Prep U QC: GI/GU

A nurse is caring for a 6-year-old girl recently diagnosed with celiac disease and is discussing dietary restrictions with the girl's mother. Which response indicates a need for further teaching? ("My daughter is eating more vegetables." "There is gluten hidden in unexpected foods." "There are many types of flour besides wheat." "My daughter can eat any kind of fruit.")

"My daughter can eat any kind of fruit." (Explanation: While most fruits and fruit juices are allowed, the nurse needs to make sure the mother knows that some fruit pie fillings and dried fruit may contain gluten.)

The nurse is caring for the parents of a newborn who has an undescended testicle. Which comment by the parents indicates understanding of the condition? ("Our son may need surgery on his testes before we are discharged to go home." "Our son may have to go through life without two testes." "Our son's condition may resolve on its own." "Our son will likely have a high risk of cancer in his teen years as a result of this condition.")

"Our son's condition may resolve on its own." (Explanation: Normally both testes will descend prior to birth. In the event this does not happen the child will be observed for the first 6 months of life. If the testicle descends without intervention further treatment will not be needed. Surgical intervention is not needed until after 6 months if the testicle has not descended.)

A nurse is caring for a client with a diagnosis of acute glomerulonephritis. Which intervention would the nurse expect to be included in the treatment plan? Select all that apply. (1 to 2 week course of antibiotics keeping the client in semi-Fowler position antihypertensive therapy high-protein diet blood glucose checks)

1 to 2 week course of antibiotics keeping the client in semi-Fowler position antihypertensive therapy high-protein diet (Explanation: Children with a diagnosis of acute glomerulonephritis usually will have an underlying streptococcal infection requiring a two-week course of antibiotics. Keeping the child in a semi-Fowler position and initiating a high-protein diet to supplement losing large amounts of protein in the urine is indicated. The child will be started on a course of antihypertensive therapy for high blood pressure. Blood glucose monitoring is not indicated.)

The nurse is caring for a child admitted with congenital aganglionic megacolon. Which clinical manifestation would likely have been noted in the child with this diagnosis? (Prolonged bleeding Chronic cough Persistent constipation Irregular breathing)

Persistent constipation (Explanation: Congenital aganglionic megacolon, also called Hirschsprung disease, is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Prolonged bleeding is a manifestation of hemophilia. A chronic cough is noted in the child with cystic fibrosis. Irregular breathing occurs in children with seizures.)

The nurse recognizes that what would be a likely physiologic cause for a child to have enuresis? (Regression to get attention Stress and stressful situations Sexual abuse Sleeping too soundly)

Sleeping too soundly (Explanation: Physiologic causes may include a small bladder capacity, urinary tract infection, and lack of awareness of the signal to empty the bladder because of sleeping too soundly. Psychological causes might include rigorous toilet training, resentment toward family caregivers or a desire to regress to an earlier level of development to receive more care and attention or emotional stress and stressful situations. Enuresis can be a symptom of sexual abuse.)

The nurse is caring for a child admitted with acute glomerulonephritis. Which clinical manifestation would likely have been noted in the child with this diagnosis? (Loose, dark stools Tea-colored urine Strawberry-red tongue Jaundiced skin)

Tea-colored urine (Explanation: The presenting symptom in acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as tea- or cola-colored. Periorbital edema may accompany or precede hematuria. Loose stools are seen in diarrhea. A strawberry-colored tongue is a symptom seen in the child with Kawasaki disease. Jaundiced skin is noted in hepatitis.)

To prevent further urinary tract infections in a preschooler, what measures would you teach her mother? (Encourage her to be more ambulatory to increase urine output. Teach her to take frequent tub baths to clean her perineal area. Suggest she drink less fluid daily to concentrate urine. Teach her to wipe her perineum front to back after voiding.)

Teach her to wipe her perineum front to back after voiding. (Explanation: Escherichia coli can be easily spread from the rectum to the urinary meatus and cause infection if girls do not take precautions against this.)

A child is having the urine checked for a routine well visit. When analyzing the results, what would positive leukocytes indicate? (This may indicate a urinary tract infection. This determines the presence of sugar in the urine. This indicates renal disease. This determines the presence of red blood cells in the urine.)

This may indicate a urinary tract infection. (Explanation: A leukocyte is a white blood cell and is normally not present in the urine. Positive leukocytes may indicate a urinary tract infection. Red blood cells in the urine equate to bleeding. Glucose in the urinalysis would be identified as such and may be a concern for diabetes. Urine that is positive for leukocytes would also need to be cultured to determine the type and amount of bacteria growth so the appropriate antibiotic can be administered.)

