Peds PrepU: Chapter 20

An 8-month-old infant is brought to the clinic for evaluation. The mother tells the nurse that she has noticed some white patches on the infant's tongue that look like curdled milk after breastfeeding. The nurse suspects oral candidiasis (thrush). Which question would the nurse use to help confirm this suspicion? A) "Are you having breast pain when you nurse the baby?" B) "Has he had any dairy problems recently?" C) "Is he experiencing any vomiting lately?" D) "How have his stools been this past week?"

"Are you having breast pain when you nurse the baby?" The infant may develop thrush from the mother if the mother has a fungal infection of the breast. Asking the mother about breast pain would be important because this type of infection can cause the mother a great deal of pain with nursing. Dairy products are not associated with oral candidiasis but are associated with the development of infectious diarrhea in infants. Vomiting is unrelated to thrush. The infant also may have candidal diaper rash, but this would be manifested on the skin as a beefy-red rash with satellite lesions, not in his stools.

The nurse is preparing an 18-month-old for discharge after treatment for dehydration following diarrhea. Which of the following would the nurse most likely include in the discharge teaching? a) "Give her plenty of fruit juice or soda." b) "Make sure she gets lots of clear liquids." c) "Offer her flavored gelatin if she is hungry." d) "Encourage bananas, applesauce, and crackers."

"Encourage bananas, applesauce, and crackers." Correct Explanation: After rehydration is achieved it is important to encourage the child to consume a regular diet in order to maintain energy and growth. The solid foods presented are easily digested and age appropriate. The parents should avoid prolonged used of clear liquids in the child with diarrhea because "starvation stools" might result. Fluids high in glucose such as fruit juice, gelatin, and soda may worsen diarrhea. Gelatin is high in glucose and may worsen diarrhea.

The nurse is taking a health history of an 11-year-old girl with recurrent abdominal pain. Which response would lead the nurse to suspect irritable bowel syndrome? A) "I always feel better after I have a bowel movement." B) "I don't take any medicine right now." C) "The pain comes and goes." D) "The pain doesn't wake me up in the middle of the night."

"I always feel better after I have a bowel movement." In cases of irritable bowel syndrome, the pain may be relieved by defecation. Use of medications and pain that comes and goes or wakes the person up in the middle of the night are all relevant findings pertinent to recurrent abdominal pain.

The nurse has performed client teaching to 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 occurred? A) "I have a lot of diarrhea every day because of how my small intestine is damaged." B) "It's unusual for someone my age to get Crohn disease." C) "I may end up with a colectomy because the disease is continuous from the beginning to the end of my intestines." D)"I have to be careful because I am prone to not absorbing nutrients."

"I have to be careful because I am prone to not absorbing nutrients." Crohn disease typically effects the small intestine more than the large intestine and it's onset is between the ages of 10 to 20 years. The cobblestone lesions in the small intestine prevents absorption of nutrients that normally occurs. The diarrhea is not directly related to the cobblestone lesions, and ulcerative colitis is characterized by the disease effecting the intestine(s) in a continuous pattern.

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? A) "I should position him on his abdomen with knees bent." B) "He will require 250 to 500 mL of enema solution." C) "I should wash my hands and then wear gloves." D) "He should retain the solution for 5 to 10 minutes."

"I should position him on his abdomen with knees bent." A 5-year-old child should lie on his left side with his right leg flexed toward the chest. An infant or toddler is positioned on his abdomen. Using 250 to 500 mL of solution, washing hands and wearing gloves, and retaining the solution for 5 to 10 minutes are appropriate responses.

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? A) "I will weigh her every morning at the same time." B) "I will make sure there is plenty of orange juice available. It's her favorite juice." C) "I will monitor her IV line to help maintain her fluid volume." D) "I will teach her mother to give her small drinks frequently."

"I will make sure there is plenty of orange juice available. It's her favorite juice." Proper interventions for children at risk for fluid volume deficit include maintaining IV line and administer IV fluid as ordered to maintain fluid volume. Offer small amounts of oral rehydration solution frequently to maintain fluid volume. Small amounts are usually well tolerated by children with diarrhea and vomiting. Avoid high-carbohydrate fluids such as Kool-Aid and fruit juice, as they are low in electrolytes, and increased simple carbohydrate consumption can decrease stool transit time. Daily weights are one of the best indicators of fluid volume status in children.

The nurse is collecting data on a 2-year-old child admitted with a diagnosis of gastroenteritis. When interviewing the caregivers, which of the following questions would be most important for the nurse to ask? a) "Tell me about the types of stools you child has been having." b) "What foods has your child eaten during the last few days." c) "How many times a day does your child urinate?" d) "How long has your child been toilet trained?"

"Tell me about the types of stools you child has been having." Explanation: For the child with gastroenteritis, the interview with the family caregiver must include specific information about the history of bowel patterns and the onset of diarrheal stools, with details on number and type of stools per day. Recent eating patterns, if the child is toilet trained, and how many times a day the child urinates are important questions, but the highest priority is gathering data regarding the stools and stool pattern.

The school nurse is working with a 10-year-old girl with recurrent abdominal pain. The girl's teacher has been less than understanding about the frequent absences and trips to the nurse's office. How should the nurse respond? A) "Be patient; she is trying some new medication." B) "The pain she is having is real." C) "The family is working toward improvement." D) "Please do not add to this family's stress."

"The pain she is having is real." It is important to educate the teacher that this recurrent abdominal pain is a true pain that the child feels and it is not "in her mind." Telling the teacher not to add to the family's stress or that the family is working toward improvement does not teach. The nurse must have the permission of the family to discuss the girl's medication.

