Ricci Chapter 42

The nurse is talking with a woman in her second trimester of pregnancy who has been diagnosed with polyhydramnios. The physician has ordered an ultrasound be performed to check for the presence of esophageal atresia. Which statement by the woman indicates an understanding of the relationship between these conditions? "Babies with esophageal atresia produce an excessive amount of amniotic fluid." "Reductions in amniotic fluid are associated with the development of esophageal atresia." "Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup." "Enzymes in amniotic fluid can cause the development of esophageal atresia."

"Babies with esophageal atresia produce an excessive amount of amniotic fluid." Review the maternal history for polyhydramnios. Often this is the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. Esophageal atresia is an underlying cause of polyhydramnios.

The nurse is caring for a 2-year-old boy with an umbilical hernia and is teaching the mother about this condition. Which response from the mother indicates a need for further teaching? "I can tape a quarter over the hernia to reduce it." "An incarcerated hernia is rare, but it can occur." "I need to watch for pain, tenderness, or redness." "My son could have some appearance-related self-esteem issues."

"I can tape a quarter over the hernia to reduce it." The use of home remedies to reduce an umbilical hernia should be discouraged because of the risk of bowel strangulation. The mother needs to be aware that strangulation can occur, but it is rare with an umbilical hernia. Pain, tenderness, or redness indicates an incarcerated hernia, which although rare with umbilical hernias, can occur.

The nurse is teaching the mother of a 5-year-old boy with a history of impaction how to administer enemas at home. Which response from the mother indicates a need for further teaching? "I should position him on his abdomen with knees bent." "He will require 250 to 500 mL of enema solution." "I should wash my hands and then wear gloves." "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 mother of an infant tells the nurse during a routine visit to the clinic that she often notices a bulging mass in the lower abdominal and groin area when her baby cries. She asks the nurse if this is normal. How should the nurse respond? "The muscle wall of infants are not yet strong so it isn't unusual to see this happening when the baby is crying or straining." "I didn't notice any masses while I was assessing your infant. It may just appear they have a mass due to pressure in the abdomen when crying." "I will be sure to note this in your child's chart so it is something we will continue to monitor in future visits." "I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately."

"I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately." The mother is describing common symptoms of an inguinal hernia. It may be possible to visualize the mass, but often the mass is seen only during crying or straining, making it difficult to actually identify in the clinic setting. It is important to notify the physician so treatment can be initiated.

A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition? Barium enema Surgery Upper endoscopy Endoscopic retrograde cholangiopancreatography

Barium enema 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.

The nurse is caring for an infant recently diagnosed with oral candidiasis (thrush) who has been prescribed nystatin. Which statement by the infant's mother would suggest a need for further education? "I will add the nystatin to her bottle four times per day." "I will use a cotton tipped applicator to apply the medication to her mouth." "I will make sure to clean all of her toys before I give them to her." "I will watch for diaper rash."

"I will add the nystatin to her bottle four times per day." Administer nystatin suspension four times per day following feeding, not mixed in the bottle, to allow the medication to remain in contact with the lesions. In the younger infant, apply nystatin to the lesions with a cotton-tipped applicator. Infants and young children often mouth their toys, so it is important to clean them appropriately. Explain to parents of infants with oral candidiasis (thrush) the importance of reporting diaper rash because fungal infections in the diaper area often occur concomitantly with thrush and also need to be treated.

The student nurse is caring for a child with the nursing diagnosis "Risk for fluid volume deficit related to inadequate oral intake." Which statement by the student would indicate a need for further education by the nursing instructor? "I will monitor her IV line to help maintain her fluid volume." "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." "I will weigh her every morning at the same time."

"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 mother of a young child who has been treated for a bacterial urinary tract infection tells the nurse her daughter has a white thick covering over her tongue. The mother states that she "has tried everything to get it off my child's tongue." How should the nurse respond? "Have you tried using a toothbrush to get it off?" "That is a common side effect after taking an antibiotic. It will go away after the antibiotic is out of the system." "It is likely an infection was caused by the antibiotic for the urinary tract infection. I am sure a different antibiotic will help it." "It's not unusual for a fungal infection to occur while taking an antibiotic for an infection. I will let your primary care provider know so we can get it treated."

