GI review

62. The nurse is interviewing the parents of a 6-year-old who has been experiencing constipation. Which could be a causative factor? Select all that apply. 1. Hypothyroidism. 2. Muscular dystrophy. 3. Myelomeningocele. 4. Drinks a lot of milk. 5. Active in sports.

1, 2, 3, 4. 1. Hypothyroidism can be a causative factor in constipation. 2. Weakened abdominal muscles can be seen in muscular dystrophy and can lead to constipation. 3. Myelomeningocele affects the innervation of the rectum and can lead to constipation. 4. Excessive milk consumption can lead to constipation. Richardson, Beth. Pediatric Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 156). F.A. Davis Company. Kindle Edition.

61. Which child may need extra fluids to prevent dehydration? Select all that apply. 1. 7-day-old receiving phototherapy. 2. 6-month-old with newly diagnosed pyloric stenosis. 3. 2-year-old with pneumonia. 4. 2-year-old with full-thickness burns to the chest, back, and abdomen. 5. 13-year-old who has just started her menses.

1, 2, 3, 4. 1. The lights in phototherapy increase insensible fluid loss, requiring the nurse to monitor fluid status closely. 2. The infant with pyloric stenosis is likely to be dehydrated due to persistent vomiting. 3. A 2-year-old with pneumonia may have increased insensible fluid loss due to tachypnea associated with respiratory illness. The nurse needs to monitor fluid status cautiously because fluid overload can result in increased respiratory distress. 4. The child with a burn experiences extensive extracellular fluid loss and is at great risk for dehydration. The younger child is at greater risk due to greater proportionate body surface area.

37. Which should be included in the plan of care for a 14-month-old whose cleft palate was repaired 12 hours ago? Select all that apply. 1. Allow the infant to have familiar items of comfort such as a favorite stuffed animal and a "sippy" cup. 2. Once liquids have been tolerated, encourage a bland diet such as soup, Jell-O, and saltine crackers. 3. Administer pain medication on a regular schedule, as opposed to an as-needed schedule. 4. Use a Yankauer suction catheter on the infant's mouth to decrease the risk of aspiration of oral secretions. 5. When discharged, remove elbow restraints.

1, 3. 1. The child should not be allowed to use anything that creates suction in the mouth, such as pacifiers or straws. "Sippy" cups are acceptable. 3. Pain medication should be administered regularly to avoid crying, which places stress on the suture line.

4. A 4-month-old is brought to the emergency department with severe dehydration. The heart rate is 198, and her blood pressure is 68/38. The infant's anterior fontanel is sunken. The nurse notes that the infant does not cry when the intravenous line is inserted. The child's parents state that she has not "held anything down" in 18 hours. The nurse obtains a finger-stick blood sugar of 94. Which would the nurse expect to do immediately? 1. Administer a bolus of normal saline. 2. Administer a bolus of D10W. 3. Administer a bolus of normal saline with 5% dextrose added to the solution. 4. Offer the child an oral rehydrating solution such as Pedialyte.

1. Administer a bolus of normal saline. 1. Dehydration is corrected with the administration of an isotonic solution, such as normal saline or lactated Ringer solution.

28. Which manifestations should the nurse expect to find in a child in the early stages of acute hepatitis? 1. Nausea, vomiting, and generalized malaise. 2. Nausea, vomiting, and pain in the left upper quadrant. 3. Generalized malaise and yellowing of the skin and sclera. 4. Yellowing of the skin and sclera without any other generalized complaints.

1. The early stage of acute hepatitis is referred to as the anicteric phase, during which the child usually complains of nausea, vomiting, and generalized malaise.

53. The parent of a child being evaluated for celiac disease asks the nurse why it is important to make dietary changes. Select the nurse's best response. 1. "The body's response to gluten causes damage to the mucosal cells in the intestine, leading to absorption problems." 2. "The body's response to consumption of anything containing gluten is to create special cells called villi, which leads to more diarrhea." 3. "The body's response to gluten causes the intestine to become more porous and hang on to more of the fat-soluble vitamins, leading to vitamin toxicity." 4. "The body's response to gluten causes damage to the mucosal cells, leading to malabsorption of water and hard, constipated stools."

1. The inability to digest protein leads to an accumulation of an amino acid that is toxic to the mucosal cells and villi, leading to absorption problems.

31. Which manifestation would the nurse expect to see in a 4-week-old infant with biliary atresia? 1. Abdominal distention, enlarged liver, enlarged spleen, clay-colored stool, and tea-colored urine. 2. Abdominal distention, multiple bruises, bloody stools, and hematuria. 3. Yellow sclera and skin tones, excessively oily skin, and prolonged bleeding times. 4. No manifestations until the disease has progressed to the advanced stage.

1. The infant with biliary atresia usually has an enlarged liver and spleen. The stools appear clay-colored due to the absence of bile pigments. The urine is tea-colored due to the excretion of bile salts.

13. The nurse is caring for an infant diagnosed with Hirschsprung disease. The mother states she is pregnant with a boy and wants to know if her new baby will likely have the disorder. Select the nurse's best response. 1. "Genetics play a small role in Hirschsprung disease, so there is a chance the baby will develop it as well." 2. "There is no evidence to support a genetic link, so it is very unlikely the baby will also have it." 3. "It is rarely seen in boys, so it is not likely your new baby will have Hirschsprung disease." 4. "Hirschsprung disease is seen only in girls, so your new baby will not be at risk."

1. There is a genetic component to Hirschsprung disease, so any future siblings are also at risk.

14. The nurse is caring for an infant newly diagnosed with Hirschsprung disease. What does the nurse understand about this infant's condition? 1. There is a lack of peristalsis in the large intestine and an accumulation of bowel contents, leading to abdominal distention. 2. There is excessive peristalsis throughout the intestine, resulting in abdominal distention. 3. There is a small-bowel obstruction leading to ribbon-like stools. 4. There is inflammation throughout the large intestine, leading to accumulation of intestinal contents and abdominal distention.

1. There is a lack of peristalsis in the large intestine and an accumulation of bowel contents, leading to abdominal distention.

50. The nurse is providing discharge instructions to the parents of an infant who has had surgery to open a low imperforate anus. The nurse knows that the discharge instructions have been understood when the child's parents say: 1. "We will use an oral thermometer because we cannot use a rectal one." 2. "We will call the physician if the stools change in consistency." 3. "Our infant will never be toilet-trained." 4. "We understand that it is not unusual for our infant's urine to contain stool."

2. A change in stool consistency is important to report because it could indicate stenosis of the rectum.

12. Which discharge instruction for a child diagnosed with encopresis should the nurse question? 1. Limit the intake of milk. 2. Offer a diet high in protein. 3. Obtain a complete dietary log. 4. Follow up with a child psychologist.

