peds ch 20

The nurse is collecting data on a 2-year-old child admitted with a diagnosis of gastroenteritis. When interviewing the caregivers, which question is most important for the nurse to ask? "how many times a day does your child urinate?" "tell me about the types of stools you child has been having." "what foods has your child eaten during the last few days." "how long has your child been toilet trained?"

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

The nurse is caring for a 13-year-old girl with suspected autoimmune hepatitis. The girl inquires about the testing required to evaluate the condition. How should the nurse respond? "you will most likely have a blood test to check for certain antibodies." "you will most likely be tested for ammonia levels." "you will most likely have viral studies." "you will most likely have an ultrasound evaluation."

"you will most likely have a blood test to check for certain antibodies."

The nurse is administering an enteral feeding to a child with a gastrostomy tube (G-tube). Which action will the nurse take when administering a prescribed feeding through the client's G-tube? use a syringe plunger to administer the feeding check for gastric residual before starting feeding position the client with the head of the bed at a 20° angle after feeding, flush the tube with a small amount of saline and leave the G-tube open for 2 minutes

check for gastric residual before starting feeding

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? cleft palate pyloric stenosis esophageal atresia (EA) hernia

esophageal atresia (EA)

An 18-month-old infant is brought to the emergency department with flu-like symptoms. The infant 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: cystic fibrosis. gastroesophageal reflux disease. inflammatory bowel disease. Hirschsprung disease.

gastroesophageal reflux disease.

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? gastroenteritis ulcerative colitis (UC) short bowel syndrome (SBS) hirschsprung disease

hirschsprung disease

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? short-bowel/short-gut syndrome necrotizing enterocolitis intussusception volvulus with malrotation

intussusception

The parents of a 6-month-old have brought their child to the emergency department with vomiting and diarrhea for the past 3 days. The report the child as being very lethargic today. During the assessment the nurse notes decreased skin turgor, delayed capillary refill, and pale, slightly dry skin. Based on the objective and subjective data, what does the nurse determine the child to be? severely dehydrated moderately dehydrated well hydrated mildly dehydrated

moderately dehydrated

The emergency department nurse is assessing a child who has presented with a 2-day history of nausea and vomiting with pain that is isolated to the right upper quadrant of the abdomen. Which action is most appropriate? assess the child's usual urinary voiding pattern encourage fluid intake administer antacids as ordered prepare the child for admission to the hospital

prepare the child for admission to the hospital

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? maintenance of electrolyte balance reduction of hypertension prevention of hypoglycemia prevention of T-cell rejection of the transplanted liver

prevention of hypoglycemia

The nurse is caring for a child admitted with pyloric stenosis. Which clinical manifestation would likely have been noted in the child with this diagnosis? severe abdominal pain projectile vomiting explosive diarrhea frequent urination

projectile vomiting

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? "you must be meticulous in caring for the surrounding skin." "gather all of your supplies before you begin." "call the doctor immediately if the stoma is not pink/red and moist." "you may need adhesive remover to ease pouch removal."

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

A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason? confirm pancreatitis detect Helicobacter pylori evaluate gastric pH determine esophageal contractility

detect Helicobacter pylori

What occurs in the gastrointestinal system of the child with Hirschsprung disease? there is an invagination or telescoping of one portion of the bowel into a distal portion. there is a relaxed sphincter in the lower portion of the esophagus. there is a severe narrowing of the lumen of the pylorus. there is a partial or complete mechanical obstruction in the intestine.

there is a partial or complete mechanical obstruction in the intestine.

The nurse is talking with a woman who is in her 2nd trimester of pregnancy who has been diagnosed with polyhdyramnios. The physician has ordered an ultrasound be performed to check for the presence of esophageal atresia. Which statement by the woman indicates an understanding of the relationship between these conditions? "enzymes in amniotic fluid can cause the development of esophageal atresia." "reductions in amniotic fluid are associated with the development of esophageal atresia." "babies with esophageal atresia produce an excessive amount of amniotic fluid." "babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup."

"babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup."

The nurse is caring for a child that was dehydrated following gastric surgery but has since been re-hydrated. The physician orders intravenous maintenance fluid rate for the child. How will the nurse determine the intravenous maintenance fluid rate per hour for this child who weighs 40 kg?

79 ml/hr

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? in this disorder the sphincter that leads into the stomach is relaxed. a partial or complete intestinal obstruction occurs. there are recurrent paroxysmal bouts of abdominal pain. a thickened, elongated muscle causes an obstruction at the end of the stomach.

a partial or complete intestinal obstruction occurs.

A 3-year-old child has been brought to the clinic for assessment because of frequent episodes of constipation. After ruling an out an organic cause, the child's plan of care should prioritize: teaching the child habits that promote normal bowel function. teaching the child's caregivers the need to toilet the child hourly during the day. teaching the child's caregivers how to safely administer an enema. administering over the counter stool softeners on a temporary basis.

administering over the counter stool softeners on a temporary basis.

