GI/ GU Alterations CH 42 and 43 (E2)
Why should the infant's with cleft lip or palate respiratory status be continuously assessed?
Aspiration
What are the most common causes of prerenal in children?
Persistent vomiting and diarrhea
Intrinsic renal
Related to diseases and nephrotoxins that damage the glomeruli, tubules, or renal vasculature
Hemodialysis
Removes toxins and excess fluid from the blood by pumping the child's blood through a machine and then re-infusing the blood into the child
How is thrush treated?
-Oral antifungal agents (Mycostatin suspension)
What topics should be educated about after surgery to fix Hirschsprung's disease?
-Ostomy care -Wound care -S/S of infection -S/S of dehydration
What are the common clinical manifestations of meckel diverticulum?
-Pain -Bloody stools -Anemia
What does treatment for chronic renal failure include?
-Restrict potassium and sodium -Growth hormones
What are the signs and symptoms of infants with GER?
-Vomiting or spitting up after a meal -Weight loss -Failure to thrive -Irritability -Blood in vomit -Respiratory issues
Malnutrition, Kwashiorkor
A malnutrition disease, chiefly of children caused by severe protein and vitamin deficiency and characterized by retarded growth, changes in pigmentation, potbelly, and anemia
A physical exam showing meckel diverticulum will reveal what?
-Abdominal distention -Hypoactive bowel sounds -Abdominal mass -Guarding -Rebound tenderness
What are the clinical manifestations of the child with a UTI?
-Abdominal or suprapubic pain -Voiding frequency -Voiding urgency -Dysuria -New or increased incidence of enuresis -Fever -Vomiting
Medications for short bowel syndrome include what?
-Antibiotics to control bacterial overgrowth -Vitamin and mineral supplementation to replace lost vitamins -Antidiarrheal agents to decrease stool output -TPN for adequate growth
What are the 3 C's of TEF/Atresia?
-Coughing -Choking -Cyanosis
What are common complications of cleft lip and palate?
-Ear infections and hearing loss -Speech and language problems -Teeth may not erupt normally
The keys to prevention of long-term sequelae such as hypertension in children with urologic conditions are what?
-Early diagnosis and intervention -Prevention of infection -Close clinical follow-up
After hypertrophic pyloric stenosis surgery, parents should be taught to report what?
-Excessive vomiting -Abdominal tenderness -Fever -Incisional redness -Drainage
What are clinical manifestations of vesicoureteral reflux?
-Fever -Dysuria -Frequency or urgency -Nocturia -Hematuria -Back, abdomen, or flank pain
What are the clinical manifestations of the infant with a UTI?
-Fever -Irritability -Vomiting -Poor weight gain/ Failure to thrive -Jaundice
Oral Candidiasis (Thrush)
-Fungal infection in the mouth -Thick white patches that do not scrape off
What are the signs and symptoms of a child with GER?
-Heartburn -Discomfort and abdominal pain -Difficulty swallowing -Chronic cough -Non cardiac chest pain
What does renal failure result in?
-Hypertension -Electrolyte imbalances (low calcium, high potassium) -Fluid imbances -Elevated BUN and creatinine -Acid/base imbalances -Poor feeding -Vomiting -Lethargy -Seizures -Pallor
Prerenal
-Most common cause in children -Related to a reduction in renal perfusion in a normal kidney
After cleft lip repair, what should the suture line be cleaned with?
-Normal saline -Water -Diluted peroxide
What is the average age a child develops appendicitis?
10 years old
What is a newborn's stomach capacity?
10-20 mL
At what age is cleft lip usually repaired?
2-3 months
90% of all umbilical hernias close by what age?
5 years old
At what age is cleft palate usually repaired?
