Exam 3 (145) Maternal/Newborn

Children with failure to thrive fall below the _________ percentile in weight and height on growth charts.

3rd

A newborn's total body weight is about ________ water. -77% -60% -55% -45%

77%

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 mL's of oral fluid to make up for the fluid loss? -18 -36 -64 -81

81 10mL/kg=formula for oral fluid replacement

Why are infants more vulnerable to fluid and electrolyte imbalances than adults? -they have a smaller surface area than adults in proportion to body weight -water needs and losses per kilogram are lower than those for adults -a greater percentage of body water in infants is extracellular -infants have a lower metabolic turnover of water

A greater percentage of body water in infants is extracellular

Parents ask the nurse how their infant developed a Meckels diverticulum. What condition, will the nurse explain, is present causing this diagnosis? -the yolk sac remains connected to the intestine -there is inflammation of the illeocecal valve -a pouch forms when the vitelline duct fails to disappear -there is weakness in the abdominal wall

A pouch forms when the vitelline duct fails to disappear

Which statement by a mother may indicate a cause of her sons vitamin C deficiency? -we get our fruits from homemade preserves -we use milk from our own goats -we grow all our own veggies -we're not big meat eaters

We get all our fruits from homemade preserves

The nurse is teaching a parent about pyrvinium (Povan). What would be included in regard to potential side effects? -diarrhea -skin rash -red stool -metallic taste

Red stool

Signs and symptoms of dehydration in the infant with diarrhea include:

Sunken eyes and fontanelle Dry skin Dry tongue and mucous membranes Decreased urination

Describe assessment findings in a newborn who has pyloric stenosis

Sunken fontanelle, in elastic or "tenting" skin, reduced urine output, signs of malnutrition

Which finding in a newborn is suggestive of tracheoesophageal fistula? -failure to pass meconium in 24 hours -choking on the first feeding -palpable mass in the sternum area -visible peristalsis across abdomen

Choking on the first feeding

Herniorrhaphy

Surgical repair of a hernia

What description of a child's stool characteristics leads the nurse to suspect intussusception? -currant jelly -black and tarry -green liquid -greasy and foul-smelling

Currant jelly

Children with intussusception may have bowel movements containing blood and mucus and no feces. These are called....

Currant jelly stools

Persistent vomiting can result in _____________, and ___________. _______________.

Dehydration and electrolyte imbalance

Hirschsprung's disease is treated ________________. It may be necessary for the infant to have a _____________ temporarily.

Surgically, colostomy

Dehydration

A complication of the vomiting associated with pyloric stenosis

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

They cause evaporation of fluid on the mucous membranes

What sign(s) indicate(s) moderate dehydration? (SATA) -10% weight loss -dry mucous membranes -normal anterior fontanelle -increased urinary output -lethargy

10% weight loss, dry mucous membrane, normal anterior fontanelle

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

2-month-old with a urine output of 150 ml in 24 hours Should be between 400-500mL/25hrs

The earliest sign of Hirschsprung's disease is failure to pass meconium stools within ____ to _____ bourse after birth

24 to 48

What is the treatment of choice for a child with intussusception? -a barium enema -immediate surgery -IV fluids until the spasms subside -gastric lavage

A barium enema

When a child has pinworms, the nurse should know that: -a warm stool specimen must be sent to the lab -the child will be hospitalized for the duration of infection -any family member with symptoms should be treated -any pregnant household member must be treated with mebendazole

Any family member with symptoms should be treated

The decreased incidence of rickets in the world is attributed to _________. _____________ and ____________ _. ____________ ____________.

Vitamin supplements and vitamin D fortified foods

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? -hyperkalemia -hypernatremia -acidosis -alkalosis

Alkalosis

Following surgery for pyloric stenosis, an infant awoke from anesthesia hungry and crying. What is the most appropriate nursing action? -delay feeding the child for 6 hours -offer regular formula thinned with water -give small amounts of regular formula thickened with cereal -allow 1 ounce of glucose water at frequent intervals

Allow 1 ounce of glucose water at frequent intervals

Pyloric stenosis

An obstruction at the lower end of the stomach caused by an overgrowth (hypertrophy) of the circular muscles of the pylorus or by spasms of sphincters

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

An oral rehydrating solution, such as pedialyte

The infant with tracheoesophageal fistula will _____________ and ____________ when the first feeding is given

Vomit, choke

Projectile vomiting

Vomiting in which the stomach contents are forcibly ejected

Treatment of choice for intussusception is reduction through the use of a...

