Chp. 26, Pediatric GI dysfunctions
1. What test is used to screen for carbohydrate malabsorption? a. Stool pH b. Urine ketones c. C urea breath test d. ELISA stool assay
A
48. What intervention is contraindicated in a suspected case of appendicitis? a. Enemas b. Palpating the abdomen c. Administration of antibiotics d. Administration of antipyretics for fever
A
5. A 2-year-old child has a chronic history of constipation and is brought to the clinic for evaluation. What should the therapeutic plan initially include? a. Bowel cleansing b. Dietary modification c. Structured toilet training d. Behavior modification
A
9. The nurse is preparing to admit a 10-year-old child with appendicitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Fever b. Vomiting c. Tachycardia d. Flushed face e. Hyperactive bowel sounds
A B C
21. What term describes invagination of one segment of bowel within another? a. Atresia b. Stenosis c. Herniation d. Intussusception
D
33. What should preoperative care of a newborn with an anorectal malformation include? a. Frequent suctioning b. Gastrointestinal decompression c. Feedings with sterile water only d. Supine position with head elevated
B
7. The nurse is caring for a child with celiac disease. The nurse understands that what may precipitate a celiac crisis? (Select all that apply.) a. Exercise b. Infections c. Fluid overload d. Electrolyte depletion e. Emotional disturbance
B D E
25. A child with acute gastrointestinal bleeding is admitted to the hospital. The nurse observes which sign or symptom as an early manifestation of shock? a. Restlessness b. Rapid capillary refill c. Increased temperature d. Increased blood pressure
A
41. What is the purpose in using cimetidine (Tagamet) for gastroesophageal reflux? a. The medication reduces gastric acid secretion. b. The medication neutralizes the acid in the stomach. c. The medication increases the rate of gastric emptying time. d. The medication coats the lining of the stomach and esophagus.
A
11. After surgery yesterday for gastroesophageal reflux, the nurse finds that the infant has somehow removed the nasogastric (NG) tube. What nursing action is most appropriate to perform at this time? a. Notify the practitioner. b. Insert the NG tube so feedings can be given. c. Replace the NG tube to maintain gastric decompression. d. Leave the NG tube out because it has probably been in long enough.
A
19. What information should the nurse include when teaching an adolescent with Crohn disease (CD)? a. How to cope with stress and adjust to chronic illness b. Preparation for surgical treatment and cure of CD c. Nutritional guidance and prevention of constipation d. Prevention of spread of illness to others and principles of high-fiber diet
A
44. An infant with short bowel syndrome will be on total parenteral nutrition (TPN) for an extended period of time. What should the nurse monitor the infant for ? a. Central venous catheter infection, electrolyte losses, and hyperglycemia b. Hypoglycemia, catheter migration, and weight gain c. Venous thrombosis, hyperlipidemia, and constipation d. Catheter damage, red currant jelly stools, and hypoglycemia
A
45. A child is being admitted to the hospital with acute gastroenteritis. The health care provider prescribes an antiemetic. What antiemetic does the nurse anticipate being prescribed? a. Ondansetron (Zofran) b. Promethazine (Phenergan) c. Metoclopramide (Reglan) d. Dimenhydrinate (Dramamine)
A
6. What statement best describes Hirschsprung disease? a. The colon has an aganglionic segment. b. It results in frequent evacuation of solids, liquid, and gas. c. The neonate passes excessive amounts of meconium. d. It results in excessive peristaltic movements within the gastrointestinal tract.
A
3. The school nurse is teaching a group of adolescents about avoiding contaminated water during a mission trip. What should the nurse include in the teaching? (Select all that apply.) a. Ice b. Meats c. Raw vegetables d. Unpeeled fruits e. Carbonated beverages
A B C D
12. The nurse is preparing to admit a 5-year-old child with hepatitis A. What clinical features of hepatitis A should the nurse recognize? (Select all that apply.) a. The onset is rapid. b. Fever occurs early. c. There is usually a pruritic rash. d. Nausea and vomiting are common. e. The mode of transmission is primarily by the parenteral route.
A B D
14. The nurse is preparing to admit a 7-year-old child with Crohn disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Pain is common. b. Weight loss is severe. c. Rectal bleeding is common. d. Diarrhea is moderate to severe. e. Anal and perianal lesions are rare.
