Chapter 24: The Child with Gastrointestinal Dysfunction

13. A mother calls the clinic nurse about her 4-year-old son who has acute diarrhea. She has been giving him the antidiarrheal drug loperamide (Imodium A-D). The nurse's response should be based on knowledge that this drug is: a. not indicated. b. indicated because it slows intestinal motility. c. indicated because it decreases diarrhea. d. indicated because it decreases fluid and electrolyte losses.

ANS: A

28. Bismuth subsalicylate, clarithromycin, and metronidazole are prescribed for a child with a peptic ulcer to: a. eradicate Helicobacter pylori. b. coat gastric mucosa. c. treat epigastric pain. d. reduce gastric acid production.

ANS: A

3. Which type of dehydration is defined as "dehydration that occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportion"? a. Isotonic dehydration b. Hypotonic dehydration c. Hypertonic dehydration d. All types of dehydration in infants and small children

ANS: A

31. The best chance of survival for a child with cirrhosis is: a. liver transplantation. b. treatment with corticosteroids. c. treatment with immune globulin. d. provision of nutritional support.

ANS: A

36. The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's postoperative care include: a. arm restraints, postural drainage, mouth irrigations. b. cleansing the suture line, supine and side-lying positions, arm restraints. c. mouth irrigations, prone position, cleansing suture line. d. supine and side-lying positions, postural drainage, arm restraints.

ANS: B

32. A nurse is admitting an infant with biliary atresia. Which is the earliest clinical manifestation of biliary atresia the nurse should expect to assess? a. Jaundice b. Vomiting c. Hepatomegaly d. Absence of stooling

ANS: A

38. The nurse is caring for a neonate with a suspected tracheoesophageal fistula. Nursing care should include: a. elevating the head but give nothing by mouth. b. elevating the head for feedings. c. feeding glucose water only. d. avoiding suctioning unless infant is cyanotic.

ANS: A

48. A nurse is receiving report on a newborn admitted yesterday after a gastroschisis repair. In the report, the nurse is told the newborn has a physician's prescription for an NG tube to low intermittent suction. The reporting nurse confirms that the NG tube is to low intermittent suction and draining light green stomach contents. Upon initial assessment, the nurse notes that the newborn has pulled the NG tube out. Which is the priority action the nurse should take? a. Replace the NG tube and continue the low intermittent suction. b. Leave the NG tube out and notify the physician at the end of the shift. c. Leave the NG tube out and monitor for bowel sounds. d. Replace the NG tube, but leave to gravity drainage instead of low wall suction.

ANS: A

50. A child has recurrent abdominal pain (RAP) and a dairy-free diet has been prescribed for 2 weeks. Which explanation is the reason for prescribing a dairy-free diet? a. To rule out lactose intolerance b. To rule out celiac disease c. To rule out sensitivity to high sugar content d. To rule out peptic ulcer disease

ANS: A

40. Pyloric stenosis can best be described as: a. dilation of the pylorus. b. hypertrophy of the pyloric muscle. c. hypotonicity of the pyloric muscle. d. reduction of tone in the pyloric muscle.

ANS: B

27. Which is used to treat moderate to severe inflammatory bowel disease? a. Antacids b. Antibiotics c. Corticosteroids d. Antidiarrheal medications

ANS: C

2. Which is true concerning hepatitis B? (Select all that apply.) a. Hepatitis B cannot exist in carrier state. b. Hepatitis B can be prevented by HBV vaccine. c. Hepatitis B can be transferred to an infant of a breastfeeding mother. d. Onset of hepatitis B is insidious. e. Principal mode of transmission for hepatitis B is fecal-oral route. f. Immunity to hepatitis B occurs after one attack.

ANS: B, C, D, F

16. Which therapeutic management treatment is implemented for children with Hirschsprung disease? a. Daily enemas b. Low-fiber diet c. Permanent colostomy d. Surgical removal of affected section of bowel

ANS: D

22. Which clinical manifestation would 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. Abdominal pain that is most intense at McBurney point

ANS: D

34. Caring for the newborn with a cleft lip and palate before surgical repair includes: a. gastrostomy feedings. b. keeping infant in near-horizontal position during feedings. c. allowing little or no sucking. d. providing satisfaction of sucking needs.

ANS: D

5. A nurse is conducting dietary teaching on high-fiber foods for parents of a child with constipation. Which foods should the nurse include as being high in fiber? (Select all that apply.) a. White rice b. Avocados c. Whole grain breads d. Bran pancakes e. Raw carrots

ANS: C, D, E

15. Which is a high-fiber food that the nurse should recommend for a child with chronic constipation? a. Popcorn b. Pancakes c. Muffins d. Ripe bananas

ANS: A

3. A nurse is planning preoperative care for a newborn with tracheoesophageal fistula (TEF). Which interventions should the nurse plan to implement? (Select all that apply.) a. Positioning with head elevated on a 30-degree plane b. Feedings through a gastrostomy tube c. Nasogastric tube to continuous low wall suction d. Suctioning with a Replogle tube passed orally to the end of the pouch e. Gastrostomy tube to gravity drainage

ANS: A, D, E

11. A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet with the family. Which statement by the parent would indicate a correct understanding of the teaching? a. "I will keep my child on a clear liquid diet for the next 24 hours." b. "I should encourage my child to drink carbonated drinks but avoid food for the next 24 hours." c. "I will offer my child bananas, rice, applesauce, and toast for the next 48 hours." d. "I should have my child eat a normal diet with easily digested foods for the next 48 hours."

