Peds - GI, GU, Cardiac

After assessing a child, the nurse suspects coarctation of the aorta based on a finding of: A) Femoral pulse weaker than brachial pulse. B) Bounding pulse. C) Narrow pulse. D) Hepatomegaly.

A. Femoral pulse weaker than brachial pulse Explanation: A femoral pulse that is weak or absent in comparison to the brachial pulse is associated with coarctation of the aorta. Bounding pulse is characteristic of patent ductus arteriosus or aortic regurgitation. A narrow or thread pulse is associated with heart failure or severe aortic stenosis. Hepatomegaly is a sign of right-sided heart failure

A parent is told their infant has a heart defect with a left to right shunt. What is the best way for the nurse to explain this type of shunting to the parent? A) This type of shunting causes an increase of blood to the lungs. B) This type of shunting causes an increase of blood to the systemic circulation. C) This type of shunting causes a decrease of blood to the lungs. D) This type of shunting causes a decrease of blood to the brain.

A. This type of shunting causes an increase of blood to the lungs. Explanation: This type of shunting causes an increase of blood to the lungs. A right to left shunt causes an increase in blood to the systemic circulation that is mixed with deoxygenated blood.

A nurse is teaching the parents of a child who has rheumatic fever. Which of the following statements by a parent indicates an understanding of the teaching? A. My child may take aspirin for his joint pain. B. My child will need a blood transfusion prior to discharge. C. I will need to wear a gown when I'm in my child's room. D. I will apply lotion to my child's peeling hands.

A. My child may take aspirin for his joint pain. Rationale: Children who have rheumatic fever may take salicylates (aspirin) to control inflammatory process that occurs in the joints.

A 3-year-old is admitted to the pediatric unit with a diagnosis of HUS. The child is very pale and lethargic. Stools have progressed from watery to bloody diarrhea. Blood work indicates low hemoglobin and low hematocrit levels. The child has not had any urine output in 24 hours. The nurse expects which of the following to be added to the plan of care? 1. initiation of dialysis 2. close observation of the child's hemodynamic status 3. diuretic therapy to force urinary output 4. monitoring of urinary output

ANS: 1. initiation of dialysis Because the child is symptomatic, dialysis is the treatment of choice.

A nurse is assessing a child who has a ventricular septal defect. Which of the following findings should the nurse expect? A. Diastolic murmur B. Murmur at the left sternal border. C. Cyanosis that increases with crying. D. Widened pulse pressure

B. Murmur at the left sternal border. Rationale: A ventricular septal defect (a hole in the septal wall between the ventricles) is an acyanotic heart defect. A systolic murmur can be heard best at the lower left sternal border. The sound is transmitted in the direction of blood flow, so any backflow of blood from the left to the right ventricle through the septal defect is best heard in this area.

A nurse is planning care for an adolescent who has sickle cell anemia and is experiencing a vaso-occlusion crisis. Which of the following interventions should the nurse include in the plan? A. Apply cold compresses to the child's extremities. B. Administer meperidine every 4 hr until the crisis has resolved. C. Maintain the child on bed rest. D Decrease the child's fluid intake for 8 hr.

C. Maintain the child on bedrest. Rationale: The nurse should maintain bed rest for this child who is experiencing a vaso-occlusive crisis to minimize the energy expenditure and avoid additional oxygen needs.

A nurse is caring for a school-aged child who has hemophilia and fell on the playground. The child reports a pain level of 4 on a scale of 0-10. Which of the following actions should the nurse take? A. Administer an NSAID B. Perform passive ROM exercise on the joint C. Administer cryoprecipitate D. Apply an ice pack to the joint.

D. Apply an ice pack to the joint. Rationale: Immediately following an injury, a joint should be rested, elevated, and have ice applied to minimize bleeding into the joint.

Sam, age 11, has a diagnosis of rheumatic fever and has missed school for a week. What is the most likely cause of this problem? a. previous streptococcal throat infection b. history of open heart surgery at 5 years of age c. playing too much soccer and not getting enough rest d. exposure to a sibling with pneumonia

a. previous streptococcal throat infection Rheumatic fever occurs as a sequela to group A streptococcal infection.

The nurse reviews the record of a child who is suspected to have glomerulonephritis. Which statement by the child's parent should the nurse expect that is associated with this diagnosis? 1."I'm so glad they didn't find any protein in his urine." 2."I noticed his urine was the color of coca-cola lately." 3."His health care provider said his kidneys are working well." 4."The nurse who admitted my child said his blood pressure was low."

ANS: 2. "I noticed his urine was the color of coca-cola lately." Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Gross hematuria, resulting in dark, smoky, cola-colored or brown-colored urine, is a classic symptom of glomerulonephritis. Blood urea nitrogen levels and serum creatinine levels may be elevated, indicating that kidney function is compromised. A mild to moderate elevation in protein in the urine is associated with glomerulonephritis. Hypertension is also common due to fluid volume overload secondary to the kidneys not working properly.

The nurse is providing discharge instructions to the mother of a child who had a cleft palate repair. Which statement should the nurse make to the mother? 1."You should use a plastic spoon to feed the child." 2."You need to use an orthodontic nipple on the child's bottle." 3."You can allow the child to use a pacifier but only for 30 minutes at a time." 4."You need to monitor the child's temperature for signs of infection using an oral thermometer."

ANS: 2. "You need to use an orthodontic nipple on the child's bottle." An orthodontic nipple should be placed on the child's bottle, and the mother should be instructed to give the child baby food or baby food mixed with water. The mother should be instructed that straws, pacifiers, spoons, or fingers must be kept away from the child's mouth for 7 to 10 days after surgery. A pacifier should not be used for at least 2 weeks following the surgical repair. Additionally, the mother should be advised to avoid taking oral temperatures.

The nurse knows that which of the following need to be present to diagnose HUS? 1. Increased red blood cells with a low reticulocyte count, increased platelet count,and renal failure. 2. Decreased red blood cells with a high reticulocyte count, decreased platelet count, and renal failure. 3. Increased red blood cells with a high reticulocyte count, increased platelet count,and renal failure. 4. Decreased red blood cells with a low reticulocyte count, decreased platelet count,and renal failure.

