Pediatric GI

Diagnosis of hepatitis B is confirmed by the detection of various hepatitis virus antigens, and the antibodies that are produced in response to the infection. Match the antibody or antigen to its definition. a. HBsAg b. Anti-HBs c. HBcAg d. HBeAg 1. Indicates active infection 2. Detected only in the liver 3. Indicates resolving or past infection 4. Indicates ongoing infection or carrier state

1 D 2 C 3 B 4 A

What information should the nurse include when teaching an adolescent with Crohn disease (CD)? a. How to cope with stress and adjust to chronic illness b. Preparation for surgical treatment and cure of CD c. Nutritional guidance and prevention of constipation d. Prevention of spread of illness to others and principles of high-fiber diet

A CD is a chronic illness with a variable course and many potential complications. Guidance about living with chronic illness is essential for adolescents. Stress management techniques can help with exacerbations and possible limitations caused by the illness. At this time, there is no cure for CD. Surgical intervention may be indicated for complications that cannot be controlled by medical and nutritional therapy. Nutritional guidance is an essential part of management. Constipation is not usually an issue with CD. CD is not infectious, so transmission is not a concern. A low-fiber diet is indicated.

The nurse admits an infant with vomiting and the diagnosis of hypertrophic pyloric stenosis. Which metabolic alteration should the nurse plan to assess for with this infant? a. Metabolic alkalosis b. Metabolic acidosis c. Respiratory acidosis d. Respiratory alkalosis

A Frequent projectile vomiting, characteristic of pyloric stenosis, results in a loss of nonvolatile acids that decreases hydrogen ion concentration. This results in an excess of bicarbonate that increases arterial pH above 7.45 (metabolic alkalosis). Metabolic acidosis, respiratory acidosis, and respiratory alkalosis do not result from vomiting.

What intervention is contraindicated in a suspected case of appendicitis? a. Enemas b. Palpating the abdomen c. Administration of antibiotics d. Administration of antipyretics for fever

A In any instance in which severe abdominal pain is observed and appendicitis is suspected, the nurse must be aware of the danger of administering laxatives or enemas. Such measures stimulate bowel motility and increase the risk of perforation. The abdomen is palpated after other assessments are made. Antibiotics should be administered, and antipyretics are not contraindicated.

What is an expected outcome for the child with irritable bowel disease? a. Decreasing symptoms b. Adherence to a low-fiber diet c. Increasing milk products in the diet d. Adapting the lifestyle to the lifelong problems

A Management of irritable bowel disease is aimed at identifying and decreasing exposure to triggers and decreasing bowel spasms, which will decrease symptoms. Management includes maintenance of a healthy, well-balanced, moderate-fiber, lower-fat diet. A moderate amount of fiber in the diet is indicated for the child with irritable bowel disease. No modification in dairy products is necessary unless the child is lactose intolerant. Irritable bowel syndrome is typically self-limiting and resolves by age 20 years.

What statement best describes Hirschsprung disease? a. The colon has an aganglionic segment. b. It results in frequent evacuation of solids, liquid, and gas. c. The neonate passes excessive amounts of meconium. d. It results in excessive peristaltic movements within the gastrointestinal tract.

A Mechanical obstruction in the colon results from a lack of innervation. In most cases, the aganglionic segment includes the rectum and some portion of the distal colon. There is decreased evacuation of the large intestine secondary to the aganglionic segment. Liquid stool may ooze around the blockage. The obstruction does not affect meconium production. The infant may not be able to pass the meconium stool. There is decreased movement in the colon.

An infant with short bowel syndrome will be on total parenteral nutrition (TPN) for an extended period of time. What should the nurse monitor the infant for ? a. Central venous catheter infection, electrolyte losses, and hyperglycemia b. Hypoglycemia, catheter migration, and weight gain c. Venous thrombosis, hyperlipidemia, and constipation d. Catheter damage, red currant jelly stools, and hypoglycemia

A Numerous complications are associated with short bowel syndrome and long-term TPN. Infectious, metabolic, and technical complications can occur. Sepsis can occur after improper care of the catheter. The gastrointestinal tract can also be a source of microbial seeding of the catheter. The nurse should monitor for catheter infection, electrolyte losses, and hyperglycemia. Hypoglycemia, weight gain, constipation, or red currant jelly stools are not characteristics of short bowel syndrome with extended TPN.

A child is being admitted to the hospital with acute gastroenteritis. The health care provider prescribes an antiemetic. What antiemetic does the nurse anticipate being prescribed? a. Ondansetron (Zofran) b. Promethazine (Phenergan) c. Metoclopramide (Reglan) d. Dimenhydrinate (Dramamine)

A Ondansetron reduces the duration of vomiting in children with acute gastroenteritis. This would be the expected prescribed antiemetic. Adverse effects with earlier generation antiemetics (e.g., promethazine and metoclopramide) include somnolence, nervousness, irritability, and dystonic reactions and should not be routinely administered to children. For children who are prone to motion sickness, it is often helpful to administer an appropriate dose of dimenhydrinate (Dramamine) before a trip, but it would not be ordered as an antiemetic.

What is the purpose in using cimetidine (Tagamet) for gastroesophageal reflux? a. The medication reduces gastric acid secretion. b. The medication neutralizes the acid in the stomach. c. The medication increases the rate of gastric emptying time. d. The medication coats the lining of the stomach and esophagus.

A Pharmacologic therapy may be used to treat infants and children with gastroesophageal reflux disease. Both H2-receptor antagonists (cimetidine [Tagamet], ranitidine [Zantac], or famotidine [Pepcid]) and proton pump inhibitors (esomeprazole [Nexium], lansoprazole [Prevacid], omeprazole [Prilosec], pantoprazole [Protonix], and rabeprazole [Aciphex]) reduce gastric hydrochloric acid secretion.

Which order should the nurse question when caring for a child after surgery for Hirschsprungs disease? a. Monitor rectal temperature every 4 hours and report an elevation greater than 38.5 C. b. Assess stools after surgery. c. Keep the child NPO until bowel sounds return. d. Maintain IV fluids at an ordered rate.

A Rectal temperatures should not be taken after this surgery. Rectal temperatures are generally not the route of choice for children because of the routes traumatic nature. Assessing stools after surgery is an appropriate intervention postoperatively. Stools should be soft and formed. Keeping the child NPO until bowel sounds return is an appropriate intervention postoperatively. Maintaining IV fluids at an ordered rate is an appropriate postoperative order.

A child with acute gastrointestinal bleeding is admitted to the hospital. The nurse observes which sign or symptom as an early manifestation of shock? a. Restlessness b. Rapid capillary refill c. Increased temperature d. Increased blood pressure

A Restlessness is an indication of impending shock in a child. Capillary refill is slowed in shock. The child will feel cool. The blood pressure initially remains within the normal range and then declines.

What test is used to screen for carbohydrate malabsorption? a. Stool pH b. Urine ketones c. C urea breath test d. ELISA stool assay

A The anticipated pH of a stool specimen is 7.0. A stool pH of less than 5.0 is indicative of carbohydrate malabsorption. The bacterial fermentation of carbohydrates in the colon produces short-chain fatty acids, which lower the stool pH. Urine ketones detect the presence of ketones in the urine, which indicates the use of alternative sources of energy to glucose. The C urea breath test measures the amount of carbon dioxide exhaled. It is used to determine the presence of Helicobacter pylori. ELISA (enzyme-linked immunosorbent assay) detects the presence of antigens and antibodies. It is not useful for disorders of metabolism.