"It's not unusual for a fungal infection to occur while taking an antibiotic for an infection. I will let your primary care provider know so we can get it treated." Oral candidiasis (thrush) is a fungal infection that can occur on the tongue while on an antibiotic for an unrelated bacterial infection. The antibiotic destroys normal flora, which allows the fungal infection to occur. Thrush requires an antifungal agent, such as nystatin liquid, to destroy the infection. Additional antibiotics will not help since it is a fungal infection.

The nurse is caring for a child with gastrointestinal concerns. What statement by the parent would indicate a need for the nurse to further assess the child for constipation? "My child has such large bowl movements that it clogs the toilet." "My child only has a bowel movement about four times a week." "My child eats vegetables and fresh fruit, but does not like beans." "My child does not have liquid stool or leak liquid stools that I am aware of."

"My child has such large bowl movements that it clogs the toilet." Constipation may manifest by bowel movements that are large enough to clog the toilet, fewer bowel movements than normal, and bowel movements that are hard and pellet-like. Constipation is not likely if the child eats fruits and vegetables, even when beans are not incorporated into the child's diet. Passage of liquid stools can be a sign of constipation.

A nurse is caring for a 6-year-old girl recently diagnosed with celiac disease and is discussing dietary restrictions with the girl's mother. Which response indicates a need for further teaching? "My daughter is eating more vegetables." "There is gluten hidden in unexpected foods." "There are many types of flour besides wheat." "My daughter can eat any kind of fruit."

"My daughter can eat any kind of fruit." While most fruits and fruit juices are allowed, the nurse needs to make sure the mother knows that some fruit pie fillings and dried fruit may contain gluten.

The nurse is caring for a 4-year-old with oral vesicles and ulcers from herpangina. The child is refusing fluids due to the pain and the mother is concerned about his hydration status. Which of the suggestions would be most appropriate? "Offer 'magic mouthwash' followed by a popsicle." "Encourage him to have some soda." "Offer him some orange juice." "Try some Anbesol or Kank-A."

"Offer 'magic mouthwash' followed by a popsicle." Children are more likely to cooperate with interventions if play is involved. "Magic" analgesic mouthwash followed by a popsicle is most likely to alleviate some pain and then provide hydration. Soda should be avoided because it can cause stinging and burning. Orange juice should be avoided because it can cause stinging and burning. Anbesol might be helpful but it will likely be difficult to apply. Additionally, oral analgesics are often necessary.

The student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply. "Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "Most children with celiac disease are diagnosed within the first year of life." "The only treatment for celiac disease is a strict gluten-free diet." "Gluten is found in most wheat products, rye, barley and possibly oats." "The entire family will need to eat a gluten-free diet."

"Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "The only treatment for celiac disease is a strict gluten-free diet." "Gluten is found in most wheat products, rye, barley and possibly oats." Celiac disease is an immunologic disorder in which gluten causes damage to the small intestine. The only treatment currently is consuming a gluten-free diet. While the child needs to have a gluten-free diet, the rest of the family does not. Most children present by the age of 2 for evaluation. Symptoms of celiac disease include diarrhea, constipation, steatorrhea, weight loss, poor muscle tone, anemia and dental disorders. Gluten is found in most grains, like wheat, rye, barley and possibly oats.

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

"Tell me about the types of stools your child has been having." 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 the number and type of stools per day. Recent eating patterns, determining 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 nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis? "The treatment for the disorder will be a surgical procedure." "Your child will be treated with oral iron preparations to correct the anemia." "We will give enemas until clear and then teach you how to do these at home." "Your child will receive counseling so the underlying concerns will be addressed."

"The treatment for the disorder will be a surgical procedure." Treatment of congenital aganglionic megacolon involves surgery with the ultimate resection of the aganglionic portion of the bowel. Chronic anemia may be present, but iron will not correct the disorder. Enemas may be given to initially achieve bowel elimination, but they will not treat the disorder. Differentiation must be made between this condition and psychogenic megacolon because of coercive toileting or other emotional problems. The child with aganglionic megacolon does not withhold stools or defecate in inappropriate places, and no soiling occurs.

The nurse is preparing a client for surgery and the client asks, "What does it mean when they say they are going to reduce my abdominal hernia?" Which response by the nurse is most appropriate? "This means the hernia contents will be manipulated back into your peritoneal cavity during surgery." "If you do not understand this, I need to cancel your surgery and have the health care provider come back." "All this means is that the herniated intestines are twisted and edematous, which is why you need surgery." "The health care provider will remove about half of the herniated contents during the procedure."