ANS: 2. Decreased red blood cells with a high reticulocyte count, decreased platelet count,and renal failure. The triad in HUS includes decreased red blood cells (with a high reticulocyte count as the body attempts to produce more red blood cells), decreased platelet count, and renal failure.

The nurse admits a child to the hospital with a diagnosis of pyloric stenosis. On assessment, which data would the nurse expect to obtain when asking the parent about the child's symptoms? 1.Watery diarrhea 2.Projectile vomiting 3.Increased urine output 4.Vomiting large amounts of bile

ANS: 2. Projectile vomiting In pyloric stenosis, hypertrophy of the circular muscles of the pylorus causes narrowing of the pyloric canal between the stomach and the duodenum. Clinical manifestations of pyloric stenosis include projectile vomiting, irritability, hunger and crying, constipation, and signs of dehydration, including a decrease in urine output.

Invagination of one segment of bowel within another is called: a. atresia. b. stenosis. c. herniation. d. intussusception.

ANS: D. intussusception Intussusception occurs when a proximal section of the bowel telescopes into a more distal segment, pulling the mesentery with it. The mesentery is compressed and angled, resulting in lymphatic and venous obstruction. Invagination of one segment of bowel within another is the definition of intussusception, not atresia, stenosis, or herniation.

A nurse is caring for an infant who as a tracheoesophageal fistula. Which of the following actions should the nurse take? A. Place the infant in a lateral position. B. Perform oropharyngeal suctioning C. Administer ranitidine orally D. Thickening the infant's formula

B. Perform oropharyngeal suctioning Rationale: When caring for an infant who has a tracheoesophageal fistula, the nurse should perform frequent oropharyngeal suctioning to decrease the infant's risk of aspiration.

A nurse is caring for an infant who has a cleft palate. The parents ask the nurse how long they should wait before the child can have corrective surgery. The nurse should explain that the parents should wait no longer than 6 to 12 months for surgery to prevent which of the following outcomes? A. Repeated ear infections B. Nutritional deficits C. Immune system deficits D. Difficulty with language acquisitions.

D. Difficulty with language acquisitions. Rationale: Clients who have a cleft palate can have difficulty acquiring language because they need to use the palate for vocalizing sounds. Because of the cleft in the palate, these infants could develop poor speech habits.

A nurse is caring for a child who has tetralogy of Fallot. Which of the following laboratory values should the nurse expect to find? A. Platelet count of 20,000/mm^3 B. WBC 4,000/mm^3 C. Thyroid stimulating hormone 7.0 microunits/mL D. RBC 6.8 million/uL

D. RBC 6.8 million/uL Rationale: A child who has tetralogy of Fallot experiences cyanosis; therefore the body responds buy increasing RBC production (polycythemia) in an attempt to supply oxygen to all body parts.

On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease? 1.Cracked lips 2.Normal appearance 3.Conjunctival hyperemia 4.Desquamation of the skin

ANS: 3. Conjunctival hyperemia Rationale: Kawasaki disease, also known as mucocutaneous lymph node syndrome, is an acute systemic inflammatory illness. In the acute stage, the child has a fever, conjunctival hyperemia, red throat, swollen hands, rash, and enlargement of the cervical lymph nodes. In the subacute stage, cracking lips and fissures, desquamation of the skin on the tips of the fingers and toes, joint pain, cardiac manifestations, and thrombocytosis occur. In the convalescent stage, the child appears normal, but signs of inflammation may be present

The nurse is planning care for a child with hemolytic-uremic syndrome who has been anuric and will be receiving peritoneal dialysis treatment. The nurse should plan to implement which measure? 1.Restrict fluids as prescribed. 2.Care for the arteriovenous fistula. 3.Encourage foods high in potassium. 4.Administer analgesics as prescribed.

ANS: 1. Restrict fluids as prescribed. Hemolytic-uremic syndrome is thought to be associated with bacterial toxins, chemicals, and viruses that result in acute kidney injury in children. Clinical manifestations of the disease include acquired hemolytic anemia, thrombocytopenia, renal injury, and central nervous system symptoms. A child with hemolytic-uremic syndrome undergoing peritoneal dialysis because of anuria would be on fluid restriction. Pain is not associated with hemolytic-uremic syndrome, and potassium would be restricted, not encouraged, if the child is anuric. Peritoneal dialysis does not require an arteriovenous fistula (only hemodialysis).

The nurse notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of: a. poor appetite. b. increased potassium intake. c. reduction of edema. d. restriction to bed rest.

ANS: C. reduction of edema. This amount of weight loss in this period is a result of the improvement of renal function and mobilization of edema fluid. Poor appetite and bed rest would not result in a weight loss of 8 pounds in 4 days. Foods with substantial amounts of potassium are avoided until renal function is normalized.

José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be: a. directed at his parents because he is too young to understand. b. detailed in regard to the actual procedures so he will know what to expect. c. done several days before the procedure so that he will be prepared. d. adapted to his level of development so that he can understand.

ANS: D. adapted to his level of development so that he can understand. Preoperative teaching should always be directed at the child's stage of development. The caregivers also benefit from the same explanations. The parents may ask additional questions, which should be answered, but the child needs to receive the information based on developmental level. Preschoolers will not understand in-depth descriptions and should be prepared close to the time of the cardiac catheterization.

Surgical closure of the ductus arteriosus would: a. stop the loss of unoxygenated blood to the systemic circulation. b. decrease the edema in legs and feet. c. increase the oxygenation of blood. d. prevent the return of oxygenated blood to the lungs.

ANS: D. prevent the return of oxygenated blood to the lungs. The ductus arteriosus allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, causing a right-to-left shunt. If this is surgically closed, no additional oxygenated blood (from the aorta) will return to the lungs through the pulmonary artery. The aorta carries oxygenated blood to the systemic circulation. Because of the higher pressure in the aorta, blood is shunted into the pulmonary artery and the pulmonary circulation. Edema in the legs and feet is usually a sign of heart failure. This repair would not directly affect the edema. Increasing the oxygenation of blood would not interfere with the return of oxygenated blood to the lungs.