2. A diet high in protein will cause more constipation.

22. The parents of a child being evaluated for appendicitis tell the nurse the physician said their child has a positive Rovsing sign. They ask the nurse what this means. Select the nurse's best response. 1. "Your child's physician should answer that question." 2. "A positive Rovsing sign means the child feels pain in the right side of the abdomen when the left side is palpated." 3. "A positive Rovsing sign means pain is felt when the physician removes the hand from the abdomen." 4. "A positive Rovsing sign means pain is felt in the right lower quadrant when the child coughs."

2. A positive Rovsing sign occurs when the left lower quadrant is palpated and pain is felt in the right lower quadrant.

59. The nurse is caring for an infant who has been diagnosed with short bowel syndrome (SBS). The parent asks how the disease will affect the child. Select the nurse's best response. 1. "Because your child has a shorter intestine than most, your child will likely experience constipation and will need to be placed on a bowel regimen." 2. "Because your child has a shorter intestine than most, he will not be able to absorb all the nutrients and vitamins in food and will need to get nutrients in other ways." 3. "Unfortunately, most children with this diagnosis do not do very well." 4. "The prognosis and course of the disease have changed because hyperalimentation is available."

2. Because the intestine is used for absorption, children with SBS usually need alternative forms of nutrition such as hyperalimentation.

26. The nurse is caring for a 3-year-old who had an appendectomy 2 days ago. The child has a fever of 101.8°F (38.8°C) and breath sounds are slightly diminished in the right lower lobe. Which action is most appropriate? 1. Teach the child how to use an incentive spirometer. 2. Encourage the child to blow bubbles. 3. Obtain an order for intravenous antibiotics. 4. Obtain an order for Tylenol (acetaminophen).

2. Blowing bubbles is a developmentally appropriate way to help the preschooler take deep breaths and cough.

43. The nurse is providing discharge teaching to the parents of an infant with an umbilical hernia. Which should be included in the plan of care? 1. If the hernia has not resolved on its own by the age of 12 months, surgery is generally recommended. 2. If the hernia appears to be more swollen or tender, seek medical care immediately. 3. To help the hernia resolve, place a pressure dressing over the area gently. 4. If the hernia is repaired surgically, there is a strong likelihood that it will return.

2. If the hernia appears larger, swollen, or tender, the intestine may be trapped, which is a surgical emergency.

40. The nurse is caring for a newborn who has just been diagnosed with tracheo -esophageal fistula and is scheduled for surgery. Which should the nurse expect to do in the pre-operative period? 1. Keep the child in a monitored crib, obtain frequent vital signs, and allow the parents to visit but not hold their infant. 2. Administer intravenous fluids and antibiotics. 3. Place the infant on 100% oxygen via a non-rebreather mask. 4. Have the mother feed the infant slowly in a monitored area, stopping all feedings 4 to 6 hours before surgery.

2. Intravenous fluids are administered to prevent dehydration because the infant is NPO. Intravenous antibiotics are administered to prevent pneumonia because aspiration of secretions is likely.

35. The nurse is caring for a newborn with a cleft lip and palate. The mother states, "I will not be able to breastfeed my baby." Select the nurse's best response. 1. "It sounds like you are feeling discouraged. Would you like to talk about it?" 2. "Sometimes breastfeeding is still an option for babies with a cleft lip and palate. Would you like more information?" 3. "Although breastfeeding is not an option, you have the option of pumping your milk and then feeding it to your baby with a special nipple." 4. "We usually discourage breastfeeding babies with cleft lip and palate as it puts them at an increased risk for aspiration."

2. Some mothers are able to breastfeed their infants who have a cleft lip and palate. The breast can help fill in the cleft and help the infant create suction.

27. The nurse is providing discharge instructions to the parents of a child who had an appendectomy for a ruptured appendix 5 days ago. The nurse knows that further education is required when the parent states: 1. "We will wait a few days before allowing our child to return to school." 2. "We will wait 2 weeks before allowing our child to return to sports." 3. "We will call the pediatrician's office if we notice any drainage around the wound." 4. "We will encourage our child to go for walks every day."

2. The child should wait 6 weeks before returning to any strenuous activity.

51. The nurse is caring for a neonate with an anorectal malformation. The nurse notes that the infant has not passed any stool per rectum but the infant's urine contains meconium. The nurse can make which assumption? 1. The child likely has a low anorectal malformation. 2. The child likely has a high anorectal malformation. 3. The child will not need a colostomy. 4. This malformation will be corrected with a nonoperative rectal pull-through.

2. The presence of stool in the urine indicates that the anorectal mal - formation is high.

32. The nurse is caring for an infant with biliary atresia. The parents ask why the child is receiving cholestyramine. Select the nurse's best response. 1. To lower your child's cholesterol. 2. To relieve your child's itching. 3. To help your child gain weight. 4. To help feedings be absorbed in a more efficient manner.

2. The primary reason cholestyramine is administered to the child with biliary atresia is to relieve pruritus.

20. The nurse is administering Prilosec (omeprazole) to a 3-month-old with gastro -esophageal reflux (GER). The child's parents ask the nurse how the medication works. Select the nurse's best response. 1. "Prilosec is a proton pump inhibitor that is commonly used for reflux in infants." 2. "Prilosec decreases stomach acid, so it will not be as irritating when your child spits up." 3. "Prilosec helps food move through the stomach quicker, so there will be less chance for reflux." 4. "Prilosec relaxes the pressure of the lower esophageal sphincter."

2. This accurate description gives the parents information that is clear and concise.

29. Which foods should be offered to a child with hepatitis? 1. A tuna sandwich on whole wheat bread and a cup of skim milk. 2. Clear liquids, such as broth, and Jell-O. 3. A hamburger, French fries, and a diet soda. 4. A peanut butter sandwich and a milkshake.

29. 1. A diet that is high in protein and carbohydrates helps maintain caloric intake and protein stores while preventing muscle wasting. A low-fat diet prevents abdominal distention.

55. Which would the nurse expect to be included in the diagnostic workup of a child with suspected celiac disease? 1. Obtain complete blood count and serum electrolytes. 2. Obtain complete blood count and stool sample; keep child NPO. 3. Obtain stool sample and prepare child for jejunal biopsy. 4. Obtain complete blood count and serum electrolytes; monitor child's response to gluten-containing diet.

3. A stool sample for analysis of fat and a jejunal biopsy can confirm the diagnosis.

11. A child is diagnosed with chronic constipation that has been unresponsive to dietary and activity changes. Which pharmacological measure is most appropriate? 1. Natural supplements and herbs. 2. Stimulant laxative. 3. Osmotic agent. 4. Pharmacological measures are not used in pediatric constipation.

