N341: Exam 2

by what age does the fetus' bladder capacity increases to adult size?

1 year

How much can the newborn's stomach contain?

10-20 mLs

How much can an infant's stomach contain?

200 mLs

Until when are babies GI tracts fully matured?

Age 2

What is priority when feeding an infant with cleft lip/palate?

Aspiration - some infants will need to be fed with a special cleft nipple

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? A. Refer the family to a social worker or mental health practitioner. B. Explain to the parents that surgical intervention will fix the defect in the baby's lip. C. Ask the parents if they have any questions regarding the care of their child. D. Teach the mother the appropriate technique for breast-feeding an infant with cleft lip.

C. Ask the parents if they have any questions regarding the care of their child.

What medication is used for a patient with nephrotic syndrome to heal the glomerulus?

Cortiosteroids (i.e prednisone, triamcinolone, )

A 5-year old who had a renal transplant 9 months ago and has no history of chickenpox presents to the pediatric clinic for his vaccinations. Which is the most appropriate set to give? a. DTaP, IPV b. DTaP, IPV, MMR, varicella c. DTaP, IPV, varicella d. IPV only

a. DTaP, IPV

A 3-month-old infant presents with a history of vomiting after feeding. The plan for the infant is to rule out GER. What information from the history would lead the nurse to believe that this infant may need further intervention? a. poor weight gain b. small "spits" after feeding c. sleeps through the night d. difficult to burp

a. poor weight gain GER is considered a routine and benign occurrence unless it is significant enough to cause respiratory symptoms or, as in this infant, to interfere with growth, in which case it would be considered gastroesophageal reflux disease, and would warrant treatment.

What can indicate dehydration in infants?

absence of tears when crying and sunken fontanel

An adolescent who is a competitive swimmer comes to the emergency department complaining of localized aching pain in his shoulder. He states, "I've been practicing really hard and long to get myself ready for my meet this weekend." The area is tender to the touch. The nurse determines that the adolescent is most likely experiencing which type of pain? a. Cutaneous pain b. Deep somatic pain c. Visceral pain d. Neuropathic pain

b. Deep somatic pain

The nurse is preparing to assess the pain of a 3-year-old child who had surgery the day before. Which pain assessment method would be most appropriate for the nurse to use? a. FACES pain rating scale and poker chip tool b. FACES pain rating scale, observation of the child, and parent report c. Asking the parents to rate their child's pain using the word-graphic rating scale d. Visual analog scale

b. FACES pain rating scale, observation of the child, and parent report

The nurse is caring for a child who has had diarrhea and vomiting for the past several days. What is the priority nursing assessment? a. Determine the child's weight. b. Ask if the family has traveled outside of the country. c. Assess circulation and perfusion. d. Send a stool specimen to the lab

c. Assess circulation and perfusion. Infants and children are at increased risk for dehydration and hypovolemia compared with adults. The nurse must quickly determine if the child with diarrhea and vomiting needs rehydration to prevent further (and usually quick) deterioration.

What condition can occur post-strep infection?

Glomerulonephritis

The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis?

Hard, moveable "olive-like mass" in the upper right quadrant

If a baby does not pass meconium within the first 24 hours of life, what can this indicate?

Hirschsprung disease

The nurse is developing a teaching plan for the parents of an 11-month-old infant with gastroesophageal reflux disease (GERD). The child will be managed medically. What actions would the nurse incorporate into the teaching plan?

Keeping the child upright for 30 minutes after feeding Giving the child small frequent feedings Administering prokinetics to empty the stomach quickly

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?

Mother age 42 with pregnancy

A 12-year-old boy has just undergone a liver transplantation and is recovering. After performing a finger stick puncture and assessing the results, the nurse administers a 10% solution of dextrose IV. What is the correct rationale for this intervention?

Prevention of hypoglycemia

patient's diagnosed with hypospadis is prone to what medical problems?

UTI, wound infection, and fistuals

A mother brings her 6-month-old infant to the clinic. The child has been vomiting since early morning and has had diarrhea since the day before. His temperature is 38°C, pulse 140, and respiratory rate 38. He has lost 6 oz since his well-child visit 4 days ago. He cries before passing a bowel movement. He will not breastfeed today. What is the priority nursing diagnosis? a. thermoregulation alteration b. pain (abdominal) related to diarrhea c. fluid volume deficit related to excessive losses and inadequate intake d. alteration in nutrition, less than body requirements, related to decreased oral intake

c. fluid volume deficit related to excessive losses and inadequate intake Infants are at significant risk for dehydration due to their increased proportion of body fluid as compared with adults. Although fever and pain are important, fluid volume takes priority in the infant with fluid losses or decreased intake.