ANS: D

39. Which type of hernia has an impaired blood supply to the herniated organ? a. Hiatal hernia b. Incarcerated hernia c. Omphalocele d. Strangulated hernia

ANS: D

4. A nurse is admitting an infant with dehydration caused from water loss in excess of electrolyte loss. Which type of dehydration is this infant experiencing? a. Isotonic b. Isosmotic c. Hypotonic d. Hypertonic

ANS: D

43. An infant with pyloric stenosis experiences excessive vomiting that can result in: a. hyperchloremia. b. hypernatremia. c. metabolic acidosis. d. metabolic alkalosis.

ANS: D

44. Invagination of one segment of bowel within another is called: a. atresia. b. stenosis. c. herniation. d. intussusception.

ANS: D

9. A child is admitted with bacterial gastroenteritis. Which lab results of a stool specimen confirm this diagnosis? a. Eosinophils b. Occult blood c. pH less than 6 d. Neutrophils and red blood cells

ANS: D

1. A child who has just had definitive repair of a high rectal malformation is to be discharged. Which should the nurse address in the discharge preparation of this family? (Select all that apply.) a. Perineal and wound care b. Necessity of firm stools to keep suture line clean c. Bowel training beginning as soon as child returns home d. Reporting any changes in stooling patterns to practitioner e. Use of diet modification to prevent constipation

ANS: A, D, E

17. Enemas are ordered to empty the bowel preoperatively for a child with Hirschsprung disease. The enema solution should be: a. tap water. b. normal saline. c. oil retention. d. phosphate preparation.

ANS: B

20. A 4-month-old infant has gastroesophageal reflux (GER) but is thriving without other complications. Which should the nurse suggest to minimize reflux? a. Place in Trendelenburg position after eating. b. Thicken formula with rice cereal. c. Give continuous nasogastric tube feedings. d. Give larger, less frequent feedings.

ANS: B

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

ANS: B

30. Which vaccine is now recommended for the immunization of all newborns? a. Hepatitis A vaccine b. Hepatitis B vaccine c. Hepatitis C vaccine d. Hepatitis A, B, and C vaccines

ANS: B

4. The nurse is preparing to care for an infant returning from pyloromyotomy surgery. Which prescribed orders should the nurse anticipate implementing? (Select all that apply.) a. NPO for 24 hours b. Administration of analgesics for pain c. Ice bag to the incisional area d. IV fluids continued until tolerating PO e. Clear liquids as the first feeding

ANS: B, D, E

10. Which therapeutic management should the nurse prepare to initiate first for a child with acute diarrhea and moderate dehydration? a. Clear liquids b. Adsorbents, such as kaolin and pectin c. Oral rehydration solution (ORS) d. Antidiarrheal medications such as paregoric

ANS: C

7. Which pathogen is the viral pathogen that frequently causes acute diarrhea in young children? a. Giardia organisms b. Shigella organisms c. Rotavirus d. Salmonella organisms

ANS: C

1. Which condition in a child should alert a nurse for increased fluid requirements? a. Fever b. Mechanical ventilation c. Congestive heart failure d. Increased intracranial pressure (ICP)

ANS: A

12. A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting. Therapeutic management of this child should begin with: a. intravenous (IV) fluids. b. ORS. c. clear liquids, 1 to 2 ounces at a time. d. administration of antidiarrheal medication.

ANS: A

47. An infant with short bowel syndrome will be discharged home on total parenteral nutrition (TPN) and gastrostomy feedings. Nursing care should include: a. preparing family for impending death. b. teaching family signs of central venous catheter infection. c. teaching family how to calculate caloric needs. d. securing TPN and gastrostomy tubing under diaper to lessen risk of dislodgment.

ANS: B

49. Parents of a child undergoing an endoscopy to rule out peptic ulcer disease (PUD) from H. pylori ask the nurse, "If H. pylori is found will my child need another endoscopy to know that it is gone?" Which is the nurse's best response? a. "Yes, the only way to know the H. pylori has been eradicated is with another endoscopy." b. "We can collect a stool sample and confirm that the H. pylori has been eradicated." c. "A blood test can be done to determine that the H. pylori is no longer present." d. "Your child will always test positive for H. pylori because after treatment it goes into remission, but can't be completely eradicated."