6-9 months
A 3-month-old infant presents with a history of vomiting after feeding. The plan for the infant is to rule out GER. What information from the history would lead the nurse to believe that this infant may need further intervention? A) Poor weight gain B) Small "spits" after feeding C) Sleeps through the night D) Difficult to burp
A
A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition? A) Barium enema B) Surgery C) Endoscopic retrograde cholangiopancreatography D) Upper endoscopy
A
A nurse is caring for a preschooler who has nephrotic syndrome. Which of the following findings should the nurse report to the provider? A) Blood protein 5.0 g/dL B) Hgb 14.5 g/dL C) Hct 40% D) Platelet 200,000 mm3
A
Clinical manifestations: -Hematuria (tea/cola colored urine) -Hypertension -Edema (worse in morning) A) Acute glomerulonephritis B) Nephrotic syndrome
A
Diagnostic: -History -Presenting symptoms -Renal ultrasound -Urinalysis A) Acute glomerulonephritis B) Nephrotic syndrome
A
Disorder that occurs suddenly and is characterized by hematuria, proteinuria, edema, and renal insuffciency A) Acute glomerulonephritis B) Nephrotic syndrome
A
Lab results: -Elevated BUN -Elevated ESR -Elevated ASO titer -Elevated creatinine -Electrolyte imbalance A) Acute glomerulonephritis B) Nephrotic syndrome
A
Nursing considerations: -I/O every shift -Call HCP if <1-2 mL/kg/hr*** -Daily weights -Monitor cardiopulmonary status every shift -Fluid restrictions as ordered*** -Low salt diet*** -Cluster care to promote rest*** -Frequent position changes every 2 hours -Good daily hygiene -Monitor for signs of dehydration -VS every shift -Parental education A) Acute glomerulonephritis B) Nephrotic syndrome
A
Occurs most frequently in young school-age children A) Acute glomerulonephritis B) Nephrotic syndrome
A
Speech and language problems are more common with A) Cleft lip B) Cleft palate
A
The nurse is administering an IV infusion of albumin to a child with nephrotic syndrome. What is the primary concern for the nurse when administering this medication to the child? A) Fluid overload B) Electrolyte imbalance C) Increased blood pressure D) Urine output
A
The nurse is assessing a hospitalized child diagnosed with nephrotic syndrome. What assessment(s) is most important for the nurse to complete to help identify hypoalbuminemia in this child? A) The heart rate and blood pressure B) The respiratory rate and heart rate C) The blood pressure and oxygen saturation D) The heart and lung sounds
A
The nurse is auscultating the bowel sounds of a 4-year-old child and documents hypoactive bowel sounds. What might this finding indicate? A) Obstruction B) Gasteroenteritis C) Diarrhea D) Infection
A
The nurse is caring for a 12-year-old girl with nephrotic syndrome. The girl confides that she feels like a "freak" compared to her peers because of her weight, edema, and moon face. Which response by the nurse would be most appropriate? A) "Let's put you in touch with some other girls who are also having the same body changes." B) "Luckily, this is just a temporary, unfortunate part of your condition; you need to accept it." C) "Your real friends do not care about your appearance and just want you to get well." D) "You are beautiful in your own way; what matters is what is on the inside."
A
The nurse is providing care to a child with acute renal failure. What assessment would be a priority for the nurse to determine if this child is developing hyperkalemia? A) Increased muscle tone B) Pulse rate and rhythm C) Abdominal pain D) The blood pressure
B
The nurse is caring for a 2-year-old child with an umbilical hernia and is teaching the parent about this condition. Which response from the parent indicates a need for further teaching? A) "I can tape a quarter over the hernia to reduce it." B) "I need to watch for pain, tenderness, or redness." C) "Incarceration is rare, but it can occur." D) "My child could have some appearance-related self-esteem issues."
A
The nurse is caring for a 3-year-old girl with short bowel syndrome as a result of trauma to the small intestine. The girl's mother is extremely anxious and tells the nurse she is afraid she will never learn how to care for her daughter at home. How should the nurse respond? A) "I will help you become an expert on your daughter's care." B) "You must learn how to care for your daughter at home." C) "You really need the support of your husband." D) "There is a lot to learn and you need a positive attitude."