3. A stool softener is the drug of choice because it will lead to easier evacuation.

15. The nurse is caring for a 3-month-old being evaluated for possible Hirschsprung disease. His parents call the nurse and show her his diaper containing a large amount of mucus and bloody diarrhea. The nurse notes that the infant is irritable and his abdomen appears very distended. Which should be the nurse's next action? 1. Reassure the parents that this is an expected finding and not uncommon. 2. Call a code for a potential cardiac arrest, and stay with the infant. 3. Immediately obtain all vital signs with a quick head-to-toe assessment. 4. Obtain a stool sample for occult blood.

3. All vital signs need to be evaluated because the child with enterocolitis can quickly progress to a state of shock. A quick head-to-toe assessment will allow the nurse to evaluate the child's circulatory system.

7. The nurse is caring for a 9-month-old with diarrhea secondary to rotavirus. The child has not vomited and is mildly dehydrated. Which is likely to be included in the discharge teaching? 1. Administer Imodium as needed. 2. Administer Kaopectate as needed. 3. Continue breastfeeding per routine. 4. The infant may return to day care 24 hours after antibiotics have been started.

3. Breastfeeding is usually well tolerated and helps prevent death of intestinal villi and malabsorption. The test taker can eliminate answer 4 as antibiotics are not effective with viruses such as rotavirus. Answers 1 and 2 can be eliminated as antidiarrheal agents are not recommended in the pediatric population.

48. The nurse is caring for a 5-month-old infant with a diagnosis of intussusception. The infant has periods of irritability during which the knees are brought to chest and the infant cries, alternating with periods of lethargy. Vital signs are stable and within age-appropriate limits. The physician elects to give an enema. The parents ask the purpose of the enema. Select the nurse's most appropriate response. 1. "The enema will confirm the diagnosis. If the test result is positive, your child will need to have surgery to correct the intussusception." 2. "The enema will confirm the diagnosis. Although very unlikely, the enema may also help fix the intussusception so that your child will not immediately need surgery." 3. "The enema will help confirm the diagnosis and has a good chance of fixing the intussusception." 4. "The enema will help confirm the diagnosis and may temporarily fix the intussusception. If the bowel returns to normal, there is a strong likelihood that the intussusception will recur."

3. In most cases of intussusception in young children, an enema is successful in reducing the intussusception.

10. The parents of a 4-year-old ask the nurse how to manage their child's constipation. Select the nurse's best response. 1. "Add 2 ounces of apple or pear juice to the child's diet." 2. "Be sure your child eats a lot of fresh fruit such as apples and bananas." 3. "Encourage your child to drink more fluids." 4. "Decrease bulky foods such as whole-grain breads and rice."

3. Increasing fluid consumption helps to decrease the hardness of the stool.

45. The nurse is caring for an 8-week-old infant being evaluated for pyloric stenosis. Which statement by the parent would be typical for a child with this diagnosis? 1. "The baby is a very fussy eater and just does not want to eat." 2. "The baby tends to have a very forceful vomiting episode about 30 minutes after most feedings." 3. "The baby is always hungry after vomiting so I refeed." 4. "The baby is happy in spite of getting really upset after spitting up."

3. Infants with pyloric stenosis are always hungry and often appear malnourished.

60. The nurse is caring for a 3-month-old infant who has short bowel syndrome (SBS) and has been receiving total parenteral nutrition (TPN). The parents ask if their child will ever be able to eat. Select the nurse's best response. 1. "Children with SBS are never able to eat and must receive all of their nutrition in intravenous form." 2. "You will have to start feeding your child because children cannot be on TPN longer than 6 months." 3. "We will start feeding your child soon so that the bowel continues to receive stimulation." 4. "Your child will start receiving tube feedings soon but will never be able to eat by mouth."

3. It is important to begin feedings as soon as the bowel is healed so that it receives stimulation and does not atrophy.

25. The nurse is caring for a 5-year-old who has just returned from having an appendectomy. Which is the optimal way to manage pain? 1. Intravenous morphine as needed. 2. Liquid Tylenol (acetaminophen) with codeine as needed. 3. Morphine administered through a PCA pump. 4. Intramuscular morphine as needed.

3. Morphine administered through a PCA pump offers the child control over managing pain. The PCA pump also has the benefit of offering a basal rate as well as an as-needed rate for optimal pain management.

6. The parent of a 5-year-old states that the child has been having diarrhea for 24 hours, vomited twice 2 hours ago, and now claims to be thirsty. The parent asks what to offer the child because the child is refusing Pedialyte. Select the nurse's most appropriate response. 1. "You can offer clear diet soda such as Sprite and ginger ale." 2. "Pedialyte is really the best thing for your child, who, if thirsty enough, will eventually drink it." 3. "Pedialyte is really the best thing for your child. Allow your child some choice in the way to take it by offering small amounts in a spoon, medicine cup, or syringe." 4. "It really does not matter what your child drinks as long as it is kept down. Try offering small amounts of fluids in medicine cups."

3. Pedialyte is the first choice, as recommended by the American Academy of Pediatrics. Offering the child appropriate choices may allow the child to feel empowered and less likely to refuse the Pedialyte. Small, frequent amounts are usually better tolerated.

5. The nurse is caring for a 2-year-old child who was admitted to the pediatric unit for moderate dehydration due to vomiting and diarrhea. The child is restless, with periods of irritability. The child is afebrile with a heart rate of 148 and a blood pressure of 90/42. Baseline laboratory tests reveal the following: Na 152, Cl 119, and glucose 115. The parents state that the child has not urinated in 12 hours. After establishing a saline lock, the nurse reviews the physician's orders. Which order should the nurse question? 1. Administer a saline bolus of 10 mL/kg, which may be repeated if the child does not urinate. 2. Recheck serum electrolytes in 12 hours. 3. After the saline bolus, begin maintenance fluids of D5 1 /4 NS with 10 mEq KCl/L. 4. Give clear liquid diet as tolerated.

3. Potassium is contraindicated because the child has not yet urinated. Potassium is not added to the maintenance fluid until kidney function has been verified.

44. The nurse is caring for an infant with pyloric stenosis. The parent asks if any future children will likely have pyloric stenosis. Select the nurse's best response. 1. "You seem worried; would you like to discuss your concerns?" 2. "It is very rare for a family to have more than one child with pyloric stenosis." 3. "Pyloric stenosis can run in families. It is more common among males." 4. "Although there can be a genetic link, it is very unusual for girls to have pyloric stenosis."

3. Pyloric stenosis can run in families, and it is more common in males.

3. A 4-month-old has had vomiting and diarrhea for 24 hours. The infant is fussy, and the anterior fontanel is sunken. The nurse notes the infant does not produce tears when crying. Which task will help confirm the diagnosis of dehydration? 1. Urinalysis obtained by bagged specimen. 2. Urinalysis obtained by sterile catheterization. 3. Analysis of serum electrolytes. 4. Analysis of cerebrospinal fluid.

3. The analysis of serum electrolytes offers the most information and assists with the diagnosis of dehydration. Infants have limited ability to concentrate urine, so answers 1 and 2 can be eliminated immediately.

