Pedi Gastro Q&A

1. A nurse is assessing an infant. Which of the following are clinical manifestations of hypertrophic pyloric stenosis? (Select all that apply.) A.`Projectile vomiting B. Dry mucus membranes C. Currant jelly stools D. Sausage-shaped abdominal mass E. Constant hunger

1. A. CORRECT: A client who has a pyloric stricture has thickening of the pyloric sphincter, resulting in projectile vomiting. B. CORRECT: A client who has pyloric stricture is unable to consume adequate food and fluid, resulting in dehydration. Dry mucous membranes is a clinical manifestation of hypertrophic pyloric stenosis. C. INCORRECT: A client who has intussusception have bloody mucus stools, resulting in currant jelly stools. D. INCORRECT: A client who has intussusception have telescoping intestine, resulting sausage shaped abdominal mass. E. CORRECT: A client who has pyloric stricture is unable to consume adequate food and fluid, resulting in constant hunger. NCLEX® Connection: Physiological Adaptations, Pathophysiology

The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which symptom of this disorder documented? 1. Watery diarrhea 2. Ribbon-like stools 3. Profuse projectile vomiting 4. Bright red blood and mucus in the stools

4. Bright red blood and mucus in the stools Rationale: Intussusception is a telescoping of one portion of the bowel into another. The condition results in an obstruction to the passage of intestinal contents. A child with intussusception typically has severe abdominal pain that is crampy and intermittent, causing the child to draw in the knees to the chest. Vomiting may be present, but is not projectile. Bright red blood and mucus are passed through the rectum and commonly are described as currant jelly-like stools. Watery diarrhea and ribbon-like stools are not manifestations of this disorder.

The nurse is reviewing the laboratory results for an infant with suspected hypertrophic pyloric stenosis. What should the nurse expect to note as the most likely finding in this infant? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

2. Metabolic alkalosis Rationale: Laboratory findings in an infant with hypertropic pyloric stenosis include metabolic alkalosis as a result of the vomiting that occurs in this disorder. Additional findings include decreased serum potassium and sodium levels, increased pH and bicarbonate level, and decreased chloride level. Options 1, 3, and 4 are incorrect.

An emergency department nurse is performing an assessment on a child with a suspected diagnosis of intussusception. Which assessment question for the parents will elicit the most specific data related to this disorder? 1. "Does the child have any food allergies?" 2. "What do the bowel movements look like?" 3. "Has the child eaten any food in the last 24 hours?" 4. "Can you describe the type of pain that the child is experiencing?"

4. "Can you describe the type of pain that the child is experiencing?" Rationale: A report of severe colicky abdominal pain in a healthy, thriving child between 3 and 17 months of age is the classic presentation of intussusception. Typical behavior includes screaming and drawing the knees up to the chest. Options 1, 2, and 3 are important aspects of a health history but are not specific to the diagnosis of intussusception.

The clinic nurse reviews the record of an infant and notes that the health care provider has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which symptom most likely led the mother to seek health care for the infant? 1. Diarrhea 2. Projectile vomiting 3. Regurgitation of feedings 4. Foul-smelling ribbon-like stools

4. Foul-smelling ribbon-like stools Rationale: Hirschsprung's disease is a congenital anomaly also known as congenital aganglionosis or aganglionic megacolon. It occurs as the result of an absence of ganglion cells in the rectum and other areas of the affected intestine. Chronic constipation beginning in the first month of life and resulting in pellet-like or ribbon-like stools that are foul-smelling is a clinical manifestation of this disorder. Delayed passage or absence of meconium stool in the neonatal period is also a sign. Bowel obstruction especially in the neonatal period, abdominal pain and distention, and failure to thrive are also clinical manifestations. Options 1, 2, and 3 are not associated specifically with this disorder.

