Peds NCLEX: GU & GI

2. The nurse is caring for a 4- year-old who weighs 15 kg. At the end of a 10-hour period, the nurse notes the urine output to be 150 mL. What action does the nurse take? 1. The nurse notifies the physician because this urine output is too low. 2. The nurse encourages the patient to increase oral intake in order to increase urine output. 3. The nurse records the patient's urine output in the chart. 4. The nurse administers isotonic fluid intravenously to help with the rehydration process.

3. Recording the patient's urine output in the chart is the appropriate action because the urine output is within the expected range of 1-2 mL/kg/hr.

17. The nurse is caring for a newborn male with hypospadias. His parents ask if circumcision is an option. Which is the nurse's best response? 1. "Circumcision is a fading practice and is now contraindicated in most children." 2. "Circumcision in children with hypospadias is recommended because it helps prevent infection." 3. "Circumcision is an option, but it cannot be done at this time." 4. "Circumcision can never be performed in a child with hypospadias."

3. "Circumcision is an option, but it cannot be done at this time." It is usually recommended that circumcision be delayed in the child with hypospadias because the foreskin may be needed for repair of the defect.

41. The nurse is giving discharge instructions to the parents of a 1-month-old infant with tracheoesophageal atresia. The infant is being discharged with a GT. The nurse knows that the parents understand the discharge teaching when the mother states: 1. "I will give my baby feedings through the GT but place liquid medications in the corner of the mouth to be absorbed." 2. "I will flush the GT with 2 ounces of water after each feeding to prevent the GT from clogging." 3. "I will clean the area around the GT with soap and water every day." 4. "I will place petroleum jelly around the GT if any redness develops."

3. "I will clean the area around the GT with soap and water every day." The area around the GT should be cleaned with soap and water to prevent an infection.

52. The nurse is caring for a newborn with an anorectal malformation and has had a colostomy placed. The nurse knows that more education is needed when the infant's parent states which of the following? 1. "I will make sure the stoma is red." 2. "There should not be any discharge or irritation around the outside of the stoma." 3. "I will keep a bag attached to avoid the contents of the small intestine coming in contact with the baby's skin." 4. "As my baby grows, a pattern will develop over time, and there should be predictable bowel movements."

3. "I will keep a bag attached to avoid the contents of the small intestine coming in contact with the baby's skin." The colostomy contains stool from the large intestine; an ileostomy contains the very irritating stool from the small intestine.

14. The parents of a child hospitalized with MCNS ask why the last blood test revealed elevated lipids. What is the nurse's best response? 1. "If your child had just eaten a fatty meal, the lipids may have been falsely elevated." 2. "It's not unusual to see elevated lipids in children because of the dietary habits of today." 3. "Since your child is losing so much protein, the liver is stimulated and ends up making more lipids." 4. "Your child's blood is very concentrated because of the edema, so the lipids are falsely elevated."

3. "Since your child is losing so much protein, the liver is stimulated and ends up making more lipids." In MCNS, the lipids are truly elevated. Lipoprotein production is increased because of the increased stimulation of the liver hypoalbuminemia.

45. The nurse is caring for an 8-week-old infant being evaluated for pyloric stenosis. Which of the following statements made by the parents would be typical of a child with this diagnosis? 1. "The baby is a very fussy eater and just does not want to eat." 2. "The baby tends to have a very forceful vomiting episode approximately 30 minutes after most feedings." 3. "The baby is always hungry." 4. "The baby is happy in spite of getting really upset on spitting up."

3. "The baby is always hungry." Infants with pyloric stenosis are always hungry and often appear malnourished.

48. The nurse is caring for a 5-month-old infant with a diagnosis of intussusception. The infant has periods of irritability during which the knees are brought to chest and the infant cries, alternating with periods of lethargy. Vital signs are stable and within age-appropriate limits. The physician elects to give an enema. The parents ask the purpose of is the enema. Select the nurse's most appropriate response. 1. "The enema will confirm the diagnosis. If the test result is positive, your child will need to have surgery to correct the intussusception." 2. "The enema will confirm the diagnosis. Although very unlikely, the enema may also help fix the intussusception so that your child will not immediately need surgery." 3. "The enema will help confirm diagnosis and has a good chance of fixing the intussusception." 4. "The enema will help confirm the diagnosis and may temporarily fix the intussusception. If the bowel returns to normal, there is a strong likelihood that the intussusception will recur."

3. "The enema will help confirm diagnosis and has a good chance of fixing the intussusception." In most cases of intussusception in young children, an enema is successful in reducing the intussusception.

62. The nurse is interviewing the parents of a 6-year-old who has been experiencing constipation. Which of the following could be a causative factor? Select all that apply. 1. Hypothyroidism. 2. Muscular dystrophy. 3. Myelomeningocele. 4. Drinks a lot of milk. 5. Active in sports.

