Chapter 28: The child with a Gastrointestinal Condition

12. The nurse explains that the treatment of choice for a child with intussusception is: a. a barium enema. b. immediate surgery. c. IV fluids until the spasms subside. d. gastric lavage.

ANS: A A barium enema is the treatment of choice for intussusception because the passage of the barium frequently "un-telescopes" the bowel. Surgery is scheduled only if reduction is not achieved

28. An infant is admitted to the hospital with severe dehydration. Laboratory results show pH 7.32, PaCO2 40, HCO3- 21. The nurse interprets these values as: a. metabolic acidosis. b. metabolic alkalosis. c. respiratory acidosis. d. respiratory alkalosis.

ANS: A A pH lower than 7.35 indicates acidosis. If the child's pH falls in the same line as the HCO3-, the problem is metabolic (see Table 27-4).

5. An appropriate intervention for a 3-month-old infant who has gastroesophageal reflux is to: a. position the infant in the crib on his or her abdomen, with the head elevated. b. administer medication as ordered to stimulate the pyloric sphincter. c. give thin rice cereal with formula before feeding solid foods. d. place the infant in an infant seat after feedings.

ANS: A After feedings, the infant is placed in a prone position to avoid increased intraabdominal pressure.

11. Intussusception would be suspected when parents describe the child's stools as: a. currant jelly. b. black and tarry. c. green liquid. d. greasy and foul-smelling.

ANS: A Bowel movements of blood and mucus that contain no feces ("currant jelly" stools) are common about 12 hours after the onset of the obstruction.

9. The instruction the nurse would give to parents about preventing the spread and reinfection of pinworms is to: a. keep children's nails short. b. dress child in loose-fitting underwear. c. clean the bathroom with bleach solution. d. wash bed linens in cold water.

ANS: A One intervention to prevent the further spread of pinworms is to keep the child's fingernails short. Pinworms are not spread from person to person.

21. A 7-month-old infant is admitted to the hospital with a diagnosis of acute gastroenteritis. The priority goal of the infant's care is to prevent: a. fluid and electrolyte imbalance. b. nutritional deficiency. c. skin breakdown. d. malabsorption.

ANS: A The priority goal of care in gastroenteritis is preventing fluid and electrolyte imbalance.

25. The statement by a mother that may indicate a cause of her son's vitamin C deficiency is: a. "We get our fruits from homemade preserves." b. "We use milk from our own goats." c. "We grow all our own vegetables." d. "We're not big meat eaters."

ANS: A Vitamin C is destroyed by heat.

3. On the second day of hospitalization for a 3-month-old brought in for treatment for gastroenteritis, the nurse makes all of the assessments listed below. Which assessment finding indicates ineffectiveness of treatment? a. Weight loss of 4 ounces b. Dry mucous membranes c. Decreased skin turgor d. Depressed fontanelle

ANS: A Weight loss is the most significant indicator of dehydration because an infant's weight is comprised of 77% water.

7. A mother reports that her child has been scratching the anal area and complaining of itching. Based on this information, the nurse might suspect this child has: a. pinworms. b. giardiasis. c. ringworm. d. roundworm

ANS: A With pinworms, the nurse or parent may notice that the child scratches the anal area and complains of itchiness. The other choices do not cause this reaction

33. What sign(s) indicate(s) moderate dehydration? Select all that apply. a. 10% weight loss b. Dry mucous membranes c. Normal anterior fontanel d. Increased urinary output e. Lethargy

ANS: A, B, C The child that is moderately dehydrated will have lost 10% of his body weight, will have dry mucous membranes, normal (nonsunken) anterior fontanelle, decreased urine output, and will be irritable.

32. What assessment(s) would lead a nurse to suspect Hirschsprung's disease in a 1-month-old infant? Select all that apply. a. Ribbon-like stools b. Fever c. Failure to thrive d. Vomiting e. Diminished peristalsis

ANS: A, B, C, D, E All options are significant indicators of Hirschsprung's disease.

