Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder - ML4

Correct response: Lower right Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Appendicitis, p. 1528.

A 10-year-old male presents with low-grade fever, nausea, and abdominal pain. The nurse examining him suspects appendicitis and checks for rebound tenderness in what quadrant? Lower right Upper right Upper left Lower left

Correct response: No intervention is needed, as the opening will most likely close spontaneously. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Umbilical Hernia, p. 1520.

A 3-month-old girl is found to have an umbilical hernia at a well visit. On examination, the nurse discovers that the fascial ring through which the intestine protrudes is about 1 cm in diameter. Which statement by the nurse to the girl's father would indicate the likely intervention required to correct this condition? Wrapping an elastic band around the child's waist should correct the problem. No intervention is needed, as the opening will most likely close spontaneously. Taping a silver dollar over the area will help reduce the hernia. Surgery at age 1 to 2 years will likely be needed to repair the condition.

Correct response: Do not rub or put pressure on the abdomen. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Appendicitis, p. 1528.

A child is admitted with a temperature, 101.2°F (38.4°C); pulse rate 100 beats/min; respirations 24 breaths/min. On admission the pain is localized in right lower quadrant. Legs are drawn up against the abdomen. Bowel sounds are sluggish. Rebound tenderness is present. White blood cell count of 17,000/mm3. Ultrasound confirms appendicitis. Which instruction would the nurse give to the child and the parent? Use a heating pad to decrease the abdominal discomfort. Do not rub or put pressure on the abdomen. Place an ice pack over the place of the discomfort. Drink cool fluids to reduce the temperature.

Correct response: detect Helicobacter pylori Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, COMMON LABORATORY AND DIAGNOSTIC TESTS 42.1 (Continued ), p. 1510. a rapid diagnostic procedure used to identify infections by Helicobacter pylori, a spiral bacterium implicated in gastritis, gastric ulcer, and peptic ulcer disease. It is based upon the ability of H. pylori to convert urea to ammonia and carbon dioxide.

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 determine esophageal contractility confirm pancreatitis

Correct response: acute upper GI bleeding Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Vomiting, p. 1522. Vomiting bright red blood indicates acute upper GI bleeding. Emesis containing brown, foul-smelling stool indicates GI obstruction. Stool with red blood and mucus is associated with intussusception. Bleeding is not generally indicative of gastroesophageal reflux.

A mother brings her 3-year-old son to the ER and tells the triage nurse that he has been vomiting blood. A medical history determines that the 3-year-old has no history of GI disturbances and his only symptoms are a slightly elevated fever and vomiting bright red blood. Based on these symptoms, what condition might the nurse suspect? acute upper GI bleeding gastroesophageal reflux GI tract obstruction intussusception

Correct response: Hirschsprung disease Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Hirschsprung Disease (Congenital Aganglionic Megacolon), p. 1536.

A neonatal nurse teaches students how to recognize gastrointestinal disorders in infants. The nurse tells the students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease? Short bowel syndrome (SBS) Ulcerative colitis (UC) Hirschsprung disease Gastroenteritis

Correct response: "I sense you could use more information on caring for a cleft palate. Would you be interested in meeting with other parents who have dealt with this?" Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Cleft Lip and Palate, p. 1518.

A nurse caring for an infant born with a cleft palate notices that the parents rarely interact with their child. The nurse overhears the mother telling her spouse that she "feels like crying" every time she looks at their infant. What would be the best response from the nurse? "I sense you could use more information on caring for a cleft palate. Would you be interested in meeting with other parents who have dealt with this?" "Your infant needs you right now. You should put your negative feelings about the condition aside for your infant's sake." "Many infants are born with this condition. Your infant's palate is not nearly as bad as some cases." "Keep in mind that your infant's condition is not life-threatening and can be corrected eventually."

Correct response: esophageal atresia (EA) Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Esophageal Atresia and Tracheoesophageal Fistula, p. 910.