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? promoting comfort improving hydration maintaining skin integrity preparing family for home care

improving hydration

A mother is alarmed because her 6-week-old boy has begun vomiting almost immediately after every feeding. In the past week, the vomiting has grown more forceful, with the vomit projecting several feet from his mouth. He is always hungry again just after vomiting. At the physician's office, the nurse holds the child and gives him a bottle of water. While he drinks, she notes an olive-size lump in his right abdomen. Which condition should the nurse suspect in this child? gastroesophageal reflux peptic ulcer disease appendicitis pyloric stenosis

pyloric stenosis

A 6-week-old infant is diagnosed with pyloric stenosis. When taking a health history from the parent, which symptom would the expect to hear described? vomiting about 2 hours after feeding chronic diarrhea vomiting immediately after feeding refusal to eat

vomiting immediately after feeding

The nurse has performed client teaching to a 15-year-old boy with Crohn disease, and his parents, regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning occurred? "i have to be careful because I am prone to not absorbing nutrients." "i may end up with a colectomy because the disease is continuous from the beginning to the end of my intestines." "i have a lot of diarrhea every day because of how my small intestine is damaged." "it's unusual for someone my age to get Crohn disease."

"i have to be careful because I am prone to not absorbing nutrients."

The nurse is caring for an infant recently diagnosed with thrush and was prescribed nystatin. Which statement by the infant's mother would suggest a need for further education? "i will make sure to clean all of her toys before I give them to her." "i will watch for diaper rash." "i will use a cotton tipped applicator to apply the medication to her mouth." "i will add the nystatin to her bottle four times per day."

"i will add the nystatin to her bottle four times per day."

The infant is listless with sunken fontanels and has been diagnosed with dehydration. The infant is still producing at least 1 mL/kg each hour of urine. The infant weighs 13.2 lb (6 kg). At the minimum, how many milliliters of urine will the infant produce during the next 8-hour shift? Record your answer using a whole number.

48

The nurse is conducting a physical examination of an 18-month-old with suspected intussusception. Which finding would the nurse identify as the hallmark of this condition? a sausage-shaped mass in the upper midabdomen abdominal pain and guarding perianal skin tags skin tenting

a sausage-shaped mass in the upper midabdomen

A mother brings her 3-year-old son to the ER and tells the triage nurse that he has been vomiting blood. A medical history determines that the 3-year-old has no history of GI disturbances and his only symptoms are a slightly elevated fever and vomiting bright red blood. Based on these symptoms, what condition might the nurse suspect? intussusception gi tract obstruction gastroesophageal reflux acute upper GI bleeding

acute upper GI bleeding

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? toast bananas oatmeal potatoes

bananas

The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child? severe constipation with occasional ribbon-like stools forceful vomiting followed by the child being eager to eat again bouts of diarrhea with failure to gain weight effortless vomiting just after the child has eaten

effortless vomiting just after the child has eaten

The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis? abdominal pain and irritability perianal fissures and skin tags hard, moveable "olive-like mass" in the upper right quadrant sausage-shaped mass in the upper mid abdomen

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

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 gastroesophageal reflux? a thickened, elongated muscle causes an obstruction at the end of the stomach. a partial or complete intestinal obstruction occurs. in this disorder the sphincter that leads into the stomach is relaxed. there are recurrent paroxysmal bouts of abdominal pain.

in this disorder the sphincter that leads into the stomach is relaxed.

A mother calls the doctor's office and tells the nurse that she is concerned because her 4-month-old keeps "spitting up" with every feeding. What would indicate that the child is regurgitating as opposed to vomiting? is projected 1 ft away from infant only occurs with feeding is curdled and extremely sour smelling continues until stomach is empty

only occurs with feeding

The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is: respiratory distress painless rectal bleeding ischemia dehydration

painless rectal bleeding

The nurse is caring for a 2-year-old child with a gastrointestinal infection resulting in 4 to 5 liquid stools per day over the past 3 days. Based on this information, which nursing diagnoses should the nurse include in the child's care plan? Select all that apply. risk for impaired skin integrity diarrhea risk for deficient fluid volume disturbed body image imbalanced nutrition: less than body requirements

risk for impaired skin integrity diarrhea risk for deficient fluid volume

An adolescent has hepatitis B. What would be the most important nursing action? close observation to detect cerebral hallucinations strict calculation of caloric and vitamin B intake conscientious collection of stool for ova and parasites strict enforcement of standard precautions

strict enforcement of standard precautions

An adolescent is diagnosed with hepatitis A. Which problem should be considered when planning care? the adolescent will be very irritable and perhaps require sedation. the adolescent will become fatigued easily. the adolescent's urine will be dark and infectious. hypothermia is common.

the adolescent will become fatigued easily.