A
The nurse is caring for a 5-month-old boy with an undescended left testis. What would the nurse identify as indicative of true cryptorchidism? A) Testis cannot be "milked" down inguinal canal B) Venous varicosity detected along the spermatic cord C) Fluid detected in scrotal sac D) Testis can briefly be brought into scrotum
A
The nurse is examining a 7-year-old child with suspected appendicitis. Which physical findings would indicate the possibility of appendicitis? A) Persistent, right lower quadrant pain with rebound tenderness B) Tenderness that comes and goes in the lower abdomen C) Intermittent, left lower quadrant pain with rebound tenderness D) Diffuse, intermittent abdominal pain
A
The nurse is reviewing the medical record of a child with a cleft lip and palate. When reviewing the child's history, what would the nurse identify as a risk factor for this condition? A) Mother age 42 with pregnancy B) History of hypoxia at birth C) Preterm birth D) Maternal use of acetaminophen in third trimester
A
Therapeutic management: -Supportive -Antihypertensives -Diuretics -Low salt diet A) Acute glomerulonephritis B) Nephrotic syndrome
A
A child is diagnosed with short bowel syndrome. What would the nurse expect to be included in the child's plan of care? SELECT ALL THAT APPLY A) Antibiotics B) Vitamin supplements C) Total parenteral nutrition D) Immunosuppressants E) Laxatives
A, B, C
A nurse is assessing a child who has nephrotic syndrome. Which of the following findings should the nurse expect? SELECT ALL THAT APPLY A) Urine dipstick +2 protein B) Edema in the ankles C) Hyperlipidemia D) Polyuria E) Anorexia
A, B, C, E
A nurse is teaching a parent of an infant about GERD. Which of the following should the nurse include in the teaching? SELECT ALL THAT APPLY A) Offer frequent feedings B) Thicken formula with rice cereal C) Use a bottle with a one-way valve D) Position baby upright after feedings E) Use a wide-based nipple for feedings
A, B, D
The nurse is caring for a child with celiac disease. The parents and the child have attended a class with a group of other clients with the disorder. Which statements by the child or the parents indicate the need for further teaching? SELECT ALL THAT APPLY A) "Celiac disease is the same as gluten intolerance that everyone is talking about these days." B) "I must be careful to eat only 100% whole grain foods." C) "I hope they find a cure for celiac disease some day." D) "I love pasta, so as long as I only eat it occasionally I should be fine." E) "My brother and sister are more likely to develop celiac disease since I have it."
A, B, D
The nurse is developing a teaching plan for the parents of an 11-month-old infant with gastroesophageal reflux disease (GERD). The child will be managed medically. What actions would the nurse incorporate into the teaching plan? SELECT ALL THAT APPLY A) Giving the child small frequent feedings B) Administering prokinetics to empty the stomach quickly C) Burping the infant at the end of the feeding D) Keeping the child upright for 30 minutes after feeding E) Thinning the formula with water to ease flow
A, B, D
A nurse is assessing an infant who has hypertrophic pyloric stenosis. Which of the following manifestations should the nurse expect? SELECT ALL THAT APPLY A) Projectile vomiting B) Dry mucus membranes C) Currant jelly stools D) Sausage-shaped abdominal mass E) Constant hunger
A, B, E
The nurse is caring for a child diagnosed with acute post-streptococcal glomerulonephritis. When assessing the child, what findings does the nurse anticipate? SELECT ALL THAT APPLY A) Weight gain B) Headache C) A recent gastrointestinal infection resulting in severe diarrhea D) Clear, straw colored urine E) Generalized edema
A, B, E
A nurse is caring for a child who has Meckel's diverticulum. Which of the following manifestations should the nurse expect? SELECT ALL THAT APPLY A) Abdominal pain B) Fever C) Mucus and blood in stools D) Vomiting E) Rapid, shallow breathing
A, C
Meckel Diverticulum
The result of an incomplete fusion of the omphalmesenteric duct during embryonic development causing a fibrous band to connect the small intestine to the umbilicus
A group of nursing students are reviewing information about celiac disease. The students demonstrate understanding of this disorder when they identify which classic symptoms? SELECT ALL THAT APPLY A) Polycythemia B) Failure to thrive C) Steatorrhea D) Diarrhea E) Sunken abdomen F) Constipation
B, C, D, F
A nurse is assessing a child who has a UTI. Which of the following are manifestations of a UTI? SELECT ALL THAT APPLY A) Night sweats B) Swelling of the face C) Pallor D) Pale-colored urine E) Fatigue
B, C, E
Appendicitis
Acute inflammation of the appendix
What should be done if anemia is significant in the infant with meckel diverticulum?
Administer packed RBCs
When treating thrush, mycostatin should be administered (before/after) the patient eats.