"This means the hernia contents will be manipulated back into your peritoneal cavity during surgery." A hernia in the abdominal region is considered reducible when its contents are easily manipulated back through the inguinal ring into the peritoneal cavity. The nurse would reinforce this education, already provided by the primary health care provider when the surgery was explained, to the client. It is not necessary to cancel surgery when the nurse can provide education to the client. Reducing does not mean the intestines are twisted and edematous. Nor does it mean half of the contents will be removed.

A child is experiencing an acute exacerbation of Crohn disease for which she is prescribed prednisone. The nurse teaches the parents and child about this medication. Which statement by the parents indicates that the teaching was successful? "We should not stop this medication abruptly." "She might lose some weight initially." "This drug helps to control the abdominal cramping." "We might notice some of the medication in her stool."

"We should not stop this medication abruptly." 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.

The nurse is caring for a 13-year-old girl with suspected autoimmune hepatitis. The girl inquires about the testing required to evaluate the condition. How should the nurse respond? "You will most likely have a blood test to check for certain antibodies." "You will most likely have an ultrasound evaluation." "You will most likely have viral studies." "You will most likely be tested for ammonia levels."

"You will most likely have a blood test to check for certain antibodies." Anti-nuclear antibodies are one of the diagnostic tests performed to diagnose autoimmune hepatitis. Ultrasound is performed to assess for liver or spleen abnormalities. Viral studies are performed to screen for viral causes of hepatitis. Ammonia levels may be ordered if hepatic encephalopathy is suspected.

The nurse is providing care to a child who has had an appendectomy for a perforated appendix. The nurse would anticipate intravenous antibiotic therapy for how long? 7 to 14 days 5 to 7 days 3 to 5 days 1 to 3 days

7 to 14 days 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 caring for a child with a diagnosis of pyloric stenosis during the preoperative phase of the child's treatment. What is the highest priority at this time? Preparing family for home care Promoting comfort Maintaining skin integrity Improving hydration

Improving hydration 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.

A child presents with intermittent abdominal pain, severe anorexia, and diarrhea. The child's height and weight are significantly behind standards for age. There is skin breakdown in the anal region. The nurse explains that this presentation is consistent with which diagnosis? Crohn disease ulcerative colitis food poisoning Hirschsprung disease

Crohn disease Intermittent abdominal pain, anorexia, diarrhea, growth delays, and perianal lesions are characteristic of Crohn disease. In ulcerative colitis, the pain is continuous with bloody diarrhea, but anorexia, weight loss, and growth delay are mild. Food poisoning is an acute condition and may result in weight loss but not growth delays. In Hirschsprung disease the bowel lacks nerve innervation, so it lacks motility and fecal output.

A parent brings a 2-year-old child to the health clinic with reports of diarrhea, vomiting, and abdominal pain. The father tells the nurse that he is a single parent and his child is enrolled in a local day care center. Based on this information, what gastrointestinal condition might the nurse suspect? Appendicitis Pancreatitis Gastroenteritis Hirschsprung disease

Gastroenteritis Outbreaks of gastroenteritis routinely occur in day care 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.

A nurse prepares a menu for a client with Crohn disease. What is the focus of dietary management for this disease? High carbohydrate, high protein Low calorie, high carbohydrate High calorie, high fiber Low fiber, low calorie

High carbohydrate, high protein The goal of nutritional intervention is to provide adequate nutrient intake to optimize normal growth and development—including pubertal development, which is frequently delayed—and to prevent and correct nutrient deficiencies. Adequate nutrition with a high-protein and high-carbohydrate diet may be recommended.

A neonatal nurse teaches students how to recognize gastrointestinal disorders in infants. The nurse tells the students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease? Gastroenteritis Ulcerative colitis (UC) Hirschsprung disease Short bowel syndrome (SBS)

Hirschsprung disease The nurse should suspect Hirschsprung disease when the newborn does not pass meconium in the first 24 hours after birth, and has bilious vomiting or abdominal distention and feeding intolerance with bilious aspirates and vomiting. Typical signs and symptoms of gastroenteritis include diarrhea, nausea, vomiting, and abdominal pain. The characteristic GI manifestation of UC is bloody diarrhea accompanied by crampy, typically left-sided lower abdominal pain. Clinical manifestations of untreated SBS include profuse watery diarrhea, malabsorption, and failure to thrive.