A B D
6. The nurse is preparing to admit a 6-year-old child with irritable bowel syndrome (IBS). What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Flatulence b. Constipation c. No urge to defecate d. Absence of abdominal pain e. Feeling of incomplete evacuation of the bowel
A B E
5. The nurse is teaching parents of a child with gastroesophageal reflux (GER) disease foods that can exacerbate acid reflux. What foods should be included in the teaching session? (Select all that apply.) a. Citrus b. Bananas c. Spicy foods d. Peppermint e. Whole wheat bread
A C D
11. The nurse is preparing to admit a 6-month-old child with gastroesophageal reflux disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Spitting up b. Bilious vomiting c. Failure to thrive d. Excessive crying e. Respiratory problems
A C D E
8. The nurse is preparing to admit a 6-year-old child with celiac disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Steatorrhea b. Polycythemia c. Malnutrition d. Melena stools e. Foul-smelling stools
A C E
10. The nurse is preparing to admit a 2-month-old child with hypertrophic pyloric stenosis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Weight loss b. Bilious vomiting c. Abdominal pain d. Projectile vomiting e. The infant is hungry after vomiting
A D E
23. An infant with short bowel syndrome is receiving total parenteral nutrition (TPN). The practitioner has added continuous enteral feedings through a gastrostomy tube. The nurse recognizes this as important for which reason? a. Wean the infant from TPN the next day b. Stimulate adaptation of the small intestine c. Give additional nutrients that cannot be included in the TPN d. Provide parents with hope that the child is close to discharge
B
24. Melena, the passage of black, tarry stools, suggests bleeding from which source? a. The perianal or rectal area b. The upper gastrointestinal (GI) tract c. The lower GI tract d. Hemorrhoids or anal fissures
B
26. What signs or symptoms are most commonly associated with the prodromal phase of acute viral hepatitis? a. Bruising and lethargy b. Anorexia and malaise c. Fatigability and jaundice d. Dark urine and pale stools
B
27. What immunization is recommended for all newborns? a. Hepatitis A vaccine b. Hepatitis B vaccine c. Hepatitis C vaccine d. Hepatitis A, B, and C vaccines
B
28. The nurse is discussing home care with a mother whose 6-year-old child has hepatitis A. What information should the nurse include? a. Advise bed rest until 1 week after the icteric phase. b. Teach infection control measures to family members. c. Inform the mother that the child cannot return to school until 3 weeks after onset of jaundice. d. Reassure the mother that hepatitis A cannot be transmitted to other family members.
B
29. What therapeutic intervention provides the best chance of survival for a child with cirrhosis? a. Nutritional support b. Liver transplantation c. Blood component therapy d. Treatment with corticosteroids
B
35. The parents of a newborn with an umbilical hernia ask about treatment options. The nurse's response should be based on which knowledge? a. Surgery is recommended as soon as possible. b. The defect usually resolves spontaneously by 3 to 5 years of age. c. Aggressive treatment is necessary to reduce its high mortality. d. Taping the abdomen to flatten the protrusion is sometimes helpful.
B
39. A 6-month-old infant with Hirschsprung disease is scheduled for a temporary colostomy. What should postoperative teaching to the parents include? a. Dilating the stoma b. Assessing bowel function c. Limitation of physical activities d. Measures to prevent prolapse of the rectum
B
4. What is a high-fiber food that the nurse should recommend for a child with chronic constipation? a. White rice b. Popcorn c. Fruit juice d. Ripe bananas
B
50. The nurse is evaluating the laboratory results of a stool sample. What is a normal finding? a. The laboratory reports a stool pH of 5.0. b. The laboratory reports a negative guaiac. c. The laboratory reports low levels of enzymes. d. The laboratory reports reducing substances present.
B
7. What procedure is most appropriate for assessment of an abdominal circumference related to a bowel obstruction? a. Measuring the abdomen after feedings b. Marking the point of measurement with a pen c. Measuring the circumference at the symphysis pubis d. Using a new tape measure with each assessment to ensure accuracy
B
8. A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. How should the nurse prepare this child? a. It is unnecessary because of child's age. b. It is essential because it will be an adjustment. c. Preparation is not needed because the colostomy is temporary. d. Preparation is important because the child needs to deal with negative body image.