After
A 4-year-old girl presents with recurrent urinary tract infection. A prior workup did not reveal any urinary tract abnormalities. What is the priority nursing action? A) Obtain a sterile urine sample after completion of antibiotics. B) Teach appropriate toileting hygiene. C) Prepare the child for surgery to reimplant the ureters. D) Administer antibiotics intramuscularly.
B
A child is diagnosed with hemolytic-uremic syndrome. Review of the child's laboratory test results would reveal which finding? A) Decreased BUN and creatinine B) Decreased platelets and leukocytosis C) Hypernatremia and hypokalemia D) Respiratory acidosis and protetinuria
B
A child presents with a 2-day history of fever, abdominal pain, occasional vomiting, and decreased oral intake. Which finding would the nurse prioritize for immediate reporting to the physician? A) Temperature 101.9°F B) Rebound tenderness and abdominal guarding C) Parents will be leaving the child alone in the hospital. D) Child can tolerate only sips of fluid without nausea.
B
A nurse is caring for a child who has Hirschsprung's disease. Which of the following actions should the nurse take? A) Encourage a high-fiber, low-protein, low-calorie diet. B) Prepare the family for surgery. C) Place an NG tube for decompression. D) Initiate bed rest.
B
A nurse is caring for a child who has enuresis. Which of the following is a complication of enuresis? A) UTIs B) Emotional problems C) Urosepsis D) Progressive kidney disease
B
A nurse is caring for a school-age child who has acute glomerulonephritis. Which of the following findings should the nurse report to the provider? A) BUN 8 mg/dL B) Blood creatinine 1.3 mg/dL C) BP 100/74 mmHg D) Urine output 550 mL in 24 hours
B
A nurse is caring for an infant who has just returned from PACU following cleft lip and palate repair. Which of the following actions should the nurse take? A) Remove packing in the mouth. B) Place the infant in an upright position. C) Offer a pacifier with sucrose. D) Assess the mouth with a tongue blade.
B
A nurse is preparing a presentation for a local parent group about UTIs in children. Which organism would the nurse incorporate into the presentation as the most common cause? A) Klebsiella B) E. Coli C) Staphylococcus aureus D) Pseudomonas
B
After teaching the parents of a child with a hydrocele about this condition, which statement indicated that the teaching was successful? A) "If this gets worse and we don't treat it, our son could become infertile." B) "This condition should gradually go away on its own." C) "The surgeon is going to operate on him immediately." D) "It's going to be difficult putting ice packs on his scrotum."
B
Clinical manifestations: -Proteinuria (frothy urine) -Edema (worsens during the day) -Abdominal pain -Weight gain -Hypovolemia -Pallor -Fatigue A) Acute glomerulonephritis B) Nephrotic syndrome
B
Diagnostic: -History -Clinical manifesations A) Acute glomerulonephritis B) Nephrotic syndrome
B
Kidney disorder characterized by proteinuria, hypoalbuminemia, and edema A) Acute glomerulonephritis B) Nephrotic syndrome
B
Lab results: -Urinalysis (3 to 4+ protein) -Hypoalbuminemia -Elevated cholesterol -Elevated triglycerides -Elevated Hbg and Hct -Elevated platelets A) Acute glomerulonephritis B) Nephrotic syndrome
B
Nursing considerations: -Position changes every 2 hours -Good daily hygiene -Support and elevate edematous body parts with pillows*** -Physical activity as tolerated*** -Antibiotics as ordered*** -VS every shift -I/O every shift -Monitor lab values*** -Observe for signs of dehydration -Daily weights -No added salt diet*** -Measure abdominal girth daily*** -Administer diuretics as ordered*** -Monitor cardiopulmonary status every shift -Parental education A) Acute glomerulonephritis B) Nephrotic syndrome
B
Occurs most frequently in children between ages 2 and 6 years A) Acute glomerulonephritis B) Nephrotic syndrome
B
The mother of a 3-week-old infant old brings her daughter in for an evaluation. During the visit, the mother tells the nurse that her baby is spitting up after feedings. Which response by the nurse would be most appropriate? A) "We need to tell the doctor about this." B) "Infants this age commonly spit up." C) "Your daughter might have an allergy." D) "Don't worry; you're just feeding her too much."
