MN Chapter 28 The child with gastrointestinal condition

after surgery to correct pyloric stenosis the nurse instructs the parents about the postoperative feeding schedule for the infant. the parents exhibit understanding of these instructions when they state they can start feeding the child within which of the following time frames

6 hours Rationale: clear liquids containing glucose and electrolytes are usually prescribed 4-6 hours after surgery

which of the following should the nurse assess in a newborn diagnosed with an anorectal malformation. select all that apply

abdominal distension loose stools meconium in urine Rationale: anorectal malformations present with lack of stool or evidence of meconium in the urine through a fistula. meconium is not found in the stool, because stool does not pass, abdominal distention and vomiting occur

which of the following would most likely alert the nurse to the possibility that a preschooler is experiencing moderate dehydration

absence of tear formation

an adolescent male client scheduled for an emergency appendectomy is to be transferred directly from the emergency room tot he operating room. which of the following statements by the client should the nurse interpret as most significant

all of sudden it doesn't hurt at all Rationale: this may indicate that the appendicitis has ruptured

which of the following is a normal response from an adolescent who has just returned from surgery

I am worried about my scar

A newborn who had a surgical repair of a tracheoesophageal fistula (TEF) is started on oral feedings. Which of the following should the nurse include in the teaching plan for the mother about oral feedings?

They are best planned in conjunction with observations of the infant's behavior. Rationale: when initiating oral feedings after surgical repair of a TEF, it is best to follow a plan of care in conjunction with observation of the infant's needs and behavior

after teaching the mother of an infant with pyloric stenosis about the disease which of the following, if stated by the mother as a cause indicates effective teaching

an enlarged muscle below the stomach sphincter Rationale: pyloric stenosis involves hypertrophy of the pylorus muscle distal to the stomach and bof the gastric outlet resulting in vomiting, metabolic acidosis and dehydration

parent report that their 1 yr old is drooling and having a choking episode with excessive amounts of mucus and color changes especially during feedings, the nurse should contact the primary care provider to further assess the baby and request a prescription for

an x-ray with orogastric catheter placement Rationale: The drooling and excessive mucus production is highly suggestive of a tracheoesophageal fistula (TEF)

a nasogastric tube inserted during surgery to correct and infant's intussusception is no longer freely removing gastric secretions, which of the following should the nurse do next

aspirate the tube with a syringe Rationale: the first action is to check the placement of the tube to ensure that it is in the correct position. to check the tube position, the nurse would aspirate the tube with a syringe

after surgery to repair a tracheoesophageal fistula, an infant receives gastronomy tube feedings. after feedings. after feeding the infant by this method the nurse cradles and rocks the infant for about 15 minutes primary to help accomplish which of the following

associate eating with a pleasurable experience Rationale: the nurse can help meet the psychological needs of an infant being fed through a gastronomy tube by rocking the infant after feeding

which of the foll would an infant whose had surgery to correct intussusception be at risk for

auscultation of bowel sounds Rationale: development of paralytic ileus postoperatively is a functional obstruction of the bowel. bowel sounds may be hyperactive but then diminish and cease.

a nurse is caring for a 10 month old weighing 8.0 kg who was admitted for dehydration. the infant has vomited 5 times in the last 3h and has had no wet diapers in the last 8h. which prescription should the HCP prescribe

begin an IV line and a fluid bolus of dextrose Rationale: a fluid bolus should consists of an isotonic fluid such as a normal saline or lactated ringers. D5 45% normal saline is an appropriate IV fluid for infants

which of the following assessment findings should alert the nurse to suspect appendicitis in a male adolescent with severe abdominal pain

bowel sounds are heard twice in 2 minutes

which of the following instructions should the nurse expect to include in the discharge teaching plan for the parent of an infant who has had an inguinal herniorrhaphy

change diapers as soon as they become soiled rationale: changing the diaper as soon as it becomes soiled prevents wound infections, the most common complication after inguinal hernia repair in an infant secondary to possible wound contamination with urine and stool

which of the following behavior exhibited by the parents of an infant with pyloric stenosis should the nurse correctly interpret as a positive indication of parental coping

discuss the infants care realistically Rationale: the parent's ability to verbalize the infant's care realistically indicates that they are working through their fears and concerns

after undergoing surgical correction of pyloric stenosis, an infant is returned tit he room in stable condition. while standing by the crib the mother says "perhaps if i had brought my baby to to the hospital sooner, the surgery could have been avoided, which is the nurse's best response

do you think that earlier hospitalization could have avoided surgery

after completing diagnostic testing, the surgeon has scheduled a newborn with the diagnosis is an imperforate anus for surgery the next day. the infant's parents are catholic and do not want the surgery to take place unless the infant has been baptized, the nurse asks the parents