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? pyloric stenosis cleft palate hernia esophageal atresia (EA)

Correct response: liver function tests Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, COMMON LABORATORY AND DIAGNOSTIC TESTS 42.1 (Continued ), p. 1510.

A parent brings the 10-year-old child in to the clinic. The nurse notes: icteric sclera and skin, headache, anorexia, vomiting, and temperature 101.8°F (38.8°C). The parent states the child has had the symptoms since returning to the US from India a few days ago. The nurse will anticipate preparing the child for which test? fecal ova and parasite test liver function tests abdominal ultrasound magnetic resonance imaging (MRI)

Correct response: 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. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Gastroesophageal Reflux Disease, p. 1532. The traditional treatment of GI reflux is to feed infants a formula thickened with rice cereal (1 tbsp of cereal per 1 oz of formula or breast milk) while holding them in an upright position and then keeping them upright in an infant chair for 30 minutes after feeding so gravity can help prevent reflux. There is no need for the mother to switch from breastfeeding to formula. 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 child in a more upright position during and following feeding; they would not be appropriate at this point.

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. Consult the heath care provider regarding having botulinum toxin injected into the lower esophageal sphincter. If breastfeeding, switch to feeding the infant formula. Consult a pediatric surgeon regarding having a myotomy procedure performed. 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.

Correct response: gastroesophageal reflux disease. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Gastroesophageal Reflux Disease, p. 1530.

An 18-month-old infant is brought to the emergency department with flu-like symptoms. The infant is diagnosed with pneumonia secondary to aspiration of stomach contents. The nurse explains to the parents that pneumonia is a condition that often occurs secondary to: gastroesophageal reflux disease. Hirschsprung disease. inflammatory bowel disease. cystic fibrosis.

Correct response: Strict enforcement of standard precautions Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Hepatitis, p. 1545.

An adolescent has hepatitis B. What would be the most important nursing action? Strict enforcement of standard precautions Strict calculation of caloric and vitamin B intake Close observation to detect cerebral hallucinations Conscientious collection of stool for ova and parasites

orrect response: The adolescent will become fatigued easily. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Hepatitis, p. 1544. Most children with hepatitis are exhausted. Urine is not infectious.

An adolescent is diagnosed with hepatitis A. Which problem should be considered when planning care? Hypothermia is common. The adolescent will be very irritable and perhaps require sedation. The adolescent's urine will be dark and infectious. The adolescent will become fatigued easily.

Correct response: "I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Inguinal Hernia, p. 1519.' The mother is describing common symptoms of an inguinal hernia. It may be possible to visualize the mass, but often the mass is seen only during crying or straining, making it difficult to actually identify in the clinic setting. It is important to notify the physician so treatment can be initiated.

The mother of an infant tells the nurse during a routine visit to the clinic that she often notices a bulging mass in the lower abdominal and groin area when her baby cries. She asks the nurse if this is normal. How should the nurse respond? "I will be sure to note this in your child's chart so it is something we will continue to monitor in future visits." "I didn't notice any masses while I was assessing your infant. It may just appear they have a mass due to pressure in the abdomen when crying." "The muscle wall of infants are not yet strong so it isn't unusual to see this happening when the baby is crying or straining." "I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately."

Correct response: painless rectal bleeding. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Meckel Diverticulum, p. 1518.

The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is: Dehydration Painless rectal bleeding Respiratory distress Ischemia

Correct response: "I have to be careful because I am prone to not absorbing nutrients." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Inflammatory Bowel Disease, p. 1539. Crohn disease typically effects the small intestine more than the large intestine and it's onset is between the ages of 10 to 20 years. The cobblestone lesions in the small intestine prevents absorption of nutrients that normally occurs. The diarrhea is not directly related to the cobblestone lesions, and ulcerative colitis is characterized by the disease effecting the intestine(s) in a continuous pattern.

