RNSG 2201 Care of Children and Family Evolve Ch 25

What does the nurse teach a parent about careful food preparation to prevent food poisoning? Select all that apply.

"Cook meat until the pink color disappears." "Wash hands and utensils with hot, soapy water." "Cook the meat to an internal temperature of 71°C." (Food poisoning occurs when there is overgrowth of harmful bacteria in food. The meat should always be cooked until gray inside. Presence of pink indicates that the meat is undercooked. Hands and utensils must be washed with hot, soapy water to prevent the spread of bacteria. Meat must be cooked to an internal temperature of 71°C. Ground meat should be quickly frozen to prevent spoilage and bacterial growth. Food should never be thawed on the counter because this encourages microbial growth.)

A 10-year-old child brought to the emergency department is suspected of having appendicitis. Physical examination revealed tenderness at the McBurney point. The nurse asks the child to state the order in which the symptoms were experienced. Which order stated by the child suggests that the child has appendicitis?

1. Periumbilical pain 2.Nausea 3.Right lower quadrant pain 4.Vomiting with fever (Classically, appendicitis involves a sequence of symptoms. The first symptom is periumbilical pain, then abdominal pain located around the umbilicus, followed by nausea. Pain shifts to the right lower quadrant as the inflammation progresses to involve the serosa of the appendix and the peritoneum of the abdominal wall. Finally it is followed by vomiting with fever. If the child's symptoms presented in that order, it suggests appendicitis. The McBurney point is the most common point of tenderness in a child with appendicitis. It is located two-thirds the distance along a line between the umbilicus and the anterosuperior iliac spine. The peak incidence of appendicitis is at 10 years of age.)

How soon in development are the esophagus and stomach considered identifiable?

4 weeks gestation (Development of the esophagus and stomach are considered identifiable at 4 weeks gestation. At full term the mechanical functions of digestion are relatively immature but intact. At 26 weeks of gestation, uncoordinated contractions of the gastrointestinal (GI) tract occur, but emptying is slow. By the third trimester motility of the GI tract is improving.)

The nurse in the emergency department is triaging patients. Which child must be seen first?

A child with stridor who appears anxious (Using the ABC (airway, breathing, and circulation) prioritization approach, the child with stridor from a foreign body in the throat must be seen first. Stridor indicates partial or complete obstruction from the foreign body in the throat. A child with severe bloody diarrhea; a severe burn on the leg; and screaming, crying, and holding the abdomen are not priorities before airway obstruction.)

Which clinical manifestations does the nurse observe in a child that confirms intussusception and to rule out hypertrophic pyloric stenosis? Select all that apply.

Acute abdominal pain. Currant jelly-like stools. Drawing the knees to the chest. Palpable sausage-shaped mass in upper right quadrant. (A child with intussusception has acute abdominal pain and passes currant jelly-like stools because venous engorgement causes leaking of blood and mucus into the intestinal lumen. The child draws the knees to the chest. A sausage-shaped mass is palpable in the upper right quadrant because in intussusception a proximal segment of the bowel telescopes into a more distal segment, pulling the mesentery with it. Compression of mesentery results in lymphatic and venous obstruction. Vomiting is seen both in intussusception and hypertrophic pyloric stenosis. In hypertrophic pyloric stenosis, an olive-shaped tumor is palpable in the epigastrium just to the right of the umbilicus because of the hypertrophied pylorus.)

The nurse explains to the nursing student the various causes and conditions associated with acute diarrhea. Which topics are included in this discussion? Select all that apply.

Antibiotics. Otitis media. Overfeeding. (Causes and conditions associated with acute diarrhea include antibiotics, otitis media, and overfeeding. Iron and immobility contribute to constipation.)

A young teen with a fever and a history of constipation who has been experiencing 10/10 right-sided abdominal pain, suddenly stops crying and states, "I feel better." What is the nurse's best action?

Assess the abdomen (A young teen with a fever and history of constipation who has been experiencing 10/10 right-sided abdominal pain and who suddenly stops crying because "I feel better" may be experiencing perforation of the appendix that will lead to peritonitis. Careful assessment of the abdomen is appropriate for the nurse to do. Giving an enema is contraindicated for severe abdominal pain. Preparing for discharge and assessing for bowel movement are not appropriate inventions.)

Which substance is necessary for absorption of vitamins A, D, E, and K?

Bile is necessary for absorption of vitamins A, D, E, and K. Insulin is a hormone that allows the body to use sugar (glucose) from carbohydrates. Amylase is the enzyme used to help break down carbohydrates. Chyme is the partially digested food and water secretions that are delivered to the small intestines.

What is the similarity between gastroschisis and omphalocele?

