Peds week 2: GI, chronic disease

Denial is a common reaction to the diagnosis of a disability or chronic illness. Which applies to denial as a defense mechanism? A. Denial is maladaptive. B. Denial is a necessary cushion to prevent disintegration of the family's psyche. C. Denial prevents a sense of hope. D. Denial prevents the mobilization of energies toward goal-directed, problem-solving behavior.

B. Denial is a necessary cushion to prevent disintegration of the family's psyche.

Based on clinical findings, a child is going to die soon and the parents have established a "death vigil." Nurses on the unit can assist the family by A. making sure that the family remains at the bedside until the child passes. B. arranging for other family members and ancillary services such as hospice to alternate time spent with the child. C. asking that the child be medicated continuously with the hopes that it speed up the process. D. talking about funeral arrangements to provide a sense of closure.

B. arranging for other family members and ancillary services such as hospice to alternate time spent with the child.

Which describes avoidance behaviors parents may exhibit when learning that their child has a chronic condition? (Select all that apply.) a. Refuses to agree to treatment b. Shares burden of disorder with others c. Verbalizes possible loss of child d. Withdraws from outside world e. Punishes self because of guilt and shame

a. Refuses to agree to treatment d. Withdraws from outside world e. Punishes self because of guilt and shame

Parents are asking about an early intervention program for their child who has special needs. The nurse relates that this program is for which age of child? a. Birth to 1 year of age b. Birth to 3 years of age c. Ages 1 to 4 d. Ages 4 and 5

b. Birth to 3 years of age

Which vaccine is now recommended for the immunization of all newborns? a. Hepatitis A vaccine b. Hepatitis B vaccine c. Hepatitis C vaccine d. Hepatitis A, B, and C vaccines

b. Hepatitis B vaccine Universal vaccination for hepatitis B is now recommended for all newborns. A vaccine is available for hepatitis A, but it is not yet universally recommended. No vaccine is currently available for hepatitis C. Only hepatitis B vaccine is recommended for newborns.

A 9-year-old boy has several physical disabilities. His father explains to the nurse that his son concentrates on what he can, rather than cannot, do and is as independent as possible. What is the nurse's best interpretation of this statement? a. The father is experiencing denial b. The father is expressing his own views c. The child is using an adaptive coping style d. The child is using a maladaptive coping style

c. The child is using an adaptive coping style

What are the results of excessive vomiting in an infant with pyloric stenosis? a. Hyperchloremia b. Hypernatremia c. Metabolic acidosis d. Metabolic alkalosis

d. Metabolic alkalosis Infants with excessive vomiting are prone to metabolic alkalosis from the loss of hydrogen ions. Chloride ions and sodium are lost with vomiting. Metabolic alkalosis, not acidosis, is likely.

A child is admitted with bacterial gastroenteritis. Which lab results of a stool specimen confirm this diagnosis? a. Eosinophils b. Occult blood c. pH less than 6 d. Neutrophils and red blood cells

d. Neutrophils and red blood cells Neutrophils and red blood cells in stool indicate bacterial gastroenteritis. Protein intolerance and parasitic infections are suspected in the presence of eosinophils. Occult blood may indicate pathogens such as Shigella, Campylobacter, or hemorrhagic Escherichia coli strains. A pH of less than 6 may indicate carbohydrate malabsorption or secondary lactase insufficiency.

Which term best describes a multidisciplinary approach to the management of a terminal illness that focuses on symptom control and support? a. Dying care b. Curative care c. Restorative care d. Palliative care

d. Palliative care

The nurse working with families of children with chronic diseases is concerned with helping the parents and siblings avoid compassion fatigue. Which activities would the nurse encourage for the families? Select all that apply. A. Exercising B. Moving away to another city C. Fostering social relationships in their community D. Developing a hobby, either individually or as a family E. Getting more than 10 hours of sleep in a 24-hour period

A. Exercising C. Fostering social relationships in their community D. Developing a hobby, either individually or as a family

In reaction to a child's death which individuals may exhibit going through the grief stage reactions? Select all that apply. A. Family members B. Nurses involved in patient's care C. Physicians taking care of the patient and family D. Only family members who were at the hospital with the patient.

A. Family members B. Nurses involved in patient's care C. Physicians taking care of the patient and family

The potential effects of chronic illness or disability on a child's development vary at different ages. What is a threat to a toddler's normal development? A. Hindered mobility B. Poorly defined body image C. Limited opportunities for socialization D. Limited opportunities to achieve and accomplish

A. Hindered mobility

A 4-year-old's concept of death is that A. death is temporary. B. death is permanent. C. death is personified in various forms. D. death is inevitable at some age.

A. death is temporary.

The nurse notes that the parents of a critically ill child spend a large amount of time talking with the parents of another child who is also seriously ill. They talk with these parents more than with the nurses. The nurse should recognize that this behavior indicates A. that parent-to-parent support is valuable. B. that parent-to-parent dependence is unhealthy. C. the situation has developed because the nurses are unresponsive to the parents. D. the situation is unusual and has the potential to increase friction between the parents and nursing staff.

A. that parent-to-parent support is valuable.

At the time of a child's death, the nurse tells his mother, "We will miss him so much." What is the best interpretation of this statement? a. Pretending to be experiencing grief b. Expressing personal feelings of loss c. Denying the mother's sense of loss d. Talking when listening would be better

ANS: B A patient's death is one of the most stressful aspects of critical care or oncology nursing. Nurses experience reactions similar to those of family members because of their involvement with the child and family during the illness. Nurses often have feelings of personal loss when a patient dies.

What clinical manifestations would the nurse expect to find in a newborn who has developed necrotizing enterocolitis (NEC)? A. Hyperthermia B. Gastric residual and melena C. The passage of ribbon-like stools D. Projectile vomiting

B. Gastric residual and melena The most prominent signs of NEC are abdominal distention, gastric residuals, and blood in the stools (melena). NEC resembles septicemia; the newborn may "not look well," in addition to having nonspecific signs such as lethargy, poor feeding, hypotension, hypothermia, bile-stained vomitus, and oliguria. The newborn with NEC is more likely to be seen with hypothermia, not hyperthermia. The passage of ribbon-like stools is seen in newborns and infants born with Hirschsprung disease. Projectile vomiting is seen in newborns and infants with pyloric stenosis.

An infant with neurologic impairment and delay is receiving several medications. A proton pump inhibitor is one of the medications the infant is receiving. Which medication(s) is/are proton pump inhibitor(s)? (Select all that apply.) A. Ranitidine (Zantac) B. Omeprazole (Prilosec) C. Pantoprazole (Protonix) D. Glycopyrrolate (Robinul) E. Bethanechol (Urecholine)

B. Omeprazole (Prilosec) C. Pantoprazole (Protonix)

The nurse is caring for a child dying from cancer. A physical sign that the child is approaching death is A. rapid pulse. B. change in respiratory pattern. C. sensation of cold although body feels hot. D. loss of hearing followed by loss of other senses.

B. change in respiratory pattern.

A 9-year-old boy has several physical disabilities. His father explains to the nurse that his son concentrates on what he can do, rather than what he cannot do, and is as independent as possible. Based on the nurse's knowledge of family-centered care and various disabilities, the nurse interprets the child's behavior and father's attitude as that the A. father is experiencing denial. B. child is using an adaptive coping style. C. child is using a maladaptive coping style. D. father is expressing his own fears about his child's disability.

B. child is using an adaptive coping style.

The nurse is caring for an 8-year-old child hospitalized with a chronic illness. The child has a tracheostomy and a parent is rooming-in. The parent insists on providing almost all of the child's care and tells the nurses how to care for the child. When planning the child's care, the primary nurse should recognize that the parent is A. controlling and demanding. B. assuming the nurse's role. C. the expert in care of the child. D. afraid to allow the nurses to function independently.

C. the expert in care of the child.

In developing palliative care for a child with a terminal disease, the nurse would incorporate: A. Efforts to restore level of function to pre-disease status. B. Have the child hospitalized as this clinical setting is the best place to provide this type of care. C. It begins when the likelihood of impending death becomes clearly evident. D. It allows for the incorporation of a multidisciplinary approach to meet the emerging needs of the patient and family members.

D. It allows for the incorporation of a multidisciplinary approach to meet the emerging needs of the patient and family members.