do you want me to help arrange baptism

when developing the plan of care for neonate who was diagnosed with an anorectal malformation and who subsequently underwent surgery, which of the following would be most helpful in facilitating parent-infant bonding

encouraging the parents to hold their infant Rationale: this promotes parent-infant attachment

a client with Hirschsprung disease is scheduled tp receive a temporary colostomy. When discussing the diagnosis and treatment with the parents which of the following would be most appropriate

encouraging them to ask questions Rationale: misconceptions can be clarified

the mother ask how to bathe baby after inguinal surgery repair

give him a sponge bath daily for 1 week Rationale: the incision must be kept clean adn sry as possible

immediately after the first oral feeding after corrective surgery for pyloric stenosis a 4 week old infant is fussy and restless, which of the following actions would be most appropriate at this time

give the infant more to eat Rationale: giving the infant a pacifier would help meet nonnutritive sucking needs and ensure oral gratification. sucking aids in calming the infant

the parent of a child with tracheoesophageal fistula express feelings of guilt about their baby's anomaly, which of the approaches by the nurse best support the parents

helping the parents accept their feelings as a normal reaction Rationale: the parents of children born with defects often have feelings of guilt and ask what they might have done to cause the condition or how they might have avoided it. it is important to allow parents to express their feelings and to accept their feelings as normal reactions.

when teaching the parent of an infant with Hirschsprung disease who received a temporary colostomy about the types of foods the infant will be able to eat

high-residue-diet Rationale: a regular diet would be recommended for the child with a colostomy, no special diet is needed.

the nurse is showing the parent of a child Hirschsprung disease where the aganglionic area is located

in the lower portion of the sigmoid colon Rationale:

an adolescent is being seen in the clinic for abdominal pain with a fever, in which order should the nurse assess the abdomen

inspect auscultate percuss palpate

when assessing a 4-month-old infant diagnosed with the possible intussusception, the nurse should expect the mother to relate which of the following about the infant's crying and episodes of pain

intermittent with knees drawn to chest Rationale: the infant with intussusception experience acute episodes of colic-like abdominal pain. typically the infant screams and draws the knees to the chest

an adolescent who had an appendectomy and developed peritonitis has nausea which of the foll should the nurse do first

irrigate the nasogastric tube Rationale: after appendectomy the patient would have a nasogastric tube put in place

when an infant returns to the unit after imperforate anus repair, the nurse should place the infant in which of the following positions

lying on the side with hips elevated Rationale: after surgical repair of imperforate anus, the infant should be positioned either supine with legs suspended 90 degree angle or on either side with hips elevated to prevent pressure on the perineum

an infant admitted with the diagnosis of hypertrophic pyloric stenosis presents with a history of vomiting. the nurse should anticipate that the infant's vomitus would contain gastric contents and which of the following

mucus and streak of blood Rationale: vomitus of an infant contain streaks of blood, mucus and gastric contents

after teaching the mother of a neonate who has successfully undergone surgery to repair a low anorectal anomaly, the mother indicates that she understands her child's prognosis when she states which of the following

my child has a good chance of being potty trained Rationale: Rationale: children who undergo surgical correction for low anorectal anomalies as infants usually are continent. fecal continence can be expected after successful correction of anal membrane atresia

the father of a neonate scheduled for gastrointestinal surgery asks the nurse how newborns respond to painful stimuli, which of the following is the nurse's best response

newborns typically move their whole body in response to pain Rationale: the neonate respond to pain with total body movement and brief, loud crying that ceases with distraction

a 10y old male is 24h postappendectomy. he is awake, alert and oriented. he tells the nurse that he is experiencing pain. he has a prescription for morphine, which is the priority nursing action in managing the child's pain

obtain vital signs with a pain score

a severely dehydrated child , in which order should the nurse implement care

obtain vs and weight insert an IV and infuse fluids apply a urine collection bag draw blood for laboratory tests

a child is admitted with a diagnosis of possible appendicitis. the child is in acute pain. which of the following nursing interventions would be appropriate prior to surgery to decrease pain

offer an ice pack encourage child to assume a position of comfort limit child's activity

when developing the preoperative plan for an infant with Hirschsprung disease which of the following should the nurse include

restricting oral intake to clear liquids Rationale: before intestinal surgery , dietary intake is limited to clear liquids or 24h to 48h

when teaching the mother if an infant who received a temporary colostomy for treatment of Hirschsprung disease about how the stoma should appear

stay deep red in color Rationale: a stoma should be deep red in color, if it is a dark red to purplish color that may indicate impaired circulation to the stoma

