Chapter 15/18, GI disorders - PEDS

A nurse is attempting to differentiate between gastroschisis and an omphalocele to a group of nursing students. Which statement is correct? "Malrotation is not present in either defect." "An omphalocele is contained in a membranous sac." "Gastroschisis is usually located at the umbilicus." "Gastroschisis is an abdominal wall defect where the intestinal contents are outside of the abdominal wall in a newborn."

"Gastroschisis is an abdominal wall defect where the intestinal contents are outside of the abdominal wall in a newborn."

The parent of a client who had a ruptured appendix thought their child was just constipated. The parent is now verbalizing feelings of guilt. What should the nurse say in order to reassure the parent? "Perhaps you should have brought the child in sooner." "Would you like me to call your husband, as children and youth services have been notified?" "It's OK, there was no way for you to know that it was his appendix." "He has a fever. Did he have cold recently? It could be related to that."

"It's OK, there was no way for you to know that it was his appendix."

A child is diagnosed with nonalcoholic fatty liver disease (NAFLD). When explaining what this is to the parents, which statement would be most accurate? "This condition leads to liver disease and your child may need a liver transplant." "There is fat in the liver but little or no inflammation or liver cell damage." "Nonalcoholic steatohepatitis (NASH) is a type of NAFLD that can be diagnosed in utero." "Left lower quadrant pain frequently occurs with NAFLD."

"There is fat in the liver but little or no inflammation or liver cell damage.

Peptic ulcers are usually treated with "triple therapy." What does "triple therapy" consist of? Select all that apply. Proton pump inhibitor (PPI) Vancomycin Amoxicillin Clarithromycin Milk of magnesia

1, 3, 4

The nurse is discussing treatments for intussusception with a client. Which statement made by the nurse is correct? Select all that apply. "Intussusception most often resolves on its own without intervention." "Reduction may be performed with barium or air insufflation." "Intussusception can block blood supply to the affected portion of the intestine." "This is the most common cause of intestinal obstruction in children less than 3 years of age." "Surgical intervention may be required if the initial attempt at reduction fails."

2, 3, 4, 5

At a well checkup, the parent reports that her child is constipated. What questions should the nurse ask to gain knowledge about the child's stool pattern? Select all that apply. "Do you force your child to go to the bathroom?" "How often does your child have a bowel movement?" "What is the consistency of the stool when they have one? Is it hard, soft, or liquid?" "Does your child have a ritual when they go to the bathroom?" "Does your child strain when having a bowel movement?"

2, 3, 4, 5

A nurse is caring for an infant admitted with pyloric stenosis. What are some of the assessment findings the nurse would expect? Select all that apply. Bilious vomiting Failure to thrive (FTT) Irritability Metabolic alkalosis Diarrhea

2, 3, 4

The nursing students asks the nurse what the main causes of failure to thrive (FTT) are. What should the nurse include as some of the main causes? Select all that apply. Intermittent diarrhea Inadequate intake for age Inadequate caloric absorption Excessive calorie expenditure with poor intake An infant being fed every 4 ounces of formula 3-4 hours

2, 3, 4

The nurse is educating a family about hepatitis. Which statements are true about hepatitis? Select all that apply. "Hepatitis B is caused by the oral-fecal route." "Hepatitis A, B, & C may not exhibit symptoms early on in the disease process." "Hepatitis C is caused by exposure to infected blood or blood products through sexual contact." "Good hand hygiene is important in hepatitis B." "In children older than 12 years of age, Ledipasvir/sofosbuvir (Harvoni) is an antiviral treatment that can treat Hepatitis C."

2, 3, 5

A child is being followed at the pediatric clinic for poor weight gain. What exemplifies that a child may have non-organic failure to thrive (FTT)? A child that has food rituals Abdominal distention Diarrhea Vomiting of feeds

A child that has food rituals

An 8-year-old reports right lower quadrant (RLQ) abdominal pain. The parent states, "He is just not himself. He's not playing and just lays on the sofa in a fetal position." Upon physical exam, he has rebound pain and pain in the RLQ when jumping. What does the assessment data indicate may be occurring with this child? Celiac disease Appendicitis Rotavirus Inflammatory bowel disease

Appendicitis

A newborn has been diagnosed with Hirschsprung's disease. The parents are confused and ask the nurse what symptoms lead to this diagnosis. The nurse should explain the most common symptoms as: Development of acute diarrhea and dehydration Currant, jelly-like gelatinous stools Severe projectile vomiting and electrolyte imbalance Failure to pass a meconium stool with abdominal distention

Failure to pass a meconium stool with abdominal distention

The nurse is educating the parent about non-medicinal measures that can be tried to treat constipation in children. Which measures are accurate? Increase fruits and vegetables in the diet Decrease fluid intake Decrease daily fiber intake Use behavior modification and have the child sit on the toilet until they defecate, even if it takes an hour

