Nur 221-Test 3

The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration?

Tenting of skin

Which of the following is most correct regarding the gastrointestinal system of the child?

The child cannot break down and use complex carbohydrates in the same way the adult can.

The nurse is working with the mother of a newborn. The mother asks why a baby needs small feedings at frequent intervals. The nurse explains to the mother that this is necessary because in the infant

The enzymes secreted by the liver and pancreas are reduced.

The nurse is caring for a 6-month-old girl with diarrhea and dehydration. The mother is concerned because the girl has some patches on her tongue. Which of the following features indicates a geographic tongue rather than thrush?

The patches are light in color on the tongue.

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of colic?

There are recurrent paroxysmal bouts of abdominal pain.

In caring for an infant diagnosed with pyloric stenosis, the nurse would anticipate that she would:

prepare the infant for surgery.

You care for a 12-year-old girl with Crohn disease. A primary assessment you would want to make when caring for her would be to note if:

she has a temperature.

A 4-month-old has had a fever, vomiting, and loose watery stools every few hours for 2 days. The mother calls the physician's office and asks the nurse what she should do. Which response by the nurse is most appropriate?

"Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment."

The nurse is teaching the mother of an infant with a temporary ileostomy about stoma care. What is the most important instruction to emphasize to the mother to avoid an emergency situation?

"Call the doctor immediately if the stoma is not pink/red and moist."

The nurse is preparing an 18-month-old for discharge after treatment for dehydration following diarrhea. Which of the following would the nurse most likely include in the discharge teaching?

"Encourage bananas, applesauce, and crackers."

A nurse caring for Paulo, an infant born with a cleft palate, notices that the parents rarely interact with their child. The nurse overhears the mother telling her husband that she "feels like crying" every time she looks at their son. What would be the best response from the nurse?

"I sense you could use more information on caring for a cleft palate. Would you be interested in meeting with other parents who have dealt with this?"

The nurse is providing instructions to the parents of a 10-year-old boy who has undergone a barium swallow/upper and lower GI for suspected inflammatory bowel disease. Which of the following instructions is most important?

"It is very important to drink lots of water and fluids after the test is finished."

The nurse is collecting data on a 2 ½-year-old child admitted with a diagnosis of gastroenteritis. When interviewing the caregivers, which question is most important for the nurse to ask?

"Tell me about the types of stools you child has been having."

A physician recommends a gastrostomy for a 4-year-old client with an obstruction. The parents ask the certified wound, ostomy, and continence nurse (CWOCN) what the surgery entails. What is the nurse's best response?

"The surgery creates an opening between the stomach and abdominal wall."

The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis?

"The treatment for the disorder will be a surgical procedure."

A child is experiencing an acute exacerbation of Crohn disease for which she is prescribed prednisone. The nurse teaches the parents and child about this medication. Which statement by the parents indicates that the teaching was successful?

"We should not stop this medication abruptly."

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?

7 to 14 days

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of congenital aganglionic megacolon?

A partial or complete intestinal obstruction occurs.

The nurse is to obtain a stool specimen from a 4-year-old child who has very liquid stool. The child is ambulatory but weak. Which collection method would be most effective for the nurse to use?

Apply a urine bag to the anal area.

A child with cirrhosis of the liver is admitted to the acute care facility in preparation for a liver transplant. When completing the physical examination, which of the following would the nurse expect to assess?

Assessment findings associated with cirrhosis include jaundice, ascites, spider angiomas, and palmar erythema. Fatty stools are associated with celiac disease.

A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason?

Detect Helicobacter pylori

A nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. What GI condition might this history precipitate?

Esophageal atresia (EA)

A child is diagnosed with short bowel syndrome. Which of the following would the nurse expect to be included in the child's plan of care?

For the child with short bowel syndrome, typically, antibiotics, vitamin and mineral supplements, antidiarrheal agents, and total parenteral nutrition are prescribed. Laxatives and immunosuppressants are not used.

The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis?

Hard, moveable "olive-like mass" in the upper right quadrant

An adolescent boy is diagnosed with hepatitis A. Which problem should be considered when planning care?

He will become fatigued easily.

A neonatal nurse teaches students how to recognize gastrointestinal disorders in infants. The nurse tells the students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease?

Hirschsprung disease

The nurse is caring for a child with a diagnosis of pyloric stenosis during the preoperative phase of the child's treatment. What is the highest priority at this time?

Improving hydration

A 9-month-old girl is brought to the emergency room with what appears to be bouts of intense abdominal pain 15 minutes apart in which she draws up her legs and cries, often accompanied by vomiting. In between the bouts, the child recovers and appears to be without symptoms. Blood is found in the stool. What condition should the nurse suspect in this case?