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? a) "We should not stop this medication abruptly." b) "This drug helps to control the abdominal cramping." c) "She might lose some weight initially." d) "We might notice some of the medication in her stool"

"We should not stop this medication abruptly." Explanation: Prednisone is a corticosteroid. Stopping the medication abruptly could lead to adrenal insufficiency. Weight gain would be associated with corticosteroid use. Weight loss is associated with the disease. Corticosteroids help to reduce inflammation and suppress the normal immune response. Typically, anti-inflammatory agents such as mesalamine may appear in the stool. This indicates poor absorption

A group of nursing students are reviewing information about inflammatory bowel disease in preparation for a class discussion on the topic. The students demonstrate understanding of the material when they identify which characteristics of Crohn disease? Select all that apply. A) Distributed in a continuous fashion B) Most common between the ages of 10 to 20 years C) Elevated erythrocyte sedimentation rate D) Low serum iron levels E) Tenesmus F) Loss of haustra within bowel

- Most common between the ages of 10 to 20 years - Elevated erythrocyte sedimentation rate - Low serum iron levels Crohn disease is most common between the ages of 10 and 20 years. Erythrocyte sedimentation rate is elevated and serum iron levels are low. Ulcerative colitis is distributed continuously distal to proximal, with tenesmus and loss of haustra within the bowel. Crohn disease is segmental, with disease-free skip areas common, and the bowel wall has a cobblestone appearance.

The nurse is determining maintenance fluid requirements for a child who weighs 25 kg. How much fluid would the child need per day? A) 1,560 mL B) 1,600 mL C) 1,650 mL D) 1,700 mL

1,600 mL Using the following formula of 100 mL/kg for the first 10 kg, plus 50 mL/kg for the next 10 kg, and then 20 mL/kg for the remaining kg, the child would require (100 x 10) + (50 x 10) + (20 x 5) = 1,000 + 500 + 100 = 1,600 mL in 24 hours.

The child has been diagnosed with severe dehydration. The physician has ordered the nurse to administer a bolus of 20 mL/kg of normal saline over a 2-hour period. The child weighs 63.5 pounds. How should the nurse set the child's intravenous administration pump? (mL/hour) Round to the nearest whole number. ___ mL/hour

289 Explanation: The child weighs 63.5 pounds. 63.5 pounds x 1 kg/2.2 pounds = 577.2727 mL 577.2727 mL of normal saline/2 hours = 288.6364 mL Rounded to the nearest whole number = 289 mL/hour

The infant is listless with sunken fontanels 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 pounds. At the minimum, how many milliliters of urine will the infant produce during the next 8-hour shift? ___ ml

48 Explanation: 13.2 pounds x 1 kg/2.2 pounds = 6 kg 6 kg x 1 mL/kg = 6 mL/hour 6 mL x 8 hours = 48 mL/8-hour shift

After teaching the parents of a 6-year-old how to administer an enema, the nurse determines that the teaching was successful when they state that they will give how much solution to their child? A) 100 to 200 mL B) 200 to 300 mL C) 250 to 500 mL D) 500 to 1,000 mL

500 to 1,000 mL For a school-age child, typically 500 to 1,000 mL of enema solution is given. For an infant, 250 mL or less is used; for a toddler or preschooler, 250 to 500 mL is used.

The nurse is preparing to administer intravenous fluids to manage a child with dehydration. The medical record indicates the child weighs 60 pounds (27.2 kg). How many milliliters will initially be administered? Record your answer using two decimal places.

545.45 mL Nursing goals for the infant or child with dehydration are aimed at restoring fluid volume and preventing progression to hypovolemia. Provide oral rehydration to children for mild to moderate states of dehydration. Children with severe dehydration should receive intravenous fluids. Initially, administer 20 mL/kg of normal saline or lactated Ringer, and then reassess the hydration status.

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 which time frame? a) 7 to 14 days b) 1 to 3 days c) 3 to 5 days d) 5 to 7 days

7 to 14 days Explanation: The child with a perforated appendix requires 7 to 14 days of intravenous antibiotic therapy. If the child has a suppurative or gangrenous appendix that was not perforated, 2 to 3 days of antibiotics would be most likely ordered.

The nurse is conducting a physical examination of an 18-month-old with suspected intussusception. Which of the following findings would the nurse identify as the hallmark of this condition? a) A sausage-shaped mass in the upper midabdomen b) Abdominal pain and guarding c) Perianal skin tags d) Skin tenting

A sausage-shaped mass in the upper midabdomen Explanation: A sausage-shaped mass in the upper midabdomen is the hallmark of intussusception. Perianal skin tags are highly suspicious of Crohn disease. Abdominal pain and guarding are also common with intussusception but are seen with many other conditions. Tenting would indicate dehydration

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 most accurate related to the diagnosis of pyloric stenosis? a) A partial or complete intestinal obstruction occurs. b) In this disorder the sphincter that leads into the stomach is relaxed. c) There are recurrent paroxysmal bouts of abdominal pain. d) A thickened, elongated muscle causes an obstruction at the end of the stomach.

A thickened, elongated muscle causes an obstruction at the end of the stomach. Correct Explanation: Pyloric stenosis is characterized by hypertrophy of the circular muscle fibers of the pylorus, with a severe narrowing of its lumen. The pylorus is thickened to as much as twice its size, is elongated, and has a consistency resembling cartilage. As a result of this obstruction at the distal end of the stomach, the stomach becomes dilated. Congenital aganglionic megacolon is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Colic consists of recurrent paroxysmal bouts of abdominal pain. Gastroesophageal reflux (GER) occurs when the sphincter in the lower portion of the esophagus is relaxed and allows gastric contents to be regurgitated back into the esophagus.

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? a) GI tract obstruction b) Intussusception c) Gastroesophageal reflux d) Acute upper GI bleeding

Acute upper GI bleeding Correct Explanation: Vomiting bright red blood indicates acute upper GI bleeding. Emesis containing brown, foul-smelling stool indicates GI obstruction. Stool with red blood and mucus is associated with intussusception. Bleeding is not generally indicative of gastroesophageal reflux.

