GI Practice Questions

What is the best description of pyloric stenosis? 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 Hypertrophic pyloric stenosis occurs when the circumferential muscle of the pyloric sphincter becomes thickened, resulting in elongation and narrowing of the pyloric channel. Dilation of the pylorus, hypotonicity of the pyloric muscle, and reduction of tone in the pyloric muscle are not the definition of pyloric stenosis.

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 Remove restraints periodically, while supervising the infant, to allow him or her to exercise arms and to provide cuddling and tactile stimulation. The infant should not be left in the crib, but should be removed for appropriate holding and stimulation. Analgesia and sedation are administered for pain. Heavy sedation is not indicated. The child should not be placed in the prone position.

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 Rotavirus is the most frequent viral pathogen that causes diarrhea in young children. Giardia (parasite) and Salmonella are bacterial pathogens that cause diarrhea. Shigella is a bacterial pathogen that is uncommon in the United States.

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 The diagnosis of pyloric stenosis is often made after the history and physical examination. The olive-like mass is easily palpated when the stomach is empty, the infant is quiet, and the abdominal muscles are relaxed. Abdominal rigidity and substernal retraction are usually not present. The upper abdomen, not lower abdomen, is distended.

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 Visible gastric peristaltic waves that move from left to right across the epigastrium and weight loss are observed in pyloric stenosis. Abdominal rigidity and pain on palpation or a rounded abdomen and hypoactive bowel sounds are usually not present. The upper abdomen, not lower abdomen, is distended.

Andy is 30 kg child who is admitted to the pediatric unit with dehydration He is currently NPO and is receiving IV fluids at maintenance. What is the hourly rate that the IV should be set at? a. 60 ml/hr b. 70 ml/hr c. 80 ml/hr d. 90 ml/hr

B. 70ml/hr

Julie is a newborn infant diagnosed with tracheoespohageal fistula (TEF). When reveiwing Julie's history, the nurse would expect to find which of the following? a. Julie tolerated feedings for a few days, then experienced projectile vomiting b. Julie's mother stated that she barely looked pregnant and never needed to wear maternity clothes c. Julie continuously appeared hungry despite being fed every 2 hours d. Julie appeared to have a lot of secretions and became cyanotic when fed

D. Julie appeared to have a lot of secretions and became cyanotic when fed

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

ANS: A Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume. Respiratory rate influences insensible fluid loss and should be monitored in the mechanically ventilated child. Congestive heart failure is a case of fluid overload in children. Increased ICP does not lead to increased fluid requirements in children.

The mother of newborn Hannah, an infant with cleft palate tells the nurse that she is so disappointed because she probably won't be able to nurse Hannah. Which of the following is the nurse's best response? a. "Some mother's are still able to nurse their baby, have you tried yet?" b. "I understand you are frustrated, let's talk about other ways to feel close to Hannah." c. The risk of aspiration is too great, I know you want what is best for Hannah." d. "It will be hard enough to feed Hannah with a bottle. I certainly wouldn't attempt to breastfeed."

ANS: A In many cases the mother's breast helps to fill the cleft, allowing the infant to create suction in her mouth. The mother may just be assuming that breastfeeding is not an option. It is good to explore the mother's feelings but assessing whether she has attempted breastfeeding is the first step. Breastfeeding does not increase the risk of aspiration. It is best for the nurse not to point out potential difficulties.

The nurse is providing education about proper feeding of a two month old after a cleft lip repair. Which is the correct information to provide to parents about feeding their infant? a. Breast-feed or bottle-feed b. Use a cup c. Use a paper straw d. Use a medicine dropper

ANS: A Infants can be breast fed or bottle fed after cleft lip repair with careful attention to not put strain on the suture line and to maintain elbow restraints.

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 Jaundice is the earliest and most striking manifestation of biliary atresia. It is first observed in the sclera and may be present at birth but is usually not apparent until age 2 to 3 weeks. Vomiting is not associated with biliary atresia. Hepatomegaly and abdominal distention are common but occur later. Stools are large and lighter in color than expected because of the lack of bile.

