chapter 24 GI conditions

19. A child is taking azathioprine (Imuran) for moderate Crohn's disease. Which assessment finding best indicates that an important goal related to this medication has been met? A. The child has not developed seasonal illnesses. B. Edema and fluid retention have been eliminated. C. Stools are more solid and passed less often. D. Weight gain has been consistent at each visit.

ANS: A Imuran is an immunosuppressive drug. Patients taking this medication (and others like it) are more prone to catching seasonal illnesses to which they are exposed in the community. A lack of such illnesses indicates that a goal for the diagnosis of risk for infection (important when using this drug) has been met. Weight gain would indicate better absorption of nutrients, which is a problem in Crohn's disease, but it is not most closely correlated to this drug. The other two options are not related to this drug.

25. A nurse is conducting prenatal classes and teaches about common congenital defects. A pregnant woman asks how to prevent Meckel diverticulum, which she had when she was born. What information does the nurse provide to this pregnant woman? A. Adequate intake of folic acid will prevent this condition from developing. B. Avoid second-hand smoke, pollution, and exposure to heavy metals. C. Early initiation of breastfeeding after birth is a preventative measure. D. This condition is not preventable, but good prenatal care is still important.

ANS: D There are no preventative measures for Meckel diverticulum, but the nurse should still encourage the woman to maintain good prenatal care.

35. A father brings his son to the emergency department complaining that the child has a fever and severe, foul-smelling diarrhea. The child's only previous health complaint was constipation. The nurse notes abdominal distention and firmness on palpation. Which nursing action takes priority? A. Have the father sign a consent for emergency surgery. B. Place the child on NPO status and insert an NG tube. C. Prepare to administer intravenous antibiotics. D. Start an IV and provide maintenance and replacement fluids.

ANS: D This child's presentation is consistent with Hirschsprung disease and enterocolitis, which is a serious complication. Although all options are appropriate, the priority is to start an IV and provide fluids. Airway, breathing, and circulation come first.

9. In order to prevent omphalitis in an infant, which instructions does the nurse provide to the parents prior to discharge from the hospital? (Select all that apply.) A. Administration of prophylactic antibiotics B. How to position a baby for diaper changes C. Importance of monitoring stool frequency D. Positioning of baby's diaper below the umbilicus E. Stump cleaning with recommended solution

ANS: D, E Omphalitis is infection of the umbilical cord stump. Prevention methods include keeping the area clean and dry, cleansing the umbilical stump with the recommended solution, and positioning the baby's diaper below the level of the umbilicus. The other three interventions are not related to preventing omphalitis.

6. A pediatrician diagnoses gastroesophageal reflux (GER) in an infant. Which information will the nurse provide during the teaching session to the infant's parents? (Select all that apply.) A. Causes the infant to refuse feedings because of discomfort B. Includes the return of gastric contents from the stomach C. Includes symptoms such as vomiting and regurgitation D. Results in an infant who is often fussy and irritable E. Usual treatment is a Nissen fundoplication

ANS: A, B, C, D GER is the return of gastric contents from the stomach through the lower esophageal sphincter into the esophagus. This may be "silent" or accompanied by vomiting or regurgitation. Often this is associated with apnea, congestion, irritability, or food aversion. Treatment includes lifestyle changes and/or medication. A Nissen fundoplication is used to treat severe disease or disease that is unresponsive to other treatment options.

28. A nurse notes that a patient has a bluish discoloration of the periumbilical area. Which term will the nurse use when documenting this finding in the medical record? A. Cullen's sign B. Grey Turner's sign C. Kernig's sign D. Psoas sign

ANS: A Cullen's sign is an indication of pancreatitis and is described as a bluish periumbilical discoloration. Grey Turner's sign is also an indication of pancreatitis and is a bluish discoloration of the flank. Kernig's sign is used to assess for meningitis. Psoas sign is used to assess for pancreatitis.

31. A nurse is caring for a child with irritable bowel syndrome (IBS) who has severe abdominal cramping. Which medication would the nurse question for this child? A. Bisacodyl (Dulcolax) B. Hyoscyamine (Levsin) C. Phenobarbital (Donnatal) D. Scopolomine (Isopto)

ANS: A Levsin, Donnatal, and Isopto are all anti-spasmodics. Dulcolax is a stool softener.