which of the following would indicate that an infant with tracheoesophageal fistula (TEF) needs suctioning

substernal retractions Rationale: with a TEF overflow of secretions into the larynx leads to laryngospasm. this obstruction to inspiration stimulates the strong contraction of accessory muscles of the thorax to assist the diaphragm in breathing. this produces substernal retractions

a 6month old had a pyloromyotomy to correct pyloric stenosis. three days after surgery the parents have placed their infant in his infant seat, the nurse should do which of the following

tell the parents they have positioned the infant correctly Rationale: following pyloromyotomy the infant should be positioned with the head elevated and slightly with the head elevated and slightly on the right side to promote gastric emptying-the parents have positioned their infant correctly

an infant with Hirschsprung disease undergoes surgery with the creation of a temporary colostomy. which of the following statements by the parent regarding the colostomy indicates the need for further teaching

the colostomy will give time for the nerves to return to normal Rationale:

which of the foll is the priority assessment for an adolescent on return to the nursing unit after appendectomy

the dressing on the surgical site Rationale: to determine whether there is an drainage or bleeding

when assessing an infant with suspected inguinal hernia which of the following findings would be most appropriate

the inguinal swelling is reddened and the abdomen is distended Rationale: abdominal distention and a redness of the inguinal swelling are significant findings. the presence in conjunction with are tenderness and inability to reduce the hernia indicate an incarcerated hernia

after teaching the parents of an infant with Hirschsprung disease the nurse determines that the parents understands the diagnosis when the father states which of the foll

the nerves at the end of the large colon are missing Rationale: The primary defect in Hirschsprung disease is an absence of autonomic parasympathetic ganglion cells

which if the following positions would you place a patient postoperative after an appendectomy

the semi-Fowler's position Rationale: right side lying position helps to localize the infection

after teaching the parents of a neonate diagnosed with a tracheoesophageal fistula (TEF) about this anomaly, the nurse determines that the teaching was successful when the father describes the condition as which of the following

there is a blind upper pouch and an opening from the esophagus into the airway Rationale: although TEF can include several different structural anomalies, the most common type involves a blind pouch and a fistula from the esophagus into the trachea

the nurse is administering gastrotomy feedings to an infant after surgery to correct a tracheoesophageal fistula (TEF) to prevent air from entering the stomach once the syringe barrel is attached to the gastrotomy tube the nurse should

unclamp the tube after pouring the complete amount of formula to be administered into the syringe barrel Rationale: the best way to prevent air from entering the stomach when feeding an infant through a gastronomy tube is to open the clamp after all the formula has been placed in the syringe barrel.

A newborn admitted with pyloric stenosis is lethargic and has poor skin turgor. The primary care provider has ordered I.V. fluids of dextrose water with sodium and potassium. The baby's admission potassium level is 3.4Meq/ L. The nurse should:

verify that the infant has urinated" Rationale: normal serum potassium levels are 3.5 to 4.5. elevated potassium levels can cause life threatening cardiac arrhythmias. the nurse must verify that the client has the ability to clear potassium through urination before administration of the drug

the HCP is able to reduce an infant's hernia and schedule the infant for a herniorrhaphy in 2 days. the mother asks the nurse why the surgery is not performed now. which of the following responses indicate that the nurse understands the rationale for delaying the surgery

waiting 2 days helps allow any edema and inflammation in the area to subside Rationale: if nonoperative reduction is successful delaying surgery for 2-3 days allows the edema and inflammation int he inguinal area to subside

when an infant with pyloric stenosis is admitted to the hospital, which of the following should the nurse do first?

weigh an infant Rationale: unless the infant is in hypovolemic shock, obtaining a baseline weight is an important first action because the weight is used to calculate the child's birth and electrolyte needs

which of the following would be best activity for the nurse to include in the plan of care for an infant experiencing severe diarrhea

weighing the infant each day Rationale: because an infant experiencing severe diarrhea is at high risk for a fluid volume deficiency so the nurse need to evaluate the infants fluid balance status

during physical assessment of a 4 mo old infant with Hirschsprung disease, the nurse would most likely note which of the following

weight less than expected for height and age Rationale: the infant with Hirschsprung disease typically display failure to thrive with poor weight gain due to malabsorption of nutrients

when obtaining the nursing history from the mother of an infant with suspected intussusception which of the following questions would be most appropriate

what do the stools look like Rationale: for the infant with intussusception the stools characteristically have the appearance of currant jelly because of the intestinal inflammation and hemorrhage resulting from the intestinal obstruction

when obtaining the initial health history from a 10y old child with abdominal pain and suspected appendicitis which of the foll questions would be most helpful in eliciting data to help support the diagnosis

where did the pain start