Both are congenital abdominal wall defects. (Gastroschisis and omphalocele are common forms of congenital abdominal wall defects. Because gastroschisis is generally an isolated defect, it has a good prognosis with survival rates above 89%. Omphaloceles, which can be associated with other serious anomalies, do not always have such high survival rates. Whereas omphalocele is usually covered by a translucent peritoneal sac, gastroschisis is not covered by a peritoneal sac. Whereas omphalocele is often associated with other anomalies such as cardiac, neurologic, and skeletal anomalies, gastroschisis is usually not associated with other congenital anomalies.)

Which are malabsorptive causes of chronic diarrhea? Select all that apply.

Celiac disease. Lactose intolerance. Short-bowel syndrome. (Malabsorptive causes of chronic diarrhea include celiac disease, lactose intolerance, and short-bowel syndrome. Ulcerative colitis and Crohn disease are inflammatory bowel diseases.)

Which statements about constipation are correct? Select all that apply.

Constipation with fecal stooling is called encopresis. Most children have no underlying cause identified for constipation. Constipation is associated with drugs such as diuretics, antihistamines, and antieplileptics. (Statements that are correct related to constipation include: that constipation with fecal stooling is called encopresis and most children have no underlying cause identified for constipation. In addition, constipation is associated with drugs such as diuretics, antihistamines, and antieplileptics. It is not a chronic disease process and not defined as hardness of stool for 4 weeks, but for 2 weeks.)

A teen has a sigmoid colon bleed. The teen describes the stool as bright red. The nurse uses which term to document this report?

Hematochezia (Hematochezia is passage of bright red blood per rectum, usually indicating lower gastrointestinal (GI) tract bleeding. Melena is dark-colored, tarry stool that suggests upper GI bleeding such as from the stomach. Meconium is the first stool of a newborn. Hematemesis is vomiting bright red blood.)

Which are causes of chronic diarrhea? Select all that apply.

Immunodeficiency. Malabsorption syndromes. Inflammatory bowel disease. (Causes of chronic diarrhea include immunodeficiency, malabsorption syndromes, and inflammatory bowel disease. Antibiotic therapy and upper respiratory infections are acute causes of diarrhea.)

Which are the most important basic assessments a nurse needs to perform for a child with gastrointestinal disease? Select all that apply.

Intake and output. Height and weight. Abdominal examination. (The most important basic assessments a nurse needs to perform for a child with gastrointestinal disease include intake and output, height and weight, and abdominal examination. The urease test is not a basic assessment. It involves a biopsy of the stomach. The Romberg test evaluates for neurologic function.)

Which are secretions used in chemical digestion? Select all that apply.

Lipase. Insulin. Mucous. Enzymes. Hydrochloric Acid. (Secretions used in chemical digestion include lipase, insulin, mucous, enzymes, and hydrochloric acid. Chyme is the result of chemical digestion. It is the partially digested food and water secretions that are delivered to the small intestines.)

An 8-year-old child with a stomach ulcer passes a dark-colored, tarry stool. Which term does the nurse use to document this stool?

Melena (Melena is dark-colored, tarry stool that suggests upper gastrointestinal (GI) bleeding such as from the stomach. Meconium is the first stool of a newborn. Hematemesis is vomiting bright red blood and hematochezia is passage of bright red blood per rectum, usually indicating lower GI tract bleeding.)

Which are clinical manifestations of gastrointestinal dysfunction in children? Select all that apply.

Melena Jaundice Encopresis Failure to thrive (Clinical manifestations of gastrointestinal dysfunction in children include melena, jaundice, encopresis, and failure to thrive. Clubbing of fingers is associated with chronic respiratory problems.)

Which signs prompt the nurse to call for immediate assistance while monitoring a child admitted with acute gastrointestinal bleeding? Select all that apply.

Pallor. Poor capillary refill. Increased heart rate. (Pallor, poor capillary refill, and increased heart rate should prompt the nurse to call for assistance immediately because these are symptoms of shock. Hot extremities and decreased respiratory rate are not symptoms of acute gastrointestinal bleeding. Cool extremities and increased respiratory rate are other symptoms of shock and require immediate treatment.)

Which symptom does the nurse identify as the most common clinical manifestation of gastroesophageal reflux (GER) in an infant?

Passive regurgitation (Passive regurgitation is the most common clinical manifestation of GER in an infant. Gagging, coughing, and excessive crying are some other clinical manifestations of GER in an infant; however, passive regurgitation is the most common one.)

Which symptoms support the diagnosis of Crohn disease and ruling out of ulcerative colitis, based on the clinical manifestations in a child with inflammatory bowel disease? Select all that apply.

Perianal lesions. Fistulas and strictures. Extraintestinal manifestations. (Perianal lesions, fistulas, and strictures are the features of Crohn disease and are rare in ulcerative colitis. Extraintestinal manifestations such as pyoderma gangrenosum, uveitis, and episcleritis are more common in Crohn disease than in ulcerative colitis. Diarrhea and joint pain are seen in both Crohn disease and ulcerative colitis. Fever and weight loss are usually seen in Crohn disease, but even some cases of ulcerative colitis may have fever and weight loss. Therefore, ulcerative colitis cannot be ruled out based on fever and weight loss.)

