Gastrointestinal Disorders of the Child NCLEX
The mother of a child diagnosed with oral candidiasis calls the child's pediatric care office. The mother tells the nurse that the child is taking Mycostatin and Flucanozole and has vomited 10 minutes ago. Which initial statement by the nurse is best? 1) Your child need to be seen in the clinic immediately. Please let me make you an appointment. 2) When was the last time your child received his medications? 3) What did your child eat for breakfast this morning? 4) Are you breastfeeding?
Answer: 2) Flucanozole can cause nausea and vomiting if not taken with meals, so the nurse should initially ask when the child last received this medication. Then, the nurse should inquire when the child last ate. The child may need to be seen in the clinic, but the nurse should assess the situation further first.
A group of student nurses are reviewing nursing diagnoses for cleft lip and cleft palate. The students recognize which of the following as priority nursing diagnosis for children with cleft lip and cleft palate? 1) Ineffective bonding related to inability to maintain effective mother-child feeding habits 2) Altered nutrition: less than body requirements related to excessive feeding time and child fatigue 3) Risk for altered self perception related to nasal quality of speech and delays in speech development 4) Risk for infection related to build-up of fluid in the middle ear and chronic otitis media
Answer: 2) Our biggest concerns in a child with cleft lip and cleft palate are nutrition (including the risk for aspiration/choking) and bonding. However, nutrition trumps bonding.
After 12 hours of labor, a G1P1 mother has just given birth to an infant with omphalocele. Which action should the nurse take first? 1) Place the infant in a radiant warmer 2) Establish an IV site in preparation for fluid and antibiotic administration 3) Cover the abdominal organs with a non-adherent sterile dressing. 4) Insert an orogastric tube and maintain low suction.
Answer: 3) Initially, the organs and/or sac need to be protected from rupture and infection, so a sterile dressing must be applied immediately. This also helps prevent further fluid losses. Next, the child should be placed in a radiant warmer to prevent hypothermia, which is a huge risk here. The nurse can then assess the child further, establish an IV site, and insert an orogastric tube.
When discussing with the child's mother the recommended diet for a child who is experiencing diarrhea, which teaching point made by the nurse is incorrect? 1) Avoid fruit juice and gelatin, because these are high in glucose. 2) We want your child to get back to his regular diet as quickly as possible. 3) We recommend the BRAT diet for children until they can resume their regular diet. 4) We really like to avoid the use of clear liquids in a child with diarrhea.
Answer: 3) The BRAT diet is not recommended anymore. See page 721.
Eight hours after a child undergoes a stool diversion, the nurse is providing education to the child's parents about caring for the ostomy. Which statement by the child's parents indicates the need for further teaching? 1) "We will keep the pouch tucked inside our baby's diaper." 2) "We will ensure our baby doesn't wear anything too tight around the site where his stool comes out." 3) "We will use a powder that will help protect our baby's skin around his stoma site." 4) "Some days our baby may produce more stool than on other days."
Answer: 4) The healthcare provider needs to be notified if the baby's stool output is greatly increased, if the stoma is prolapsed or retracted or any color but pink/red, if the stoma is dry, or if the child is producing less stool than normal. See page 707.
The nurse understands that the young child is at a greater risk of developing fluid loss than an adult because of which of the following? Select all that apply: A) Greater body surface area B) Thinner skin C) Renal immaturity D) Higher likelihood of febrile illness E) Higher basic metabolic rate
Answer: A, C, D, and E. (pages 695-696)
You are taking care of an infant who has come back from having cleft lip and palate repair. The nurse would include all of the following in the plan of care except: A) Use of pacifier to prevent vigorous crying B) Holding, cuddling and rocking of infant C) Arm restraints or mummy restraint D) Placing infant in the supine position
Answer: A. It would be important to protect the palate operative site by avoiding putting items in the mouth that might disrupt the sutures such as suction catheters, spoons, straws, pacifiers, or plastic syringes. It would be important to keep the infant from rubbing the surgical sight. To prevent this the infant will be placed in the supine or side-lying position and arm restraints are often used. Holding, cuddling and rocking the infant can help soothe and comfort the infant after surgery.
You are the awesome nursing teacher with a huge class of 80 students. Yikes. Anyway, in pediatric clinical, you ask the students to differentiate omphalocele and gastroschisis. Which statement, if made by a student, indicates that they were smart and knew the right answer? A) The contents of the omphacele contain organs such as the bladder and uterus while gastroschisis contains pieces of the digestive tract B) With omphacele, the organs are covered with a protective sheath while with gastroschisis the organs protruding from the abdomen are exposed completely. C) In gastroschisis, parts of the intestines protrude through in a sac from the umbilicus while in omphacele, they can protrude from anywhere in the abdominal wall. D) Both disorders consist of portions of the digestive tract protruding out of a dysfunctional abdominal wall, gastroschisis also contains portions of the biliary tract
Answer: B. See page 711.