The nurse has performed client education for a 15-year-old boy with Crohn disease and his parents regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning has occurred? "It's unusual for someone my age to get Crohn disease." "I may end up with a colectomy because the disease is continuous from the beginning to the end of my intestines." "I have a lot of diarrhea every day because of how my small intestine is damaged." "I have to be careful because I am prone to not absorbing nutrients."

Correct response: Check for gastric residual before starting feeding. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Short Bowel Syndrome, p. 1537.

The nurse is administering an enteral feeding to a child with a gastrostomy tube (G-tube). Which action will the nurse take when administering a prescribed feeding through the client's G-tube? Use a syringe plunger to administer the feeding. Check for gastric residual before starting feeding. After feeding, flush the tube with a small amount of saline and leave the G-tube open for 2 minutes. Position the client with the head of the bed at a 20° angle.

Correct response: Tenting of skin Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, COMPARISON CHART 42.1 Dehydration, p. 1521. Tenting of skin is an indicator of severe dehydration. Soft and flat fontanels indicate mild dehydration. Pale and slightly dry mucosa indicates mild or moderate dehydration. Blood pressure of 80/42 mm Hg is a normal finding for an infant.

The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration? Blood pressure of 80/42 mm Hg Tenting of skin Soft and flat fontanels (fontanelles) Pale and slightly dry mucosa

Correct response: fever Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, COMPARISON CHART 42.2 Features of Crohn Disease and Ulcerative Colitis, p. 1538.

The nurse is caring for a 12-year-old child with Crohn disease. What assessment finding will the nurse report to the health care provider when caring for the child? clear lung sounds fever report of a headache no joint swelling

Correct response: "You will most likely have a blood test to check for certain antibodies." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Hepatitis, p. 1544.

The nurse is caring for a 13-year-old girl with suspected autoimmune hepatitis. The girl inquires about the testing required to evaluate the condition. How should the nurse respond? "You will most likely have viral studies." "You will most likely have an ultrasound evaluation." "You will most likely be tested for ammonia levels." "You will most likely have a blood test to check for certain antibodies."

Correct response: "Offer 'magic mouthwash' followed by a popsicle." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Oral Lesions, p. 1526. Older children with herpangina or stomatitis can "swish and spit" various formulations of "magic mouthwash" (typically a combination of liquid diphenhydramine, liquid acetaminophen, and milk of magnesia); they may offer some pain relief. Common over-the-counter medications such as Anbesol, Orajel, and Kank-A may be helpful for topical pain relief, though oral analgesics are often necessary. The child with herpangina is typically an infant or young child (Romero, 2020). It may be very difficult to coach a young child to drink fluids when his or her mouth is hurting. Playing games and offering favorite fluids and popsicles may encourage adequate oral intake. It is important to avoid carbonated beverages and citrus juices when oral lesions are present as they can cause further stinging and burning. TAKE NOTE! Viscous lidocaine should be used with caution in younger children as a topical treatment for numbing the lesions or as a swish-and-spit treatment because they may swallow the lidocaine (Wolters Kluwer Clinical Drug Information [WKCDI], 2020).

The nurse is caring for a 4-year-old with oral vesicles and ulcers from herpangina. The child is refusing fluids due to the pain and the mother is concerned about his hydration status. Which of the suggestions would be most appropriate? "Try some Anbesol or Kank-A." "Offer him some orange juice." "Encourage him to have some soda." "Offer 'magic mouthwash' followed by a popsicle."

Correct response: Take a stool culture Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, COMMON LABORATORY AND DIAGNOSTIC TESTS 42.1 (Continued ), p. 1510.

The nurse is caring for a 6-month-old infant who was admitted to the emergency department 24 hours ago with signs of severe diarrhea. The infant's rectal temperature is 104°F (40°C), with weak and rapid pulse and respirations. The skin is pale and cool. The child is on IV rehydration therapy, but the diarrhea is persisting. The infant has not voided since being admitted. Which is the priority nursing intervention? Take a stool culture Administer IV potassium Feed the child a cracker Administer antibiotic therapy

Correct response: Persistent constipation Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Hirschsprung Disease (Congenital Aganglionic Megacolon), p. 1536.

