Chapter 15 GI Peds
A 3-month-old infant has gastroesophageal reflux disease (GERD), but is thriving without complications. Which interventions should the nurse suggest to minimize reflux? Give continuous nasogastric feedings Give larger, less frequent feedings Thicken formula with rice cereal Place infant in a car seat after feeding
Thicken formula with rice cereal
A 2-month-old has severe reflux disease (GERD) and is not gaining weight. Which surgical intervention would be indicated that entails wrapping the stomach around the esophagus to prevent reflux? Hiatal hernia repair Nissen fundoplication Pyloromyotomy Cardiac sphincterotomy
Nissen fundoplication
A 10-year-old presents with epigastric pain and nausea, and states they have pain that wakes them up at night. They say they feel better if they eat cookies or crackers. What condition does the nurse suspect the symptoms indicate? Ulcerative colitis Lactose intolerance Peptic ulcer disease Intussusception
Peptic ulcer disease
The nurse is explaining the similarities and differences between Crohn's disease and ulcerative colitis to a group of student nurses. Which statement is most accurate in explaining a similarity or difference between the two? "Corticosteroids are used only in Crohn's to induce remission." "Surgery is always required with Crohn's." "Both Crohn's disease and ulcerative colitis are forms of inflammatory bowel disease." "Taking antidiarrheals will cure ulcerative colitis but not Crohn's disease."
"Both Crohn's disease and ulcerative colitis are forms of inflammatory bowel disease."
A school-age child with acute diarrhea from gastroenteritis has mild dehydration and is being given oral rehydration solutions (ORS). The client's parent calls the clinic nurse because their child is also occasionally vomiting. The nurse should recommend which intervention to the parent? "Bring the child to the hospital immediately for intravenous fluids." "Alternate between giving oral rehydration solutions (ORS) and carbonated drinks, as they soothe the stomach." "Continue to give oral rehydration solutions (ORS) frequently in small amounts." "Recommend making the child nothing by mouth (NPO) for 8 hours and resume oral rehydration solutions (ORS) if vomiting has subsided."
"Continue to give oral rehydration solutions (ORS) frequently in small amounts."
The nurse is discharging a newborn that was diagnosed with pediatric gastroesophageal reflux disease (GERD). Upon discharge, what information should the nurse provide to the parent? "It is important to position your infant upright, elevating the head of the bed." "You should discontinue breastfeeding, as this might worsen your infant's condition." "If you are bottle feeding, it is important to use a concentrated formula." "You should avoid placing your infant in a carrier directly after feeding." "You should provide your infant with large, less frequent feedings."
"It is important to position your infant upright, elevating the head of the bed." "You should avoid placing your infant in a carrier directly after feeding."
The parent of a client who had a ruptured appendix thought their child was just constipated. The parent is now verbalizing feelings of guilt. What should the nurse say in order to reassure the parent? "Perhaps you should have brought the child in sooner." "Would you like me to call your husband, as children and youth services have been notified?" "It's OK, there was no way for you to know that it was his appendix." "He has a fever. Did he have cold recently? It could be related to that."
"It's OK, there was no way for you to know that it was his appendix.
In educating parents of an adolescent diagnosed with ulcerative colitis, which statement would indicate that the learner understands what the most important part of care is? "We should take them to the emergency department with signs of bleeding or pain." "We should make sure they eat when having a flare in order to optimize their nutrition." "Stress reduction techniques like visualization and relaxation should be avoided when dealing with ulcerative colitis." "If side effects occur, we should try to cope with them, since the medications are important to take."
"We should take them to the emergency department with signs of bleeding or pain."
A nurse is caring for an infant admitted with pyloric stenosis. What are some of the assessment findings the nurse would expect? Select all that apply. Bilious vomiting Failure to thrive (FTT) Irritability Metabolic alkalosis Diarrhea
Failure to thrive (FTT) Irritability Metabolic alkalosis
Which of the following is a potential assessment finding in an infant with pyloric stenosis? Sandifer's syndrome Forceful vomiting Abdominal distention Watery diarrhea
Forceful vomiting
The nurse is discussing treatments for intussusception with a client. Which statement made by the nurse is correct? Select all that apply. "Intussusception most often resolves on its own without intervention." "Reduction may be performed with barium or air insufflation." "Intussusception can block blood supply to the affected portion of the intestine." "This is the most common cause of intestinal obstruction in children less than 3 years of age." "Surgical intervention may be required if the initial attempt at reduction fails."
"Reduction may be performed with barium or air insufflation." "Intussusception can block blood supply to the affected portion of the intestine." "This is the most common cause of intestinal obstruction in children less than 3 years of age." "Surgical intervention may be required if the initial attempt at reduction fails."
