Chapter 28: The Child with a Gastrointestinal Condition

The nurse explains the medically accepted definition of constipation is fewer than _____ bowel movements in a 2-week period.

ANS: seven The medically accepted definition of constipation is fewer than seven bowel movements in a 2-week period.

What is the treatment of choice for a child with intussusception? a. A barium enema b. Immediate surgery c. IV fluids until the spasms subside d. Gastric lavage

ANS: A A barium enema is the treatment of choice for intussusception because the passage of the barium frequently "un-telescopes" the bowel. Surgery is scheduled only if reduction is not achieved.

An infant is admitted to the hospital with severe dehydration. Laboratory results show pH 7.32, PaCO2 40, HCO3- 21. How does the nurse interpret these values? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

ANS: A A pH lower than 7.35 indicates acidosis. If the child's pH falls in the same line as the HCO3-, the problem is metabolic (see Table 27-4).

Which is the most appropriate intervention for a 3-month-old infant who has gastroesophageal reflux? a. Position the infant in the crib on his or her abdomen, with the head elevated. b. Administer medication as ordered to stimulate the pyloric sphincter. c. Give thin rice cereal with formula before feeding solid foods. d. Place the infant in an infant seat after feedings.

ANS: A After feedings, the infant is placed in a prone position to avoid increased intraabdominal pressure.

What description of a child's stool characteristic leads the nurse to suspect intussusception? a. Currant jelly b. Black and tarry c. Green liquid d. Greasy and foul-smelling

ANS: A Bowel movements of blood and mucus that contain no feces ("currant jelly" stools) are common about 12 hours after the onset of the obstruction.

What instruction will the nurse give to parents about preventing the spread and reinfection of pinworms? a. Keep children's nails short. b. Dress child in loose-fitting underwear. c. Clean the bathroom with bleach solution. d. Wash bed linens in cold water.

ANS: A One intervention to prevent the further spread of pinworms is to keep the child's fingernails short. Pinworms are not spread from person to person.

A 7-month-old infant is admitted to the hospital with a diagnosis of acute gastroenteritis. What will be the nurse's priority goal of the infant's care? a. Prevent fluid and electrolyte imbalance. b. Prevent nutritional deficiency. c. Prevent skin breakdown. d. Prevent malabsorption.

ANS: A The priority goal of care in gastroenteritis is preventing fluid and electrolyte imbalance.

Which assessment would the nurse report to the physician immediately? a. 2-month-old with a urine output of 150 mL in 24 hours b. 3-year-old with a urine output of 650 mL in 24 hours c. 8-year-old with a urine output of over 1000 mL in 24 hours d. 14-year-old with a urine output of 800 mL in 24 hours

ANS: A The urine output of a 2-month-old infant should be between 400 and 500 mL/24 hours.

Which statement by a mother may indicate a cause of her son's vitamin C deficiency? a. "We get our fruits from homemade preserves." b. "We use milk from our own goats." c. "We grow all our own vegetables." d. "We're not big meat eaters."

ANS: A Vitamin C is destroyed by heat.

On the second day of hospitalization for a 3-month-old brought in for treatment for gastroenteritis, the nurse makes all of the assessments listed below. Which assessment finding indicates ineffectiveness of treatment? a. Weight loss of 4 ounces b. Dry mucous membranes c. Decreased skin turgor d. Depressed fontanelle

ANS: A Weight loss is the most significant indicator of dehydration because an infant's weight comprises 77% water.

A mother reports that her child has been scratching the anal area and complaining of itching. What does the nurse suspect based on this information? a. Pinworms b. Giardiasis c. Ringworm d. Roundworm

ANS: A With pinworms, the nurse or parent may notice that the child scratches the anal area and complains of itchiness. The other choices do not cause this reaction.

What sign(s) indicate(s) moderate dehydration? (Select all that apply.) a. 10% weight loss b. Dry mucous membranes c. Normal anterior fontanel d. Increased urinary output e. Lethargy

ANS: A, B, C The child that is moderately dehydrated will have lost 10% of his body weight, will have dry mucous membranes, normal (nonsunken) anterior fontanelle, decreased urine output, and will be irritable.

What assessment(s) would lead a nurse to suspect Hirschsprung's disease in a 1-month-old infant? (Select all that apply.) a. Ribbon-like stools b. Fever c. Failure to thrive d. Vomiting e. Diminished peristalsis

ANS: A, B, C, D, E All options are significant indicators of Hirschsprung's disease.

Which finding in a newborn is suggestive of tracheoesophageal fistula? a. Failure to pass meconium in 24 hours b. Choking on the first feeding c. Palpable mass in the sternal area d. Visible peristalsis across abdomen

ANS: B After birth, a newborn with tracheoesophageal fistula will vomit and choke when the first feeding is introduced.

A child is brought to the emergency department because he ingested an unknown quantity of acetaminophen (Tylenol). What does the nurse expect this child to receive following gastric lavage? a. Activated charcoal b. N-acetylcysteine c. Vitamin K d. Syrup of ipecac

ANS: B Gastric lavage is followed by N-acetylcysteine (Mucomyst), the antidote for acetaminophen.