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? Irregular breathing Persistent constipation Chronic cough Prolonged bleeding

Correct response: Effortless vomiting just after the child has eaten Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Vomiting, p. 1522.

The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child? Severe constipation with occasional ribbon-like stools Forceful vomiting followed by the child being eager to eat again Effortless vomiting just after the child has eaten Bouts of diarrhea with failure to gain weight

Correct response: "I will add the nystatin to her bottle four times per day." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Oral Candidiasis (Thrush), p. 1525. Administer nystatin suspension four times per day following feeding, not mixed in the bottle, to allow the medication to remain in contact with the lesions. In the younger infant, apply nystatin to the lesions with a cotton-tipped applicator. Infants and young children often mouth their toys, so it is important to clean them appropriately. Explain to parents of infants with thrush the importance of reporting diaper rash because fungal infections in the diaper area often occur concomitantly with thrush and also need to be treated.

The nurse is caring for an infant recently diagnosed with oral candidiasis (thrush) who has been prescribed nystatin. Which statement by the infant's mother would suggest a need for further education? "I will watch for diaper rash." "I will add the nystatin to her bottle four times per day." "I will make sure to clean all of her toys before I give them to her." "I will use a cotton tipped applicator to apply the medication to her mouth."

Correct response: "Tell me about the types of stools your child has been having." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Diarrhea, p. 1524.

The nurse is collecting data on a 2-year-old child admitted with a diagnosis of gastroenteritis. When interviewing the caregivers, which question is most important for the nurse to ask? "What foods has your child eaten during the last few days?" "How many times a day does your child urinate?" "How long has your child been toilet trained?" "Tell me about the types of stools your child has been having."

Correct response: "This means the hernia contents will be manipulated back into your peritoneal cavity during surgery." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Inguinal Hernia, p. 1519. If a mass is felt upon palpation, the physician or nurse practitioner may attempt to reduce the hernia by pushing it back through the external inguinal ring. The physician or nurse practitioner may ask the nurse to assist in a reduction, most likely helping to hold the child in a position that will allow the physician or nurse practitioner to reduce the hernia. Reduction is only a temporary method of managing inguinal hernias; they must be corrected surgically. If reduction is not possible even with sedation, the hernia could be incarcerated (Hoffenberg et al., 2018). An incarcerated hernia could eventually lead to bowel strangulation. The hernia should be manually reduced as needed until the time of the surgery, so teach the family how to reduce the hernia. Instruct the family to contact the surgeon immediately if the hernia becomes irreducible. Provide routine pre- and postoperative care during inguinal hernia surgical repair, including child and family education to relieve anxiety.

The nurse is preparing a client for surgery and the client asks, "What does it mean when they say they are going to reduce my abdominal hernia?" Which response by the nurse is most appropriate? "This means the hernia contents will be manipulated back into your peritoneal cavity during surgery." "All this means is that the herniated intestines are twisted and edematous, which is why you need surgery." "If you do not understand this, I need to cancel your surgery and have the health care provider come back." "The health care provider will remove about half of the herniated contents during the procedure."

Correct response: Applesauce Bananas Skim milk Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, TEACHING GUIDELINES 42.2 Dietary Considerations in a Gluten-Free Diet, p. 1541.

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which foods would be permitted in the diet of the child with celiac syndrome? Select all that apply. Bananas Applesauce Skim milk Wheat bread Rye bread

Correct response: recently finished the last chemotherapy treatment for leukemia severe malabsorption from a GI disorder Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Oral Lesions, p. 1525. Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder - Page 1525 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 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. history of anemia frequent bouts of constipation several episodes of tonsillitis recently finished the last chemotherapy treatment for leukemia severe malabsorption from a GI disorder

Correct response: mother age 42 with pregnancy Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Cleft Lip and Palate, p. 1517.

