Chapter 42 PrepU GI
The nurse is talking with a woman in her second trimester of pregnancy who has been diagnosed with polyhydramnios. The physician has ordered an ultrasound be performed to check for the presence of esophageal atresia. Which statement by the woman indicates an understanding of the relationship between these conditions?
"Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup."
A 4-month-old has had a fever, vomiting, and loose watery stools every few hours for 2 days. The mother calls the physician's office and asks the nurse what she should do. Which response by the nurse is most appropriate?
"Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment."
The nurse is teaching the mother of an infant with a temporary ileostomy about stoma care. What is the most important instruction to emphasize to the mother to avoid an emergency situation?
"Call the doctor immediately if the stoma is not pink/red and moist."
The nurse is caring for a 2-year-old boy with an umbilical hernia and is teaching the mother about this condition. Which response from the mother indicates a need for further teaching?
"I can tape a quarter over the hernia to reduce it."
The nurse has performed client education for a 15-year-old boy with Crohn disease and his parents regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning has occurred?
"I have to be careful because I am prone to not absorbing nutrients."
The nurse is caring for an infant recently diagnosed with oral candidiasis (thrush) who has been prescribed nystatin. Which statement by the infant's mother would suggest a need for further education?
"I will add the nystatin to her bottle four times per day."
The parent of a 3-week-old infant brings the infant in for an evaluation. During the visit, the parent tells the nurse that the infant is spitting up after feedings. Which response by the nurse would be most appropriate?
"Infants this age commonly spit up."
The student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply.
"Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "The only treatment for celiac disease is a strict gluten-free diet." "Gluten is found in most wheat products, rye, barley and possibly oats."
The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis?
"The treatment for the disorder will be a surgical procedure."
The nurse is caring for a newborn diagnosed with imperforate anus following delivery. The physician has discussed the treatment options and prognosis with the parents. The nurse is talking with the parents and determines that learning has occurred when the parents make which statement?
"We are worried that our child may have other congenital problems that we aren't aware of."
A school-aged child is brought to the emergency room with severe abdominal pain. The nurse performs a physical assessment. Which assessment parameters indicate appendicitis? Select all that apply.
- Normal to hyperactive bowel sounds early - Hypoactive bowel sounds with perforation - Irritation and pain in the right lower quadrant - Low-grade fever, nausea, anorexia, and vomiting
The nurse is caring for a child prescribed vancomycin 15 mg/kg IV every 6 hours for peritonitis. The child weights 45 lb (20.5 kg). How many milligrams will the nurse administer to this child in 24 hours?
1230
Which client most likely has ulcerative colitis rather than Crohn disease?
16-year-old female with continuous distribution of disease in the colon, distal to proximal
The infant is listless with sunken fontanels (fontanelles) and has been diagnosed with dehydration. The infant is still producing at least 1 mL/kg each hour of urine. The infant weighs 13.2 lb (6 kg). At the minimum, how many milliliters of urine will the infant produce during the next 8-hour shift? Record your answer using a whole number.
48
The nurse is providing care to a child who has had an appendectomy for a perforated appendix. The nurse would anticipate intravenous antibiotic therapy for how long?
7 to 14 days
The nurse is caring for a pediatric client with idiopathic celiac disease. Which meal will the nurse select for this client?
Baked salmon, potato slices, vanilla ice cream, and apple juice
A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition?
Barium enema
The nurse is taking a health history of a 2-year-old girl presenting with a sudden onset of severe vomiting. Which description would suggest an obstruction?
Bilious vomiting
The mother of a newborn with a cleft lip reports she is having a hard time looking her baby. What is the best action by the nurse?
Encourage the mother to provide care for her infant.
A neonatal nurse teaches students how to recognize gastrointestinal disorders in infants. The nurse tells the students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease?
Hirschsprung disease
A child is hospitalized with dehydration as a result of rotavirus. When reviewing the plan of treatment, what can the nurse anticipate will be included? Select all that apply.
IV fluid administration monitor of intake and output daily weight assessment
The nurse is caring for a child with a diagnosis of pyloric stenosis during the preoperative phase of the child's treatment. What is the highest priority at this time?
Improving hydration
A 9-month-old girl is brought to the emergency room with what appears to be bouts of intense abdominal pain 15 minutes apart in which she draws up her legs and cries, often accompanied by vomiting. In between the bouts, the child recovers and appears to be without symptoms. Blood is found in the stool. What condition should the nurse suspect in this case?
Intussusception
A 10-year-old male presents with low-grade fever, nausea, and abdominal pain. The nurse examining him suspects appendicitis and checks for rebound tenderness in what quadrant?
Lower right
The nurse is caring for a teenager diagnosed with acute pancreatitis. Which order would the nurse question?