Increase fruits and vegetables in the diet

A young child is suspected of having intussusception. Which assessment findings correlate with this condition? Legs extended when crying Severe gastroesophageal reflux Irritability Bloody diarrhea

Irritability

A 6-year-old is admitted with suspected appendicitis. The client reports abdominal pain. What would be the best way to quantify the child's pain? Use the FLACC scale Use the revised FACES scale Use the 0 to 10 numeric scale Ask the child to describe the pain

Use the revised FACES scale

A child has just been diagnosed with cystic fibrosis (CF). The nurse is teaching the client and their family about the importance of maintaining proper nutrition. Which statement made by the nurse is accurate? "The diet of a child with CF should be low calorie and low protein." "A gastrostomy tube may be required if failure to thrive occurs." "It is okay to eat whatever you want as long as you eat something." "It is important for you to take vitamin B & C since you have trouble absorbing them."

"A gastrostomy tube may be required if failure to thrive occurs."

The nurse is explaining the similarities and differences between Crohn's disease and ulcerative colitis to a group of student nurses. Which statement is most accurate in explaining a similarity or difference between the two? "Corticosteroids are used only in Crohn's to induce remission." "Surgery is always required with Crohn's." "Both Crohn's disease and ulcerative colitis are forms of inflammatory bowel disease." "Taking antidiarrheals will cure ulcerative colitis but not Crohn's disease."

"Both Crohn's disease and ulcerative colitis are forms of inflammatory bowel disease."

A school-age child with acute diarrhea from gastroenteritis has mild dehydration and is being given oral rehydration solutions (ORS). The client's parent calls the clinic nurse because their child is also occasionally vomiting. The nurse should recommend which intervention to the parent? "Bring the child to the hospital immediately for intravenous fluids." "Alternate between giving oral rehydration solutions (ORS) and carbonated drinks, as they soothe the stomach." "Continue to give oral rehydration solutions (ORS) frequently in small amounts." "Recommend making the child nothing by mouth (NPO) for 8 hours and resume oral rehydration solutions (ORS) if vomiting has subsided."

"Continue to give oral rehydration solutions (ORS) frequently in small amounts."

A child is diagnosed with cystic fibrosis (CF). The nurse is educating the family about pancreatic enzymes. The nurse would determine that education has been successful if the family states: "Pancreatic enzymes can be skipped from time to time." "Enzymes work for about 4 hours after eating." "Lower doses of enzymes may be required for foods high in fat." "Enzymes are not needed with foods like fruits, juice, soft drinks, or sports drinks."

"Enzymes are not needed with foods like fruits, juice, soft drinks, or sports drinks."

A child is diagnosed with ulcerative colitis (UC). The child states, "Why do I have this disease? It is not fair." Which statement by the nurse would be best to help this child cope? "I'm sorry but no one knows why, so you will just have to make the best of it." "At least you will be able to eat anything you want and not gain weight." "Why don't you go to a camp with other children who have ulcerative colitis?" "I will be here every time you come into the hospital, so don't worry."

"Why don't you go to a camp with other children who have ulcerative colitis?"

The mother of a newborn diagnosed with tracheoesophageal fistula (TEF) asks the nurse about the condition. Which statement is correct in educating this mother about TEF? "This was caused because of you not taking enough folic acid in the first trimester of your pregnancy." "Your child will most likely be prone to frequent fractures of the extremities." "Your child will need to be on antibiotics of invasive procedures prophylactically." "Your baby should be able to start tube feedings in 2 to 3 days after the surgical repair."

"Your baby should be able to start tube feedings in 2 to 3 days after the surgical repair.

A 9-year-old is admitted with an inguinal hernia. In assessing this child, what signs would indicate incarceration? Select all that apply. Increase in pain Bilious vomiting Bradycardia Diarrhea Presence of a hydrocele

1, 2

A premature infant is diagnosed with necrotizing enterocolitis (NEC). What assessment findings would the nurse expect to see? Select all that apply. Large nasogastric residuals (> 2mls) Stool positive for occult blood Distended, tense abdomen No issues with apnea Good temperature stability and thermoregulation

1, 2, 3

An 8-week-old infant is diagnosed with reflux (GERD) and has been started on medications. What medications will the nurse administer to decrease stomach acid and help with the symptoms of reflux? Select all that apply. Ranitidine Metoclopramide Omeprazole Prevenique Promethazine

1, 2, 3

The nurse is teaching a group of parents about the common medications used in children with stomach ulcers. Which medication should the nurse include in the teaching? Select all that apply. Omeprazole Lansoprazole Ranitidine Bisacodyl Mineral oil

1, 2, 3

The nurse is educating the client about "trigger" foods associated with irritable bowel syndrome (IBS). What do some of these foods include? Select all that apply. Fatty foods Dairy Carbonated beverages Caffeine Spaghetti/pasta

1, 2, 3, 4

A newborn had a repair of Type I tracheoesophageal fistula (TEF). Which statement would be correct in educating the family of what to expect in the immediate post-operative period? Select that apply. "Frequent suctioning with a pre-measured catheter is required." "The head of bed should be elevated 30-45 degrees." "If there is no leak 5-7 days after the surgical repair, oral feedings will be started." "This type of TEF cannot be surgically repaired." "The baby will be on acid suppression therapy using a proton pump inhibitor (PPI), such as Lansoprazole postoperatively."

