Chapter 22: The Child with GI Dysfunction

Which diet is most appropriate for the child with celiac disease? A. Salt-free diet B. Phenylalanine-free diet C. Low-gluten diet D. High-calorie, low-protein, low-fat diet

C. Celiac disease is characterized by intolerance of gluten, the protein found in wheat, barley, rye, and oats. A low-gluten diet is indicated for life. The diet for a child with celiac disease does not have to be salt free. A low-phenylalanine diet is indicated in phenylketonuria. The diet of a child with celiac disease should be high in calories and protein and low in fat, in addition to the low-gluten requirement.

A 2-month-old breastfed infant is successfully rehydrated with oral rehydration solutions (ORSs) for acute diarrhea. Instructions to the mother about breastfeeding should include to A. continue breastfeeding. B. stop breastfeeding until breast milk is cultured. C. stop breastfeeding until diarrhea is absent for 24 hours. D. express breast milk and dilute with sterile water before feeding.

A. Breastfeeding should continue even if the infant has acute diarrhea. Culturing the breast milk is not necessary. Breastfeeding can continue with ORS to replace the ongoing fluid loss due to the diarrhea. Breast milk should not be diluted.

Which statement best describes Hirschsprung disease? A. The colon has an aganglionic segment. B. There is a passage of excessive amounts of meconium in the neonate. C. It results in excessive peristaltic movements within the gastrointestinal tract. D. It results in frequent evacuation of solids, liquids, and gas.

A. Hirschsprung disease is a mechanical obstruction caused by a lack of motility of a segment of the intestine as a result of the lack of ganglionic cells; therefore, it is referred to as aganglionic megacolon. Hirschsprung disease is associated with a neonate's inability to pass meconium or an older child's inability to pass feces. There is a lack of peristalsis in the affected segment of the infant or child with Hirschsprung disease. The infant or child with Hirschsprung disease will be seen with constipation or the passage of ribbon-like stools.

What should the nurse consider when providing support to a family whose infant has just been diagnosed with biliary atresia? A. Liver transplantation may be needed eventually. B. Death usually occurs by 6 months of age. C. The prognosis for full recovery is excellent. D. Children with surgical correction live normal lives.

A. Approximately 80% to 90% of children with biliary atresia will require liver transplantation. If the condition is untreated, death will usually occur by 2 years of age. Long-term survival is possible with surgical intervention. Liver transplantation is usually required for long-term survival. Even with surgical intervention, most children progress to liver failure and require transplantation.

The nurse is caring for a child with probable intussusception. The child had diarrhea before admission, but while waiting for administration of air pressure to reduce the intussusception, the child passed a normal brown stool. What is the most appropriate nursing action? A. Notify the physician. B. Measure the abdominal girth. C. Auscultate for bowel sounds. D. Take vital signs, including blood pressure.

A. Passage of a normal stool indicates that the intussusception has resolved. Notification of the physician is essential to determine whether a change in the treatment plan is indicated. Measurement of the abdominal girth may be indicated, but notifying the physician is the priority. Auscultating for bowel sounds may be indicted, but notifying the physician is the priority. Taking the vital signs, including the blood pressure, may be indicated, but notifying the physician is the priority.

When considering Crohn's and Ulcerative Colitis (UC) as disease states, which clinical symptoms may appear to be common presentations in both? A. Rashes and joint pain B. Rectal bleeding C. Growth restriction D. Fistulas and strictures

A. Rashes and joint pain are common presentations in both Crohn's and UC. Rectal bleeding is more common in UC. Growth restriction, fistulas and strictures are more common in Crohn's.

In performing a work up for a school aged child who reports frequent abdominal pain symptoms, what information would be critical to collect in order to make an accurate clinical diagnosis? A. Find out the duration, onset and quality characteristics of the symptoms. B. Ask the child's parents for detailed information. C. Find out if the child has any food allergies or food intolerances. D. Take and document vital signs to establish a clinical baseline.

A. School-age children typically relate recurrent abdominal pain. As such it is critical to obtain factors related to the pain characteristics, onset, duration and symptoms. This will help to correlate with potential organic and non-organic causes. Asking the parents' for detailed information may be needed but not at present to determine what type of pain the child is experiencing. Although it is important to denoted food allergies and food intolerance, the primary concern is abdominal pain presentation. Similarly, vital signs should be recorded but it is not the most critical piece of data that must be collected.

