Peds GI questions
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.
"Although your child will require surgery, there are different ways to manage the disease, depending on how much bowel is involved." . The aganglionic portion needs to be removed. Although most children have a temporary colostomy placed, many infants are able to bypass the colostomy and have the bowel immediately reattached.
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.
"Genetics play a small role in Hirschsprung disease, so there is a chance the baby will develop it as well." There is a genetic component to Hirschsprung disease, so any future siblings are also at risk.
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?
. Encourage the child to blow bubbles Blowing bubbles is a developmentally appropriate way to help the preschooler take deep breaths and cough.
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?
. Immediately obtain all vital signs with a quick head-to-toe assessment.
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?
. Morphine administered through a PCA pump. Morphine administered through a PCA pump offers the child control over managing pain. The PCA pump also has the benefit of offering a basal rate as well as an as-needed rate for optimal pain management.
. Which would the nurse expect to be included in the diagnostic workup of a child with suspected celiac disease?
. Obtain stool sample and prepare child for jejunal biopsy . A stool sample for analysis of fat and a jejunal biopsy can confirm the diagnosis.
The nurse is caring for an infant newly diagnosed with Hirschsprung disease. What does the nurse understand about this infant's condition?
There is a lack of peristalsis in the large intestine and an accumulation of bowel contents, leading to abdominal distention In Hirschsprung disease, a portion of the large intestine has an area lacking in ganglion cells. This results in a lack of peristalsis as well as an accumulation of bowel contents and abdominal distention
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.
"Give your child 1 /2 ounce of Pedialyte every 10 minutes. If vomiting continues, wait an hour, and then repeat what you previously gave." Offering small amounts of clear liquids is usually well tolerated. If the child vomits, make NPO to allow the stomach to rest and then restart fluids. The child in this scenario is described as playful and therefore does not appear to be at risk for dehydration.
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
"Prilosec decreases stomach acid, so it will not be as irritating when your child spits up."
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?
"The baby is always hungry after vomiting so I refeed." Infants with pyloric stenosis are always hungry and often appear malnourished
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.
"The body's response to gluten causes damage to the mucosal cells in the intestine, leading to absorption problems." . 1. The inability to digest protein leads to an accumulation of an amino acid that is toxic to the mucosal cells and villi, leading to absorption problems
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
"Your baby is too young to be physically capable of spitting out fluids and will automatically swallow anything." Swallowing is a reflex in infants younger than 6 weeks.
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.
"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." In the immediate post-operative period, the child is usually sleepy but can be roused. The child usually has an intravenous line for hydration and pain medication.
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
"Your infant will need to have some tests in the emergency room to determine if anything serious is going on." The infant is displaying signs of intussusception. This is an emergency that needs to be evaluated to prevent ischemia and perforation.
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.
. "A positive Rovsing sign means the child feels pain in the right side of the abdomen when the left side is palpated." A positive Rovsing sign occurs when the left lower quadrant is palpated and pain is felt in the right lower quadrant.
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
. "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 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.
. "Pyloric stenosis can run in families. It is more common among males." Pyloric stenosis can run in families, and it is more common in males.
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
. "The enema will help confirm the diagnosis and has a good chance of fixing the intussusception." In most cases of intussusception in young children, an enema is successful in reducing the intussusception.
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?
. 30 minutes before the feeding . Zantac decreases gastric acid secretion and should be administered 30 minutes before a feeding.
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?
. Continue breastfeeding per routine. . Breastfeeding is usually well tolerated and helps prevent death of intestinal villi and malabsorption.
Which child may need extra fluids to prevent dehydration? Select all that apply 1. 7-day-old receiving phototherapy. 2. 6-month-old with newly diagnosed pyloric stenosis. 3. 2-year-old with pneumonia. 4. 2-year-old with full-thickness burns to the chest, back, and abdomen. 5. 13-year-old who has just started her menses.
1. The lights in phototherapy increase insensible fluid loss, requiring the nurse to monitor fluid status closely. 2. The infant with pyloric stenosis is likely to be dehydrated due to persistent vomiting. 3. A 2-year-old with pneumonia may have increased insensible fluid loss due to tachypnea associated with respiratory illness. The nurse needs to monitor fluid status cautiously because fluid overload can result in increased respiratory distress. 4. The child with a burn experiences extensive extracellular fluid loss and is at great risk for dehydration. The younger child is at greater risk due to greater proportionate body surface area.
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:
2. "We will wait 2 weeks before allowing our child to return to sports." The child should wait 6 weeks before returning to any strenuous activity
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?
3. Right side-lying. The right side-lying position promotes comfort and allows the peritoneal cavity to drain
The mother of a newborn asks the nurse why the infant has to nurse so frequently. Which is the best response?
3. The newborn's stomach capacity is small, and peristalsis is more rapid than in older children The small-stomach capacity and rapid movement of fluid through the digestive system account for the need for small frequent feedings
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.
4. Encourage the parents to hold the infant in an upright position for 30 minutes following a feeding. 5. Suggest that the parents burp the infant after every 1-2 ounces consumed.
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?
4. Cheese, banana slices, rice cakes, and whole milk. 4. Cheese, banana slices, rice cakes, and whole milk do not contain gluten.
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?
4. Immediately notify the physician of the child's status The physician should be notified immediately, as a sudden change or loss of pain often indicates a perforated appendix.
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?
Administer a bolus of normal saline . Dehydration is corrected with the administration of an isotonic solution, such as normal saline or lactated Ringer solution.
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?
After the saline bolus, begin maintenance fluids of D5 1 /4 NS with 10 mEq KCl/L Potassium is contraindicated because the child has not yet urinated. Potassium is not added to the maintenance fluid until kidney function has been verified.
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?
Analysis of serum electrolytes. The analysis of serum electrolytes offers the most information and assists with the diagnosis of dehydration.
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?
Keep infant NPO; begin intravenous fluids at maintenance; place nasogastric tube (NGT) to low wall suction . In addition to giving fluids intravenously and keeping the infant NPO, an NGT is placed to decompress the stomach.
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?
Prepare to get the infant ready for immediate surgical correction. . Intussusception with peritonitis is a surgical emergency, so preparing the infant for surgery is the nurse's top priority