PEDS GI
Immediately notify the physician of the child's status.
A 10-year-old is being evaluated for possible appendicitis and complains 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 should be the nurse's next action?
Analysis of serum electrolytes.
A 4-month-old has had vomiting and diarrhea for 24 hours. The infant is fussy, and the anterior fontanel is sunken. The nurse notes the infant does not produce tears when crying. Which task will help confirm the diagnosis of dehydration?
Administer a bolus of normal saline.
A 4-month-old is brought to the emergency department with severe dehydration. The 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 would the nurse expect to do immediately?
Osmotic agent
A child is diagnosed with chronic constipation that has been unresponsive to dietary and activity changes. Which pharmacological measure is most appropriate?
"NEC occurs only in preemies and low-birth-weight infants."
More education about necrotizing enterocolitis (NEC) is needed in a nursing in-service when one of the participants states:
Immediately obtain all vital signs with a quick head-to-toe assessment.
The nurse is caring for a 3-month-old being evaluated for possible Hirschsprung disease. His parents call the nurse and show her his diaper containing a large amount of mucus and bloody diarrhea. The nurse notes that the infant is irritable and his abdomen appears very distended. Which should be the nurse's next action?
"We will start feeding your child soon so that the bowel continues to receive stimulation."
The nurse is caring for a 3-month-old infant who has short bowel syndrome (SBS) and has been receiving total parenteral nutrition (TPN). The parents ask if their child will ever be able to eat. Select the nurse's best response.
Encourage the child to blow bubbles.
The nurse is caring for a 3-year-old who had an appendectomy 2 days ago. The child has a fever of 101.8°F (38.8°C) and breath sounds are slightly diminished in the right lower lobe. Which action is most appropriate?
Supine.
The nurse is caring for a 4-month-old who has just had an isolated cleft lip repaired. Select the best position for the child in the immediate post-operative period.
30 minutes before the feeding.
The nurse is caring for a 4-month-old with gastroesophageal reflux (GER). The infant is due to receive Zantac (rantadine). Based on the medication's mechanism of action, when should this medication be administered?
"The enema will help confirm the diagnosis and has a good chance of fixing the intussusception."
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 the enema. Select the nurse's most appropriate response.
Keep infant NPO; begin intravenous fluids at maintenance; place nasogastric tube (NGT) to low wall suction
The nurse is caring for a 7-week-old scheduled for a pyloromyotomy in 24 hours. Which would the nurse expect to find in the plan of care?
Continue breastfeeding per routine.
The nurse is caring for a 9-month-old with diarrhea secondary to rotavirus. The child has not vomited and is mildly dehydrated. Which is likely to be included in the discharge teaching?
The child likely has a high anorectal malformation.
The nurse is caring for a neonate with an anorectal malformation. The nurse notes that the infant has not passed any stool per rectum but the infant's urine contains meconium. The nurse can make which assumption?
Administer intravenous fluids and antibiotics.
The nurse is caring for a newborn who has just been diagnosed with tracheo - esophageal fistula and is scheduled for surgery. Which should the nurse expect to do in the pre-operative period?
"Sometimes breastfeeding is still an option for babies with a cleft lip and palate. Would you like more information?"
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.
"I will keep a bag attached to avoid the contents of the small intestine coming in contact with the baby's skin."
The nurse is caring for a newborn with an anorectal malformation and a colostomy. The nurse knows that more education is needed when the infant's parent states which of the following?
Maternal polyhydramnios
The nurse is caring for a newborn with esophageal atresia. When reviewing the mother's history, which would the nurse expect to find?
"The baby is always hungry after vomiting so I refeed."
The nurse is caring for an 8-week-old infant being evaluated for pyloric stenosis. Which statement by the parent would be typical for a child with this diagnosis?
"Although your child will require surgery, there are different ways to manage the disease, depending on how much bowel is involved."
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.
"Genetics play a small role in Hirschsprung disease, so there is a chance the baby will develop it as well."
The nurse is caring for an infant diagnosed with Hirschsprung disease. The mother states she is pregnant with a boy and wants to know if her new baby will likely have the disorder. Select the nurse's best response.