The nurse is attending to an infant with esophageal atresia and a tracheoesophageal fistula. The infant is choking, regurgitating, and has frothy saliva and abundant mucus. Which intervention does the nurse choose to facilitate drainage of secretions into the stomach?

Placing the infant in a supine position (The infant is placed in a supine position, because it facilitates drainage of secretions into the stomach and prevents aspiration. Airway patency is monitored to detect signs of airway occlusion. Oxygen is administered to prevent hypoxia. The mouth and nose are suctioned to relieve and prevent airway obstruction.)

Parents reported to the nurse that their child is passing less than three hard stools per week for the past month. After performing oral clean out for 3 days, the child has been put on maintenance therapy. Which oral laxative is the best treatment choice for maintenance therapy?

Polyethylene glycol (Polyethylene glycol is the best treatment choice for maintenance therapy due to the minimal side effects and taste. Moreover, it can be mixed with any drink, which makes it easier to administer to children. It also increases fluid in the colon and the additional volume of fluid stimulates the urge to defecate. Lactulose is also an oral laxative; however, it is less effective than polyethylene glycol. Mineral oil is also an oral laxative; however, it should be given carefully to avoid the risk of aspiration. The combination of milk and molasses is not an oral laxative; it is used for enema clean out.)

Which are the most common consequences of gastrointestinal disease in children? Select all that apply.

Poor growth. Poor growth. Malabsorption. Electrolyte disturbances. (The most common consequences of gastrointestinal disease in children include poor growth, malnutrition, malabsorption, and electrolyte disturbances. Obesity is not associated with the consequences of gastrointestinal disease.)

Which is the most common cause of diarrhea in children under 5?

Rotavirus (The most common cause of diarrhea in children under 5 is rotavirus. There is a high incidence of Salmonella species and Escherichia coli in the summer months, but rotavirus is the most common cause of diarrhea in children under 5. Clostridium difficile is associated with alteration of normal intestinal flora by antibiotics.)

Which terms describe the functions of the gastrointestinal tract? Select all that apply.

Secretory. Absorption. Endocrine. Immunologic. (The various functions of the gastrointestinal tract include secretory, endocrine, absorption, and immunologic. The cardiac system has circulatory function.)

Which stage of liver disease does the patient with chronic active hepatitis have if the pathology report of the patient shows fibrosis or scarring?

Stage 3 (In chronic active hepatitis cases, liver function does not return completely. The liver disease progression can be characterized pathologically by four stages. Stage 3 is characterized by fibrosis or scarring. Stage 1 is characterized by mononuclear inflammatory cells surrounding small bile ducts. Stage 2 is characterized by proliferation of small bile ductules and, finally, stage 4 is characterized by liver cirrhosis.)

Which diagnostic test does the nurse request to detect carbohydrate malabsorption in a child?

Stool pH (The nurse requests the stool pH test to detect carbohydrate malabsorption in a child. Stool pH less than 5 suggests carbohydrate malabsorption because colonic bacteria ferment undigested carbohydrates and fermentation produces short-chain fatty acids which lower stool pH. The urease test is used to determine the presence of Helicobacter pylori in the stomach. The urease test involves staining and placing the stomach biopsy in Christensen urea medium, which turns color in the presence of H. pylori. H. pylori synthesizes urease, the enzyme which hydrolyses urea to form ammonia and carbon dioxide. Rectal manometry is used to measure anal sphincter function and detect constipation and Hirschsprung disease. It records reflex responses of the anal sphincter to transient distention of the rectal balloon. Esophageal pH monitoring is used to determine the frequency and duration of gastric acid reflux into the esophagus. A probe is placed through the nose into the distal esophagus and pH is recorded over time.)

Which are common causes of functional constipation among school-age children? Select all that apply.

Stresses. Environmental changes. Change in toileting pattern. (Common causes of functional constipation among school-age children include stress, environmental changes, and change in toileting pattern. Hypothyroidism is an organic cause of constipation. Increased activity associated with sporting activities would promote normal stooling.)

A mother fears her child has a piece of hot dog lodged in the throat. The nurse knows which signs and symptoms are associated with foreign body ingestion? Select all that apply.

Stridor. Vomiting and gagging. Dyspnea and wheezing. Choking followed by vigorous coughing. (Signs and symptoms associated with foreign body ingestion include stridor, vomiting, gagging, dyspnea, wheezing, and choking followed by vigorous coughing. Dry mouth is not a symptom, but excessive drooling is associated with foreign body ingestion.)

Which tests are used to test for Helicobacter pylori? Select all that apply.

Urease test. Serology test. C urea breath test. (Helicobacter pylori tests include the urease test, serology test, and the C urea breath test. Ultrasonography is used to locate, measure, and delineate abdominal organs. Occult blood guaiac tests are used to detect the presence of blood in the stool.)