Barium enema

What would the nurse expect to find in a child admitted to the hospital for nonorganic failure to thrive? -cry to be picked up -be limp like a rag doll -be responsive to cuddling -weigh in the 10th percentile for age

Be limp like a rag doll

What interventions will the nurse perform when feeding a child with pyloric stenosis? (SATA) -give a formula thinned with water -burp the infant before and during feeding -give the feeding slowly -refeed if the infant vomits -position infant on left side after feeding

Burp the infant before and during feeding, give the feeding slowly, refeed if the infant vomits

List four signs of rickets

Bowlegs Knock knees Beading of the ribs Improper formation of teeth

What does the nurse expect the appearance of stools of a child with celiac disease to be? -ribbon-like -hard, constipated -bulky, frothy -loose, foul-smelling

Bulky, frothy

The nurse explains that because ________________ beverages cause diuresis, they are not good choices for fluid replacement in a child who is dehydrated.

Caffeinated

The nurse reminds parents of a child allergic to cows milk that they should avoid foods that list __________ as part of their contents.

Casein

Incarceration

Constriction or irreducibility

The nurse explains that rickets, a deficiency disease that causes bony deformities, is caused by the inadequate supply of vitamin ____.

D

Which statement made by a patient alerts the nurse to the need for additional education about poison prevention? -I keep the poison control center phone number easily accessible -all medication is kept out of reach in a locked cabinet -I keep a bottle of syrup of ipecac handy -our garden is free from marigolds

I keep a bottle of syrup of ipecac handy

The nurse is planning a parent education program about lead poisoning prevention. What will be included regarding primary sources of lead in the community? -increased lead content of air -use of aluminum cookware -deteriorating paint in older buildings -inhaling smog

Deteriorating paint in older buildings

Pica

Eating non food items

Which approach might best support maternal attachment when caring for a child with failure to thrive? -point out areas where the mother needs improvement -send the mother to a parenting class -encourage the mother to participate in the child's care -leave the room when the mother visits

Encourage the mother to participate in the child's care

Which diagnostic test permits visualization of the upper GI tract?

Endoscopy

Which action should the nurse take before adding potassium to a child's IV? -take a baseline blood pressure -determine if the child can tolerate oral fluids -establish that the child is voiding -place the child on a cardiac monitor

Establish that the child is voiding

In children younger than age 2 years, a greater percentage of body water is contained in the ______________ compartment

Extracellular

Failure to thrive

Fail to gain and often lose weight without an obvious cause

The nurse doing a newborn assessment knows the earliest sign of Hirschsprung's disease is: -failure to pass meconium -large, bulky, and frothy stools -acute, sudden diarrhea -ribbon-like stools

Failure to pass meconium

The priority goal of nursing care for the infant with gastroenteritis is preventing or correcting.........

Fluid and electrolyte imbalance

List four or more common tests used to diagnose GI disorders

GI series Barium enema Flat plate of the abdomen CBC with differential Sigmoidoscopy Endoscopy Colonoscopy Ultrasonography Liver blood tests and biopsy Malabsorption tests ESR Stool culture Rectal biopsy

Shock (hypovolemia)

Greatest threat to life in isotonic dehydration

A child appears apathetic and weak. His growth is below normal for his age. There is a white streak in the child's hair. The nurse recognizes these signs as characteristic of.....

Kwashiorkor

A child is brought into the ED with suspected appendicitis. What signs and symptoms does the nurse expect to assess? -left lower quadrant pain -guarding -rebound tenderness -decreased C-reactive protein -pain on lifting thigh when supine

Guarding, rebound tenderness, pain on lifting thigh when supine

Hernias are successfully repaired by the surgical operation called a ____________.

Herniaorrphaphy

The greatest threat to life in isotonic dehydration is: -hypervolemic shock -hypovolemic shock -decreased K levels -clammy mucous membranes

Hypovolemic shock

Lead poisoning can have a lasting effect on the _________ system.

Nervous

A frightened mother calls the pediatricians office because her child swallowed dishwashing detergent. What is the most appropriate action? -induce vomitting by giving the child syrup of ipecac -take the child to the local ER -give the child activated charcoal mixed with juice -give the child milk to soothe affected mucous membranes

Take the child to the local ER

What is the most common sign of pinworms?