Which food choice by a parent of a 2-year-old child with celiac disease indicates a need for further teaching? a. Oatmeal b. Rice cake c. Corn muffin d. Meat patty

A The child with celiac disease is unable to fully digest gluten, the protein found in wheat, barley, rye, and oats. Oatmeal contains gluten and is not an appropriate food selection. Rice is an appropriate choice because it does not contain gluten. Corn is digestible because it does not contain gluten. Meats do not contain gluten and can be included in the diet of a child with celiac disease.

A 2-year-old child has a chronic history of constipation and is brought to the clinic for evaluation. What should the therapeutic plan initially include? a. Bowel cleansing b. Dietary modification c. Structured toilet training d. Behavior modification

A The first step in the treatment of chronic constipation is to empty the bowel and allow the distended rectum to return to normal size. Dietary modification is an important part of the treatment. Increased fiber and fluids should be gradually added to the childs diet. A 2-year-old child is too young for structured toilet training. For an older child, a regular schedule for toileting should be established. Behavior modification is part of the overall treatment plan. The child practices releasing the anal sphincter and recognizing cues for defecation.

Which is the best response for the nurse to make to parents who ask why their infant has a nasogastric tube to intermittent suction after abdominal surgery? a. The nasogastric tube decompresses the abdomen and decreases vomiting. b. We can keep a more accurate measure of intake and output with the nasogastric tube. c. The tube is used to decrease postoperative diarrhea. d. Believe it or not, the nasogastric tube makes the baby more comfortable after surgery.

A The nasogastric tube provides decompression and decreases vomiting. A nursing responsibility when a patient has a nasogastric tube is measurement of accurate intake and output, but this is not why nasogastric tubes are inserted. Nasogastric tube placement does not decrease diarrhea. The presence of a nasogastric tube can be perceived as a discomfort by the patient.

Which prescribed formula should the nurse plan to provide for an infant with lactose intolerance? a. Isomil b. Enfamil c. Similac d. Good Start

A The treatment for lactose intolerance is removal of lactose from the diet. Formulas that do not contain lactose (Isomil, Nursoy, Nutramigen, Prosobee, and other soy-based formulas) may be given to the infant suspected of having lactose intolerance. Enfamil, Similac, and Good Start are all milk-based formulas.

The nurse notes on assessment that a 1-year-old child is underweight, with abdominal distention, thin legs and arms, and foul-smelling stools. The nurse suspects failure to thrive associated with which condition? a. Celiac disease b. Intussusception c. Irritable bowel syndrome d. Imperforate anus

A These are classic symptoms of celiac disease. Intussusception is not associated with failure to thrive or underweight, thin legs and arms, and foul-smelling stools. Stools are like currant jelly. Irritable bowel syndrome is characterized by diarrhea and pain, and the child does not typically have thin legs and arms. Imperforate anus is the incomplete development or absence of the anus in its normal position in the perineum. Symptoms are evident in early infancy.

After surgery yesterday for gastroesophageal reflux, the nurse finds that the infant has somehow removed the nasogastric (NG) tube. What nursing action is most appropriate to perform at this time? a. Notify the practitioner. b. Insert the NG tube so feedings can be given. c. Replace the NG tube to maintain gastric decompression. d. Leave the NG tube out because it has probably been in long enough.

A When surgery is performed on the upper gastrointestinal tract, usually the surgical team replaces the NG tube because of potential injury to the operative site. The decision to replace the tube or leave it out is made by the surgical team. Replacing the tube is also usually done by the practitioner because of the surgical site.

A nurse is teaching a group of parents about tracheoesophageal fistula. Which statement, made by the nurse, is accurate about tracheoesophageal fistula (TEF)? a. This defect results from an embryonal failure of the foregut to differentiate into the trachea and esophagus. b. It is a fistula between the esophagus and stomach that results in the oral intake being refluxed and aspirated. c. An extra connection between the esophagus and trachea develops because of genetic abnormalities. d. The defect occurs in the second trimester of pregnancy.

A When the foregut does not differentiate into the trachea and esophagus during the fourth to fifth week of gestation, a TEF occurs. TEF is an abnormal connection between the esophagus and trachea. There is no connection between the trachea and esophagus in normal fetal development. Tracheoesophageal fistula occurs early in pregnancy during the fourth to fifth week of gestation.

The nurse is preparing to admit a 10-year-old child with appendicitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Fever b. Vomiting c. Tachycardia d. Flushed face e. Hyperactive bowel sounds

A, B, C Clinical manifestations of appendicitis include fever, vomiting, and tachycardia. Pallor is seen, not a flushed face, and the bowel sounds are hypoactive or absent, not hyperactive.

The school nurse is teaching a group of adolescents about avoiding contaminated water during a mission trip. What should the nurse include in the teaching? (Select all that apply.) a. Ice b. Meats c. Raw vegetables d. Unpeeled fruits e. Carbonated beverages

A, B, C, D The best measure during travel to areas where water may be contaminated is to allow children to drink only bottled water and carbonated beverages (from the container through a straw supplied from home). Children should also avoid tap water, ice, unpasteurized dairy products, raw vegetables, unpeeled fruits, meats, and seafood.

The nurse is preparing to admit a 5-year-old child with hepatitis A. What clinical features of hepatitis A should the nurse recognize? (Select all that apply.) a. The onset is rapid. b. Fever occurs early. c. There is usually a pruritic rash. d. Nausea and vomiting are common. e. The mode of transmission is primarily by the parenteral route.

A, B, D Clinical features of hepatitis A include a rapid onset, fever occurring early, and nausea and vomiting. A rash is rare, and the mode of transmission is by the fecaloral route, rarely by the parenteral route.

The nurse is preparing to admit a 7-year-old child with Crohn disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Pain is common. b. Weight loss is severe. c. Rectal bleeding is common. d. Diarrhea is moderate to severe. e. Anal and perianal lesions are rare.

A, B, D Clinical manifestations of Crohn disease include pain, severe weight loss, and moderate to severe diarrhea. Rectal bleeding is rare, but anal and perianal lesions are common.

The nurse is preparing to admit a 6-year-old child with irritable bowel syndrome (IBS). What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Flatulence b. Constipation c. No urge to defecate d. Absence of abdominal pain e. Feeling of incomplete evacuation of the bowel

A, B, E Children with IBS often have alternating diarrhea and constipation, flatulence, bloating or a feeling of abdominal distention, lower abdominal pain, a feeling of urgency when needing to defecate, and a feeling of incomplete evacuation of the bowel.

The nurse is teaching parents of a child with gastroesophageal reflux (GER) disease foods that can exacerbate acid reflux. What foods should be included in the teaching session? (Select all that apply.) a. Citrus b. Bananas c. Spicy foods d. Peppermint e. Whole wheat bread

A, C, D Avoidance of certain foods that exacerbate acid reflux (e.g., caffeine, citrus, tomatoes, alcohol, peppermint, spicy or fried foods) can improve mild GER symptoms. Bananas and whole wheat bread will not exacerbate acid reflux.

The nurse is preparing to admit a 6-month-old child with gastroesophageal reflux disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Spitting up b. Bilious vomiting c. Failure to thrive d. Excessive crying e. Respiratory problems

A, C, D, E Clinical manifestations of gastroesophageal reflux disease include spitting up, failure to thrive, excessive crying, and respiratory problems. Hematemesis, not bilious vomiting, is a manifestation.