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

ANS: A Raisins are a high-fiber food. Pancakes and muffins do not have significant fiber unless made with fruit or bran. Raw fruits, especially those with skins and seeds, other than ripe bananas, have high fiber.

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 The main consideration is helping the child adhere to dietary management. Considerable time is spent explaining to the child and parents about the disease process, the specific role of gluten in aggravating the condition, and foods that must be restricted. Referral to a nutritionist would help in this process. The most severe symptoms usually occur in early childhood and adult life. Dietary avoidance of gluten should be lifelong. Celiac disease is not transmissible or stress related.

A four year old who has just had her appendix out, wakes up with her mother at the bedside. Which of the following comments would be most developmentally appropriate: a. "When you feel better your friends can come visit you" b. "There is a big band-aid where the doctors fixed your belly pain" c. "You will be able to return to preschool really soon" d. "Let's close the curtain while I look at your tummy'

ANS: B A four year old would not be as concerned with friends visiting or privacy. Returning to school may not be "really soon". Four year olds are concerned with body integrity. Telling her there is a big band-aid covering the area will alleviate fears of "things leaking out".

Eight week old Hannah is admitted for surgery to repair her cleft lip. What is the most important nursing intervention following surgery? a. Lay the baby on her stomach to prevent aspiration b. Decrease stress on the suture line c. Provide adequate oral nutrition d. Use a hard nipple and pacifier in order to teach the child how to suck properly

ANS: B Decreasing stress on the suture line is the most important post-operative nursing intervention in the care of an infant with cleft lip repair. Interventions include placing the infant on his back to sleep to prevent pressure on the face, arm restraints to prevent the infant from placing her hands in her mouth. Feeding may resume as usual using a regular nipple for a bottle or breast feeding.

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. What is the initial therapeutic approach for the mother? 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 For parents, cleft lip and cleft palate deformities are particularly disturbing. The nurse must emphasize not only the infant's physical needs but also the parents' emotional needs. The mother needs to be able to express her feelings before she can accept her child. Although the nurse will restate what the physician has told the mother about plastic surgery, it is not part of the initial therapeutic approach. As the mother expresses her feelings, the nurse's actions should convey to the parents that the infant is a precious human being. The nurse emphasizes the child's normalcy and helps the mother recognize the child's uniqueness.

The nurse is providing discharge instructions to a 14 year old with ulcerative colitis. Which is the nurse's best advice concerning her diet? a. "You'll know what to eat by how your body responds. Keeping a journal is always a good idea." b. "It is recommended that you eat high protein, high calorie, and low fat foods." c. "It is recommended that you eat high protein, high fat foods." d. "That is a good question. I will have the dietician come talk to you."

ANS: B High protein, high calorie foods help to promote growth. High fat foods tend to cause irritability and cramping. Keeping a food diary and consulting with a dietician are appropriate but providing a general answer is incorrect. If the child is being discharged, seeing a dietician might not be possible.

The nurse is providing education to Kirsten's parents. Kirsten is a 6 week old infant diagnosed with gastroesophageal reflux (GER). Which of the following should the nurse include in her teaching plan? a. Although most children should be put on their backs to sleep, Kirsten should be placed on her side to avoid aspiration b. Kirsten should be fed in smaller amounts each feeding c. The time between Kirsten's feedings should be stretched out as much as possible to assure the stomach is fully empty. d. Kirsten's parents should decrease the caloric density of her feedings

ANS: B Infants with GER tolerate small, frequent feedings and being held in the upright position for 30 minutes following a feeding. All infants should be placed on their backs to sleep to prevent SIDS. The caloric density of her feeds may need increased not decreased.