The nurse is performing a gastrointestinal assessment on a 7-year-old boy. The parents are assisting with the history. Which assessment findings are indicative of constipation? Select all that apply. A) "Our child only has 3 to 4 bowel movements per week." B) "Our child complains of pain because his bowel movements are so hard." C) "Our child tells us that his belly hurts a lot of the time." D) "I can tell he holds his bowel movement much of the time because of the way he stands." E) "I find smears of stool in his underwear almost every day."

B,C,D,E Pain, stool withholding behavior (retentive posturing), and encopresis (soiling of fecal contents into the underwear beyond the age of expected toilet training) are all signs of chronic functional constipation. Less than 3 bowel movements is considered constipation.

The nurse is doing dietary teaching with the caregivers of a child diagnosed with idiopathic celiac disease. Of the following foods, which would most likely be appropriate in the child's diet? a) Oatmeal b) Potatoes c) Toast d) Bananas

Bananas Correct Explanation: The young child should be started on a starch-free, low-fat diet. Bananas contain invert sugar and are usually well tolerated. Products that contain wheat, rye, or oats should be excluded

A child is diagnosed with intussusception. The nurse anticipates that which of the following would be attempted first to reduce this condition? a) Endoscopic retrograde cholangiopancreatography b) Surgery c) Upper endoscopy d) Barium enema

Barium enema Explanation: A barium enema is successful in reducing a large percentage of intussusception cases. Other cases are reduced surgically. Upper endoscopy is used to visualize the upper gastrointestinal tract from the mouth to the upper jejunum. Endoscopic retrograde cholangiopancreatography is used to view the hepatobiliary system.

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? A) "Give a clear pediatric electrolyte replacement for the next few hours, then call back to report on how your child is doing." B) "Do not give the child anything to drink for 4 hours. If the fever goes down and the loose stools stop, you can resume breastfeeding." C) "Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." D) "Continue breastfeeding as you have been doing. The fluid from the breast milk is important to maintain fluid balance."

C) "Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." Infants are comprised of a high percentage of fluid that can be lost very quickly when vomiting, fever, and diarrhea are all present. This infant needs to be seen by the physician based on her age and symptoms; hospitalization may be necessary for intravenous rehydration depending upon her status when assessed.

The nurse is caring for a 4-year-old boy who has undergone an appendectomy. The child is unwilling to use the incentive spirometer. Which approach would be most appropriate to elicit the child's cooperation? A) "Can you cough for me please?" B) "You must blow in this or you might get pneumonia." C) "If you don't try, I will have to get the doctor." D) "Can you blow this cotton ball across the tray?"

Can you blow this cotton ball across the tray Children are more likely to cooperate with interventions if play is involved. Encourage deep breathing by playing games. Asking the boy to cough is less likely to engage him. Telling the child he might get pneumonia is not age appropriate and is unhelpful. Threatening to call the doctor is unhelpful and inappropriate. Remember, however, that the incentive spirometer works on the principle of the amount of air inhaled, not exhaled. Having the child take a deep breath prior to blowing the cotton ball is a beginning step.

The nurse is providing care to a child with an intussusception. The child has a bowel movement and the nurse inspects the stool. The nurse would most likely document the stool's appearance as having what quality? A) Greasy B) Clay-colored C) Currant jellyñlike D) Bloody

Currant jelly-like The child with intussusception often exhibits currant jelly-like stools that may or may not be positive for blood. Greasy stools are associated with celiac disease. Clay-colored stools are observed with biliary atresia. Bloody stools can be seen with several gastrointestinal disorders, such as inflammatory bowel disease.

The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration? A) Pale and slightly dry mucosa B) Soft and flat fontanels C) Blood pressure of 80/42 mm Hg D) Tenting of skin

D) Tenting of skin Tenting of skin is an indicator of severe dehydration. Soft and flat fontanels indicate mild dehydration. Pale and slightly dry mucosa indicates mild or moderate dehydration. Blood pressure of 80/42 mm Hg is a normal finding for an infant.

A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason? a) Confirm pancreatitis b) Evaluate gastric pH c) Determine esophageal contractility d) Detect Helicobacter pylori

Detect Helicobacter pylori Explanation: Urea breath test is used to detect the presence of H. pylori in the exhaled breath. This test does not evaluate gastric pH. Serum amylase and lipase levels are used to confirm pancreatitis. Esophageal manometry is used to evaluate esophageal contractile activity and effectiveness.

The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which of the following clinical manifestations would likely be seen in this child? a) Forceful vomiting followed by the child being eager to eat again. b) Effortless vomiting just after the child has eaten. c) Severe constipation with occasional ribbon-like stools d) Bouts of diarrhea with failure to gain weight

Effortless vomiting just after the child has eaten. Explanation: Almost immediately after feeding, the child with gastroesophageal reflux vomits the contents of the stomach. The vomiting is effortless, not projectile in nature.

A preschooler has celiac disease. Her mother is preparing a gluten-free diet. By preparing which breakfast foods would you believe she understands the diet? a) Eggs and orange juice b) Rye toast and peanut butter c) Wheat toast and grape jelly d) Cheerios (oat cereal) and skim milk

Eggs and orange juice Correct Explanation: Children with celiac disease cannot digest the protein in common grains, such as wheat, rye, and oats

The pH of blood is normally slightly acidic, ranging from 6.85 to 6.95. a) True b) False

False Correct Explanation: The pH of blood is normally slightly alkaline, ranging from 7.35 to 7.45.

The nurse has admitted a child with a diagnosis of severe gastroenteritis. To help prevent the risk of transmitting infection to other patients, the nurse should a) Discourage anyone from visiting b) Follow standard precautions c) Wear a mask when handling articles contaminated with feces d) Sterilize thermometers between patients

Follow standard precautions Explanation: To prevent the spread of possibly infectious organisms to other pediatric patients, follow standard precautions issued by the Centers for Disease Control. Gloves should be worn when handling items contaminated with feces, but masks are not necessary. Visitor should be limited to family only. Take the temperature with a thermometer that is used only for that child.