The nurse is discussing home care with the mother of a 6-year-old child with hepatitis A. Part of the discharge teaching plan should include? A. Bed rest is important until 1 week after the icteric phase. B. The child should not return to school until 3 weeks after the icteric phase. C. Reassure the mother that hepatitis A cannot be transmitted to other family members. D. Teach infection control measures to family members.

D. Teach infection control measures to family members. Hepatitis A is a contagious disease, transmitted through the fecal-oral route. The nurse should teach infection control measures to family members. Hepatitis A does not usually have an icteric phase and often is subclinical. The period of communicability for hepatitis A is the latter half of the incubation period to 1 week after the onset of clinical illness; therefore, the child can return to school after that time frame. Hepatitis A is infectious through the fecal-oral route; therefore, family members may be susceptible to acquiring the disease if they fail to institute proper infection control measures.

The nurse assesses a neonate immediately after birth. Clinical sign-symptom of tracheoesophageal fistula is A. jaundice. B. bile-stained vomitus. C. absence of sucking. D. excessive amount of frothy saliva in the mouth.

D. excessive amount of frothy saliva in the mouth. Excessive salivation and drooling are indicative of tracheoesophageal fistulas. With a fistula, the child has difficulty managing the secretions, which may cause choking, coughing, and cyanosis. Jaundice is not usually associated with a tracheoesophageal fistula. Bile-stained vomitus is not usually associated with a tracheoesophageal fistula. The infant is able to suck with a tracheoesophageal fistula but is not able to manage the secretions.

A 5-year-old child's sibling dies from sudden infant death syndrome (SIDS). The parents are concerned because the child showed more outward grief when their cat died than for the sibling's death. Based on the nurse's knowledge of development, the nurse explains that this behavior suggests A. maladaptive coping, and a referral is needed for counseling. B. the child is not old enough to have a concept of death. C. the child is not old enough to have formed a significant attachment to her sibling. D. the death may be so painful and threatening that the child must deny it for now to protect her psyche.

D. the death may be so painful and threatening that the child must deny it for now to protect her psyche.

Dietary management of a child with inflammatory bowel disease (IBD) should include A. low protein. B. low calorie. C. high fiber. D. vitamin supplements.

D. vitamin supplements. Multivitamins, iron, and folic acid supplementation are recommended for the child with IBD. A high-protein, high-calorie diet is needed to help correct nutritional deficits. A high-fiber diet is not recommended for IBD. Even small amounts of bran have been associated with a worsening of the child's condition.

Which are appropriate statements the nurse should make to parents after the death of their child? (Select all that apply.) a. "We feel so sorry that we couldn't save your child." b. "Your child isn't suffering anymore." c. "I know how you feel." d. "You're feeling all the pain of losing a child." e. "You are still young enough to have another baby."

a. "We feel so sorry that we couldn't save your child." d. "You're feeling all the pain of losing a child."

A child dependent on medical technology is preparing to be discharged from the hospital to home. Which predischarge assessments should the nurse ensure? (Select all that apply.) a. Emergency care and transport plan b. Reliance on private duty nurses to teach the family infection control practices c. Financial arrangements d. Individualized home plan to be completed within the first month of the child's discharge

a. Emergency care and transport plan c. Financial arrangements

A nurse is admitting a child with Crohn disease. Parents ask the nurse, "How is this disease different from ulcerative colitis?" Which statement should the nurse make when answering this question? a. "With Crohn disease the inflammatory process involves the whole GI tract." b. "There is no difference between the two diseases." c. "The inflammation with Crohn disease is limited to the colon and rectum." d. "Ulcerative colitis is characterized by skip lesions."

a. "With Crohn disease the inflammatory process involves the whole GI tract." The chronic inflammatory process of Crohn disease involves any part of the GI tract from the mouth to the anus but most often affects the terminal ileum. Crohn disease involves all layers of the bowel wall in a discontinuous fashion, meaning that between areas of intact mucosa, there are areas of affected mucosa (skip lesions). The inflammation found with ulcerative colitis is limited to the colon and rectum, with the distal colon and rectum the most severely affected. Inflammation affects the mucosa and submucosa and involves continuous segments along the length of the bowel with varying degrees of ulceration, bleeding, and edema.

The nurse is providing support to a family who is experiencing anticipatory grief related to their child's imminent death. Which of the following is an appropriate nursing intervention? a. Be available to the family. b. Attempt to "lighten the mood." c. Suggest activities to cheer up the family. d. Discourage crying until actual time of death.

a. Be available to the family.

The nurse is caring for a neonate with a suspected tracheoesophageal fistula. What nursing care should be included? a. Elevate the head but give nothing by mouth. b. Elevate the head for feedings. c. Feed glucose water only. d. Avoid suctioning unless infant is cyanotic.

a. Elevate the head but give nothing by mouth. When a newborn is suspected of having a tracheoesophageal fistula, the most desirable position is supine with the head elevated on an inclined plane of at least 30 degrees. It is imperative that any source of aspiration be removed at once; oral feedings are withheld. Feedings should not be given to infants suspected of having tracheoesophageal fistulas. The oral pharynx should be kept clear of secretion by oral suctioning. This is to prevent the cyanosis that is usually the result of laryngospasm caused by overflow of saliva into the larynx.

Why are bismuth subsalicylate, clarithromycin, and metronidazole prescribed for a child with a peptic ulcer? a. Eradicate Helicobacter pylori b. Coat gastric mucosa c. Treat epigastric pain d. Reduce gastric acid production

a. Eradicate Helicobacter pylori The drug therapy combination of bismuth subsalicylate, clarithromycin, and metronidazole is effective in the treatment of H. pylori and is prescribed to eradicate it.

Which condition in a child should alert a nurse for increased fluid requirements? a. Fever b. Mechanical ventilation c. Congestive heart failure d. Increased intracranial pressure (ICP)

a. Fever Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume. Respiratory rate influences insensible fluid loss and should be monitored in the mechanically ventilated child. Congestive heart failure is a case of fluid overload in children. Increased ICP does not lead to increased fluid requirements in children.

Which is the most appropriate nursing intervention to promote normalization in a school-age child with a chronic illness? a. Give the child as much control as possible. b. Ask the child's peer to make the child feel normal. c. Convince the child that nothing is wrong with him or her. d. Explain to parents that family rules for the child do not need to be the same as for healthy siblings.

a. Give the child as much control as possible.

A common parental reaction to a child with special needs is parental overprotection. What parental behavior is suggestive of this behavior? a. Giving inconsistent discipline b. Providing consistent, strict discipline c. Forcing child to help self, even when not capable d. Encouraging social and educational activities not appropriate to child's level of capability

a. Giving inconsistent discipline

The nurse is caring for a child who has just died. The parents ask to be left alone so that they can rock their child one more time. What is the nurse's most appropriate response? a. Grant their request b. Assess why they feel this is necessary c. Discourage this because it will only prolong their grief d. Kindly explain that they need to say good-bye to their child now and leave

a. Grant their request The parents should be allowed to remain with their child after the death. The nurse can remove all the tubes and equipment and offer the parents the option of preparing the body.

A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting. What should therapeutic management of this child begin with? a. Intravenous (IV) fluids b. ORS c. Clear liquids, 1 to 2 ounces at a time d. Administration of antidiarrheal medication

a. Intravenous (IV) fluids In children with severe dehydration, IV fluids are initiated. ORS is acceptable therapy if the dehydration is not severe. Diarrhea is not managed by using clear liquids by mouth. These fluids have a high carbohydrate content, low electrolyte content, and high osmolality. Antidiarrheal medications are not recommended for the treatment of acute infectious diarrhea.

Which is most descriptive of a school-age child's reaction to death? a. Is very interested in funerals and burials b. Has little understanding of words such as forever c. Imagines the deceased person to be still alive d. Has an idealistic view of the world and criticizes funerals as barbaric

a. Is very interested in funerals and burials

The parents of a child born with disabilities ask the nurse for advice about discipline. What information about disciple should the nurse's response include? a. It is essential for the child. b. It is too difficult to implement with a special-needs child. c. It is not needed unless the child becomes problematic. d. It is best achieved with punishment for misbehavior.

a. It is essential for the child.

A nurse is admitting an infant with biliary atresia. Which is the earliest clinical manifestation of biliary atresia the nurse should expect to assess? a. Jaundice b. Vomiting c. Hepatomegaly d. Absence of stooling

a. Jaundice Jaundice is the earliest and most striking manifestation of biliary atresia. It is first observed in the sclera and may be present at birth but is usually not apparent until age 2 to 3 weeks. Vomiting is not associated with biliary atresia. Hepatomegaly and abdominal distention are common but occur later. Stools are large and lighter in color than expected because of the lack of bile.