PO pain management
The nurse is caring for a child admitted with pyloric stenosis. Which clinical manifestation would likely have been noted in the child with this diagnosis?
Projectile vomiting
A child with inflammatory bowel disease is started on an anti-inflammatory medication. Which item(s) would the nurse teach the child and parents about being on this type of medication? Select all that apply.
Use sunscreen and protective clothing while outside. Increase folic acid intake. Drink adequate fluids to avoid crystallization of sulfa in urine. Administer the medication just after meals to avoid gastrointestinal irritation.
A mother brings her 3-year-old son to the ER and tells the triage nurse that he has been vomiting blood. A medical history determines that the 3-year-old has no history of GI disturbances and his only symptoms are a slightly elevated fever and vomiting bright red blood. Based on these symptoms, what condition might the nurse suspect?
acute upper GI bleeding
A 3-year-old child has been brought to the clinic for assessment of chronic constipation. After ruling out an organic cause, what will the nurse prioritize in the child's plan of care?
administering over-the-counter stool softeners but for no longer than 1 week
A child is diagnosed with short bowel syndrome. What would the nurse expect to be included in the child's plan of care? Select all that apply.
antibiotics vitamin supplements total parenteral nutrition
The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which foods would be permitted in the diet of the child with celiac syndrome? Select all that apply.
applesauce bananas skim milk
A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason?
detect Helicobacter pylori
A nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. What GI condition might this history precipitate?
esophageal atresia (EA)
The nurse is caring for a 12-year-old child with Crohn disease. What assessment finding will the nurse report to the health care provider when caring for the child?
fever
An 18-month-old infant is brought to the emergency department with flu-like symptoms. The infant is diagnosed with pneumonia secondary to aspiration of stomach contents. The nurse explains to the parents that pneumonia is a condition that often occurs secondary to:
gastroesophageal reflux disease.
The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis?
hard, moveable "olive-like mass" in the upper right quadrant
The parent reports that the health care provider said that the infant had a hernia but cannot remember which type. When recalling what the health care provider said, the parent said that a surgeon will repair it soon and there is no problem with the testes. Which hernia type is anticipated?
inguinal hernia
A toddler is being seen in the clinic. The parents describe a 2-day history of vomiting and diarrhea. The nurse's assessment finds the toddler is listless, has pale and slightly dry mucous membranes, and has decreased skin turgor. Based on this assessment, what intervention would the nurse implement first?
oral rehydration therapy
The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is:
painless rectal bleeding.
A parent brings a 10-year-old child to the emergency room with reports of abdominal pain. The nurse performing a physical assessment notes the following symptoms: upper right quadrant pain that radiates to the back; fever; nausea; and abdominal distention. Which disease would the nurse suspect?
pancreatitis
The nurse is assessing a toddler and palpates a sausage-shaped mass in the upper mid abdomen. When taking the toddler's history, what question would the nurse ask the parent first?
"Has your toddler been having different colored stools?"
The mother of an infant tells the nurse during a routine visit to the clinic that she often notices a bulging mass in the lower abdominal and groin area when her baby cries. She asks the nurse if this is normal. How should the nurse respond?
"I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately."
A nurse is caring for a 6-year-old girl recently diagnosed with celiac disease and is discussing dietary restrictions with the girl's mother. Which response indicates a need for further teaching?
"My daughter can eat any kind of fruit."
The nurse is preparing a client for surgery and the client asks, "What does it mean when they say they are going to reduce my abdominal hernia?" Which response by the nurse is mostappropriate?
"This means the hernia contents will be manipulated back into your peritoneal cavity during surgery."
A child is experiencing an acute exacerbation of Crohn disease for which she is prescribed prednisone. The nurse teaches the parents and child about this medication. Which statement by the parents indicates that the teaching was successful?
"We should not stop this medication abruptly."
A nurse manages the interdisciplinary care for an infant born with an omphalocele. What is an accurate description of the care for an omphalocele?
Obtain IV access to give fluid resuscitation and correct any electrolyte abnormalities.
The emergency department nurse is assessing a child who has presented with a 2-day history of nausea and vomiting with pain that is isolated to the right upper quadrant of the abdomen. Which action is most appropriate?
Prepare the child for admission to the hospital.
An adolescent has hepatitis B. What would be the most important nursing action?
Strict enforcement of standard precautions
The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration?
Tenting of skin
An adolescent is diagnosed with hepatitis A. Which problem should be considered when planning care?
The adolescent will become fatigued easily.
What occurs in the gastrointestinal system of the child with Hirschsprung disease?
There is a partial or complete mechanical obstruction in the intestine.