The nurse is collecting data on a child who has been brought to the clinic. The child has urticaria, pruritus, stomach pains, and respiratory symptoms. The nurse recognizes that the clinical manifestations noted in this child are commonly seen in which of the following disorders? a) Vitamin deficiency b) Protein malnutrition c) Calcium insufficiency d) Food allergies

Food allergies Correct Explanation: Common symptoms of food allergies are urticaria (hives), pruritus (itching), stomach pains, and respiratory symptoms.

A father brings Jacob, age 2, to the health clinic with complaints of diarrhea, vomiting, and abdominal pain. The father tells the nurse that he is a single parent and Jacob is enrolled in a local daycare center. Based on this information, what gastrointestinal condition might the nurse suspect? a) Pancreatitis b) Appendicitis c) Gastroenteritis d) Hirschsprung disease

Gastroenteritis Explanation: Outbreaks of gastroenteritis routinely occur in daycare centers, schools, institutions for the handicapped, and other places where overcrowding is prevalent and hygiene is inadequate. Typical signs and symptoms include diarrhea, nausea, vomiting, and abdominal pain.

Noah is an 18-month-old who is brought to the ER with flu-like symptoms. He 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: a) Hirschsprung disease b) Cystic fibrosis c) Inflammatory bowel disease d) Gastroesophageal reflux disease

Gastroesophageal reflux disease Correct Explanation: The child with gastroesophageal reflux disease may present with the physical findings of pneumonia secondary to aspiration of refluxed stomach contents.

The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis? A) Perianal fissures and skin tags B) Sausage-shaped mass in the upper mid abdomen C) Hard, moveable "olive-like mass" in the upper right quadrant D) Abdominal pain and irritability

Hard, moveable "olive-like mass" in the upper right quadrant A hard, moveable "olive-like mass" in the right upper quadrant is the hypertrophied pylorus. A sausage-shaped mass in the upper mid abdomen is the hallmark of intussusception. Perianal fissures and skin tags are typical with Crohn disease. Abdominal pain and irritability is common with pyloric stenosis but are seen with many other conditions

The parents of a 6-week-old boy come to the clinic for evaluation because the infant has been vomiting. The parents report that the vomiting has been increasing in frequency and forcefulness over the last week. The mother says, "Sometimes, it seems like it just bursts out of his mouth." A diagnosis of hypertrophic pyloric stenosis is suspected. When performing the physical examination, what would the nurse most likely find? A) Sausage-shaped mass in the upper midabdomen B) Hard, moveable, olive-shaped mass in the right upper quadrant C) Tenderness over the McBurney point in the right lower quadrant D) Abdominal pain in the epigastric or umbilical region

Hard, moveable, olive-shaped mass in the right upper quadrant With hypertrophic pyloric stenosis, a hard, moveable, olive-shaped mass would be palpated in the right upper quadrant. A sausage-shaped mass in the upper midabdomen would suggest intussusception. Tenderness over the McBurney point would be associated with appendicitis. Epigastric or umbilical pain would be associated with peptic ulcer disease.

A 2-month-old boy is admitted to the emergency room with severe diarrhea. Intravenous fluid is prescribed for him. Before adding potassium to this solution, which assessment would you record? a) He cries with tears. b) He has voided. c) His hands are restrained. d) He "attunes" to a music box.

He has voided. Explanation: With severe diarrhea, kidney function may fail. It is important to document that kidney function is intact before adding potassium to prevent hyperkalemia.

The nurse is caring for a child with a diagnosis of pyloric stenosis during the preoperative phase of the child's treatment. Which of the following goal has the highest priority at this time? a) Preparing family for home care b) Promoting comfort c) Improving hydration d) Maintaining skin integrity

Improving hydration Explanation: Preoperatively the highest priority for the child with pyloric stenosis is to improve nutrition and hydration. Maintaining mouth and skin integrity, and relieving family anxiety are important, but these are not the priority. The child will not likely have intense pain. Preparing the family for home care would be a postoperative goal.

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 most accurate related to the diagnosis of gastroesophageal reflux? a) A partial or complete intestinal obstruction occurs. b) In this disorder the sphincter that leads into the stomach is relaxed. c) A thickened, elongated muscle causes an obstruction at the end of the stomach. d) There are recurrent paroxysmal bouts of abdominal pain.

In this disorder the sphincter that leads into the stomach is relaxed. Explanation: Gastroesophageal reflux (GER) occurs when the sphincter in the lower portion of the esophagus, which leads into the stomach, is relaxed and allows gastric contents to be regurgitated back into the esophagus. Congenital aganglionic megacolon is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Colic consists of recurrent paroxysmal bouts of abdominal pain. Pyloric stenosis is characterized by hypertrophy of the circular muscle fibers of the pylorus which leads to an obstruction at the distal end of the stomach.

The mother of a 3-week-old infant old brings her daughter in for an evaluation. During the visit, the mother tells the nurse that her baby is spitting up after feedings. Which response by the nurse would be most appropriate? A) "We need to tell the doctor about this." B) "Infants this age commonly spit up." C) "Your daughter might have an allergy." D) "Don't worry; you're just feeding her too much."

Infants this age commonly spit up In infants younger than 1 month of age, the lower esophageal sphincter is not fully developed, so infants younger than 1 month of age frequently regurgitate after feedings. Many children younger than 1 year of age continue to regurgitate for several months, but this usually disappears with age. The mother's report is not a cause for concern so the physician does not need to be notified. Additional information would be needed to determine if the infant had an allergy. Although the infant's stomach capacity is small, telling the mother not to worry does not address the mother's concern, and telling her that she is feeding the daughter too much implies that she is doing something wrong.