The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also has a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100℉ (37.8℃). The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have: (a urinary tract infection. lipoid nephrosis {idiopathic nephrotic syndrome}. acute glomerulonephritis. rheumatic fever.)

acute glomerulonephritis. (Explanation: Acute glomerulonephritis is a condition that appears to be an allergic reaction to specific infections, most often group A beta-hemolytic streptococcal infections such as rheumatic fever. Presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection such as strep throat, otitis media, tonsillitis, or impetigo. Usually the presenting symptom is grossly bloody urine. Periorbital edema may accompany or precede hematuria. Fever may be 103℉ to 104℉ {39.4℃ to 40℃} at the onset, but decreases in a few days to about 100℉ {37.8℃}. Slight headache and malaise are usual, and vomiting may occur.)

A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason? (detect Helicobacter pylori evaluate gastric pH confirm pancreatitis determine esophageal contractility)

detect Helicobacter pylori (Explanation: Urea breath test is used to detect the presence of H. pylori in the exhaled breath. This test does not evaluate gastric pH. Serum amylase and lipase levels are used to confirm pancreatitis. Esophageal manometry is used to evaluate esophageal contractile activity and effectiveness.)

A nurse caring for a client diagnosed with Chlamydia trachomatis can expect which subsequent tests? (syphilis gonorrhea trichomoniasis candidiasis)

gonorrhea (Explanation: Since there is a strong association between gonorrhea and a chlamydial infection, the client would be tested for gonorrhea as well.)

Which clinical manifestation should a nurse recognize as most significant when assessing a client who is suspected of having female circumcision? (menses missing clitoris vaginal discharge redness and swelling)

missing clitoris (Explanation: Clients who are assessed with a missing clitoris should receive further workup for female circumcision. Redness, swelling, and vaginal discharge can be indicated for infection. Menses is not affected in clients with female circumcision.)

The caregiver of a child diagnosed with celiac disease tells the nurse that the child has large amounts of bulky stools and what looks like fat in the stools. The clinical manifestation this caregiver is describing is: (steatorrhea. severe diarrhea. currant jelly stools. projectile stools.)

steatorrhea. (Explanation: Celiac disease is an immunologic response to gluten, which causes damage to the small intestine. Steatorrhea {fatty stools} is a classic symptom of celiac disease. Symptoms also include abdominal distention or bloating, constipation, and nutritional deficiencies. Currant jelly stools are a sign of intussusception. Projectile vomiting is a sign of pyloric stenosis. Severe diarrhea could be caused by a bacteria or virus. Projectile stools represent severe diarrhea.)

A child is hospitalized with dehydration as a result of rotavirus. When reviewing the plan of treatment, what can the nurse anticipate will be included? Select all that apply. (antidiarrheal agents antibiotic therapy IV fluid administration monitor of intake and output daily weight assessment)

∙ monitor of intake and output ∙ IV fluid administration ∙ daily weight assessment (Explanation: Rotavirus is viral in nature. Antibiotic therapy is not used in the care and treatment of a viral infection. Antidiarrhea medications are not utilized as they are not effective. Intake and output will be observed. Daily weight will aid in the determination of hydration status. IV fluids may be indicated in the rehydration process.)

A 4-month-old has had a fever, vomiting, and loose watery stools every few hours for 2 days. The mother calls the physician's office and asks the nurse what she should do. Which response by the nurse is most appropriate? ("Do not give the child anything to drink for 4 hours. If the fever goes down and the loose stools stop, you can resume breastfeeding." "Continue breastfeeding as you have been doing. The fluid from the breast milk is important to maintain fluid balance." "Give a clear pediatric electrolyte replacement for the next few hours, then call back to report on how your child is doing." "Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment.")

"Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." (Explanation: An infant's body comprises a high percentage of fluid that can be lost very quickly when vomiting, fever, and diarrhea are all present. This infant needs to be seen by the physician based on her age and symptoms; hospitalization may be necessary for intravenous rehydration depending upon her status when assessed.)

The nurse is caring for a 2-year-old boy with an umbilical hernia and is teaching the mother about this condition. Which response from the mother indicates a need for further teaching? ("I can tape a quarter over the hernia to reduce it." "An incarcerated hernia is rare, but it can occur." "I need to watch for pain, tenderness, or redness." "My son could have some appearance-related self-esteem issues.")