41. The nurse is giving discharge instructions to the parent of a 1-month-old infant with tracheoesophageal fistula and a gastrostomy tube (GT). The nurse knows the mother understands the discharge teaching when she states: 1. "I will give my baby feedings through the GT but place liquid medications in the corner of the mouth to be absorbed." 2. "I will flush the GT with 2 ounces of water after each feeding to prevent the GT from clogging." 3. "I will clean the area around the GT with soap and water every day." 4. "I will place petroleum jelly around the GT if any redness develops."

3. The area around the GT should be cleaned with soap and water to prevent an infection.

52. The nurse is caring for a newborn with an anorectal malformation and a colostomy. The nurse knows that more education is needed when the infant's parent states which of the following? 1. "I will make sure the stoma is red." 2. "There should not be any discharge or irritation around the outside of the stoma." 3. "I will keep a bag attached to avoid the contents of the small intestine coming in contact with the baby's skin." 4. "As my baby grows, a pattern will develop over time, and there should be predictable bowel movements."

3. The colostomy contains stool from the large intestine; an ileostomy contains the very irritating stool from the small intestine.

23. Which is the best position for an 8-year-old who has just returned to the pediatric unit after an appendectomy for a ruptured appendix? 1. Semi-Fowler. 2. Prone. 3. Right side-lying. 4. Left side-lying.

3. The right side-lying position promotes comfort and allows the peritoneal cavity to drain.

36. The nurse is caring for a 4-month-old who has just had an isolated cleft lip repaired. Select the best position for the child in the immediate post-operative period. 1. Right side-lying. 2. Left side-lying. 3. Supine. 4. Prone.

3. The supine position is preferred because there is decreased risk of the infant rubbing the suture line.

19. The nurse is caring for a 4-month-old with gastroesophageal reflux (GER). The infant is due to receive Zantac (rantadine). Based on the medication's mechanism of action, when should this medication be administered? 1. Immediately before a feeding. 2. 30 minutes after the feeding. 3. 30 minutes before the feeding. 4. At bedtime.

3. Zantac decreases gastric acid secretion and should be administered 30 minutes before a feeding.

54. The nurse is caring for a 14-year-old with celiac disease. The nurse knows that the patient understands the diet instructions by ordering which of the following meals? 1. Eggs, bacon, rye toast, and lactose-free milk. 2. Pancakes, orange juice, and sausage links. 3. Oat cereal, breakfast pastry, and nonfat skim milk. 4. Cheese, banana slices, rice cakes, and whole milk.

4. Cheese, banana slices, rice cakes, and whole milk do not contain gluten.

24. The nurse is to receive a 4-year-old from the recovery room after an appendectomy. The parents have not seen the child since surgery and ask what to expect. Select the nurse's best response. 1. "Your child will be very sleepy, have an intravenous line in the hand, and have a nasal tube to help drain the stomach. If your child needs pain medication, it will be given intravenously." 2. "Your child will be very sleepy, have an intravenous line in the hand, and have white stockings to help prevent blood clots. If your child needs pain medication, we will give it intravenously or provide a liquid to swallow." 3. "Your child will be wide awake and will have an intravenous line in the hand. If your child needs pain medication, we will give it intravenously or provide a liquid to swallow." 4. "Your child will be very sleepy and have an intravenous line in the hand. If your child needs pain medication, we will give it intravenously."

4. In the immediate post-operative period, the child is usually sleepy but can be roused. The child usually has an intravenous line for hydration and pain medication.

49. The nurse will soon receive a 4-month-old who has been diagnosed with intussusception. The infant is described as very lethargic with the following vital signs: T 101.8°F (38.7°C), HR 181, BP 68/38. The reporting nurse states the infant's abdomen is very rigid. Which is the most appropriate action for the receiving nurse? 1. Prepare to accompany the infant to a computed tomography scan to confirm the diagnosis. 2. Prepare to accompany the infant to the radiology department for a reducing enema. 3. Prepare to start a second intravenous line to administer fluids and antibiotics. 4. Prepare to get the infant ready for immediate surgical correction.

4. Intussusception with peritonitis is a surgical emergency, so preparing the infant for surgery is the nurse's top priority.

17. Which should the nurse include in the plan of care to decrease symptoms of gastroesophageal reflux (GER) in a 2-month-old? Select all that apply. 1. Place the infant in an infant seat immediately after feedings. 2. Place the infant in the prone position immediately after feeding to decrease the risk of aspiration. 3. Encourage the parents not to worry because most infants outgrow GER within the first year of life. 4. Encourage the parents to hold the infant in an upright position for 30 minutes following a feeding. 5. Suggest that the parents burp the infant after every 1-2 ounces consumed.

4. Keeping the infant in an upright position is the best way to decrease the symptoms of GER. The infant can also be placed in the supine position with the head of the crib elevated. A harness can be used to keep the child from sliding down. 5. Burping the infant frequently may help decrease spitting up by expelling air from the stomach more often.

9. The nurse receives a call from the parent of a 10-month-old who has vomited three times in the past 8 hours. The parent describes the baby as playful and wanting to drink. The parent asks the nurse what to give the child. Select the nurse's best response. 1. "Replace the next feeding with regular water, and see if that is better tolerated." 2. "Do not allow your baby to eat any solids; give half the normal formula feeding, and see if that is better tolerated." 3. "Do not let your baby eat or drink anything for 24 hours to give the stomach a chance to rest." 4. "Give your child 1 /2 ounce of Pedialyte every 10 minutes. If vomiting continues, wait an hour, and then repeat what you previously gave."

4. Offering small amounts of clear liquids is usually well tolerated. If the child vomits, make NPO to allow the stomach to rest and then restart fluids. The child in this scenario is described as playful and therefore does not appear to be at risk for dehydration.

30. Which would be an appropriate activity for the nurse to recommend to the parent of a toddler just diagnosed with acute hepatitis? 1. Climbing in a "playscape." 2. Kicking a ball. 3. Playing video games in bed. 4. Playing with puzzles in bed.

4. Playing with puzzles is a developmentally appropriate activity for a 3-year-old on bedrest.

16. The nurse is caring for an 8-week-old male who has just been diagnosed with Hirschsprung disease. The parents ask what they should expect. Select the nurse's best response. 1. "It is really an easy disease to manage. Most children are placed on stool softeners to help with constipation until it resolves." 2. "A permanent stool diversion, called a colostomy, will be placed by the surgeon to bypass the narrowed area." 3. "Daily bowel irrigations will help your child maintain regular bowel habits." 4. "Although your child will require surgery, there are different ways to manage the disease, depending on how much bowel is involved."

4. The aganglionic portion needs to be removed. Although most children have a temporary colostomy placed, many infants are able to bypass the colostomy and have the bowel immediately reattached.