A frightened mother calls the pediatrician's office because her child swallowed dishwashing detergent. What is the most appropriate action? a. Induce vomiting by giving the child syrup of ipecac. b. Take the child to the local emergency department. c. Give the child activated charcoal mixed with juice. d. Give the child milk to soothe affected mucous membranes.

ANS: B Inducing vomiting is no longer recommended because it may pose additional problems. The child should be taken immediately to the nearest emergency department along with the packaging of the ingested substance.

What would the nurse expect to find in a child admitted to the hospital for nonorganic failure to thrive? a. Cry to be picked up b. Be limp like a rag doll c. Be responsive to cuddling d. Weigh in the 10th percentile for age

ANS: B Some children with failure to thrive have rag-doll limpness (hypotonia) and appear wary of their caregivers.

A child has been diagnosed with ascariasis (roundworm). Which statement made by her mother that may suggest a cause for her condition? a. "I've been airing out the house on these nice breezy days." b. "My child often goes out to the garden and pulls up a carrot to eat." c. "She runs barefoot so much I have to wash her feet at least twice a day." d. "We just remodeled our bathroom at home."

ANS: B The child can ingest roundworm eggs from contaminated soil.

The nurse is interviewing parents of an infant with pyloric stenosis. What would the nurse expect the parents to report? a. Diarrhea b. Projectile vomiting c. Poor appetite d. Constipation

ANS: B Vomiting is the outstanding symptom of pyloric stenosis. Food is ejected with considerable force, which is described as projectile vomiting.

What interventions will the nurse perform when feeding a child with pyloric stenosis? (Select all that apply.) a. Give a formula thinned with water. b. Burp the infant before and during feeding. c. Give the feeding slowly. d. Refeed if the infant vomits. e. Position infant on left side after feeding.

ANS: B, C, D Children with pyloric stenosis are given formula thickened with cereal; the infant is burped before and during feeding to get rid of any gas in the stomach; the infant is fed slowly and refed if vomiting occurs. The infant is positioned on the right side to allow the weight of the feeding to stay in the stomach against the pyloric valve.

Parents have adopted a child with the diagnosis of kwashiorkor. What is most likely to be observed when assessing this child? (Select all that apply.) a. Hyperactivity b. White streak in hair c. Edematous abdomen d. Slowed growth e. Thick, oily hair

ANS: B, C, D Kwashiorkor means, in native dialect, "the disease of the deposed baby when the next one is born," indicating that the child no longer breastfeeds because a sibling is born and takes over the breast of the mother. Oral intake then is deficient in protein. The child fails to grow normally. The muscles become weak and wasted. There is edema of the abdomen that may become generalized. Diarrhea, skin infections, irritability, anorexia, and vomiting may be present. The hair becomes thin and dry. Because protein is the basis of melanin, a substance that provides color to hair, melanin becomes deficient. This is the reason the earliest sign of this protein malnutrition is a white streak in the hair of the child (depigmentation). The child looks apathetic and weak.

A child is brought into the ED with suspected appendicitis. What signs and symptoms does the nurse expect to assess? (Select all that apply.) a. Left lower quadrant pain b. Guarding c. Rebound tenderness d. Decreased C-reactive protein e. Pain on lifting thigh when supine

ANS: B, C, E With appendicitis on examination, characteristic tenderness in the right lower quadrant known as McBurney's point will occur. Other diagnostic signs include guarding (tightening of the abdominal muscles or rigidity of the abdomen on palpation); rebound tenderness (pressing the RLQ with rapid release of pressure causes severe pain); pain on lifting the thigh while in the supine position is caused by muscle irritation. C-reactive protein levels will be increased after 12 hours if any infection is present.

Why are infants more vulnerable to fluid and electrolyte imbalances than adults? a. They have a smaller surface area than adults in proportion to body weight. b. Water needs and losses per kilogram are lower than those for adults. c. A greater percentage of body water in infants is extracellular. d. Infants have a lower metabolic turnover of water.

ANS: C A greater percentage of body water is contained in the extracellular compartment of children under 2 years of age.

The nurse is speaking to the parent of a 3-year-old child who has mild diarrhea. What dietary modification would the nurse advise? a. Soft foods with rice, bananas, toast, and applesauce b. Small amounts of clear fluids such as gelatin c. An oral rehydrating solution, such as Pedialyte d. Chicken soup because it is high in sodium

ANS: C An oral rehydrating solution is recommended to replace fluids and electrolytes lost from frequent bowel movements.

What does the nurse expect the appearance of the stools of a child with celiac disease to be? a. Ribbon like b. Hard, constipated c. Bulky, frothy d. Loose, foul-smelling

ANS: C Celiac disease causes malabsorption. Stools that are large, bulky, and frothy may indicate malabsorption.