A child with leukemia received chemotherapy about 10 days ago. She presents today with a temperature of 100.4°F, an absolute neutrophil count of 500, and mild bleeding of the gums. What is the priority nursing intervention? a. Administer IV antibiotics as ordered. b. Provide vigorous oral care frequently with a firm toothbrush. c. Monitor pulse and blood pressure for changes. d. Administer packed red blood cell transfusion.

ANS: A. Administer IV antibiotics as ordered. The neutropenic child must have IV antibiotics started as soon as possible in the event of fever to prevent overwhelming infection and sepsis.

Which is instituted for the therapeutic management of minimal change nephrotic syndrome? a. Corticosteroids b. Antihypertensive agents c. Long-term diuretics d. Increased fluids to promote diuresis

ANS: A. Corticosteroids Corticosteroids are the first line of therapy for minimal change nephrotic syndrome. Response is usually seen within 7 to 21 days. Antihypertensive agents and long-term diuretic therapy are usually not necessary. A diet that has fluid and salt restrictions may be indicated.

The nurse is admitting a child with a Wilms tumor. Which is the initial assessment finding associated with this tumor? a. Abdominal swelling b. Weight gain c. Hypotension d. Increased urinary output

ANS: A. Abdominal swelling The initial assessment finding with a Wilms (kidney) tumor is abdominal swelling. Weight loss, not weight gain, may be a finding. Hypertension occasionally occurs with a Wilms tumor. Urinary output is not increased, but hematuria may be noted.

A 2-year-old is admitted to the pediatric floor with a diagnosis of HUS. Which of the following would the nurse likely find in the child's history? 1. frequent UTIs and possible VUR. 2. The child had vomiting and diarrhea before admission 3. The child was stung by a bee and experienced localized edema to the site for 3 days. 4. The child had previously been healthy and did not show any signs of illness until this admission.

ANS: 2. The child had vomiting and diarrhea before admission HUS is often preceded by diarrhea that may be caused by E. coli present in undercooked meat.

A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandmother of the child visits and brings a fresh bouquet of flowers picked from her garden and asks the nurse for a vase for the flowers. Which response should the nurse provide to the grandmother? 1. "I have a vase in the utility room, and I will get it for you." 2. "I will get the vase and wash it well before you put the flowers in it." 3. "The flowers from your garden are beautiful, but should not be placed in the child's room at this time." 4. "When you bring the flowers into the room, place them on the bedside stand as far away from the child as possible."

ANS: 3. "The flowers from your garden are beautiful, but should not be placed in the child's room at this time." Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). For a hospitalized neutropenic child, flowers or plants should not be kept in the room because standing water and damp soil harbor Aspergillus and Pseudomonas aeruginosa, to which the child is susceptible. In addition, fresh fruits and vegetables harbor molds and should be avoided until the white blood cell count increases.

The nurse reviews the record of a newborn infant and notes that a diagnosis of esophageal atresia with tracheoesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record? 1.Incessant crying 2.Coughing at nighttime 3.Choking with feedings 4.Severe projectile vomiting

ANS: 3. Choking with feedings In esophageal atresia and tracheoesophageal fistula, the esophagus terminates before it reaches the stomach, ending in a blind pouch, and a fistula is present that forms an unnatural connection with the trachea. Any child who exhibits the "3 Cs"—coughing and choking with feedings and unexplained cyanosis—should be suspected to have tracheoesophageal fistula. Options 1, 2, and 4 are not specifically associated with tracheoesophageal fistula.

A 10 y/o child with hemophilia A has slipped on the ice and bumped his knee. The nurse should prepare to administer which prescription? 1. Injection of factor X 2. Intravenous infusion of iron 3. Intravenous infusion of factor VIII 4. Intramuscular injection of iron using the Z-track method

ANS: 3 Intravenous infusion of factor VIII Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. The primary treatment is replacement of the missing clotting factor; additional medications, such as agents to relieve pain, may be prescribed depending on the source of bleeding from the disprder. A child with hemophilia A is at risk for joint bleeding after a fall. Factor VIII would be prescribed intravenously to replace the missing clotting factor and minimize the bleeding. Factor X and iron are not used to treat children with hemophilia A.

A 16-month-old with HUS has had blood and urine samples sent to the laboratory.Which of the following results are most consistent with his HUS? 1. Hematuria, massive proteinuria, elevated blood urea nitrogen, and creatinine. 2. Hematuria, mild proteinuria, decreased blood urea nitrogen, and creatinine. 3. Hematuria, mild proteinuria, increased blood urea nitrogen, and creatinine. 4. Ketonuria, massive proteinuria, elevated blood urea nitrogen, and creatinine.

ANS: 3. Hematuria, mild proteinuria, increased BUN, and creatinine are all present in HUS.

The nurse is reviewing the health care provider's documentation in the record of a child admitted with a diagnosis of intussusception. The nurse expects to note that the health care provider has documented which manifestation? 1.Scleral jaundice 2.Projectile vomiting 3.Currant jelly stools 4.Pale-colored and hard stools

ANS: 3. Currant jelly stools In the child with intussusception, bright red blood and mucus are passed through the rectum, resulting in what is commonly described as currant jelly stools. The child classically presents with severe abdominal pain that is crampy and intermittent, causing the child to draw the knees in to the chest. Vomiting may be present, but not projectile. Scleral jaundice and pale-colored, hard stools are not manifestations of this disorder.

The nurse has admitted a four-year-old client to the pediatric unit for the treatment of Kawasaki disease. Which is the nurse's priority intervention during the admission of the client? A. Initiate the administration of intravenous immunoglobulin B. Obtain a consultation with a Child Life Specialist C. Decrease external stimuli D. Provide parental education about the child's condition.