1. The finding in a newborn suggestive of tracheoesophageal fistula is: a. failure to pass meconium in 24 hours. b. choking on the first feeding. c. palpable mass in the sternal area. d. visible peristalsis across abdomen.

ANS: B After birth, a newborn with tracheoesophageal fistula will vomit and choke when the first feeding is introduced.

15. A child is brought to the emergency department because he ingested an unknown quantity of acetaminophen (Tylenol). After gastric lavage is completed, the nurse might expect this child to receive: a. activated charcoal. b. N-acetylcysteine. c. vitamin K. d. syrup of ipecac.

ANS: B Gastric lavage is followed by N-acetylcysteine (Mucomyst), the antidote for acetaminophen.

17. A frightened mother calls the pediatrician's office because her child swallowed dishwashing detergent. The most appropriate action is to: a. induce vomiting by giving the child syrup of ipecac. b. take the child to the local emergency department. c. give the child activated charcoal mixed with juice. d. give the child milk to soothe affected mucous membranes.

ANS: B Inducing vomiting is no longer recommended because it may pose additional problems. The child should be taken immediately to the nearest emergency department along with the packaging of the ingested substance.

23. The nurse would expect a child admitted to the hospital for nonorganic failure to thrive to: a. cry to be picked up. b. be limp like a rag doll. c. be responsive to cuddling. d. weigh in the 10th percentile for age.

ANS: B Some children with failure to thrive have rag-doll limpness (hypotonia) and appear wary of their caregivers.

18. A child has been diagnosed with ascariasis (roundworm). The statement made by her mother that may suggest a cause for her condition is: a. "I've been airing out the house on these nice breezy days." b. "My child often goes out to the garden and pulls up a carrot to eat." c. "She runs barefoot so much I have to wash her feet at least twice a day." d. "We just remodeled our bathroom at home."

ANS: B The child can ingest roundworm eggs from contaminated soil.

6. The nurse interviewing parents of an infant with pyloric stenosis would expect the parents to report if the infant has had: a. diarrhea. b. projectile vomiting. c. poor appetite. d. constipation.

ANS: B Vomiting is the outstanding symptom of pyloric stenosis. Food is ejected with considerable force, which is described as projectile vomiting.

31. When feeding a child with pyloric stenosis, what interventions will the nurse perform? Select all that apply. a. Give a formula thinned with water. b. Burp the infant before and during feeding. c. Give the feeding slowly. d. Refeed if the infant vomits. e. Position infant on left side after feeding.

ANS: B, C, D Children with pyloric stenosis are given formula thickened with cereal; the infant is burped before and during feeding to get rid of any gas in the stomach; the infant is fed slowly and refed if vomiting occurs. The infant is positioned on the right side to allow the weight of the feeding to stay in the stomach against the pyloric valve.

27. One reason that infants are more vulnerable to fluid and electrolyte imbalances than adults is that: a. they have a smaller surface area than adults in proportion to body weight. b. water needs and losses per kilogram are lower than those for adults. c. a greater percentage of body water in infants is extracellular. d. infants have a lower metabolic turnover of water.

ANS: C A greater percentage of body water is contained in the extracellular compartment of children under 2 years of age.

22. The nurse, speaking to the parent of a 3-year-old child who has mild diarrhea, would advise the dietary modification of: a. soft foods with rice, bananas, toast, and applesauce. b. small amounts of clear fluids such as gelatin. c. an oral rehydrating solution, such as Pedialyte. d. chicken soup because it is high in sodium.

ANS: C An oral rehydrating solution is recommended to replace fluids and electrolytes lost from frequent bowel movements.

19. The nurse would expect the stools of a child with celiac disease to have which appearance? a. Ribbon like b. Hard, constipated c. Bulky, frothy d. Loose, foul-smelling

ANS: C Celiac disease causes malabsorption. Stools that are large, bulky, and frothy may indicate malabsorption.

10. A mother reports that her 2-year-old child experiences constipation frequently. The nurse would recommend to the mother to include what food in the child's diet? a. Cooked vegetables b. Pretzels c. Whole-grain cereal d. Yogurt

ANS: C Dietary modifications for constipation include eating more high-roughage foods such as whole-grain breads and cereals.

