peds #6 GI

A parent of a child who is diagnosed with Crohn's Disease asks why her child can't have popcorn. What is your best response? A. Your child can have popcorn except when there is a flare-up of the disease. Limit fiber such as popcorn during a flare-up to reduce aggravating the intestine B. Popcorn can cause appendicitis C. Popcorn causes Crohn's Disease D. Popcorn can lead to perforation of the intestine

A. Your child can have popcorn except when there is a flare-up of the disease. Limit fiber such as popcorn during a flare-up to reduce aggravating the intestine

The nurse is preparing to admit a 7-year-old child with Crohn disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Pain is common. b. Weight loss is severe. c. Rectal bleeding is common. d. Diarrhea is moderate to severe. e. Anal and perianal lesions are rare.

ANS: A, B, D Clinical manifestations of Crohn disease include pain, severe weight loss, and moderate to severe diarrhea. Rectal bleeding is rare, but anal and perianal lesions are common.

The nurse is preparing to admit a 6-month-old child with gastroesophageal reflux disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Spitting up b. Bilious vomiting c. Failure to thrive d. Excessive crying e. Respiratory problems

ANS: A, C, D, E Clinical manifestations of gastroesophageal reflux disease include spitting up, failure to thrive, excessive crying, and respiratory problems. Hematemesis, not bilious vomiting, is a manifestation.

One of the major differences in clinical presentation between Crohn disease (CD) and ulcerative colitis (UC) is that UC is more likely to cause which clinical manifestation? a. Pain b. Rectal bleeding c. Perianal lesions d. Growth retardation

ANS: B Rectal bleeding is more common in UC than CD. Pain, perianal lesions, and growth retardation are common manifestations of CD.

A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. What recommendation should the nurse include in teaching this parent? a. Surgical therapy is indicated. b. Place in prone position for sleep after feeding. c. Thicken feedings and enlarge the nipple hole. d. Reduce the frequency of feeding by encouraging larger volumes of formula.

ANS: C Thickened feedings decrease the child's crying and increase the caloric density of the feeding. Although it does not decrease the pH, the number and volume of emesis are reduced. Surgical therapy is reserved for children who have failed to respond to medical therapy or who have an anatomic abnormality. The prone position is not recommended because of the risk of sudden infant death syndrome. Smaller, more frequent feedings are more effective than less frequent, larger volumes of formula.

A child with pyloric stenosis is having excessive vomiting. The nurse should assess for what potential complication? a. Hyperkalemia b. Hyperchloremia c. Metabolic acidosis d. Metabolic alkalosis

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

What term describes invagination of one segment of bowel within another? 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. Atresia is the absence or closure of a natural opening in the body. Stenosis is a narrowing or constriction of the diameter of a bodily passage or orifice. Herniation is the protrusion of an organ or part through connective tissue or through a wall of the cavity in which it is normally enclosed.

Which assessment finding should the nurse expect in an infant with Hirschsprung disease? a. "Currant jelly" stools b. Constipation with passage of foul-smelling, ribbon-like stools c. Foul-smelling, fatty stools d. Diarrhea

B. Constipation results from absence of ganglion cells in the rectum and colon, and is present since the neonatal period with passage of frequent foul-smelling, ribbon-like, or pellet-like stools.

9. Baby Ellie is diagnosed with gastroesophageal reflux (GER); which of the following nursing diagnoses would be inappropriate? A. Risk for aspiration B. Impaired oral mucous membrane C. Deficient fluid volume D. Imbalanced nutrition: Less than body requirements

B: GER is the backflow of gastric contents into the esophagus resulting from relaxation or incompetence of the lower-esophageal (cardiac) sphincter. No alteration in the oral mucous membranes occurs with this disorder. A,C,D: Fluid volume deficit, risk for aspiration, and imbalanced nutrition are appropriate nursing diagnoses.

8. Which of the following parameters would Nurse Max monitor to evaluate the effectiveness of thickened feedings for an infant with gastroesophageL REFLUX (GER)? A. Urine B. Vomiting C. Weight D. Stools

B: Thickened feedings are used with GERto stop the vomiting. Therefore, the nurse would monitor the child's vomiting to evaluate the effectiveness of using the thickened feedings. A,D: No relationship exists between feedings and characteristics of stools and urine. C: If feedings are ineffective, this should be noted before there is any change in the child's weight.

13. In pediatric gastroesophageal reflux disease (GERD), the immaturity of lower esophageal sphincter function is manifested by frequent transient lower esophageal relaxations, which result in retrograde flow of gastric contents into the esophagus. Which statement about the esophagus is TRUE? Select all that apply. A. It is a cartilaginous tube. B. It has upper and lower sphincters. C. It lies anterior to the trachea. D. It extends from the nasal cavity to the stomach. E. All statements describe the esophagus.

B: Upper and lower esophageal sphincters, located at the upper and lower ends of the esophagus, respectively, regulate the movement of food into and out of the esophagus. A: The esophagus is a muscular tube, lined with moist stratified squamous epithelium. C: It lies anterior to the vertebrae and posterior to the trachea within the mediastinum. D: It extends from the pharynx to the stomach. It is about 25 centimeters (cm) long.