5. A nurse is preparing oral rehydration solution for a child weighing 13.7 lb (6.21 kg). How much solution should the nurse prepare for one feeding? A. 0.5-2 mL B. 2-4 mL C. 6 mL D. 10 mL

ANS: A Depending on the child's age and size, the nurse should offer oral rehydration solution in the amount of 0.5-2 mL in 15-minute intervals.

33. A nurse is teaching a group of day-care providers about infection control. Which action does the nurse explain is the best way to prevent children from contracting diarrhea? A. Good hand-washing practices B. Limiting toy sharing to small groups C. Providing less juice with sugar D. Wearing gloves to change diapers

ANS: A Good hand-washing practices are the best method to prevent acute diarrhea, and other diseases as well. The other actions may be useful, but are not nearly as vital as proper hand hygiene.

39. A pediatric clinic nurse is educating parents about an important primary prevention measure for hepatitis A. Which topic does the nurse include in the teaching session? A. Genetic counseling B. Immune globulin C. Immunization D. Oatmeal baths

ANS: C Primary prevention measures are those that prevent the onset of disease. Immunizations are a prime example of primary prevention. Immune globulin is given to children after an exposure, and although it is considered a primary prevention measure, it is not as important as vaccination. Genetic counseling is not indicated because hepatitis is a viral disease. Oatmeal baths would be suggested for a child who already has hepatitis and pruritus.

18. An adolescent is being treated with sulfasalazine (Azulfadine) for moderate Crohn's disease. How does the nurse explain the action of this medication to the patient? A. Causes immunosuppression B. Lessens diarrhea occurrences C. Reduces inflammation D. Treats crampy abdominal pain

ANS: C Sulfasalazine is a 5-aminosalicylic acid drug that reduces inflammation.

9. A child may have a deficiency in production of prothrombin and fibrinogen. The nurse anticipates diagnostic testing related to which organ? A. Duodenum B. Gallbladder C. Liver D. Pancreas

ANS: C The liver is responsible for production of antibodies, bile, prothrombin, and fibrinogen.

1. The student nurse studying the digestive system knows that most of the work of absorption occurs through a system of villi and folds in which gastrointestinal structure? A. Gallbladder B. Large intestine C. Small intestine D. Stomach

ANS: C The small intestine does most of the work of absorption through a system of villi and folds, which increases the absorptive surface. The large intestine takes care of elimination. In the stomach, food mixes with gastric fluids and is then propelled into the small intestine. The gallbladder, which lies within the inferior surface of the liver, excretes and stores bile.

21. A new nurse is caring for a toddler with failure to thrive (FTT). Which action by the new nurse would cause the preceptor nurse to intervene? A. Collaborating with laboratory to schedule blood draws well before mealtime B. Hiding needed medication and supplements in child's favorite food C. Teaching parents how a child's nutrition needs differ from an adult's D. Weighing the child at the same time each day on the same scale

ANS: B Hiding medications in a child's favorite food is deleterious, because it may make the child mistrustful of the nurse and may cause the child to refuse to eat favorite foods. The preceptor should intervene and correct the new nurse taking this action. The other interventions are appropriate.

27. After surgical correction of a Meckel diverticulum, what nursing action is the most important? A. Administration of total parenteral nutrition B. Care of a nasogastric tube and oral care C. Referral to a dietician for low-residue diet D. Teaching parents and child colostomy care

ANS: B Postoperatively after a Meckel diverticulum surgery, the child will have a nasogastric tube in place. The nurse needs to provide proper care of this tube, including good oral care. The other interventions are not warranted.

3. The pediatric nurse is caring for a child with biliary atresia who underwent a Kasai procedure. Which assessment findings indicate that the procedure has been successful? (Select all that apply.) A. Improved skin integrity B. Lessened jaundice in sclera C. Stools that are lighter in color D. Urine that becomes lighter in color E. Vomitus that no longer contains bile

ANS: A, B, D A Kasai procedure attempts to restore bile drainage from the liver into the intestines. The child whose procedure was successful would demonstrate improvement in symptoms, including improved skin integrity (less pruritus and itching), less jaundice, darker stools, and lighter urine. Bilious vomit is not related.

