Chapter 22: The Child with Gastrointestinal Dysfunction ANS

Which therapeutic management treatment is implemented for children with Hirschsprung disease?

Surgical removal of affected section of bowel

The nurse is caring for an infant with suspected pyloric stenosis. Which clinical manifestation would indicate pyloric stenosis?

Visible peristalsis and weight loss

A nurse is conducting an in-service on gastrointestinal disorders. The nurse includes that melena, the passage of black, tarry stools, suggests bleeding from which area?

Upper gastrointestinal (GI) tract

The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's postoperative care include:

cleansing the suture line, supine and side-lying positions, arm restraints.

The nurse is caring for a neonate with a suspected tracheoesophageal fistula. Nursing care should include:

elevating the head but give nothing by mouth.

A nurse is conducting dietary teaching on high-fiber foods for parents of a child with constipation. Which foods should the nurse include as being high in fiber? (Select all that apply.)

Whole grain breads Bran pancakes Raw carrots

The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. Which is appropriate to relieve the abdominal discomfort?

Allow to assume position of comfort.

Which is true concerning hepatitis B? (Select all that apply.)

Hepatitis B can be prevented by HBV vaccine. Hepatitis B can be transferred to an infant of a breastfeeding mother. Onset of hepatitis B is insidious. Immunity to hepatitis B occurs after one attack.

A nurse is admitting an infant with dehydration caused from water loss in excess of electrolyte loss. Which type of dehydration is this infant experiencing?

Hypertonic

A 4-month-old infant has gastroesophageal reflux (GER) but is thriving without other complications. Which should the nurse suggest to minimize reflux?

Thicken formula with rice cereal.

Invagination of one segment of bowel within another is called:

intussusception

An infant is brought to the emergency department with dehydration. Which physical assessment finding does the nurse expect?

Poor skin turgor

Enemas are ordered to empty the bowel preoperatively for a child with Hirschsprung disease. The enema solution should be:

normal saline.

Which type of dehydration is defined as "dehydration that occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportion"?

Isotonic dehydration

A nurse is receiving report on a newborn admitted yesterday after a gastroschisis repair. In the report, the nurse is told the newborn has a physician's prescription for an NG tube to low intermittent suction. The reporting nurse confirms that the NG tube is to low intermittent suction and draining light green stomach contents. Upon initial assessment, the nurse notes that the newborn has pulled the NG tube out. Which is the priority action the nurse should take?

Replace the NG tube and continue the low intermittent suction.

A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. The nurse should recognize that preparing this child psychologically is:

necessary because it will be an adjustment.

The nurse is caring for a boy with probable intussusception. He had diarrhea before admission but, while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool. Which nursing action is the most appropriate?

Notify practitioner.

A newborn was admitted to the nursery with a complete bilateral cleft lip and palate. The physician explained the plan of therapy and its expected good results. However, the mother refuses to see or hold her baby. Initial therapeutic approach to the mother should be:

encouraging her to express her feelings.

Bismuth subsalicylate, clarithromycin, and metronidazole are prescribed for a child with a peptic ulcer to:

eradicate Helicobacter pylori.

A nurse is conducting an in-service on childhood gastrointestinal disorders. Which statement is most descriptive of Meckel diverticulum?

Intestinal bleeding may be mild or profuse.

A mother calls the clinic nurse about her 4-year-old son who has acute diarrhea. She has been giving him the antidiarrheal drug loperamide (Imodium A-D). The nurse's response should be based on knowledge that this drug is:

not indicated.

The nurse is explaining to a parent how to care for a school-age child with vomiting associated with a viral illness. Which action should the nurse include?

Brush teeth or rinse mouth after vomiting.

Which is a parasite that causes acute diarrhea?

Giardia lamblia

When caring for a child with probable appendicitis, the nurse should be alert to recognize that which condition or symptom is a sign of perforation?

Sudden relief from pain

A mother who intended to breastfeed has given birth to an infant with a cleft palate. Nursing interventions should include:

encouraging and helping mother to breastfeed.

A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting. Therapeutic management of this child should begin with:

intravenous (IV) fluids.

A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet with the family. Which statement by the parent would indicate a correct understanding of the teaching?

"I should have my child eat a normal diet with easily digested foods for the next 48 hours."

A nurse is admitting a child with Crohn disease. Parents ask the nurse, "How is this disease different from ulcerative colitis?" Which statement should the nurse make when answering this question?

"With Crohn's the inflammatory process involves the whole GI tract."