39. Which should be the nurse's immediate action when a newborn begins to cough and choke and becomes cyanotic while feeding? 1. Inform the physician of the situation. 2. Have the mother stop feeding the infant, and observe to see if the choking episode resolves on its own. 3. Immediately determine the infant's oxygen saturation, and have the mother stop feeding the infant. 4. Take the infant from the mother, and administer blow-by oxygen while obtaining the infant's oxygen saturation.

4. The infant should be taken from the mother and placed in the crib where the nurse can assess the baby. Oxygen should be administered immediately, and vital signs should be obtained.

34. The parents of a newborn diagnosed with a cleft lip and palate ask the nurse when their child's lip and palate will most likely be repaired. Select the nurse's best response. 1. "The palate and the lip are usually repaired in the first few weeks of life so that the baby can grow and gain weight." 2. "The palate and the lip are usually not repaired until the baby is approximately 6 months old so that the mouth has had enough time to grow." 3. "The lip is repaired in the first few months of life, but the palate is not usually repaired until the child is 3 years old." 4. "The lip is repaired in the first few weeks of life, but the palate is not usually repaired until the child is 18 months old."

4. The lip is repaired in the first few weeks of life, but the palate is not usually repaired until the child is 18 months old.

21. A 10-year-old is being evaluated for possible appendicitis and complains of nausea and sharp abdominal pain in the right lower quadrant. An abdominal ultrasound is scheduled, and a blood count has been obtained. The child vomits, finds the pain relieved, and calls the nurse. Which should be the nurse's next action? 1. Cancel the ultrasound, and obtain an order for oral Zofran (ondansetron). 2. Cancel the ultrasound, and prepare to administer an intravenous bolus. 3. Prepare for the probable discharge of the patient. 4. Immediately notify the physician of the child's status.

4. The physician should be notified immediately, as a sudden change or loss of pain often indicates a perforated appendix.

42. An expectant mother asks the nurse if her new baby will have an umbilical hernia. The nurse bases the response on the fact that it occurs: 1. More often in large infants. 2. In white infants more than in African American infants. 3. Twice as often in male infants. 4. More often in premature infants.

4. Umbilical hernias occur more often in premature infants.

14. Which of the following laboratory values, often found in acute diarrhea with dehydration, will return to normal after hydration of the patient? a. Elevated hemoglobin, hematocrit, blood urea nitrogen (BUN), and creatinine b. Decreased hemoglobin, hematocrit, BUN, and creatinine c. Red blood cells in stool d. Decreased white blood cell count, decreased hemoglobin, elevated BUN, and creatinine

A

43. A common feature of inflammatory bowel diseases (IBD) in pediatric patients is: a. growth failure. b. chronic constipation. c. obstruction. d. burning epigastric pain.

A

48. The most reliable way to detect peptic ulcer disease in children is: a. fiberoptic endoscopy. b. an upper GI series. c. C urea breath test. d. complete blood count with differential, erythrocyte sedimentation rate, and stool analysis.

A

55. An invagination of one portion of the intestine into another is called: a. intussusception. b. pyloric stenosis. c. tracheoesophageal fistula. d. Hirschsprung disease.

A

56. Al, age 5 months, is suspected of having intussusception. What clinical manifestations would he most likely have? a. Crampy abdominal pain, inconsolable crying, a drawing up of the knees to the chest, and passage of red, currant jelly-like stools b. Fever; diarrhea; vomiting; lowered white blood cell count; and tender, distended abdomen c. Weight gain, constipation, refusal to eat, and rebound tenderness d. Abdominal distention, periodic pain, hypotension, and lethargy

A

57. Which of the following usually indicates that the intussusception has reduced itself? a. Passage of a normal brown stool b. Increase in appetite c. Hyperactive bowel sounds d. Normal complete blood count

A

60. Symptoms in celiac disease include stools that are: a. fatty, frothy, bulky, and foul smelling. b. currant jelly-appearing. c. small, frothy, and dark green. d. white with an ammonia-like smell.

A

63. Jerry, a 4-year-old, is brought to the emergency department by his parents, who say he vomited a large amount of bright red blood. Jerry is pale, is cool to the touch, and has increased respiratory rate and heart rate. The nurse expects priority care at this time to include: a. administration of intravenous fluids, usually normal saline or lactated Ringer solution. b. stool testing for blood by Hemoccult. c. insertion of a nasogastric tube for ice-water lavage. d. preparation for tracheostomy.

A

79. Danny is now 2 hours postoperative. During surgery, his appendix was found to have ruptured before surgery. A priority nursing diagnosis at this time would be: a. high risk for spread of infection related to rupture. b. pain related to inflamed appendix. c. altered growth and development related to hospital care. d. anxiety related to knowledge deficit regarding disease.

A

80. Which of the following is the most critical outcome for Danny after surgery? a. Danny's peritonitis has resolved as evidenced by no fever, lack of elevated white blood cell count, and a wound that is clean and healing. b. Danny's pain is relieved as evidenced by no verbalization of pain and the fact that Danny is resting quietly. c. Danny and his family demonstrate understanding of hospitalization. d. Danny is able to express feelings and concerns.

A

77. Danny is admitted to the hospital with a diagnosis of acute appendicitis. The nurse should institute which one of the following independent nursing actions? a. Allow clear liquids only. b. Start intravenous fluids with antibiotics. c. Insert a nasogastric tube and connect to suction. d. Monitor closely for progression of symptoms.

A white blood cell count with a differential elevated greater than 10,000/mm3, with an elevated number of bands indicating a shift to the left; C-reactive protein elevation that rises within 12 hours of the onset of infection

15. What are the four major goals in the management of acute diarrhea?

Assessment of fluid and electrolyte imbalance; rehydration; maintenance fluid therapy; reintroduction of adequate diet

12. Johnny, age 2 years, is diagnosed with uncomplicated diarrhea with no signs of dehydration. Diagnostic evaluation should include which one of the following? a. Cultures of the stool b. Presence of associated symptoms c. Complete blood count d. Urine specific gravity

B

46. IBD can be treated with immunomodulators such as 6-mercaptopurine and azathioprine. When the patient is receiving these drugs, the nurse knows that which of the following adverse effects can occur? a. Anemia b. Malignancy c. Peripheral neuropathy d. Decreased serum calcium levels, leading to osteoporosis

B

47. The pediatric nurse knows that the child diagnosed with IBD needs nutritional support that includes: a. avoiding all foods high in fat. b. supplementation with multivitamins, iron, and folic acid. c. meal planning for three large meals daily. d. using bran as a source for high fiber.