4. The pediatric nurse is monitoring a child for signs of hepatitis. Which documented assessment findings indicate that the child is experiencing the preicteric phase of this disease process? (Select all that apply.) A. Anorexia B. Hepatomegaly C. Jaundice D. Nausea E. Spleenomegaly

ANS: A, D Headache, anorexia, malaise, abdominal pain, nausea, and vomiting are characteristic of the preicteric phase, which lasts approximately 1 week and usually precedes the onset of clinically detectable disease. The most common symptoms of the icteric phase are jaundice and hepatomegaly, which may last several weeks.

10. In providing anticipatory guidance, what does the nurse teach parents about nutrition in their 4-year-old child? A. Food jags are common in this age group. B. Give the child a wide variety of foods. C. Introduce foods slowly and carefully. D. Provide 108 kcal/kg (50 kcal/lb).

ANS: B At this age, the child's gastrointestinal system is mature enough to handle a wide variety of foods. Food jags are most common in toddlers. Introducing foods slowly and carefully is more appropriate to an infant. Infants, not preschoolers, need 108 kcal/kg.

13. A nurse is caring for an infant waiting for surgical correction of intussusception. The child passes a diarrheal stool. Which action by the nurse is the most appropriate? A. Document the findings. B. Increase the IV fluid rate. C. Notify the physician. D. Weigh the child's diaper.

ANS: C Intussusception is a condition in which a portion of the bowel invaginates or telescopes into another portion of bowel, creating a partial bowel obstruction. Spontaneous passage of stool may indicate resolution of the obstruction, so the nurse should contact the provider immediately. Documentation should always occur but is not the only action the nurse takes. Increasing the IV fluid rate based on passing a stool is not needed. Weighing the child's diaper is also not the priority.

17. A school-age child presents with crampy lower abdominal pain, uveitis, and arthralgias. Which diagnostic test does the nurse prepare the patient and parents for based on the assessment findings? A. Colonoscopy B. Flat plate of the abdomen C. Gastric biopsy D. Nuclear medicine scan

ANS: A Abdominal pain accompanied by uveitis (inflammation of the eye) and arthralgias (joint pain) is associated with Crohn's disease and ulcerative colitis. The best diagnostic tests for these disorders are endoscopy and colonoscopy. The nurse should educate the patient and parents on this exam. A flat plate (plain x-ray) may be ordered but will not yield as specific information as the colonoscopy. A biopsy and nuclear medicine scan are not indicated.

38. The pediatric nurse is caring for a hospitalized child with cirrhosis who has 4+ pitting edema. Which laboratory value would the nurse correlate with the edema? A. Albumin: low B. Cholesterol: low C. Prothrombin time: high D. White blood cell count: high

ANS: A All of these laboratory values are typical in a patient with cirrhosis. However, albumin deficiency causes fluid to be lost from the vascular space, leading to edema.

6. A pediatric nurse is caring for a 10-year-old patient on the pediatric unit who has been vomiting upon arising in the morning for the past 2 days. The nurse knows that this symptom is often associated with which condition? A. Bowel blockage B. Neurological involvement C. Stomach cancer D. Ulcerative colitis

ANS: B Vomiting upon arising in the morning is often associated with neurological involvement.

7. A pediatric clinic nurse is caring for several children with umbilical hernias. For which of the children does the nurse plan to educate the parents on surgical correction? (Select all that apply.) A. 7-year-old child with 1-cm hernia B. Child with hernia that can't be replaced C. Enlarging hernia in a 2-year-old D. 1-year-old with 0.5-cm hernia E. 3-year-old with 2-cm hernia

ANS: A, B, C Most umbilical hernias resolve on their own between the ages of 3 and 5 years. A hernia larger than 1.5 cm is less likely to close on its own and may need surgical correction. Surgery is considered for persistent hernias beyond the age of 5 years, incarcerated hernias (a hernia not able to be replaced in the abdomen), and hernias that enlarge dramatically. The 7-year-old, the child with the hernia that can't be replaced, and the 2-year-old with an enlarging hernia are the most likely candidates for surgical repair. The other two children will be managed with watchful waiting.