B
The nurse is caring for a 2-month-old with cleft palate. The child will undergo corrective surgery at age 3 months. The mother would like to continue breastfeeding the baby after surgery and wonders if it is possible. How should the nurse respond? A) "There is a good chance that you will be able to breastfeed almost immediately." B) "Breastfeeding is likely to be possible but check with the surgeon." C) "After the suture line heals, breastfeeding can resume." D) "We will have to wait and see what happens after the surgery."
B
The nurse is caring for a 4-year-old with a suspected UTI. What would be most appropriate to say to the child when obtaining a urine specimen from him? A) "I will need a urine sample." B) "Let your mom help you tinkle in this cup." C) "Please tinkle in this cup right now." D) "Please void in this cup instead of the toilet."
B
The nurse is caring for an infant with a temporary ileostomy. As part of the plan of care, the nurse monitors for skin breakdown around the stoma. If redness occurs, what would be most appropriate to promote healing and prevent further skin breakdown? A) Clean the area well with a scented diaper wipe. B) Apply a barrier/ healing cream or paste on the skin. C) Use a barrier wafer to attach the appliance. D) Sanitize the area with an alcohol wipe after each diaper change.
B
The nurse is conducting a physical examination of an 18-month-old with suspected intussusception. Which finding would the nurse identify as the hallmark of this condition? A) Skin tenting B) A sausage-shaped mass in the upper midabdomen C) Perianal skin tags D) Abdominal pain and guarding
B
The nurse is preparing a teaching plan for the parents of a child with a UTI. In educating the parents, the nurse would recommend that the child avoid A) a liberal fluid intake B) caffeine C) cranberry juice D) cotton underwear
B
The nurse is taking a health history of a child with suspected acute post-streptococcal glomerulonephritis. Which response by the client's parent will the nurse highlight for the primary health care provider as an indicator for this condition? A) "My child has recently reported urinary frequency." B) "My child just got over a head cold with laryngitis." C) "My child's urine is pale yellow in color." D) "My child's eyes appear sunken to me."
B
The nurse is teaching the parent of an infant with a temporary ileostomy about stoma care. What is the most important instruction to emphasize to the parent to avoid an emergency situation? A) "You may need adhesive remover to ease pouch removal." B) "Call the healthcare provider immediately if the stoma is not pink/red and moist." C) "Gather all of your supplies before you begin." D) "You must be meticulous in caring for the surrounding skin."
B
The nurse is visually inspecting a urine specimen from a 12-year-old boy. The nurse documents gross hematuria with a specimen of which color? A) Cloudy yellow B) Cola colored C) Pale to almost clear urine D) Light orange to moderately yellow colored
B
The parents of a 6-week-old boy come to the clinic for evaluation because the infant has been vomiting. The parents report that the vomiting has been increasing in frequency and forcefulness over the last week. The mother says, "Sometimes, it seems like it just bursts out of his mouth." A diagnosis of hypertrophic pyloric stenosis is suspected. When performing the physical examination, what would the nurse most likely find? A) Sausage-shaped mass in the upper midabdomen B) Hard, moveable, olive-shaped mass in the right upper quadrant C) Tenderness over the McBurney point in the right lower quadrant D) Abdominal pain in the epigastric or umbilical region
B
The parents of a boy diagnosed with Hirschsprung disease are anxious and fearful of the upcoming surgery. The mother states, "I'm worried about having to care for our son's ostomy." Which intervention would be most helpful for the parents? A) Explaining to them about the diagnosis and surgery B) Having a wound, ostomy, and continence nurse meet with them C) Reinforcing that the ostomy will be temporary D) Teaching them about the medications used to slow stool output
B
Therapeutic management: -Prednisone to initiate remission -Diuretics -Possible administration of albumin -Antibiotics to prevent infection -No added salt diet A) Acute glomerulonephritis B) Nephrotic syndrome
B
When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority? A) Excess fluid volume B) Risk for infection C) Activity intolerance D) Imbalanced nutrition less than body requirements
B
When the nurse is caring for a child with hemolytic uremic syndrome or acute glomerulonephritis and the child is not yet toilet trained, which action by the nurse would best determine fluid retention? A) Test urine for specific gravity. B) Weigh child daily. C) Weigh the wet diapers. D) Measure abdominal girth daily.
