CAQ: Pediatric GI
The nurse is providing care to a 6-week-old infant who is hospitalized for poor growth. The infant is currently being breastfed and is diagnosed with failure to thrive (FTT). Which is the priority nursing assessment for this infant? 1 Family financial difficulties 2 Uncoordinated suck and swallow 3 Neglect and abuse by the parents 4 Knowledge deficit related to nutritional intake
2- Uncoordinated suck and swallow Most cases of poor growth and FTT in the first two months of life occur due to an uncoordinated suck and swallow during feedings (formula or breast); therefore, this is the priority nursing assessment. Assessing for financial difficulties, neglect and abuse, and a knowledge deficit are appropriate but not the priority in this situation.
After several episodes of abdominal pain and vomiting, a 5-month-old infant is admitted with a tentative diagnosis of intussusception. What assessment should the nurse document that will aid confirmation of the diagnosis? 1 Frequency of crying 2 Amount of oral intake 3 Characteristics of stools 4 Absence of bowel sounds
3- Characteristics of stools Because intussusception creates intestinal obstruction in which the intestine "telescopes" and becomes trapped, passage of intestinal contents is lessened; stools are red and look like currant jelly because of the mixing of stool with blood and mucus. Frequency of crying is not specific to a diagnosis of intussusception. Accurate intake and output records are important, but they are not essential for confirming this diagnosis. Bowel sounds will not be affected significantly with intussusception.
Elbow restraints are prescribed for an 18-month-old toddler who just had surgery for a cleft palate. The nurse explains to the parents that the restraints are used to keep the child from doing what? 1 Playing with unsterile toys 2 Rolling to a supine position 3 Putting fingers into the mouth 4 Removing the nasogastric tube
3- Putting fingers into the mouth The suture lines in the mouth must be protected. Because the toddler uses the mouth to explore the environment, elbow restraints are needed to keep the child from placing fingers or objects in the mouth. The child should have time to play with toys, but with supervision to prevent mouthing activities that could disrupt the suture line. The supine position is acceptable; the toddler should be able to move freely when asleep. A nasogastric tube is not used.
The nurse plans to perform an abdominal assessment of a 10-year-old child with suspected appendicitis. List in order of priority the techniques the nurse should use when assessing this child's abdomen. 1. Auscultating for bowel sounds 2. Asking where it hurts 3. Assessing the abdomen by touch 4. Visually examining the abdomen 5. Warming the stethoscope's diaphragm
Correct1.Asking where it hurts Correct2.Visually examining the abdomen Correct3.Warming the stethoscope's diaphragm Correct4.Auscultating for bowel sounds Correct5.Assessing the abdomen by touch Asking the child where it hurts is the first step of the assessment; the answer may influence the subsequent assessment. Inspection is the second part of the assessment; it involves observing the contour and symmetry of the abdomen. Warming the stethoscope's diaphragm before auscultation will help prevent tightening of the abdominal muscles. Auscultation is the next part of the assessment; it involves listening for bowel sounds and recording them as present, hypoactive, hyperactive, or absent; it must be done before palpation because touching the abdomen may alter the bowel sounds. Palpation is the final component of an abdominal assessment.
An infant has been admitted with failure to thrive (FTT). The nurse knows that more education is needed when one of the parents makes what statement? 1 "I can double the amount of water in the formula to save money." 2 "I need to hold her head up a little higher than her stomach when I feed her." 3 "I need to burp the baby when the feeding is done to get rid of swallowed air." 4 "I need to make sure that the formula is in the nipple so she doesn't swallow so much air."
1- "I can double the amount of water in the formula to save money." Doubling the amount of water in the formula reduces the baby's caloric intake. Holding the head up, burping the baby, and making sure that formula is in the nipple are all ways to increase caloric intake and reduce the chance of postfeeding vomiting due to air swallowing.
A nurse is educating a group of mothers about the nutritional needs of toddlers. Which of these statements made by a mother indicate the need for further teaching? Select all that apply. 1 "I need to give more than 24 ounces of milk per day." 2 "I should provide more calories from fats than proteins." 3 "I should refrain from giving grapes, nuts, and raw vegetables." 4 "I should give foods rich in calcium and phosphorus for healthy bone growth." 5 "I should try to give small, frequent meals consisting of breakfast, lunch, and dinner."
1- "I need to give more than 24 ounces of milk per day." 2- "I should provide more calories from fats than proteins." Toddlers who consume more than 24 ounces of milk daily in place of other foods may develop milk anemia, because milk is a poor source of iron. A toddler needs more protein than fats in the diet. Certain foods, such as nuts, grapes, and raw vegetables, as well as hot dogs, candy, and popcorn, have been implicated in choking deaths and should be avoided. Calcium and phosphorus are important for healthy bone growth. Small frequent meals consisting of breakfast, lunch, and dinner with three interspersed high nutrient-dense snacks help improve nutritional intake.