The nurse is caring for Jed, a newborn with suspected TEF. When his mother offered him his first feeding, Jed became cyanotic with coughing and choked. Which of the following would the nurse expect to be part of Jed's care? a. Allow Jed's mother to feed him pedialyte slowly in a monitored area, stopping all feedings six hours before surgery b. Begin IV fluids and IV antibiotics c. Admit Jed to the ICU and immediately place him on 100% oxygen d. Allow Jed's parents to visit him in the PICU, but not hold him unitl immediately before his surgery

ANS: B Oral feedings are immediately stopped when a child is suspected of having TEF. An IV is started and fluids are administered to prevent dehydration. IV antiobiotics are started to prevent and treat pneumonia that is caused from aspiration. Unless the newborn's oxygen saturations drop, 100% oxygen is not required. Oxygen is delivered at the lowest amount to keep oxygen saturations above 94%. Parents are encouraged to stay in the ICU and hold the infant as much as possible.

A mother who intended to breastfeed has given birth to an infant with a cleft palate. What nursing interventions should be included? 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 The mother who wishes to breastfeed may need encouragement and support because the defect does present some logistical issues. The nipple must be positioned and stabilized well back in the infant's oral cavity so that the tongue action facilitates milk expression. Because breastfeeding is an option, if the mother wishes to breastfeed, medications should not be given to suppress lactation. Because breastfeeding can usually be accomplished, gavage feedings are not indicated. The suction required to stimulate milk, absent initially, may be useful before nursing to stimulate the let-down reflex.

What is the most common assessment finding in a child with ulcerative colitis? a. Abdominal cramps b. Bloody diarrhea c. Anal fissures d. Abdominal distention

ANS: B Ulcerative colitis is one form of inflammatory bowel disease (IBD) involving symmetrical and contiguous bowel ulcers attacking the mucosa of the bowel wall in the large intestine. The edema and inflammation in the bowel leads to bloody diarrhea, weight loss, anorexia, nausea and vomiting

What is the most common assessment finding in a child with ulcerative colitis? a. Abdominal cramps b. Bloody diarrhea c. Anal fissures d. Abdominal distention

ANS: B Ulcerative colitis is one form of inflammatory bowel disease (IBD) involving symmetrical and contiguous bowel ulcers attacking the mucosa of the bowel wall in the large intestine. The edema and inflammation in the bowel leads to bloody diarrhea, weight loss, anorexia, nausea and vomiting

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 Universal vaccination for hepatitis B is now recommended for all newborns. A vaccine is available for hepatitis A, but it is not yet universally recommended. No vaccine is currently available for hepatitis C. Only hepatitis B vaccine is recommended for newborns.

The nurse is providing dietary teaching for the parents of a child with celiac disease. This child should avoid: a. Vegetables b. Fruits c. Prepared puddings d. Rice

ANS: C Celiac disease is a gluten induced enteropathy caused by an insenstivity to gluten found in wheat. Gluten is contained in wheat, rye, barley and oats. Substitutions include corn, rice and millet. Thickeners used in prepared puddings, malted milkshakes and ice cream contain gluten and therfore should be avoided.

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 Clinical manifestations of dehydration include poor skin turgor, weight loss, lethargy, and tachycardia. The infant would have prolonged capillary refill, not brisk.

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

ANS: C Corticosteroids, such as prednisone and prednisolone, are used in short bursts to suppress the inflammatory response in inflammatory bowel disease. Antacids and antidiarrheal medications are not drugs of choice in the treatment of inflammatory bowel disease. Antibiotics may be used as an adjunctive therapy to treat complications.

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

ANS: C G. lamblia is a parasite that represents 10% of non-dysenteric illness in the United States. Shigella, Salmonella, and E. coli are bacterial pathogens.

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

ANS: C 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.

When developing a postoperative plan of care for an infant scheduled for cleft lip repair, the nurse should assign highest priority to which intervention? a. Comforting the child as quickly as possible b. Maintaining the child in a prone position c. Restraining the child's arms at all times using elbow restraints d. Avoid disturbing any crusts that form on the suture line

ANS: C Nursing interventions following a cleft lip repair focus on monitoring for respiratory distress and maintaining an intact suture line. The infant should be placed on his back for sleeping and the infant's arms should be kept away from his mouth which can be accomplished using elbow restraints. The greatest danger post-operatively after cleft lip or cleft palate repair is rupture of the suture lines.