A nurse explains to the family of an infant with an inguinal hernia that the surgeon will attempt manual reduction prior to surgical repair. Which statement describes this technique? the client is sedated, the lower torso is elevated, and the contents are gently manipulated back into the stomach. the client is sedated, an incision is made in the peritoneal cavity, and the contents are gently manipulated back into the stomach. the client is sedated and the incarcerated contents of the hernia are manipulated back into the peritoneal cavity. the client is sedated, the lower torso is lowered, and the contents of the hernia are manipulated back into the peritoneal cavity.

the client is sedated and the incarcerated contents of the hernia are manipulated back into the peritoneal cavity.

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? "continue breastfeeding as you have been doing. The fluid from the breast milk is important to maintain fluid balance." "do not give the child anything to drink for 4 hours. If the fever goes down and the loose stools stop, you can resume breastfeeding." "bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." "give a clear pediatric electrolyte replacement for the next few hours, then call back to report on how your child is doing."

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

The nurse is caring for a child following surgery due to a motor vehicle accident. The child suffered extensive damage to the small intestine resulting in short bowel syndrome. The parents voice concern to the nurse that their child will "never be the same." Which is the best response by the nurse? "having a chronic condition is difficult but you have to be strong for your child. You are your child's main support and will be needed." "i know it must be difficult for you to wrap your heads around this situation but there was nothing you could have done to prevent this from happening." "there are so many new treatments available every day. There may be something to correct this in the near future." "i cannot imagine what you are going through. We are here to support and educate you on your child's condition and treatments."

"i cannot imagine what you are going through. We are here to support and educate you on your child's condition and treatments."

A nurse caring for an infant born with a cleft palate, notices that the parents rarely interact with their child. The nurse overhears the mother telling her spouse that she "feels like crying" every time she looks at their infant. What would be the best response from the nurse? "keep in mind that your infant's condition is not life-threatening and can be corrected eventually." "your infant needs you right now. You should put your negative feelings about the condition aside for your infant's sake." "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?" "many infants are born with this condition. Your infant's palate is not nearly as bad as some cases."

"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 student nurse is caring for a child with the nursing diagnosis "Risk for fluid volume deficit related to inadequate oral intake". Which statement by the student would indicate a need for further education by the nursing instructor? "i will teach her mother to give her small drinks frequently." "i will weigh her every morning at the same time." "i will monitor her IV line to help maintain her fluid volume." "i will make sure there is plenty of orange juice available. It's her favorite juice."

"i will make sure there is plenty of orange juice available. It's her favorite juice."

The nurse is performing discharge teaching for a 16-year-old diagnosed with peptic ulcer disease. Which statements by the parents and client demonstrate learning has occurred? "i will need to make sure to take all of the antibiotic prescribed." "the prednisone that I take for my rheumatoid arthritis may be a cause of my peptic ulcer disease." "my proton pump inhibitor should be taken when I feel discomfort." "it's important to take my histamine agonist medication at the appropriate time." "my mom having peptic ulcer disease has nothing to do with my having it."

"i will need to make sure to take all of the antibiotic prescribed." "it's important to take my histamine agonist medication at the appropriate time." "the prednisone that I take for my rheumatoid arthritis may be a cause of my peptic ulcer disease."

The student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply. "most children with celiac disease" "the only treatment for celiac disease is a strict gluten-free diet." "symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "gluten is found in most wheat products, rye, barley and possibly oats." "the entire family will need to eat gluten-free."

"the only treatment for celiac disease is a strict gluten-free diet." "symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "gluten is found in most wheat products, rye, barley and possibly oats."

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? "we will give enemas until clear and then teach you how to do these at home." "your child will be treated with oral iron preparations to correct the anemia." "your child will receive counseling so the underlying concerns will be addressed." "the treatment for the disorder will be a surgical procedure."

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

The nurse is caring for a 2-year-old boy with an umbilical hernia and is teaching the mother about this condition. Which response from the mother indicates a need for further teaching? "incarceration is rare, but it can occur." "i can tape a quarter over the hernia to reduce it." "my son could have some appearance-related self-esteem issues." "i need to watch for pain, tenderness, or redness."

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

The nurse is preparing a client for surgery and the client asks, "What does it mean when they say they are going to reduce my abdominal hernia?" Which response by the nurse is most appropriate? "all this means is that the herniated intestines are twisted and edematous, which is why you need surgery." "this means the hernia contents will be manipulated back into your peritoneal cavity during surgery." "the health care provider will remove about half of the herniated contents during the procedure." "if you do not understand this, I need to cancel your surgery and have the health care provider come back."

"this means the hernia contents will be manipulated back into your peritoneal cavity during surgery."

The client calls the health care provider's office stating that her preschooler drank laundry detergent from under the sink. Which statement by the parent needs further instruction? "i will call the Poison Control Center now." "i will find out how much of the liquid my child drank.' "i will watch my child's breathing status and keep my child calm." "i will use syrup of ipecac to get it out of my child's system."

"i will use syrup of ipecac to get it out of my child's system."

The nurse is caring for a 12-year-old child with Crohn disease. A primary assessment the nurse would want to make when caring for the child would be to note if: lung sounds are clear. the child reports a headache. the child has a temperature. the joints are not swollen.

the child has a temperature.