Which is an appropriate nursing intervention when providing comfort and support for a child when death is imminent? a. Limit care to essentials. b. Avoid playing music near the child. c. Explain to the child the need for constant measurement of vital signs. d. Whisper to the child instead of using a normal voice.

a. Limit care to essentials.

What offers the best chance of survival for a child with cirrhosis? a. Liver transplantation b. Treatment with corticosteroids c. Treatment with immune globulin d. Provision of nutritional support

a. Liver transplantation The only successful treatment for end-stage liver disease and liver failure may be liver transplantation, which has improved the prognosis for many children with cirrhosis. Liver transplantation has revolutionized the approach to cirrhosis. Liver failure and cirrhosis are indications for transplantation. Liver transplantation reflects the failure of other medical and surgical measures to prevent or treat cirrhosis.

A mother calls the clinic nurse about her 4-year-old son who has acute diarrhea. She has been giving him the antidiarrheal drug loperamide (Imodium A-D). The nurse's response should be based on what knowledge about this drug? a. Not indicated b. Indicated because it slows intestinal motility c. Indicated because it decreases diarrhea d. Indicated because it decreases fluid and electrolyte losses

a. Not indicated Antidiarrheal medications are not recommended for the treatment of acute infectious diarrhea. These medications have adverse effects and toxicity, such as worsening of the diarrhea because of slowing of motility and ileus, or a decrease in diarrhea with continuing fluid losses and dehydration. Antidiarrheal medications are not recommended in infants and small children.

The nurse is caring for a boy with probable intussusception. He had diarrhea before admission but, while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool. Which nursing action is the most appropriate? a. Notify practitioner b. Measure abdominal girth c. Auscultate for bowel sounds d. Take vital signs, including blood pressure

a. Notify practitioner Passage of a normal brown stool indicates that the intussusception has reduced itself. This is immediately reported to the practitioner, who may choose to alter the diagnostic-therapeutic care plan. The first action would be to report the normal stool to the practitioner.

The nurse is providing support to parents at the time their child is diagnosed with chronic disabilities. The nurse notices that the parents keep asking the same questions. What is the nurse's best intervention? a. Patiently continue to answer questions. b. Kindly refer them to someone else for answering their questions. c. Recognize that some parents cannot understand explanations. d. Suggest that they ask their questions when they are not upset.

a. Patiently continue to answer questions.

A child who has just had definitive repair of a high rectal malformation is to be discharged. Which should the nurse address in the discharge preparation of this family? (Select all that apply.) a. Perineal and wound care b. Necessity of firm stools to keep suture line clean c. Bowel training beginning as soon as child returns home d. Reporting any changes in stooling patterns to practitioner e. Use of diet modification to prevent constipation

a. Perineal and wound care d. Reporting any changes in stooling patterns to practitioner e. Use of diet modification to prevent constipation Wound care instruction is necessary in a child who is being discharged after surgery. The parents are taught to notify the practitioner if any signs of an anal stricture or other complications develop. Constipation is avoided, since a firm stool will place strain on the suture line. Fiber and stool softeners are often given to keep stools soft and avoid tension on the suture line. The child needs to recover from the surgical procedure. Then bowel training may begin, depending on the child's developmental and physiologic readiness.

A nurse is planning preoperative care for a newborn with tracheoesophageal fistula (TEF). Which interventions should the nurse plan to implement? (Select all that apply.) a. Positioning with head elevated on a 30-degree plane b. Feedings through a gastrostomy tube c. Nasogastric tube to continuous low wall suction d. Suctioning with a Replogle tube passed orally to the end of the pouch e. Gastrostomy tube to gravity drainage

a. Positioning with head elevated on a 30-degree plane d. Suctioning with a Replogle tube passed orally to the end of the pouch e. Gastrostomy tube to gravity drainage The most desirable position for a newborn who has TEF is supine (or sometimes prone) with the head elevated on an inclined plane of at least 30 degrees. This positioning minimizes the reflux of gastric secretions at the distal esophagus into the trachea and bronchi, especially when intra-abdominal pressure is elevated. It is imperative to immediately remove any secretions that can be aspirated. Until surgery, the blind pouch is kept empty by intermittent or continuous suction through an indwelling double-lumen or Replogle catheter passed orally or nasally to the end of the pouch. In some cases, a percutaneous gastrostomy tube is inserted and left open so that any air entering the stomach through the fistula can escape, thus minimizing the danger of gastric contents being regurgitated into the trachea. The gastrostomy tube is emptied by gravity drainage. Feedings through the gastrostomy tube and irrigations with fluid are contraindicated before surgery in an infant with a distal TEF. A nasogastric tube to low intermittent suctioning could not be accomplished because the esophagus ends in a blind pouch in TEF.

Which is a high-fiber food that the nurse should recommend for a child with chronic constipation? a. Raisins b. Pancakes c. Muffins d. Ripe bananas

a. Raisins Raisins are a high-fiber food. Pancakes and muffins do not have significant fiber unless made with fruit or bran. Raw fruits, especially those with skins and seeds, other than ripe bananas, have high fiber

Which is an important nursing consideration in the care of a child with celiac disease? a. Refer to a nutritionist for detailed dietary instructions and education. b. Help child and family understand that diet restrictions are usually only temporary. c. Teach proper hand washing and standard precautions to prevent disease transmission. d. Suggest ways to cope more effectively with stress to minimize symptoms.

a. Refer to a nutritionist for detailed dietary instructions and education. The main consideration is helping the child adhere to dietary management. Considerable time is spent explaining to the child and parents about the disease process, the specific role of gluten in aggravating the condition, and foods that must be restricted. Referral to a nutritionist would help in this process. The most severe symptoms usually occur in early childhood and adult life. Dietary avoidance of gluten should be lifelong. Celiac disease is not transmissible or stress related.

nurse is receiving report on a newborn admitted yesterday after a gastroschisis repair. In the report, the nurse is told the newborn has a physician's prescription for an NG tube to low intermittent suction. The reporting nurse confirms that the NG tube is to low intermittent suction and draining light green stomach contents. Upon initial assessment, the nurse notes that the newborn has pulled the NG tube out. Which is the priority action the nurse should take? a. Replace the NG tube and continue the low intermittent suction. b. Leave the NG tube out and notify the physician at the end of the shift. c. Leave the NG tube out and monitor for bowel sounds. d. Replace the NG tube, but leave to gravity drainage instead of low wall suction.

a. Replace the NG tube and continue the low intermittent suction. A newborn with a gastroschisis performed the day before will require bowel decompression with an NG tube to low wall intermittent suction. The nurse's priority action is to replace the NG tube and continue with the low wall intermittent suctioning. The NG tube cannot be left out this soon after surgery. The physician's prescription was to have the NG tube to low wall intermittent suction, so the tube cannot be placed to gravity drainage.

A cure is no longer possible for a young child with cancer. The nursing staff recognizes that the goal of treatment must shift from cure to palliation. Which is an important consideration at this time? a. The family is included in the decision to shift the goals of treatment. b. The decision must be made by the health professionals involved in the child's care. c. The family needs to understand that palliative care takes place in the home. d. The decision should not be communicated to the family because it will encourage a sense of hopelessness.

a. The family is included in the decision to shift the goals of treatment.

The nurse is talking with the parents of a child who died 6 months ago. They sometimes still "hear" the child's voice and have trouble sleeping. They describe feeling "empty" and depressed. How should the nurse interpret these feelings? a. These are normal grief responses b. The pain of the loss is usually less by this time c. These grief responses are more typical of the early stages of grief d. This grieving is essential until the pain is gone and the child is gradually forgotten.

a. These are normal grief responses

A child has recurrent abdominal pain (RAP) and a dairy-free diet has been prescribed for 2 weeks. Which explanation is the reason for prescribing a dairy-free diet? a. To rule out lactose intolerance b. To rule out celiac disease c. To rule out sensitivity to high sugar content d. To rule out peptic ulcer disease

a. To rule out lactose intolerance Treatment for RAP involves providing reassurance and reducing or eliminating symptoms. Dietary modifications may include removal of dairy products to rule out lactose intolerance. Fructose is eliminated to rule out sensitivity to high sugar content, and gluten is removed to rule out celiac disease. A dairy-free diet would not rule out peptic ulcer disease.