The nurse is reviewing the medical record of a child with a cleft lip and palate. When reviewing the child's history, what would the nurse identify as a risk factor for this condition? History of hypoxia at birth Preterm birth Maternal use of acetaminophen in third trimester Mother age 42 with pregnancy

Correct response: "I should position him on his abdomen with knees bent." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, COMMON MEDICAL TREATMENTS 42.1 Gastrointestinal Disorders, p. 1513. 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 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 wash my hands and then wear gloves." "I should position him on his abdomen with knees bent." "He will require 250 to 500 mL of enema solution." "He should retain the solution for 5 to 10 minutes."

Correct response: "Infants this age commonly spit up." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, VARIATIONS IN PEDIATRIC ANATOMY AND PHYSIOLOGY, p. 1506.

The parent of a 3-week-old infant brings the infant in for an evaluation. During the visit, the parent tells the nurse that the infant is spitting up after feedings. Which response by the nurse would be most appropriate? "Infants this age commonly spit up." "Do not worry; you are just feeding your infant too much." "Thicken the formula by adding rice cereal." "Your child might have an allergy."

Correct response: inguinal hernia Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Inguinal Hernia, p. 1519.

The parent reports that the health care provider said that the infant had a hernia but cannot remember which type. When recalling what the health care provider said, the parent said that a surgeon will repair it soon and there is no problem with the testes. Which hernia type is anticipated? umbilical hernia inguinal hernia hiatal hernia diaphragmatic hernia

Correct response: "I will make sure there is plenty of orange juice available. It's her favorite juice." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Dehydration, p. 1520. Proper interventions for children at risk for fluid volume deficit include maintaining IV line and administer IV fluid as ordered to maintain fluid volume. Offer small amounts of oral rehydration solution frequently to maintain fluid volume. Small amounts are usually well tolerated by children with diarrhea and vomiting. Avoid high-carbohydrate fluids such as Kool-Aid and fruit juice, as they are low in electrolytes, and increased simple carbohydrate consumption can decrease stool transit time. Daily weights are one of the best indicators of fluid volume status in children

The student nurse is caring for a child with the nursing diagnosis "Risk for fluid volume deficit related to inadequate oral intake." Which statement by the student would indicate a need for further education by the nursing instructor? "I will teach her mother to give her small drinks frequently." "I will make sure there is plenty of orange juice available. It's her favorite juice." "I will monitor her IV line to help maintain her fluid volume." "I will weigh her every morning at the same time."

Correct response: "Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "The only treatment for celiac disease is a strict gluten-free diet." "Gluten is found in most wheat products, rye, barley and possibly oats." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Celiac Disease, pp. 1540-1541. Celiac disease is an immunologic disorder in which gluten causes damage to the small intestine. The only treatment currently is a gluten-free diet. While the child needs to have a gluten-free diet, the rest of the family does not. Most children present by the age of 2 for evaluation. Symptoms of celiac disease include diarrhea, constipation, steatorrhea, weight loss, poor muscle tone, anemia and dental disorders. Gluten is found in most grains, like wheat, rye, barley and possibly oats.

The student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply. "Most children with celiac disease are diagnosed within the first year of life." "Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "Gluten is found in most wheat products, rye, barley and possibly oats." "The only treatment for celiac disease is a strict gluten-free diet." "The entire family will need to eat a gluten-free diet."

Correct response: Prepare the child for admission to the hospital. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder, Gallbladder Disease, p. 1543. The child's presentation is consistent with cholecystitis, which necessitates surgery in most cases. The child should be kept NPO and antacids are of no benefit. Genitourinary involvement is atypical.

The emergency department nurse is assessing a child who has presented with a 2-day history of nausea and vomiting with pain that is isolated to the right upper quadrant of the abdomen. Which action is most appropriate? Encourage fluid intake. Prepare the child for admission to the hospital. Assess the child's usual urinary voiding pattern. Administer antacids as ordered.