1, 2, 3, 4. 1. Hypothyroidism can be a causative factor in constipation. 2. Weakened abdominal muscles can be seen in muscular dystrophy and can lead to constipation. 3. Myelomeningocele affects the innervation of the rectum and can lead to constipation. 4. Excessive milk consumption can lead to constipation. 5. Activity tends to decrease constipation and increase regularity.

4. A 4-month-old female is brought to the emergency department with severe dehydration. Her heart rate is 198, and her blood pressure is 68/38. The infant's anterior fontanel is sunken. The nurse notes that the infant does not cry when the intravenous line is inserted. The child's parents state that she has not "held anything down" in 18 hours. The nurse obtains a finger-stick blood sugar of 94. Which of the following would the nurse expect to do immediately? 1. Administer a bolus of normal saline. 2. Administer a bolus of D10W. 3. Administer a bolus of normal saline with 5% dextrose added to the solution. 4. Offer the child an oral rehydrating solution such as Pedialyte.

1. Administer a bolus of normal saline. Dehydration is corrected with the administration of an isotonic solution, such as normal saline or lactated Ringer solution.

13. The nurse is teaching the family about MCNS and explains that the clinical manifestations are due to which of the following? 1. Chemical changes in the composition of albumin. 2. Increased permeability of the glomeruli. 3. Obstruction of the capillaries of the glomeruli because of antibody-antigen complex formation. 4. Loss of the kidney's ability to excrete waste and concentrate urine.

2. Increased permeability of the glomeruli. Increased permeability of the glomeruli in MCNS allows large substances such as protein to pass through and be excreted in the urine.

An infant returns to the nursing unit after the surgical repair of a cleft lip located on the right side of the lip. The best position to place this infant at this time is which? 1. A flat position 2. A prone position 3. On his or her left side 4. On his or her right side

3. On his or her left side After the repair of a cleft lip, the infant should be positioned on the side opposite to the repair to prevent contact of the suture lines with the bed linens. In this case, it is best to place the infant on the left side. Additionally, the flat or prone position can result in aspiration if the infant vomits. Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process: Implementation Content Area: Child Health: Gastrointestinal Strategy(ies): Strategic Words Priority Concepts: Clinical Judgment, Safety

25. The nurse is caring for a 5-year-old who has just returned from having an appendectomy. Which of the following is the optimal way to manage pain? 1. Intravenous morphine as needed. 2. Liquid Tylenol with codeine as needed. 3. Morphine administered through a PCA pump. 4. Intramuscular morphine as needed.

3. Morphine administered through a PCA pump. Morphine administered through a PCA pump offers the child control over managing pain. The PCA pump also has the benefit of offering a basal rate as well as an as-needed rate for optimal pain management.

Which condition in males would the nurse assess as a medical emergency? a. Cryptorchidism b. Testicular torsion c. Phimosis d. Inguinal hernia

Answer: b. Testicular torsion Feedback: Testicular torsion is a medical emergency and should be surgically repaired within 4 to 6 hours of onset. The testis rotates on its spermatic cord, obstructing blood supply. Inguinal hernia is when a portion of abdominal cavity protrudes into the groin. It is usually repaired after 3 months of age and is not considered emergent unless the hernia is incarcerated. Cryptorchidism is when a testicle is not descended. It is present at birth, and if the testicle does not descend by 1 to 2 years of age, it is repaired. Phimosis is when the skin around the glans of the penis is not retractable by young childhood.

What clinical manifestations would the nurse expect to find in a newborn who has developed necrotizing enterocolitis (NEC)? A. Hyperthermia B. Gastric residual and melena C. The passage of ribbon-like stools D. Projectile vomiting

B. Gastric residual and melena The most prominent signs of NEC are abdominal distention, gastric residuals, and blood in the stools (melena). NEC resembles septicemia; the newborn may "not look well," in addition to having nonspecific signs such as lethargy, poor feeding, hypotension, hypothermia, bile-stained vomitus, and oliguria.The newborn with NEC is more likely to be seen with hypothermia, not hyperthermia.The passage of ribbon-like stools is seen in newborns and infants born with Hirschsprung disease.Projectile vomiting is seen in newborns and infants with pyloric stenosis.

A 4-year-old child has ingested a toxic dose of iron. The parent reports that the child vomited and complained of gastric pain an hour ago but "feels fine" now. The parent is not certain when the child ingested the iron tablets. The most appropriate recommendation by the nurse to the parent is to A. observe the child closely for 2 more hours. B. bring the child to the hospital immediately. C. administer activated charcoal. D. administer ipecac to induce vomiting if the child does not vomit again within 1 hour.

B. bring the child to the hospital immediately. The child should be transported to the hospital immediately for assessment and possible gastric lavage.The period of concern for complications of iron toxicity is from 30 minutes to 6 hours.Activated charcoal does not bind iron and, therefore, is not a course of treatment for this child.Ipecac is not recommended for poisonings.