A mother is alarmed because her 6-week-old boy has begun vomiting almost immediately after every feeding. In the past week, the vomiting has grown more forceful, with the vomit projecting several feet from his mouth. He is always hungry again just after vomiting. At the physician's office, the nurse holds the child and offers him a bottle. While he drinks, the nurse notes an olive-size lump in his right abdomen. Which condition should the nurse suspect in this child?
pyloric stenosis
A nurse caring for an infant born with a cleft palate notices that the parents rarely interact with their child. The nurse overhears the mother telling her spouse that she "feels like crying" every time she looks at their infant. What would be the best response from the nurse?
"I sense you could use more information on caring for a cleft palate. Would you be interested in meeting with other parents who have dealt with this?"
The nurse is teaching the mother of a 5-year-old boy with a history of impaction how to administer enemas at home. Which response from the mother indicates a need for further teaching?
"I should position him on his abdomen with knees bent."
The mother of a young child who has been treated for a bacterial urinary tract infection tells the nurse her daughter has a white thick covering over her tongue. The mother states that she "has tried everything to get it off my child's tongue." How should the nurse respond?
"It's not unusual for a fungal infection to occur while taking an antibiotic for an infection. I will let your primary care provider know so we can get it treated."
The nurse is caring for a 4-year-old with oral vesicles and ulcers from herpangina. The child is refusing fluids due to the pain and the mother is concerned about his hydration status. Which of the suggestions would be most appropriate?
"Offer 'magic mouthwash' followed by a popsicle."
The nurse is collecting data on a 2-year-old child admitted with a diagnosis of gastroenteritis. When interviewing the caregivers, which question is most important for the nurse to ask?
"Tell me about the types of stools your child has been having."
The nurse is caring for a 13-year-old girl with suspected autoimmune hepatitis. The girl inquires about the testing required to evaluate the condition. How should the nurse respond?
"You will most likely have a blood test to check for certain antibodies."
The nurse is caring for a child who was dehydrated following gastric surgery but has since been rehydrated. The health care provider prescribes intravenous maintenance fluids for the child. Calculate the intravenous maintenance fluid rate per hour for this child, who weighs 40 kg. Record your answer using a whole number.
79
The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child?
Effortless vomiting just after the child has eaten
The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is mostaccurate related to the diagnosis of gastroesophageal reflux?
In this disorder the sphincter that leads into the stomach is relaxed.
In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention?
Prepare the infant for surgery.
The nurse is caring for a 6-month-old infant with diarrhea and dehydration. The parent is concerned because the infant has some patches on the tongue. Which feature indicates a geographic tongue?
Some patches are light in color and other patches are dark in color.
A 6-week-old infant is diagnosed with pyloric stenosis. When taking a health history from the parent, which symptom would the nurse expect to hear described?
Vomiting immediately after feeding
The nurse is reviewing the medical record of a child with a cleft lip and palate. When reviewing the child's history, what would the nurse identify as a risk factor for this condition?
mother age 42 with pregnancy
The caregiver of a child diagnosed with celiac disease tells the nurse that the child has large amounts of bulky stools and what looks like fat in the stools. The clinical manifestation this caregiver is describing is:
steatorrhea.
A child with liver cirrhosis is admitted to the acute care facility in preparation for a liver transplant. What finding(s) would the nurse document after completing this child's assessment? Select all that apply.
yellow skin and sclera liver palpable palms of hands reddened confused mental status
The student nurse is caring for a child with the nursing diagnosis "Risk for fluid volume deficit related to inadequate oral intake." Which statement by the student would indicate a need for further education by the nursing instructor?
"I will make sure there is plenty of orange juice available. It's her favorite juice."
The nurse is caring for a 6-month-old infant who was admitted to the emergency department 24 hours ago with signs of severe diarrhea. The infant's rectal temperature is 104°F (40°C), with weak and rapid pulse and respirations. The skin is pale and cool. The child is on IV rehydration therapy, but the diarrhea is persisting. The infant has not voided since being admitted. Which is the prioritynursing intervention?
Take a stool culture
A 3-month-old is admitted with severe diarrhea. Yesterday, the infant weighed 11 pounds (5 kg). Today, this infant weighs 9 pounds, 8 ounces (4.3 kg). Based on this information the nurse documents that the infant has:
severe dehydration.
A child is admitted with a temperature, 101.2°F (38.4°C); pulse rate 100 beats/min; respirations 24 breaths/min. On admission the pain is localized in right lower quadrant. Legs are drawn up against the abdomen. Bowel sounds are sluggish. Rebound tenderness is present. White blood cell count of 17,000/mm3. Ultrasound confirms appendicitis. Which instruction would the nurse give to the child and the parent?
Do not rub or put pressure on the abdomen.
The nurse is administering an enteral feeding to a child with a gastrostomy tube (G-tube). Which action will the nurse take when administering a prescribed feeding through the client's G-tube?
Check for gastric residual before starting feeding.