"I can tape a quarter over the hernia to reduce it." (Explanation: The use of home remedies to reduce an umbilical hernia should be discouraged because of the risk of bowel strangulation. The mother needs to be aware that strangulation can occur, but it is rare with an umbilical hernia. Pain, tenderness, or redness indicates an incarcerated hernia, which although rare with umbilical hernias, can occur.She needs to understand the signs of strangulation and understand that some children have self-esteem issues related to the large protrusion of the unrepaired umbilical hernia. Physical needs of the child have priority over any types of potential psychosocial issues. Self-esteem issues may arise due to a large protrusion of an unrepaired umbilical hernia.)

The nurse is providing discharge teaching regarding oral fluid rehydration to a mother who brought her child to the clinic because of vomiting over the past 2 days. The child is mildly dehydrated. Which comments by the mother indicated learning occurred? ("I should not give my child any fluids for 1 to 2 hours after an episode of vomiting." "My child can drink milk if he feels like it to help in rehydration." "Oral rehydration solutions (ORS) are good sources of fluids for rehydration." "I should be sure my child receives 50 to 100 ml/kg of oral rehydration solution (ORS) over 4 hours." "Solutions like Pedialyte are not necessary for mild dehydration.")

"I should be sure my child receives 50 to 100 ml/kg of oral rehydration solution (ORS) over 4 hours." "I should not give my child any fluids for 1 to 2 hours after an episode of vomiting." "Oral rehydration solutions (ORS) are good sources of fluids for rehydration." (Explanation: In the child with mild to moderate dehydration resulting from vomiting, withhold oral feeding for 1 to 2 hours after emesis, after which time oral rehydration can begin. Tap water, milk, undiluted fruit juice, soup, and broth are not appropriate for oral rehydration. Oral rehydration solutions include Pedialyte, Infalyte, and Ricelyte. The recommendation for children with mild to moderate dehydration is 50 to 100 ml/kg of ORS over 4 hours.)

The nurse is teaching the mother of a 5-year-old boy with a history of impaction how to administer enemas at home. Which response from the mother indicates a need for further teaching? ("I should position him on his abdomen with knees bent." "He will require 250 to 500 mL of enema solution." "I should wash my hands and then wear gloves." "He should retain the solution for 5 to 10 minutes.")

"I should position him on his abdomen with knees bent." (Explanation: A 5-year-old child should lie on his left side with his right leg flexed toward the chest. An infant or toddler is positioned on his abdomen. Using 250 to 500 mL of solution, washing hands and wearing gloves, and retaining the solution for 5 to 10 minutes are appropriate responses.)

The nurse is performing discharge teaching for an adolescent diagnosed with peptic ulcer disease. Which statement(s) by the adolescent demonstrate learning has occurred? Select all that apply. ("I will need to make sure to take all of the antibiotic prescribed." "It is important to take my histamine agonist medication at the appropriate time." "My proton pump inhibitor should be taken when I feel discomfort." "The prednisone that I take for my rheumatoid arthritis may be a cause of my peptic ulcer disease." "I will just take the proton pump inhibitor instead of the histamine agonist because it works faster.")

"I will need to make sure to take all of the antibiotic prescribed." "The prednisone that I take for my rheumatoid arthritis may be a cause of my peptic ulcer disease." "It is important to take my histamine agonist medication at the appropriate time." (Explanation: If Helicobacter pylori (H. pylori) was detected as a cause of the peptic ulcer disease, the client will be prescribed an antibiotic and should take all of the medication. Histamine agonists and/or proton pump inhibitors should be taken routinely as prescribed. Risk factors include a family history of peptic ulcer disease or other gastrointestinal diseases, or chronic salicylate or prednisone use. Proton pump inhibitors are not intended to provide immediate relief. It takes 1 to 4 days to become fully effective. Histamine agonists start to work within 15 minutes and can last 12 hours per dose.)

A child, diagnosed with a urinary tract infection, is afraid to void because it hurts. What action should the nurse recommend to the parent to help relieve this fear? (Have the child sit in a sitz bath of warm water to void. Offer the child cranberry juice to make the urine less acidic. Administer pain medication as prescribed. Help the child relax with diversionary activities.)

Have the child sit in a sitz bath of warm water to void. (Explanation: A child with a urinary tract infection can have symptoms of dysuria, frequency, hesitancy, and urgency. Many children will not want to void because it burns or causes spasms and pain when attempting to do so. One way to help the child is to have them sit in a tub of warm water. The warmth helps the muscles relax so voiding can occur more easily and with less pain. Cranberry juice can be useful when a urinary tract infection is occurring. Bacteria causes the urine to be more alkaline and cranberry juice has the ability to produce more acidity. Pain medications may be prescribed, but they are of little benefit if the problem with voiding is spasms. Diversionary activities may be helpful but they do not have the relaxing benefit of the warmth of the water.)