A mother reports that her 2-year-old child experiences constipation frequently. Which food would the nurse recommend to include in the child's diet? a. Cooked vegetables b. Pretzels c. Whole-grain cereal d. Yogurt

ANS: C Dietary modifications for constipation include eating more high-roughage foods such as whole-grain breads and cereals.

Parents ask the nurse how their infant developed a Meckel's diverticulum. What condition, will the nurse explain, is present causing this diagnosis? a. The yolk sac remains connected to the intestine. b. There is inflammation of the ileocecal valve. c. A pouch forms when the vitelline duct fails to disappear. d. There is a weakness in the abdominal wall.

ANS: C If the vitelline duct fails to disappear completely after birth, a blind pouch may form.

Why are rapid respirations a possible cause of dehydration? a. They prevent the child from drinking. b. They increase circulation, thus increasing urine production. c. They cause evaporation of fluid on the mucous membranes. d. They often lead to vomiting.

ANS: C Rapid respirations cause increased insensible fluid loss.

The nurse is teaching a parent about pyrvinium (Povan). What would be included in regard to potential side effects? a. Diarrhea b. Skin rash c. Red stool d. Metallic taste

ANS: C The nurse should advise parents that pyrvinium stains clothing and turns stools red.

The nurse is planning a parent education program about lead poisoning prevention. What will be included regarding primary sources of lead in the community? a. Increased lead content of air b. Use of aluminum cookware c. Deteriorating paint in older buildings d. Inhaling smog

ANS: C The primary source of lead is paint from old, deteriorating buildings.

Which statement made by a parent alerts the nurse to the need for additional education about poison prevention? a. "I keep the poison control center phone number easily accessible." b. "All medication is kept out of reach in a locked cabinet." c. "I keep a bottle of syrup of ipecac handy." d. "Our garden is free from marigolds."

ANS: C Traditionally, syrup of ipecac was the treatment of choice to remove some types of poisons from a child's system and parents were advised to keep a supply on hand in the home. However, the American Academy of Pediatrics (AAP) revised this policy in 2003. Parents are now advised to call the poison control center and bring the container of the substance ingested to the hospital emergency department as quickly as possible because stomach lavage is rarely effective 1 hour or more after ingestion. Ipecac syrup should not be kept in the home. Uncontrolled vomiting can cause serious complications.

The nurse is instructing a mother how to administer oral nystatin suspension prescribed to treat thrush. What will the nurse include? a. Pour the prescribed amount into a nipple and have the infant suck the medication. b. Squirt the prescribed dose into the back of the mouth and have the infant swallow. c. Give the medication mixed with a small amount of juice in a bottle. d. Use a sterile applicator to swab the medication on the oral mucosa.

ANS: D An appropriate way to administer nystatin is to moisten a sterile applicator with the medication and then swab it on the inside of the mouth.

A child is brought to the pediatric clinic because he has been vomiting for the past 2 days. What acid-base imbalance would the nurse expect to occur from this persistent vomiting? a. Hyperkalemia b. Hypernatremia c. Acidosis d. Alkalosis

ANS: D Hydrochloric acid and sodium chloride from the stomach are lost from persistent vomiting. This results in alkalosis.

The nurse has reviewed dietary restrictions for celiac disease with concerned parents. Which grain will the nurse explain can be eaten with celiac disease? a. Wheat b. Oats c. Barley d. Rice

ANS: D Rice is a gluten-free grain that can be eaten by children afflicted with celiac disease. These children will have a lifelong restriction of wheat, oats, barley, and rye.

An infant is admitted to the hospital with severe isotonic dehydration. For what is this child at the highest risk? a. Metabolic alkalosis b. Hypocalcemia c. Sepsis d. Shock

ANS: D Shock is the greatest threat to life in isotonic dehydration.

Following surgery for pyloric stenosis, an infant awoke from anesthesia hungry and crying. What is the most appropriate nursing action? a. Delay feeding the child for 6 hours. b. Offer regular formula thinned with water. c. Give small amounts of regular formula thickened with cereal. d. Allow 1 ounce of glucose water at frequent intervals.

ANS: D Small oral feedings of glucose water are given after recovery from anesthesia. Feedings are gradually increased to larger amounts of regular formula.

The nurse is caring for an 18-pound child who has had one stool of diarrhea. The nurse knows that the child needs to consume how many milliliters of oral fluid to make up for the fluid loss? a. 18 b. 36 c. 64 d. 81

ANS: D The formula for oral fluid replacement is 10 mL/kg. 18 pounds = 8.1 kg 10 = 81 mL.

Which nursing interventions will be implemented for the mother of a 10-month-old infant with nonorganic failure to thrive? a. Pointing out errors that the nurse observes when the mother is caring for the infant b. Discussing negative characteristics of the infant with the mother c. Having the nurse provide as much of the infant's care as possible d. Teaching the mother about the developmental milestones to expect in the next few months

ANS: D The nurse can increase parent's knowledge of growth and development by providing anticipatory guidance about normal developmental milestones.