2. The nurse on a pediatric unit is caring for a child with short bowel syndrome. When providing nutritional therapy for the child, the nurse checks for feeding intolerance by making which daily assessments? (Select all that apply.) A. Intake and output B. Stool volume C. Specific gravity D. Vital signs E. Weight

ANS: A, C, E Assessing feeding tolerance must be included as part of nursing care for a child with short bowel syndrome. Input, output, specific gravity, and weights are also assessed daily by the nurse. Stools are tested for occult blood, pH, and reducing substances. Patients are monitored for vomiting, changes in the appearance of the stools, and abdominal distention. Stool volume is not one of the daily assessments. Vital signs are assessed on all children, but are not directly related to feeding tolerance.

8. A nurse is presenting information to a support group for parents of children with inflammatory bowel disease. Which information is appropriate for the nurse to provide to these parents? (Select all that apply.) A. Both diseases seem to have an inherited or genetic aspect. B. Surgery can provide a cure for patients with Crohn's disease. C. Symptoms outside the gastrointestinal tract only occur in Crohn's disease. D. Tenesmus is a symptom commonly seen in both disorders. E. Ulcerative colitis involves a continuous segment of bowel.

ANS: A, D, E Both ulcerative colitis and Crohn's disease are inflammatory bowel disorders that have an inherited component to their etiology and have tenesmus as a common symptom. Crohn's disease is characterized by "skip"-type lesions that involve noncontiguous segments of the bowel, whereas ulcerative colitis involves a continuous segment of bowel. Surgery can provide a cure for ulcerative colitis, but not Crohn's disease. Symptoms can be seen outside the GI tract in both diseases.

37. A nurse has been working with a teenager who has celiac disease. Which statement by the patient indicates that goals for an important diagnosis have been met? A. "Gluten is obvious and easy to find in food products." B. "I am gaining weight and I have more energy." C. "Rice was my favorite; I hated to give that up." D. "When my symptoms go away I can eat wheat again."

ANS: B Celiac disease causes malabsorption of nutrients. The child who is gaining weight and is more energetic is most likely following the required diet. Because knowledge of dietary management is a major goal for patients with this disease, this statement shows that this goal has been met. The other statements are incorrect. Gluten is often hidden in foods. Rice is allowed. Following the gluten-free diet is required for life.

4. A mother brings her infant to the pediatrician for a checkup. She tells the pediatric nurse that almost every afternoon her infant fusses, generally at the same time each day and usually during the late afternoon or evening. The infant pulls both legs and arms into a flexed position. Based on this description, the nurse assesses the infant further for which condition? A. Gastric ulcers B. Infantile colic C. Meckel diverticulum D. Irritable bowel syndrome

ANS: B Colic is described as persistent, unexplained crying or fussing in infants younger than 3 months. Episodes generally occur at the same time each day, usually during the late afternoon or evening. During such episodes, the infant appears to be pulling both the legs and the arms into a flexed position.

29. A 13-year-old child has been admitted for acute pancreatitis. The parents want to know how the child contracted this disease. Which response by the nurse is the most appropriate? A. "Has your child been exposed to pancreatitis?" B. "In most cases we don't find the cause." C. "Microliths are a common causative factor." D. "Your child is probably drinking alcohol."

ANS: B In children, the causative factors for pancreatitis are different than those seen in adults, who commonly develop pancreatitis secondary to alcohol abuse. Most cases of pediatric pancreatitis are idiopathic, which means the cause is not clear. The nurse's best reply is this one. Although microliths can cause pancreatitis, this is less common, and this response contains too much medical jargon to give the parents good information. The other two responses are inaccurate.

15. The registered nurse is explaining to a nursing student that which of the following is the most common cause of gastric ulcers in children? A. Burn injury and other critical illness B. Infection with Helicobacter pylori C. Stress and living in poverty D. Use of tobacco and alcohol products

ANS: B Infection with H. pylori is the most common cause of gastric ulcers in children. Secondary ulcers are often caused by burn injury (and other critical illnesses), stress, and use of irritants such as tobacco, alcohol, NSAIDs, bisphosphonates, and potassium supplements.

11. A neonate is born with rectal atresia. Which action is the priority for this patient? A. Assist with immediate intubation. B. Obtain informed consent for surgery. C. Place the child in protective isolation. D. Teach the parents colostomy care.

ANS: B Rectal atresia is a complete obstruction of the rectum that prevents passage of stool. Immediate surgical correction is needed. The nurse places priority on obtaining informed consent. Intubation will be performed as part of the operative procedure. There is no need for protective isolation. The child may or may not need a colostomy, depending on the anatomical location of the defect.