Which foods should the nurse include when teaching a group of school-age clients regarding appropriate nutritional intake? Select all that apply. 1 Bananas 2 Fried chicken 3 Low-fat yogurt 4 Whole-wheat dinner rolls 5 Sugary, carbonated beverages
1- Bananas 3- Low-fat yogurt 4- Whole-wheat dinner rolls Foods that the nurse should encourage the school-age client to eat to promote a healthy diet include bananas, low-fat yogurt, and whole-wheat dinner rolls. Fried chicken should be avoided; however, the nurse should encourage skinless chicken breasts as an alternative. Sugary, carbonated beverages should also be avoided; however, the nurse should encourage the intake of water and 100% fruit juice.
At 18 months of age a child born with a cleft lip and palate is readmitted for palate surgery. Why does the nurse teach the parents not to brush their child's teeth immediately after the surgery? 1 The suture line might be injured. 2 A toothbrush might be frightening. 3 The child will probably have no teeth. 4 A toothbrush has not been used before.
1- The suture line might be injured. A priority during the immediate postoperative period is protecting the surgical site. A toothbrush should be a familiar sight, not a frightening one, to an 18-month-old child. An 18-month-old child has about 16 teeth; although tooth development may not be as expected, there usually are teeth. Brushing the teeth with a soft toothbrush is usually started around 6 months of age.
The nurse is providing nutritional guidance to the parents of a preschool-age client. Which parental comment would prompt the nurse to provide further education? 1 "We allow our child to drink only pasteurized apple cider." 2 "We let our child sample cookie dough while making cookies." 3 "We always wash our hands well before any food preparation." 4 "We use separate utensils for food preparation and for eating."
2- "We let our child sample cookie dough while making cookies." Raw cookie dough contains raw eggs which increase the risk for foodborne illness; therefore, this statement indicates the need for further teaching. Allowing the child to drink pasteurized apple cider, washing hands before food preparation, and using separate utensils for food preparation and for eating do not indicate the need for further education.
A severely dehydrated infant with gastroenteritis is admitted to the pediatric unit. Nothing-by-mouth (NPO) status is prescribed. The parents ask why their baby cannot be fed. The nurse explains that it is necessary to do what? 1 Correct electrolyte imbalances 2 Allow the intestinal tract to rest 3 Determine the cause of the diarrhea 4 Prevent perianal irritation from the diarrhea
2- Allow the intestinal tract to rest Withholding food reduces the need for intestinal activity, which rests the intestines and minimizes diarrhea and the loss of fluid. Although intravenous therapy will be started for rehydration and to correct electrolyte imbalances, this is not the reason for the NPO status. Stool cultures are used to determine the cause of the diarrhea. Perianal irritation is prevented with meticulous skin care, not by withholding food and fluids.
A 6-week-old infant has just been found to have gastroesophageal reflux. What teaching is most important to discuss with the parents at this time? 1 Feeding cereal with a spoon 2 Providing formula thickened with cereal 3 Placing the infant on its back immediately after feedings 4 Explaining changes in care after surgical repair of the esophageal defect
2- Providing formula thickened with cereal For some infants the thickened formula decreases the number of vomiting episodes while increasing caloric intake to support adequate growth. Breast milk can be placed in a bottle and thickened with cereal. A 6-week-old infant cannot take food from a spoon and swallow it. Placing the infant on its back after feedings increases the risk for aspiration. These infants should not be left alone after feeding. Surgery may be indicated only after more conservative treatments have been tried or if complications such as respiratory distress, esophagitis, or esophageal stricture occur.
A nurse provides instructions to a group of adolescents about ways to prevent obesity. Which statements made by an adolescent indicates a need for further learning? Select all that apply. 1 "I should avoid trans fats." 2 "I should limit portion sizes." 3 "I should consume a high-fat diet." 4 "I should take highly refined starch food." 5 "I should watch television for four hours only."
3- "I should consume a high-fat diet." 4- "I should take highly refined starch food." 5- "I should watch television for four hours only." A high-fat diet should be avoided by adolescents. Highly refined starches and sugars should be avoided because they are rich in calories. Adolescents should be advised to watch less than two hours of television per day. Most dieticians and nutrition experts recommend a diet with no trans fats. Adolescents should limit portion sizes to improve body weight.
A 3-week-old infant has surgery for esophageal atresia. What is the immediate postoperative nursing care priority for this infant? 1 Giving the oral feedings slowly 2 Reporting vomiting to the practitioner 3 Checking the patency of the nasogastric tube 4 Monitoring the child for signs of infection at the incision site
3- Checking the patency of the nasogastric tube A nasogastric tube is used after surgery to decompress the stomach and limit tension on the suture line. As another means of limiting pressure on the suture line, oral feedings should not be implemented in the immediate postoperative period when the nasogastric tube is in place. Vomiting indicates obstruction of the nasogastric tube; this is why the initial action should be to check the patency of the tube. It is too soon for signs of infection to occur.