An adolescent is admitted and diagnosed with irritable bowel syndrome (IBS). The nursing providing discharge instructions should instruct the child to avoid which foods? Select all that apply. Caffeinated soda Milk and cheese Kiwi and strawberries Oranges and grapefruit Lean chicken and fish
Caffeinated soda Milk and cheese Oranges and grapefruit
A child has just been diagnosed with cystic fibrosis (CF). The nurse is teaching the client and their family about the importance of maintaining proper nutrition. Which statement made by the nurse is accurate? "The diet of a child with CF should be low calorie and low protein." "A gastrostomy tube may be required if failure to thrive occurs." "It is okay to eat whatever you want as long as you eat something." "It is important for you to take vitamin B & C since you have trouble absorbing them."
"A gastrostomy tube may be required if failure to thrive occurs."
The nurse is assessing a child who presents with diarrhea. Which questions would be important to ask the caregivers? Select all that apply. "How frequent is the diarrhea?" "Are the stools bloody?" "Did you insert anything in the rectum to cause this?" "Is the stool watery?" "Don't you make your child wash their hands so they don't get sick?"
"How frequent is the diarrhea?" "Are the stools bloody?" "Is the stool watery?"
An 8-year-old reports right lower quadrant (RLQ) abdominal pain. The parent states, "He is just not himself. He's not playing and just lays on the sofa in a fetal position." Upon physical exam, he has rebound pain and pain in the RLQ when jumping. What does the assessment data indicate may be occurring with this child? Celiac disease Appendicitis Rotavirus Inflammatory bowel disease
Appendicitis
Gastroesophageal reflux disease is characterized by which of the following in infants? Select all that apply. Increased hunger Arching of back, neck, and head during feeding Bilious vomiting Crying Currant-jelly stools
Arching of back, neck, and head during feeding Crying
The nurse is teaching about Crohn's disease. Which symptoms would the nurse include in explaining the clinical presentation of Crohn's disease? Constipation Diarrhea Symptoms of gastric reflux Weight gain
Diarrhea
A newborn has been diagnosed with Hirschsprung's disease. The parents are confused and ask the nurse what symptoms lead to this diagnosis. The nurse should explain the most common symptoms as: Development of acute diarrhea and dehydration Currant, jelly-like gelatinous stools Severe projectile vomiting and electrolyte imbalance Failure to pass a meconium stool with abdominal distention
Failure to pass a meconium stool with abdominal distention
A 9-year-old is admitted with an inguinal hernia. In assessing this child, what signs would indicate incarceration? Select all that apply. Increase in pain Bilious vomiting Bradycardia Diarrhea Presence of a hydrocele
Increase in pain Bilious vomiting
A young child is suspected of having intussusception. Which assessment findings correlate with this condition? Legs extended when crying Severe gastroesophageal reflux Irritability Bloody diarrhea
Irritability
Constipation is treated with __________________ in infants, and with ________________ in older children and adolescents. Mineral oil; lactulose Docusate sodium; polyethylene glycol 3350 Bisacodyl; lactulose Lactulose; polyethylene glycol 3350
Lactulose; polyethylene glycol 3350
The nurse recognizes that the most common symptom of a peptic ulcer is: Pain Bleeding Vomiting Diarrhea
Pain
A parent visits the clinic and tells the nurse that her 5-week-old male infant has had projectile vomiting that smells sour for the past two days. The nurse should refer the family to a health care provider for a possible diagnosis of: Pyloric stenosis Hiatal hernia Peptic ulcer Intestinal atresia
Pyloric stenosis
The nurse is educating a client with celiac disease about nutrition. Which diet would be the best choice? Tuna on wheat toast Ham and Swiss cheese on rye bread Rice and beans Chicken salad on a croissant
Rice and beans
A parent brings a child to the emergency department (ED). The client has been reporting abdominal pain for over a week and reports feeling constipated. Admission vital signs are: Temp 102.1, HR 110, RR 30, BP 115/84. An abdominal ultrasound revealed free fluid in the abdomen. What would most likely be the child's issue? Constipation Intussusception Crohn's disease Ruptured appendix
Ruptured appendix
A nurse is caring for a severely dehydrated child. The child has had nausea and vomiting for three days. The health care provider orders a 20 ml/kg bolus of intravenous (IV) fluid of an isotonic crystalloid. Which IV fluid would be the best choice? Sodium Chloride 0.9% (normal saline) Dextrose 10% and water (D10W) Dextrose 5% and 0.45% normal saline (D5 ½ NSS) Dextrose 5% and 0.9% normal saline (D5NSS)
Sodium Chloride 0.9% (normal saline)
Cystic fibrosis is a hereditary disorder that affects the pancreas, intestines, and bronchi. Which of the following are common assessment findings? Select all that apply. Steatorrhea Meconium ileus Failure to thrive Jaundice Dark urine and light-colored stools
Steatorrhea Meconium ileus Failure to thrive
A 6-year-old is admitted with suspected appendicitis. The client reports abdominal pain. What would be the best way to quantify the child's pain? Use the FLACC scale Use the revised FACES scale Use the 0 to 10 numeric scale Ask the child to describe the pain
Use the revised FACES scale
Which of the following assessment findings are associated with the diagnosis of Hirschsprung's disease? Select all that apply. Foul-smelling stools Vomiting Ribbon-like or watery stools Scaphoid appearance to abdomen Poor weight gain
Vomiting Ribbon-like or watery stools Poor weight gain
A 2-month-old presents to the emergency department (ED). The parent states, "I was feeding my child a bottle and he just turned blue. He frequently does this, but this time I had to rub his chest to get him to breathe. I notice a lot of crying after eating too." What further questions might the nurse ask the parent to assess if the infant has reflux? Select all that apply. "Does he arch? If he does, it is definitely reflux." "Have you noticed your baby spit up after feedings and, if so, how much?' "Can you tell me how often during the feeding you burp your baby?" "Tell me more about these episodes of turning blue. Is it always after he eats?" "What position do you feed your baby in? Is he lying flat, or do you have his head slightly elevated when feeding?"