The nurse is reviewing information on pyloric stenosis. Which of the following reflects accurate information? a. It only occurs in males b. Vomiting will gradually become more projectile and contain more bile as the pylorus muscle thickens c. Surgical correction involves spreading open the muscle around the pyloric valve. d. A sausage shaped mass can be palpated in the lower abdomen

ANS: C Surgical correction involves spreading open the muscle around the pyloric valve thereby relieving the obstruction. Although it occurs more frequently in males, it can occur in females. Vomiting will gradually become more porjectile as the muscle thickens but it will not contain bile. An olive shaped mass can be palpated in the upper right abdomen.

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 The child's age dictates the type and extent of psychological preparation. When a colostomy is performed, the child who is at least preschool age is told about the procedure and what to expect in concrete terms, with the use of visual aids. It is necessary to prepare a 3-year-old child for procedures. The preschooler is not yet concerned with body image.

A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with GER. What is the purpose of this medication? a. Prevent reflux b. Prevent hematemesis c. Reduce gastric acid production d. Increase gastric acid production

ANS: C The mechanism of action of histamine-receptor antagonists is to reduce the amount of acid present in gastric contents and perhaps prevent esophagitis. Preventing reflux or hematemesis and increasing gastric acid production are not the modes of action of histamine-receptor antagonists.

When caring for a 12 month old with diarrhea and metabolic acidosis, the nurse expects to see which of the following? a. A reduced white blood cell count b. A decreased platelet count c. Shallow respirations d. Tachypnea

ANS: D A child with metabolic acidosis will develop compensatory tachypnea to blow-off CO2, physiologic acid, and therefore reduce overall acidosis.

A 10 month old is admitted to the hospital with dehydration and metabolic acidosis. What is the most common cause of dehydration and acidosis in infants? a. Early introduction of solid foods b. Inadequate perianal hygiene c. Tachypnea d. Diarrhea

ANS: D Diarrhea is a common cause of metabolic acidosis among infants. The infant with diarrhea loses HCO3 in the stool and therefore develops metabolic acidosis.

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 Easily digested foods such as cereals, cooked vegetables, and meats should be provided for the child. Early reintroduction of nutrients is desirable. Continued feeding or reintroduction of a regular diet has no adverse effects and actually lessens the severity and duration of the illness. Clear liquids and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic. The BRAT diet has little nutritional value and is high in carbohydrates.

What are the results of excessive vomiting in an infant with pyloric stenosis? a. Hyperchloremia b. Hypernatremia c. Metabolic acidosis d. Metabolic alkalosis

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

You are caring for a seven month old who is suspected of having intussusception. What clinical manifestations most likely be present? a. Abdominal pain, vomiting, olive shaped mass to the right of the umbilicus b. Anorexia, abdominal distention, constipation c. Malnourished looking child, fever, diarrhea d. Inconsolable crying, abdominal pain, sausage shaped mass in the right lower quadrant

ANS: D Intussusception is an acute condition involving the telscoping of one portion of the bowel in on itself causing acute lymphatic and venous obstruction that results in ischemia, mucous backflow into the intestine and leaking of blood into the intestine. The classic sign is current jelly stools. A palpable sausage shaped mass can often be felt in the right lower quadrant of the abdomen. Other clinical manifestations include episodic acute abdominal pain with drawing up of the knees and inconsolability. Bilious vomiting may also be present. The child usually appears otherwise well nourished.

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

ANS: 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. Invagination of one segment of bowel within another is the definition of intussusception, not atresia, stenosis, or herniation.

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 Most children with Hirschsprung disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter. Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. The colostomy that is created in Hirschsprung disease is usually temporary.