The nurse is caring for a 6-year-old child with acute glomerulonephritis. When reviewing the client's laboratory results, which result is most important to review with the health care provider? (White blood cells: 8,000/µL {8.0 ×109/L} Urine culture positive for contaminants Positive culture for group A streptococcus Negative for respiratory syncytial virus {RSV})

Positive culture for group A streptococcus (Explanation: Acute glomerulonephritis may result as an autoimmune response to the invasion of group A streptococcus. This group of streptococci affect the glomeruli of the kidneys. This would be addressed by the health care provider and is the most important of the laboratory results presented. If there is an active strep infection, it would need to be treated with an antibiotic. The white blood cell count is within normal limits. It is good to be negative for respiratory syncytial virus. The urine culture would have to be redone due to contamination. It does not provide an accurate status of the child's urine.)

In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention? (Prepare the infant for surgery. Medicate the infant with analgesics. Change the infant's diet to one that is lactose-free. Assist in doing a barium enema procedure on the infant.)

Prepare the infant for surgery. (Explanation: In pyloric stenosis, the thickened muscle of the pylorus causes gastric outlet obstruction. The treatment is a surgical correction called a pyloromyotomy. The condition is not painful, so no analgesics would be needed until after surgical repair. The condition is not related to lactose in the diet, so changing to lactose-free formula would not correct the condition. A barium enema would be used to diagnose intussusception.)

The nurse obtains a history from the parent of a child with glomerulonephritis about how the child became ill. What would the nurse expect the parent to report? (Reddish-brown, smoky-colored urine Diuresis and pallor Headache, loss of appetite Loss of weight, oliguria)

Reddish-brown, smoky-colored urine (Explanation: Acute glomerulonephritis can occur following a streptococcal infection. The immune process of the illness affects the structure of the kidney as well as the function of the kidney. Acute glomerulonephritis often presents with glomeruli bleeding. The nurse should inspect the urine with a dipstick. There will be increased protein evident. Inspect the urine for gross hematuria, which will cause the urine to appear tea colored, reddish-brown or smoky. The child may have a slight weight gain from slight edema. The blood pressure will be elevated and the child will experience a decreased urine output.)

A 10-year-old child in renal failure is on continuous cycling peritoneal dialysis (CCPD). What would be important to teach the parents? (Dialysis solution must be infused over a period of 30 minutes. Slight bleeding from the exchange catheter is to be expected. The return solution will be cloudy because of urea in it. Severe cramping and pain should not occur with an infusion.)

Severe cramping and pain should not occur with an infusion. (Explanation: Continuous cycling peritoneal dialysis {CCPD} allows a child to go to school or participate in other activities while receiving dialysis . With CCPD, a permanent dialysis catheter is inserted and sutured into place at the abdomen. Although commercial devices may be used, for the simplest method, the child or parent attaches a bag of dialysis fluid and tubing to this and infuses a prescribed dialysis solution by gravity drainage; the bag and tubing are then rolled into a compact square under the child's clothes. The infused solution remains in the child for 4 to 6 hours during the day {8 hours at night}; the dialysate bag is then lowered, and the solution drains from the peritoneal cavity into it. The bag and fluid are then discarded and a new bag of dialysate solution is attached and raised, and new solution is infused. The child should be assessed for toleration of the fluid volume instilled into the peritoneum. The abdomen will remain distended while the fluid is indwelling. The child may be slightly uncomfortable from the pressure but should not experience severe cramping or pain. The return flow should be clear. A cloudy return flow or severe pain or cramping suggests infection. The dialysate solution will fill from gravity so there is no specified time frame for instillation and will also be affected by the amount of dialysate solution to be instilled.)

A pediatric client is scheduled for an intravenous pyelogram (IVP) of the kidney this afternoon. Which situation would require immediate attention by the nurse? (The child is diapered. The child's appetite is poor. The child does not have intravenous access. The child is unable to ambulate.)

The child does not have intravenous access. (Explanation: An intravenous pyelogram is an X-ray study of the upper urinary tract in which a radio opaque dye is injected into a peripheral vein, requiring intravenous access. The other choices are not a priority for this client.)

