Peds GI Practice Questions

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. A. "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." B. "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." C. "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." D. "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."

D

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. A. "Replace the next feeding with regular water and see if that is better tolerated." B. "Do not allow your baby to eat any solids; give half the normal formula feeding and see if that is better tolerated." C. "Do not let your baby eat or drink anything for 24 hours to give the stomach a chance to rest." D. "Give your child 1/2 ounce of Pedialyte every 10 minutes. If vomiting continues, wait an hour, and then repeat what you previously gave."

D

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? A. Prepare to accompany the infant to a computed tomography scan to confirm the diagnosis. B. Prepare to accompany the infant to the radiology department for a reducing enema. C. Prepare to start a second intravenous line to administer fluids and antibiotics. D. Prepare to get the infant ready for immediate surgical correction.

D

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. A. Place the infant in an infant seat immediately after feedings. B. Place the infant in the prone position immediately after feeding to decrease the risk of aspiration. C. Encourage the parents not to worry because most infants outgrow GER within the first year of life. D. Encourage the parents to hold the infant in an upright position for 30 minutes following a feeding. E. Suggest that the parents burp the infant after every 1-2 ounces consumed.

D & E

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. A. "Prilosec is a proton pump inhibitor that is commonly used for reflux in infants." B. "Prilosec decreases stomach acid, so it will not be as irritating when your child spits up." C. "Prilosec helps food move through the stomach quicker, so there will be less chance for reflux." D. "Prilosec relaxes the pressure of the lower esophageal sphincter."

B

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? A. Teach the child how to use an incentive spirometer. B. Encourage the child to blow bubbles. C. Obtain an order for intravenous antibiotics. D. Obtain an order for Tylenol (acetaminophen).

B

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. A. "It sounds like you are feeling discouraged. Would you like to talk about it?" B. "Sometimes breastfeeding is still an option for babies with a cleft lip and palate. Would you like more information?" C. "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." D. "We usually discourage breastfeeding babies with cleft lip and palate as it puts them at an increased risk for aspiration."

B

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: A. "We will wait a few days before allowing our child to return to school." B. "We will wait 2 weeks before allowing our child to return to sports." C. "We will call the pediatrician's office if we notice any drainage around the wound." D. "We will encourage our child to go for walks every day."

B

Which manifestation suggests that an infant is developing necrotizing enterocolitis (NEC)? A. Absorption of bolus orogastric feedings at a faster rate than previous feedings. B. Bloody diarrhea. C. Increased bowel sounds. D. Appears hungry right before a scheduled feeding.

B

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. A. "You can offer clear diet soda such as Sprite and ginger ale." B. "Pedialyte is really the best thing for your child, who, if thirsty enough, will eventually drink it." C. "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." D. "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."

C

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? A. Cancel the ultrasound, and obtain an order for oral Zofran (ondansetron). B. Cancel the ultrasound, and prepare to administer an intravenous bolus. C. Prepare for the probable discharge of the patient. D. Immediately notify the physician of the child's status.

D

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.

D

More education about necrotizing enterocolitis (NEC) is needed in a nursing in-service when one of the participants states: A. "Encouraging the mother to pump her milk for the feedings helps prevent NEC." B. "Some sources state that the occurrence of NEC has increased because so many preterm infants are surviving." C. "When signs of sepsis appear, the infant will likely deteriorate quickly." D. "NEC occurs only in preemies and low-birth-weight infants."

D

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? A. Eggs, bacon, rye toast, and lactose-free milk. B. Pancakes, orange juice, and sausage links. C. Oat cereal, breakfast pastry, and nonfat skim milk. D. Cheese, banana slices, rice cakes, and whole milk.

D

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. A. "It is really an easy disease to manage. Most children are placed on stool softeners to help with constipation until it resolves." B. "A permanent stool diversion, called a colostomy, will be placed by the surgeon to bypass the narrowed area." C. "Daily bowel irrigations will help your child maintain regular bowel habits." D. "Although your child will require surgery, there are different ways to manage the disease, depending on how much bowel is involved."