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

A toddler is brought to the emergency room with sudden onset of abdominal pain, vomiting, and stools that look like current jelly. To confirm intussusception, the nurse expects the doctor to order which of the following? a. A barium enema b. Suprapubic catheter insertion c. Nasogastric tube insertion d. Nasogastric tube insertion

ANS: A Intussusception is a telescoping or invagination of a bowel segment into itself. Its cause is not well-understood. Children typically present with signs ofacute abdominal pain iwth drawing up of the knees to the chest. The classic symptom is current jelly-like stools. The diagnosis of intussusception is made based on the administration of a barium or water-soluble contrast with air pressure enema in order to reeduce the invagination of the bowel segment. If the enema is unsuccessful, surgery is indicated to remove the gangrenous portion of the bowel.

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 Isotonic dehydration is the correct term for this definition and is the most frequent form of dehydration in children. Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic. Hypertonic dehydration results from water loss in excess of electrolyte loss and is usually caused by a proportionately larger loss of water or a larger intake of electrolytes. This definition is specific to isotonic dehydration.

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 Passage of a normal brown stool indicates that the intussusception has reduced itself. This is immediately reported to the practitioner, who may choose to alter the diagnostic-therapeutic care plan. The first action would be to report the normal stool to the practitioner.

Mrs. Walker asks the nurse if it matters when they give their infant Tyler his ranitidine. Which of the following is the nurse's best response? a. "Since ranitidine is an antacid it doesn't matter when you give it." b. "It would be easiest to give it with Tyler's feeding." c. "It would be best to give the medication 30 minutes before Tyler eats." d. "It would be best to give the medication 30 minutes after Tyler eats."

ANS: C Antacids reduce esophagitis by decreasing the amount of acid present in the stomach contents. It is most effective when given 30 minutes prior to a feeding.

The nurse is working in the emergency room when Mrs. Evans brings 4 year old Sally in to be evaluated. Sally has been vomiting and having diarrhea for 2 days. Mrs. Evans states Sally hasn't been able to keep anything down. The nurse notes Sally is pale adn has dark circles around her eyes. Sally is very lethargic and doesn't cry or move when the nurse obtains her vital signs. Which of the following should the nurse anticipate will be included in Sally's plan of care? a. Administering an IV bolus of normal saline b. Administering an IV bolus with fluids containing both saline and glucose to help correct dehydration and hypoglycemia c. Give Sally a Pedialyte popsicle to avoid traumatizing her with an invasive procedure d. Encourage Sally's mother to attempt giving her clear liquids by mouth prior to starting an IV.

ANS: A The child that has been experiencing vomiting and diarrhea an is lethargic is already severely dehydrated and needs immediate rehydration. It is essential to administer a hypotonic IV fluid such as normal saline. A solution containing glucose should never be given as a bolus as it could lead to cerebral edema and death. The child described in this scenario is already severely dehydrated and needs IV not oral hydration.

A 12 year old with inflammatory bowel disease (IBD) has recently developed mouth ulcers and arthritis in the joints. Which of the following is likely? a. The patient has Crohn's disease b. The patient has Ulcerative colitis c. It is impossible to determine the type of IBD, but it is likely there is a seconary inflammatory illness unrelated to IBD d. The medications used to treat IBD tend to cause mouth ulcers and arthritic pain

ANS: A These inflammatory signs are more closely linked to Crohn's disease and are not likely related to medications.

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 The most desirable position for a newborn who has TEF is supine (or sometimes prone) with the head elevated on an inclined plane of at least 30 degrees. This positioning minimizes the reflux of gastric secretions at the distal esophagus into the trachea and bronchi, especially when intra-abdominal pressure is elevated. It is imperative to immediately remove any secretions that can be aspirated. Until surgery, the blind pouch is kept empty by intermittent or continuous suction through an indwelling double-lumen or Replogle catheter passed orally or nasally to the end of the pouch. In some cases, a percutaneous gastrostomy tube is inserted and left open so that any air entering the stomach through the fistula can escape, thus minimizing the danger of gastric contents being regurgitated into the trachea. The gastrostomy tube is emptied by gravity drainage. Feedings through the gastrostomy tube and irrigations with fluid are contraindicated before surgery in an infant with a distal TEF. A nasogastric tube to low intermittent suctioning could not be accomplished because the esophagus ends in a blind pouch in TEF.