B
A nurse is teaching a parent of a child who has a UTI. Which of the following should the nurse include in the teaching? SELECT ALL THAT APPLY A) Wear nylon underpants B) Avoid bubble baths C) Empty bladder completely with each void D) Watch for manifestations of infection E) Wipe perineal area back to front
B, C, D
A child is hospitalized with acute post-streptococcal glomerulonephritis. What assessments should the nurse include in the plan of care for this child? SELECT ALL THAT APPLY A) LOC B) Pain C) BP D) Auscultate lung sounds E) Inspect the urine
B, C, D, E
After teaching the parents of a child diagnosed with celiac disease about nutrition, the nurse determines that the teaching was effective when the parents identify which foods as appropriate for their child? SELECT ALL THAT APPLY A) Wheat germ B) Peanut butter C) Carbonated drinks D) Shellfish E) Jelly F) Flavored yogurt
B, C, D, E
The nurse is caring for a 6-month-old with a cleft lip and palate. The mother of the child demonstrates understanding of the disorder with which statements? SELECT ALL THAT APPLY A) "My smoking during pregnancy didn't have anything to do with this disorder. Smoking primarily causes low birth weight." B) "I know my baby takes a lot longer to feed than most children this age." C) "It really worries me that my baby may have some other disorders that haven't been detected yet." D) "I wonder if my baby will develop speech problems when language development begins?" E) "Thankfully there are healthcare providers that specialize in correcting this type of disorder."
B, C, D, E
The nurse is performing a GI assessment on a 7-year-old boy. The parents are assisting with the history. Which assessment findings are indicative of constipation? SELECT ALL THAT APPLY A) "Our child only has 3 to 4 bowel movements per week." B) "Our child complains of pain because his bowel movements are so hard." C) "Our child tells us that his belly hurts a lot of the time." D) "I can tell he holds his bowel movement much of the time because of the way he stands." E) "I find smears of stool in his underwear almost every day."
B, C, D, E
The nurse is reviewing the health history of a client suspected of having vesicoureteral reflux. What findings in the health history are consistent with this disorder? SELECT ALL THAT APPLY A) Pyuria B) Hematuria C) Flank pain D) History or repeated urinary tract infections. E) Urinary frequency
B, C, D, E
A nurse is caring for a child who has acute post-streptococcal glomerulonephritis. Which of the following manifestations should the nurse expect? SELECT ALL THAT APPLY A) Pale urine B) Periorbital edema C) Ill appearance D) Decreased creatinine E) Hypertension
B, C, E
A nurse is assessing an infant who has a suspected UTI. Which of the following are expected findings? SELECT ALL THAT APPLY A) Increase in hunger B) Irritability C) Decrease in urination D) Vomiting E) Fever
B, D, E
What is successful at reducing intussusception in a large number or cases?
Barium enema
What should be monitored with intussusception?
Bilious vomiting
Bulimia nervosa
Binge eat and purge
The infant after cleft palate repair should be closely observed for what?
Bleeding and aspiration
Short Bowel Syndrome
Body condition where client is unable to absorb enough nutrients from food he eats because of a lack of small intestines
Why should breastfeeding be encouraged for babies that have cleft lip?
Breast tissue fills the gap
A group of nursing students are reviewing the variations in the genitourinary system in children as compared with adults. The students demonstrate understanding of this information when they state: A) A child's kidneys are surrounded by more fat padding than an adult's kidneys. B) The renal system usually reaches functional maturity by age 5 years. C) Bladder capacity reaches adult capacity by age 1 year. D) Glomerular filtration rate is faster in infants than in adults.
C
A mother brings her 6-month-old infant to the clinic. The child has been vomiting since early morning and has had diarrhea since the day before. His temperature is 38°C, pulse 140, and respiratory rate 38. He has lost 6 oz since his well-child visit 4 days ago. He cries before passing a bowel movement. He will not breastfeed today. What is the priority nursing analysis? A) Altered thermoregulation B) Pain (abdominal) related to diarrhea C) Hypovolemia related to excessive losses and inadequate intake D) Alteration in nutritional status related to decreased oral intake
C
A nurse identifies a diagnosis of "Impaired urinary elimination related to infection in the urinary tract as manifested by dysuria" for a preschooler. When developing the plan of care, what would be most important for the nurse to do first? A) Develop a schedule for bladder emptying B) Encourage fluid intake C) Assess usual voiding patterns D) Monitor intake and output
C
The nurse is caring for a client with hemolytic-uremic syndrome (HUS). The client is demonstrating oliguria. What does the nurse expect to find when reviewing the client's records? A) A pattern of below-normal blood pressure B) Higher fluid output than fluid intake C) Elevated BUN and creatinine levels D) Increased GFR
C
The nurse is preparing a 7-year-old girl for discharge after treatment for nephrotic syndrome. Which instructions would the nurse include in the discharge teaching plan for the parents? A) "She should try to avoid protein." B) "Here is some written information from the dietitian." C) "Let's meet with the dietitian and plan some meals." D) "She must severely restrict her sodium intake."