A child has a nasogastric (NG) tube after surgery for acute appendicitis. What is the purpose of the NG tube? A. Maintain electrolyte balance B. Maintain an accurate record of output C. Maintain gastric decompression D. Prevent infection

C. Maintain gastric decompression The NG tube is used to maintain gastric decompression until intestinal activity returns.The NG tube may adversely affect electrolyte balance by removing stomach secretions.NG drainage is one part of the child's output. The nurse would need to incorporate the NG drainage with other output.There is no relationship between the NG tube and prevention of the spread of infection.

A young child is diagnosed with vesicoureteral reflux. What would the nurse expect to read in the medical history that the child had been experiencing? A. Incontinence B. Hypotension C. Recurrent kidney infections D. Increased renal arterial perfusion

C. Recurrent kidney infections Reflux allows urine flow to be forced back to the kidneys. When the urine is infected, this contributes to kidney infections.

The nurse assesses a neonate immediately after birth. Clinical sign-symptom of tracheoesophageal fistula is A. jaundice. B. bile-stained vomitus. C. absence of sucking. D. excessive amount of frothy saliva in the mouth.

D. excessive amount of frothy saliva in the mouth. Excessive salivation and drooling are indicative of tracheoesophageal fistulas. With a fistula, the child has difficulty managing the secretions, which may cause choking, coughing, and cyanosis.Jaundice is not usually associated with a tracheoesophageal fistula.Bile-stained vomitus is not usually associated with a tracheoesophageal fistula.The infant is able to suck with a tracheoesophageal fistula but is not able to manage the secretions.

The nurse is conducting an admission assessment on a school-age child with acute renal failure. Which are the primary clinical manifestations the nurse expects to find with this condition? a. Oliguria and hypertension b. Hematuria and pallor c. Proteinuria and muscle cramps d. Bacteriuria and facial edema

a. Oliguria and hypertension The principal feature of acute renal failure is oliguria; hypertension is a nonspecific clinical manifestation. Hematuria and pallor, proteinuria and muscle cramps, and bacteriuria and facial edema are not principal features of acute renal failure.

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.

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

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.

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.

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.

Which is a common side effect of short-term corticosteroid therapy? a. Fever b. Hypertension c. Weight loss d. Increased appetite

d. Increased appetite Side effects of short-term corticosteroid therapy include an increased appetite. Fever is not a side effect of therapy. It may be an indication of infection. Hypertension is not usually associated with initial corticosteroid therapy. Weight gain, not weight loss, is associated with corticosteroid therapy.

Which is the most common cause of acute renal failure in children? a. Pyelonephritis b. Tubular destruction c. Urinary tract obstruction d. Severe dehydration

d. Severe dehydration The most common cause of acute renal failure in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume. Pyelonephritis and tubular destruction are not common causes of acute renal failure. Obstructive uropathy may cause acute renal failure, but it is not the most common cause.

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.

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.

16. The nurse is caring for an 8-week-old male who has just been diagnosed with Hirschsprung disease. The parents ask what they should expect. Select the nurse's best response. 1. "It is really an easy disease to manage. Most children are placed on stool softeners to help with constipation until the constipation resolves." 2. "A permanent stool diversion, called a colostomy, will be placed by the surgeon to bypass the narrowed area." 3. "Daily bowel irrigations will help your child maintain regular bowel habits." 4. "Although your child will require surgery, there are different ways to manage the disease, depending on how much of your child's bowel is involved."

4. "Although your child will require surgery, there are different ways to manage the disease, depending on how much of your child's bowel is involved." The aganglionic portion needs to be removed. Although most children have a temporary colostomy placed, many infants are able to bypass the colostomy and have the bowel immediately reattached.

16. A 3-year-old returns to the pediatric clinic after having had MCNS. His parents ask the nurse how to prevent the child from having it again. What is the nurse's best response? 1. "It is very rare for a child to have a relapse after having fully recovered." 2. "Unfortunately, many children have cycles of relapses, and there is very little that can be done to prevent it." 3. "Your child is much less likely to get sick again if sodium is avoided in his diet." 4. "Try to keep your child away from sick children because relapses have been associated with infectious illnesses."

4. "Try to keep your child away from sick children because relapses have been associated with infectious illnesses." Exposure to infectious illness has been linked to the relapse of nephrotic syndrome.

13. The nurse is caring for an infant diagnosed with Hirschsprung disease. The mother states she is pregnant with a male and wants to know if her new baby will likely have the disorder. Select the nurse's best response. 1. "Genetics play a small role in Hirschsprung disease, so there is a chance the baby will develop it as well." 2. "There is no evidence to support a genetic link, so it is very unlikely the baby will also have it." 3. "It is rarely seen in boys, so it is not likely your new baby will have Hirschsprung disease." 4. "Hirschsprung disease is seen only in girls, so your new baby will not be at risk."