The nurse is preparing to admit a 6-year-old child with celiac disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Steatorrhea b. Polycythemia c. Malnutrition d. Melena stools e. Foul-smelling stools

A, C, E Clinical manifestations of celiac disease include impaired fat absorption (steatorrhea and foul-smelling stools) and impaired nutrient absorption (malnutrition). Anemia, not polycythemia, is a manifestation, and melena stools do not occur.

The nurse is preparing to admit a 2-month-old child with hypertrophic pyloric stenosis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Weight loss b. Bilious vomiting c. Abdominal pain d. Projectile vomiting e. The infant is hungry after vomiting

A, D, E Clinical manifestations of hypertrophic pyloric stenosis include weight loss, projectile vomiting, and hunger after vomiting. The vomitus is nonbilious, and there is no evidence of pain or discomfort, just chronic hunger.

A 10-year-old boy is admitted to the hospital with a diagnosis of appendicitis. He is nauseated, febrile, and complaining of severe abdominal pain radiating to the right lower quadrant. During a routine nursing check, he states that his stomach doesnt hurt anymore. The nurse should suspect that: a. he is anxious about surgery. b. his appendix has ruptured. c. he does not communicate effectively about pain. d. his nausea and vomiting have decreased, thereby relieving his abdominal pain.

B A classic symptom indicating appendix rupture is the sudden relief of pain. The boy may be anxious, but this will not cause his pain to disappear. There is no evidence to substantiate the assumption that he does not communicate effectively about pain. His nausea and vomiting have not decreased, nor will this affect his abdominal pain.

What is an expected outcome for a 1-month-old infant with biliary atresia? a. Correction of the defect with the Kasai procedure b. Adequate nutrition and age-appropriate growth and development c. Increased blood pressure and adherence to a salt-free diet d. Adequate protein intake

B Adequate nutrition, preventing skin breakdown, adequate growth and development, and family education and support are expected outcomes in an infant with biliary atresia. The goal of the Kasai procedure is to allow for adequate growth until a transplant can be done. It is not a curative procedure. Although blood pressure typically is elevated, a modified salt diet is appropriate. Protein intake may need to be restricted to avoid hepatic encephalopathy.

What statement is most descriptive of Meckel diverticulum? a. It is acquired during childhood. b. Intestinal bleeding may be mild or profuse. c. It occurs more frequently in females than in males. d. Medical interventions are usually sufficient to treat the problem.

B Bloody stools are often a presenting sign of Meckel diverticulum. It is associated with mild to profuse intestinal bleeding. Meckel diverticulum is the most common congenital malformation of the gastrointestinal tract and is present in 1% to 4% of the general population. It is more common in males than in females. The standard therapy is surgical removal of the diverticulum.

A toddlers mother calls the nurse because she thinks her son has swallowed a button type of battery. He has no signs of respiratory distress. The nurses response should be based on which premise? a. An emergency laparotomy is very likely. b. The location needs to be confirmed by radiographic examination. c. Surgery will be necessary if the battery has not passed in the stool in 48 hours. d. Careful observation is essential because an ingested battery cannot be accurately detected.

B Button batteries can cause severe damage if lodged in the esophagus. If both poles of the battery come in contact with the wall of the esophagus, acid burns, necrosis, and perforation can occur. If the battery is in the stomach, it will most likely be passed without incident. Surgery is not indicated. The battery is metallic and is readily seen on radiologic examination.

Which is the best nursing response to a mother asking about the cause of her infants bilateral cleft lip? a. Did you have trouble with this pregnancy? b. Do you know of anyone in your or the fathers family born with cleft lip or palate problems? c. This defect is associated with intrauterine infection during the second trimester. d. Was your husband in the military and involved in chemical warfare?

B Cleft lip and palate result from embryonic failure resulting from multiple genetic and environmental factors. A genetic pattern or familial risk seems to exist. A troublesome pregnancy has not been associated with bilateral cleft lip. The defect occurred at approximately 6 to 8 weeks of gestation. Second-trimester intrauterine infection is not a known cause of bilateral cleft lip. Chemical warfare is not significantly associated with bilateral cleft lip and palate.

Which assessment finding should the nurse expect in an infant with Hirschsprungs disease? a.Currant jelly stools b. Constipation with passage of foul-smelling, ribbon-like stools c. Foul-smelling, fatty stools d. Diarrhea

B Constipation results from the absence of ganglion cells in the rectum and colon and is present since the neonatal period with passage of frequent foul-smelling, ribbon-like, or pellet-like stools. Currant jelly stools are associated with intussusception. Foul-smelling, fatty stools are associated with cystic fibrosis and celiac disease. Diarrhea is not typically associated with Hirschsprungs disease but may result from impaction.

A nurse is conducting a teaching session to adolescents about Crohns disease. Which statement, made by the nurse, is the most accurate? a. Crohns disease is responsive to dietary modifications. b. Crohns disease can occur anywhere in the gastrointestinal tract. c. Edema usually accompanies this disease. d. Symptoms of Crohns disease usually disappear by late adolescence.

B Crohns disease can occur anywhere in the GI tract from the mouth to the anus and is most common in the terminal ileum. Maintaining a low-fiber, low-residue, and milk-free diet may give the child some relief; however, strict restrictions may not alleviate symptoms. Diarrhea and malabsorption from Crohns disease cause weight loss, anorexia, dehydration, and growth failure. Edema does not accompany this disease. Crohns disease is a long-term health problem. Symptoms do not typically disappear by adolescence.

What should preoperative care of a newborn with an anorectal malformation include? a. Frequent suctioning b. Gastrointestinal decompression c. Feedings with sterile water only d. Supine position with head elevated

B Gastrointestinal decompression is an essential part of nursing care for a newborn with an anorectal malformation. This helps alleviate intraabdominal pressure until surgical intervention. Suctioning is not necessary for an infant with this type of anomaly. Feedings are not indicated until it is determined that the gastrointestinal tract is intact. Supine position with head elevated is indicated for infants with a tracheoesophageal fistula, not anorectal malformations.

An infant has been admitted to the Neonatal Intensive Care Unit (NICU) with a congenital gastroschisis. Which intervention should the nurse perform first upon admission to the unit? a. Place the infant flat and prone. b. Cover the defect with sterile warm, moist gauze and wrap with plastic. c. Begin a gestational age assessment. d. Wrap the infant in a warm blanket and allow the father to hold the infant briefly.

B Gastroschisis is the protrusion of intraabdominal contents through a defect in the abdominal wall lateral to the umbilical ring. There is no peritoneal sac. The defect should be immediately wrapped in warm, moist, sterile gauze and covered with plastic to keep moist. The infant cannot be placed prone as more damage could occur to the defect. Movement of the infant should be minimized so gestational age assessment and parental holding would be done after the infant is stabilized.

What is the most important action to prevent the spread of gastroenteritis in a daycare setting? a. Administering prophylactic medications to children and staff b. Frequent hand washing c. Having parents bring food from home d. Directing the staff to wear gloves at all times

B Hand washing is the most the important measure to prevent the spread of infectious diarrhea. Prophylactic medications are not helpful in preventing gastroenteritis. Bringing food from home will not prevent the spread of infectious diarrhea. Gloves should be worn when changing diapers, soiled clothing, or linens. They do not need to be worn for interactions that do not involve contact with secretions.