A nurse is caring for a child who is near death. Which physical signs indicate the child is approaching death? (Select all that apply.) a. Body feels warm b. Tactile sensation decreasing c. Speech becomes rapid d. Change in respiratory pattern e. Difficulty swallowing

b. Tactile sensation decreasing d. Change in respiratory pattern e. Difficulty swallowing

The nurse comes into the room of a child who was just diagnosed with a chronic disability. The child's parents begin to yell at the nurse about a variety of concerns. Which is the nurse's best response? a. "What is really wrong?" b. "Being angry is only natural." c. "Yelling at me will not change things." d. "I will come back when you settle down."

b. "Being angry is only natural."

Parents of a child undergoing an endoscopy to rule out peptic ulcer disease (PUD) from H. pylori ask the nurse, "If H. pylori is found, will my child need another endoscopy to know that it is gone?" Which is the nurse's best response? a. "Yes, the only way to know the H. pylori has been eradicated is with another endoscopy." b. "We can collect a stool sample and confirm that the H. pylori has been eradicated." c. "A blood test can be done to determine that the H. pylori is no longer present." d. "Your child will always test positive for H. pylori because after treatment it goes into remission but can't be completely eradicated."

b. "We can collect a stool sample and confirm that the H. pylori has been eradicated." An upper endoscopy is the procedure initially performed to diagnose PUD. A biopsy can determine the presence of H. pylori. Polyclonal and monoclonal stool antigen tests are an accurate, noninvasive method to confirm H. pylori has been eradicated after treatment. A blood test can identify the presence of the antigen to this organism, but because H. pylori was already present, it would not be as accurate as a stool sample to determine whether it has been eradicated. H. pylori can be treated and, once the treatment is complete, the stool sample can determine that it was eradicated.

Which best describes how preschoolers react to the death of a loved one? a. A preschooler is too young to have a concept of death. b. A preschooler may feel guilty and responsible for the death. c. Grief is acute but does not last long at this age. d. Grief is usually expressed in the same way in which the adults in the preschooler's life are expressing grief.

b. A preschooler may feel guilty and responsible for the death.

The nurse is preparing to care for an infant returning from pyloromyotomy surgery. Which prescribed orders should the nurse anticipate implementing? (Select all that apply.) a. NPO for 24 hours b. Administration of analgesics for pain c. Ice bag to the incisional area d. IV fluids continued until tolerating PO e. Clear liquids as the first feeding

b. Administration of analgesics for pain d. IV fluids continued until tolerating PO e. Clear liquids as the first feeding Feedings are usually instituted soon after a pyloromyotomy surgery, beginning with clear liquids and advancing to formula or breast milk as tolerated. IV fluids are administered until the infant is taking and retaining adequate amounts by mouth. Appropriate analgesics should be given around the clock because pain is continuous. Ice should not be applied to the incisional area as it vasoconstricts and would reduce circulation to the incisional area and impair healing.

The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. Which is appropriate to relieve the abdominal discomfort? a. Place in Trendelenburg position. b. Allow to assume position of comfort. c. Apply moist heat to the abdomen. d. Administer a saline enema to cleanse bowel.

b. Allow to assume position of comfort. The child should be allowed to take a position of comfort, usually with the legs flexed. The Trendelenburg position will not help with the discomfort. In any instance in which appendicitis is a possibility, there is a danger in administering a laxative or enemas or applying heat to the area. Such measures stimulate bowel motility and increase the risk of perforation.

Parents call the clinic and report that their toddler has had acute diarrhea for 24 hours. The nurse should further ask the parents if the toddler has which associated factor that is causing the acute diarrhea? a. Celiac disease b. Antibiotic therapy c. Immunodeficiency d. Protein malnutrition

b. Antibiotic therapy Acute diarrhea is a sudden increase in frequency and change in consistency of stools and may be associated with antibiotic therapy. Celiac disease is a problem with gluten intolerance and may cause chronic diarrhea if not identified and managed appropriately. Immunodeficiency would occur with chronic diarrhea. Protein malnutrition or kwashiorkor causes chronic diarrhea from lowered resistance to infection.

One of the supervisors for a home health agency asks the nurse to give the family a survey evaluating the nurses and other service providers. How should the nurse interpret this request? a. Inappropriate, unless nurses are able to evaluate family. b. Appropriate to improve quality of care. c. Inappropriate, unless nurses and other providers agree to participate. d. Inappropriate, because family lacks knowledge necessary to evaluate professionals.

b. Appropriate to improve quality of care. Quality assessment and improvement activities are essential for virtually all organizations. Family involvement is essential in evaluating a home care plan and can occur on several levels. The nurse can ask the family open-ended questions at regular intervals to assess their opinion of the effectiveness of care. Families should also be given an opportunity to evaluate the individual home care nurses, the home care agency, and other service providers periodically. The nurse is the care provider. The evaluation is of the provision of care to the patient and family. The nurse's role is not to evaluate the family. Quality-monitoring activities are required by virtually all health care agencies. During the evaluation process, the family is requested to provide their perceptions of care.

The nurse is caring for an infant whose cleft lip was repaired. What important aspects of this infant's postoperative care should be included? a. Arm restraints, postural drainage, mouth irrigations b. Cleansing the suture line, supine and side-lying positions, arm restraints c. Mouth irrigations, prone position, cleansing the suture line d. Supine and side-lying positions, postural drainage, arm restraints

b. Cleansing the suture line, supine and side-lying positions, arm restraints The suture line should be cleansed gently after feeding. The child should be positioned on the back, on the side, or in an infant seat. Elbows are restrained to prevent the child from accessing the operative site. Postural drainage is not indicated. This would increase the pressure on the operative site when the child is placed in different positions. There is no reason to perform mouth irrigations, and the child should not be placed in the prone position where injury to the suture site can occur.

Which intervention will encourage a sense of autonomy in a toddler with disabilities? a. Avoid separation from family during hospitalizations. b. Encourage independence in as many areas as possible. c. Expose child to pleasurable experiences as much as possible. d. Help parents learn special care needs of their child.

b. Encourage independence in as many areas as possible.

A mother who intended to breastfeed has given birth to an infant with a cleft palate. What nursing interventions should be included? a. Giving medication to suppress lactation. b. Encouraging and helping mother to breastfeed. c. Teaching mother to feed breast milk by gavage. d. Recommending use of a breast pump to maintain lactation until infant can suck.

b. Encouraging and helping mother to breastfeed. The mother who wishes to breastfeed may need encouragement and support because the defect does present some logistical issues. The nipple must be positioned and stabilized well back in the infant's oral cavity so that the tongue action facilitates milk expression. Because breastfeeding is an option, if the mother wishes to breastfeed, medications should not be given to suppress lactation. Because breastfeeding can usually be accomplished, gavage feedings are not indicated. The suction required to stimulate milk, absent initially, may be useful before nursing to stimulate the let-down reflex.

A newborn was admitted to the nursery with a complete bilateral cleft lip and palate. The physician explained the plan of therapy and its expected good results. However, the mother refuses to see or hold her baby. What is the initial therapeutic approach for the mother? a. Restating what the physician has told her about plastic surgery. b. Encouraging her to express her feelings. c. Emphasizing the normalcy of her baby and the baby's need for mothering. d. Recognizing that negative feelings toward the child continue throughout childhood.

b. Encouraging her to express her feelings. For parents, cleft lip and cleft palate deformities are particularly disturbing. The nurse must emphasize not only the infant's physical needs but also the parents' emotional needs. The mother needs to be able to express her feelings before she can accept her child. Although the nurse will restate what the physician has told the mother about plastic surgery, it is not part of the initial therapeutic approach. As the mother expresses her feelings, the nurse's actions should convey to the parents that the infant is a precious human being. The nurse emphasizes the child's normalcy and helps the mother recognize the child's uniqueness.

Families progress through various stages of reactions when a child is diagnosed with a chronic illness or disability. After the shock phase, a period of adjustment usually follows. This is often characterized by which of the following responses? a. Denial b. Guilt and anger c. Social reintegration d. Acceptance of the child's limitations

b. Guilt and anger For most families, the adjustment phase is accompanied by several responses. Guilt, self-accusation, bitterness, and anger are common reactions. The initial diagnosis of a chronic illness or disability often is met with intense emotion, characterized by shock and denial. Social reintegration and acceptance of the child's limitations are the culmination of the adjustment process.

