gi peds test questions
The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child? a) Forceful vomiting followed by the child being eager to eat again b) Severe constipation with occasional ribbon-like stools c) Effortless vomiting just after the child has eaten d) Bouts of diarrhea with failure to gain weight
Effortless vomiting just after the child has eaten Explanation: Almost immediately after feeding, the child with gastroesophageal reflux vomits the contents of the stomach. The vomiting is effortless, not projectile in nature.
The labor and delivery nurse is caring for a mother who has demonstrated polyhydramnios upon delivery. The newborn displays copious, frothy bubbles of mucus in the mouth and nose, as well as drooling. The nurse is concerned that the infant has what disorder? a) Gastroschisis b) Omphalocele c) Esophageal atresia d) Hiatal hernia
Esophageal atresia Explanation: Esophageal atresia refers to a congenitally interrupted esophagus where the proximal and distal ends do not communicate; the upper esophageal segment ends in a blind pouch and the lower segment ends a variable distance above the diaphragm. Polyhydramnios is often the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. Omphalocele and gastroschisis are congenital anomalies of the anterior abdominal wall. Hiatal hernia involves a weakened diaphragm.
The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis? a) Abdominal pain and irritability b) Sausage-shaped mass in the upper mid abdomen c) Perianal fissures and skin tags d) Hard, moveable "olive-like mass" in the upper right quadrant
Hard, moveable "olive-like mass" in the upper right quadrant Correct Explanation: A hard, moveable "olive-like mass" in the right upper quadrant is the hypertrophied pylorus. A sausage-shaped mass in the upper mid abdomen is the hallmark of intussusception. Perianal fissures and skin tags are typical with Crohn disease. Abdominal pain and irritability is common with pyloric stenosis but are seen with many other conditions
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? a) Hirschsprung disease b) Ulcerative colitis (UC) c) Short bowel syndrome (SBS) d) Gastroenteritis
Hirschsprung disease Explanation: The nurse should suspect Hirschsprung disease when the newborn does not pass meconium in the first 24 hours after birth, and has bilious vomiting or abdominal distention and feeding intolerance with bilious aspirates and vomiting. Typical signs and symptoms of gastroenteritis include diarrhea, nausea, vomiting, and abdominal pain. The characteristic GI manifestation of UC is bloody diarrhea accompanied by crampy, typically left-sided lower abdominal pain. Clinical manifestations of untreated SBS include profuse watery diarrhea, malabsorption, and failure to thrive.
The nurse is caring for a child with a diagnosis of pyloric stenosis during the preoperative phase of the child's treatment. What is the highest priority at this time? a) Preparing family for home care b) Promoting comfort c) Maintaining skin integrity d) Improving hydration
Improving hydration Correct Explanation: Preoperatively the highest priority for the child with pyloric stenosis is to improve nutrition and hydration. Maintaining mouth and skin integrity, and relieving family anxiety are important, but these are not the priority. The child will not likely have intense pain. Preparing the family for home care would be a postoperative goal.
A 9-month-old girl is brought to the emergency room with what appears to be bouts of intense abdominal pain 15 minutes apart in which she draws up her legs and cries, often accompanied by vomiting. In between the bouts, the child recovers and appears to be without symptoms. Blood is found in the stool. What condition should the nurse suspect in this case?
Intussusception Explanation: Intussusception, the invagination of one portion of the intestine into another, usually occurs in the second half of the first year of life. Children with this disorder suddenly draw up their legs and cry as if they are in severe pain; they may vomit. After the peristaltic wave that caused the discomfort passes, they are symptom-free and play happily. In approximately 15 minutes, however, the same phenomenon of intense abdominal pain strikes again. After approximately 12 hours, blood appears in the stool and possibly in vomitus, described as a "currant jelly" appearance.
The parents of a 6-month-old have brought their child to the emergency department with vomiting and diarrhea for the past 3 days. The report the child as being very lethargic today. During the assessment the nurse notes decreased skin turgor, delayed capillary refill, and pale, slightly dry skin. Based on the objective and subjective data, what does the nurse determine the child to be? a) Severely dehydrated b) Moderately dehydrated c) Mildly dehydrated d) Well hydrated
Moderately dehydrated Correct Explanation: In addition to these signs and symptoms, signs and symptoms of moderate dehydration also include sunken fontanels, mildly sunken orbits, and urine output
The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration? a) Pale and slightly dry mucosa b) Tenting of skin c) Soft and flat fontanels d) Blood pressure of 80/42 mm Hg
Tenting of skin Explanation: 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
In caring for an infant diagnosed with pyloric stenosis, the nurse would anticipate that she would:
prepare the infant for surgery. Explanation: A surgical procedure called a pyloromyotomy (also known as a Fredet-Ramstedt operation) is the treatment of choice for pyloric stenosis.
The parents of a 4-week-old report that their infant has forceful vomiting but seems very hungry immediately after vomiting. Upon further questioning, the nurse notifies the physician of the findings and pyloric stenosis is suspected. The nurse prepares the parents for the possibility of which diagnostic procedures and treatment? a) CT scan b) Physical examination of the abdomen c) Pyloric ultrasound d) Surgical repair e) Upper GI series
• Upper GI series • Pyloric ultrasound • Physical examination of the abdomen • Surgical repair Explanation: Frequently a diagnosis is made with the client history and palpation of a hard, moveable "olive" mass in the right upper quadrant. If no mass is palpated the most common diagnostic procedure is a pyloric ultrasound. An upper GI series is sometimes performed, but this test is much more invasive than an ultrasound. Surgical repair is necessary. A CT scan is not warranted.
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? a) Pyloric stenosis b) Cleft palate c) Hernia d) Esophageal atresia (EA)
D A maternal history of polyhydramnios is usually present in one-third of cases of EA and in some cases of tracheoesophageal fistula (TEF).
Which assessment finding would suggest that a child's postoperative feeding schedule following pyloric stenosis surgery should be slowed? a) Falling asleep at each feeding b) Vomiting c) Semiformed bowel movements d) Flatulence
vomiting Correct Explanation: Vomiting after a feeding suggests the pyloric valve is not yet able to accommodate feedings well, possibly from edema
A doctor orders an abdominal radiograph for a newborn to check for Hirschsprung disease. The nurse examines the infant and finds which symptoms that are indicative of this disease? Select all that apply. a) Bilious vomiting b) Displaced anus c) Presence of a fistula d) Abdominal distention e) Absence of stool in the rectum f) Enterocolitis
• Abdominal distention • Absence of stool in the rectum • Enterocolitis • Bilious vomiting Explanation: The nurse should suspect Hirschsprung disease when the newborn does not pass meconium in the first 24 hours after birth and has bilious vomiting or has abdominal distention, feeding intolerance, with bilious aspirates and vomiting. In anorectal malformations the anus is absent or displaced and the presence of a fistula may be noted when gas or stool is expelled from the urethra or vagina. (less)
A group of nursing students are reviewing information about celiac disease. The students demonstrate understanding of this disorder when they identify which classic symptoms? Select all that apply. a) Failure to thrive b) Constipation c) Diarrhea d) Sunken abdomen e) Steatorrhea f) Polycythemia
• Steatorrhea • Constipation • Diarrhea • Failure to thrive Explanation: Classic symptoms of celiac disease include steatorrhea, constipation, diarrhea, failure to thrive, weight loss, abdominal distention or bloating (not a sunken abdomen), and anemia (not polycythemia)