A 6weekold infant is brought by her parent into the clinic. The parent explains to the nurse that after feedings the infant vomits real strong. The nurse recognizes the symptoms of projectile vomiting. The nurse would correlate this symptom with what condition? 1. Tracheoesophageal fistula 2. Pyloric stenosis 3. Intussusception 4. Volvulus

Answer: 2 Rationale Vomiting in an infant with pyloric stenosis begins to develop between 4 and 6 weeks of age. The vomiting grows increasingly forceful until it is projectile, possibly projecting as much as 3 to 4 feet. Breastfed infants begin developing symptoms at approximately 6 weeks, because the curd of breast milk is smaller than that of cow's milk, and it passes through a hypertrophied muscle more easily. Symptoms of volvulus often follow those related to intestinal obstruction and include constipation, colicky abdominal pain, nausea, and abdominal distention. Symptoms of intussusception are characterized by sudden, severe abdominal pain vomiting and abdominal distention infant may pass a bloody stool (i.e., currant-jelly appearance). Symptoms of tracheoesophageal fistula include choking, coughing, and intermittent cyanosis during feeding, along with abdominal distention these are diagnosed most often at birth with the first feeding. (Hockenberry, Wilson, 9 ed., p. 1322.)

An infant is diagnosed with pyloric stenosis and is admitted for repair. The mother begins to cry and says, "I guess I am not a very good mother." What is the best nursing response? 1. Don't cry your baby is going to be just fine. 2. This is really a hard time for you, isnt it? Can I call someone? 3. Have you talked with the doctor about the cause of the problem? 4. Tell me, what makes you feel that you are not a good mother?

Answer: 4 Rationale This option focuses on therapeutic communication: a reflective, clarifying comment about what the mother has just said and encouragement to describe her feelings. The question asks for interpretation of mothers comment. The other options do not encourage expression of feelings, or they are blocks to therapeutic communication. (Potter, Perry, ed., p. 32.)

A child is diagnosed with Hirschsprung's disease. The nurse is teaching the parents about the cause of the disease. Which statement, if made by the parent, supports that teaching was successful? 1. "Special cells are not present in the rectum, which caused the disease." 2. "The protein part of wheat, barley, rye, and oats is not being digested fully." 3. "The disease occurs from increased bowel motility that leads to spasm and pain." 4. "The disease occurs because of inability to tolerate sugar found in dairy products."

1. "Special cells are not present in the rectum, which caused the disease." Rationale: Hirschsprung's disease also is known as congenital aganglionosis or megacolon. It results from the absence of ganglion cells in the rectum and, to various degrees, up into the colon. Option 2 describes celiac disease. Option 3 describes irritable bowel syndrome. Option 4 describes lactose intolerance.

The nurse is reviewing the laboratory test results for an infant suspected of having hypertrophic pyloric stenosis. The nurse should expect to note which value as the most likely laboratory finding in this infant? 1. Blood pH of 7.50 2. Blood pH of 7.30 3. Blood bicarbonate of 22 mEq/L 4. Blood bicarbonate of 19 mEq/L

1. Blood pH of 7.50 Rationale: Laboratory findings in an infant with hypertrophic pyloric stenosis include metabolic alkalosis due to vomiting. These include increased blood pH and bicarbonate level, decreased serum potassium and sodium levels, and a decreased chloride level. The normal pH is 7.35 to 7.45. The normal bicarbonate is 22 to 27 mm Hg.

2. A nurse is caring for a child who has Hirschsprung disease. Which of the following is an appropriate action for the nurse to take? A. Encourage a high-fiber, low-protein, low-calorie diet. B. Prepare the family for surgery. C. Place an NG for decompression. D. Initiate bedrest.

2. A. INCORRECT: A client who has Hirschsprung disease is encouraged to eat a low-fiber, high-protein, high-calorie diet. B. CORRECT: A client who has Hirschsprung disease requires surgery to remove the affected segment of the intestine. Preparing the family for surgery is an appropriate action for the nurse to take. C. INCORRECT: A client who has Hirschsprung disease is managed nutritionally. Placing an NG for decompression is not an appropriate action for the nurse to take. D. INCORRECT: A client who has Meckel's diverticulum is placed on bedrest to prevent further bleeding. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures

An infant is seen in the health care provider's office for complaints of projectile vomiting after feeding. Findings indicate that the child is fussy and is gaining weight but seems to never get enough to eat. Pyloric stenosis is suspected. Which prescription would the nurse anticipate having the highest priority in the care of this child? 1. Administer predigested formula. 2. Prepare the family for surgery for the child. 3. Administer omeprazole (Prilosec) before feeding. 4. Instruct the parents to keep a log of feedings and any reflux present.