Itching of the anal area

Which signs and symptoms are characteristic of pinworms? -diarrhea, itching, and fever -nausea, vomiting, and itching -nausea, vomiting, and weight loss -itching, irritability, and restlessness

Itching, irritability, and restlessness

What instruction will the nurse give to parents about preventing the spread and reinfection of pinworms? -keep children's nails short -dress child in loose-fitting underwear -clean the bathroom with bleach solution -wash bed linens in cold water

Keep children's nails short

Stools of the child with celiac disease are _____________, _________, and ______________

Large, bulky, and frothy

Plumbism

Lead poisoning

The nurse should explain to parents that infants are more susceptible to accidental ingestion of foreign bodies because they are -often left unattended -likely to put everything in their mouths -constantly hungry -seeking parental attention

Likely to put everything in their mouths

An overdose of acetaminophen can result in _______ damage.

Liver

The organ damaged by acetaminophen poising is the....

Liver

Isotonic

Loss of equal amounts of water and electrolytes

Hypotonic

Loss of more electrolytes than water

Hypertonic

Loss of more water than electrolytes

Identify at least three nursing interventions for an infant hospitalized for gastroenteritis

Maintain a record of I/O Skin care and frequent diaper changes to prevent excoriation Daily weight Keep infant warm Assess hydration status Maintain enteric precautions

Celiac disease is the leading _____________ problem in children.

Malabsorption

Describe the treatment of pinworms

Mebendazole (Vermox) is a single dose chewable tablet and is the drug of choice for children older than age 2. The child must be taught good hand washing, especially after bowel movements. Fingernails are kept short and a soothing ointment can be applied to the rectum

Name and describe the most common congenital malformation of the GI tract

Meckel's diverticulum, a blind pouch of intestine formed in prenatal life if the vitelline duct fails to fully close

A child's arterial blood gas results are: pH 7.30, PaCO2 36, HCO3 21. The nurse determines the child is experiencing which acid-base imbalance?

Metabolic acidosis

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? -metabolic acidosis -metabolic alkalosis -respiratory acidosis -respiratory alkalosis

Metabolic acidosis

pH 7.32. PaCO2 37. HCO3 20. Is an example of what acid-base imbalance?

Metabolic acidosis

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

My child often goes out to the garden and pulls up a carrot to eat

A child is brought to the ER because he ingested an unknown quality of acetaminophen (Tylenol). What does the nurse expect this child to receive following gastric lavage? -activated charcoal -N-acetylcysteine -vitamin K -syrup of ipecac

N-acetylcysteine

Describe the initial onset of intussusception and infant behaviors

Onset is sudden. The infant feels severe pain in the abdomen, cries loudly, strains with effort, kicks, and draws legs up to the abdomen. Initial intervals of comfort shorten. Child vomits. Bowel movements diminish and bowel movements of blood and mucus that contain no feces are common about 12 hours after onset of the obstruction.

Pyloromyotomy

Operation to correct pyloric stenosis

A 6 year old child has mild diarrhea. How would the nurse advise the child's parents about fluid and food intake?

Oral rehydrating solutions such as Pedilyte or Infalyte with a gradual introduction of a soft, bland diet. Resume regular diet within 2-3 days

The primary source of lead poisoning is _________

Paint

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? -pinworms -giardiasis -ringworm -roundworm

Pinworms

Which information would the nurse give to parents of an infant with gastroesophageal reflux disease? -feed the infant half-strength formula -position in an infant seat after feeding -increase the time between feedings -place in upright prone position after feeding

Place in upright prone position after feeding

Which is the most appropriate intervention for a 3-month-old infant who has gastroesophageal reflux? -position the infant in the crib on his or her abdomen, with the head of the bed elevated -administer medication as ordered to stimulate the pyloric sphincter -give thin rice cereal with formula before feeding solid foods -place the infant in an infant seat after feedings

Position the infant in the crib on his or her abdomen, with the head of the bed elevated

A 7-month-old infant is admitted to the hospital with a diagnosis of acute gastroenteritis. What will be the nurses priority goal of the infants care? -prevent fluid and electrolyte imbalance -prevent nutritional deficiency -prevent skin breakdown -prevent malabsorption

Prevent fluid and electrolyte imbalance

The nurse is interviewing parents of an infant with pyloric stenosis. What would the nurse expect to report? -diarrhea -projectile vomiting -poor appetite -constipation

Projectile vomiting

The nurse taking a history from parents of an infant with pyloric stenosis would expect them to report the infant experienced which sign? -constipation -projectile vomiting -diarrhea -anorexia

Projectile vomiting

Kwashiorkor results from a severe deficiency of _____________ in the child's diet

Protein

Inguinal hernia

Protrusion of part of the intestine through the umbilical ring

The goals in the treatment of poisoning are:

Remove the poison Prevent further absorption Call poison control center Provide supportive care and seek medical help

pH 7.48. PaCO2 33. HCO3 24. Is an example of what acid-base imbalance?