ANS: C. Decrease external stimuli Priority nursing goals for a child with Kawasaki disease are to promote comfort and healing and to monitor for complications. The nurse should start by assisting clients into a position of comfort and creating a calm environment by decreasing external stimulation. Including dimming the lights in their room to ease the photophobia and discomfort caused by conjunctivitis. Apply lip balm to their chapped lips and a mild lubricant to areas of rash and peeling skin. For edematous legs and feet, elevate them slightly, and perform gentle passive range of motion (ROM) exercises on each of the edematous extremities. Lastly, monitor the client's pain level, administer the prescribed analgesics, and collaborate with the Child Life Specialist for nonpharmacologic pain management strategies like distraction and quiet age-appropriate activities. The nurse should next focus on promoting healing by initiating intravenous (IV) access and infusing the prescribed intravenous immunoglobulin (IVIG). During the infusion, nurses should watch for reactions to the medications and immediately report to the healthcare provider client dizziness, flushing, headache, diaphoresis, nausea, vomiting, or upper abdominal pain. If these symptoms occur, the nurse should stop the infusion, administer antihistamines or other prescribed treatments, and restart the infusion at a lower rate once symptoms have resolved. The nurse should also ensure adequate fluid and nutrition and promote hydration by offering cool fluids, gelatin, or ice pops, and closely observing their hydration status by monitoring the client's intake and output, as well as their daily weight. The nurse should also promote nutrition by providing small, frequent, nourishing meals consisting of soft, bland foods. The nurse should also monitor the client for potential cardiac complications by auscultating heart sounds, initiate electrocardiogram (ECG) monitoring as prescribed, institute bed rest to decrease cardiac workload, and immediately report the presence of arrhythmias or abnormal heart sounds to the health care provider. Finally, the nurse should closely monitor the client's vital signs, paying particular attention to their temperature. The nurse should also Institute seizure precautions; administer prescribed oral aspirin, and institute cooling measures, as needed, such as cool compresses or tepid sponge baths, immediately reporting to the healthcare provider if the fever continues despite cooling measures.

The nurse is admitting a newborn with hypospadias to the nursery. The nurse expects which finding in this newborn? a. Absence of a urethral opening is noted. b. Penis appears shorter than usual for age. c. The urethral opening is along the dorsal surface of the penis. d. The urethral opening is along the ventral surface of the penis.

ANS: D. The urethral opening is along the ventral surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis. The urethral opening is present, but not at the glans. Hypospadias refers to the urethral opening, not to the size of the penis. Urethral opening along ventral surface of penis is known as epispadias.

Which explanation regarding cardiac catheterization is appropriate for a preschool child? a. Postural drainage will be performed every 4 to 6 hours after the test. b. It is necessary to be completely "asleep" during the test. c. The test is short, usually taking less than 1 hour. d. When the procedure is done, you will have to keep your leg straight for at least 4 hours.

ANS: D. When the procedure is done, you will have to keep your leg straight for at least 4 hours. The child's leg will have to be maintained in a straight position for approximately 4 hours. Younger children can be held in the parent's lap with the leg maintained in the correct position. Postural drainage will not be performed unless the child has corresponding pulmonary problems. The child should be sedated to lie still, but being completely asleep is not necessary. The test will vary in length of time from start to finish.

The nurse is caring for a school-age child who has had a cardiac catheterization. The child tells the nurse that the bandage is "too wet." The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is to: a. notify physician. b. apply new bandage with more pressure. c. place the child in Trendelenburg position. d. apply direct pressure above catheterization site.

ANS: D. apply direct pressure above catheterization site. If bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure over the vessel puncture. Notifying a physician and applying a new bandage can be done after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. It is not a helpful intervention to place the girl in the Trendelenburg position. It would increase the drainage from the lower extremities.

A nurse is caring for a 6-month-old infant who has intussusception. Which of the following action should the nurse take? A. Prepare to administer high-dose steroids. B. Give the child magnesium hydroxide PO. C. Prepare the child for a barium enema D. Inform the parents that the child will need a colostomy.

C. Prepare the child for a barium enema Rationale: The pressure created by a barium enema might force the bowel to resume a normal configuration. Some children with intussusception are treated with the barium enema and do not require surgical intervention.

The nurse is developing a plan of care for a child admitted with a diagnosis of Kawasaki disease. In developing the initial plan of care, the nurse should include to monitor the child for signs of which condition? 1.Bleeding 2.Failure to thrive 3.Heart failure (HF) 4.Decreased tolerance to stimulation

ANS: 3. Heart failure (HF) Rationale: Nursing care initially centers on observing for signs of HF. The nurse monitors for increased respiratory rate, increased heart rate, dyspnea, crackles, and abdominal distention. Options 1, 2, and 4 are not conditions directly associated with this disorder.

The nurse is providing home care instructions to the parents of a 10-year-old child with hemophilia. Which sport activity should the nurse suggest for this child? 1. Soccer 2. Basketball 3. Swimming 4. Field hockey

ANS: 3. Swimming Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. Children with hemophilia need to avoid contact sports and to take precautions such as wearing elbow and knee pads and helmets with other sports. The safe activity for them is swimming.

The clinic nurse instructs parents of a child with sickle cell anemia about the precipitating factors related to sickle cell crisis. Which, if identified by the parents as a precipitating factor, indicates the need for further instructions? 1. Stress 2. Trauma 3. Infection 4. Fluid overload

ANS: 4 Fluid overload Sickle cell crises are acute exacerbations of the disease, which vary considerably in severity and frequency; these include vaso-occlusive crisis, splenic sequestration, hyperhemolytic crisis, and aplastic crisis. Sickle cell crisis may be precipitated by infection, dehydration, hypoxia, trauma, or physical/emotional stress. The mother of a child with sickle cell disease should encourage fluid intake of 1 1/2 to 2 times the daily requirement to prevent dehydration.

The nurse is reviewing a treatment plan with the parents of a newborn with hypospadias. Which statement by the parents indicates their understanding of the plan? 1."Caution should be used when straddling the infant on a hip." 2."Vital signs should be taken daily to check for bladder infection." 3."Catheterization will be necessary when the infant does not void." 4."Circumcision has been delayed to save tissue for surgical repair."

ANS: 4. "Circumcision has been delayed to save tissue for surgical repair." Hypospadias is a congenital defect involving abnormal placement of the urethral orifice of the penis. In hypospadias, the urethral orifice is located below the glans penis along the ventral surface. The infant should not be circumcised because the dorsal foreskin tissue will be used for surgical repair of the hypospadias. Options 1, 2, and 3 are unrelated to this disorder.