A child needs to undergo peritoneal dialysis. What type of education would the nurse provide to the family about this process? (The peritoneal dialysis should help the child with his or her growth and blood pressure. The child will need to have increased fluid restrictions with this. Infection risk is low. This is performed for 24 hours a day.)

The peritoneal dialysis should help the child with his or her growth and blood pressure. (Explanation: The advantages of peritoneal dialysis over hemodialysis include improved growth as a result of more dietary freedom, increased independence in daily activities, and a steadier state of electrolyte balance. However, the risk for infection {peritonitis and sepsis} is a continual concern with peritoneal dialysis.)

The nurse is reviewing the health history of a client suspected of having vesicoureteral reflux. What findings in the health history are consistent with this disorder? Select all that apply. (hematuria pyuria flank pain urinary frequency history of repeated urinary tract infections)

hematuria flank pain urinary frequency history of repeated urinary tract infections (Explanation: Vesicoureteral reflux (VUR) is a condition in which urine from the bladder flows back up the ureters. Primary VUR results from a congenital abnormality at the vesicoureteral junction that results in incompetence of the valve. Secondary VUR is related to other structural or functional problems such as neurogenic bladder, bladder dysfunction, or bladder outlet obstruction. Symptoms consistent with this condition include dysuria, urinary frequency, hematuria, back or flank pain, and previous urinary tract infections. Pus in the urine is not associated with this condition.)

The nurse is performing an assessment on a child. Which finding indicates to the nurse the child is at risk for a urinary tract infection (UTI)? (washing the genital area with water daily wiping front to back after using the restroom drinking water and juice during the day holding urine while at school)

holding urine while at school (Explanation: One cause of UTIs in children is not urinating frequently at school. Cleaning the perineal area from front to back limits contamination of fecal material with the urethra. Drinking plenty, preferably water, daily helps encourage elimination, which limits UTIs. Washing the genital area with water daily does not increase the chance of a UTI.)

A nurse has just admitted a client with symptoms of vulva inflammation, pain, odor, and pruritus. Based on these findings, the nurse could conclude that this client will be diagnosed with which condition? (vulvovaginitis urinary tract infection ,UTI pelvic inflammatory disease, PID vaginal inflammation)

vulvovaginitis (Explanation: Vulvovaginitis is diagnosed with clients experiencing vaginal or vulval inflammation, pain odor, and pruritus. Pelvic inflammatory disease and urinary tract infection are not consistent with these symptoms.)

A child with liver cirrhosis is admitted to the acute care facility in preparation for a liver transplant. What finding(s) would the nurse document after completing this child's assessment? Select all that apply. (yellow skin and sclera liver palpable palms of hands reddened confused mental status fatty, foul-smelling stool)

yellow skin and sclera liver palpable palms of hands reddened confused mental status (Explanation: A child with cirrhosis would have symptoms of nausea and vomiting, jaundice, palmar erythema, ascites, weight loss, and an enlarged liver. The child's mental status could be clear or it could be confused if hepatic encephalopathy is present. The nurse would document the findings as to the amount of jaundice present, the weight of the child, the measurement of the abdomen to determine ascites, the amount of redness in the palms, and whether the liver is palpable or not. Fatty, foul-smelling stools are not seen with cirrhosis. These would be more likely in conditions like cystic fibrosis or celiac disease.)

An infant brought to the emergency department has been vomiting for 2 days. The nurse assesses the infant and finds sunken fontanels (fontanelles), tenting skin, dry mucus membranes and no urine output for 12 hours. Which intervention(s) will the nurse complete as first-line care for this infant? Select all that apply. (Insert a peripheral IV. Begin maintenance IV fluids. Start oral rehydration. Administer a prescribed IV fluid bolus. Administer an antiemetic.)

∙ Administer an antiemetic. ∙ Insert a peripheral IV. ∙ Administer a prescribed IV fluid bolus. (Explanation: This infant is showing signs of severe dehydration. These symptoms include sunken fontanels {fontanelles}, tenting of the skin, dry mucus membranes, delayed capillary refill, an increased heart rate and a urine output of less than 1ml/kg/hr. The nurse will need to insert a peripheral IV and begin the prescribed bolus IV infusion. After the bolus has been completed, the infant would need to be reassessed for urine output and symptom improvement. The health care provider would then prescribe another IV bolus or begin maintenance IV fluids. Antiemetics can be prescribed if necessary. Oral rehydration is used for mild or moderate dehydration.)