B

52. Common therapeutic management of peptic ulcer disease includes histamine receptor antagonists. Which of the following medications is an example of this drug class? a. Bismuth subsalicylate b. Famotidine (Pepcid) c. Omeprazole (Prilosec) d. Sulfasalazine

B

53. Justin, age 1 month, is brought to the clinic by his mother. The nurse suspects pyloric stenosis. Which of the following symptoms would support this theory? a. Diarrhea b. Projectile vomiting c. Fever and dehydration d. Abdominal distention

B

6. Chronic diarrhea: a. can be caused by viral, bacterial, and parasitic pathogens. b. is an increase in stool frequency and increased water content with a duration of more than 14 days. c. is a leading cause of illness in children younger than 5 years of age. d. is often associated with upper respiratory or urinary tract infections.

B

42. The clinical manifestations expected with Meckel diverticulum include which of the following? a. Fever, vomiting, and constipation b. Weight loss, hypotension, and obstruction c. Painless rectal bleeding, abdominal pain, or intestinal obstruction d. Abdominal pain, bloody diarrhea, and foul-smelling stool

C

45. Which of the following is used to visualize the surface of the GI tract to diagnose the extent of inflammation and narrowing in IBD? a. Upper GI series b. Magnetic resonance imaging c. Endoscopy d. Ultrasound

C

5. Acute diarrhea: a. can be caused by celiac disease. b. can be related to hyperthyroidism. c. can be caused by viral, bacterial, and parasitic pathogens. d. is an increase in stool frequency and increased water content with a duration of more than 14 days.

C

50. Which one of the following is not thought to contribute to peptic ulcer disease? a. H. pylori b. Alcohol and smoking c. Caffeine-containing beverages and spicy foods d. Psychologic factors such as stressful life events

C

58. Al's intussusception is reduced without surgery. The nurse should expect care for Al after the reduction to include: a. administration of antibiotics. b. enema administration to remove remaining stool. c. observation of stools. d. rectal temperatures every 4 hours.

C

61. The most important therapeutic management for the child with celiac disease is: a. eliminating corn, rice, and millet from the diet. b. adding iron, folic acid, and fat-soluble vitamins to the diet. c. eliminating wheat, rye, barley, and oats from the diet. d. educating the child's parents about the short-term effects of the disease and the necessity of reading all food labels for content until the disease is in remission.

C

72. Preoperative care of the neonate with esophageal atresia and tracheoesophageal fistula includes all of the following except: a. keep NPO. b. accumulated secretions are suctioned frequently from the mouth and pharynx. c. feed through the gastrostomy tube. d. position neonate in the supine position with the head elevated on an inclined plane of 30 degrees.

C

8. Which one of the following is most likely to cause acute diarrhea? a. Food allergy b. Malabsorption syndromes c. Parasitic infections d. Immunodeficiency

C

A school-age child with acute diarrhea and mild dehydration is being given oral rehydration solution (ORS). The child's mother calls the clinic nurse because the child is also occasionally vomiting. What should the nurse recommend? Bring the child to the hospital for intravenous fluids. Alternate giving ORS and carbonated drinks. Continue to give ORS frequently in small amounts. Institute a nothing by mouth (NPO) status for the child for 8 hours, and resume ORS if vomiting has subsided.

Continue to give ORS frequently in small amounts. Vomiting is not a contraindication to the use of ORS unless it is severe. The mother should continue to give the ORS in small amounts and at frequent intervals. For a school-age child with mild dehydration, rehydration can be safely done at home with oral solutions. Carbonated drinks should not be used. They may have a high carbohydrate content and contain caffeine, which is a diuretic and could exacerbate fluid loss and dehydration. NPO status is not indicated. Small, frequent intake of ORS is recommended.

54. Preoperatively, the nursing plan for suspected pyloric obstruction should include which of the following? i. Observation for dehydration ii. Keeping body temperature below 37.7° C (100° F) iii. Parental support and reassurance iv. Observation for coughing and gagging after feeding v. Observation of quality of stool a. i, ii, iii, iv, and v b. i, iii, and iv c. iii, iv, and v d. i, iii, and v

D

62. The prognosis for children with short-bowel syndrome has improved as a result of: a. dietary supplement of vitamin B12. b. improvement in surgical procedures to correct the defect. c. improved home care availability. d. total parenteral nutrition and enteral feeding.

D

Which factor predisposes an infant to fluid imbalances? Decreased surface area Lower metabolic rate Immature kidney functioning Decreased daily exchange of extracellular fluid

Immature kidney functioning The infant's kidneys are unable to concentrate or dilute urine, to conserve or excrete sodium, and to acidify urine. The infant has a proportionately greater body surface area, which allows for greater insensible water loss. The infant has a higher metabolic rate. The infant has an increased amount of extracellular fluid. Approximately 60% of the fluid loss is from the extracellular space.

44. Describe the pathophysiologic differences between Crohn disease (CD) and ulcerative colitis (UC).

In CD the chronic inflammatory process may involve any part of the GI tract, from the mouth to the anus, but most commonly affects the terminal ileum. It can affect segments of the intestine with intact mucosa in between. CD involves all layers of the wall. The inflammation may result in ulcerations, fibrosis, adhesions, stiffening of the bowel wall, and obstruction. In UC the inflammation is limited to the colon and rectum, with the distal colon and rectum often the most severely affected. UC involves the mucosa and submucosa; it also involves continuous segments with varying degrees of ulceration, bleeding, and edema. Long-standing UC can cause shortening of the colon and strictures (pp.

7. What type of diarrhea occurs in the first few months of life, persists for longer than 2 weeks with no recognized pathogens, and is refractory to treatment?

Intractable diarrhea of infancy

What should the nurse consider when providing support to a family whose infant has just been diagnosed with biliary atresia? Liver transplantation may be needed eventually. Death usually occurs by 6 months of age. The prognosis for full recovery is excellent. Children with surgical correction live normal lives.

Liver transplantation may be needed eventually. Approximately 80% to 90% of children with biliary atresia will require liver transplantation. If the condition is untreated, death will usually occur by 2 years of age. Long-term survival is possible with surgical intervention. Liver transplantation is usually required for long-term survival. Even with surgical intervention, most children progress to liver failure and require transplantation. Awarded 1.0 points out of 1.0 possible points.

4. What are the five most important basic nursing assessments included in a thorough GI assessment?

Measurement of intake and output, measurement of height, measurement of weight, abdominal examination, laboratory studies of urine and stool

The nurse is caring for a child with probable intussusception. The child had diarrhea before admission, but while waiting for administration of air pressure to reduce the intussusception, the child passed a normal brown stool. What is the most appropriate nursing action? Notify the physician. Measure the abdominal girth. Auscultate for bowel sounds. Take vital signs, including blood pressure.

Notify the physician. Passage of a normal stool indicates that the intussusception has resolved. Notification of the physician is essential to determine whether a change in the treatment plan is indicated. Measurement of the abdominal girth may be indicated, but notifying the physician is the priority. Auscultating for bowel sounds may be indicted, but notifying the physician is the priority. Taking the vital signs, including the blood pressure, may be indicated, but notifying the physician is the priority.