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. Which of the following conditions should the nurse suspect in this case? a) Volvulus with malrotation b) Short-bowel/short-gut syndrome c) Intussusception d) Necrotizing enterocolitis

Intussusception Explanation: Intussusception, the invagination of one portion of the intestine into another, usually occurs in the second half of the first year of life. Children with this disorder suddenly draw up their legs and cry as if they are in severe pain; they may vomit. After the peristaltic wave that caused the discomfort passes, they are symptom-free and play happily. In approximately 15 minutes, however, the same phenomenon of intense abdominal pain strikes again. After approximately 12 hours, blood appears in the stool and possibly in vomitus, described as a "currant jelly" appearance. Volvulus with malrotation and necrotizing entercolitis typically occur in the first 6 months of life and do not match the symptoms described above. Short-bowel/short-gut syndrome typically occurs when a large portion of the intestine has been removed due to a previous disease or trauma

A 10-year-old girl with an intestinal virus has been vomiting and has become dehydrated. She says she is mildly thirsty, her skin turgor is poor, and her skin is dry and cool. Her serum sodium level is normal. The nurse recognizes that she has which type of dehydration? a) Isotonic b) Hypertonic c) Acidotic d) Hypotonic

Isotonic Explanation: Signs and symptoms of isotonic dehydration include the following: mild thirst; poor skin turgor; dry, cool skin; decreased urine output; irritability; and a normal sodium level. Signs and symptoms of hypotonic dehydration include the following: moderate thirst; very poor skin turgor; clammy, cool skin; decreased urine output; lethargy; and a reduced sodium level. Signs and symptoms of hypertonic dehydration include the following: extreme thirst; moderate skin turgor; warm skin; decreased urine output; extreme lethargy; and an increased sodium level. Acidotic is not a type of dehydration

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? a) Upper left b) Upper right c) Lower left d) Lower right

Lower right Correct Explanation: With appendicitis, percussion reveals irritation and pain in the right lower quadrant. Rebound tenderness present with palpation in the right lower quadrant, is referred to as the McBurney point, an area of tenderness 1.5 to 2 in. (3.8 to 5 cm) in from the right anterior superior iliac spine along a line extending to the umbilicus.

The digestive process begins in which of the following organs of the gastrointestinal system? a) Small intestine b) Large intestine c) Mouth d) Stomach

Mouth Explanation: Food enters the mouth, and the digestive process begins. Digestion takes place by mechanical and chemical mechanisms. As the food continues through the stomach and intestines, digestion continues.

A mother calls the doctor's office and tells the nurse that she is concerned because her 4-month-old keeps "spitting up" with every feeding. Which of the following would indicate that the child is regurgitating as opposed to vomiting? a) Is curdled and extremely sour smelling b) Only occurs with feeding c) Continues until stomach is empty d) Is projected 1 ft away from infant

Only occurs with feeding Explanation: Regurgitation typically occurs only with feeding, runs out of the mouth with little force, smells barely sour and is only slightly curdled, appears to cause no pain or distress, occurs only once per feeding, and amounts to only about 1 to 2 tsp. Vomiting may occur at times other than feeding, is forceful and is typically projected 1 ft or more away from infant, is extremely sour smelling and curdled, is typically accompanied by crying, continues until the stomach is empty, and amounts to the full stomach contents.

The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is: a) Painless rectal bleeding b) Dehydration c) Respiratory distress d) Ischemia

Painless rectal bleeding Explanation: With Meckel diverticulum, most symptomatic children present younger than age 2 years. Intermittent, painless rectal bleeding is the most common clinical manifestation of Meckel diverticulum. The blood is most often bright red or maroon and may be passed independent of stool due to ulceration at the junction of the ectopic tissue and the normal ileal mucosa.

When examining the abdomen of a child, which technique would the nurse use last? A) Auscultation B) Percussion C) Palpation D) Inspection

Palpation Palpation should be the last part of the abdominal examination. Inspection, auscultation, and percussion should be done before palpation.

A mother brings her 10-year-old son to the ER with complaints 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 of the following diseases would the nurse consider as a diagnosis? a) Crohn disease b) Appendicitis c) Pancreatitis d) Ulcerative colitis

Pancreatitis Explanation: The child admitted with the suspicion of pancreatitis typically has a complaint of abdominal pain, either epigastric, upper left, or upper right quadrant pain that may radiate to the back. Nausea and vomiting, fever, tachycardia, hypotension, and jaundice may be present. Abdominal signs such as abdominal distention, decreased bowel sounds, rebound tenderness, and guarding also may be noted.

The nurse is conducting a physical examination of a child with suspected Crohn disease. Which finding would be the most suspicious of Crohn disease? A) Normal growth patterns B) Perianal skin tags or fissures C) Poor growth patterns D) Abdominal tenderness

Perianal Skin Tags or Fissures Perianal skin tags and/or fissures are highly suspicious of Crohn disease. Poor growth patterns and abdominal tenderness are common to Crohn disease but are also seen with many other conditions. Normal growth patterns would not point to Crohn disease because of problems with absorbing nutrients.

The nurse is caring for a child admitted with congenital aganglionic megacolon. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) Chronic cough b) Prolonged bleeding c) Irregular breathing d) Persistent constipation

Persistent constipation Correct Explanation: Congenital aganglionic megacolon, also called Hirschsprung disease, is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Prolonged bleeding is a manifestation of hemophilia. A chronic cough is noted in the child with cystic fibrosis. Irregular breathing occurs in children with seizures.

The nurse is examining a 7-year-old with suspected appendicitis. Which of the following physical findings would indicate the possibility of appendicitis? a) Persistent, right lower quadrant pain with rebound tenderness b) Tenderness that comes and goes in the lower abdomen c) Intermittent, left lower quadrant pain with rebound tenderness d) Diffuse, intermittent abdominal pain

Persistent, right lower quadrant pain with rebound tenderness Explanation: With appendicitis, symptoms typically do not come and go. They are usually persistent and intensify with time. With appendicitis, maximal tenderness occurs in the area of the McBurney point in the right lower quadrant, not the left. There is pain upon palpation with rebound tenderness. Pain is usually in the right lower quadrant, not the left, and is persistent. There is pain on palpation with rebound tenderness. Pain typically occurs in the right lower quadrant and is persistent and intensifies with time.