1. "Genetics play a small role in Hirschsprung disease, so there is a chance the baby will develop it as well." There is a genetic component to Hirschsprung disease, so any future siblings are also at risk.

12. A 5-year-old is hospitalized with MCNS. The nurse obtains a history from the parents. Which statement by the parents is most consistent with MCNS? 1. "Our child missed 2 days of school last week because of a really bad cold." 2. "We went camping last week, and our child's legs were covered in bug bites." 3. "Our child came home from school a week ago due to vomiting and stomach cramps." 4. "Our child has a pet turtle but does not wash hands after playing with the turtle."

1. "Our child missed 2 days of school last week because of a really bad cold." An upper respiratory infection often precedes MCNS by a few days.

53. The parents of a child being evaluated for celiac disease ask the nurse why it is important to make dietary changes. Select the nurse's best response. 1. "The body's response to gluten causes damage to the mucosal cells in the intestine, leading to absorption problems." 2. "When the child with celiac disease consumes anything containing gluten, the body responds by creating specials cells called villi, which leads to more diarrhea." 3. "The body's response to gluten causes the intestine to become more porous and hang on to more of the fat-soluble vitamins, leading to vitamin toxicity." 4. "The body's response to gluten causes damage to the mucosal cells, leading to malabsorbtion of water and hard, constipated stools."

1. "The body's response to gluten causes damage to the mucosal cells in the intestine, leading to absorption problems." The inability to digest protein leads to an accumulation of an amino acid that is toxic to the mucosal cells and villi, leading to absorption problems.

47. The nurse receives a call from the mother of a 6-month-old who describes her child as sleepy and fussy. She states that her infant vomited once this morning and had two episodes of diarrhea. The last episode contained mucus and a small amount of blood. She asks the nurse what she should do. Select the nurse's best response. 1. "Your infant will need to have some tests in the emergency room to determine if anything serious is going on." 2. "Try feeding your infant in about 30 minutes; in the event of repeat vomiting, bring the infant to the emergency room for some tests and intravenous rehydration." 3. "Many infants display these symptoms when they develop an allergy to the formula they are receiving; try switching to a soy-based formula." 4. "Do not worry about the blood and mucus in the stool; it is not unusual for infants to have blood in their stools because their intestines are more sensitive."

1. "Your infant will need to have some tests in the emergency room to determine if anything serious is going on." The infant is displaying signs of intussusception. This is an emergency that needs to be evaluated to prevent ischemia and perforation.

38. The nurse is caring for a newborn with esophageal atresia. When reviewing the mother's history, the nurse would expect to find which of the following? 1. A history of maternal polyhydramnios. 2. A pregnancy that lasted more than 38 weeks. 3. A history of poor nutrition during pregnancy. 4. A history of alcohol consumption during pregnancy.

1. A history of maternal polyhydramnios Maternal polyhydramnios is present because the infant cannot swallow and absorb the amniotic fluid in utero.

14. The nurse is caring for an infant newly diagnosed with Hirschsprung disease. Which of the following does the nurse understand about this infant's condition? 1. There is a lack of peristalsis in the large intestine and an accumulation of bowel contents, leading to abdominal distention. 2. There is excessive peristalsis throughout the intestine, resulting in abdominal distention. 3. There is a small-bowel obstruction leading to ribbon-like stools. 4. There is inflammation throughout the large intestine, leading to accumulation of intestinal contents and abdominal distention.

1. There is a lack of peristalsis in the large intestine and an accumulation of bowel contents, leading to abdominal distention. In Hirschsprung disease, a portion of the large intestine has an area lacking in ganglion cells. This results in a lack of peristalsis as well as an accumulation of bowel contents and abdominal distention.

35. The nurse is caring for a newborn with a cleft lip and palate. The mother states, "I will not be able to breastfeed my baby." Select the nurse's best response. 1. "It sounds like you are feeling discouraged. Would you like to talk about it?" 2. "Sometimes breastfeeding is still an option for babies with a cleft lip and palate. Would you like more information?" 3. "Although breastfeeding is not an option, you have the option of pumping your milk and then feeding it to your baby with a special nipple." 4. "We usually discourage breastfeeding babies with cleft lip and palate as it puts them at an increased risk for aspiration."

2. "Sometimes breastfeeding is still an option for babies with a cleft lip and palate. Would you like more information?" Some mothers are able to breastfeed their infants who have a cleft lip and palate. The breast can help fill in the cleft and help the infant create suction.

27. The nurse is providing discharge instructions to the parents of a 10-year-old who had an appendectomy for a ruptured appendix 5 days ago. The nurse knows that further education is required when the child's parent states: 1. "We will wait a few days before allowing our child to return to school." 2. "We will wait 2 weeks before allowing our child to return to sports." 3. "We will call the pediatrician's office if we notice any drainage around the wound." 4. "We will encourage our child to go for walks every day."