Respiratory alkalosis

Describe gastroesophageal reflux

Results when the lower esophageal sphincter is relaxed or not competent, which allows stomach contents to be easily regurgitated into the esophagus.

What asessment(s) would lead a nurse to suspect Hirschsprung's disease in a 1-month-old infant? (SATA) -ribbon-like stools -fever -failure to thrive -vomiting -diminished peristalsis

Ribbon-like stools, fever, failure to thrive, vomiting, diminished peristalsis (all of the above)

The nurse has reviewed dietary restrictions for celiac disease with concerned parents. Which grain will the nurse explain can be eaten with celiac disease? -wheat -oats -barley -rice

Rice

To prevent aspiration of vomitus after feeding, an infant should be placed in what position?

Right side-lying

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

Seven

An infant is admitted to the hospital with severe isotonic dehydration. For what is this child at the highest risk? -metabolic alkalosis -hypocalcemia -sepsis -shock

Shock

Describe the progression of feeding an infant after postoperative correction of pyloric stenosis

Small amounts of glucose water that gradually increase until a regular formula can be taken and retained, over feeding is avoided

Homeostasis

State of equilibrium in the body

Which nursing interventions will be implemented for the mother of a 10-month-old infant with nonorganic failure to thrive? -pointing out errors that the nurse observes when the mother is caring for the infant -discussing negative characteristics of the infant with the mother -having the nurse provide as much of the infants care as possible -teaching the mother about the developmental milestones to expect in the next few months

Teaching the mother about the developmental milestones to expect in the next few months

How is nystatin (mycostatin) applied to the mouth of a child with thrush?

The mouth is swabbed 3 or 4 times per day between feedings with sterile applicator moistened with prescribed solution

What would be included in the nurse's documentation for a child who is vomiting?

Time Amount Color Consistency Force Frequency Whether proceeded by nausea or feeding

A nurse is giving a newborn her first feeding when the baby starts coughing and choking. This is indicative of which condition?

Tracheoesophageal atresia

After a feeding, an infant with gastoesophageal reflux should be placed in which position?

Upright prone position or propped on the left side

The nurse is instructing a mother how to administer oral nystatin suspension prescribed to treat thrush. What will the nurse include? -pour the prescribed amount into a nipple and have the infant such the medication -squirt the prescribed does into the back of the mouth and have the infant swallow -give the medication mixed with a small amount of juice in a bottle -use a sterile applicator to swab the medication on the oral mucosa

Use a sterile applicator to swab the medication on the oral mucosa

Scurvy results from a deficiency of foods containing __________ ___ in the diet. To prevent scurvy, the nurse would encourage patents to include __________, ______, and _________ __________ in the child's diet.

Vitamin C, citrus, raw, and leafy greens

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? -weight loss of 4 ounces -dry mucous membranes -decreased skin turgor -depressed fontanelle

Weight loss of 4 ounces

Gluten is found in __________, _____________, ____________, and _______

Wheat, barley, oats, and rye

Parents have adopted a child with the diagnosis fo kwashiorkor. What is most likely to be observed when assessing this child? -hyperactivity -white streak in hair -edematous abdomen -slowed growth -thick,oily hair

White streak in hair, edematous abdomen, slowed growth

Name three high-fiber foods to recommend to an older child who is experiencing constipation

Whole grain breads Raw veggies and fruits Bran Popcorn

A mother reports that her 2-year-old child experiences constipation frequently. Which food would the nurse recommend to include in the child diet? -cooked vegetables -pretzels -whole-grain cereal -yogurt

Whole-grain cereals

The nurse, assessing an elevated erythrocyte sedimentation rate (ESR) for an infant with gastroenteritis, recognizes that this confirms the _______________ process that is part of this disease.

inflammatory