The nurse is discussing home care with a mother whose 6-year-old child has hepatitis A. What information should the nurse include? a. Advise bed rest until 1 week after the icteric phase. b. Teach infection control measures to family members. c. Inform the mother that the child cannot return to school until 3 weeks after onset of jaundice. d. Reassure the mother that hepatitis A cannot be transmitted to other family members.

B Hand washing is the single most effective measure in preventing and controlling hepatitis. Hepatitis A can be transmitted through the fecaloral route. Family members must be taught preventive measures. Rest and quiet activities are essential and adjusted to the childs condition, but bed rest is not necessary. The child is not infectious 1 week after the onset of jaundice and may return to school as activity level allows.

A 6-month-old infant with Hirschsprung disease is scheduled for a temporary colostomy. What should postoperative teaching to the parents include? a.Dilating the stoma b.Assessing bowel function c.Limitation of physical activities d.Measures to prevent prolapse of the rectum

B In the postoperative period, the nurse involves the parents in the care of the child with a temporary colostomy, allowing them to help with feedings and observe for signs of wound infection or irregular passage of stool (constipation or true incontinence). Some children will require daily anal dilatations in the postoperative period to avoid anastomotic strictures but not stoma dilatations. Physical activities should be encouraged. There is not a risk of prolapse of the rectum in Hirschsprung disease, just strictures.

An adolescent with irritable bowel syndrome comes to see the school nurse. What information should the nurse share with the adolescent? a. A low-fiber diet is required. b. Stress management may be helpful. c. Milk products are a contributing factor. d. Pantoprazole (a proton pump inhibitor) is effective in treatment.

B Irritable bowel syndrome is believed to involve motor, autonomic, and psychologic factors. Stress management, environmental modification, and psychosocial intervention may reduce stress and gastrointestinal symptoms. A high-fiber diet with psyllium supplement is often beneficial. Milk products can exacerbate bowel problems caused by lactose intolerance. Antispasmodic drugs, antidiarrheal drugs, and simethicone are beneficial for some individuals. Proton pump inhibitors have no effect.

An infant with short bowel syndrome is receiving total parenteral nutrition (TPN). The practitioner has added continuous enteral feedings through a gastrostomy tube. The nurse recognizes this as important for which reason? a. Wean the infant from TPN the next day b. Stimulate adaptation of the small intestine c. Give additional nutrients that cannot be included in the TPN d. Provide parents with hope that the child is close to discharge

B Long-term survival without TPN depends on the small intestines ability to increase its absorptive capacity. Continuous enteral feedings facilitate the adaptation. TPN is indicated until the child is able to receive all nutrition via the enteral route. Before this is accomplished, the small intestine must adapt and increase in cell number and cell mass per villus column. TPN is formulated to meet the infants nutritional needs. Continuous enteral feedings through a gastrostomy tube is a positive sign, but the infants ability to tolerate increasing amounts of enteral nutrition is only one factor that determines readiness for discharge.

Melena, the passage of black, tarry stools, suggests bleeding from which source? a. The perianal or rectal area b. The upper gastrointestinal (GI) tract c. The lower GI tract d. Hemorrhoids or anal fissures

B Melena is denatured blood from the upper GI tract or bleeding from the right colon. Blood from the perianal or rectal area, hemorrhoids, or lower GI tract would be bright red.

Which would be an expected outcome for the parents of a child with encopresis? a. The parents will give the child an enema daily for 34 months. b. The parents will develop a plan to achieve control over incontinence. c. The parents will have the child launder soiled clothes. d. The parents will supply the child with a low-fiber diet.

B Parents of the child with encopresis often feel guilty and believe that encopresis is willful on the part of the child. The family functions effectively by openly discussing problems and developing a plan to achieve control over incontinence. Stool softeners or laxatives, along with dietary changes, are typically used to treat encopresis. Enemas are indicated when a fecal impaction is present. Having the child launder soiled clothes is a punishment and will increase the childs shame and embarrassment. The child should not be punished for an action that is not willful. Increasing fiber in the diet and fluid intake results in greater bulk in the stool, making it easier to pass.

What procedure is most appropriate for assessment of an abdominal circumference related to a bowel obstruction? a. Measuring the abdomen after feedings b. Marking the point of measurement with a pen c. Measuring the circumference at the symphysis pubis d. Using a new tape measure with each assessment to ensure accuracy

B Pen marks on either side of the tape measure allow the nurse to measure the same spot on the childs abdomen at each assessment. The child most likely will be kept NPO (nothing by mouth) if a bowel obstruction is present. If the child is being fed, the assessment should be done before feedings. The symphysis pubis is too low. Usually the largest part of the abdomen is at the umbilicus. Leaving the tape measure in place reduces the trauma to the child.

What is a high-fiber food that the nurse should recommend for a child with chronic constipation? a. White rice b. Popcorn c. Fruit juice d. Ripe bananas

B Popcorn is a high-fiber food. Refined rice is not a significant source of fiber. Unrefined brown rice is a fiber source. Fruit juices are not a significant source of fiber. Raw fruits, especially those with skins and seeds, other than ripe bananas, have high fiber.

One of the major differences in clinical presentation between Crohn disease (CD) and ulcerative colitis (UC) is that UC is more likely to cause which clinical manifestation? a. Pain b. Rectal bleeding c. Perianal lesions d. Growth retardation

B Rectal bleeding is more common in UC than CD. Pain, perianal lesions, and growth retardation are common manifestations of CD.

Which nursing intervention is most helpful to parents of a neonate with bilateral cleft lip? a. Assure the parents that the correction will be immediate and uncomplicated. b. Show the parents before-and-after pictures of an infant whose cleft lip has been successfully repaired. c. Teach the parents about long-term enteral feedings. d. Refer the parents to a community agency that addresses this problem.

B Showing the parents pictures of successful lip repair promotes bonding and enhances coping ability. Correction is usually done around 4 weeks but may be done as early as 2 to 3 days after birth. The infant with a bilateral cleft lip can be fed orally using a compressible, longer nipple, and by making a larger hole in the nipple. Long-term enteral feedings are not usually indicated. A community agency referral is not appropriate at this time and may not be indicated long term.

Which dietary foods high in calcium should the nurse encourage a lactose intolerant child to eat? a. Yogurt b. Green leafy vegetables c. Cheese d. Rice

B The child between 1 and 10 years requires a minimum of 800 milligrams of calcium daily. Because high-calcium dairy products containing lactose are restricted from the childs diet, alternate sources such as egg yolk, green leafy vegetables, dried beans, and cauliflower must be provided to prevent hypocalcemia. Yogurt and cheese contain lactose. Rice is not high in calcium.

Nutritional management of the child with Crohn disease includes a diet that has which component? a. High fiber b. Increased protein c. Reduced calories d. Herbal supplements

B The child with Crohn disease often has growth failure. Nutritional support is planned to reduce ongoing losses and provide adequate energy and protein for healing. Fiber is mechanically hard to digest. Foods containing seeds may contribute to obstruction. A high-calorie diet is necessary to minimize growth failure. Herbal supplements should not be used unless discussed with the practitioner. Vitamin supplementation with folic acid, iron, and multivitamins is recommended.