There is a lack of peristalsis in the large intestine and an accumulation of bowel contents, leading to abdominal distention
The nurse is caring for an infant newly diagnosed with Hirschsprung disease. What does the nurse understand about this infant's condition?
"Because your child has a shorter intestine than most, he will not be able to absorb all the nutrients and vitamins in food and will need to get nutrients in other ways."
The nurse is caring for an infant who has been diagnosed with short bowel syndrome (SBS). The parent asks how the disease will affect the child. Select the nurse's best response.
To relieve your child's itching.
The nurse is caring for an infant with biliary atresia. The parents ask why the child is receiving cholestyramine. Select the nurse's best response.
"Pyloric stenosis can run in families. It is more common among males."
The nurse is caring for an infant with pyloric stenosis. The parent asks if any future children will likely have pyloric stenosis. Select the nurse's best response.
"I will clean the area around the GT with soap and water every day."
The nurse is giving discharge instructions to the parent of a 1-month-old infant with tracheoesophageal fistula and a gastrostomy tube (GT). The nurse knows the mother understands the discharge teaching when she states:
Hypothyroidism. Muscular dystrophy. Myelomeningocele. Drinks a lot of milk.
The nurse is interviewing the parents of a 6-year-old who has been experiencing constipation. Which could be a causative factor? Select all that apply.
"We will wait 2 weeks before allowing our child to return to sports."
The nurse is providing discharge instructions to the parents of a child who had an appendectomy for a ruptured appendix 5 days ago. The nurse knows that further education is required when the parent states:
"We will call the physician if the stools change in consistency."
The nurse is providing discharge instructions to the parents of an infant who has had surgery to open a low imperforate anus. The nurse knows that the discharge instructions have been understood when the child's parents say:
If the hernia appears to be more swollen or tender, seek medical care immediately.
The nurse is providing discharge teaching to the parents of an infant with an umbilical hernia. Which should be included in the plan of care?
"Your child will be very sleepy and have an intravenous line in the hand. If your child needs pain medication, we will give it intravenously."
The nurse is to receive a 4-year-old from the recovery room after an appendectomy. The parents have not seen the child since surgery and ask what to expect. Select the nurse's best response
The fundus of the stomach is wrapped around the inferior esophagus, mimicking a cardiac sphincter.
The nurse knows that Nissen fundoplication involves which of the following?
"Your infant will need to have some tests in the emergency room to determine if anything serious is going on."
The nurse receives a call from the mother of a 6-month-old who describes her child as alternately 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.
"Give your child 1 /2 ounce of Pedialyte every 10 minutes. If vomiting continues, wait an hour, and then repeat what you previously gave."
The nurse receives a call from the parent of a 10-month-old who has vomited three times in the past 8 hours. The parent describes the baby as playful and wanting to drink. The parent asks the nurse what to give the child. Select the nurse's best response.
Prepare to get the infant ready for immediate surgical correction.
The nurse will soon receive a 4-month-old who has been diagnosed with 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 is the most appropriate action for the receiving nurse?
"Pedialyte is really the best thing for your child. Allow your child some choice in the way to take it by offering small amounts in a spoon, medicine cup, or syringe."
The parent of a 5-year-old states that the child has been having diarrhea for 24 hours, vomited twice 2 hours ago, and now claims to be thirsty. The parent asks what to offer the child because the child is refusing Pedialyte. Select the nurse's most appropriate response
"The body's response to gluten causes damage to the mucosal cells in the intestine, leading to absorption problems."
The parent of a child being evaluated for celiac disease asks the nurse why it is important to make dietary changes. Select the nurse's best response.
"Your baby is too young to be physically capable of spitting out fluids and will automatically swallow anything."
The parent of a newborn asks, "Will my baby spit out the formula if it is too hot or too cold?" Select the nurse's best response.
"Encourage your child to drink more fluids."
The parents of a 4-year-old ask the nurse how to manage their child's constipation. Select the nurse's best response.
"A positive Rovsing sign means the child feels pain in the right side of the abdomen when the left side is palpated."
The parents of a child being evaluated for appendicitis tell the nurse the physician said their child has a positive Rovsing sign. They ask the nurse what this means. Select the nurse's best response.