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 Acute diarrhea is a sudden increase in frequency and change in consistency of stools and may be associated with antibiotic therapy. Celiac disease is a problem with gluten intolerance and may cause chronic diarrhea if not identified and managed appropriately. Immunodeficiency would occur with chronic diarrhea. Protein malnutrition or kwashiorkor causes chronic diarrhea from lowered resistance to infection.

The greatest post-operative danger from a cleft palate repair is: a. Pain b. Rupture of the suture lines c. Infection d. Dehydration

ANS: B Following cleft palate repair the nurse would assess for signs of bleeding such as increased swallowing and tachycardia, which would indicate rupture of the suture lines. Pain is expected and can be controlled. Infection is prevented through use of antibiotics and stringent rinsing of the mouth. Dehydration can happen but is not the biggest danger.

A child is suspected of having Hirschprung's disease. The nurse would expect the child's history of present illness to include which of the following? a. Anemia, abdominal distention, fecal soiling b. Abdominal distention, constipation, foul smelling stools c. Bloody diarrhea, fever, vomiting d. Irritability, severe abdominal cramping, fecal soiling

ANS: B Hirschprung's disease is a congenital anomaly of decreased intestinal motility resulting in mechanical obstruction of the intestine. Clinical manifestations include vomiting, constipation, abdominal distention, and ribbon-like foul smelling stools. This condition is not associated with anemia, fecal soiling or bloody diarrhea.

Which of the following assessments would you expect to find when caring for the child with pyloric stenosis? a. Projectile vomiting of bile-tinged emesis b. Visible peristaltic waves c. Metabolic acidosis d. Non-projectile vomiting

ANS: B Pyloric stenosis is the narrowing of the pyloric sphincter at the outlet of the stomach. Infants do not have signs in the first few days of life. As the pylorous narrows causing obstruction of the pyloric sphincter, the infant has clinical manifestations including: projectile vomiting of non-bilious vomitus, visible peristaltic waves across the epigastrum, signs of malnutrition and dehydration. Infants present with markedly abnomal electrolytes with signs of metabolic alkalosis revealing an increased pH and bicarbonate levels.

The 1 day old neonate is suspected to have tracheoesophageal fistula. Which nursing intervention is most appropriate for this infant? a. Avoiding suctioning unless cyanosis occurs b. Elevating the head of the bed/crib and giving nothing by mouth c. Elevating the neonate's head for 1 hour after feedings d. Giving the neonate only glucose water for the first 24 hours

ANS: B The chid with TEF is at risk for aspiration and respiratory distress due to communication between the esophagus and the trachea. The child should be NPO and should have the head of the bed elevated. Suction equipment is necessary to handle excess secretions. Ventilation equiplment is indicated due to risk for respiratory distress.

You are caring for a 3 year old admitted with diarrhea and dehydration. She is NPO for bowel rest. She has an order for IV maintenance fluids. Her weight is 13 kg. You calculate her IV fluid rate to be approximately: a. 52 ml/hr b. 46 ml/hr c. 36 ml/hr d. 26 ml/hr

ANS: B The formula to calculate maintenance fluids is 100 ml/kg for the first 10 kg of body weight + 50 ml/kg for the second 10 kg of body weight and 20 ml/kg for the remaining kg of body weight.