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 partial or complete intestinal obstruction occurs. A thickened, elongated muscle causes an obstruction at the end of the stomach. There are recurrent paroxysmal bouts of abdominal pain. In this disorder the sphincter that leads into the stomach is relaxed.

In this disorder the sphincter that leads into the stomach is relaxed. 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.

A 9-month-old girl is brought to the emergency room with what appears to be bouts of intense abdominal pain 15 minutes apart in which she draws up her legs and cries, often accompanied by vomiting. In between the bouts, the child recovers and appears to be without symptoms. Blood is found in the stool. What condition should the nurse suspect in this case? Intussusception Volvulus with malrotation Necrotizing enterocolitis Short-bowel/short-gut syndrome

Intussusception 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 enterocolitis 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 3-month-old girl is found to have an umbilical hernia at a well visit. On examination, the nurse discovers that the fascial ring through which the intestine protrudes is about 1 cm in diameter. Which statement by the nurse to the girl's father would indicate the likely intervention required to correct this condition? No intervention is needed, as the opening will most likely close spontaneously. Surgery at age 1 to 2 years will likely be needed to repair the condition. Wrapping an elastic band around the child's waist should correct the problem. Taping a silver dollar over the area will help reduce the hernia.

No intervention is needed, as the opening will most likely close spontaneously. An umbilical hernia is a protrusion of a portion of the intestine through the umbilical ring, muscle, and fascia surrounding the umbilical cord. If the fascial ring through which the intestine protrudes is less than 2 cm, closure will usually occur spontaneously after the child begins to walk so no repair of the disorder will be necessary. If the fascial ring is larger than 2 cm, ambulatory surgery for repair is generally indicated to prevent herniation and intestinal obstruction or bowel strangulation. This is usually done at 1 to 2 years of age. Some parents believe holding an umbilical hernia in place by using "belly bands" or taping a silver dollar over the area will help reduce the hernia. These actions can actually lead to bowel strangulation so should be avoided.

The nurse is caring for a teenager diagnosed with acute pancreatitis. Which order would the nurse question? NPO nasogastric tube placed to suction serum amylase levels PO pain management

PO pain management Maintain NPO status and nasogastric tube suction and patency. Administer intravenous fluids to keep the child hydrated and correct any alterations in fluid and electrolyte balance. Pain management is crucial in children with pancreatitis; due to NPO status, medications are typically prescribed intravenously. Serial monitoring of serum amylase levels will determine when oral feeding may be restarted.

The nurse is performing an assessment on a child suspected of having an inguinal hernia. Which assessment technique(s) should be used to assess for the presence of the hernia? Select all that apply. Ask the child to hold the breath and grunt forcefully. Press the palm of one hand on the abdomen and then withdraw the hand. Palpate the inguinal canal and ask the child to turn the head and cough. Palpate the inguinal canal while the child blows up a balloon. Ask the child to inhale forcefully while the inguinal canal is palpated.

Palpate the inguinal canal and ask the child to turn the head and cough. Palpate the inguinal canal while the child blows up a balloon. The inguinal hernia is a protrusion of bowel into the inguinal ring. To assess, the nurse palpates the external inguinal canals for the presence of inguinal hernias, often elicited by having the child turn the head and cough, or blow up a balloon. Coughing causes an increase in internal pressure. Pressing on the abdomen and then withdrawing the hands is a means to assess for rebound tenderness and does not provide an assessment for an inguinal hernia. Asking the child to hold the breath does not check for the hernia. Asking the child to forcefully inhale does not assess for the presence of an inguinal hernia. Holding one's breath and forceful exhalation does not alter the pressure in the lower abdomen.

The emergency department nurse is assessing a child who has presented with a 2-day history of nausea and vomiting with pain that is isolated to the right upper quadrant of the abdomen. Which action is most appropriate? Prepare the child for admission to the hospital. Assess the child's usual urinary voiding pattern. Encourage fluid intake. Administer antacids as ordered.

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 which intervention? Prepare the infant for surgery. Assist in insertion of a nasogastric (NG) tube. Change the infant's diet to one that is lactose-free. Assist in doing a barium enema procedure on the infant.

Prepare the infant for surgery. In pyloric stenosis, the thickened muscle of the pylorus causes gastric outlet obstruction. The treatment is a surgical correction called a pyloromyotomy. The condition is not related to lactose in the diet, so changing to lactose-free formula would not correct the condition. A barium enema would be used to diagnose intussusception. A nasogastric (NG) tube is inserted for gastric decompression in an infant with intussusception.