B
13. The nurse is preparing to admit a 7-year-old child with hepatitis B. What clinical features of hepatitis B should the nurse recognize? (Select all that apply.) a. The onset is rapid. b. Rash is common. c. Jaundice is present d. No carrier state exists. e. The mode of transmission is principally by the parenteral route.
B C E
2. The nurse is preparing to admit a 3-year-old child with intussusception. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Absent bowel sounds b. Passage of red, currant jelly-like stools c. Anorexia d. Tender, distended abdomen e. Hematemesis f. Sudden acute abdominal pain
B D F
1. The nurse is teaching a parent of a 6-month-old infant with gastroesophageal reflux (GER) before discharge. What instructions should the nurse include? (Select all that apply.) a. Elevate the head of the bed in the crib to a 90-degree angle while the infant is sleeping. b. Hold the infant in the prone position after a feeding. c. Discontinue breastfeeding so that a formula and rice cereal mixture can be used. d. The infant will require the Nissen fundoplication after 1 year of age. e. Prescribed cimetidine (Tagamet) should be given 30 minutes before feedings.
B E
10. A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. What recommendation should the nurse include in teaching this parent? a. Surgical therapy is indicated. b. Place in prone position for sleep after feeding. c. Thicken feedings and enlarge the nipple hole. d. Reduce the frequency of feeding by encouraging larger volumes of formula.
C
14. When caring for a child with probable appendicitis, the nurse should be alert to recognize which sign or symptom as a manifestation of perforation? a. Anorexia b. Bradycardia c. Sudden relief from pain d. Decreased abdominal distention
C
15. The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. What intervention is appropriate to relieve the abdominal discomfort during the evaluation? a. Place in the Trendelenburg position. b. Apply moist heat to the abdomen. c. Allow the child to assume a position of comfort. d. Administer a saline enema to cleanse the bowel.
C
22. A school-age child with celiac disease asks for guidance about snacks that will not exacerbate the disease. What snack should the nurse suggest? a. Pizza b. Pretzels c. Popcorn d. Oatmeal cookies
C
3. The mother of a child with cognitive impairment calls the nurse because her son has been gagging and drooling all morning. The nurse suspects foreign body ingestion. What physiologic occurrence is most likely responsible for the presenting signs? a. Gastrointestinal perforation may have occurred. b. The object may have been aspirated. c. The object may be lodged in the esophagus. d. The object may be embedded in stomach wall.
C
30. The nurse observes that a newborn is having problems after birth. What should indicate a tracheoesophageal fistula? a. Jitteriness b. Meconium ileus c. Excessive frothy saliva d. Increased need for sleep
C
31. The nurse is caring for a neonate with a suspected tracheoesophageal fistula. What should nursing care include? a. Feed glucose water only. b. Elevate the patient's head for feedings. c. Raise the patient's head and give nothing by mouth. d. Avoid suctioning unless the infant is cyanotic.
C
32. The nurse is caring for an infant who had surgical repair of a tracheoesophageal fistula 24 hours ago. Gastrostomy feedings have not been started. What do nursing actions related to the gastrostomy tube include? a. Keep the tube clamped. b. Suction the tube as needed. c. Leave the tube open to gravity drainage. d. Lower the tube to a point below the level of the stomach.
C
36. The nurse is preparing to care for a newborn with an omphalocele. The nurse should understand that care of the infant should include what intervention? a. Initiating breast- or bottle-feedings to stabilize the blood glucose level b. Maintaining pain management with an intravenous opioid c. Covering the intact bowel with a nonadherent dressing to prevent injury d. Performing immediate surgery
C
37. What should the nurse consider when providing support to a family whose infant has just been diagnosed with biliary atresia? a. The prognosis for full recovery is excellent. b. Death usually occurs by 6 months of age. c. Liver transplantation may be needed eventually. d. Children with surgical correction live normal lives.