What are the "three C's" to watch out for when feeding a child with esophageal atresia?

coughing choking cyanosis

A 3-day-old infant presenting with physiologic jaundice is hospitalized and placed under phototherapy. Which response indicates to the nurse that the parent needs more teaching? a. "My infant is at risk for dehydration." b. "My infant needs to stay under the lights, except during feeding time." c. "My infant can continue to breastfeed during this time." d. "My infant has a serious liver disease."

d. "My infant has a serious liver disease." Physiologic jaundice is a self-limiting disease without long-term effects on liver function.

A 3-year-old child is to receive a medication that is supplied as an enteric-coated tablet. What is the best nursing action? a. Crush the tablet and mix it with apple sauce. b. Dissolve the medication in the child's milk. c. Place a pill in the posterior part of the pharynx and tell the child to swallow. d. Check with the prescriber to see if an alternative form can be used.

d. Check with the prescriber to see if an alternative form can be used.

What is the most common result of a GI illness?

dehydration

When a child or infant is hospitalized, what is important to inquire about?

feeding difficulties respiratory difficulties speech development otitis media

What kind of diet is appropriate for a patient with end-stage renal disease (ESRD)?

low in protein, potassium, sodium, phosphorus, anemia High in carbohydrates, calcium

In caring for an infant diagnosed with pyloric stenosis, the nurse would anticipate that she would?

prepare the infant for surgery.

What should the nurse prevent when caring for a baby with cleft lip?

prevent vigorous or sustained crying may cause tension on the suture line

How is esophageal atresia diagnosed?

radiograph showing inserted gastric tube appearing coiled in the upper esophageal pouch OR air in the gastrointestinal tract (fistula presence)

What lab findings would confirm the diagnosis that the patient has glomerulonephritis?

tea color urine and proteinuria

Why do children have a greater risk for a UTI than adults?

they have a shorter urethra

How are children's esophagus different from adults?

The lower esophageal sphincter is not fully developed until age 1 and causes regurgitation and reflex

A child is scheduled for a bone marrow aspiration at 4 PM. The nurse would plan to apply EMLA cream to the intended site at which time? a. 1:30 PM b. 3:00 PM c. 3:30 PM d. 4:00 PM

a. 1:30 PM

When administering ear drops to a 2-year-old, which action would be most appropriate? a. Tell the child that the drops are to treat his infection. b. Pull the pinna of the child's ear down and back. c. Have the child turn his head to the opposite side after giving the drops. d. Massage the child's forehead to facilitate absorption of the medication.

b. Pull the pinna of the child's ear down and back.

After teaching a child's parents about the different methods of distraction that can be used for pain management, which statement by the parents indicates a need for additional teaching? a. "We'll have her focus on her hand and count each finger slowly." b. "We'll read some of her favorite stories to her." c. "We'll have her imagine that she's at the beach this summer." d. "She likes to play video games, so we'll bring in some from home."

c. "We'll have her imagine that she's at the beach this summer."

The nurse is performing education for the parents of an infant with bladder exstrophy. Which statement by the parents would indicate an understanding of the child's future care? a. "Care will be no different than that of any other infant." b. "My infant will only need this one surgery." c. "My child will wear diapers all his life." d. "We will need to care for the urinary diversion."

d. "We will need to care for the urinary diversion."

When developing the plan of care for a child in pain, the nurse identifies appropriate strategies aimed at modifying which factors influencing pain? a. Gender b. Cognitive level c. Previous pain experiences d. Anticipatory anxiety

d. Anticipatory anxiety

A 10-year-old child is admitted to the hospital due to history of seizure activity. As his nurse, you are called into the room by his mother, who states he is having a seizure. What would be the priority nursing intervention? a. Prevention of injury by removing the child from his bed b. Prevention of injury by placing a tongue blade in the child's mouth c. Prevention of injury by restraining the child d. Prevention of injury by placing the child on his side and opening his airway

d. Prevention of injury by placing the child on his side and opening his airway Placing the child on his side and opening his airway can help prevent aspiration.

What chronic GI disorders must be surgically treated?

pyloric stenosis omphalocele gastroschisis cleft lip/palate appendicitis hirschsprung disease intestinal malrotation

to prevent any injury to the facial suture line on a baby with cleft lip, what nursing management would you do?

reposition the infant to supine or side-lying position (may also be necessary to use arm restraints) to prevent them from rubbing the facial suture line

What are children with esophageal atresia at risk for?

respiratory complications: - pneumonitis - atelectasis (due to aspiration of food and secretions The presence of a fistula increases risk

The nurse is caring for an infant recently diagnoses with thrush and was prescribed nystatin. Which statement by the infant's mother would suggest a need for further education?

"I will add the nystatin to her bottle four times per day."

The student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply.

"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."

when caring for a child with omphalocele or gastrochisis, what should the nurse focus on?

- preventing hypothermia - maintaining perfusion to the eviscerated abdominal contents by minimizing fluid loss - protecting the exposed abdominal contents from trauma and infection

What are some common medical treatments for GI disorders?