A parent brings the 2-week-old newborn to the office because the infant has been experiencing gastroesophageal reflux over the past week. Which intervention(s) should the nurse recommend to the parent at this point? Select all that apply. (Feed the infant a formula thickened with rice cereal. Feed the infant while holding the infant in an upright position. Keep the infant upright in an infant chair/car seat for 30 minutes after feeding. If breastfeeding, switch to feeding the infant formula. Consult the heath care provider regarding having botulinum toxin injected into the lower esophageal sphincter. Consult a pediatric surgeon regarding having a myotomy procedure performed.)

∙ Feed the infant a formula thickened with rice cereal. ∙ Keep the infant upright in an infant chair/car seat for 30 minutes after feeding. ∙ Feed the infant while holding the infant in an upright position. (Explanation: The traditional treatment of gastroesophageal reflux in the infant is to feed a formula thickened with rice cereal {1 tbsp of cereal per 1 oz of formula or breast milk} while holding the infant in an upright position and then keeping the infant upright in an infant chair/car seat for 30 minutes after feeding so gravity can help prevent reflux. There is no need for the parent to switch from breastfeeding to formula-feeding. Injection of botulinum toxin into the lower esophageal sphincter and a myotomy procedure are interventions that would be considered only if the problem does not disappear with feeding solid food and maintaining the infant in a more upright position during and following feeding; these procedures would not be appropriate at this point.)

The nurse is developing a teaching plan for the parents of an 11-month-old infant with gastroesophageal reflux disease (GERD). The infant will be managed medically. What action(s) will the nurse incorporate into the teaching plan? Select all that apply. (Keep the child upright for 30 minutes after feeding. Give the child small frequent feedings. Administer a prokinetic to empty the stomach quickly. Administer omeprazole after meals. Thin the formula with water to ease the flow.)

∙ Keep the child upright for 30 minutes after feeding. ∙ Administer a prokinetic to empty the stomach quickly. ∙ Give the child small frequent feedings. (Explanation: For the infant with GERD, the parents should give the child small, frequent feedings, with frequent burping to control reflux. The parents also should keep the child upright for 30 to 45 minutes after a feeding and thicken formula with rice or oatmeal cereal. Prokinetics may be used to help empty the stomach more quickly, minimizing the amount of gastric contents in the stomach that the child can reflux.)

A child with inflammatory bowel disease is started on an anti-inflammatory medication. Which item(s) would the nurse teach the child and parents about being on this type of medication? Select all that apply. (Use sunscreen and protective clothing while outside. Increase folic acid intake. Drink adequate fluids to avoid crystallization of sulfa in urine. Administer the medication just after meals to avoid gastrointestinal irritation. Take the medication between meals to increase absorption.)

∙ Use sunscreen and protective clothing while outside. ∙ Administer the medication just after meals to avoid gastrointestinal irritation. ∙ Drink adequate fluids to avoid crystallization of sulfa in urine. ∙ Increase folic acid intake. (Explanation: Anti-inflammatory medications increase sensitivity to sunlight and may crystalize in the urine. These medications are irritating to the gastric lining and are taken with food to avoid irritation. These drugs decrease folic acid absorption; therefore, parents should anticipate a concurrent prescription for folic acid.)

The nurse is caring for a 2-year-old child with a gastrointestinal infection resulting in 4 to 5 liquid stools per day over the past 3 days. Based on this information, which important concern(s) will the nurse address in the child's care? Select all that apply. (fluid deficiency risk: dehydration diarrhea and loss of electrolytes the risk for skin maceration in the perineum undernourishment risk: malnutrition availability of parents to care for the child)

∙ fluid deficiency risk: dehydration ∙ the risk for skin maceration in the perineum ∙ diarrhea and loss of electrolytes (Explanation: Four to five loose stools per day are considered diarrhea. The child is at risk for fluid and electrolyte deficiency given the length of time and number of stools per day. The risk for skin maceration can occur in the perianal area because of the prolonged skin exposure to liquid stools. The child does not have malnutrition. Malnutrition is defined as a condition that results from a nutrient deficiency or overconsumption. Parental presence to care for the child can be addressed after the immediate needs of the child are addressed.)

The nurse is reviewing the history of a child who has chronic oral lesions. What risk factors does the nurse expect to find when reviewing the child's history? Select all that apply. (recently finished the last chemotherapy treatment for leukemia severe malabsorption from a GI disorder history of anemia several episodes of tonsillitis frequent bouts of constipation)

∙ severe malabsorption from a GI disorder ∙ recently finished the last chemotherapy treatment for leukemia (Explanation: Common risk factors for oral lesion include immune deficiency, cancer chemotherapy treatment, exposure to infectious agents, trauma, stress, or celiac or Crohn disease.)