Constipation has recently become a problem for a school-age girl. She is healthy except for seasonal allergies that are being treated with antihistamines. What should the nurse suspect caused the constipation? a. Diet b. Allergies c. Antihistamines d. Emotional factors

ANS: C Constipation may be associated with drugs such as antihistamines, antacids, diuretics, opioids, antiepileptics, and iron. Because this is the only known change in her habits, the addition of antihistamines is most likely the cause of the diarrhea. With a change in bowel habits, the role of any recently prescribed medications should be assessed.

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 Hepatitis A is the most common form of acute hepatitis in most parts of the world. It is characterized by a rapid and acute onset. The incubation period is approximately 3 weeks for hepatitis A, and the principal mode of transmission for it is the fecal-oral route. Hepatitis A does not have a carrier state

A 3 month old infant who is receiving tube feeds due to a temporary malformation of the GI system is admitted to the pediatric floor. Which of the following should the nurse encourage Amelia's mother to do during her feedings? a. Sing or play music that is calm during her feedings b. Stroke Amelia's head and talk to her during the feedings c. Give Amelia a pacifier during the feedings d. Encourage Amelia to sleep during the feedings

ANS: C It is important for an infant receiving tube feedings to have episodes of nonnutritive sucking. If offered concurrently with a feeding, sucking and mouth stimulation is associated with a positive contented feeding. Studies have also linked increased growth and development with nonnutritive sucking. While it is important for the other to interact and be present with her infant, nonnutritive sucking has a very positive overall effect. It is not necessary to encourage the infant to sleep during feedings.

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 Hypertonic dehydration results from water loss in excess of electrolyte loss. This is the most dangerous type of dehydration. It is caused by feeding children fluids with high amounts of solute. Isotonic dehydration occurs in conditions in which electrolyte and water deficits are present in balanced proportion and is another term for isomotic dehydration. Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic.

A three month old with biliary atresia is admitted to the pediatric floor. The mother asks why her infant is so irritable and restless. Which of the following is the nurse's best response? a. "The liver is enlarged and placing pressure on her abdomen causing pain. I will give her some pain medication." b. "Your baby is probably restless because of being confined to a crib and not being held and cuddled." c. "Your baby just needs more stimulation. Let's put a music toy in the crib." d. "Your baby may be feeling itchy. I can give some medication to help."

ANS: D It is common for children with biliary atresia to have extreme puritis from the build up of bile and irritation of nerve endings. It is treated with the administration of cholestyramine. Although the child with biliary atresia may have abdominal pain, puritis tends to cause the most discomfort. There is no reason not to hold the infant in this case.

The nurse is providing education on cleft lip and palate to a group of nursing students. It is apparent that more education is needed when a student states that the infants are at risk for: a. Pneumonia b. Otitis media c. Altered bonding with parents d. Gastroesophageal reflux

ANS: D There is not an increased incidence of gastroesophageal reflux in children with cleft lip and palate. The open space in the mouth increases the risk of aspiration and subsequent pneumonia. There is an increased risk for otitis media as the cleft in palate allows fluid and microorganisms to easily enter into the ear canal. Because cleft lip and cleft palate are disfiguring defects, there can be an alteration in the way the parent bonds to and copes with their child.

What should be included in caring for the newborn with a cleft lip and palate before surgical repair? 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 Using special or modified nipples for feeding techniques helps meet the infant's sucking needs. Gastrostomy feedings are usually not indicated. Feeding is best accomplished with the infant's head in an upright position. The child requires both nutritive and nonnutritive sucking.

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

B, D, E Feedings are usually instituted soon after a pyloromyotomy surgery, beginning with clear liquids and advancing to formula or breast milk as tolerated. IV fluids are administered until the infant is taking and retaining adequate amounts by mouth. Appropriate analgesics should be given around the clock because pain is continuous. Ice should not be applied to the incisional area as it vasoconstricts and would reduce circulation to the incisional area and impair healing.

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

C, D, E High-fiber foods include whole grain breads, bran pancakes, and raw carrots. Unrefined (brown) rice is high in fiber, but white rice is not. Raw fruits, especially those with skins or seeds, other than ripe banana or avocado, are high in fiber.