A child has an NG tube to continuous low intermittent suction. The physician's prescription is to replace the previous 4-hour NG output with a normal saline piggyback over a 2-hour period. The NG output for the previous 4 hours totaled 50 ml. What milliliter/hour rate should the nurse administer to replace normal saline piggyback? (Record your answer in a whole number.)

25 The previous total 4-hour output was 50 ml. To run the 50 ml over a 2-hour period, the nurse would divide 50 by 2 = 25. The normal saline replacement fluid would be run at 25 ml per hour.

A nurse is admitting an infant with biliary atresia. Which is the earliest clinical manifestation of biliary atresia the nurse should expect to assess?

Jaundice

The home care nurse has been visiting an adolescent with recently acquired tetraplegia. The teen's mother tells the nurse, "I'm sick of providing all the care while my husband does whatever he wants to, whenever he wants to do it." Which should be the initial action of the nurse?

Listen and reflect mother's feelings.

A child is admitted with bacterial gastroenteritis. Which lab results of a stool specimen confirm this diagnosis?

Neutrophils and red blood cells

Which statement best characterizes hepatitis A?

Onset is usually rapid and acute.

Which therapeutic management should the nurse prepare to initiate first for a child with acute diarrhea and moderate dehydration?

Oral rehydration solution (ORS)

Which observation made of the exposed abdomen is most indicative of pyloric stenosis?

Palpable olive-like mass

A child who has just had definitive repair of a high rectal malformation is to be discharged. Which should the nurse address in the discharge preparation of this family? (Select all that apply.)

Perineal and wound care Reporting any changes in stooling patterns to practitioner Use of diet modification to prevent constipation

Which is a high-fiber food that the nurse should recommend for a child with chronic constipation?

Popcorn

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.)

Positioning with head elevated on a 30-degree plane Suctioning with a Replogle tube passed orally to the end of the pouch Gastrostomy tube to gravity drainage

Which pathogen is the viral pathogen that frequently causes acute diarrhea in young children?

Rotavirus

Which type of hernia has an impaired blood supply to the herniated organ?

Strangulated hernia

Pyloric stenosis can best be described as:

hypertrophy of the pyloric muscle.

The best chance of survival for a child with cirrhosis is:

liver transplantation.

An infant with pyloric stenosis experiences excessive vomiting that can result in:

metabolic alkalosis.

Caring for the newborn with a cleft lip and palate before surgical repair includes:

providing satisfaction of sucking needs.

A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with GER. The purpose of this is to:

reduce gastric acid production.

An infant with short bowel syndrome will be discharged home on total parenteral nutrition (TPN) and gastrostomy feedings. Nursing care should include:

teaching family signs of central venous catheter infection.

Which condition in a child should alert a nurse for increased fluid requirements?

Fever

Constipation has recently become a problem for a school-age girl. She is healthy except for seasonal allergies that are being treated with antihistamines. The nurse should suspect that the constipation is most likely caused by:

antihistamines.

Which is used to treat moderate to severe inflammatory bowel disease?

Corticosteroids

Which clinical manifestation would be the most suggestive of acute appendicitis?

Abdominal pain that is most intense at McBurney point

Which is an important nursing consideration in the care of a child with celiac disease?

Refer to a nutritionist for detailed dietary instructions and education.

A family wants to begin oral feeding of their 4-year-old son, who is ventilator-dependent and currently tube-fed. They ask the home health nurse to feed him the baby food orally. The nurse recognizes a high risk of aspiration and an already compromised respiratory status. What is the most appropriate nursing action?

Acknowledge their request, explain the risks, and explore with the family the available options.

Parents call the clinic and report that their toddler has had acute diarrhea for 24 hours. The nurse should further ask the parents if the toddler has which associated factor that is causing the acute diarrhea?

Antibiotic therapy

Which vaccine is now recommended for the immunization of all newborns?

Hepatitis B vaccine

Parents of a child undergoing an endoscopy to rule out peptic ulcer disease (PUD) from H. pylori ask the nurse, "If H. pylori is found will my child need another endoscopy to know that it is gone?" Which is the nurse's best response?

"We can collect a stool sample and confirm that the H. pylori has been eradicated."

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.)

Administration of analgesics for pain IV fluids continued until tolerating PO Clear liquids as the first feeding

One of the supervisors for a home health agency asks the nurse to give the family a survey evaluating the nurses and other service providers. How should the nurse interpret this request?

Appropriate to improve quality of care.

During the first few days after surgery for cleft lip, which intervention should the nurse do?

Remove restraints periodically to cuddle infant.

A child has recurrent abdominal pain (RAP) and a dairy-free diet has been prescribed for 2 weeks. Which explanation is the reason for prescribing a dairy-free diet?

To rule out lactose intolerance