16. A parent calls the pediatric clinic about his child who was diagnosed with gastric ulcer disease and placed on omeprazole (Prilosec) 8 days ago. The parent states that the child has not had relief of symptoms. Which action by the nurse is the most appropriate? A. Advise the parent to bring the child in today. B. Encourage the parent to serve milk at each meal. C. Inform the provider that the child needs a different medication. D. Reassure the parent that relief may take 4-8 weeks.

ANS: D Drugs like omeprazole (proton-pump inhibitors) may take up to 4-8 weeks to provide relief of symptoms. The nurse should reassure the parent. The other actions are not warranted.

7. A pediatric nurse listens while a mother describes her toddler's eating habits. The mother states that her daughter "refuses to eat vegetables at mealtime" and "wants peanut butter sandwiches for every meal." Which action by the nurse is the most appropriate? A. Encourage the mom to keep trying to get the child to eat vegetables. B. Reassure the mother that this behavior is normal for a toddler. C. Refer the mother to a pediatric dietician for unmet nutritional needs. D. Teach the mother this behavior puts the child at risk for eating disorders.

ANS: B The nurse should reassure parents that food jags are normal at this age and that the tendencies will pass; also stress that a little patience will keep both parents and child from further gastrointestinal upsets. The nurse should also suggest that the parents not force the child to eat foods he or she is not interested in, but to provide a variety of nutritious foods during meals and for between-meal snacks in the amount appropriate for the child's age. The other options are not warranted.

14. A nurse is assessing a 6-month-old baby with volvulus. The infant's vital signs are as follows: pulse: 118 beats/minute; blood pressure: 78/54 mm Hg; respirations: 42 breaths/minute. What action by the nurse is most appropriate? A. Assess the infant's abdomen and skin. B. Document the findings in the baby's chart. C. Increase the rate of IV fluid administration. D. Notify the health-care provider immediately.

ANS: B These vital signs are appropriate for a 6-month-old baby. The nurse should document the findings in the patient's chart. A full assessment is completed, but specific assessments are not needed based on these vital signs. The IV rate does not need adjustment, and there is no need to inform the provider.

10. The pediatric nurse explaining cholelithiasis to a nursing student would describe which risk factors for this disease process? (Select all that apply.) A. Asian descent B. Hyperlipidemia C. Obesity D. Pancreatitis E. Smoking

ANS: B, C Common risk factors for cholelithiasis include hyperlipidemia, obesity, pregnancy, use of birth control pills, infection, bile stasis, congenital anomalies, use of total parenteral nutrition, and family history. Native Americans and Hispanics of both genders have the highest rate of this disease according to ethnicity. Pancreatitis is the most common complication of cholelithiasis. Smoking is not related.

1. A pediatric nurse is teaching the family of a child with celiac disease about necessary dietary modifications to manage the disease. Which information does the nurse include in the teaching session? (Select all that apply.) A. Eliminate all sources of corn. B. High-calorie, high-protein foods are preferred. C. Lactose restriction may be needed. D. Rye and wheat must be avoided. E. Watch for hidden sources of gluten.

ANS: B, C, D, E The treatment of celiac disease is a gluten-free diet. Because gluten is found mainly in wheat and rye, and to a smaller extent in barley and oat products, it is recommended that they be eliminated from the diet. Corn, rice, and millet are grains that are allowed in the diet. General dietary guidelines include high-protein, high-calorie foods. In severe cases, temporary lactose restrictions may be needed. Gluten is often hidden in food products.

5. The pediatric nurse caring for children in the emergency room teaches the student nurse about the injury statistics related to abdominal trauma. Which information does the nurse provide to the student? (Select all that apply.) A. Injuries are responsible for more than 70% of all deaths in the 15- to 24-year-old age group. B. Injuries are the leading cause of death in children and adolescents after their first year. C. Injuries from motor vehicle crashes are the main cause of accidental death in the United States. D. Injuries to the abdomen and genitourinary system are usually caused by abuse. E. Injuries to the abdominal and genitourinary area account for 10% of serious trauma.