An infant is seen in the health care provider's office for complaints of frequent vomiting and spitting up after feedings. Findings indicate that the infant is not gaining weight, and gastroesophageal reflux is suspected. Which would the nurse anticipate being prescribed initially in the care of this child? 1.Administer omeprazole before feeding. 2.Place in prone position after each feeding. 3.Instruct parents to keep a log of feedings and any reflux present. 4.Administer predigested formula and feed small, frequent feedings.

ANS: 4. Administer predigested formula and feed small, frequent feedings For infants with frequent vomiting and spitting up, the diagnosis of gastroesophageal reflux should be considered. The initial action is to alter the formula to a predigested formula and feed small, frequent feedings.After the formula is changed, the family will be instructed to keep a log of feedings and any reflux with the new formula. Medication is not started until after the formula is changed. A prone position increases the risk of reflux and thus aspiration.

The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic fever, knowing that which laboratory study would assist in confirming the diagnosis? 1.Immunoglobulin 2.Red blood cell count 3.White blood cell count 4.Anti-streptolysin O titer

ANS: 4. Anti-streptolysin O titer Rationale: Rheumatic fever is an inflammatory autoimmune disease that affects the connective tissues of the heart, joints, skin (subcutaneous tissues), blood vessels, and central nervous system. A diagnosis of rheumatic fever is confirmed by the presence of two major manifestations or one major and two minor manifestations from the Jones criteria. In addition, evidence of a recent streptococcal infection is confirmed by a positive anti-streptolysin O titer, Streptozyme assay, or anti-DNase B assay. Options 1, 2, and 3 would not help to confirm the diagnosis of rheumatic fever.

The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which sign of this disorder documented? 1.Watery diarrhea 2.Ribbon-like stools 3.Profuse projectile vomiting 4.Bright red blood and mucus in the stools

ANS: 4. Bright red blood and mucus in the stools Intussusception is a telescoping of 1 portion of the bowel into another. The condition results in an obstruction to the passage of intestinal contents. A child with intussusception typically has severe abdominal pain that is crampy and intermittent, causing the child to draw in the knees to the chest. Vomiting may be present, but is not projectile. Bright red blood and mucus are passed through the rectum and commonly are described as currant jelly-like stools. Watery diarrhea and ribbon-like stools are not manifestations of this disorder.

The clinic nurse reviews the record of an infant and notes that the health care provider has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which sign most likely led the mother to seek health care for the infant? 1.Diarrhea 2.Projectile vomiting 3.Regurgitation of feedings 4.Foul-smelling ribbon-like stools

ANS: 4. Foul-smelling ribbon-like stools Hirschsprung's disease is a congenital anomaly also known as congenital aganglionosis or aganglionic megacolon. It occurs as the result of an absence of ganglion cells in the rectum and other areas of the affected intestine. Chronic constipation beginning in the first month of life and resulting in pellet-like or ribbon-like stools that are foul-smelling is a clinical manifestation of this disorder. Delayed passage or absence of meconium stool in the neonatal period is also a sign. Bowel obstruction, especially in the neonatal period; abdominal pain and distention; and failure to thrive are also clinical manifestations. Options 1, 2, and 3 are not associated specifically with this disorder.

The nurse recognizes that clinical manifestations of nephrotic syndrome include which findings? 1.Hematuria, bacteriuria, weight gain 2.Gross hematuria, albuminuria, fever 3.Hypertension, weight loss, proteinuria 4.Massive proteinuria, hypoalbuminemia, edema

ANS: 4. Massive proteinuria, hypoalbuminemia, edema Nephrotic syndrome is a kidney disorder. Clinical manifestations of nephrotic syndrome include edema, proteinuria, hypoalbuminemia, and hypercholesterolemia in the absence of hematuria and hypertension. No fever, bacteriuria, or weight loss would be noted with this syndrome.

The nurse is caring for an infant with a suspected urinary tract infection. Which clinical manifestations should be expected? (Select all that apply.) a. Vomiting b. Jaundice c. Failure to gain weight d. Swelling of the face e. Back pain f. Persistent diaper rash

ANS: A, B, C, F. Vomiting, Jaundice, Failure to gain weight, Persistent diaper rash Vomiting, failure to gain weight, and persistent diaper rash are clinical manifestations observed in an infant with a UTI.

A school-age child is admitted to the hospital with acute glomerulonephritis and oliguria. Which dietary menu items should be allowed for this child? (Select all that apply.) a. Apples b. Bananas c. Cheese d. Carrot sticks e. Strawberries

ANS: A, D, E. Apples, Carrot sticks, Strawberries Moderate sodium restriction and even fluid restriction may be instituted for children with acute glomerulonephritis. Foods with substantial amounts of potassium are generally restricted during the period of oliguria. Apples, carrot sticks, and strawberries would be items low in sodium and allowed. Bananas are high in potassium and cheese is high in sodium. Those items would be restricted.

A nurse is planning preoperative care for a newborn with tracheoesophageal fistula (TEF). Which interventions should the nurse plan to implement? (Select all that apply.) a. Positioning with head elevated on a 30-degree plane b. Feedings through a gastrostomy tube c. Nasogastric tube to continuous low wall suction d. Suctioning with a Replogle tube passed orally to the end of the pouch e. Gastrostomy tube to gravity drainage

ANS: A, D, E. Positioning with head elevated on a 30-degree plane, Nasogastric tube to continuous low wall suction, Gastrostomy tube to gravity drainage The most desirable position for a newborn who has TEF is supine (or sometimes prone) with the head elevated on an inclined plane of at least 30 degrees. This positioning minimizes the reflux of gastric secretions at the distal esophagus into the trachea and bronchi, especially when intraabdominal pressure is elevated. It is imperative to immediately remove any secretions that can be aspirated. Until surgery, the blind pouch is kept empty by intermittent or continuous suction through an indwelling double-lumen or Replogle catheter passed orally or nasally to the end of the pouch. In some cases, a percutaneous gastrostomy tube is inserted and left open so that any air entering the stomach through the fistula can escape, thus minimizing the danger of gastric contents being regurgitated into the trachea. The gastrostomy tube is emptied by gravity drainage. Feedings through the gastrostomy tube and irrigations with fluid are contraindicated before surgery in an infant with a distal TEF. A nasogastric tube to low intermittent suctioning could not be accomplished because the esophagus ends in a blind pouch in TEF.