Which is true concerning hepatitis B? (Select all that apply.) a. Hepatitis B cannot exist in carrier state. b. Hepatitis B can be prevented by HBV vaccine. c. Hepatitis B can be transferred to an infant of a breastfeeding mother. d. Onset of hepatitis B is insidious. e. Principal mode of transmission for hepatitis B is fecal-oral route. f. Immunity to hepatitis B occurs after one attack.

b. Hepatitis B can be prevented by HBV vaccine. c. Hepatitis B can be transferred to an infant of a breastfeeding mother. d. Onset of hepatitis B is insidious. f. Immunity to hepatitis B occurs after one attack. The vaccine elicits the formation of an antibody to the hepatitis B surface antigen, which is protective against hepatitis B. Hepatitis B can be transferred to an infant of a breastfeeding mother, especially if the mother's nipples are cracked. The onset of hepatitis B is insidious. Immunity develops after one exposure to hepatitis B. Hepatitis B has a carrier state. The fecal-oral route is the principal mode of transmission for hepatitis A. Hepatitis B is transmitted through the parenteral route.

What is the best description of pyloric stenosis? a. Dilation of the pylorus b. Hypertrophy of the pyloric muscle c. Hypotonicity of the pyloric muscle d. Reduction of tone in the pyloric muscle

b. Hypertrophy of the pyloric muscle Hypertrophic pyloric stenosis occurs when the circumferential muscle of the pyloric sphincter becomes thickened, resulting in elongation and narrowing of the pyloric channel. Dilation of the pylorus, hypotonicity of the pyloric muscle, and reduction of tone in the pyloric muscle are not the definition of pyloric stenosis.

The home care nurse has been visiting an adolescent with recently acquired tetraplegia. The teen's mother tells the nurse, "I'm sick of providing all the care while my husband does whatever he wants to, whenever he wants to do it." Which should be the initial action of the nurse? a. Refer mother for counseling. b. Listen and reflect mother's feelings. c. Ask father, in private, why he does not help. d. Suggest ways the mother can get her husband to help.

b. Listen and reflect mother's feelings. It is appropriate for the nurse to reflect with the mother about her feelings, exploring issues such as an additional home health aide to help care for the child and provide respite for the mother. It is inappropriate for the nurse to agree with the mother that her husband is not helping enough. It is a judgment beyond the role of the nurse and can undermine the family relationship. Counseling is not necessary at this time. A support group for caregivers may be indicated. Asking the father why he does not help and suggesting ways to the mother to get her husband to help are interventions based on the mother's assumption of minimal contribution to the child's care. The father may have a full-time job and other commitments. The parents need to have an involved third person help them through the negotiation of responsibilities for the loss of their normal child and new parenting responsibilities.

Enemas are ordered to empty the bowel preoperatively for a child with Hirschsprung disease. What enema solution should be used? a. Tap water b. Normal saline c. Oil retention d. Phosphate preparation

b. Normal saline Isotonic solutions should be used in children. Saline is the solution of choice. Plain water is not used. This is a hypotonic solution and can cause rapid fluid shift, resulting in fluid overload. Oil-retention enemas will not achieve the "until clear" result. Phosphate enemas are not advised for children because of the harsh action of the ingredients. The osmotic effects of the phosphate enema can result in diarrhea, which can lead to metabolic acidosis.

A nurse is planning palliative care for a child with severe pain. Which should the nurse expect to be prescribed for pain relief? a. Opioids as needed b. Opioids on a regular schedule c. Distraction and relaxation techniques d. Nonsteroidal anti-inflammatory drugs

b. Opioids on a regular schedule

Kelly, an 8-year-old girl, will soon be able to return to school after an injury that resulted in several severe, chronic disabilities. Which is the most appropriate action by the school nurse? a. Recommend that the child's parents attend school at first to prevent teasing. b. Prepare the child's classmates and teachers for changes they can expect. c. Refer the child to a school where the children have chronic disabilities similar to hers. d. Discuss with the child and her parents the fact that her classmates will not accept her as they did before.

b. Prepare the child's classmates and teachers for changes they can expect.

The feeling of guilt that the child "caused" the disability or illness is especially critical in which child? a. Toddler b. Preschooler c. School-age child d. Adolescent

b. Preschooler

An infant with short bowel syndrome will be discharged home on total parenteral nutrition (TPN) and gastrostomy feedings. What should be included in the discharge teaching? a. Prepare family for impending death. b. Teach family signs of central venous catheter infection. c. Teach family how to calculate caloric needs. d. Secure TPN and gastrostomy tubing under diaper to lessen risk of dislodgement.

b. Teach family signs of central venous catheter infection. During TPN therapy, care must be taken to minimize the risk of complications related to the central venous access device, such as catheter infections, occlusions, or accidental removal. This is an important part of family teaching. The prognosis for patients with short bowel syndrome depends in part on the length of residual small intestine. It has improved with advances in TPN. Although parents need to be taught about nutritional needs, the caloric needs and prescribed TPN and rate are the responsibility of the health care team. The tubes should not be placed under the diaper due to risk of infection.

A 4-month-old infant has gastroesophageal reflux (GER) but is thriving without other complications. Which should the nurse suggest to minimize reflux? a. Place in Trendelenburg position after eating. b. Thicken formula with rice cereal. c. Give continuous nasogastric tube feedings. d. Give larger, less frequent feedings.

b. Thicken formula with rice cereal. Small, frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice cereal per ounce of formula have been recommended. Milk-thickening agents have been shown to decrease the number of episodes of vomiting and to increase the caloric density of the formula. This may benefit infants who are underweight as a result of GER disease. Placing the child in a Trendelenburg position would increase the reflux. Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive.

Which are adaptive coping patterns used by children with special needs? (Select all that apply.) a. Feels different and withdraws b. Is irritable, moody, and acts out c. Seeks support d. Develops optimism

c. Seeks support d. Develops optimism

At what age do most children have an adult concept of death as being inevitable, universal, and irreversible? a. 4 to 5 years b. 6 to 8 years c. 9 to 11 years d. 12 to 16 years

c. 9 to 11 years

The nurse observes that a seriously ill child passively accepts all painful procedures. What should the nurse recognize this child is most likely experiencing? a. A sense of hopefulness b. A sense of chronic sorrow c. A belief that procedures are a deserved punishment d. A belief that procedures are an important part of care

c. A belief that procedures are a deserved punishment

Constipation has recently become a problem for a school-age girl. She is healthy except for seasonal allergies that are being treated with antihistamines. What should the nurse suspect caused the constipation? a. Diet b. Allergies c. Antihistamines d. Emotional factors

c. Antihistamines Constipation may be associated with drugs such as antihistamines, antacids, diuretics, opioids, antiepileptics, and iron. Because this is the only known change in her habits, the addition of antihistamines is most likely the cause of the diarrhea. With a change in bowel habits, the role of any recently prescribed medications should be assessed.

The nurse is explaining to a parent how to care for a school-age child with vomiting associated with a viral illness. Which action should the nurse include? a. Avoid carbohydrate-containing liquids. b. Give nothing by mouth for 24 hours. c. Brush teeth or rinse mouth after vomiting. d. Give plain water until vomiting ceases for at least 24 hours.

c. Brush teeth or rinse mouth after vomiting. It is important to emphasize the need for the child to brush the teeth or rinse the mouth after vomiting to dilute the hydrochloric acid that comes in contact with the teeth. Ad libitum administration of glucose-electrolyte solution to an alert child will help restore water and electrolytes satisfactorily. It is important to include carbohydrate to spare body protein and avoid ketosis.

A mother of a 5-year-old child, with complex health care needs and cared for at home, expresses anxiety about attending a kindergarten graduation exercise of a neighbor's child. The mother says, "I wish it could be my child graduating from kindergarten." What should the nurse recognize the mother is experiencing? a. Abnormal anxiety b. Ineffective coping c. Chronic sorrow d. Denial

c. Chronic sorrow

The home health nurse is caring for a child who requires complex care. The family expresses frustration related to obtaining accurate information about their child's illness and its management. Which is the best action for the nurse? a. Determine why the family is easily frustrated. b. Refer the family to the child's primary care practitioner. c. Clarify the family's request, and provide the information they want. d. Answer only questions that the family needs to know about.

c. Clarify the family's request, and provide the information they want.