2. "We will wait 2 weeks before allowing our child to return to sports." The child should wait 6 weeks before returning to any strenuous activity.

40. The nurse is caring for a newborn who has just been diagnosed with tracheoesophageal atresia and is scheduled for surgery. Which of the following should the nurse expect to do in the preoperative period? 1. Keep the child in a monitored crib, obtain frequent vital signs, and allow the parents to visit but not hold their infant. 2. Administer intravenous fluids and antibiotics. 3. Place the infant on 100% oxygen via a non-rebreather mask. 4. Have the mother feed the infant slowly in a monitored area, stopping all feedings 4 to 6 hours before surgery.

2. Administer intravenous fluids and antibiotics. Intravenous fluids are administered to prevent dehydration because the infant is NPO. Intravenous antibiotics are administered to prevent pneumonia be cause aspiration of secretions is likely.

56. Which of the following manifestations suggests that an infant is developing NEC? 1. The infant absorbs bolus orogastric feedings at a faster rate than previous feedings. 2. The infant has bloody diarrhea. 3. The infant has increased bowel sounds. 4. The infant appears hungry right before a scheduled feeding.

2. Bloody diarrhea can indicate that the infant has NEC.

46. The nurse is caring for a 7-week-old scheduled for a pyloromyotomy in 24 hours. Which of the following would the nurse expect to find in the plan of care? 1. Keep infant NPO; begin intravenous fluids at maintenance. 2. Keep infant NPO; begin intravenous fluids at maintenance; place NGT to low wall suction. 3. Obtain serum electrolytes; keep infant NPO; do not attempt to pass NGT due to obstruction from pylorus. 4. Offer infant small frequent feedings; keep NPO 6 to 8 hours before surgery.

2. Keep infant NPO; begin intravenous fluids at maintenance; place NGT to low wall suction. In addition to giving fluids intravenously and keeping the infant NPO, an NGT is placed to decompress the stomach.

18. The nurse is caring for a 6-week-old infant with cerebral palsy and GER. After two hospital admissions for aspiration, the child is scheduled for a Nissen fundoplication. The nurse knows that this procedure involves which of the following? 1. The fundus of the stomach is wrapped around the inferior stomach, mimicking a lower esophageal sphincter. 2. The fundus of the stomach is wrapped around the inferior esophagus, mimicking a cardiac sphincter. 3. The fundus of the stomach is wrapped around the middle portion of the stomach, decreasing the capacity of the stomach. 4. The fundus of the stomach is dilated, decreasing the likelihood of reflux.

2. The fundus of the stomach is wrapped around the inferior esophagus, mimicking a cardiac sphincter. The Nissen fundoplication involves wrapping the fundus of the stomach around the inferior esophagus, creating a lower esophageal sphincter or cardiac sphincter.

18. A 6-week-old male is scheduled for a hypospadias and chordee repair. The parent tells the nurse, "I understand why the hypospadias repair is necessary, but do they have to fix the chordee as well?" What is the nurse's best response? 1. "I understand your concern. Parents do not want their children to undergo extra surgery." 2. "The chordee repair is done strictly for cosmetic reasons that may affect your son as he ages." 3. "The repair is done to optimize his sexual function when he is older." 4. "This is the best time to repair the chordee because he will be having surgery anyway."

3. "The repair is done to optimize his sexual function when he is older." Releasing the chordee surgically is necessary for future sexual function.

7. On reviewing information about glomerulonephritis, the nurse knows that which of the following children is at risk for developing the disease? 1. A 10-year-old recovering from viral pneumonia. 2. A 6-year-old with new-onset type 1 diabetes. 3. A 3-year-old who had impetigo 1 week ago. 4. A 5-year-old with a history of five UTIs in the previous year.

3. A 3-year-old who had impetigo 1 week ago. Impetigo is a skin infection caused by the streptococcal organism that is commonly associated with glomerulonephritis.

55. The nurse is caring for a 3-year-old undergoing evaluation for celiac disease. Which of the following would the nurse expect to be included in the child's diagnostic workup? 1. Obtain complete blood count and serum electrolytes. 2. Obtain complete blood count and stool sample; keep child NPO. 3. Obtain stool sample and prepare child for jejunal biopsy. 4. Obtain complete blood count and serum electrolytes; monitor child's response to gluten-containing diet.

3. A stool sample for analysis of fat and a jejunal biopsy can confirm the diagnosis.

37. The nurse is caring for an 18-month-old infant whose cleft palate was repaired 12 hours ago. Which of the following should be included in the plan of care? 1. Allow the infant to have familiar items of comfort such as a favorite stuffed animal and a pacifier. 2. Once liquids have been tolerated, encourage a bland diet such as soup, Jell-O, and saltine crackers. 3. Administer pain medication on a regular schedule, as opposed to an as-needed schedule. 4. Use a Yankauer suction catheter on the infant's mouth to decrease the risk of aspiration of oral secretions.