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? a) Assess the child's usual urinary voiding pattern b) Administer antacids as ordered c) Prepare the child for admission to the hospital d) Encourage fluid intake

Prepare the child for admission to the hospital The child's presentation is consistent with cholecystitis, which necessitates surgery in most cases. The child should be kept NPO and antacids are of no benefit. Genitourinary involvement is atypical.

In caring for an infant diagnosed with pyloric stenosis, the nurse would anticipate doing which of the following? a) Medicating the infant with analgesics b) Assisting in doing a barium enema procedure on the infant c) Changing the infant's diet to lactose-free d) Preparing the infant for surgery

Preparing the infant for surgery Correct Explanation: A surgical procedure called a pyloromyotomy (also known as a Fredet-Ramstedt operation) is the treatment of choice for pyloric stenosis.

The nurse is caring for a child admitted with pyloric stenosis. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) Explosive diarrhea b) Frequent urination c) Severe abdominal pain d) Projectile vomiting

Projectile vomiting Explanation: During the first weeks of life, the infant with pyloric stenosis often eats well and gains weight and then starts vomiting occasionally after meals. Within a few days the vomiting increases in frequency and force, becoming projectile. The child may have constipation, and peristaltic waves may be seen in the abdomen, but the child does not appear in severe pain. Urine output is decrease and urination is infrequent

A nursing instructor is developing a class presentation about the medications used to treat peptic ulcer disease. Which drug class would the instructor be least likely to include in the presentation? A) Antibiotics B) Proton pump inhibitors C) Histamine antagonists D) Prokinetics

Prokinetics Treatment for peptic ulcer disease includes antibiotics if Helicobacter pylori is verified, histamine antagonists, and/or proton pump inhibitors. Prokinetics are used to stimulate the gastrointestinal tract to help empty the stomach faster and promote intestinal motility. They are not used for peptic ulcer disease.

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 gives him a bottle of water. While he drinks, she notes an olive-size lump in his right abdomen. Which of the following conditions should the nurse suspect in this child? a) Appendicitis b) Gastroesophageal reflux c) Peptic ulcer disease d) Pyloric stenosis

Pyloric stenosis Correct Explanation: With pyloric stenosis, at 4 to 6 weeks of age, infants typically begin to vomit almost immediately after each feeding. The vomiting grows increasingly forceful until it is projectile, possibly projecting as much as 3 to 4 feet. Infants are usually hungry immediately after vomiting because they are not nauseated. A definitive diagnosis can be made by watching the infant drink. If a pyloric stenosis is present, the sphincter feels round and firm, approximately the size of an olive in the right abdomen. Peptic ulcer disease in neonates usually presents with hematemesis (blood in vomitus) or melena (blood in the stool). Gastroesophageal reflux involves a small (1-2 tsp) volume and is not forceful. Appendicitis typically begins with anorexia for 12 to 24 hours; children do not eat and do not act like their usual selves. Nausea and vomiting may then occur, followed by diffuse abdominal pain.

A nurse is caring for a 14-year-old girl scheduled for a barium swallow/upper gastrointestinal (GI) series. Before providing instructions, what would be the priority? A) Screening the girl for pregnancy B) Reminding her to drink plenty of fluids after the procedure C) Ordering a bowel preparation D) Reminding the girl about potential light-colored stools

Screening the girl for pregnancy Females of reproductive age must be screened for pregnancy prior to the test because radiography is used. A bowel preparation is not necessary for a barium swallow/upper GI series. The reminders about fluids and light-colored stools are appropriate but are not the first priority.

A nurse is assessing an infant who has been vomiting and experiencing diarrhea. Which of the following would indicate to the nurse that the infant is experiencing severe dehydration? Select all that apply. a) Cool mottled extremities b) Slightly decreased urine output c) Pink moist oral mucosa d) Sunken fontanels e) Bradycardia

Sunken fontanels • Bradycardia • Cool mottled extremities Explanation: Severe dehydration would be indicated by sunken fontanels, increased heart rate progressing to bradycardia, cool mottled or dusky extremities, dry oral mucosa, and significantly decreased urine output of less than 1 mL/kg/hour. Pink moist oral mucosa and slightly decreased urine output would suggest mild dehydration.

Which finding would lead the nurse to suspect that a child is experiencing moderate dehydration? A) Dusky extremities B) Tenting of skin C) Sunken fontanels D) Hypotension

Sunken fontanels A child with moderate dehydration would exhibit sunken fontanels. Severe dehydration would be characterized by dusky extremities, skin tenting, and hypotension.

The nurse is caring for a 6-month-old infant who was admitted to the emergency room 24 hours ago with signs of severe diarrhea. The infant's rectal temperature is 104° F, 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 of the following is the priority nursing intervention? a) Administer IV potassium b) Feed the child a cracker c) Take a stool culture d) Administer antibiotic therapy

Take a stool culture Correct Explanation: Treatment of severe diarrhea focuses on regulating electrolyte and fluid balance by initiating a temporary rest for the GI tract, oral or IV rehydration therapy, and discovering the organism responsible for the diarrhea. All children with severe diarrhea or diarrhea that persists longer than 24 hours should have a stool culture taken to determine if bacteria are causing the diarrhea, and if so, a definite antibiotic therapy can be prescribed. Because a side effect of many antibiotics is diarrhea, antibiotics should not routinely be used to treat diarrhea without an identifiable bacterial cause. Before the initial IV fluid is changed to a potassium solution, be certain the infant or child has voided—proof that the kidneys are functioning; in this case, the child is not voiding yet. The child should not be fed a cracker, as the GI tract should be rested until the diarrhea stops.