The nurse is talking to a parent of an infant with heart failure about feeding the infant. Which statement about feeding the child is correct? a. "You may need to increase the caloric density of your infant's formula." b. "You should feed your baby every 2 hours." c. "You may need to increase the amount of formula your infant eats with each feeding." d. "You should place a nasal oxygen cannula on your infant during and after each feeding."

ANS: A. "You may need to increase the caloric density of your infant's formula." The metabolic rate of infants with heart failure is greater because of poor cardiac function and increased heart and respiratory rates. Their caloric needs are greater than those of the average infants, yet their ability to take in the calories is diminished by their fatigue. Infants with heart failure should be fed every 3 hours; a 2-hour schedule does not allow for enough rest, and a 4-hour schedule is too long. Fluids must be carefully monitored because of the heart failure. Infants do not require supplemental oxygen with feedings.

The nurse is admitting a child with rheumatic fever. Which therapeutic management should the nurse expect to implement? a. Administering penicillin b. Avoiding salicylates (aspirin) c. Imposing strict bed rest for 4 to 6 weeks d. Administering corticosteroids if chorea develops

ANS: A. Administering penicillin The goal of medical management is the eradication of the hemolytic streptococci. Penicillin is the drug of choice. Salicylates can be used to control the inflammatory process, especially in the joints, and reduce the fever and discomfort. Bed rest is recommended for the acute febrile stage, but it does not need to be strict. The chorea is transient and will resolve without treatment.

The nurse is assessing a child after a cardiac catheterization. Which complication should the nurse be assessing for? a. Cardiac arrhythmia b. Hypostatic pneumonia c. Heart failure d. Rapidly increasing blood pressure

ANS: A. Cardiac arrhythmia Because a catheter is introduced into the heart, a risk exists of catheter-induced dysrhythmias occurring during the procedure. These are usually transient. Hypostatic pneumonia, heart failure, and rapidly increasing blood pressure are not risks usually associated with cardiac catheterization.

The nurse is caring for a neonate with a suspected tracheoesophageal fistula. Nursing care should include: a.Elevating the head but giving nothing by mouth. b.Elevating the head for feedings. c.Feeding glucose water only. d.Avoiding suctioning unless the infant is cyanotic.

ANS: A. Elevating the head but giving nothing by mouth When a newborn is suspected of having tracheoesophageal fistula, the most desirable position is supine with the head elevated on an incline plane of at least 30 degrees. It is imperative that any source of aspiration be removed at once; oral feedings are withheld. Feedings should not be given to infants suspected of having tracheoesophageal fistulas. The oral pharynx should be kept clear of secretion by oral suctioning. This is to avoid the cyanosis that is usually the result of laryngospasm caused by overflow of saliva into the larynx.

The nurse is conducting an assessment on a school-age child with urosepsis. Which assessment finding should the nurse expect? a. Fever with a positive blood culture b. Proteinuria and edema c. Oliguria and hypertension d. Anemia and thrombocytopenia

ANS: A. Fever with a positive blood culture Symptoms of urosepsis include a febrile UTI coexisting with systemic signs of bacterial illness; blood culture reveals presence of urinary pathogen. Proteinuria and edema are symptoms of minimal change nephrotic syndrome (MCNS). Oliguria and hypertension are symptoms of acute glomerulonephritis (AGN). Anemia and thrombocytopenia are symptoms of hemolytic uremic syndrome (HUS)

The nurse closely monitors the temperature of a child with minimal change nephrotic syndrome. The purpose of this assessment is to detect an early sign of which possible complication? a. Infection b. Hypertension c. Encephalopathy d. Edema

ANS: A. Infection Infection is a constant source of danger to edematous children and those receiving corticosteroid therapy. An increased temperature could be an indication of an infection. Temperature is not an indication of hypertension or edema. Encephalopathy is not a complication usually associated with minimal change nephrotic syndrome. The child will most likely have neurologic signs and symptoms.

The nurse is conducting a staff in-service on childhood-acquired heart diseases. Which is a major clinical manifestation of rheumatic fever? a. Polyarthritis b. Osler nodes c. Janeway spots d. Splinter hemorrhages of distal third of nails

ANS: A. Polyarthritis Polyarthritis, which is swollen, hot, red, and painful joints, is a major clinical manifestation of rheumatic fever. The affected joints will change every 1 to 2 days. Primarily the large joints are affected. Osler nodes, Janeway spots, and splinter hemorrhages are characteristic of infective endocarditis.

A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. Which is an appropriate nursing goal related to this? a. Prevent infection. b. Stimulate appetite. c. Detect evidence of edema. d. Ensure compliance with prophylactic antibiotic therapy.

ANS: A. Prevent infection. High-dose steroid therapy has an immunosuppressant effect. These children are particularly vulnerable to upper respiratory tract infections. A priority nursing goal is to minimize the risk of infection by protecting the child from contact with infectious individuals. Appetite is increased with prednisone therapy. The amount of edema should be monitored as part of the disease process, not necessarily related to the administration of prednisone. Antibiotics would not be used as prophylaxis.

Which should the nurse recommend to prevent urinary tract infections in young girls? a. Wear cotton underpants. b. Limit bathing as much as possible. c. Increase fluids; decrease salt intake. d. Cleanse perineum with water after voiding.

ANS: A. Wear cotton underpants. Cotton underpants are preferable to nylon underpants. No evidence exists that limiting bathing, increasing fluids/decreasing salt intake, or cleansing the perineum with water after voiding decrease urinary tract infections in young girls.

The nurse is preparing to care for an infant returning from pyloromyotomy surgery. Which prescribed orders should the nurse anticipate implementing? (Select all that apply.) a. NPO for 24 hours b. Administration of analgesics for pain c. Ice bag to the incisional area d. IV fluids continued until tolerating PO e. Clear liquids as the first feeding

ANS: B, D, E. Administration of analgesics for pain, IV fluids continued until tolerating PO, Clear liquids as the first feeding Feedings are usually instituted soon after a pyloromyotomy surgery, beginning with clear liquids advancing to formula or breast milk as tolerated. IV fluids are administered until the infant is taking and retaining adequate amounts by mouth. Appropriate analgesics should be given around the clock because pain is continuous. Ice should not be applied to the incisional area as it vasoconstricts and would reduce circulation to the incisional area and impair healing.