A mother and 7 month old infant present to the pediatric clinic. The infant appears developmentally appropriate and healthy, but the mother tells you that she is exacerbated. She says yesterday her infant had been incessantly crying with vomiting and jelly-like stool. But now, the infant appears fine. Which of the following GI disorders does the nurse suspect? A) Hypertrophic pyloric stenosis B) Celiac's disease C) Intussusception D) Encopresis
Answer: C. Intussusception is when a proximal portion of the bowel "telescopes" into a more distal portion. This produces sudden onset, crampy abdominal pain accompanied by currant jelly stools, vomiting, crying/knee drawing up, and lethargy. This disorder is episodic and often the bowel will suddenly reduce down temporarily eliminating symptoms.
A mother and 7 month old infant present to the pediatric clinic. The infant appears developmentally appropriate and healthy, but the mother tells you that she is exacerbated. She says yesterday her infant had been incessantly crying with vomiting and jelly-like stool. But now is fine. What is the nurse's first action? A) Determine prenatal status of the mother and child B) Prepare the child for immediate surgery C) Palpate the stomach for a mass D) Administer barium enema
Answer: C. Page 725. ADPIE. The nurse would further assess the child. The nurse suspects this child to possibly have intussusception. A "sausage-like" mass in the upper mid-abdomen is a hallmark sign of intussusception. It may not be present at this time, but it would be important to assess for this finding. A barium enema is often used to treat this disorder. Surgery can also be used. The prenatal status of the mother/child would not be a priority assessment.
When planning care for the infant diagnosed with cleft lip and palate, which action would the nurse take in relation to the priority nursing diagnosis for this child? A) Prevent the baby from vigorously crying B) Burp the baby well throughout feedings C) Temporarily refrain from having the baby breastfeed D) Encourage mother to use false palate covering when feeding baby
Answer: D. A false palate covering will help prevent the baby from aspirating while breastfeeding by providing a covering for the cleft palate. Adaptive nipples can also be used for this purpose. Burping the baby would be important to include in the plan of care, but would not be for the priority nursing diagnosis of risk for aspiration. It would not be necessary to have the baby refrain from breastfeeding. Preventing the baby from vigorously crying would be important postoperatively to prevent sutures from ripping.
A nurse working at a children's hospital receives report on four patients who were just admitted to the unit within the past hour. Which nurse should the nurse assess first? 1) A 9-month-old infant who has been vomiting for the past 12 hours who has a fever of 100.3. 2) A 4-month-old who is resting quietly right now with reports of jelly-like stools and severe pain for the past 6 hours. 3) A 2-year-old who with a fractured femur who was medicated 30 minutes ago for pain. 4) A 3-month-old who has passed runny stools frequently overnight with sunken anterior and posterior fontanelles.
2) Jelly-like stools and severe pain indicate intussusception, and this is a medical emergency. Afterwards, the nurse should assess the child with sunken fontanelles, as this indicates severe dehydration.
The nurse is caring for the child with cleft lip and palate. Which of the following does the nurse understand as a complication of this disorder? Select all that apply: A) Heart malformation B) Otitis media C) Altered dentation D) Speech impediments E) Encopresis
Answer: B, C, and D. These are complications that can occur with cleft lip and palate. Others include feeding difficulties, aspiration, and hearing loss (related to ear infections). Page 707.
A pediatric nurse is assessing a 2-month-old child who has been vomiting for the past 48 hours with accompanying fever of 100.7. The nurse recognizes that which of the following does not represent dehydration in an infant? 1) 3-5 wet diapers a day for the past 2 days 2) Lack of tears when crying 3) Puffiness of the skin 4) Pale oral mucosa
Answer: 3) Tenting of the skin may be seen in a child who is dehydrated. The oral mucosa should be pink and moist, tears should be present when the 2-month-old cries, and a 2-month-old should produce 6-8 wet diapers daily.
Which of the following assessment findings would the nurse most expect to find in the child who has been diagnosed with having hypertrophic pyloric stenosis? A) Currant jelly stools and a palpable, hard mass in the right upper quadrant B) Projectile vomiting and hunger soon afterwards C) Weight loss and bloody diarrhea D) Severe, crampy abdominal pain and lethargy
Answer: B. Pyloric stenosis is where the pylorus becomes edematous and large blocking the entrance out of the stomach. Projectile (forceful vomiting) and hunger afterwards would be expected in pyloric stenosis, as all nutrition is being blocked from heading into the small intestine. Other symptoms include a palpable mass in the right upper quadrant, weight loss, dehydration, and lethargy. Currant jelly stools and diarrhea would not be expected with this disorder because of the blockage created.