-cleansing enema - bowel preparation - feeding tubes - IV therapy - ostomy - oral rehydration therapy - probiotics - TPN

What assessment findings can you expect with a patient diagnosed with glomerulonephritis?

1) elevated BP 2) Mild edema 3) fatigue

A 6-year-old child is admitted to the hospital because of a possible seizure. The child's mother calls the nurse to the room because the child is "jerking all over" and won't respond when she calls the child's name. List appropriate nursing interventions for this child. Prioritize the list of interventions.

Assess ABC's prevent injury (loosen/remove tight clothing, turn child to side and open airway Time the seizure administer appropriate medications and treatments to stop seizure if ordered note characteristics/behavior seen, length of seizure, and response to interventions

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. Esophageal atresia (EA) D. Hernia

C. Esophageal atresia (EA)

The nurse must be mindful when giving a patient with nephrotic syndrome corticosteroids because?

Corticosteroids can mask the signs of infection, do not stop treatment abruptly can cause acute adrenal insufficiency, and cushing syndrome

How would you care for parents who just had a baby with a cleft lip/palate?

Encourage bonding immediately after delivery acknowledge normal feelings of guilt, anger, and sadness support the parents in providing care for the infant, particularly feeding, which is viewed as a significant nurturing function

A 4-month-old child with a history of hydrocephalus has undergone surgery for placement of a VP shunt. What information would you include in the teaching plan?

Signs and symptoms of a shunt infection, signs and symptoms of shunt malfunction, and signs and symptoms of increased ICP. Ways to promote growth and development. Need for future revisions as child grows. Referral to support groups.

what should the nurse avoid when caring for an infant with cleft lip?

Avoid putting any items in their mouth

When compared with adults, why are infants and children at an increased risk of head trauma? a. The head of the infant and young child is large in proportion to the body and the neck muscles are not well developed. b. The development of the nervous system is complete at birth but remains immature. c. The spine is very immobile in infants and young children. d. The skull is more flexible due to the presence of sutures and fontanels.

a. The head of the infant and young child is large in proportion to the body and the neck muscles are not well developed. Infants and young children have a larger head size in relation to the body and a higher center of gravity. Both cause them to hit their head more readily when involved in motor vehicle accidents, bicycle accidents, and falls.

A 6-month-old infant is admitted to the hospital with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. The priority nursing intervention would be: a. Educate the family on ways to prevent bacterial meningitis. b. Initiate appropriate isolation precautions and begin intravenous antibiotics. c. Assess the infant's fontanels. d. Encourage the mother to hold the infant and feed her.

b. Initiate appropriate isolation precautions and begin intravenous antibiotics. Initiate appropriate isolation precautions and begin intravenous antibiotics. Bacterial meningitis is a medical emergency and requires prompt hospitalization and treatment. Deterioration may be rapid and may occur in less than 24 hours, leading to long-term neurologic damage, and even death. Intravenous antibiotics will be started immediately after the LP and blood cultures have been obtained. Appropriate isolation needs to be initiated in any child with suspected or diagnosed bacterial meningitis.

A 4-year-old girl presents with recurrent urinary tract infection. A prior workup did not reveal any urinary tract abnormalities. What is the priority nursing action? a. Obtain a sterile urine sample after completion of antibiotics. b. Teach appropriate toileting hygiene. c. Prepare the child for surgery to reimplant the ureters. d. Administer antibiotics intramuscularly.

b. Teach appropriate toileting hygiene

When the nurse is caring for a child with hemolytic-uremic syndrome or acute glomerulonephritis and the child is not yet toilet trained, which action by the nurse would best determine fluid retention? a. Test urine for specific gravity. b. Weigh child daily. c. Weigh the wet diapers. d. Measure abdominal girth daily.

b. Weigh child daily.

A child presents with a 2-day history of fever, abdominal pain, occasional vomiting, and decreased oral intake. Which finding would the nurse prioritize for immediate reporting to the physician? a. temperature 101.9°F b. rebound tenderness and abdominal guarding c. Parents will be leaving the child alone in the hospital. d. Child can tolerate only sips of fluid without nausea.

b. rebound tenderness and abdominal guarding Rebound pain and abdominal guarding are signs of an acute abdomen and should be reported immediately to the physician; surgery may be needed.

At a well-child visit, hydrocephalus may be suspected in an infant if upon assessment the nurse finds: a. Narrow sutures b. Sunken fontanels c. A rapid increase in head circumference d. Increase in weight since last visit

c. A rapid increase in head circumference In the infant, the most obvious indication of hydrocephalus is often a rapid increase in head circumference. Assessment may also reveal bulging, tense fontanels with widening sutures.

What are some maternal risk factors for development of cleft lip and palate?

smoking prenatal infection advanced maternal age use of anticonvulsants, steroids, and other medications during early pregnancy

The nurse is conducting a physical examination of an 18-month-old with suspected intussusception. Which finding would the nurse identify as the hallmark of this condition?

A sausage-shaped mass in the upper midabdomen