13. Parents ask the nurse how their infant developed a Meckel's diverticulum. The nurse's response is based on the knowledge that this condition occurs when: a. the yolk sac remains connected to the intestine. b. there is inflammation of the ileocecal valve. c. a pouch forms when the vitelline duct fails to disappear. d. there is a weakness in the abdominal wall.

ANS: C If the vitelline duct fails to disappear completely after birth, a blind pouch may form.

4. The nurse is aware that rapid respirations are a possible cause of dehydration because they: a. prevent the child from drinking. b. increase circulation, thus increasing urine production. c. cause evaporation of fluid on the mucous membranes. d. often lead to vomiting.

ANS: C Rapid respirations cause increased insensible fluid loss.

8. The nurse that is teaching a parent about pyrvinium (Povan) would include the information that the drug will cause: a. diarrhea. b. skin rash. c. red stool. d. metallic taste.

ANS: C The nurse should advise parents that pyrvinium stains clothing and turns stools red.

16. The nurse, planning a parent education program about lead poisoning prevention, would include the information that the sources of lead in the community are most likely: a. increased lead content of air. b. use of aluminum cookware. c. deteriorating paint in older buildings. d. inhaling smog.

ANS: C The primary source of lead is paint from old, deteriorating buildings.

26. The nurse instructing a mother how to administer oral nystatin suspension prescribed to treat thrush would teach her to: a. pour the prescribed amount into a nipple and have the infant suck the medication. b. squirt the prescribed dose into the back of the mouth and have the infant swallow. c. give the medication mixed with a small amount of juice in a bottle. d. use a sterile applicator to swab the medication on the oral mucosa.

ANS: D An appropriate way to administer nystatin is to moisten a sterile applicator with the medication and then swab it on the inside of the mouth.

2. A child is brought to the pediatric clinic because he has been vomiting for the past 2 days. An acid-base imbalance that the nurse would expect to occur from this persistent vomiting is: a. hyperkalemia. b. hypernatremia. c. acidosis. d. alkalosis.

ANS: D Hydrochloric acid and sodium chloride from the stomach are lost from persistent vomiting. This results in alkalosis

20. After reviewing dietary restrictions for celiac disease, the nurse determines that a parent understands the information when she states that a grain that can be eaten by a child with celiac disease is: a. wheat. b. oats. c. barley. d. rice.

ANS: D Rice is a gluten-free grain that can be eaten by children afflicted with celiac disease. These children will have a lifelong restriction of wheat, oats, barley, and rye.

14. An infant is admitted to the hospital with severe isotonic dehydration. In planning the infant's care, the nurse is aware the infant is at risk for: a. metabolic alkalosis. b. hypocalcemia. c. sepsis. d. shock.

ANS: D Shock is the greatest threat to life in isotonic dehydration.

29. Following surgery for pyloric stenosis an infant awoke from anesthesia hungry and crying. The nurse should: a. delay feeding the child for 6 hours. b. offer regular formula thinned with water. c. give small amounts of regular formula thickened with cereal. d. allow one ounce of glucose water at frequent intervals.

ANS: D Small oral feedings of glucose water are given after recovery from anesthesia. Feedings are gradually increased to larger amounts of regular formula.

30. The nurse is aware that the 18-pound child must take in _____ mL of oral fluid to make up the fluid loss from one stool of diarrhea. a. 18 b. 36 c. 64 d. 81

ANS: D The formula for oral fluid replacement is 10 mL/kg. 18 pounds = 8.1 kg 10 = 81 mL

24. Nursing interventions for the mother of a 10-month-old infant with nonorganic failure to thrive would include: a. pointing out errors that the nurse observes when the mother is caring for the infant. b. discussing negative characteristics of the infant with the mother. c. having the nurse provide as much of the infant's care as possible. d. teaching the mother about the developmental milestones to expect in the next few months.

ANS: D The nurse can increase parent's knowledge of growth and development by providing anticipatory guidance about normal developmental milestones.