Your patient has projectile vomiting 30-60 minutes after feedings and is dehydrated. What condition do you suspect? A. Anorectal malformation B. Intussusception C. Pyloric stenosis D. Rectal stenosis

C

What should the nurse include when teaching an adolescent with Crohn disease? A. Preventing the spread of illness to others and nutritional guidance B. Adjusting to chronic illness and preventing the spread of illness to others C. Coping with stress and adjusting to chronic illness D. Nutritional guidance and preventing constipation

C. Coping with stress and adjusting to chronic illness

10. Steve is diagnosed with celiac disease and experiences celiac crisis secondary to upper respiratory tract infection; which of the following would Nurse Nancy expect to assess? A. Lethargy B. Weight gain C. Respiratory distress D. Watery diarrhea

D: Episodes of celiac crises are precipitated by infections, ingestion of gluten, prolonged fasting, or exposure to anticholinergics. Celiac crisis is typically characterized by severe watery diarrhea. A: Irritability, rather than lethargy, is more likely. B: Because of the fluid loss associated with the severe watery diarrhea, the child's weight is more likely to be decreased. C: Respiratory distress is unlikely in a routine upper respiratory tract infection.

2. Nurse Nancy is assessing a child with pyloric stenosis; she is likely to note which of the following? A. "Currant jelly" stools B. Regurgitation C. Steatorrhea D. Projectile vomiting

D: Projectile vomiting is a key sign of pyloric stenosis. B: Regurgitation is seen more commonly with gastroesophageal reflux. C: Steatorrhea occurs in malabsorption disorders such as celiac disease. A: "Currant jelly" stools are characteristic of intussusception.

4. Which of the following applies to the defect emerging from residual peritoneal fluid confined within the lower segment of the processus vaginalis? A. Inguinal hernia B. Incarcerated hernia C. Communicating hydrocele D. Noncommunicating hydrocele

D: With a noncommunicating hydrocele, most commonly seen at birth, residual peritoneal fluid is trapped within lower segment of the processus vaginalis (the tunica vaginalis). There is no communication with the peritoneal cavity and the fluid usually is absorbed during the first months after birth.

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. 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

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.

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

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.

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.

You are caring for newborn Jordan who is 1 hour old. You notice when you place a gloved finger in Jordan's mouth, there seems to be a hole in the top of his mouth. What condition do you suspect Jordan has? A. Tracheoesophageal fistula B. Hard palate fistula C. Cleft lip D. Omphalocele E. Cleft palate

E

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? A. Notify the physician. B. Measure the abdominal girth. C. Auscultate for bowel sounds. D. Take vital signs, including blood pressure.

A. Notify the physician.

Which order should the nurse question when caring for a 5-year-old child after surgery for Hirschsprung disease? a. Monitor rectal temperature every 4 hours and report an elevation greater than 38.5° C. b. Assess stools after surgery. c. Keep the child NPO until bowel sounds return. d. Maintain IV fluids at ordered rate.

A. Rectal temperatures should not be taken after this surgery. Rectal temperatures are generally not the route of choice for children because of the route's traumatic nature.

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

A. The colon has an aganglionic segment.

Nutritional management of the child with Crohn disease includes a diet that has which component? a. High fiber b. Increased protein c. Reduced calories d. Herbal supplements

ANS: B The child with Crohn disease often has growth failure. Nutritional support is planned to reduce ongoing losses and provide adequate energy and protein for healing. Fiber is mechanically hard to digest. Foods containing seeds may contribute to obstruction. A high-calorie diet is necessary to minimize growth failure. Herbal supplements should not be used unless discussed with the practitioner. Vitamin supplementation with folic acid, iron, and multivitamins is recommended

The nurse is preparing to admit a 3-year-old child with intussusception. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Absent bowel sounds b. Passage of red, currant jelly-like stools c. Anorexia d. Tender, distended abdomen e. Hematemesis f. Sudden acute abdominal pain

ANS: B, D, F Intussusception occurs when a proximal segment of the bowel telescopes into a more distal segment, pulling the mesentery with it and leading to obstruction. Clinical manifestations of intussusception include the passage of red, currant jelly-like stools; a tender, distended abdomen; and sudden acute abdominal pain. Absent bowel sounds, anorexia, and hematemesis are clinical manifestations observed in other types of gastrointestinal dysfunction.

A 3-day-old infant presents with abdominal distention, is vomiting, and has not passed any meconium stools. What disease should the nurse suspect? a. Pyloric stenosis b. Intussusception c. Hirschsprung disease d. Celiac disease

ANS: C The clinical manifestations of Hirschsprung disease in a 3-day-old infant include abdominal distention, vomiting, and failure to pass meconium stools. Pyloric stenosis would present with vomiting but not distention or failure to pass meconium stools. Intussusception presents with abdominal cramping and celiac disease presents with malabsorption.