C
The nurse is providing care to a child with an intussusception. The child has a bowel movement and the nurse inspects the stool. The nurse would most likely document the stool's appearance as having what quality? A) Greasy B) Clay-colored C) Currant jelly-like D) Bloody
C
The nurse is reviewing the laboratory results of a child with nephrotic syndrome. What would the nurse least likely expect to find? A) Hyperlipidemia B) Hypoalbuminemia C) Decreased BUN D) Hypoproteinemia
C
The nurse is taking a health history of a 2-year-old child presenting with a sudden onset of severe vomiting. Which description would suggest an obstruction? A) Projectile vomiting B) Effortless vomiting C) Bilious vomiting D) Bloody vomiting
C
When examining the abdomen of a child, which technique would the nurse last? A) Auscultation B) Percussion C) Palpation D) Inspection
C
If a child's inguinal hernia becomes hard, discolored, or painful, parents should immediately do what?
Call the physician
Hirschsprung's Disease (congenital megacolon)
Caused by absence of autonomic parasympathetic ganglion cells in the colon, which prevents peristalsis at that portion of the intestine
Renal failure
Condition in which the kidneys cannot concentrate urine, conserve electrolytes, or excrete waste products
Monitor the infant or child with renal failure carefully for signs of what?
Congestive heart failure
What does the stool look like in the patient with intussusception?
Currant jelly
A group of students are reviewing information about fluid balance and losses in children in comparison to adults. The students demonstrate a need for additional review when they state that A) Children have a proportionately greater amount of body water than do adults B) Fever plays a greater role in insensible fluid losses in infants and children C) A higher metabolic rate plays a major role in increased insensible fluid losses D) The infant's immature kidneys have a tendency to over-concentrate urine
D
A group of students are reviewing information about renal failure in children. The students demonstrate a need for additional teaching when they identify which agent as a potential contributor to renal failure? A) Vancomycin B) Gentamicin C) Co-trimoxazole D) Amoxicillin
D
A nurse is assessing a child who has chronic renal failure. Which of the following findings should the nurse expect? A) Flushed face B) Hyperactivity C) Weight gain D) Delayed growth
D
A nurse is planning are of a child who has a UTI. Which of the following interventions should the nurse include? A) Administer an antidiuretic B) Restrict fluids C) Evaluate the child's self-esteem D) Encourage frequent voiding
D
The nurse is providing care to a child who has had an appendectomy for a perforated appendix. The nurse would anticipate intravenous antibiotic therapy for which time frame? A) 1 to 3 days B) 3 to 5 days C) 5 to 7 days D) 7 to 14 days
D
The nurse is triaging clients as they come in to an express care facility. Which assessment finding is clinically significant for early nephrotic syndrome? A) Sacral edema B) Facial puffiness C) Edema in the hands D) Periorbital edema
D
The parents of a child diagnosed with celiac disease ask the nurse what type of food they can offer their child. What recommendation would the nurse include in the teaching plan? A) Frozen yogurt B) Rye bread C) Creamed spinach D) Fruit juice
D
What is the cardinal symptom of Hirschsprung's disease?
Delayed stool within 24-48 hours of life
The use of home remedies to reduce an umbilical hernia should be (encouraged/discouraged).
Discouraged
Chordee
Downward curvature of the penile shaft; Can accompany hypospadias
What is the bacteria that causes 80% of UTIs?
E. Coli
What type of restraint would you select for cleft lip repair?
Elbow
T/F: All children with GERD vomit.
False
T/F: If a patient is receiving a diuretic, and no urine is produced in 2 hours, then the medication is re-given.