Which assessment findings would be significant for a child with cirrhosis? a. Weight loss b. Change in level of consciousness c. Soft, smooth skin d. Pallor and cyanosis

B The child with cirrhosis must be assessed for encephalopathy, which is characterized by a change in level of consciousness. Encephalopathy can result from a buildup of ammonia in the blood from the incomplete breakdown of protein. One complication of cirrhosis is ascites. The child needs to be assessed for increasing abdominal girth and edema. A child who is retaining fluid will not exhibit weight loss. Biliary obstruction can lead to intense pruritus. The skin will be irritated from frequent scratching. A skin assessment would likely reveal jaundice. Pallor and cyanosis are associated with a cardiac problem.

A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. How should the nurse prepare this child? a. It is unnecessary because of childs age. b. It is essential because it will be an adjustment. c. Preparation is not needed because the colostomy is temporary. d. Preparation is important because the child needs to deal with negative body image.

B The childs age dictates the type and extent of psychologic preparation. When a colostomy is performed, it is necessary to prepare the child who is at least preschool age by telling him or her about the procedure and what to expect in concrete terms, with the use of visual aids. The preschooler is not yet concerned with body image.

The nurse is evaluating the laboratory results of a stool sample. What is a normal finding? a. The laboratory reports a stool pH of 5.0. b. The laboratory reports a negative guaiac. c. The laboratory reports low levels of enzymes. d. The laboratory reports reducing substances present.

B The normal stool finding is a negative guaiac. Stool pH should be 7.0 to 7.5. A stool pH <5.0 is suggestive of carbohydrate malabsorption; colonic bacterial fermentation produces short-chain fatty acids, which lower stool pH. There should be no enzymes or reducing substances present in a normal stool sample.

What therapeutic intervention provides the best chance of survival for a child with cirrhosis? a. Nutritional support b. Liver transplantation c. Blood component therapy d. Treatment with corticosteroids

B The only successful treatment for end-stage liver disease and liver failure may be liver transplantation, which has improved the prognosis for many children with cirrhosis. Liver transplantation reflects the failure of other medical and surgical measures to prevent or treat cirrhosis. Nutritional support is necessary for the child with cirrhosis, but it does not stop the progression of the disease. Blood components are indicated when the liver can no longer produce clotting factors. It is supportive therapy, not curative. Corticosteroids are not used in end-stage liver disease.

What signs or symptoms are most commonly associated with the prodromal phase of acute viral hepatitis? a. Bruising and lethargy b. Anorexia and malaise c. Fatigability and jaundice d. Dark urine and pale stools

B The signs and symptoms most common in the prodromal phase are anorexia, malaise, lethargy, and easy fatigability. Bruising would not be an issue unless liver damage has occurred. Jaundice is a late sign and often does not occur in children. Dark urine and pale stools would occur during the onset of jaundice (icteric phase) if it occurs.

The parents of a newborn with an umbilical hernia ask about treatment options. The nurses response should be based on which knowledge? a. Surgery is recommended as soon as possible. b. The defect usually resolves spontaneously by 3 to 5 years of age. c. Aggressive treatment is necessary to reduce its high mortality. d. Taping the abdomen to flatten the protrusion is sometimes helpful.

B The umbilical hernia usually resolves by ages 3 to 5 years of age without intervention. Umbilical hernias rarely become problematic. Incarceration, where the hernia is constricted and cannot be reduced manually, is rare. Umbilical hernias are not associated with a high mortality rate. Taping the abdomen flat does not help heal the hernia; it can cause skin irritation.

What immunization is recommended for all newborns? a. Hepatitis A vaccine b. Hepatitis B vaccine c. Hepatitis C vaccine d. Hepatitis A, B, and C vaccines

B Universal vaccination for hepatitis B is recommended for all newborns. Hepatitis A vaccine is recommended for infants starting at 12 months. No vaccine is currently available for hepatitis C.

The nurse is preparing to admit a 7-year-old child with hepatitis B. What clinical features of hepatitis B should the nurse recognize? (Select all that apply.) a. The onset is rapid. b. Rash is common. c. Jaundice is present d. No carrier state exists. e. The mode of transmission is principally by the parenteral route.

B, C, E Clinical features of hepatitis B include a rash, jaundice, and the mode of transmission principally by the parenteral route. The onset is insidious, not rapid, and a carrier state does exist.

The nurse is caring for a child with celiac disease. The nurse understands that what may precipitate a celiac crisis? (Select all that apply.) a. Exercise b. Infections c. Fluid overload d. Electrolyte depletion e. Emotional disturbance

B, D, E A celiac crisis can be precipitated by infections, electrolyte depletion, and emotional disturbance. Exercise or fluid overload does not precipitate a crisis.

The nurse is preparing to admit a 3-year-old child with intussusception. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Absent bowel sounds b. Passage of red, currant jellylike stools c. Anorexia d. Tender, distended abdomen e. Hematemesis f. Sudden acute abdominal pain

B, D, F Intussusception occurs when a proximal segment of the bowel telescopes into a more distal segment, pulling the mesentery with it and leading to obstruction. Clinical manifestations of intussusception include the passage of red, currant jellylike stools; a tender, distended abdomen; and sudden acute abdominal pain. Absent bowel sounds, anorexia, and hematemesis are clinical manifestations observed in other types of gastrointestinal dysfunction.

The nurse is teaching a parent of a 6-month-old infant with gastroesophageal reflux (GER) before discharge. What instructions should the nurse include? (Select all that apply.) a. Elevate the head of the bed in the crib to a 90-degree angle while the infant is sleeping. b. Hold the infant in the prone position after a feeding. c. Discontinue breastfeeding so that a formula and rice cereal mixture can be used. d. The infant will require the Nissen fundoplication after 1 year of age. e. Prescribed cimetidine (Tagamet) should be given 30 minutes before feedings.

B, E Discharge instructions for an infant with GER should include the prone position (up on the shoulder or across the lap) after a feeding. Use of the prone position while the infant is sleeping is still controversial. The American Academy of Pediatrics recommends the supine position to decrease the risk of sudden infant death syndrome even in infants with GER. Prescribed cimetidine or another proton pump inhibitor should be given 30 minutes before the morning and evening feeding so that peak plasma concentrations occur with mealtime. The head of the bed in the crib does not need to be elevated. The mother may continue to breastfeed or express breast milk to add rice cereal if recommended by the health care provider; thickening breast milk or formula with cereal is not recommended by all practitioners. The Nissen fundoplication is only done on infants with GER in severe cases with complications.

The nurse caring for a child with suspected appendicitis should question which physician prescriptions? a. Keep patient NPO. b. Start IV of D5/0.45 normal saline at 60 mL/hr. c. Apply K-pad to abdomen prn for pain. d. Obtain CBC on admission to the nursing unit.

C A K-pad (moist heat device) is contraindicated for suspected appendicitis because it may contribute to the rupture of the appendix. NPO status is appropriate for the potential appendectomy client. An IV is appropriate both as a preoperative intervention and to compensate for the short-term NPO status. Because appendicitis is frequently reflected in an elevated WBC, laboratory data are needed.

Which maternal assessment is related to the infants diagnosis of TEF? a. Maternal age more than 40 years b. First term pregnancy for the mother c. Maternal history of polyhydramnios d. Complicated pregnancy

C A maternal history of polyhydramnios is associated with TEF. Advanced maternal age is not a risk factor for TEF. The first term pregnancy is not a risk factor for an infant with TEF. Complicated pregnancy is not a risk factor for TEF.