Which is used to treat moderate to severe inflammatory bowel disease? a. Antacids b. Antibiotics c. Corticosteroids d. Antidiarrheal medications

c. Corticosteroids Corticosteroids, such as prednisone and prednisolone, are used in short bursts to suppress the inflammatory response in inflammatory bowel disease. Antacids and antidiarrheal medications are not drugs of choice in the treatment of inflammatory bowel disease. Antibiotics may be used as an adjunctive therapy to treat complications.

Which nursing intervention is especially helpful in assessing parental guilt when a disability or chronic illness is diagnosed? a. Ask the parents if they feel guilty. b. Discuss guilt only after the parents mention it. c. Discuss the meaning of the parents' religious and cultural background. d. Observe for signs of overprotectiveness.

c. Discuss the meaning of the parents' religious and cultural background.

Which is a parasite that causes acute diarrhea? a. Shigella organisms b. Salmonella organisms c. Giardia lamblia d. Escherichia coli

c. Giardia lamblia G. lamblia is a parasite that represents 10% of non-dysenteric illness in the United States. Shigella, Salmonella, and E. coli are bacterial pathogens.

A nurse is conducting an in-service on childhood gastrointestinal disorders. Which statement is most descriptive of Meckel diverticulum? a. It is more common in females than in males. b. It is acquired during childhood. c. Intestinal bleeding may be mild or profuse. d. Medical interventions are usually sufficient to treat the problem.

c. Intestinal bleeding may be mild or profuse. Bloody stools are often a presenting sign of Meckel diverticulum. It is associated with mild to profuse intestinal bleeding. It is twice as common in males as in females, and complications are more frequent in males. Meckel diverticulum is the most common congenital malformation of the GI tract and is present in 1% to 4% of the general population. The standard therapy is surgical removal of the diverticulum.

Which statement best characterizes hepatitis A? a. Incubation period is 6 weeks to 6 months. b. Principal mode of transmission is through the parenteral route. c. Onset is usually rapid and acute. d. There is a persistent carrier state.

c. Onset is usually rapid and acute. Hepatitis A is the most common form of acute hepatitis in most parts of the world. It is characterized by a rapid and acute onset. The incubation period is approximately 3 weeks for hepatitis A, and the principal mode of transmission for it is the fecal-oral route. Hepatitis A does not have a carrier state.

Which therapeutic management should the nurse prepare to initiate first for a child with acute diarrhea and moderate dehydration? a. Clear liquids b. Adsorbents, such as kaolin and pectin c. Oral rehydration solution (ORS) d. Antidiarrheal medications such as paregoric

c. Oral rehydration solution (ORS) ORS is the first treatment for acute diarrhea. Clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea. Adsorbents are not recommended. Antidiarrheals are not recommended because they do not get rid of pathogens.

Which observation made of the exposed abdomen is most indicative of pyloric stenosis? a. Abdominal rigidity b. Substernal retraction c. Palpable olive-like mass d. Marked distention of lower abdomen

c. Palpable olive-like mass The diagnosis of pyloric stenosis is often made after the history and physical examination. The olive-like mass is easily palpated when the stomach is empty, the infant is quiet, and the abdominal muscles are relaxed. Abdominal rigidity and substernal retraction are usually not present. The upper abdomen, not lower abdomen, is distended.

An infant is brought to the emergency department with dehydration. Which physical assessment finding does the nurse expect? a. Weight gain b. Bradycardia c. Poor skin turgor d.Brisk capillary refill

c. Poor skin turgor Clinical manifestations of dehydration include poor skin turgor, weight loss, lethargy, and tachycardia. The infant would have prolonged capillary refill, not brisk.

A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with GER. What is the purpose of this medication? a. Prevent reflux b. Prevent hematemesis c. Reduce gastric acid production d. Increase gastric acid production

c. Reduce gastric acid production The mechanism of action of histamine-receptor antagonists is to reduce the amount of acid present in gastric contents and perhaps prevent esophagitis. Preventing reflux or hematemesis and increasing gastric acid production are not the modes of action of histamine-receptor antagonists.

During the first few days after surgery for cleft lip, which intervention should the nurse do? a. Leave infant in crib at all times to prevent suture strain. b. Keep infant heavily sedated to prevent suture strain. c. Remove restraints periodically to cuddle infant. d. Alternate position from prone to side-lying to supine.

c. Remove restraints periodically to cuddle infant. Remove restraints periodically, while supervising the infant, to allow him or her to exercise arms and to provide cuddling and tactile stimulation. The infant should not be left in the crib, but should be removed for appropriate holding and stimulation. Analgesia and sedation are administered for pain. Heavy sedation is not indicated. The child should not be placed in the prone position.

Which pathogen is the viral pathogen that frequently causes acute diarrhea in young children? a.Giardia organisms b. Shigella organisms c. Rotavirus d. Salmonella organisms

c. Rotavirus Rotavirus is the most frequent viral pathogen that causes diarrhea in young children. Giardia (parasite) and Salmonella are bacterial pathogens that cause diarrhea. Shigella is a bacterial pathogen that is uncommon in the United States.

A school-age child is diagnosed with a life-threatening illness. The parents want to protect their child from knowing the seriousness of the illness. What should the nurse tell the parents? a. This will help the child cope effectively by denial. b. This attitude is helpful to give parents time to cope. c. Terminally ill children know when they are seriously ill. d. Terminally ill children usually choose not to discuss the seriousness of their illness.

c. Terminally ill children know when they are seriously ill.

A 16-year-old with a chronic illness has recently become rebellious and is taking risks such as missing doses of his medication. What is the best explanation for this behavior? a. Needs more discipline b. Needs more socialization with peers c. This is part of normal adolescence d. This is how he is asking for more parental control

c. This is part of normal adolescence

A nurse is conducting dietary teaching on high-fiber foods for parents of a child with constipation. Which foods should the nurse include as being high in fiber? (Select all that apply.) a. White rice b. Avocados c. Whole grain breads d. Bran pancakes e. Raw carrots

c. Whole grain breads d. Bran pancakes e. Raw carrots High-fiber foods include whole grain breads, bran pancakes, and raw carrots. Unrefined (brown) rice is high in fiber, but white rice is not. Raw fruits, especially those with skins or seeds, other than ripe banana or avocado, are high in fiber.

A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. The nurse should recognize that preparing this child psychologically is: a. not necessary because of child's age. b. not necessary because colostomy is temporary. c. necessary because it will be an adjustment. d. necessary because the child must deal with a negative body image.

c. necessary because it will be an adjustment. The child's age dictates the type and extent of psychological preparation. When a colostomy is performed, the child who is at least preschool age is told about the procedure and what to expect in concrete terms, with the use of visual aids. It is necessary to prepare a 3-year-old child for procedures. The preschooler is not yet concerned with body image.

A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet with the family. Which statement by the parent would indicate a correct understanding of the teaching? a. "I will keep my child on a clear liquid diet for the next 24 hours." b. "I should encourage my child to drink carbonated drinks but avoid food for the next 24 hours." c. "I will offer my child bananas, rice, applesauce, and toast for the next 48 hours." d. "I should have my child eat a normal diet with easily digested foods for the next 48 hours."

d. "I should have my child eat a normal diet with easily digested foods for the next 48 hours." Easily digested foods such as cereals, cooked vegetables, and meats should be provided for the child. Early reintroduction of nutrients is desirable. Continued feeding or reintroduction of a regular diet has no adverse effects and actually lessens the severity and duration of the illness. Clear liquids and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic. The BRAT diet has little nutritional value and is high in carbohydrates.

Which clinical manifestation would be the most suggestive of acute appendicitis? a. Rebound tenderness b. Bright red or dark red rectal bleeding c. Abdominal pain that is relieved by eating d. Abdominal pain that is most intense at McBurney point

d. Abdominal pain that is most intense at McBurney point Pain is the cardinal feature. It is initially generalized, usually periumbilical. The pain localizes to the right lower quadrant at McBurney point. Rebound tenderness is not a reliable sign and is extremely painful to the child. Bright red or dark red rectal bleeding and abdominal pain that is relieved by eating are not signs of acute appendicitis.