False
T/F: The child is allowed to feed their self after cleft palate repair.
False
T/F: The small intestine is mature at birth.
False
What type of vitamins should be administered in the child with short bowel syndrome?
Fat soluable
What is the infant with hypospadius not circumcised?
Foreskin may be needed for surgical repair
What may be the first sign of cleft palate?
Formula coming from the nose
Post renal
From some type of obstruction
What disorder presents with an olive shaped mass felt in the RUQ?
Hypertrophic pyloric stenosis
How is dehydration corrected pre-op for hypertrophic pyloric stenosis?
IV fluids and electrolytes
Celiac disease
Inability to digest fully the protein part of wheat, rye, oats, or barely
How does a proton pump inhibitor help GER?
Inhibits gastric secretions
A palpable sausage-shaped mass in the RUQ or mid-upper abdomen may be seen in what disorder?
Intussusception
Tracheoesophageal Fistula (TEF) or Atresia
Malformation that results from failure of the esophagus to develop as a continuous tube during the 4th to 5th weeks of gestation
What is the entry point for GI infection?
Mouth
What is the most common surgical procedure to help GER?
Nissen fundoplication
What should be done if a hernia becomes hard, discolored, or painful?
Notify HCP immediately
Umbilical hernia
Occurs when fusion of the umbilical ring is incomplete at the point where the umbilical vessels exit the abdominal wall
Hypertrophic pyloric stenosis
Occurs when the muscle surrounding the pylorus hypertrophies and obstructs gastric emptying
The lower esophageal sphincter is not fully developed until what age?
One year
In appendicitis, if the child's abdominal pain is suddenly relieved without intervention, what should be suspected?
Perforation
What is the major symptom of hypertrophic pyloric stenosis?
Projectile vomiting
Inguinal hernia
Protrusion of the bowel into the groin
Why should vigorous or sustained crying be avoided after cleft palate repair?
Puts stress on the sutures
How does a H2 receptor antagonist help GER?
Reduces acid secretions
Anorexia nervosa
Refusal to maintain body weight
Gastroesophageal Reflux (GER)
Regurgitation of gastric contents back into the esophagus
In a child with Hirschsprung's disease, what would the stool look like?
Ribbon
When a child has appendicitis, sudden pain relief may indicate what?
Ruptured appendix
How is hypertrophic pyloric stenosis corrected?
Surgery
If a barium enema fails, what is required immediately to treat intussusception?
Surgery
Intussusception
Telescoping of part of the intestine into an adjacent distal portion of the intestine causing bowel obstruction
Cryptorchidism
Testes not palpable or not easily guided into the scrotum and previously descended testis that ascends into extra-scrotal position
Why should viscous lidocaine be used with caution in younger children as a swish-and-spit treatment?
They may swallow the lidocaine
Why should the baby with cleft lip or palate be burped more frequently?
They take more air in
Gastroesophageal Reflux Disease (GERD)
Tissue damage resulting from GER
Why should the infant be placed in a supine or side-lying position on the unaffected side after cleft lip repair?
To avoid contact with bed linens
What is the goal of surgery to correct congenital malformations of the penis?
To make urinary and sexual function as normal as possible and to improve the cosmetic appearance of the penis
T/F: In the child with an ostomy, the HCP should be immediately notified if the stoma is not moist, pink, or red.
True
T/F: In the diet for celiac disease, rice and corn cereal are okay.
True
T/F: Medications commonly used in children can reduce renal function.
True
T/F: NSAIDs should be avoided in children with questionable renal function.
True
T/F: The nurse auscultates the fistula for the presence of a bruit in a child receiving chronic hemodialysis. This is a desired normal finding.
True
The infant with cleft lip or palate should be fed in what position?
Upright
Hypospadius
Urethral meatus is below the normal placement of the penis
Epispadias
Urethral meatus is on the dorsum (upper side) of the penis
Hypospadias
Urethral meatus is on the lower or underside of the penis
Vesicoureteral Reflux
Urine from the bladder flows back up the ureters
Peritoneal dialysis
Uses the abdominal cavity as a semi-permeable membrane to help remove excess fluid and waste products
Carefully assess children with end stage renal disease for what?
Worsening uremia or metabolic acidosis