What clinical manifestation should a nurse should be alert for when a diagnosis of esophageal atresia is suspected? a. A radiograph in the prenatal period indicates abnormal development. b. It is visually identified at the time of delivery. c. A nasogastric tube fails to pass at birth. d. The infant has a low birth weight.

C Atresia is suspected when a nasogastric tube fails to pass 10 to 11 centimeters beyond the gum line. Abdominal radiographs will confirm the diagnosis. Prenatal radiographs do not provide a definitive diagnosis. The defect is not externally visible. Bronchoscopy and endoscopy can be used to identify this defect. Infants with esophageal atresia may have been born prematurely and with a low birth weight, but neither is suggestive of the presence of an esophageal atresia.

A school-age child with celiac disease asks for guidance about snacks that will not exacerbate the disease. What snack should the nurse suggest? a. Pizza b. Pretzels c. Popcorn d. Oatmeal cookies

C Celiac disease symptoms result from ingestion of gluten. Corn and rice do not contain gluten. Popcorn or corn chips will not exacerbate the intestinal symptoms. Pizza and pretzels are usually made from wheat flour that contains gluten. Also, in the early stages of celiac disease, the child may be lactose intolerant. Oatmeal contains gluten.

Which diagnosis has the highest priority for the child with irritable bowel syndrome? a. Alteration in nutrition: Less than body requirements related to malabsorption b. Altered growth and development related to inadequate nutrition c. Pain related to hyperperistalsis d. Constipation related to maldigestion

C Diffuse abdominal pain unrelated to activity or meals is a common clinical manifestation of irritable bowel syndrome. Normal physical growth and development usually occur with this disorder. Constipation may occur with irritable bowel syndrome, usually alternating with diarrhea.

Which is a priority concern for a 14-year-old child with inflammatory bowel disease? a. Compliance with antidiarrheal medication therapy b. Long-term complications c. Dealing with the embarrassment and stress of diarrhea d. Home schooling

C Embarrassment and stress from chronic diarrhea are real concerns for the adolescent with inflammatory bowel disease. Antidiarrheal medications are not typically ordered for a child with inflammatory bowel disease. Long-term complications are not a priority concern for the adolescent with inflammatory bowel disease. Exacerbations may interfere with school attendance, but home schooling is not a usual consideration for the adolescent with inflammatory bowel disease.

A nurse has admitted a child to the hospital with a diagnosis of rule out peptic ulcer disease. Which test will the nurse expect to be ordered to confirm the diagnosis of a peptic ulcer? a. A 24-hour dietary history b. A positive Hematest result on a stool sample c. A fiberoptic upper endoscopy d. An abdominal ultrasound

C Endoscopy provides direct visualization of the stomach lining and confirms the diagnosis of peptic ulcer. Dietary history may yield information suggestive of a peptic ulcer, but the diagnosis is confirmed through endoscopy. Blood in the stool indicates a gastrointestinal abnormality, but it does not conclusively confirm a diagnosis of peptic ulcer. An abdominal ultrasound is used to rule out other gastrointestinal alterations such as gallstones, tumor, or mechanical obstruction.

The nurse observes that a newborn is having problems after birth. What should indicate a tracheoesophageal fistula? a. Jitteriness b. Meconium ileus c. Excessive frothy saliva d. Increased need for sleep

C Excessive frothy saliva is indicative of a tracheoesophageal fistula. The child is unable to swallow the secretions, so there are excessive amounts of saliva in the mouth. Jitteriness is associated with several disorders, including electrolyte imbalances. Meconium ileus is associated with cystic fibrosis. Increased need for sleep is not associated with a tracheoesophageal fistula.

A nurse is assisting a child with inflammatory bowel disease to choose items from the dietary menu. Which dietary item should be avoided because it is high in residue? a. Eggs b. Cheese c. Grapes d. Jello

C Fruits with skins or seeds should be avoided because they are high in residue. Cooked or canned fruits and vegetables without skins are allowed. Eggs, cheese, and Jello would be allowed on a low residue diet.

The mother of a child with cognitive impairment calls the nurse because her son has been gagging and drooling all morning. The nurse suspects foreign body ingestion. What physiologic occurrence is most likely responsible for the presenting signs? a. Gastrointestinal perforation may have occurred. b. The object may have been aspirated. c. The object may be lodged in the esophagus. d. The object may be embedded in stomach wall.

C Gagging and drooling may be signs of esophageal obstruction. The child is unable to swallow saliva, which contributes to the drooling. Signs of gastrointestinal (GI) perforation include chest or abdominal pain and evidence of bleeding in the GI tract. If the object was aspirated, the child would most likely have coughing, choking, inability to speak, or difficulty breathing. If the object was embedded in the stomach wall, it would not result in symptoms of gagging and drooling.

An infant had a gastrostomy tube placed for feedings after a Nissen fundoplication and bolus feedings are initiated. Between feedings while the tube is clamped, the infant becomes irritable, and there is evidence of cramping. What action should the nurse implement? a. Burp the infant. b. Withhold the next feeding. c. Vent the gastrostomy tube. d. Notify the health care provider.

C If bolus feedings are initiated through a gastrostomy after a Nissen fundoplication, the tube may need to remain vented for several days or longer to avoid gastric distention from swallowed air. Edema surrounding the surgical site and a tight gastric wrap may prohibit the infant from expelling air through the esophagus, so burping does not relieve the distention. Some infants benefit from clamping of the tube for increasingly longer intervals until they are able to tolerate continuous clamping between feedings. During this time, if the infant displays increasing irritability and evidence of cramping, some relief may be provided by venting the tube. The next feeding should not be withheld, and calling the health care provider is not necessary.

The nurse is caring for a child with Meckel diverticulum. What type of stool does the nurse expect to observe? a. Steatorrhea b. Clay colored c. Currant jellylike d. Loose stools with undigested food

C In Meckel diverticulum the bleeding is usually painless and may be dramatic and occur as bright red or currant jellylike stools, or it may occur intermittently and appear as tarry stools. The stools are not clay colored, steatorrhea, or loose with undigested food.

The nurse is caring for an infant who had surgical repair of a tracheoesophageal fistula 24 hours ago. Gastrostomy feedings have not been started. What do nursing actions related to the gastrostomy tube include? a. Keep the tube clamped. b. Suction the tube as needed. c. Leave the tube open to gravity drainage. d. Lower the tube to a point below the level of the stomach.

C In the immediate postoperative period, the gastrostomy tube is open to gravity drainage. This usually is continued until the infant is able to tolerate feedings. The tube is unclamped in the postoperative period to allow for the drainage of secretions and air. Gastrostomy tubes are not suctioned on an as-needed basis. They may be connected to low suction to facilitate drainage of secretions. Lowering the tube to a point below the level of the stomach would create too much pressure.

The postoperative care plan for an infant with surgical repair of a cleft lip includes which intervention? a. A clear liquid diet for 72 hours b. Nasogastric feedings until the sutures are removed c. Elbow restraints to keep the infants fingers away from the mouth d. Rinsing the mouth after every feeding

C Keeping the infants hands away from the incision reduces potential complications at the surgical site. The infants diet is advanced from clear liquid to soft foods within 48 hours of surgery. After surgery, the infant can resume preoperative feeding techniques. Rinsing the mouth after feeding is an inappropriate intervention. Feeding a small amount of water after feedings will help keep the mouth clean. A cleft lip repair site should be cleansed with a wet sterile cotton swab after feedings.