1, 2, 3, 5

A nurse is describing nursing interventions for a client that is obese. Which interventions would be accurate? Select all that apply. Educating client for symptoms of heart disease Monitoring for uncontrolled hypertension Checking blood sugars only if there is a family history of diabetes Suggesting a sleep study Urging parents to give children whatever they want to eat when they become upset in order to enhance emotional well-being

1, 2, 4

An adolescent is admitted and diagnosed with irritable bowel syndrome (IBS). The nursing providing discharge instructions should instruct the child to avoid which foods? Select all that apply. Caffeinated soda Milk and cheese Kiwi and strawberries Oranges and grapefruit Lean chicken and fish

1, 2, 4

The nurse is assessing a child who presents with diarrhea. Which questions would be important to ask the caregivers? Select all that apply. "How frequent is the diarrhea?" "Are the stools bloody?" "Did you insert anything in the rectum to cause this?" "Is the stool watery?" "Don't you make your child wash their hands so they don't get sick?"

1, 2, 4

The nurse recognizes which symptoms as typical signs of dehydration? Select all that apply. Little to no urine output Crying without tears Urine specific gravity of 1.005 Sunken fontanel Heart palpitations

1, 2, 4

The nurse is teaching a family about bilirubin encephalopathy (kernicterus). Which statement would be accurate in educating the family? Select all that apply. "Your baby may exhibit a high-pitched cry." "Hypotonia or hypertonia may be present." "Seizures are not common with this condition." "Your baby will have no problems sucking or taking a bottle." "Opisthonic posturing or arching can happen with this condition."

1, 2, 5

The nurse is caring for a newborn who was born with gastroschisis. Which nursing interventions are accurate in the care of and newborn born with this condition? Select all that apply. Insert an orogastric tube to decompress the intestines Place the newborn in a prone position Cover the defect with sterile normal saline non-adherent dressing after delivery Observe closely for defecation Support the newborn with fluids and parenteral nutrition

1, 3, 4, 5

The nurse is teaching a client about their Crohn's disease diagnosis. Which responses determine that the client understands the education provided? Select all that apply. "Crohn's disease is an immune response to injured tissue." "Crohn's disease is an acute one-time inflammatory disorder." "Crohn's disease can affect any part of the GI tract from the mouth to the anus." "Crohn's disease is more commonly found in the small intestine." "Crohn's disease may extend through the entire thickness of the bowel."

1, 3, 4, 5

The nurse is discharging a newborn that was diagnosed with pediatric gastroesophageal reflux disease (GERD). Upon discharge, what information should the nurse provide to the parent? "It is important to position your infant upright, elevating the head of the bed." "You should discontinue breastfeeding, as this might worsen your infant's condition." "If you are bottle feeding, it is important to use a concentrated formula." "You should avoid placing your infant in a carrier directly after feeding." "You should provide your infant with large, less frequent feedings."

1, 4

The nurse knows the emergent care for clients with Crohn's disease include which of the following? Select all that apply. High dose corticosteroid therapy Encourage the client to eat solids Diet high in potassium Intravenous (IV) fluid therapy Treatment with aspirin to decrease inflammation

1, 4

Celiac disease is suspected in a 6-month-old child. What signs and symptoms would this child most likely experience? Select all that apply. Abdominal bloating Constipation Accelerated growth and development Flatulence Dental enamel defects in the teeth

1, 4, 5

A 2-month-old presents to the emergency department (ED). The parent states, "I was feeding my child a bottle and he just turned blue. He frequently does this, but this time I had to rub his chest to get him to breathe. I notice a lot of crying after eating too." What further questions might the nurse ask the parent to assess if the infant has reflux? Select all that apply. "Does he arch? If he does, it is definitely reflux." "Have you noticed your baby spit up after feedings and, if so, how much?' "Can you tell me how often during the feeding you burp your baby?" "Tell me more about these episodes of turning blue. Is it always after he eats?" "What position do you feed your baby in? Is he lying flat, or do you have his head slightly elevated when feeding?"