"Have you noticed your baby spit up after feedings and, if so, how much?' "Can you tell me how often during the feeding you burp your baby?" "Tell me more about these episodes of turning blue. Is it always after he eats?" "What position do you feed your baby in? Is he lying flat, or do you have his head slightly elevated when feeding?"
At a well checkup, the parent reports that her child is constipated. What questions should the nurse ask to gain knowledge about the child's stool pattern? Select all that apply. "Do you force your child to go to the bathroom?" "How often does your child have a bowel movement?" "What is the consistency of the stool when they have one? Is it hard, soft, or liquid?" "Does your child have a ritual when they go to the bathroom?" "Does your child strain when having a bowel movement?"
"How often does your child have a bowel movement?" "What is the consistency of the stool when they have one? Is it hard, soft, or liquid?" "Does your child have a ritual when they go to the bathroom?" "Does your child strain when having a bowel movement?"
A premature infant is diagnosed with severe necrotizing enterocolitis (NEC). The infant had surgery to remove all but 12 inches of bowel and now has short bowel syndrome (SBS). What actions would be appropriate for the nurse to take for an infant with severe SBS in the immediate post-operative period? Administer total parenteral nutrition (TPN) to provide immediate nutrition Start PO feeds in small quantities immediately postoperatively Prepare for a colostomy Administer laxatives to maintain bowel patency
Administer total parenteral nutrition (TPN) to provide immediate nutrition
The nurse is educating the client about peptic ulcer disease. Which are the most common causes of peptic ulcer disease that should be emphasized? Select all that apply. Helicobacter pylori (H Pylori) Long-term acetaminophen usage Stress Spicy food Chronic aspirin use
Helicobacter pylori (H Pylori) Chronic aspirin use
The nurse is educating a client diagnosed with Irritable Bowel Syndrome (IBS). What statement indicates that the client understands the education provided? "IBS does not cause changes in bowel tissue." "IBS increases the risk of colorectal cancer." "This is a condition that is acute, temporary, and usually only occurs once in a life-time." "Abdominal pain is limited with IBS."
"IBS does not cause changes in bowel tissue."
The nurse is teaching a client about their Crohn's disease diagnosis. Which responses determine that the client understands the education provided? Select all that apply. "Crohn's disease is an immune response to injured tissue." "Crohn's disease is an acute one-time inflammatory disorder." "Crohn's disease can affect any part of the GI tract from the mouth to the anus." "Crohn's disease is more commonly found in the small intestine." "Crohn's disease may extend through the entire thickness of the bowel."
"Crohn's disease is an immune response to injured tissue." "Crohn's disease can affect any part of the GI tract from the mouth to the anus." "Crohn's disease is more commonly found in the small intestine." "Crohn's disease may extend through the entire thickness of the bowel."
The nurse is performing an abdominal assessment on a child. Why is it important to perform auscultation before palpation? Children don't like the coldness of the stethoscope and this will alter the exam. Bowel sounds are a priority in abdominal assessment. Palpation will change the quality of bowel sounds and therefore alter the assessment. Children view palpation as tickling, so this should be done last.
Palpation will change the quality of bowel sounds and therefore alter the assessment.
The nurse observes a newborn become cyanotic when feeding. What procedure will the nurse perform as prescribed to assess for a tracheoesophageal fistula (TEF)? Feed the newborn with smaller, frequent feedings Attempt to pass a nasogastric tube (NG tube) Check for simian creases on the palms of the hands Administer a saline lavage
Attempt to pass a nasogastric tube (NG tube)