The nurse is preparing to care for a newborn with an omphalocele. The nurse should understand that care of the infant should include what intervention? a. Initiating breast- or bottle-feedings to stabilize the blood glucose level b. Maintaining pain management with an intravenous opioid c. Covering the intact bowel with a nonadherent dressing to prevent injury d. Performing immediate surgery

C Nursing care of an infant with an omphalocele includes covering the intact bowel with a nonadherent dressing to prevent injury or placing a bowel bag or moist dressings and a plastic drape if the abdominal contents are exposed. The infant is not started on any type of feeding but has a nasogastric tube placed for gastric decompression. Pain management is started after surgery, but surgery is not done immediately after birth. The infant is medically stabilized before different surgical options are considered.

Which stool characteristic should the nurse expect to assess with a child diagnosed with intussusception? a. Ribbon-like stools b. Hard stools positive for guaiac c. Currant jelly stools d. Loose, foul-smelling stools

C Pressure on the bowel from obstruction leads to passage of currant jelly stools. Ribbon-like stools are characteristic of Hirschsprungs disease. With intussusception, passage of bloody mucus stools occurs. Stools will not be hard. Loose, foul-smelling stools may indicate infectious gastroenteritis.

Which information does the nurse include when teaching the parents of a 5-week-old infant about pyloromyotomy? a. The infant will be in the hospital for a week. b. The surgical procedure is routine and no big deal. c. The prognosis for complete correction with surgery is good. d. They will need to ask the physician about home care nursing.

C Pyloromyotomy is the definitive treatment for pyloric stenosis. Prognosis is good with few complications. These comments reassure parents. The infant will remain in the hospital for a day or two postoperatively. Although the prognosis for surgical correction is good, telling the parents that surgery is no big deal minimizes the infants condition. Home care nursing is not necessary after pyloromyotomy.

What is the most important information to be included in the discharge planning for an infant with gastroesophageal reflux? a. Teach the parents to position the infant on the left side. b. Reinforce the parents knowledge of the infants developmental needs. c. Teach the parents how to do infant cardiopulmonary resuscitation (CPR). d. Have the parents keep an accurate record of intake and output.

C Risk of aspiration is a priority nursing diagnosis for the infant with gastroesophageal reflux. The parents must be taught infant CPR. Correct positioning minimizes aspiration. The correct position for the infant is on the right side after feeding and supine for sleeping. Knowledge of developmental needs should be included in discharge planning for all hospitalized infants but is not the most important in this case. Keeping a record of intake and output is not a priority and may not be necessary.

When caring for a child with probable appendicitis, the nurse should be alert to recognize which sign or symptom as a manifestation of perforation? a. Anorexia b. Bradycardia c. Sudden relief from pain d. Decreased abdominal distention

C Signs of peritonitis, in addition to fever, include sudden relief from pain after perforation. Anorexia is already a clinical manifestation of appendicitis. Tachycardia, not bradycardia, is a manifestation of peritonitis. Abdominal distention usually increases in addition to an increase in pain (usually diffuse and accompanied by rigid guarding of the abdomen).

A child has a nasogastric (NG) tube after surgery for Hirschsprung disease. What is the purpose of the NG tube? a. Prevent spread of infection. b. Monitor electrolyte balance. c. Prevent abdominal distention. d. Maintain accurate record of output.

C The NG tube is placed to suction out gastrointestinal secretions and prevent abdominal distention. The NG tube would not affect infection. Electrolyte content of the NG drainage can be monitored. Without the NG tube, there would be no drainage. After the NG tube is placed, it is important to maintain an accurate record of intake and output. This is not the reason for placement of the tube.

The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. What intervention is appropriate to relieve the abdominal discomfort during the evaluation? a. Place in the Trendelenburg position. b. Apply moist heat to the abdomen. c. Allow the child to assume a position of comfort. d. Administer a saline enema to cleanse the bowel.

C The child should be allowed to take a position of comfort, usually with the legs flexed. The Trendelenburg position will not help with the discomfort. If appendicitis is a possibility, administering laxative or enemas or applying heat to the area is dangerous. Such measures stimulate bowel motility and increase the risk of perforation.

A 3-day-old infant presents with abdominal distention, is vomiting, and has not passed any meconium stools. What disease should the nurse suspect? a. Pyloric stenosis b. Intussusception c. Hirschsprung disease d. Celiac disease

C The clinical manifestations of Hirschsprung disease in a 3-day-old infant include abdominal distention, vomiting, and failure to pass meconium stools. Pyloric stenosis would present with vomiting but not distention or failure to pass meconium stools. Intussusception presents with abdominal cramping and celiac disease presents with malabsorption.

What is an appropriate statement for the nurse to make to parents of a child who has had a barium enema to correct an intussusception? a. I will call the physician when the baby passes his first stool. b. I am going to dilate the anal sphincter with a gloved finger to help the baby pass the barium. c. I would like you to save all the soiled diapers so I can inspect them. d. Add cereal to the babys formula to help him pass the barium.

C The nurse needs to inspect diapers after a barium enema because it is important to document the passage of barium and note the characteristics of the stool. The physician does not need to be notified when the infant passes the first stool. Dilating the anal sphincter is not appropriate for the child after a barium enema. After reduction, the infant is given clear liquids and the diet is gradually increased.

parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. What recommendation should the nurse include in teaching this parent? a. Surgical therapy is indicated. b. Place in prone position for sleep after feeding. c. Thicken feedings and enlarge the nipple hole. d. Reduce the frequency of feeding by encouraging larger volumes of formula.

C Thickened feedings decrease the childs crying and increase the caloric density of the feeding. Although it does not decrease the pH, the number and volume of emesis are reduced. Surgical therapy is reserved for children who have failed to respond to medical therapy or who have an anatomic abnormality. The prone position is not recommended because of the risk of sudden infant death syndrome. Smaller, more frequent feedings are more effective than less frequent, larger volumes of formula.

The nurse is assisting a child with celiac disease to select foods from a menu. What foods should the nurse suggest? a. Hamburger on a bun b. Spaghetti with meat sauce c. Corn on the cob with butter d. Peanut butter and crackers

C Treatment of celiac disease consists primarily of dietary management. Although a gluten-free diet is prescribed, it is difficult to remove every source of this protein. Some patients are able to tolerate restricted amounts of gluten. Because gluten occurs mainly in the grains of wheat and rye but also in smaller quantities in barley and oats, these foods are eliminated. Corn, rice, and millet are substitute grain foods. Corn on the cob with butter would be gluten free.

What should the nurse consider when providing support to a family whose infant has just been diagnosed with biliary atresia? a. The prognosis for full recovery is excellent. b. Death usually occurs by 6 months of age. c. Liver transplantation may be needed eventually. d. Children with surgical correction live normal lives.

C Untreated biliary atresia results in progressive cirrhosis and death usually by 2 years of age. Surgical intervention at 8 weeks of age is associated with somewhat better outcomes. Liver transplantation is also improving outcomes for 10-year survival. Even with surgical intervention, most children require supportive therapy. With early intervention, 10-year survival rates range from 27% to 75%.

The nurse is caring for a neonate with a suspected tracheoesophageal fistula. What should nursing care include? a. Feed glucose water only. b. Elevate the patients head for feedings. c. Raise the patients head and give nothing by mouth. d. Avoid suctioning unless the infant is cyanotic.