ANS: B, C, E The leading cause of death in children and adolescents after the first year of life is injuries. Injuries are responsible for more than 50% of all deaths in the 15- to 24-year-old age group Motor vehicle injuries are the primary cause of accidental death in the United States, with nearly 60% occurring with unrestrained children. Ten percent of incidents of serious trauma to children occur as a result of abdominal and genitourinary injury.

30. A patient has pancreatitis. Which daily laboratory test will the nurse review as a priority for this patient? A. Amylase B. C-reactive protein C. Lipase D. White blood cell count

ANS: C Although all options are routine laboratory tests for the patient with pancreatitis, lipase is the best indicator of pancreatic function, as it stays elevated longer than amylase.

2. During a well-child visit, the pediatric nurse performs a physical assessment on a 2-year-old patient. Which of the following developmental characteristics would the nurse expect to be the case for a child of 2 years? A. Average weight gain is 10 to 12 lb/year. B. The digestive system grows rapidly, increasing caloric needs. C. The salivary glands reach adult size. D. Stomach capacity increases to about 200 mL.

ANS: C By 2 years, the child's salivary glands reach adult size (Murphy, 2004). The average toddler gains 5 to 6 lb/year (2.3 to 2.7 kg/year). The stomach capacity increases to about 500 mL, and the growth of the child's digestive system slows during the toddler years, which leads to a reduction in caloric needs from those during the infant period.

8. A school-age child has a diagnosis of constipation. When planning dietary teaching for the parents, what food does the nurse emphasize as a means to decrease constipation? A. Cheese B. Milk C. Produce D. Rice

ANS: C Constipation can be partially managed with good dietary habits, including eating lots of fresh produce for fiber and increasing water intake.

34. A mother is distraught after learning that her son has Hirschsprung disease. She asks the nurse how she could have prevented this from occurring. Which response by the nurse is most appropriate? A. "Did you use recreational drugs during pregnancy?" B. "How much alcohol did you consume while pregnant?" C. "Nothing; this disease seems to be familial in origin." D. "You probably did not get enough folic acid in your diet."

ANS: C Hirschsprung disease is a familial condition, often associated with other congenital abnormalities such as trisomy 21. The nurse should assure the mother that she did not cause this problem. The other options are not appropriate.

36. The nurse explains to the nursing student that lactose is hydrolyzed into glucose and galactose in which organ? A. Gallbladder B. Large intestine C. Small intestine D. Stomach

ANS: C Lactose is hydrolyzed into glucose and galactose in the small intestine through the action of the enzyme lactase.

20. A nurse in a community clinic assesses children for signs of failure to thrive (FTT). Which child's assessment finding is most concerning to this nurse? A. Child's parent asking questions about feeding B. Mother demonstrating improper burping technique C. Weight for age and sex at the 4th percentile D. Weight for length at 86% of ideal weight

ANS: C No specific diagnostic tests exist for failure to thrive (FTT); however, there are several assessment criteria that can be used to identify children at risk for FTT. One such criterion is weight for age and sex below the 5th percentile. Asking questions about feeding is appropriate. Demonstrating improper burping technique creates an opportunity for teaching the correct process. Improper burping combined with other risk factors may be a concern. Weight for length less than the 85th percentile of ideal weight is a concern, so this child has a normal weight-for-length finding.

32. A child has been admitted to the hospital with acute diarrhea. Which assessment finding by the nurse would indicate that goals for the priority nursing diagnosis have been met? A. No stooling for 4 hours B. Perineal skin intact C. Stable weight for 2 days D. White blood cell count normal

ANS: C The priority for a child with diarrhea is to maintain or restore fluid volume. Weight is the most sensitive noninvasive indicator of fluid status, and a stable weight over 2 days indicates hemodynamic stability. Alterations in skin integrity may or may not be present, but if present, they would not take priority over fluid balance. Not having a stool for 4 hours does not indicate resolution of the priority problem. WBC may be normal in cases of diarrhea, but even if abnormal, the WBC does not address fluid status.

3. A parent calls the after-hours clinic nurse's line and describes a bulging mass in his 6-month-old son's scrotal area that used to disappear when the child was quiet. Now the mass is constantly present. What action by the nurse is the most appropriate? A. Ask the parent to call in the morning to make an appointment. B. Have the father withhold all feedings for 24 hours. C. Instruct the father to take the child to an emergency department. D. Reassure the father the condition is benign unless bloody diarrhea occurs.