The nurse is talking with a woman in her second trimester of pregnancy who has been diagnosed with polyhydramnios. The physician has ordered an ultrasound be performed to check for the presence of esophageal atresia. Which statement by the woman indicates an understanding of the relationship between these conditions? ("Babies with esophageal atresia produce an excessive amount of amniotic fluid." "Reductions in amniotic fluid are associated with the development of esophageal atresia." "Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup." "Enzymes in amniotic fluid can cause the development of esophageal atresia.")

"Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup." (Explanation: Review the maternal history for polyhydramnios. Often this is the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. Esophageal atresia is an underlying cause of polyhydramnios.)

The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis? ("The treatment for the disorder will be a surgical procedure." "Your child will be treated with oral iron preparations to correct the anemia." "We will give enemas until clear and then teach you how to do these at home." "Your child will receive counseling so the underlying concerns will be addressed.")

"The treatment for the disorder will be a surgical procedure." (Explanation: Treatment of congenital aganglionic megacolon involves surgery with the ultimate resection of the aganglionic portion of the bowel. Chronic anemia may be present, but iron will not correct the disorder. Enemas may be given to initially achieve bowel elimination, but they will not treat the disorder. Differentiation must be made between this condition and psychogenic megacolon because of coercive toileting or other emotional problems. The child with aganglionic megacolon does not withhold stools or defecate in inappropriate places, and no soiling occurs.)

The infant is listless with sunken fontanels (fontanelles) and has been diagnosed with dehydration. The infant is still producing at least 1 mL/kg each hour of urine. The infant weighs 13.2 lb (6 kg). At the minimum, how many milliliters of urine will the infant produce during the next 8-hour shift? Record your answer using a whole number.

48 mL (Explanation: Urine output should be calculated using weight in kilograms. 6 kg x 1 mL/kg = 6 mL/hour 6 mL x 8 hours = 48 mL/8-hour shift)

The nurse is caring for a child who was dehydrated following gastric surgery but has since been rehydrated. The health care provider prescribes intravenous maintenance fluids for the child. Calculate the intravenous maintenance fluid rate per hour for this child, who weighs 40 kg. Record your answer using a whole number.

79 mL (Explanation: The formula to determine maintenance fluid rate is: *100 ml/kg for first 10 kg *50 ml/kg for next 10 kg *20 ml/kg for remaining kg * Add together for total ml needed per 24-hour period. *Divide by 24 for ml/hour fluid requirement. Therefore, for a child weighing 40 kg the equation is: *100 X 10= 1000 *50 X 10= 500 *20 X 20= 400 *1000 + 500 + 400= 1900 *1900/24= 79.17= 79 ml/hr)

The nurse observes the interactions of parents with their infant who was born with a cleft lip. The mother is attempting to feed the baby, but does not make eye contact. The father is watching television with his back turned to the mother and baby. What psychosocial nursing intervention would be most helpful to this family? (Ask the parents if they have any questions regarding the care of their child. Explain to the parents that surgical intervention will fix the defect in the baby's lip. Teach the mother the appropriate technique for breastfeeding an infant with cleft lip. Refer the family to a social worker or mental health practitioner.)

Ask the parents if they have any questions regarding the care of their child. (Explanation: The family's emotional response to the birth of a child with cleft lip, palate, or both may range from grief to anger to denial. The nurse should encourage the parents to express their feelings and provide the parents with opportunities and support for normal infant-parent interactions.)

A 7-year-old boy has experienced repeated urinary tract infections (UTIs). His older sister also experienced repeated UTIs and was diagnosed with vesicoureteral reflux, a condition that tends to appear in families. Therefore, the nurse suspects this same condition in this client. Which diagnostic tests would confirm this suspicion? (Cystoscopy Urinalysis Urine culture Blood urea nitrogen test)

Cystoscopy (Explanation: Cystoscopy, or examination of the bladder and ureter openings by direct examination with a cystoscope introduced into the bladder through the urethra, is done to evaluate for possible vesicoureteral reflux or urethral stenosis. A urine culture is used to diagnose a urinary tract infection {UTI}, or the presence of bacteria in urine. Urinalysis involves use of a chemical reagent strip to detect glucose, protein, and occult blood and to measure pH, as well as use of a refractometer to measure specific gravity. A blood urea nitrogen {BUN} test measures the level of urea in blood or how well the kidneys can clear this from the bloodstream.)