"The lip is repaired in the first few weeks of life, but the palate is not usually repaired until the child is 18 months old."
The parents of a newborn diagnosed with a cleft lip and palate ask the nurse when their child's lip and palate will most likely be repaired. Select the nurse's best response.
A 2-year-old who had a relapse of one diarrhea episode after restarting a normal diet.
Which child can be discharged without further evaluation
7-day-old receiving phototherapy. 6-month-old with newly diagnosed pyloric stenosis. 2-year-old with pneumonia. 2-year-old with full-thickness burns to the chest, back, and abdomen.
Which child may need extra fluids to prevent dehydration? Select all that apply.
Offer a diet high in protein.
Which discharge instruction for a child diagnosed with encopresis should the nurse question?
A tuna sandwich on whole wheat bread and a cup of skim milk.
Which foods should be offered to a child with hepatitis?
A palliative procedure in which the bile duct is attached to a loop of bowel to assist with bile drainage.
Which is an accurate description of a Kasai procedure?
Right side-lying
Which is the best position for an 8-year-old who has just returned to the pediatric unit after an appendectomy for a ruptured appendix?
Abdominal distention, enlarged liver, enlarged spleen, clay-colored stool, and tea-colored urine
Which manifestation would the nurse expect to see in a 4-week-old infant with biliary atresia?
Nausea, vomiting, and generalized malaise.
Which manifestations should the nurse expect to find in a child in the early stages of acute hepatitis?
Allow the infant to have familiar items of comfort such as a favorite stuffed animal and a "sippy" cup. Administer pain medication on a regular schedule, as opposed to an as-needed schedule.
Which should be included in the plan of care for a 14-month-old whose cleft palate was repaired 12 hours ago? Select all that apply.
Encourage the parents to hold the infant in an upright position for 30 minutes following a feeding. Suggest that the parents burp the infant after every 1-2 ounces consumed
Which should the nurse include in the plan of care to decrease symptoms of gastroesophageal reflux (GER) in a 2-month-old? Select all that apply
Playing with puzzles in bed.
Which would be an appropriate activity for the nurse to recommend to the parent of a toddler just diagnosed with acute hepatitis?
Obtain stool sample and prepare child for jejunal biopsy.
Which would the nurse expect to be included in the diagnostic workup of a child with suspected celiac disease?
Morphine administered through a PCA pump.
. The nurse is caring for a 5-year-old who has just returned from having an appendectomy. Which is the optimal way to manage pain?
Bloody diarrhea.
. Which manifestation suggests that an infant is developing necrotizing enterocolitis (NEC)?
Take the infant from the mother, and administer blow-by oxygen while obtaining the infant's oxygen saturation.
. Which should be the nurse's immediate action when a newborn begins to cough and choke and becomes cyanotic while feeding?
More often in premature infants.
An expectant mother asks the nurse if her new baby will have an umbilical hernia. The nurse bases the response on the fact that it occurs:
After the saline bolus, begin maintenance fluids of D5 1 /4 NS with 10 mEq KCl/L.
The nurse is caring for a 2-year-old child who was admitted to the pediatric unit for moderate dehydration due to vomiting and diarrhea. The child is restless, with periods of irritability. The child is afebrile with a heart rate of 148 and a blood pressure of 90/42. Baseline laboratory tests reveal the following: Na 152, Cl 119, and glucose 115. The parents state that the child has not urinated in 12 hours. After establishing a saline lock, the nurse reviews the physician's orders. Which order should the nurse question?
The newborn's stomach capacity is small, and peristalsis is more rapid than in older children.
The mother of a newborn asks the nurse why the infant has to nurse so frequently. Which is the best response?
"Prilosec decreases stomach acid, so it will not be as irritating when your child spits up."
The nurse is administering Prilosec (omeprazole) to a 3-month-old with gastro - esophageal reflux (GER). The child's parents ask the nurse how the medication works. Select the nurse's best response.
Prepare to administer antibiotics intravenously.
The nurse is caring for a 1-month-old term infant who experienced an anoxic episode at birth. The health-care team suspects that the infant is developing necrotizing en - terocolitis (NEC). Which would the nurse expect to be included in the plan of care?
Cheese, banana slices, rice cakes, and whole milk.
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?