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

Projectile vomiting 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 decreased and urination is infrequent.

The nurse is caring for a 6-month-old infant with diarrhea and dehydration. The parent is concerned because the infant has some patches on the tongue. Which feature indicates a geographic tongue? Some patches are light in color and other patches are dark in color. The patches are thick, white plaques on the tongue. There are also plaques on the buccal mucosa. There are also white patches on the erupted teeth.

Some patches are light in color and other patches are dark in color. A geographic tongue is a benign, noncontagious condition characterized by a reduction in the filiform papillae. Oral candidiasis (thrush) is characterized by thick, white plaques that form on the tongue. With thrush, plaques also appear on the buccal mucosa and often occur concomitantly in the diaper area. There would not be any patches on the few teeth the infant may have by that age.

An adolescent has hepatitis B. What would be the most important nursing action? Conscientious collection of stool for ova and parasites Strict calculation of caloric and vitamin B intake Strict enforcement of standard precautions Close observation to detect cerebral hallucinations

Strict enforcement of standard precautions Hepatitis B is spread through IV drug use, sex, contaminated blood and perinatally. The treatment is rest, hydration, and nutrition. Hospitalization is required if there is vomiting, dehydration, elevated bleeding times and mental status changes. The adolescent should be taught about good hygiene, safe sex practices, careful handwashing and blood/bodily fluid contact precautions. Using standard precautions of gloves and good handwashing will help prevent spread of the disease. Ova and parasites are not present with hepatitis B. A good diet with adequate protein and vitamins will help the body heal, so these should not be restricted. The nurse observes for mental status changes. These can occur as a complication, but preventing spread of the disease is the nursing priority.

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

Tenting of skin Tenting of skin is an indicator of severe dehydration. Soft and flat fontanels (fontanelles) 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.

An adolescent is diagnosed with hepatitis A. Which problem should be considered when planning care? The adolescent will become fatigued easily. The adolescent will be very irritable and perhaps require sedation. Hypothermia is common. The adolescent's urine will be dark and infectious.

The adolescent will become fatigued easily. Hepatitis A is transmitted via the oral-fecal route; it is water borne and often occurs in areas of poor sanitation. The adolescent with hepatitis A will exhibit flu-like symptoms, a headache, anorexia and fatigue. The urine is not infectious and fever may be present as opposed to hypothermia. Irritability is not one of the symptoms of hepatitis A. The client is usually lethargic or listless.

What occurs in the gastrointestinal system of the child with Hirschsprung disease? There is a partial or complete mechanical obstruction in the intestine. There is a severe narrowing of the lumen of the pylorus. There is an invagination or telescoping of one portion of the bowel into a distal portion. There is a relaxed sphincter in the lower portion of the esophagus.

There is a partial or complete mechanical obstruction in the intestine. Congenital aganglionic megacolon, also called Hirschsprung disease, is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. A narrowing of the lumen of the pylorus is associated with pyloric stenosis in young infants. The telescoping of the bowel is intussusception. The relaxed sphincter in the lower portion of the esophagus is related to gastrointestinal reflux disorder.

The nurse is teaching the mother of an infant with a temporary ileostomy about stoma care. What is the most important instruction to emphasize to the mother to avoid an emergency situation? a. "Call the doctor immediately if the stoma is not pink/red and moist." b. "Gather all of your supplies before you begin." c. "You may need adhesive remover to ease pouch removal." d. "You must be meticulous in caring for the surrounding skin."

a. "Call the doctor immediately if the stoma is not pink/red and moist." Explanation: A healthy stoma is pink and moist. If the stoma is dry or pale, the mother must notify the health care provider immediately because it could indicate compromised circulation. Gathering supplies is important but would not be involved in avoiding an emergency situation. All of the other instructions are valid, but emphasizing the color of the healthy stoma is most important to avoid an emergency situation. Adhesive remover may be needed to ease pouch removal, but this action would not necessarily avoid an emergency situation. Meticulous skin care is important, but this action would not necessarily avoid an emergency situation.

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 congenital aganglionic megacolon? a. A partial or complete intestinal obstruction occurs. b. A thickened, elongated muscle causes an obstruction at the end of the stomach. c. There are recurrent paroxysmal bouts of abdominal pain. d. In this disorder the sphincter that leads into the stomach is relaxed.

a. A partial or complete intestinal obstruction occurs. Explanation: Congenital aganglionic megacolon, also called Hirschsprung disease, is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. 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. 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.