Which neurologic manifestation should the nurse anticipate for a toddler-age client exposed to low doses of lead? 1 Coma 2 Paralysis 3 Convulsions 4 Learning difficulties
3- Convulsions Learning difficulties are a clinical manifestation the nurse should anticipate for a toddler-age client exposed to low doses of lead. Coma, paralysis, and convulsion are clinical manifestations associated with high-dose lead exposure.
A newborn has just been admitted to the pediatric surgical unit from the birth hospital with a diagnosis of tracheoesophageal fistula. In what position should this child be maintained? 1 Prone, to reduce risk of aspiration 2 Trendelenburg, to drain stomach contents 3 Semi-Fowler, to reduce the risk of chemical pneumonia 4 Supine, to reduce the risk of sudden infant death syndrome
3- Semi-Fowler, to reduce the risk of chemical pneumonia Because of the connection between the lower esophagus and the trachea, this child is maintained in a semi- to high Fowler position to reduce the risk of acidic stomach contents entering the trachea and causing inflammation of the lung tissues. Vomiting may or may not occur with this type of defect, because the esophagus does connect to the stomach. The semi-Fowler position would be more effective than the prone position in reducing aspiration. The Trendelenburg position will increase the risk of pneumonia. The concern is the tracheoesophageal fistula, not the risk of sudden infant death syndrome.
An infant with a diaphragmatic hernia undergoes corrective surgery. What nursing assessment indicates that the infant's respiratory condition has improved? 1 Cessation of crying 2 Retention of 1 oz (30 mL) of formula 3 Reduction of arterial blood pH to 7.31 4 Auscultation of breath sounds bilaterally
4- Auscultation of breath sounds bilaterally Bilateral breath sounds indicate that the lungs are expanded and functioning. Lack of crying is not a reliable indicator that the respiratory status is improving; it may indicate that the infant is hypoxic and too fatigued to cry. The expected pH is 7.35 to 7.45; a decreasing pH indicates respiratory acidosis, which can be attributed to decreased gas exchange. Retention of formula is unrelated to gas exchange.
A 1-year-old infant with a distended abdomen is admitted to the pediatric unit with the diagnosis of Hirschsprung disease. In which position should the nurse place the infant? 1 Prone 2 Sitting 3 Supine 4 Lateral
4- Lateral In the lateral position the distended abdomen does not press against the diaphragm, facilitating lung expansion. The prone position is difficult to assume with a distended abdomen; also, the weight of the body will limit lung expansion. The sitting position is not conducive to easy breathing and is difficult to assume with abdominal distention. The distended abdomen will press against the thighs and then the diaphragm, which will hinder full lung expansion. The supine position will interfere with respiration because the abdominal distention will exert pressure against the diaphragm.
After her baby undergoes corrective surgery for hypertrophic pyloric stenosis, the mother is asked to offer the first feeding. The infant sucks it eagerly and vomits immediately. What is the nurse's explanation to the mother? 1 "This often occurs after the first feeding." 2 "The baby is ridding postoperative mucus." 3 "Your feeding technique may need to be changed." 4 "Feedings will have to be stopped until peristalsis improves."
1- "This often occurs after the first feeding." Explaining that the first postoperative feeding usually induces vomiting provides correct information while supporting the anxious parent. Vomiting is not caused by mucus accumulation. Questioning the mother's feeding technique may cause guilt; although the feeding technique may need to be changed, discussing it at this time is inappropriate. When the vomiting subsides, the feeding is continued.
An infant with a diagnosis of failure to thrive has been receiving enteral feedings for 3 days. All feedings have been retained, but the skin and mucous membranes are dry, and the infant has lost weight. What should the nurse do first in light of these findings? 1 Notify the practitioner 2 Document the assessment findings 3 Increase the fluid component in the feeding 4 Increase the calorie component of the feeding
1- Notify the practitioner Dry mucous membranes and weight loss are classic signs of dehydration. The nurse should calculate the infant's fluid requirements, then obtain a prescription from the practitioner to increase either free water or the amount of the feedings as needed. The findings are not expected; documenting them without notifying the practitioner is unsafe. The nurse may not change the composition of the feeding without a practitioner's prescription.
What clinical finding does a nurse expect when assessing a 4-month-old infant with gastroenteritis and moderate dehydration? 1 Urine output of 50 mL/hr 2 Depressed anterior fontanel 3 History of allergies to certain formulas 4 Capillary refill time of less than 2 seconds
2- Depressed anterior fontanel A depressed anterior fontanel is a classic sign of moderate dehydration in infants that results from a decrease in cerebrospinal fluid. Urine output of 50 mL/hr indicates adequate hydration; output will be decreased in dehydration. A history of allergies to certain formulas is unrelated to fluid loss from gastroenteritis. Capillary refill time of less than 2 seconds is an expected capillary refill time and is not indicative of moderate dehydration.