Intussusception

The nurse is caring for a neonate who has undergone an intestinal pull-through procedure for an imperforate anus. Which of the following would be most important for the nurse to do postoperatively?

Listening for bowel sounds

A 10-year-old male presents with low-grade fever, nausea, and abdominal pain. The nurse examining him suspects appendicitis and checks for rebound tenderness in what quadrant?

Lower right

A mother brings her 10-year-old son to the ER with complaints of abdominal pain. The nurse performing a physical assessment notes the following symptoms: upper right quadrant pain that radiates to the back; fever; nausea; and abdominal distention. Which disease would the nurse consider as a diagnosis?

Pancreatitis

The nurse is obtaining the history of an infant with a suspected intestinal obstruction. Which response regarding newborn stool patterns would indicate a need for further evaluation for Hirschsprung disease?

Passed a meconium plug

A nurse is assessing an infant who has been vomiting and experiencing diarrhea. Which of the following would indicate to the nurse that the infant is experiencing severe dehydration? Select all that apply.

• Sunken fontanels • Bradycardia • Cool mottled extremities

The nurse is caring for a 2-year-old boy with an umbilical hernia and is teaching the mother about this condition. Which of the following responses from the mother indicates a need for further teaching?

"I can tape a quarter over the hernia to reduce it."

A nurse is caring for a 6-year-old girl recently diagnosed with celiac disease and is discussing dietary restrictions with the girl's mother. Which response indicates a need for further teaching?

"My daughter can eat any kind of fruit."

The nurse is caring for a 4-year-old with oral vesicles and ulcers from herpangina. The child is refusing fluids due to the pain and the mother is concerned about his hydration status. Which of the suggestions would be most appropriate?

"Offer 'magic mouthwash' followed by a popsicle."

The nurse is conducting a physical examination of an 18-month-old with suspected intussusception. Which of the following findings would the nurse identify as the hallmark of this condition?

A sausage-shaped mass in the upper midabdomen

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of pyloric stenosis?

A thickened, elongated muscle causes an obstruction at the end of the stomach.

The nurse is doing dietary teaching with the caregivers of a child diagnosed with idiopathic celiac disease. Of the following foods, which would most likely be appropriate in the child's diet?

Bananas

A child is diagnosed with intussusception. The nurse anticipates that which of the following would be attempted first to reduce this condition?

Barium enema

The nurse is taking a health history of a 2-year-old girl presenting with a sudden onset of severe vomiting. Which of the following descriptions would suggest an obstruction distal to the ampulla of Vater?

Bilious vomiting

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?

Mother age 42 with pregnancy.

The nurse is examining a 7-year-old with suspected appendicitis. Which of the following physical findings would indicate the possibility of appendicitis?

Persistent, right lower quadrant pain with rebound tenderness

A 12-year-old boy has just undergone a liver transplantation and is recovering. After performing a finger stick puncture and assessing the results, the nurse administers a 10% solution of dextrose IV. What is the correct rationale for this intervention?

Prevention of hypoglycemia

The nurse is caring for a 2-month-old boy who is receiving IV fluids for dehydration due to gastroenteritis. The infant's initial fluid balance has been restored and the physician has ordered IV fluids at a maintenance rate. Due to the child's age, the nurse must be aware of which of the following key observations?

Signs of skin tenting

The nurse is caring for a 6-month-old infant who was admitted to the emergency room 24 hours ago with signs of severe diarrhea. The infant's rectal temperature is 104° F (40° C), with weak and rapid pulse and respirations. The skin is pale and cool. The child is on IV rehydration therapy, but the diarrhea is persisting. The infant has not voided since being admitted. Which is the priority nursing intervention?

Take a stool culture

Noah is an 18-month-old who is brought to the ER with flu-like symptoms. He is diagnosed with pneumonia secondary to aspiration of stomach contents. The nurse explains to the parents that pneumonia is a condition that often occurs secondary to:

gastroesophageal reflux disease.

The nurse is assessing a child with suspected necrotizing enterocolitis. Which of the following would the nurse expect to find? Select all that apply.

• Abdominal distention • Bilious vomiting

A group of nursing students are reviewing information about celiac disease. The students demonstrate understanding of this disorder when they identify which classic symptoms?

• Failure to thrive • Constipation • Diarrhea • Steatorrhea

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. Which of the following would the nurse incorporate into the teaching plan? Select all that apply.

• Giving the child small frequent feedings • Administering prokinetics to empty the stomach quickly • Keeping the child upright for 30 minutes after feeding

The nurse examining an infant forms the following diagnosis: "Risk for impaired skin integrity related to effects of diarrhea." This diagnosis would be most appropriate for which disease states? Select all that apply.

• Inflammatory bowel disease • Crohn disease • Ulcerative colitis