A school-age child has been admitted to the hospital with an exacerbation of nephrotic syndrome. Which clinical manifestations should the nurse expect to assess? (Select all that apply.) a. Weight loss b. Facial edema c. Cloudy smoky brown-colored urine d. Fatigue e. Frothy-appearing urine

ANS: B, D, E. Facial edema, Fatigue, Frothy-appearing urine A child with nephrotic syndrome will present with facial edema, fatigue, and frothy-appearing urine (proteinuria). Weight gain, not loss, is expected because of the fluid retention. Cloudy smoky brown-colored urine is seen with acute glomerulonephritis but not with nephrotic syndrome because there is no gross hematuria associated with nephrotic syndrome.

The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's postoperative care include: a.Arm restraints, postural drainage, mouth irrigations. b.Cleansing suture line, supine and side-lying positions, arm restraints. c.Mouth irrigations, prone position, cleansing suture line. d.Supine and side-lying positions, postural drainage, arm restraints.

ANS: B. Cleansing suture line, supine and side-lying positions, arm restraints. The suture line should be cleansed gently after feeding. The child should be positioned on back or side or in infant seat. Elbows are restrained to prevent the child from accessing the operative site. Postural drainage is not indicated. This would increase the pressure on the operative site when the child is placed in different positions. Mouth irrigations would not be indicated.

Which best describes acute glomerulonephritis? a. Occurs after a urinary tract infection b. Occurs after a streptococcal infection c. Associated with renal vascular disorders d. Associated with structural anomalies of genitourinary tract

ANS: B. Occurs after a streptococcal infection Acute glomerulonephritis is an immune-complex disease that occurs after a streptococcal infection with certain strains of the group A â-hemolytic streptococcus. Acute glomerulonephritis usually follows streptococcal pharyngitis and is not associated with renal vascular disorders or genitourinary tract structural anomalies.

Which is an objective of care for a 10-year-old child with minimal change nephrotic syndrome? a. Reduce blood pressure. b. Reduce excretion of urinary protein. c. Increase excretion of urinary protein. d. Increase ability of tissues to retain fluid.

ANS: B. Reduce excretion of urinary protein. The objectives of therapy for the child with minimal change nephrotic syndrome include reduction of the excretion of urinary protein, reduction of fluid retention, prevention of infection, and minimization of complications associated with therapy. Blood pressure is usually not elevated in minimal change nephrotic syndrome. Excretion of urinary protein and fluid retention are part of the disease process and must be reversed.

Which is included in the diet of a child with minimal change nephrotic syndrome? a. High protein b. Salt restriction c. Low fat d. High carbohydrate

ANS: B. Salt restriction Salt is usually restricted (but not eliminated) during the edema phase. The child has little appetite during the acute phase. Favorite foods are provided (with the exception of high-salt ones) in an attempt to provide nutritionally complete meals.

The nurse is teaching parents about prevention of urinary tract infections in children. Which factor predisposes the urinary tract to infection? a. Increased fluid intake b. Short urethra in young girls c. Prostatic secretions in males d. Frequent emptying of the bladder

ANS: B. Short urethra in young girls The short urethra in females provides a ready pathway for invasion of organisms. Increased fluid intake and frequent emptying of the bladder offer protective measures against urinary tract infections. Prostatic secretions have antibacterial properties that inhibit bacteria.

A 4-month-old infant has gastroesophageal reflux disease (GERD) but is thriving without other complications. What should the nurse suggest to minimize reflux? a.Place in Trendelenburg position after eating. b.Thicken formula with rice cereal. c.Give continuous nasogastric tube feedings. d.Give larger, less frequent feedings.

ANS: B. Thicken formula with rice cereal. Small frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice cereal per ounce of formula has been recommended. Milk thickening agents have been shown to decrease the number of episodes of vomiting and increase the caloric density of the formula. This may benefit infants who are underweight as a result of GERD. Placing the child in a Trendelenburg position would increase the reflux. Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive. Smaller, more frequent feedings are recommended in reflux.

The nurse is teaching parents about signs of digoxin (Lanoxin) toxicity. Which is a common sign of digoxin toxicity? a. Seizures b. Vomiting c. Bradypnea d. Tachycardia

ANS: B. Vomiting Vomiting is a common sign of digoxin toxicity. Seizures are not associated with digoxin toxicity. The child will have a slower heart rate, not respiratory rate. The heart rate will be slower, not faster.

A child is admitted with acute glomerulonephritis. The nurse should expect the urinalysis during this acute phase to show: a. bacteriuria, hematuria. b. hematuria, proteinuria. c. bacteriuria, increased specific gravity. d. proteinuria, decreased specific gravity.

ANS: B. hematuria, proteinuria. Urinalysis during the acute phase characteristically shows hematuria and proteinuria. Bacteriuria and changes in specific gravity are not usually present during the acute phase.

The nurse is teaching the parent about the diet of a child experiencing severe edema associated with acute glomerulonephritis. Which information should the nurse include in the teaching? a. "You will need to decrease the number of calories in your child's diet." b. "Your child's diet will need an increased amount of protein." c. "You will need to avoid adding salt to your child's food." d. "Your child's diet will consist of low-fat, low-carbohydrate foods."

ANS: C. "You will need to avoid adding salt to your child's food." For most children, a regular diet is allowed, but it should contain no added salt. The child should be offered a regular diet with favorite foods. Severe sodium restrictions are not indicated.

A 5-year-old has been diagnosed with Wilms tumor. What is the priority nursing intervention for this child? a. Educate the parents about dialysis, as the kidney will be removed. b. Measure abdominal girth every shift. c. Avoid palpating the child's abdomen. d. Monitor BUN and creatinine every 4 hours.