3. Administer pain medication on a regular schedule, as opposed to an as-needed schedule. Pain medication should be administered regularly to avoid crying, which places stress on the suture line.

15. The nurse is caring for a 2-year-old hospitalized with MCNS. The edema has progressed from periorbital to generalized. The skin appears stretched, and areas of breakdown are noted over the bony prominences. The child has been receiving Lasix twice daily for several days. In order to reduce edema, which of the following does the nurse expect to be included in the treatment plan? 1. An increase in the amount and frequency of Lasix. 2. Addition of a second diuretic, such as mannitol. 3. Administration of intravenous albumin. 4. Elimination of all fluids and sodium from the child's diet.

3. Administration of intravenous albumin. In cases of severe edema, albumin is used to help return the fluid to the bloodstream from the subcutaneous tissue.

The nurse is reviewing the health record of an infant with a diagnosis of gastroesophageal reflux. Which signs/symptoms of this disorder should the nurse expect to note documented in the record? 1. Excessive oral secretions 2. Bowel sounds heard over the chest 3. Hiccuping and spitting up after a meal 4. Coughing, wheezing, and short periods of apnea

3. Hiccuping and spitting up after a meal Clinical manifestations of all types of gastroesophageal reflux include vomiting (spitting up) after a meal, hiccupping, and recurrent otitis media related to pooled secretions in the nasopharynx during sleep. Option 1 is a clinical manifestation of esophageal atresia and tracheoesophageal fistula. Option 2 is a clinical manifestation of congenital diaphragmatic hernia. Option 4 is a clinical manifestation of hiatal hernia. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process: Data Collection Content Area: Child Health: Gastrointestinal Strategy(ies): Subject Priority Concepts: Fluid and Electrolyte Balance, Gas Exchange

15. The nurse is caring for a 3-month-old male who is being evaluated for possible Hirschsprung disease. His parents call the nurse and state that his diaper contains a large amount of mucus and bloody diarrhea. The nurse notes that the infant is irritable and his abdomen appears very distended. Which of the following should be the nurse's next action? 1. Reassure the parents that this is an expected finding and not uncommon. 2. Call a code for a potential cardiac arrest, and stay with the infant. 3. Immediately obtain all vital signs with a quick head-to-toe assessment. 4. Obtain a stool sample for occult blood.

3. Immediately obtain all vital signs with a quick head-to-toe assessment. All vital signs need to be evaluated because the child with enterocolitis can quickly progress to a state of shock A quick head-to-toe assessment will allow the nurse to evaluate the child's circulatory system.

44. The nurse is caring for an infant with pyloric stenosis. The parents ask if any future children will likely have pyloric stenosis. Select the nurse's best response. 1. "You seem worried; would you like to discuss your concerns?" 2. "It is very rare for a family to have more than one child with pyloric stenosis." 3. "Pyloric stenosis can run in families. It is more common among males." 4. "Although there can be a genetic link, it is very unusual for girls to have pyloric stenosis."

3. Pyloric stenosis can run in families, and it is more common in males.

23. The nurse is caring for an 8-year-old who has just returned to the pediatric unit after an appendectomy for a ruptured appendix. Which of the following is the best position for the child? 1. Semi-Fowler. 2. Prone. 3. Right side-lying. 4. Left side-lying..

3. Right side-lying. The right side-lying position promotes comfort and allows the peritoneal cavity to drain

2. The mother of a newborn asks the nurse why she has to nurse so frequently. The nurse replies using which of the following principles? 1. Formula tends to be more calorically dense, and formula-fed babies require fewer feedings than breastfed babies. 2. The newborn's stomach capacity is small, and peristalsis is slow. 3. The newborn's stomach capacity is small, and peristalsis is more rapid than in older children. 4. Breastfed babies tend to take longer to complete a feeding than formula-fed babies.

3. The newborn's stomach capacity is small, and peristalsis is more rapid than in older children. The small-stomach capacity and rapid movement of fluid through the digestive system account for the need for small frequent feedings.

54. The nurse is caring for a 14-year-old with celiac disease. The nurse knows that the patient understands the diet instructions by ordering which of the following meals? 1. Eggs, bacon, rye toast, and lactose-free milk. 2. Pancakes, orange juice, and sausage links. 3. Oat cereal, breakfast pastry, and nonfat skim milk. 4. Cheese, banana slices, rice cakes, and whole milk.