C When a newborn is suspected of having a tracheoesophageal fistula, the most desirable position is supine with the head elevated on an inclined plane of at least 30 degrees. It is imperative that any source of aspiration be removed at once; oral feedings are withheld. The oral pharynx should be kept clear of secretions by oral suctioning. This is to prevent the cyanosis that is usually the result of laryngospasm caused by overflow of saliva into the larynx.

The nurse is teaching parents about high-fiber foods that can prevent constipation. What foods should the nurse include in the teaching? (Select all that apply.) a. Oranges b. Bananas c. Lima beans d. Baked beans e. Raisin bran cereal

C, D, E Lima beans have 13.2 g of fiber in 1 cup, baked beans have 10.4 g of fiber in 1 cup, and raisin bran cereal has 7.3 g of fiber in 1 cup. One orange has only 3.1 g of fiber, and 1 banana has only 3.1 g of fiber, so they are not recommended as high-fiber foods.

A child is admitted to the pediatric floor for appendicitis. Which assessment finding will the nurse monitor that indicates the appendix has ruptured? a. Abdominal pain shifts from the left to the right side. b. Vomiting and diarrhea become more intense. c. Elevated temperature decreases to normal. d. Abdominal pain is relieved.

D Abdominal pain is relieved when appendix rupture occurs. Pain in the right lower quadrant is suggestive of appendicitis. Abdominal pain does not shift from one side to the other. The child with appendicitis may have vomiting and diarrhea. A rupture does not intensify symptoms. Because peritonitis is associated with a ruptured appendix, the temperature would be elevated in the presence of infection.

A health care provider prescribes feedings of 1 to 2 oz Pedialyte every 3 hours and to advance to 1/2 strength Similac with iron as tolerated postoperatively for an infant who had a pyloromyotomy. The nurse should decide to advance the feeding if which occurs? a. The infants IV line has infiltrated. b. The infant has not voided since surgery. c. The infants mother states the infant is tolerating the feeding okay. d. The infant is taking the Pedialyte without vomiting or distention.

D After a pyloromyotomy, feedings are usually instituted within 12 to 24 hours, beginning with clear liquids. They are offered in small quantities at frequent intervals. Supervision of feedings is an important part of postoperative care. The feedings are advanced only if the infant is taking the clear liquids without vomiting or distention. Feedings would not be advanced if the infant has not voided, the IV line becomes infiltrated, or the mother states the infant is tolerating the feedings.

What should the nurse teach a school-age child and his parents about the management of ulcer disease? a. Eat a bland, low-fiber diet in small frequent meals. b. Eat three balanced meals a day with no snacking between meals. c. The child needs to eat alone to avoid stress. d. Do not give antacids 1 hour before or after antiulcer medications.

D Antacids can interfere with antiulcer medication if given less than 1 hour before or after antiulcer medications. A bland diet is not indicated for ulcer disease. The diet should be a regular diet that is low in caffeine, and the child should eat a meal or snack every 2 to 3 hours. Eating alone is not indicated.

Which nursing diagnosis has the highest priority for the child with celiac disease? a. Pain related to chronic constipation b. Altered growth and development related to obesity c. Fluid volume excess related to celiac crisis d. Imbalanced nutrition: Less than body requirements related to malabsorption

D Imbalanced nutrition: Less than body requirements related to malabsorption is the highest priority nursing diagnosis because celiac disease causes gluten enteropathy, a malabsorption condition. The pain associated with celiac disease is associated with diarrhea, not constipation. Celiac disease causes altered growth and development associated with malnutrition, not obesity. Celiac crisis causes fluid volume deficit.

A child with pyloric stenosis is having excessive vomiting. The nurse should assess for what potential complication? a. Hyperkalemia b. Hyperchloremia c. Metabolic acidosis d. Metabolic alkalosis

D Infants with excessive vomiting are prone to metabolic alkalosis from the loss of hydrogen ions. Potassium and chloride ions are lost with vomiting. Metabolic alkalosis, not acidosis, is likely.

An infant is born with a gastroschisis. Care preoperatively should include which priority intervention? a. Prone position b. Sterile water feedings c. Monitoring serum laboratory electrolytes d. Covering the defect with a sterile bowel bag

D Initial management of a gastroschisis involves covering the exposed bowel with a transparent plastic bowel bag or loose, moist dressings. The infant cannot be placed prone, and feedings will be withheld until surgery is performed. Electrolyte laboratory values will be monitored but not before covering the defect with a sterile bowel bag.

What term describes invagination of one segment of bowel within another? a. Atresia b. Stenosis c. Herniation d. Intussusception

D Intussusception occurs when a proximal section of the bowel telescopes into a more distal segment, pulling the mesentery with it. The mesentery is compressed and angled, resulting in lymphatic and venous obstruction. Atresia is the absence or closure of a natural opening in the body. Stenosis is a narrowing or constriction of the diameter of a bodily passage or orifice. Herniation is the protrusion of an organ or part through connective tissue or through a wall of the cavity in which it is normally enclosed.

Which intervention should be included in the nurses plan of care for a 7-year-old child with encopresis who has cleared the initial impaction? a. Have the child sit on the toilet 30 minutes when he gets up in the morning and at bedtime. b. Increase sugar in the childs diet to promote bowel elimination. c. Use a Fleet enema daily. d. Give the child a choice of beverage to mix with a laxative.

D Offering realistic choices is helpful in meeting the school-age childs sense of control. To facilitate bowel elimination, the child should sit on the toilet for 5 to 10 minutes after breakfast and dinner. Decreasing the amount of sugar in the diet will help keep stools soft. Daily Fleet enemas can result in hypernatremia and hyperphosphatemia and are used only during periods of fecal impaction.

What clinical manifestation should be the most suggestive of acute appendicitis? a. Rebound tenderness b. Bright red or dark red rectal bleeding c. Abdominal pain that is relieved by eating d. Colicky, cramping, abdominal pain around the umbilicus

D Pain is the cardinal feature. It is initially generalized, usually periumbilical. The pain becomes constant and may shift to the right lower quadrant. Rebound tenderness is not a reliable sign and is extremely painful to the child. Bright or dark red rectal bleeding and abdominal pain that is relieved by eating are not signs of acute appendicitis.

The nurse should instruct parents to administer a daily proton pump inhibitor to their child with gastroesophageal reflux at which time? a. Bedtime b. With a meal c. Midmorning d. 30 minutes before breakfast

D Proton pump inhibitors are most effective when administered 30 minutes before breakfast so that the peak plasma concentrations occur with mealtime. If they are given twice a day, the second best time for administration is 30 minutes before the evening meal.

A child who has just had definitive repair of a high rectal malformation is to be discharged. What should the nurse address in the discharge preparation of this family? a. Safe administration of daily enemas b. Necessity of firm stools to keep suture line clean c. Bowel training beginning as soon as the child returns home d. Changes in stooling patterns to report to the practitioner

D The parents are taught to notify the practitioner if any signs of an anal stricture or other complications develop. Constipation is avoided because a firm stool will place strain on the suture line. Daily enemas are contraindicated after surgical repair of a rectal malformation. Fiber and stool softeners are often given to keep stools soft and avoid tension on the suture line. The child needs to recover from the surgical procedure. Then bowel training may begin, depending on the childs developmental and physiologic readiness.