A family wants to begin oral feeding of their 4-year-old son, who is ventilator-dependent and currently tube-fed. They ask the home health nurse to feed him the baby food orally. The nurse recognizes a high risk of aspiration and an already compromised respiratory status. What is the most appropriate nursing action? a. Refuse to feed him orally because the risk is too high. b. Explain the risks involved, and then let the family decide what should be done. c. Feed him orally because the family has the right to make this decision for their child. d. Acknowledge their request, explain the risks, and explore with the family the available options.

d. Acknowledge their request, explain the risks, and explore with the family the available options. Parents want to be included in the decision making for their child's care. The nurse should discuss the request with the family to ensure this is the issue of concern, and then they can explore potential options together. Merely refusing to feed the child orally does not determine why the parents wish the oral feedings to begin and does not involve them in the problem solving. The decision to begin or not change feedings should be a collaborative one, made in consultation with the family, nurse, and appropriate member of the health care team.

At what developmental period do children have the most difficulty coping with death, particularly if it is their own? a. Toddlerhood b. Preschool c. School-age d. Adolescence

d. Adolescence

A nurse is admitting an infant with dehydration caused from water loss in excess of electrolyte loss. Which type of dehydration is this infant experiencing? a. Isotonic b. Isosmotic c. Hypotonic d. Hypertonic

d. Hypertonic Hypertonic dehydration results from water loss in excess of electrolyte loss. This is the most dangerous type of dehydration. It is caused by feeding children fluids with high amounts of solute. Isotonic dehydration occurs in conditions in which electrolyte and water deficits are present in balanced proportion and is another term for isomotic dehydration. Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic.

What is invagination of one segment of bowel within another called? a. Atresia b. Stenosis c. Herniation d. Intussusception

d. Intussusception Intussusception occurs when a proximal section of the bowel telescopes into a more distal segment, pulling the mesentery with it. The mesentery is compressed and angled, resulting in lymphatic and venous obstruction. Invagination of one segment of bowel within another is the definition of intussusception, not atresia, stenosis, or herniation.

The nurse is talking with the parent of a child newly diagnosed with a chronic illness. The parent is upset and tearful. The nurse asks, "Whom do you talk to when something is worrying you?" How should the nurse's statement be interpreted? a. Inappropriate, because the parent is so upset b. A diversion of the present crisis to similar situations with which the parent has dealt c. An intervention to find someone to help the parent d. Part of assessing the parent's available support system

d. Part of assessing the parent's available support system

Most parents of children with special needs tend to experience chronic sorrow. What characterizes chronic sorrow? a. Lack of acceptance of the child's limitation b. Lack of available support to prevent sorrow c. Periods of intensified sorrow when experiencing anger and guilt d. Periods of intensified sorrow and loss that occur in waves over time

d. Periods of intensified sorrow and loss that occur in waves over time

A preschooler is found digging up a pet bird that was recently buried after it died. What is the best explanation for this behavior? a. Has a morbid preoccupation with death b. Is looking to see whether a ghost took it away c. The loss is not yet resolved, and professional counseling is needed d. Reassurance is needed that the pet has not gone somewhere else

d. Reassurance is needed that the pet has not gone somewhere else

Which nursing intervention should the nurse include to help the siblings of a child with special needs cope? a. Explain to the siblings that embarrassment is unhealthy b. Encourage the parents not to expect siblings to help them care for the child with special needs c. Provide information to the siblings about the child's condition only as they request it d. Suggest to the parents ways of showing gratitude to the siblings who help care for the child with special needs

d. Suggest to the parents ways of showing gratitude to the siblings who help care for the child with special needs

A child has a nasogastric (NG) tube after surgery for acute appendicitis. What is the purpose of the NG tube? A. Maintain electrolyte balance B. Maintain an accurate record of output C. Prevent the spread of infection D. Prevent abdominal distention

D. Prevent abdominal distention

The nurse is caring for a boy with probable intussusception. He had diarrhea before admission; but, while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool. What is the most appropriate nursing action? A. Notify physician B. Measure abdominal girth C. Auscultate for bowel sounds D. Take vital signs, including blood pressure

A. Notify physician Passage of a normal stool indicates that the intussusception has resolved. Notification of the physician is essential to determine whether a change in treatment plan is indicated. These actions may be indicated, but the physician still should be notified as to the change in status. These actions may be indicated, but the physician still should be notified as to the change in status. These actions may be indicated, but the physician still should be notified as to the change in status.

When considering Crohn's and Ulcerative Colitis (UC) as disease states, which clinical symptoms may appear to be common presentations in both? A. Rashes and joint pain B. Rectal bleeding C. Growth restriction D. Fistulas and strictures

A. Rashes and joint pain

Which statement best describes Hirschsprung disease? A. The colon has an aganglionic segment. B. There is a passage of excessive amounts of meconium in the neonate. C. It results in excessive peristaltic movements within the gastrointestinal tract. D. It results in frequent evacuation of solids, liquids, and gas.

A. The colon has an aganglionic segment.

A 2-month-old breastfed infant is successfully rehydrated with oral rehydration solutions (ORSs) for acute diarrhea. Instructions to the mother about breastfeeding should include to A. continue breastfeeding. B. stop breastfeeding until breast milk is cultured. C. stop breastfeeding until diarrhea is absent for 24 hours. D. express breast milk and dilute with sterile water before feeding.

A. continue breastfeeding.

The nurse observes erythema, pain, and edema at a child's intravenous (IV) infusion site with streaking along the vein. The nurse's priority action is to A. immediately stop the infusion. B. check for a good blood return. C. ask another nurse to check the IV site. D, increase IV drip with normal saline for 1 minute and recheck.

A. immediately stop the infusion.

What should the nurse include when teaching an adolescent with Crohn disease? A. Preventing the spread of illness to others and nutritional guidance B. Adjusting to chronic illness and preventing the spread of illness to others C. Coping with stress and adjusting to chronic illness D. Nutritional guidance and preventing constipation

C. Coping with stress and adjusting to chronic illness

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

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

It is time to give a 3-year-old medication. What approach is most likely to receive a positive response from the child? A. "It's time for your medication now. Would you like water or apple juice afterward?" B. "Wouldn't you like to take your medicine now?" C. "You must take your medicine because the doctor says it will make you better." D. "See how nicely your roommate took medicine? Now take yours."

A. "It's time for your medication now. Would you like water or apple juice afterward?"

In performing a work up for a school aged child who reports frequent abdominal pain symptoms, what information would be critical to collect in order to make an accurate clinical diagnosis? A. Find out the duration, onset and quality characteristics of the symptoms. B. Ask the child's parents for detailed information. C. Find out if the child has any food allergies or food intolerances. D. Take and document vital signs to establish a clinical baseline.

A. Find out the duration, onset and quality characteristics of the symptoms.

What should the nurse consider when providing support to a family whose infant has just been diagnosed with biliary atresia? A. Liver transplantation may be needed eventually. B. Death usually occurs by 6 months of age. C. The prognosis for full recovery is excellent. D. Children with surgical correction live normal lives.

A. Liver transplantation may be needed eventually. Approximately 80% to 90% of children with biliary atresia will require liver transplantation. If the condition is untreated, death will usually occur by 2 years of age. Long-term survival is possible with surgical intervention. Liver transplantation is usually required for long-term survival. Even with surgical intervention, most children progress to liver failure and require transplantation.

Which question would the nurse utilize in order to assess family stress levels with regard to chronic disease of their 4-year-old child? A. Do you find satisfaction in your work? B. What is your educational level? C. How do you think your other children feel about their brother's condition? D. Are there any other problems that I could help you with?

C. How do you think your other children feel about their brother's condition?

Which factor predisposes an infant to fluid imbalances? A. Decreased surface area B. Lower metabolic rate C. Immature kidney functioning D. Decreased daily exchange of extracellular fluid

C. Immature kidney functioning

You are educating nursing student regarding fluid requirements for pediatric patients who present with comorbidities. Increased need for fluid requirements would be consistent with treatment management for which conditions? Select all that apply. A. Congestive Heart Failure (CHF) B. Diabetic ketoacidosis (DKA) C. Syndrome of inappropriate diuretic hormone (SIADH) D. Diabetes Insipidus(DI) E. Burns

B. Diabetic ketoacidosis (DKA) D. Diabetes Insipidus(DI) E. Burns

Several nurses tell their nursing supervisor that they want to be able to attend the funeral of a child for whom they had cared. They say that they felt especially close to both the child and the family. The supervisor should recognize that attending the funeral is A. appropriate because families expect this expression of concern. B. appropriate because it can assist in the resolution of personal grief. C. inappropriate because it is considered unprofessional behavior on the part of the nurses. D. inappropriate because it increases burnout of the nursing staff.