ANS: C. Avoid palpating the child's abdomen. Excessive palpation of the abdomen in a child with Wilms' tumor can cause seeding of the tumor, leading to metastasis.

Which observation made of the exposed abdomen is most indicative of pyloric stenosis? a. Abdominal rigidity b. Substernal retraction c. Palpable olive-like mass d. Marked distention of lower abdomen

ANS: C. Palpable olive-like mass The diagnosis of pyloric stenosis is often made after the history and physical examination. The olive-like mass is easily palpated when the stomach is empty, the infant is quiet, and the abdominal muscles are relaxed. Abdominal rigidity and substernal retraction are usually not present. The upper abdomen, not lower abdomen, is distended.

A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with gastroesophageal reflux. The purpose of this is to: a.Prevent reflux. b.Prevent hematemesis. c.Reduce gastric acid production. d.Increase gastric acid production.

ANS: C. Reduce gastric acid production. The mechanism of action of histamine-receptor antagonists is to reduce the amount of acid present in gastric contents and may prevent esophagitis. Preventing reflux and hematemesis, and increasing gastric acid production are not the modes of action of histamine-receptor antagonists.

Which action by the school nurse is important in the prevention of rheumatic fever? a. Encourage routine cholesterol screenings. b. Conduct routine blood pressure screenings. c. Refer children with sore throats for throat cultures. d. Recommend salicylates instead of acetaminophen for minor discomforts.

ANS: C. Refer children with sore throats for throat cultures. Nurses have a role in prevention—primarily in screening school-age children for sore throats caused by group A -hemolytic streptococci. They can achieve this by actively participating in throat culture screening or by referring children with possible streptococcal sore throats for testing. Cholesterol and blood pressure screenings do not facilitate the recognition and treatment of group A -hemolytic streptococci. Salicylates should be avoided routinely because of the risk of Reye syndrome after viral illnesses.

During the first few days after surgery for cleft lip, which intervention should the nurse do? a. Leave infant in crib at all times to prevent suture strain. b. Keep infant heavily sedated to prevent suture strain. c. Remove restraints periodically to cuddle infant. d. Alternate position from prone to side-lying to supine.

ANS: C. Remove restraints periodically to cuddle infant Remove restraints periodically, while supervising the infant, to allow him or her to exercise arms and to provide cuddling and tactile stimulation. The infant should not be left in the crib, but should be removed for appropriate holding and stimulation. Analgesia and sedation are administered for pain. Heavy sedation is not indicated. The child should not be placed in the prone position.

The nurse is caring for an infant with suspected pyloric stenosis. Which clinical manifestation would indicate pyloric stenosis? a.Abdominal rigidity and pain on palpation b.Rounded abdomen and hypoactive bowel sounds c.Visible peristalsis and weight loss d.Distention of lower abdomen and constipation

ANS: C. Visible peristalsis and weight loss Visible gastric peristaltic waves that move from left to right across the epigastrium are observed in pyloric stenosis. Abdominal rigidity and pain on palpation, and rounded abdomen and hypoactive bowel sounds are usually not present. The upper abdomen is distended, not the lower abdomen.

A child with leukemia has the following a.m. laboratory results: Hgb 8.0, Hct 24.2, WBC 8,000, platelets 150,000. What is the priority nursing assessment? a. Monitor for fever. b. Assess for bruising or bleeding. c. Determine intake and output. d. Assess for pallor, fatigue, and tachycardia.

ANS: D. Assess for pallor, fatigue, and tachycardia. The Hgb and Hct indicate anemia, which results in fatigue, pallor, and tachycardia.

Which is a common, serious complication of rheumatic fever? a. Seizures b. Cardiac arrhythmias c. Pulmonary hypertension d. Cardiac valve damage

ANS: D. Cardiac valve damage Cardiac valve damage is the most significant complication of rheumatic fever. Seizures, cardiac arrhythmias, and pulmonary hypertension are not common complications of rheumatic fever.

While assessing a 4-month-old infant, the nurse notes that the baby experiences a hypercyanotic spell. What is the priority nursing action? a. Provide supplemental oxygen by face mask. b. Administer a dose of IV morphine sulfate. c. Begin cardiopulmonary resuscitation. d. Place the infant in a knee-to-chest position.

ANS: D. Place the infant in a knee-to-chest position. Hypercyanotic spells are a dangerous event. Placing the infant in a knee-to-chest position increases systemic vascular resistance, thereby improving pulmonary blood flow. It is the first action the nurse should take.

Therapeutic management of most children with Hirschsprung's disease is primarily: a.Daily enemas. b.Low-fiber diet. c.Permanent colostomy. d.Surgical removal of affected section of bowel

ANS: D. Surgical removal of affected section of bowel Most children with Hirschsprung's disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter. Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet until the child is physically ready for surgery. The colostomy that is created in Hirschsprung's disease is usually temporary.

43. An infant with pyloric stenosis experiences excessive vomiting that can result in: a. hyperchloremia. b. hypernatremia. c. metabolic acidosis. d. metabolic alkalosis.

ANS: D. metabolic alkalosis Infants with excessive vomiting are prone to metabolic alkalosis from the loss of hydrogen ions. Chloride ions and sodium are lost with vomiting. Metabolic alkalosis, not acidosis, is likely.

A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurse's best response should be that the: a. blood pressure will stabilize. b. the child will have more energy. c. urine will be free of protein. d. urinary output will increase.

ANS: D. urinary output will increase. An increase in urinary output may signal resolution of the acute glomerulonephritis. If blood pressure is elevated, stabilization usually occurs with the improvement in renal function. The child having more energy and the urine being free of protein are related to the improvement in urinary output.

A nurse is caring for a 6-week-old infant following a pyloromyotomy. Which of the following forms of feeding should the nurse anticipate for the infant 6 hr after the procedure. A. Bottle formula with added protein. B. Small, frequent bottle feedings of electrolyte solution. C. Continuous nasoduodenal tube feedings. D. Bolus feedings via gastrostomy tube.

B. Small, frequent bottle feedings of electrolyte solution. Rationale: Feedings begin 4 to 6 hours after the surgical procedure. The nurse should anticipate feeding the infant small, frequent increments of an electrolyte solution or sterile water.