The nurse is caring for a 6-month-old infant who was admitted to the emergency room 24 hours ago with signs of severe diarrhea. The infant's rectal temperature is 104° F, 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 of the following is the priority nursing intervention? a) Take a stool culture b) Feed the child a cracker c) Administer antibiotic therapy d) Administer IV potassium

Take a stool culture Explanation: Treatment of severe diarrhea focuses on regulating electrolyte and fluid balance by initiating a temporary rest for the GI tract, oral or IV rehydration therapy, and discovering the organism responsible for the diarrhea. All children with severe diarrhea or diarrhea that persists longer than 24 hours should have a stool culture taken to determine if bacteria are causing the diarrhea, and if so, a definite antibiotic therapy can be prescribed. Because a side effect of many antibiotics is diarrhea, antibiotics should not routinely be used to treat diarrhea without an identifiable bacterial cause. Before the initial IV fluid is changed to a potassium solution, be certain the infant or child has voided—proof that the kidneys are functioning; in this case, the child is not voiding yet. The child should not be fed a cracker, as the GI tract should be rested until the diarrhea stops.

Which of the following is most correct regarding the gastrointestinal system of the child? a) The child cannot break down and use complex carbohydrates in the same way the adult can. b) The child's gastrointestinal system is fully matured when the child is born. c) The enzymes secreted by the child's liver and pancreas are much greater in amount than in the adult. d) The speed with which food passes through the gastrointestinal tract in the child is much slower than in the adult.

The child cannot break down and use complex carbohydrates in the same way the adult can. Explanation: In the GI tract of the newborn the enzymes secreted by the liver and pancreas are reduced. Thus, the infant cannot break down and use complex carbohydrates. In the infant, food moves through the GI tract with increased speed. The GI tract matures and the capacity of the GI tract increases as the child gets older.

The nurse is working with the mother of a newborn. The mother asks why a baby needs small feedings at frequent intervals. The nurse explains to the mother that this is necessary because in the infant a) The enzymes secreted by the liver and pancreas are reduced b) The pylorus has not been fully formed c) Peristaltic action is absent in the lower portion of the bowel d) Food moves more slowly through the GI tract

The enzymes secreted by the liver and pancreas are reduced Explanation: In the newborn the enzymes secreted by the liver and pancreas are reduced. Thus, the infant cannot break down and use complex carbohydrates. As a result, the newborn diet must be adjusted to allow for this immaturity. By the age of 4 to 6 months, the needed enzymes are usually sufficient in amount. The smaller capacity of the infant's stomach and the increased speed at which food moves through the GI tract require feeding smaller amounts at more frequent intervals. In addition, the small capacity of the colon leads to a bowel movement after each feeding. The pyloric spincter is formed, but is lax and does not have bearing on the frequency of feeding.

In understanding the gastrointestinal system, the nurse recognizes that this system includes the stomach and intestines as well as which of the following? a) A protective cushion lining the organs b) The brain and spinal cord c) The pharynx and esopagus d) Nerves throughout the abdomen

The pharynx and esopagus Explanation: The main organs of the gastrointestinal (GI) or digestive system are the mouth, pharynx (throat), esophagus, stomach, small intestine, large intestine, rectum, and anal canal. The brain, spinal column and nerves are part of the nervous system and there is a protective coating surrounding the nerves.

The nurse is discussing the diagnosis of intussuseption with a group of peers. Which of the following is an accurate statement regarding this disorder? a) The stools of the infant are called currant jelly stools and consist of blood and mucuous. b) The infant is pale, cries weakly, and has spasms of pain continuously. c) The disorder is seen most often in female infants under the age of 3 months. d) There is a telescoping of the lower part of the bowel up over the upper part of the bowel.

The stools of the infant are called currant jelly stools and consist of blood and mucuous. Explanation: In the child with intussusception, the stools consist of blood and mucus, thereby earning the name currant jelly stools. There is a telescoping of the upper portion of the bowel slipping over the lower portion.The condition occurs more often in boys than in girls and the highest incidence occurs in infants between the ages of 4 and 10 months. The infant who previously appeared healthy and happy suddenly becomes pale, cries out sharply, and draws up the legs in a severe colicky spasm of pain. This spasm may last for several minutes, after which the infant relaxes and appears well until the next episode, which may occur 5, 10, or 20 minutes later

Constipation may be initially caused by psychological problems. a) True b) False

True Explanation: Some children begin holding stool for psychological reasons. Once the process begins, however, the hardened stool, the anal fissures, and the pain on defecation soon occur, and what began for an emotional reason becomes a physical ailment. This is important to understand, because with these children, therapy involves both counseling to correct the initial problem and treatment of the physical symptoms

Which of the following assessments would suggest that a child's postoperative feeding schedule following pyloric stenosis surgery should be slowed? a) Flatulence b) Vomiting c) Semiformed bowel movements d) Falling asleep at each feeding

Vomiting Explanation: Vomiting after a feeding suggests the pyloric valve is not yet able to accommodate feedings well, possibly from edema.

A 6-month-old boy is diagnosed with pyloric stenosis. When you take a health history from his mother, which symptom would you expect to hear her describe? a) Chronic diarrhea b) Vomiting about 2 hours after feeding c) Vomiting immediately after feeding d) Refusal to eat

Vomiting immediately after feeding Explanation: A narrowing of the pyloric valve leads to projectile vomiting soon after eating.

12-year-old Hilary is brought to the emergency room by her parents with severe abdominal pain. The nurse performs a physical assessment to check for appendicitis. Which of the following assessment parameters indicate appendicitis? Select all that apply. a) Hypoactive bowel sounds with perforation b) Distended abdomen with unperforated appendicitis c) Low-grade fever, nausea, anorexia, and vomiting d) Rebound tenderness present with palpation in the left upper quadrant e) Irritation and pain in the right lower quadrant f) Normal to hyperactive bowel sounds early

a) Hypoactive bowel sounds with perforation c) Low-grade fever, nausea, anorexia, and vomiting e) Irritation and pain in the right lower quadrant f) Normal to hyperactive bowel sounds early Explanation: On auscultation, bowel sounds are normal to hyperactive early in the course of appendicitis but become hypoactive with perforation. Percussion reveals irritation and pain in the right lower quadrant. Rebound tenderness is present with palpation in the right lower quadrant. Low-grade fever, nausea, anorexia, and vomiting typically occur after the onset of abdominal pain. The abdomen appears flat with unperforated appendicitis, but abdominal distention may be present once perforation occurs.