B. appropriate because it can assist in the resolution of personal grief.

A 4-year-old child has ingested a toxic dose of iron. The parent reports that the child vomited and complained of gastric pain an hour ago but "feels fine" now. The parent is not certain when the child ingested the iron tablets. The most appropriate recommendation by the nurse to the parent is to A. observe the child closely for 2 more hours. B. bring the child to the hospital immediately. C. administer activated charcoal. D. administer ipecac to induce vomiting if the child does not vomit again within 1 hour.

B. bring the child to the hospital immediately. The child should be transported to the hospital immediately for assessment and possible gastric lavage. The period of concern for complications of iron toxicity is from 30 minutes to 6 hours. Activated charcoal does not bind iron and, therefore, is not a course of treatment for this child. Ipecac is not recommended for poisonings.

A child has been diagnosed with hepatitis A and received treatment. Based on this information the nurse determines that A. the illness was transmitted via blood route. B. immunity has been acquired for this type. C. crossover immunity is present for all types of hepatitis. D. the patient will now be a carrier for this type.

B. immunity has been acquired for this type. Once a patient has been exposed and treated, they develop immunity to this type but there is no crossover immunity to other hepatitis types. Hepatitis A if transmitted through fecal-oral route and is not blood borne. There is no carrier state for Hepatitis A.

Which diet is most appropriate for the child with celiac disease? A. Salt-free diet B. Phenylalanine-free diet C. Low-gluten diet D. High-calorie, low-protein, low-fat diet

C. Low-gluten diet The diet does not have to be salt free. Low phenylalanine is indicated in phenylketonuria. Celiac disease is characterized by intolerance to gluten, the protein found in wheat, barley, rye, and oats. A low-gluten diet is indicated. Diet should be high in calories and protein and low in fat.

Following a child's death in the hospital, hospital policy dictates that the family must be asked about the possibility of organ donation. What measures would help to support the family and nurse during this difficult time with regard to this issue? A. Even though it may be hospital policy, consider each death individually and if the parents seem too upset, refrain from asking the question. B. Make sure that the question has already been addressed prior to the child's death for it will be too difficult to discuss afterwards. C. The hospital should provide training for health care providers to assist them in having to ask this question following any patient's death. D. Ask the family members about this option just prior to the body being removed from the unit, so they will have less time to dwell on the dilemma.

C. The hospital should provide training for health care providers to assist them in having to ask this question following any patient's death.

The care of a newborn with a cleft lip and palate before surgical repair includes A. little to no sucking. B. gastrostomy feedings. C. providing nonnutritive and nutritive sucking. D. positioning infant in near-horizontal for feeding.

C. providing nonnutritive and nutritive sucking.

The nurse needs to give an injection to a 4-year-old in the deltoid muscle. Based on the nurse's knowledge of preschool development, the most appropriate approach by the nurse is to A. smile while giving the injection to help the child relax. B. tell the child that you will be so quick, the injection won't even hurt. C. explain that child will experience "a little stick in the arm." D. Explain with concrete terms such as "putting medicine under the skin."

D. Explain with concrete terms such as "putting medicine under the skin."

A child is exhibiting signs of clinical dehydration. Which laboratory value would support a diagnosis of hypertonic dehydration? A. Serum sodium level of 135 mEq/dL B. Plasma osmolality of 275 mOsm/L C. Calculation of loss of body fluid weight at 25 mL/kg D. Serum sodium level of 150 mEq/dL

D. Serum sodium level of 150 mEq/dL Hypertonic dehydration would result in an increase in serum sodium levels in proportion to fluid loss. Normal serum sodium level ranges between 135 and 145 mEq/dL. Normal plasma osmolality is within the 275 to 295 mOsm/L. Calculation of loss of body fluid weight in terms of moderate loss would be at 50 mL/kg with 100 mL/kg being severe.

When evaluating the extent of an infant's dehydration, the nurse should recognize that the symptoms of severe dehydration (15%) are A. tachycardia, decreased tears, 5% weight loss. B. normal pulse and blood pressure, intense thirst. C. irritability, moderate thirst, normal eyes and fontanels. D. tachycardia, parched mucous membranes, sunken eyes and fontanels.

D. tachycardia, parched mucous membranes, sunken eyes and fontanels.

T/F: 1 g of diaper weight equals 1 ml of urine

False

T/F: A BRAT diet is recommended for children with acute diarrhea.

False

T/F: Infants are at the same risk of fluid depletion as school age children.

False

T/F: If a child has a cleft lip and palate, they are repaired at the same time.

False -cleft lip 2-3 months. rule of 10...10 lbs, 10 weeks, hgb of 10. -palate= 6-12 months.

T/F: Both Crohn disease and ulcerative colitis are forms of Inflammatory bowel disease.

True

T/F: H&H will be increased with extracellular fluid volume decrease.

True

T/F: Pain at McBurney point is indicative of appendicitis.

True

T/F: The 3 C's associated with tracheoesophageal fistula are coughing, choking, cyanosis.

True

T/F: Two major abdominal defects in children are gastroschisis and omphalocele

True

T/F: A history of projectile vomiting would be a clinical manifestation indicative of pyloric stenosis.

True

Which type of dehydration is defined as "dehydration that occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportion"? a. Isotonic dehydration b. Hypotonic dehydration c. Hypertonic dehydration d. All types of dehydration in infants and small children

a. Isotonic dehydration Isotonic dehydration is the correct term for this definition and is the most frequent form of dehydration in children. Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic. Hypertonic dehydration results from water loss in excess of electrolyte loss and is usually caused by a proportionately larger loss of water or a larger intake of electrolytes. This definition is specific to isotonic dehydration.

When caring for a child with probable appendicitis, the nurse should be alert to recognize that which condition or symptom is a sign of perforation? a. Bradycardia b. Anorexia c. Sudden relief from pain d. Decreased abdominal distention

c. Sudden relief from pain Signs of peritonitis, in addition to fever, include sudden relief from pain after perforation. Tachycardia, not bradycardia, is a manifestation of peritonitis. Anorexia is already a clinical manifestation of appendicitis. Abdominal distention usually increases.

A nurse is conducting an in-service on gastrointestinal disorders. The nurse includes that melena, the passage of black, tarry stools, suggests bleeding from which area? a. Perianal or rectal area b. Hemorrhoids or anal fissures c. Upper gastrointestinal (GI) tract d. Lower GI tract

c. Upper gastrointestinal (GI) tract Melena is denatured blood from the upper GI tract or bleeding from the right colon. Blood from the perianal or rectal area, hemorrhoids, or lower GI tract would be bright red.

The nurse is caring for an infant with suspected pyloric stenosis. Which clinical manifestation would indicate pyloric stenosis? a. Abdominal rigidity and pain on palpation b. Rounded abdomen and hypoactive bowel sounds c. Visible peristalsis and weight loss d. Distention of lower abdomen and constipation

c. Visible peristalsis and weight loss Visible gastric peristaltic waves that move from left to right across the epigastrium and weight loss are observed in pyloric stenosis. Abdominal rigidity and pain on palpation or a rounded abdomen and hypoactive bowel sounds are usually not present. The upper abdomen, not lower abdomen, is distended.

What should be included in caring for the newborn with a cleft lip and palate before surgical repair? a. Gastrostomy feedings b. Keeping infant in near-horizontal position during feedings c. Allowing little or no sucking d. Providing satisfaction of sucking needs

d. Providing satisfaction of sucking needs Using special or modified nipples for feeding techniques helps meet the infant's sucking needs. Gastrostomy feedings are usually not indicated. Feeding is best accomplished with the infant's head in an upright position. The child requires both nutritive and nonnutritive sucking.

Which type of hernia has an impaired blood supply to the herniated organ? a. Hiatal hernia b. Incarcerated hernia c. Omphalocele d. Strangulated hernia

d. Strangulated hernia A strangulated hernia is one in which the blood supply to the herniated organ is impaired. Hiatal hernia is the intrusion of an abdominal structure, usually the stomach, through the esophageal hiatus. Incarcerated hernia is a hernia that cannot be reduced easily. Omphalocele is the protrusion of intra-abdominal viscera into the base of the umbilical cord. The sac is covered with peritoneum, not skin.

Which therapeutic management treatment is implemented for children with Hirschsprung disease? a. Daily enemas b. Low-fiber diet c. Permanent colostomy d. Surgical removal of affected section of bowel

d. Surgical removal of affected section of bowel Most children with Hirschsprung disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter. Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. The colostomy that is created in Hirschsprung disease is usually temporary.