6. Will is being assessed by Nurse Lucas for possible intussusception; which of the following would be least likely to provide valuable information? A. Abdominal palpation B. Family history C. Pain pattern D. Stool inspection

B: Because intussusception is not believed to have familial tendency, obtaining a family history would provide the least amount of information. A,C,D: Stool inspection, pain pattern, and abdominal palpation would reveal possible indicators of intussusception. "Currant jelly" stools, containing blood and mucus, are an indication of intussusception. Acute, episodic abdominal pain is characteristic of intussusception. A sausage-shaped mass may be palpated in the right upper quadrant. Question 7 WRONG

3. An 11-year-old girl with celiac disease was discharged from the hospital. An appropriate teaching was carried out by the nurse if the parents are aware of avoiding which of the following? A. Chicken B. Wheat C. Milk D. Rice

B: Children with celiac disease cannot tolerate or digest gluten. Therefore, because of its gluten content, wheat and wheat-containing products must be avoided. A,C,D: Rice, milk, and chicken do not contain gluten and need not be avoided.

1. Dustin who was diagnosed with Hirschsprung's disease has a fever and watery explosive diarrhea. Which of the following would Nurse Joyce do first? A. Administer an antidiarrheal. B. Notify the physician immediately. C. Monitor the child every 30 minutes. D. Nothing. (These findings are common in Hirschsprung's disease.)

B: For the child with Hirschsprung's disease, fever and explosive diarrhea indicate enterocolitis, a life-threatening situation. Therefore, the physician should be notified directly. A: Generally, because of the intestinal obstruction and inadequate propulsive intestinal movement, antidiarrheals are not used to treat Hirschsprung's disease. C: The child is acutely ill and requires intervention, with monitoring more frequently than every 30 minutes. D: Hirschsprung's disease typically presents with chronic constipation.

15. Nurse Lonnie is aware that the most common assessment finding in a child with ulcerative colitis is: A. Intense abdominal cramps B. Profuse diarrhea C. Anal fissures D. Abdominal distention

B: Ulcerative colitis causes profuse diarrhea. A,C,D: Intense abdominal cramps, anal fissures, and abdominal distensions are more common in Crohn's disease.

5. Baby Jonathan was born with cleft lip (CL); Nurse Barbara would be alert that which of the following will most likely be compromised? A. GI function B. Locomotion C. Sucking ability D. Respiratory status

C: Because of the defect, the child will be unable to form mouth adequately around the nipple, thereby requiring special devices to allow for feeding and sucking gratification. A: GI functioning is not compromised in the child with a CL. B: Locomotion would be a problem for older infant because of the use of restraints. D: Respiratory status may be compromised if the child is fed improperly during post-operative period.

7. Mr. and Ms. Byers' child failed to pass meconium within the first 24 hours after birth; this may indicate which of the following? A. Celiac disease B. Intussusception C. Hirschsprung's disease D. Abdominal-wall defect

C: Failure to pass meconium within the first 24 hours after birth may be a sign of Hirschsprung's disease, a congenital anomaly resulting in mechanical obstruction due to weak motility in an intestinal segment. A,B,D: Failure to pass meconium is not connected with celiac disease, intussusception, or abdominal-wall defect.

14. Mrs. Byers tells the nurse that she is very worried because her 2-year old child does not finish his meals. What should the nurse advise the mother? A. Make the child seat with the family in the dining room until he finishes his meal B. Provide quiet environment for the child before meals C. Do not give snacks to the child before meals D. Put the child on a chair and feed him

C: If the child is hungry he/she more likely would finish his meals. Therefore, the mother should be advised not to give snacks to the child. The child is a "busy toddler." He/she will not able to keep still for a long time.

11. Nurse Karen is providing postoperative care for Dustin who has cleft palate (CP); she should position the child in which of the following? A. In an infant seat B. In the supine position C. In the prone position D. On his side

C: Postoperatively, children with a CP should be placed on their abdomens to facilitate drainage. A: Using an infant seat does not facilitate drainage. B: If the child is placed int he supine position, aspiration is a concern. D: Side-lying does not facilitate drainage as well as the prone position.

A child experiences profuse watery diarrhea and is admitted to the pediatric unit with a diagnosis of gastroenteritis and dehydration. Which of these assessment findings would alert the healthcare provider to the presence of compensated shock? A: Hypotension B: Metabolic acidosis C: Narrow pulse pressure D:Pulmonary crackles

C:When a patient loses large amounts of fluids, the body will first attempt to compensate for the decreased circulating volume.

Which of the following nursing diagnoses would be inappropriate for the infant with gastroesophageal reflux (GER)? A. Deficient fluid volume B. Risk for aspiration C. Imbalanced nutrition: less than body requirements D. Impaired oral mucous membrane

D. Impaired oral mucous membrane

12. Nurse Joyce is assessing a child's cultural background, she should keep in mind that: A. Cultural background usually has little bearing on a family's health practices B. Physical characteristics mark the child as part of a particular culture C. Heritage dictates a group's shared values D. Behavioral patterns are passed from one generation to the next

D: A family's behavioral patterns and values are passed from one generation to the next. A: Cultural background commonly plays a major role in determining a family's health practices. B: Physical characteristics do not indicate a child's culture. C: Although heritage plays a role in culture, it does not dictate a group's shared values and its effect on culture is weaker than that of behavioral patterns.