39. What are the classic first symptoms of appendicitis?

Periumbilical pain, followed by nausea, right-sided lower quadrant pain, and then later vomiting with fever

A child has a nasogastric (NG) tube after surgery for acute appendicitis. What is the purpose of the NG tube? Maintain electrolyte balance Maintain an accurate record of output Incorrect Prevent the spread of infection Prevent abdominal distention

Prevent abdominal distention

The nurse is discussing home care with the mother of a 6-year-old child with hepatitis A. Part of the discharge teaching plan should include? Bed rest is important until 1 week after the icteric phase. The child should not return to school until 3 weeks after the icteric phase. Reassure the mother that hepatitis A cannot be transmitted to other family members. Teach infection control measures to family members.

Teach infection control measures to family members. Hepatitis A is a contagious disease, transmitted through the fecal-oral route. The nurse should teach infection control measures to family members. Hepatitis A does not usually have an icteric phase and often is subclinical. The period of communicability for hepatitis A is the latter half of the incubation period to 1 week after the onset of clinical illness; therefore, the child can return to school after that time frame. Hepatitis A is infectious through the fecal-oral route; therefore, family members may be susceptible to acquiring the disease if they fail to institute proper infection control measures.

Which statement best describes Hirschsprung disease? The colon has an aganglionic segment. There is a passage of excessive amounts of meconium in the neonate. It results in excessive peristaltic movements within the gastrointestinal tract. It results in frequent evacuation of solids, liquids, and gas.

The colon has an aganglionic segment. Hirschsprung disease is a mechanical obstruction caused by a lack of motility of a segment of the intestine as a result of the lack of ganglionic cells; therefore, it is referred to as aganglionic megacolon. Hirschsprung disease is associated with a neonate's inability to pass meconium or an older child's inability to pass feces. There is a lack of peristalsis in the affected segment of the infant or child with Hirschsprung disease. The infant or child with Hirschsprung disease will be seen with constipation or the passage of ribbon-like stools.

16. What is the most appropriate therapeutic management for rehydration of Jenny, age 8 months, who has been diagnosed with acute diarrhea and has evidence of mild dehydration? a. Beginning oral rehydration therapy of 40 to 50 ml/kg within 4 hours b. Restarting lactose-free formula c. Encouraging oral intake of clear fluids, such as fruit juices and gelatin d. Feeding the BRAT diet, which consists of bananas, rice, apples, and toast or tea

a. Beginning oral rehydration therapy of 40 to 50 ml/kg within 4 hours

71. The nurse observes frothy saliva in the mouth and nose of the neonate, as well as frequent drooling. When fed, the infant swallows normally, but suddenly the fluid returns through the infant's nose and mouth. The nurse should suspect what medical condition? a. Esophageal atresia b. Cleft palate c. Anorectal malformation d. Biliary atresia

a. Esophageal atresia

41. a. What is the name given to the most intense site of pain in appendicitis? b. Where is this site located?

a. McBurney point (p. 1079) b. Midway between the right anterosuperior iliac crest and the umbilicus (p. 1079)

9. Which one of the following is most likely to develop acute diarrhea? a. The 2-month-old infant who attends daycare each day b. The 18-month-old infant who stays at home each day with his mother c. The 6-year-old child who attends public school d. The 24-month-old infant with two older brothers, ages 5 years and 8 years

a. The 2-month-old infant who attends daycare each day

38. The child with irritable bowel syndrome is most likely to present with: a. history of alternating diarrhea and constipation, recurrent abdominal pain, and bloating. b. alternating patterns of constipation and bloody diarrhea with little flatulence. c. history of parasitic infections, poor nutrition, and low abdominal pain. d. history of colic, laxative abuse, and growth retardation.

a. history of alternating diarrhea and constipation, recurrent abdominal pain, and bloating

25. Pica should be considered in which of the following children coming to the health clinic? a. Seven-year-old with nausea and vomiting for the past 3 days b. Four-year-old with history of celiac disease being seen with anemia and abdominal pain c. Two-year-old who is still drinking from a bottle and is seen with anemia d. Four-month-old who is crying, is irritable, and has reddish stools

b. Four-year-old with history of celiac disease being seen with anemia and abdominal pain

28. After fecal impaction is removed, maintenance therapy for constipation may include laxative use. Why is polyethylene glycol considered safe to use for pediatric patients? a. Decreases fluid in the colon b. Increases fluid in the colon c. Increases peristaltic stimulation d. Increases osmotic pressure and acidification of the colon contents

b. Increases fluid in the colon

37. The nurse instructs the parents of a 4-month-old with GER to include which one of the following in the infant's care? a. Stop breastfeeding, since breast milk is too thin and easily leads to reflux. b. Rescheduling of the family's routine to accommodate more frequent feeding times. c. Increase the infant's intake of fruit and citrus juices. d. Try to increase feeding volume right before bedtime, because this is the time when the stomach is more able to retain foods.

b. Rescheduling of the family's routine to accommodate more frequent feeding times

36. Which of the following information given to the parents about administration of a proton pump inhibitor for the treatment of GER is correct? a. The medication is administered on a full stomach. b. The medication is administered 30 minutes before breakfast. c. The medication will be immediately effective in suppressing acid formation. d. Side effects of the drug include increased fatigue, dry mouth, and bloating.

b. The medication is administered 30 minutes before breakfast.

30. Sally, age 5, has been diagnosed with chronic constipation. Management includes: a. decreasing the water and increasing the milk in Sally's diet. b. an organized approach of at least 6 to 12 months of treatment to be effective. c. daily use of rectal stimulation to promote stool passage. d. having Sally sit on the toilet each day until she has a bowel movement.

b. an organized approach of at least 6 to 12 months of treatment to be effective.

35. In preschool children, GER may manifest with: a. symptoms of heartburn and reswallowing. b. intermittent vomiting. c. respiratory conditions such as bronchospasm and pneumonia. d. failure to thrive, bleeding, and dysphagia.

b. intermittent vomiting

27. Constipation in infancy: a. may be due to normal developmental changes. b. may be related to dietary practices. c. is found more often in breast-fed infants. d. may be due to environmental stressors.

b. may be related to dietary practices

68. The best definition of biliary atresia is: a. jaundice persisting beyond 2 weeks of age with elevated direct bilirubin levels. b. progressive inflammatory process causing intrahepatic and extrahepatic bile duct fibrosis. c. absence of bile pigment. d. hepatomegaly and palpable liver.

b. progressive inflammatory process causing intrahepatic and extrahepatic bile duct fibrosis.