A mother brings her 2-week-old newborn to the doctor's office because the child has been experiencing gastroesophageal reflux over the past week. Which of the following interventions should the nurse recommend to the mother at this point? (Select all that apply.) a) Keep the infant upright in an infant chair for 1 hour after feeding b) Feed the infant while holding her in an upright position c) Consult a pediatric surgeon regarding having a myotomy procedure performed d) Consult the physician regarding having botulinum toxin injected into the lower esophageal sphincter e) If breastfeeding, switch to formula f) Feed the infant a formula thickened with rice cereal

a) Keep the infant upright in an infant chair for 1 hour after feeding b) Feed the infant while holding her in an upright position f) Feed the infant a formula thickened with rice cereal Explanation: The traditional treatment of GI reflux is to feed infants a formula thickened with rice cereal (1 tbsp of cereal per 1 oz of formula or breast milk) while holding them in an upright position and then keeping them upright in an infant chair for 1 hour after feeding so gravity can help prevent reflux. There is no need for the mother to switch from breastfeeding to formula. Injection of botulinum toxin into the lower esophageal sphincter and a myotomy procedure are interventions that would be considered only if the problem does not disappear with feeding solid food and maintaining the child in a more upright position during and following feeding; they would not be appropriate at this point.

The nurse is to obtain a stool specimen from a 4-year-old child who has very liquid stool. The child is ambulatory but weak. Which collection method would be most effective for the nurse to use? a) Use a clean bedpan to collect the specimen. b) Apply a urine bag to the anal area. c) Have the child defecate into a container in the toilet. d) Use a tongue blade to scrape a specimen from a diaper.

b) Apply a urine bag to the anal area. Explanation: With very liquid stool, applying a urine bag to the anal area is most effective in collecting the specimen. Using a tongue blade to scrape a specimen from a diaper would be appropriate if the stool is formed. However, putting a diaper on a 4-year-old would be demeaning. Defecating into a collection container that sits at the back of the toilet would be more appropriate for an older child who is ambulatory. A bedpan would be appropriate if the child was bedridden.

The nurse examining an infant forms the following diagnosis: "Risk for impaired skin integrity related to effects of diarrhea." This diagnosis would be most appropriate for which of the following disease states (select all that apply): a) Pyloric stenosis b) Crohn disease c) Ulcerative colitis d) Inflammatory bowel disease e) Congenital diaphragmatic hernia f) Meckel diverticulum

b) Crohn disease c) Ulcerative colitis d) Inflammatory bowel disease Explanation: Inflammatory bowel disease (IBD) is a group of diseases characterized by inflammation of the GI tract and diarrhea. Crohn disease (CD) and ulcerative colitis (UC) are the most common forms of IBD and account for more than 80% of all cases.

The nurse caring for a patient with Crohn disease knows that long-term complications for this patient might include (select all that apply): a) Pancreatitis b) Gallstones c) Stricture d) Short-bowel syndrome e) Intra-abdominal abscess formation f) Fistula

c) Stricture d) Short-bowel syndrome e) Intra-abdominal abscess formation f) Fistula Explanation: Crohn disease is a recurrent disease. Long-term complications may include stricture, fistula, and intra-abdominal abscess formation. Individuals with severe disease who require extensive resection of diseased bowel may be left with short bowel syndrome and long-term dependence on PN.

A 7-year-old boy has experienced severe diarrhea resulting from an intestinal virus. The nurse is concerned that the child will develop an acid-base imbalance. Which of the following blood test results would indicate that the boy is experiencing metabolic acidosis? a) pH of 7.35, HCO3 of 24 mEq/L b) pH of 7.4, HCO3 of 26 mEq/L c) pH of 7.5, HCO3 of 29 mEq/L d) pH of 7.25, HCO3 of 20 mEq/L

pH of 7.25, HCO3 of 20 mEq/L Correct Explanation: The pH of blood is normally slightly alkaline, ranging from 7.35 to 7.45. The level of bicarbonate (HCO3) in arterial blood is normally 22 to 26 mEq/L. Metabolic acidosis results from diarrhea as a great deal of sodium is lost with stool. With metabolic acidosis, arterial blood gas analysis will reveal a decreased pH (under 7.35) and a low HCO3 value (near or below 22 mEq/L). With metabolic alkalosis, pH will be elevated (near or above 7.45), and HCO3 level will be near or above 28 mEq/L

A group of students are reviewing information about fluid balance and losses in children in comparison to adults. The students demonstrate a need for additional review when they state that: A) children have a proportionately greater amount of body water than do adults. B) fever plays a greater role in insensible fluid losses in infants and children. C) a higher metabolic rate plays a major role in increased insensible fluid losses. D) the infant's immature kidneys have a tendency to overconcentrate urine.

the infant's immature kidneys have a tendency to overconcentrate urine. The young infant's renal immaturity does not allow the kidneys to concentrate urine as well as in older children and adults, placing them at risk for dehydration or overhydration. Children do have a proportionately greater amount of body water than adults, and fever is important in promoting insensible fluid losses in infants and children because children become febrile more readily and their fevers are higher than those in adults. Children also experience a higher metabolic rate, which accounts for increased insensible fluid losses and increased need for water for excretory function.

The nurse is assessing a child with suspected necrotizing enterocolitis. Which of the following would the nurse expect to find? Select all that apply. a) Abdominal distention b) Bilious vomiting c) Tachypnea d) Clay-colored stools e) Hyperirritability

• Abdominal distention • Bilious vomiting Explanation: Assessment findings associated with necrotizing enterocolitis include abdominal distention and tenderness, bloody stools, feeding intolerance characterized by bilious vomiting, sepsis, lethargy, apnea, and shock.