The nurse is working with the mother of a toddler experiencing constipation. What information regarding childhood constipation should the nurse share with the mother? Select all that apply. a. "Have your son sit on the toilet twice a day, after breakfast and dinner, for 5 to 15 minutes." b. "Reward your child with a sticker only when he has a bowel movement." c. "If your child has a fecal impaction, you can give him an enema." d. "Reward your child for sitting on the toilet as asked, not just when he has a bowel movement." e. "You should not give your son laxatives."

a. "Have your son sit on the toilet twice a day, after breakfast and dinner, for 5 to 15 minutes." c. "If your child has a fecal impaction, you can give him an enema." d. "Reward your child for sitting on the toilet as asked, not just when he has a bowel movement." Explanation: Proper education for constipation in children includes educating the families about the importance of compliance with medication use. Many children present to their physician or nurse practitioner with fecal impaction or partial impaction. Teach parents how to disimpact their children at home; this often requires an enema or stimulation therapy. To facilitate daily bowel evacuation, the child should sit on the toilet twice a day (after breakfast and dinner) for 5 to 15 minutes. Instruct the family to keep a "star" or reward chart to encourage compliance. Parents should award the star for compliance with time sitting on the toilet and should not reserve rewards for successful bowel movements only.

The nurse has performed client education for a 15-year-old boy with Crohn disease and his parents regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning has occurred? a. "I have to be careful because I am prone to not absorbing nutrients." b. "I have a lot of diarrhea every day because of how my small intestine is damaged." c. "I may end up with a colectomy because the disease is continuous from the beginning to the end of my intestines." d. "It's unusual for someone my age to get Crohn disease."

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

A nurse caring for an infant born with a cleft palate notices that the parents rarely interact with their child. The nurse overhears the mother telling her spouse that she "feels like crying" every time she looks at their infant. What would be the best response from the nurse? a. "I sense you could use more information on caring for a cleft palate. Would you be interested in meeting with other parents who have dealt with this?" b. "Your infant needs you right now. You should put your negative feelings about the condition aside for your infant's sake." c. "Many infants are born with this condition. Your infant's palate is not nearly as bad as some cases." d. "Keep in mind that your infant's condition is not life-threatening and can be corrected eventually."

a. "I sense you could use more information on caring for a cleft palate. Would you be interested in meeting with other parents who have dealt with this?" Explanation: For many parents, having their infant born with a cleft lip or palate is overwhelming and to some even appalling. The nurse can support the parents by acknowledging their normal feelings of guilt, anger, and sadness. The nurse should support the family's adjustment to an infant's condition by demonstrating an accepting, caring attitude toward the child and family and providing the parents with opportunities and support for normal infant-parent interactions. Many parents need additional support outside the hospital or during surgical repairs. Parent-to-parent support groups are available and parents should be given information about to how to contact a local group. It may be difficult for a parent to bond with an infant who the parent feels is not perfect and those feeling cannot be easily dismissed. It does not matter if the defect is not life-threatening; it is still important to the parents and requires much skill to repair and heal. Stating this is being judgmental.

A 9-year-old child has undergone a temporary colostomy in the ascending colon several days ago. The nurse has just completed discharge teaching to the child and the parents. Which statements by the child or parents warrants additional instruction from the nurse? Select all that apply. a. "It is important to change the pouch and skin appliance every other day to decrease the risk of problems with the skin." b. "I know the location of the colostomy may cause stool to be of somewhat liquid consistency so the appliance will need to be emptied frequently." c. "This is probably going to be very difficult for our child with returning to school because of the care of the appliance and pouching system." d. "We will need to use an antimicrobial soap to cleanse the area around the stoma in order to prevent any skin infection." e. "We should let the doctor know right away if the stoma becomes pale."

a. "It is important to change the pouch and skin appliance every other day to decrease the risk of problems with the skin." d. "We will need to use an antimicrobial soap to cleanse the area around the stoma in order to prevent any skin infection." Explanation: Appliances and pouches can be left in place for 4 days as long as the appliance is intact; changing more frequently can lead to skin impairment. Regular soap, not antimicrobial soap, and water is all that is needed to clean around the stoma site. Antimicrobial and perfumed soaps may be irritating to the skin. An ascending colostomy will produce unformed, thick liquid stool so emptying the pouch more frequently will be necessary; this will likely be a challenge for the child at school initially. A pale stoma indicates poor perfusion; this should be reported to the physician immediately.