2, 3, 4, 5

The nurse enters the room of an infant who is being admitted for severe dehydration. What order of care should the nurse provide for the infant? Start an intravenous line Perform a quick assessment of the child Administer 20 ml/kg or isotonic normal saline solution Obtain the infant's weight

2, 4, 1, 3

A premature infant is diagnosed with severe necrotizing enterocolitis (NEC). The infant had surgery to remove all but 12 inches of bowel and now has short bowel syndrome (SBS). What actions would be appropriate for the nurse to take for an infant with severe SBS in the immediate post-operative period? Administer total parenteral nutrition (TPN) to provide immediate nutrition Start PO feeds in small quantities immediately postoperatively Prepare for a colostomy Administer laxatives to maintain bowel patency

Administer total parenteral nutrition (TPN) to provide immediate nutrition

The nurse observes a newborn become cyanotic when feeding. What procedure will the nurse perform as prescribed to assess for a tracheoesophageal fistula (TEF)? Feed the newborn with smaller, frequent feedings Attempt to pass a nasogastric tube (NG tube) Check for simian creases on the palms of the hands Administer a saline lavage

Attempt to pass a nasogastric tube (NG tube)

A 1-month-old infant is noted to have significant jaundice. The mother states the urine in the infant's diapers appear very dark. She also noticed the color of the stool is gray in color. What might the nurse suspect this infant has? Malabsorption syndrome Dehydration Biliary atresia Nonalcoholic fatty liver disease (NAFLD)

Biliary atresia

The nurse is teaching about Crohn's disease. Which symptoms would the nurse include in explaining the clinical presentation of Crohn's disease? Constipation Diarrhea Symptoms of gastric reflux Weight gain

Diarrhea

A 3-year-old child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting from gastroenteritis. The child is listless and lethargic. What action by the nurse would assist in the management of the child's condition? Administer oral rehydration solutions Administer clear liquids by mouth, 1 to 2 ounces at a time Initiate intravenous (IV) fluids Administer of antidiarrheal medications

Initiate intravenous (IV) fluids

A 2-month-old has severe reflux disease (GERD) and is not gaining weight. Which surgical intervention would be indicated that entails wrapping the stomach around the esophagus to prevent reflux? Hiatal hernia repair Nissen fundoplication Pyloromyotomy Cardiac sphincterotomy

Nissen fundoplication

The nurse is performing an abdominal assessment on a child. Why is it important to perform auscultation before palpation? Children don't like the coldness of the stethoscope and this will alter the exam. Bowel sounds are a priority in abdominal assessment. Palpation will change the quality of bowel sounds and therefore alter the assessment. Children view palpation as tickling, so this should be done last.

Palpation will change the quality of bowel sounds and therefore alter the assessment.

The nurse is providing education to the parent of a child about how medications are used to treat constipation in children. What is the most commonly used, well-tolerated medication that the nurse suggests? Mineral oil Polyethylene glycol Lactulose Bisacodyl

Polyethylene glycol

An infant is suspected of having neonatal jaundice. What symptoms would the nurse expect to see that would correlate with neonatal jaundice? Blue sclera Hyper-excitability and tremors Poor feeding by mouth Present with anemia from red blood cell breakdown

Poor feeding by mouth

A parent visits the clinic and tells the nurse that her 5-week-old male infant has had projectile vomiting that smells sour for the past two days. The nurse should refer the family to a health care provider for a possible diagnosis of: Pyloric stenosis Hiatal hernia Peptic ulcer Intestinal atresia

Pyloric Stenosis

The nurse is educating a client with celiac disease about nutrition. Which diet would be the best choice? Tuna on wheat toast Ham and Swiss cheese on rye bread Rice and beans Chicken salad on a croissant

Rice and beans

A parent brings a child to the emergency department (ED). The client has been reporting abdominal pain for over a week and reports feeling constipated. Admission vital signs are: Temp 102.1, HR 110, RR 30, BP 115/84. An abdominal ultrasound revealed free fluid in the abdomen. What would most likely be the child's issue? Constipation Intussusception Crohn's disease Ruptured appendix

Ruptured appendix

A nurse is caring for a severely dehydrated child. The child has had nausea and vomiting for three days. The health care provider orders a 20 ml/kg bolus of intravenous (IV) fluid of an isotonic crystalloid. Which IV fluid would be the best choice? Sodium Chloride 0.9% (normal saline) Dextrose 10% and water (D10W) Dextrose 5% and 0.45% normal saline (D5 ½ NSS) Dextrose 5% and 0.9% normal saline (D5NSS)

Sodium Chloride 0.9% (normal saline)

The nurse is talking to a group of adolescents who are overweight. Which verbalized behavior is an example of the best exercise plan for weight loss? Walking for 30 minutes 6 or 7 days/week Playing soccer for an hour on the weekend Lifting weights 15 minutes a day, 3 times a week Playing an interactive video game every day for an hour

Walking for 30 minutes 6 or 7 days/week