ANS: C This child has signs of an incarcerated hernia, which is a hernia that cannot be returned to the abdominal cavity. This can lead to strangulation or necrosis of the bowel if not treated promptly. Because it is after hours, the nurse should instruct the father to take the child to an emergency department for treatment. Waiting to call for an appointment in the morning increases the risk of complications. Holding feedings and bloody diarrhea are not related to this condition.

22. A parent calls the pediatric clinic to make an appointment for her child who complains of periumbilical pain that has progressed to right lower quadrant pain. Later the parent calls to cancel the appointment, stating that the pain went away spontaneously after the child used a heating pad. What action by the nurse is most appropriate? A. Ask the parent if the child has diarrhea or a fever. B. Encourage the parent to keep the appointment anyway. C. Instruct the parent to take the child to an emergency department. D. Reassure the parent she can bring the child in if the pain returns.

ANS: C This child has the classic pain presentation of appendicitis. Appendicitis pain that resolves spontaneously is often indicative of perforation. The child needs to be seen in an emergency department. The other actions are not appropriate at this time.

11. A nurse is teaching a parent about strategies for managing colic in the infant. Which suggestions does the nurse provide to this parent? (Select all that apply.) A. Change the baby's feeding schedule. B. Encourage daily use of probiotics. C. Provide a peaceful environment. D. Swaddle and rock the child when fussy. E. Switch from breast milk to formula .

ANS: C, D Management strategies for colic include supporting the parents, reassuring the parents that the child is healthy, reinforcing the parents' attempts to comfort their child, swaddling and/or rocking the baby, decreasing environmental stimulation, assessing and re-teaching feeding and burping technique if needed, and providing an opportunity for parents to express their frustrations. Changing the baby's feeding schedule and switching from breast to cow's milk are not recommended. Probiotics may be useful, but studies on their use have been inconclusive.

26. A child in the emergency department has a suspected Meckel diverticulum. What diagnostic testing is most important for the nurse to facilitate? A. Abdominal ultrasound B. Complete blood count C. Non-contrast CT scan D. Radionuclide scintigraphy

ANS: D A nuclear medicine scan, specifically radionuclide scintigraphy (Meckel scan), is the best diagnostic test for this condition. Anemia can occur in undiagnosed disease, but is nonspecific. The other two studies are not diagnostic for Meckel diverticulum.

23. A nurse is performing a focused abdominal assessment on a child complaining of stomach pain. Which assessment finding warrants immediate action by the nurse? A. Complains of pain of 4 on 1-10 scale B. Lack of rebound tenderness C. Negative obturator sign D. Positive heel-drop jarring test

ANS: D A positive heel-drop jarring test involves having the patient stand on his or her toes for 15 seconds then drop onto the heels. Pain elicited with this assessment is indicative of appendicitis. The patient may also wince when getting off the examination table. The nurse should notify the provider immediately. Pain is nonspecific and needs treatment, but does not need immediate action. A negative obturator sign is normal, as is the lack of rebound tenderness.

12. A child is being discharged from the hospital after a pyloromyotomy. Which discharge instruction does the nurse provide for the parents? A. Keep child NPO for 48 hours. B. Monitor the skin around the colostomy. C. No pain control should be needed. D. Report vomiting after 48 hours.

ANS: D A pyloromyotomy is performed for pyloric stenosis performed via laparoscopy. Some vomiting may still occur for up to 36 hours postoperatively, but vomiting persisting beyond 48 hours needs to be reported to the health-care provider. Small feedings are usually started around 4-6 hours postoperatively. A colostomy is not performed for this condition. With any invasive surgical procedure, pain control will be needed based on assessment of the patient.

24. A school-age child is being discharged after a laparoscopic appendectomy. Which discharge teaching does the nurse provide to the child and family? A. Allow activity as the child desires. B. Call the surgeon for reports of pain. C. Empty the drains twice a day. D. Report redness or heat at the incision sites.

ANS: D Discharge instructions after appendectomy include monitoring for signs of infection, which include redness and heat at the sites. Activity and eating should be progressive, especially in a younger child who might not have the ability to determine what activity is appropriate postoperatively. After a laparoscopic appendectomy, no drains will be present. Some pain is expected, and parents need teaching on pain management.