D

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? A. Administer Imodium as needed. B. Administer Kaopectate as needed. C. Continue breastfeeding per routine. D. The infant may return to day care 24 hours after antibiotics have been started.

C

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? A. Administer a bolus of normal saline. B. Administer a bolus of D10W. C. Administer a bolus of normal saline with 5% dextrose added to the solution. D. Offer the child an oral rehydrating solution such as Pedialyte.

A

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. A. "Genetics play a small role in Hirschsprung disease, so there is a chance the baby will develop it as well." B. "There is no evidence to support a genetic link, so it is very unlikely the baby will also have it." C. "It is rarely seen in boys, so it is not likely your new baby will have Hirschsprung disease." D. "Hirschsprung disease is seen only in girls, so your new baby will not be at risk."

A

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

A

The nurse receives a call from the mother of a 6-month-old who describes her child as alternately sleepy and fussy. She states that her infant vomited once this morning and had two episodes of diarrhea. The last episode contained mucus and a small amount of blood. She asks the nurse what she should do. Select the nurse's best response. A. "Your infant will need to have some tests in the emergency room to determine if anything serious is going on." B. "Try feeding your infant in about 30 minutes; in the event of repeat vomiting, bring the infant to the emergency room for some tests and intravenous rehydration." C. "Many infants display these symptoms when they develop an allergy to the formula they are receiving; try switching to a soy-based formula." D. "Do not worry about the blood and mucus in the stool; it is not unusual for infants to have blood in their stools because their intestines are more sensitive."

A

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. A. "The body's response to gluten causes damage to the mucosal cells in the intestine, leading to absorption problems." B. "The body's response to consumption of anything containing gluten is to create special cells called villi, which leads to more diarrhea." C. "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." D. "The body's response to gluten causes damage to the mucosal cells, leading to malabsorption of water and hard, constipated stools."

A

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

A, B, C, D

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? A. "The baby is a very fussy eater and just does not want to eat." B. "The baby tends to have a very forceful vomiting episode about 30 minutes after most feedings." C. "The baby is always hungry after vomiting so I refeed." D. "The baby is happy in spite of getting really upset after spitting up."

C

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? A. Urinalysis obtained by bagged specimen. B. Urinalysis obtained by sterile catheterization. C. Analysis of serum electrolytes. D. Analysis of cerebrospinal fluid.

C

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

C

The nurse is caring for a 1-month-old term infant who experienced an anoxic episode at birth. The health-care team suspects that the infant is developing necrotizing enterocolitis (NEC). Which would the nurse expect to be included in the plan of care? A. Immediately remove the feeding nasogastric tube (NGT) from the infant. B. Obtain vital signs every 4 hours. C. Prepare to administer antibiotics intravenously. D. Change feedings to half-strength, administer slowly via a feeding pump.

C

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? A. Administer a saline bolus of 10 mL/kg, which may be repeated if the child does not urinate. B. Recheck serum electrolytes in 12 hours. C. After the saline bolus, begin maintenance fluids of D5 1/4 NS with 10 mEq KCl/L. D. Give clear liquid diet as tolerated.

C

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? A. Reassure the parents that this is an expected finding and not uncommon. B. Call a code for a potential cardiac arrest and stay with the infant. C. Immediately obtain all vital signs with a quick head-to-toe assessment. D. Obtain a stool sample for occult blood.

C

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. A. Right side-lying. B. Left side-lying. C. Supine. D. Prone.

C

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? A. Immediately before a feeding. B. 30 minutes after the feeding. C. 30 minutes before the feeding. D. At bedtime.

C

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. A. "The enema will confirm the diagnosis. If the test result is positive, your child will need to have surgery to correct the intussusception." B. "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." C. "The enema will help confirm the diagnosis and has a good chance of fixing the intussusception." D. "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."

C