69. Which one of the following would not be expected in the child diagnosed with cirrhosis? a. Hepatosplenomegaly b. Elevated liver function tests c. Decreased ammonia levels d. Ascites

c. Decreased ammonia levels

18. Which of the following dietary instructions given by the nurse to the parents of a pediatric patient with acute diarrhea without dehydration is correct? a. Follow the BRAT diet for the first 24 hours. b. Give clear fluid diet for the first 24 hours. c. Give fluids and a normal diet during diarrhea illness. d. Keep the patient NPO (nothing by mouth) until stool output slows.

c. Give fluids and a normal diet during diarrhea illness.

c. What is the term used to describe pain elicited by deep percussion and sudden release, indicating the presence of peritoneal irritation?

c. Rebound tenderness

32. To confirm the diagnosis of Hirschsprung disease, the nurse prepares the child for which one of the following tests? a. Barium enema b. Upper GI series c. Rectal biopsy d. Esophagoscopy

c. Rectal biopsy

19. Which one of the following nursing interventions is not appropriate for 6-month-old Terry, admitted to the pediatric unit with acute diarrhea and vomiting? a. Ongoing assessment of Terry's intake and output and physical appearance b. Education of the parents about the necessity of administering oral rehydration solution c. Rectal temperatures at least every 4 hours to monitor fever elevations d. Gentle cleansing of perianal areas and application of protective topical ointments

c. Rectal temperatures at least every 4 hours to monitor fever elevations

A 2-month-old breastfed infant is successfully rehydrated with oral rehydration solutions (ORSs) for acute diarrhea. Instructions to the mother about breastfeeding should include to continue breastfeeding. stop breastfeeding until breast milk is cultured. stop breastfeeding until diarrhea is absent for 24 hours. express breast milk and dilute with sterile water before feeding.

continue breastfeeding.

11. Which one of the following is not a serious and immediate physiologic disturbance associated with severe diarrheal disease? a. Dehydration b. Acid-base imbalance c. Circulatory status impairment d. Decreased growth rate

d. Decreased growth rate

31. Which of the following is a congenital anomaly that results in mechanical obstruction from inadequate motility of part of the intestine? a. Intussusception b. Short-bowel syndrome c. Crohn disease d. Hirschsprung disease

d. Hirschsprung disease

33. The nurse would expect to see what clinical manifestations in the child diagnosed with Hirschsprung disease? a. History of bloody diarrhea, fever, and vomiting b. Irritability, severe abdominal cramps, fecal soiling c. Decreased hemoglobin, increased serum lipids, and positive stool for O&P d. History of constipation; abdominal distention; and passage of ribbonlike, foul-smelling stools

d. History of constipation; abdominal distention; and passage of ribbonlike, foul-smelling stool

77. Danny is admitted to the hospital with a diagnosis of acute appendicitis. The nurse should institute which one of the following independent nursing actions? a. Allow clear liquids only. b. Start intravenous fluids with antibiotics. c. Insert a nasogastric tube and connect to suction. d. Monitor closely for progression of symptoms.

d. Monitor closely for progression of symptoms.

40. Which one of the following would alert the nurse to possible peritonitis from a ruptured appendix in a child suspected of having appendicitis? a. Colicky abdominal pain with guarding of the abdomen b. Periumbilical pain that progresses to the lower right quadrant of the abdomen with an elevated white blood cell count c. Low-grade fever of 38° C (100.6° F) with the child demonstrating difficulty walking and assuming a side-lying position with the knees flexed toward the chest d. Temperature of 38.8° C (102° F), rigid guarding of the abdomen, and sudden relief from abdominal pain

d. Temperature of 38.8° C (102° F), rigid guarding of the abdomen, and sudden relief from abdominal pain

20. Prevention measures for diarrhea in children include all of the following except: a. wash hands, utensils, and work area with hot, soapy water after contact with raw meat. b. proper disposal of soiled diapers. c. during travel to areas where water may be contaminated, allow the child to drink only bottled water from the container through a straw supplied from home. d. administration of vaccines and medications to prevent traveler's diarrhea before travel.

d. administration of vaccines and medications to prevent traveler's diarrhea before travel.

34. The transfer of gastric contents into the esophagus is termed: a. esophageal atresia. b. Meckel diverticulum. c. gastritis. d. gastroesophageal reflux (GER).

d. gastroesophageal reflux (GER).

17. Early reintroduction of nutrients (normal diet) in the patient with diarrhea: a. is delayed until after the diarrhea has stopped except in the case of breast-fed infants. b. has adverse effects and actually prolongs diarrhea. c. should be limited to formula-fed infants being given lactose-free formula. d. has no adverse effects, lessens the severity and duration of the illness, and improves weight gain when compared to gradual reintroduction of foods.

d. has no adverse effects, lessens the severity and duration of the illness, and improves weight gain when compared to gradual reintroduction of foods.

21. The major emphasis of nursing care for the vomiting infant or child is: a. determining prior treatments used for the vomiting. b. preventing the spread of the infection. c. managing the fever associated with the vomiting. d. observing and reporting vomiting behavior and associated symptoms.

d. observing and reporting vomiting behavior and associated symptoms.

The nurse assesses a neonate immediately after birth. Clinical sign-symptom of tracheoesophageal fistula is jaundice. bile-stained vomitus. absence of sucking. excessive amount of frothy saliva in the mouth.

excessive amount of frothy saliva in the mouth. Excessive salivation and drooling are indicative of tracheoesophageal fistulas. With a fistula, the child has difficulty managing the secretions, which may cause choking, coughing, and cyanosis. Jaundice is not usually associated with a tracheoesophageal fistula. Bile-stained vomitus is not usually associated with a tracheoesophageal fistula. The infant is able to suck with a tracheoesophageal fistula but is not able to manage the secretions.

Management of the child with a peptic ulcer often includes milk at frequent intervals. proton pump inhibitors. antacids 1 and 3 hours before meals and at bedtime. coping with stress and adjusting to chronic illness.

proton pump inhibitors. Proton pump inhibitors block the production of acid. They are well tolerated and have infrequent side effects. Milk is not beneficial in the management of peptic ulcer disease. Proton pump inhibitors are more effective than antacids. Coping with stress is beneficial, but peptic ulcer disease is treatable. Awarded 0.0 points out of 1.0 possible points.

When evaluating the extent of an infant's dehydration, the nurse should recognize that the symptoms of severe dehydration (15%) are tachycardia, decreased tears, 5% weight loss. normal pulse and blood pressure, intense thirst. irritability, moderate thirst, normal eyes and fontanels. tachycardia, parched mucous membranes, sunken eyes and fontanels.

tachycardia, parched mucous membranes, sunken eyes and fontanels.

Dietary management of a child with inflammatory bowel disease (IBD) should include low protein. low calorie. high fiber. vitamin supplements.

vitamin supplements. Multivitamins, iron, and folic acid supplementation are recommended for the child with IBD. A high-protein, high-calorie diet is needed to help correct nutritional deficits. A high-calorie, high-protein diet is needed to help correct nutritional deficits. A high-fiber diet is not recommended for IBD. Even small amounts of bran have been associated with a worsening of the child's condition.