2. Prepare the family for surgery for the child. Rationale: Infants with projectile vomiting after feeding that are fussy should be suspected of pyloric stenosis. The treatment for this diagnosis is surgery. The other options are treatment measures that may be prescribed for gastroesophageal reflux.

A mother brings her 5-week-old infant to the health care clinic and tells the nurse that the child has been vomiting after meals. The mother reports that the vomiting is becoming more frequent and forceful. The nurse suspects pyloric stenosis and asks the mother which assessment question to elicit data specific to this condition? 1. "Are the stools ribbon-like and is the infant eating poorly?" 2. "Does the infant suddenly become pale, begin to cry, and draw the legs up to the chest?" 3. "Does the vomit contain sour undigested food without bile, and is the infant constipated?" 4. "Does the infant cry loudly and continuously during the evening hours but nurses or takes formula well?

3. "Does the vomit contain sour undigested food without bile, and is the infant constipated?" Rationale: Option 3 presents classic symptoms of pyloric stenosis. Stools that are ribbon-like and a child who is eating poorly are signs of congenital megacolon (Hirschsprung's disease). An infant who suddenly becomes pale, cries out, and draws the legs up to chest is demonstrating physical signs of intussusception. Crying during the evening hours, appearing to be in pain, eating well, and gaining weight are clinical manifestations of colic.

A nurse is reviewing the health care provider's documentation in the record of a child admitted with a diagnosis of intussusception. The nurse expects to note that the health care provider has documented which manifestation? 1. Scleral jaundice 2. Projectile vomiting 3. Currant jelly stools 4. Pale-colored and hard stools

3. Currant jelly stools Rationale: In the child with intussusception, bright red blood and mucus are passed through the rectum, resulting in what is commonly described as currant jelly stools. The child classically presents with severe abdominal pain that is crampy and intermittent, causing the child to draw the knees in to the chest. Vomiting may be present, but not projectile. Options 1 and 4 are not manifestations of this disorder.

The nurse is collecting data on an infant with a diagnosis of suspected Hirschsprung's disease. Which question to the mother will most specifically elicit information regarding this disorder? 1. "Does your infant have diarrhea?" 2. "Is your infant constantly vomiting?" 3. "Does your infant constantly spit up feedings?" 4. "Does your infant have foul-smelling, ribbon-like stools?"

4. "Does your infant have foul-smelling, ribbon-like stools?" Rationale: Chronic constipation, beginning in the first month of life and resulting in pellet-like or ribbon stools that are foul-smelling, is a clinical manifestation of Hirschsprung's disease. Delayed passage or absence of meconium stool in the neonatal period is the primary sign. Bowel obstruction, especially in the neonatal period, abdominal pain and distention, and failure to thrive are also clinical manifestations. Options 1, 2, and 3 are not specific clinical manifestations of this disorder.

The nurse admits a child to the hospital with a diagnosis of pyloric stenosis. On assessment, which data would the nurse expect to obtain when asking the mother about the child's symptoms? 1. Watery diarrhea 2. Projectile vomiting 3. Increased urine output 4. Vomiting large amounts of bile

2. Projectile vomiting Rationale: In pyloric stenosis, hypertrophy of the circular muscles of the pylorus causes narrowing of the pyloric canal between the stomach and the duodenum. Clinical manifestations of pyloric stenosis include projectile vomiting, irritability, hunger and crying, constipation, and signs of dehydration including a decrease in urine output.

The nurse is caring for a client with a suspected intestinal obstruction. In what order would the nurse perform the abdominal assessment? 1. Auscultate for presence of bowel sounds. 2. Observe the contour of the abdomen. 3. Palpate to determine areas of tenderness. 4. Percuss to identify solid areas verses air.

Answer: 2,1,4,3 Rationale Assessment of the abdomen should include inspection first to observe for contour, symmetry, and any skin abnormalities. Auscultation is the next step. This is done prior to palpation and percussion to prevent the alteration of bowel sound. Next, palpation is used to detect any tenderness or rigidity. Finally, percussion is performed to determine if any fluid, distention, or masses exist. (Lewis, et al, 8 ed., p. 908910.)