C
38. A 3-day-old infant presents with abdominal distention, is vomiting, and has not passed any meconium stools. What disease should the nurse suspect? a. Pyloric stenosis b. Intussusception c. Hirschsprung disease d. Celiac disease
C
43. The nurse is assisting a child with celiac disease to select foods from a menu. What foods should the nurse suggest? a. Hamburger on a bun b. Spaghetti with meat sauce c. Corn on the cob with butter d. Peanut butter and crackers
C
47. An infant had a gastrostomy tube placed for feedings after a Nissen fundoplication and bolus feedings are initiated. Between feedings while the tube is clamped, the infant becomes irritable, and there is evidence of cramping. What action should the nurse implement? a. Burp the infant. b. Withhold the next feeding. c. Vent the gastrostomy tube. d. Notify the health care provider.
C
49. The nurse is caring for a child with Meckel diverticulum. What type of stool does the nurse expect to observe? a. Steatorrhea b. Clay colored c. Currant jelly-like d. Loose stools with undigested food
C
9. A child has a nasogastric (NG) tube after surgery for Hirschsprung disease. What is the purpose of the NG tube? a. Prevent spread of infection. b. Monitor electrolyte balance. c. Prevent abdominal distention. d. Maintain accurate record of output.
C
4. The nurse is teaching parents about high-fiber foods that can prevent constipation. What foods should the nurse include in the teaching? (Select all that apply.) a. Oranges b. Bananas c. Lima beans d. Baked beans e. Raisin bran cereal
C D E
13. What clinical manifestation should be the most suggestive of acute appendicitis? a. Rebound tenderness b. Bright red or dark red rectal bleeding c. Abdominal pain that is relieved by eating d. Colicky, cramping, abdominal pain around the umbilicus
D
20. A child with pyloric stenosis is having excessive vomiting. The nurse should assess for what potential complication? a. Hyperkalemia b. Hyperchloremia c. Metabolic acidosis d. Metabolic alkalosis
D
34. A child who has just had definitive repair of a high rectal malformation is to be discharged. What should the nurse address in the discharge preparation of this family? a. Safe administration of daily enemas b. Necessity of firm stools to keep suture line clean c. Bowel training beginning as soon as the child returns home d. Changes in stooling patterns to report to the practitioner
D
40. An infant is born with a gastroschisis. Care preoperatively should include which priority intervention? a. Prone position b. Sterile water feedings c. Monitoring serum laboratory electrolytes d. Covering the defect with a sterile bowel bag
D
42. A health care provider prescribes feedings of 1 to 2 oz Pedialyte every 3 hours and to advance to 1/2 strength Similac with iron as tolerated postoperatively for an infant who had a pyloromyotomy. The nurse should decide to advance the feeding if which occurs? a. The infant's IV line has infiltrated. b. The infant has not voided since surgery. c. The infant's mother states the infant is tolerating the feeding okay. d. The infant is taking the Pedialyte without vomiting or distention.
D
46. The nurse should instruct parents to administer a daily proton pump inhibitor to their child with gastroesophageal reflux at which time? a. Bedtime b. With a meal c. Midmorning d. 30 minutes before breakfast
D
16. What statement is most descriptive of Meckel diverticulum? a. It is acquired during childhood. b. Intestinal bleeding may be mild or profuse. c. It occurs more frequently in females than in males. d. Medical interventions are usually sufficient to treat the problem.
B
17. One of the major differences in clinical presentation between Crohn disease (CD) and ulcerative colitis (UC) is that UC is more likely to cause which clinical manifestation? a. Pain b. Rectal bleeding c. Perianal lesions d. Growth retardation
B
18. Nutritional management of the child with Crohn disease includes a diet that has which component? a. High fiber b. Increased protein c. Reduced calories d. Herbal supplements
B
12. An adolescent with irritable bowel syndrome comes to see the school nurse. What information should the nurse share with the adolescent? a. A low-fiber diet is required. b. Stress management may be helpful. c. Milk products are a contributing factor. d. Pantoprazole (a proton pump inhibitor) is effective in treatment.
B
2. A toddler's mother calls the nurse because she thinks her son has swallowed a button type of battery. He has no signs of respiratory distress. The nurse's response should be based on which premise? a. An emergency laparotomy is very likely. b. The location needs to be confirmed by radiographic examination. c. Surgery will be necessary if the battery has not passed in the stool in 48 hours. d. Careful observation is essential because an ingested battery cannot be accurately detected.
B