ANS: B

6. Parents call the clinic and report that their toddler has had acute diarrhea for 24 hours. The nurse should further ask the parents if the toddler has which associated factor that is causing the acute diarrhea? a. Celiac disease b. Antibiotic therapy c. Immunodeficiency d. Protein malnutrition

ANS: B

29. Which statement best characterizes hepatitis A? a. Incubation period is 6 weeks to 6 months. b. Principal mode of transmission is through the parenteral route. c. Onset is usually rapid and acute. d. There is a persistent carrier state.

ANS: C

5. An infant is brought to the emergency department with dehydration. Which physical assessment finding does the nurse expect? a. Weight gain b. Bradycardia c. Poor skin turgor d. Brisk capillary refill

ANS: C

8. Which is a parasite that causes acute diarrhea? a. Shigella organisms b. Salmonella organisms c. Giardia lamblia d. Escherichia coli

ANS: C

26. A nurse is admitting a child with Crohn disease. Parents ask the nurse, "How is this disease different from ulcerative colitis?" Which statement should the nurse make when answering this question? a. "With Crohn's the inflammatory process involves the whole GI tract." b. "There is no difference between the two diseases." c. "The inflammation with Crohn's is limited to the colon and rectum." d. "Ulcerative colitis is characterized by skip lesions."

ANS: A

45. The nurse is caring for a boy with probable intussusception. He had diarrhea before admission but, while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool. Which nursing action is the most appropriate? a. Notify practitioner. b. Measure abdominal girth. c. Auscultate for bowel sounds. d. Take vital signs, including blood pressure.

ANS: A

46. Which is an important nursing consideration in the care of a child with celiac disease? a. Refer to a nutritionist for detailed dietary instructions and education. b. Help child and family understand that diet restrictions are usually only temporary. c. Teach proper hand washing and standard precautions to prevent disease transmission. d. Suggest ways to cope more effectively with stress to minimize symptoms.

ANS: A

33. A newborn was admitted to the nursery with a complete bilateral cleft lip and palate. The physician explained the plan of therapy and its expected good results. However, the mother refuses to see or hold her baby. Initial therapeutic approach to the mother should be: a. restating what the physician has told her about plastic surgery. b. encouraging her to express her feelings. c. emphasizing the normalcy of her baby and the baby's need for mothering. d. recognizing that negative feelings toward the child continue throughout childhood.

ANS: B

35. A mother who intended to breastfeed has given birth to an infant with a cleft palate. Nursing interventions should include: a. giving medication to suppress lactation. b. encouraging and helping mother to breastfeed. c. teaching mother to feed breast milk by gavage. d. recommending use of a breast pump to maintain lactation until infant can suck.

ANS: B

14. Constipation has recently become a problem for a school-age girl. She is healthy except for seasonal allergies that are being treated with antihistamines. The nurse should suspect that the constipation is most likely caused by: a. diet. b. allergies. c. antihistamines. d. emotional factors.

ANS: C

18. A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. The nurse should recognize that preparing this child psychologically is: a. not necessary because of child's age. b. not necessary because colostomy is temporary. c. necessary because it will be an adjustment. d. necessary because the child must deal with a negative body image.

ANS: C

19. The nurse is explaining to a parent how to care for a school-age child with vomiting associated with a viral illness. Which action should the nurse include? a. Avoid carbohydrate-containing liquids. b. Give nothing by mouth for 24 hours. c. Brush teeth or rinse mouth after vomiting. d. Give plain water until vomiting ceases for at least 24 hours.

ANS: C

2. A nurse is conducting an in-service on gastrointestinal disorders. The nurse includes that melena, the passage of black, tarry stools, suggests bleeding from which area? a. Perianal or rectal area b. Hemorrhoids or anal fissures c. Upper gastrointestinal (GI) tract d. Lower GI tract

ANS: C

21. A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with GER. The purpose of this is to: a. prevent reflux. b. prevent hematemesis. c. reduce gastric acid production. d. increase gastric acid production.

ANS: C

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

ANS: C

25. A nurse is conducting an in-service on childhood gastrointestinal disorders. Which statement is most descriptive of Meckel diverticulum? a. It is more common in females than in males. b. It is acquired during childhood. c. Intestinal bleeding may be mild or profuse. d. Medical interventions are usually sufficient to treat the problem.

ANS: C

37. During the first few days after surgery for cleft lip, which intervention should the nurse do? a. Leave infant in crib at all times to prevent suture strain. b. Keep infant heavily sedated to prevent suture strain. c. Remove restraints periodically to cuddle infant. d. Alternate position from prone to side-lying to supine.

ANS: C

41. Which observation made of the exposed abdomen is most indicative of pyloric stenosis? a. Abdominal rigidity b. Substernal retraction c. Palpable olive-like mass d. Marked distention of lower abdomen

ANS: C

42. The nurse is caring for an infant with suspected pyloric stenosis. Which clinical manifestation would indicate pyloric stenosis? a. Abdominal rigidity and pain on palpation b. Rounded abdomen and hypoactive bowel sounds c. Visible peristalsis and weight loss d. Distention of lower abdomen and constipation

ANS: C