4. Cheese, banana slices, rice cakes, and whole milk do not contain gluten.

The nurse reviews the record of a 3-week-old infant and notes that the health care provider has documented a diagnosis of suspected Hirschsprung's disease. The nurse understands that which manifestation led the mother to seek health care for the infant? 1. Diarrhea 2. Projectile vomiting 3. The regurgitation of feedings 4. Foul-smelling, ribbon-like stools

4. Foul-smelling, ribbon-like stools Chronic constipation that begins during the first month of life and that results in foul-smelling, ribbon-like or pellet-like stools is a clinical manifestation of Hirschsprung's disease. The delayed passage or absence of meconium stool during the neonatal period is a characteristic sign. Bowel obstruction (especially during the neonatal period), abdominal pain and distention, and failure to thrive are also signs and symptoms. This disorder results in a decrease in passage of stool, so diarrhea would not be a presenting manifestation. Hirschsprung's disease affects the colon, so regurgitation and vomiting most often associated with esophageal and stomach pathology would not be presenting manifestations. Level of Cognitive Ability: Understanding Client Needs: Physiological Integrity Integrated Process: Nursing Process: Data Collection Content Area: Child Health: Gastrointestinal Strategy(ies): Subject Priority Concepts: Elimination, Nutrition

21. The nurse is caring for a 10-year-old who is being evaluated for possible appendicitis. The child has been complaining of nausea and sharp abdominal pain in the right lower quadrant. An abdominal ultrasound is scheduled, and a blood count has been obtained. The child vomits, finds the pain relieved, and calls the nurse. Which of the following should be the nurse's next action? 1. Cancel the ultrasound, and obtain an order for oral Zofran. 2. Cancel the ultrasound, and prepare to administer an intravenous bolus. 3. Prepare for the probable discharge of the patient. 4. Immediately notify the physician of the child's status.

4. Immediately notify the physician of the child's status. The physician should be notified immediately, as a sudden change or loss of pain often indicates a perforated appendix

17. The nurse is caring for a 2-month-old infant diagnosed with GER. Which of the following should the nurse include in the plan of care to decrease the incidence of symptoms of GER? 1. Place the infant in an infant seat immediately after feedings. 2. Place the infant in the prone position immediately after feeding to decrease the risk of aspiration. 3. Encourage the parents not to worry because most infants outgrow GER within the first year of life. 4. Encourage the parents to hold the infant in an upright position for 30 minutes following a feeding.

4. Keeping the infant in an upright position is the best way to decrease the symptoms of GER. The infant can also be placed in the supine position with the head of the crib elevated. A harness can be used to keep the child from sliding down.

49. A nurse working in an emergency room of a large pediatric hospital receives a transfer call from a reporting nurse at a local community hospital. The nurse will soon receive a 4-month-old who has been diagnosed with an intussusception. The infant is described as very lethargic with the following vital signs, T 101.8°F (38.7°C), HR 181, BP 68/38. The reporting nurse states the infant's abdomen is very rigid. Which of the following is the most appropriate action for the receiving nurse? 1. Prepare to accompany the infant to a computed tomography scan to confirm the diagnosis. 2. Prepare to accompany the infant to the radiology department for a reducing enema. 3. Prepare to start a second intravenous line to administer fluids and antibiotics. 4. Prepare to get the infant ready for immediate surgical correction.

4. Prepare to get the infant ready for immediate surgical correction. Intussusception with peritonitis is a surgical emergency, so preparing the infant for surgery is the nurse's top priority.

The nurse reviews the record of a 1-year-old child seen in the clinic and notes that the health care provider has documented a diagnosis of celiac crisis. Which symptom should the nurse expect to note in this condition? 1. Anorexia 2. Joint pain 3. Constipation 4. Profuse, watery diarrhea

4. Profuse, watery diarrhea Clinical signs/symptoms associated with celiac crisis include profuse, watery diarrhea and vomiting that quickly lead to severe dehydration and *metabolic acidosis.* The cause of the crisis is usually infection or hidden sources of gluten. The child may require intravenous fluids to correct fluid and acid-base imbalances, albumin to treat shock, and corticosteroids to decrease severe mucosal inflammation. Level of Cognitive Ability: Understanding Client Needs: Physiological Integrity Integrated Process: Nursing Process: Data Collection Content Area: Child Health: Gastrointestinal Strategy(ies): Subject Priority Concepts: Elimination, Fluid and Electrolyte Balance

39. The nurse is in the room while a mother of a newborn is feeding her infant for the first time. The baby immediately begins coughing and choking. The nurse notes that the baby is extremely cyanotic. Which of the following should be the nurse's immediate action? 1. Call the physician, and inform the physician of the situation. 2. Have the mother stop feeding the infant, and observe to see if the choking episode resolves on its own. 3. Immediately determine the infant's oxygen saturation, and have the mother stop feeding the infant. 4. Take the infant from the mother, and administer blow-by oxygen while obtaining the infant's oxygen saturation.

4. Take the infant from the mother, and administer blow-by oxygen while obtaining the infant's oxygen saturation. The infant should be taken from the mother and placed in the crib where the nurse can assess the baby. Oxygen should be administered immediately, and vital signs should be obtained.