A nurse is discussing the care of an infant with colic. What should the nurse explain to the parents is the cause of colicky behavior? 1 Inadequate peristalsis 2 Paroxysmal abdominal pain 3 An allergic response to certain proteins in milk 4 A protective mechanism designed to eliminate foreign proteins
2- Paroxysmal abdominal pain The traditional efforts to explain and treat colic center on the paroxysmal abdominal pain; multiple factors appear to be involved, including immaturity of the intestinal nervous system and lack of normal intestinal flora. Peristalsis is effective because these infants thrive physically and gain weight. The origin of colic is unknown at this time.
A nurse is teaching parents about the nutritional needs of their 15-year-old child. What information should the nurse provide? Select all that apply. 1 Increase the child's fat intake 2 Provide iron-rich foods to the child 3 Increase the child's daily protein intake 4 Curb the child's diet to help prevent obesity 5 Provide adequate vitamin supplementation to your child
2- Provide iron-rich foods to the child 3- Increase the child's daily protein intake The nurse should instruct the parents to provide an iron-rich diet to the child. This will help prevent anemia. The nurse should instruct the parents to increase the child's protein intake. Fat needs do not increase in adolescents, so the nurse should not ask the parents to increase the child's fat intake. Increasing physical activity is often more important than curbing fat intake in countering obesity. Vitamin and mineral supplements are not required, so the nurse should instruct the parents to avoid them.
The nurse educates an obese adolescent about healthy dietary habits and risk associated with obesity. Which statement by the adolescent indicates the need for further counseling? 1 "I should do exercise." 2 "I should play more outdoor games." 3 "I should watch more TV to reduce the stress." 4 "I should modify my diet and have lots of vegetables and water."
3- "I should watch more TV to reduce the stress." The cause of obesity can be stress, but rather than watching TV to reduce the stress, some other activities like dancing, which involve physical movements, can be done. Any type of physical exercise helps in fat burning. Playing outdoor games not only is a physical exercise but also helps to reduce the stress. Reducing the consumption of fat-rich diet and replacing it with vegetables will reduce the amount of fat consumed by one and drinking high amount of water helps to detoxify the body.
The mother of an 18-month-old child with a cleft palate asks the nurse why the pediatrician has recommended that closure of the palate be performed before the child is 2 years old. How should the nurse respond? 1 "As the child gets older, the palate gets wider and more difficult to repair." 2 "Eruption of the 2-year molars often complicates the surgical procedure." 3 "You need to have the surgery performed before your child starts to use faulty speech patterns." 4 "After a child is 2 years old, surgery is frightening, so you need to avoid it if at all possible."
3- "You need to have the surgery performed before your child starts to use faulty speech patterns." Children with cleft palate have distinctive speech because they cannot control the airflow required for articulate speech; although affected children usually need speech therapy after surgery, correct speech will be easier to learn when surgery is performed before they start to speak. Although the palate does widen with age, this is not the reason that the repair is made at this age; these children may need multiple surgeries as the palate develops. A child with a cleft palate requires orthodontic and prosthodontic treatment for many years because of the malformed palate and the malposition of the teeth; the eruption of the teeth may be considered relative to the timing of surgery throughout childhood, but the 2-year molars are of little importance when the overall problem is considered. Invasive procedures are more frightening for a preschooler than for a toddler.
The nurse should assess an infant with gastroesophageal reflux for what complication? 1 Bowel obstruction 2 Abdominal distention 3 Increased hematocrit 4 Respiratory problems
4- Respiratory problems Reflux of gastric contents to the pharynx predisposes the infant to aspiration and the development of respiratory problems. There is no risk for a bowel obstruction; the problem is an incompetent esophageal sphincter. An increased hematocrit is not expected unless there is severe dehydration. Abdominal distention does not occur, because gastric contents are forcefully vomited.
A nurse is caring for an infant who has undergone surgery to repair a diaphragmatic hernia. What is the best position for the nurse to place the infant in? 1 Semi-Fowler in an infant seat 2 Side-lying on the unaffected side 3 Prone with the head turned to the side 4 Supine with the head of the bed elevated
4- Supine with the head of the bed elevated The supine position keeps pressure off the surgical site. Elevating the head of the bed allows the abdominal organs to move downward, away from the diaphragm, which will promote respiratory expansion. Using an infant seat will not promote maximal aeration of the lungs, because hip flexion adds tension to the abdominal muscles. Placing the infant on the unaffected side limits gas exchange in the lung on the unoperated side. The prone position increases the effort of breathing, because respiratory excursion is impeded by the weight of the body.