A child is hospitalized because of persistent vomiting. The nurse should monitor the child closely for which problem? 1. Diarrhea 2. Metabolic acidosis 3. Metabolic alkalosis 4. Hyperactive bowel sounds

3. Metabolic alkalosis Rationale: Vomiting causes the loss of hydrochloric acid and subsequent metabolic alkalosis. Metabolic acidosis would occur in a child experiencing diarrhea because of the loss of bicarbonate. Diarrhea might or might not accompany vomiting. Hyperactive bowel sounds are not associated with vomiting.

The mother of an infant diagnosed with Hirschsprung's disease asks the nurse about the disorder. What should the nurse tell the mother about the disease? 1. It is complete small intestinal obstruction. 2. It is congenital aganglionosis or megacolon. 3. It is severe inflammation of the gastrointestinal tract. 4. It is condition that causes the pyloric valve to remain open

2. It is congenital aganglionosis or megacolon. Rationale: Hirschsprung's disease is also known as congenital aganglionosis or megacolon. It is the result of an absence of ganglion cells in the rectum and to varying degrees upward in the colon. The remaining options are incorrect descriptions.

After hydrostatic reduction for intussusception, the nurse should expect to observe which client response? 1. Abdominal distention 2. Currant jelly-like stools 3. Severe colicky-type pain with vomiting 4. Passage of barium or water-soluble contrast with stools

4. Passage of barium or water-soluble contrast with stools Rationale: Intussusception is the telescoping of one portion of the bowel into another. Hydrostatic reduction may be necessary to resolve the condition. After hydrostatic reduction, the nurse observes for the passage of barium or water-soluble contrast material with stools. Options 1 and 2 are clinical indicators of intussusception. Option 3 is a sign of an unresolved gastrointestinal disorder.

The nurse is developing a plan of care for an infant being admitted with hypertrophic pyloric stenosis who is scheduled for pyloromyotomy. In the preoperative period, which position should the nurse suggest to document in the plan of care? 1. In an infant seat placed in the crib 2. Prone with the head of the bed elevated 3. Supine with the head at a 90-degree angle 4. Supine with the head of the bed at a 30-degree angle

2. Prone with the head of the bed elevated Rationale: In the preoperative period, the infant is positioned prone with the head of the bed elevated to reduce the risk of aspiration. Options 1, 3, and 4 are inappropriate positions for preventing this risk.

A 1-year-old child is diagnosed with intussusception, and the mother of the child asks the nurse to describe the disorder. Which statement is correct about intussusception? 1. "It is an acute bowel obstruction." 2. "It is a condition that causes an acute inflammatory process in the bowel." 3. "It is a condition in which a distal segment of the bowel prolapses into a proximal segment of the bowel." 4. "It is a condition in which a proximal segment of the bowel prolapses into a distal segment of the bowel."

4. "It is a condition in which a proximal segment of the bowel prolapses into a distal segment of the bowel." Rationale: Intussusception occurs when a proximal segment of the bowel prolapses into a distal segment of the bowel. It is not an acute bowel obstruction, but it is a common cause in infants and young children. It is not an inflammatory process.

A child is diagnosed with intussusception. On performing an assessment of the child, the nurse keeps in mind which finding as a characteristic of this disorder? 1. The presence of fecal incontinence 2. Incomplete development of the anus 3. The infrequent and difficult passage of dry stools 4. Invagination of a section of the intestine into the distal bowel

4. Invagination of a section of the intestine into the distal bowel Rationale: Intussusception is an invagination of a section of the intestine into the distal bowel. It is the most common cause of bowel obstruction in children aged 3 months to 6 years. The presence of fecal incontinence describes encopresis. Encopresis generally affects preschool and school-aged children. Incomplete development of the anus describes imperforate anus, and this disorder is diagnosed in the neonatal period. The infrequent and difficult passage of dry stools describes constipation. Constipation can affect any child at any time, although the incidence peaks at age 2 to 3 years.