The nurse is assigned to care for a child who is scheduled for an appendectomy. Which prescriptions does the nurse anticipate to be prescribed? Select all that apply. 1. Administer a Fleet enema. 2. Initiate an intravenous line. 3. Maintain nothing-by-mouth status. 4. Administer intravenous antibiotics. 5. Administer preoperative medications 6. Place a heating pad on the abdomen to decrease pain.

ANS 2,3,4,5 During the preoperative period, enemas or laxatives should not be administered. In addition, heat should not be applied to the abdomen. Any of these interventions can cause the rupture of the appendix and resultant peritonitis. Intravenous fluids would be started, and the child should receive nothing by mouth while awaiting surgery. Antibiotics are usually administered because of the risk of perforation. Preoperative medications are administered as prescribed. Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process: Planning Content Area: Child Health: Gastrointestinal Strategy(ies): Subject Priority Concepts: Inflammation, Safety

What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux? a. The importance of taking prophylactic antibiotics b. Suggestions for how to maintain fluid restrictions c. The use of bubble baths as an incentive to increase bath time d. The need for the child to hold urine for 6 to 8 hours

ANS: A A Prophylactic antibiotics are used to prevent urinary infection in a child with vesicoureteral reflux, although this treatment plan has become controversial. B Fluids are not restricted when a child has vesicoureteral reflux. In fact, fluid intake should be increased as a measure to prevent UTIs. C Bubble baths should be avoided to prevent urethral irritation and possible UTI. D To prevent UTIs, the child should be taught to void frequently and never resist the urge to urinate.

A nurse is assessing an infant for urinary tract infection (UTI). Which assessment findings should the nurse expect? Select all that apply. a. Change in urine odor or color b. Enuresis c. Fever or hypothermia d. Voiding urgency e. Poor weight gain

ANS: A, C, E Correct The signs of a UTI in an infant include fever or hypothermia, irritability, dysuria as evidenced by crying when voiding, change in urine odor or color, poor weight gain, and feeding difficulties. Incorrect Enuresis and voiding urgency should be assessed in an older child.

A nurse is planning care for a child admitted with nephrotic syndrome. Which interventions should be included in the plan of care? Select all that apply. a. Administration of antihypertensive medications b. Daily weights c. Salt-restricted diet d. Frequent position changes e. Teaching parents to expect tea-colored urine

ANS: B, C, D A. Nephrotic syndrome does not require antihypertensive medications. These are administered for acute glomerulonephritis. B. A child with nephrotic syndrome will need to be monitored closely for fluid excess so daily weights are important. C. The diet is salt restricted to prevent further retention of fluid. D. Because of the fluid excess, frequent position changes are required to prevent skin breakdown. E. Tea-colored urine is expected with acute glomerulonephritis, but not nephrotic Syndrome. The urine in nephrotic syndrome is frothy indicating protein is being lost in the urine.

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 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.

Parents ask the nurse "when should our child's hypospadias be corrected?" The nurse responds based upon the knowledge that correction of hypospadias should be accomplished by the time the child is a. 1 month of age b. 6 to 12 months of age c. School age d. Sexually mature

ANS: B. 6 to 12 months of age A. Surgery to correct hypospadias is not performed when the infant is this young. B. The correction of hypospadias should ideally be accomplished by the time the child is 6 to 12 months of age and before toilet training. C. It is preferable for hypospadias to be surgically corrected before the child enters school so that the child has normal toileting behaviors in the presence of his peers. D. Corrective surgery for hypospadias is done long before sexual maturity.

The nurse assessing a child with acute poststreptococcal glomerulonephritis should be alert for which finding? a. Increased urine output b. Hypotension c. Tea-colored urine d. Weight gain

ANS: C. Tea-colored urine A In acute poststreptococcal Glomerulonephritis the urine output may be decreased. B In acute poststreptococcal glomerulonephritis blood pressure may be increased. C Acute poststreptococcal glomerulonephritis is characterized by hematuria, proteinuria, edema, and renal insufficiency. Tea-colored urine is an indication of hematuria. D Edema may be noted around the eyelids and ankles in patients with acute poststreptococcal glomerulonephritis; however, weight gain is associated with nephrotic syndrome.

Which intervention is appropriate when examining a male infant for cryptorchidism? a. Cooling the examiner's hands b. Taking a rectal temperature c. Eliciting the cremasteric reflex d. Warming the room

ANS: D- Warming the room A. Examining the infant with cold hands is uncomfortable for the infant and likely to cause the infant's testes to retract into the inguinal canal. It may also cause the infant to be uncooperative during the examination. B. A rectal temperature yields no information about cryptorchidism. C. Testes can retract into the inguinal canal if the infant is upset or cold or if the cremasteric reflex is elicited. This can lead to an incorrect diagnosis. D. For the infant's comfort, the infant should be examined in a warm room with the examiner's hands warmed. Testes can retract into the inguinal canal if the infant is upset or cold.