastroenteritis

A mother is alarmed because her 6-week-old boy has begun vomiting almost immediately after every feeding. In the past week, the vomiting has grown more forceful, with the vomit projecting several feet from his mouth. He is always hungry again just after vomiting. At the physician's office, the nurse holds the child and gives him a bottle of water. While he drinks, she notes an olive-size lump in his right abdomen. Which condition should the nurse suspect in this child?

Pyloric stenosis

The nurse is caring for a 6-month-old girl with diarrhea and dehydration. The mother is concerned because the girl has some patches on her tongue. Which feature indicates a geographic tongue rather than oral candidiasis (thrush)?

The patches are light in color on the tongue.

What occurs in the gastrointestinal system of the child with Hirschsprung disease?

There is a partial or complete mechanical obstruction in the intestine.

A 6-week-old infant is diagnosed with pyloric stenosis. When taking a health history from the parent, which symptom would the nurse expect to hear described?

Vomiting immediately after feeding