An infant with neurologic impairment and delay is receiving several medications. A proton pump inhibitor is one of the medications the infant is receiving. Which medication(s) is/are proton pump inhibitor(s)? (Select all that apply.) A. Ranitidine (Zantac) B. Omeprazole (Prilosec) C. Pantoprazole (Protonix) D. Glycopyrrolate (Robinul) E. Bethanechol (Urecholine)

B, C Omeprazole (Prilosec) utilizes a proton pump inhibitor that blocks the action of acid- producing cells. Pantoprazole (Protonix) utilizes a proton pump inhibitor that blocks the action of acid- producing cells. Ranitidine (Zantac) is a histamine-2 (H2) receptor blocker, not a proton pump inhibitor. Ranitidine (Zantac) inhibits the action of histamine at the H2 receptor site in the stomach that results in the inhibition of gastric acid secretion. Glycopyrrolate (Robinul) is an anticholinergic agent that is used to inhibit excessive salivation. Bethanechol (Urecholine) is a prokinetic drug and remains controversial in use.

You are educating nursing student regarding fluid requirements for pediatric patients who present with comorbidities. Increased need for fluid requirements would be consistent with treatment management for which conditions? (Select all that apply.) A. CHF B. DKA C. SIADH D. DI E. Burns

B, D, E Increased fluid requirements would occur in response to DKA, DI and burns. CHF and SIADH would lead to decreased fluid requirements.

Management of the child with a peptic ulcer often includes A. milk at frequent intervals. B. proton pump inhibitors. C. antacids 1 and 3 hours before meals and at bedtime. D. coping with stress and adjusting to chronic illness.

B. Proton pump inhibitors block the production of acid. They are well tolerated and have infrequent side effects. Milk is not beneficial in the management of peptic ulcer disease. Proton pump inhibitors are more effective than antacids. Coping with stress is beneficial, but peptic ulcer disease is treatable.

A child has been diagnosed with hepatitis A and received treatment. Based on this information the nurse determines that A. the illness was transmitted via blood route. B. immunity has been acquired for this type. C. crossover immunity is present for all types of hepatitis. D. the patient will now be a carrier for this type.

B. Once a patient has been exposed and treated, they develop immunity to this type but there is no crossover immunity to other hepatitis types. Hepatitis A if transmitted through fecal-oral route and is not blood borne. There is no carrier state for Hepatitis A.

A 4-year-old child has ingested a toxic dose of iron. The parent reports that the child vomited and complained of gastric pain an hour ago but "feels fine" now. The parent is not certain when the child ingested the iron tablets. The most appropriate recommendation by the nurse to the parent is to A. observe the child closely for 2 more hours. B. bring the child to the hospital immediately. C. administer activated charcoal. D. administer ipecac to induce vomiting if the child does not vomit again within 1 hour.

B. The child should be transported to the hospital immediately for assessment and possible gastric lavage. The period of concern for complications of iron toxicity is from 30 minutes to 6 hours. Activated charcoal does not bind iron and, therefore, is not a course of treatment for this child. Ipecac is not recommended for poisonings.

What clinical manifestations would the nurse expect to find in a newborn who has developed necrotizing enterocolitis (NEC)? A. Hyperthermia B. Gastric residual and melena C. The passage of ribbon-like stools D. Projectile vomiting

B. The most prominent signs of NEC are abdominal distention, gastric residuals, and blood in the stools (melena). NEC resembles septicemia; the newborn may "not look well," in addition to having nonspecific signs such as lethargy, poor feeding, hypotension, hypothermia, bile-stained vomitus, and oliguria. The newborn with NEC is more likely to be seen with hypothermia, not hyperthermia. The passage of ribbon-like stools is seen in newborns and infants born with Hirschsprung disease. Projectile vomiting is seen in newborns and infants with pyloric stenosis.

What should the nurse include when teaching an adolescent with Crohn disease? A. Preventing the spread of illness to others and nutritional guidance B. Adjusting to chronic illness and preventing the spread of illness to others C. Coping with stress and adjusting to chronic illness D. Nutritional guidance and preventing constipation

C. Crohn disease is a chronic disease with life-altering complications. The nursing interventions include helping the child cope with stress and adjust to the illness. Nutritional guidance is necessary, but Crohn disease is not infectious. Adjustment to chronic illness is necessary, but Crohn disease is not infectious. Nutritional guidance is necessary, but constipation is not an issue.

The care of a newborn with a cleft lip and palate before surgical repair includes A. little to no sucking. B. gastrostomy feedings. C. providing nonnutritive and nutritive sucking. D. positioning infant in near-horizontal for feeding.

C. Infants need nutritive and nonnutritive sucking. Nutritive and nonnutritive sucking is important to the infant. Gastrostomy feedings are not usually required or indicated. The appropriate positioning for the infant is the upright position.

Which factor predisposes an infant to fluid imbalances? A. Decreased surface area B. Lower metabolic rate C. Immature kidney functioning D. Decreased daily exchange of extracellular fluid

C. The infant's kidneys are unable to concentrate or dilute urine, to conserve or excrete sodium, and to acidify urine. The infant has a proportionately greater body surface area, which allows for greater insensible water loss. The infant has a higher metabolic rate. The infant has an increased amount of extracellular fluid. Approximately 60% of the fluid loss is from the extracellular space.