A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage bladder spasms? (Allow tubes to dangle freely to encourage flow. Encourage high fluid intake. Increase low-fat foods. Apply antibiotic ointment to tube site.)

Encourage high fluid intake. (Explanation: Prevent bladder stimulation secondary to a full rectum by completing a preoperative bowel evacuation, encouraging a high fluid intake, promoting early ambulation postoperatively, and administering a stool softener or glycerin suppository postoperatively.)

A symptom often seen in acute glomerulonephritis is edema. The most common site the edema is first noted is in which area of the body? (Ankles Hands Eyes Sacrum)

Eyes (Explanation: Periorbital edema may accompany or precede hematuria in children with acute glomerulonephritis. Edema in the ankles, hands and sacrum are not noted in acute glomerulonephritis.)

The nurse is caring for a neonate who has undergone an intestinal pull-through procedure for an imperforate anus. Which action would be most important for the nurse to do postoperatively? (Listening for bowel sounds Observing the abdominal skin Determining the infant's ability to suck on a pacifier Turning the infant every 4 hours)

Listening for bowel sounds (Explanation: Bowel sounds will allow the nurse to know how peristalsis is progressing after surgery. This will determine when the infant is able to receive nourishment other than through the intravenous route. Observing the perianal skin would be important because the perianal skin is at significant risk for breakdown because this will be the first time that stool has passed through the anal sphincter. The infant's ability to suck on the pacifier is important but is unrelated to the surgery. The infant should be turned at least every 2 hours.)

The nurse is caring for a 10-year-old boy with end-stage kidney disease (ESKD) with metabolic acidosis. What would the nurse expect to administer if ordered? (Sodium bicarbonate tablets Ferrous sulfate Vitamin D Erythropoietin)

Sodium bicarbonate tablets (Explanation: Bicitra or sodium bicarbonate tablets are used for the correction of acidosis. Ferrous sulfate is used for the treatment of anemia. Vitamin D and calcium are used for the correction of hypocalcemia and hyperphosphatemia. Erythropoietin stimulates red blood cell growth.)

A 5-year-old boy occasionally wets his bed at night and his pants during the day. Which finding would indicate an organic cause—as opposed to a functional cause—of this enuresis? (The boy has only begun wetting the bed and his pants recently, 1 year after being successfully potty-trained. The boy only wets the bed on nights that he is exceptionally tired. The boy only wets his pants when he is absorbed in playing video games. The boy only wets his bed on the nights his father forgets to take him to the bathroom to void before going to bed.)

The boy has only begun wetting the bed and his pants recently, 1 year after being successfully potty-trained. (Explanation: Enuresis is primary, or functional, if bladder training was never achieved, acquired or secondary or organic if control was established but has now been lost. Enuresis when exceptionally tired, while absorbed in some activity, or when a parent forgets to remind the child is more likely to be primary rather than organic.)

The nurse is caring for a 3-year-old child with the surgical repair of hypospadias. The preschooler returned from the postanesthesia care unit with an indwelling urinary catheter. What parental teaching is most helpful? (The catheter insertion site will leave only a minimal scar. Back pressure from such drainage may result in nephrotic syndrome. The child must be reevaluated at puberty for testicular function. The child will always have tenderness on penile erection.)

The catheter insertion site will leave only a minimal scar. (Explanation: Hypospadias is a urethral defect in which the opening is on the ventral surface rather than at the end of the penis. If left untreated, it may mean the boy will not be able to void standing as the aim will be different; in addition, it will cause interference with the deposition of sperm during intercourse. The completed surgery requires the use of a catheter. The catheter, along with the penis, is taped to the abdomen to reduce pressure on the urethral sutures. The tube insertion site will leave only a minimal scar, if any. A hypospadias repair should have no long-term consequences.)

The nurse is caring for a child who receives dialysis via an AV fistula. Which finding indicates an immediate need to notify the physician? (presence of a bruit presence of a thrill dialysate without fibrin or cloudiness absence of a thrill)

absence of a thrill (Explanation: The nurse should always auscultate the site for presence of a bruit and palpate for presence of a thrill. The nurse should immediately notify the physician if there is an absence of a thrill. Dialysate without fibrin or cloudiness is normal and is used with peritoneal dialysis, not hemodialysis.)

A nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. What GI condition might this history precipitate? (esophageal atresia {EA} cleft palate pyloric stenosis hernia)

esophageal atresia (EA) (Explanation: A maternal history of polyhydramnios is usually present in one-third of cases of EA and in some cases of tracheoesophageal fistula, TEF)