A school-age child with acute diarrhea and mild dehydration is being given oral rehydration solution (ORS). The child's mother calls the clinic nurse because the child is also occasionally vomiting. What should the nurse recommend? A. Bring the child to the hospital for intravenous fluids. B. Alternate giving ORS and carbonated drinks. C. Continue to give ORS frequently in small amounts. D. Institute a nothing by mouth (NPO) status for the child for 8 hours, and resume ORS if vomiting has subsided.

C. Vomiting is not a contraindication to the use of ORS unless it is severe. The mother should continue to give the ORS in small amounts and at frequent intervals. For a school-age child with mild dehydration, rehydration can be safely done at home with oral solutions. Carbonated drinks should not be used. They may have a high carbohydrate content and contain caffeine, which is a diuretic and could exacerbate fluid loss and dehydration. NPO status is not indicated. Small, frequent intake of ORS is recommended.

Dietary management of a child with inflammatory bowel disease (IBD) should include A. low protein B. low calorie C. high fiber D. vitamin supplements

D. Multivitamins, iron, and folic acid supplementation are recommended for the child with IBD. A high-protein, high-calorie diet is needed to help correct nutritional deficits. A high-fiber diet is not recommended for IBD. Even small amounts of bran have been associated with a worsening of the child's condition.

The nurse assesses a neonate immediately after birth. Clinical sign-symptom of tracheoesophageal fistula is A. jaundice B. bile-stained vomitus C. absence of sucking D. excessive amount of frothy saliva in the mouth

D. Excessive salivation and drooling are indicative of tracheoesophageal fistulas. With a fistula, the child has difficulty managing the secretions, which may cause choking, coughing, and cyanosis. Jaundice is not usually associated with a tracheoesophageal fistula. Bile-stained vomitus is not usually associated with a tracheoesophageal fistula. The infant is able to suck with a tracheoesophageal fistula but is not able to manage the secretions.

The nurse is discussing home care with the mother of a 6-year-old child with hepatitis A. Part of the discharge teaching plan should include? A. Bed rest is important until 1 week after the icteric phase. B. The child should not return to school until 3 weeks after the icteric phase. C. Reassure the mother that hepatitis A cannot be transmitted to other family members. D. Teach infection control measures to family members.

D. Hepatitis A is a contagious disease, transmitted through the fecal-oral route. The nurse should teach infection control measures to family members. Hepatitis A does not usually have an icteric phase and often is subclinical. The period of communicability for hepatitis A is the latter half of the incubation period to 1 week after the onset of clinical illness; therefore, the child can return to school after that time frame. Hepatitis A is infectious through the fecal-oral route; therefore, family members may be susceptible to acquiring the disease if they fail to institute proper infection control measures.

A child is exhibiting signs of clinical dehydration. Which laboratory value would support a diagnosis of hypertonic dehydration? A. Serum sodium level of 135 mEq/dL B. Plasma osmolality of 275 mOsm/L C. Calculation of loss of body fluid weight at 25 mL/kg D. Serum sodium level of 150 mEq/dL

D. Hypertonic dehydration would result in an increase in serum sodium levels in proportion to fluid loss. Normal serum sodium level ranges between 135 and 145 mEq/dL. Normal plasma osmolality is within the 275 to 295 mOsm/L. Calculation of loss of body fluid weight in terms of moderate loss would be at 50 mL/kg with 100 mL/kg being severe.

When evaluating the extent of an infant's dehydration, the nurse should recognize that the symptoms of severe dehydration (15%) are A. tachycardia, decreased tears, 5% weight loss. B. normal pulse and blood pressure, intense thirst. C. irritability, moderate thirst, normal eyes and fontanels. D. tachycardia, parched mucous membranes, sunken eyes and fontanels.

D. Symptoms of severe dehydration include tachycardia, parched mucous membranes, and sunken eyes and fontanels. In severe dehydration, there is a 15% weight loss in infants, not 5%, although the infant will exhibit tachycardia and decreased tears. Tachycardia, orthostatic hypotension and shock, and intense thirst would be expected in an infant with severe dehydration. The infant would be extremely irritable, with sunken eyes and fontanels, if severely dehydrated.

A child has a nasogastric (NG) tube after surgery for acute appendicitis. What is the purpose of the NG tube? A. Maintain electrolyte balance B. Maintain an accurate record of output C. Prevent the spread of infection D. Prevent abdominal distention

D. The NG tube is used to maintain gastric decompression until intestinal activity returns. The NG tube may adversely affect electrolyte balance by removing stomach secretions. NG drainage is one part of the child's output. The nurse would need to incorporate the NG drainage with other output. There is no relationship between the NG tube and prevention of the spread of infection.