The nurse is caring for an infant. The infant's mother asks the nurse, "What did the doctor mean when he said she may have regurgitation?" What response by the nurse is appropriate? a. "Regurgitation is the backflow of stomach contents up into the esophagus or mouth." b. "Regurgitation is not normal in infants. She will need more testing to see what is causing this." c. "Regurgitation is just another term for vomiting. All infants vomit some." d. "Regurgitation is when an infant can't tolerate their formula. You will need to switch."

a. "Regurgitation is the backflow of stomach contents up into the esophagus or mouth." Explanation: Regurgitation is the backflow of stomach contents up into the esophagus and/or oral cavity. The muscle tone of the lower esophageal sphincter is not fully developed until age 1 month, 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.

A preschooler has celiac disease. The parent is preparing a gluten-free diet. The nurse knows that the parent understands the diet when the parent prepares which breakfast foods? a. Eggs and orange juice b. Wheat toast and grape jelly c. Cheerios (oat cereal) and skim milk d. Rye toast and peanut butter

a. Eggs and orange juice Explanation: Celiac disease is an immunological disorder in which gluten causes damage to the small intestines. Gluten is commonly found in grains. Children with celiac disease cannot digest the protein in common grains, such as wheat, rye, and oats. Providing foods with rye, wheat, and oats would cause the child to develop symptoms and worsen the situation.

The nurse is caring for a 6-month-old infant who was admitted to the emergency department 24 hours ago with signs of severe diarrhea. The infant's rectal temperature is 104°F (40°C), with weak and rapid pulse and respirations. The skin is pale and cool. The child is on IV rehydration therapy, but the diarrhea is persisting. The infant has not voided since being admitted. Which is the priority nursing intervention? a. Take a stool culture b. Administer antibiotic therapy c. Administer IV potassium d. Feed the child a cracker

a. Take a stool culture Explanation: Treatment of severe diarrhea focuses on regulating electrolyte and fluid balance by initiating a temporary rest for the gastrointestinal 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; 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 gastrointestinal tract should be rested until the diarrhea stops.

The health care provider prescribes an abdominal radiograph for a newborn to check for Hirschsprung disease. The nurse examines the newborn and finds which symptoms that are indicative of this disease? Select all that apply. a. abdominal distention b. absence of stool in the rectum c. enterocolitis d. bilious vomiting e. displaced anus f. presence of a fistula

a. abdominal distention b. absence of stool in the rectum c. enterocolitis d. bilious vomiting Explanation: Hirschsprung disease is a movement disorder of the intestinal tract. The ganglion are missing, which causes inadequate motility. The nurse should suspect Hirschsprung disease when the newborn does not pass meconium in the first 24 hours after birth and has bilious vomiting or has abdominal distention, feeding intolerance with bilious aspirates, and vomiting. In anorectal malformations, the anus is absent or displaced and the presence of a fistula may be noted when gas or stool is expelled from the urethra or vagina.

The nurse teaches a parent to differentiate between regurgitation and vomiting in the infant. The parent correctly states which characteristic of regurgitation? Select all that apply. a. occurs with feeding b. no appearance of distress c. followed by dry retching d. forceful expulsion of stomach contents e. timing unrelated to feeding

a. occurs with feeding b. no appearance of distress Explanation: Regurgitation occurs with feeding; the infant does not exhibit signs of distress. Forceful expulsion of stomach contents that is followed by dry retching unrelated to feeding are characteristics of vomiting.

A 3-month-old is admitted with severe diarrhea. Yesterday, the infant weighed 11 pounds (5 kg). Today, this infant weighs 9 pounds, 8 ounces (4.3 kg). Based on this information the nurse documents that the infant has: a. severe dehydration. b. failure to thrive. c. malabsorption syndrome. d. risk for fluid volume deficit.

a. severe dehydration. Explanation: A loss of more than 10% of body weight in a day is a sign of severe dehydration. Failure to thrive and malabsorption syndrome are long-term conditions, not objectively defined by a 24-hour weight change. This child is no longer at risk for a fluid volume deficit but is showing signs of dehydration.

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which foods would be permitted in the diet of the child with celiac syndrome? Select all that apply. applesauce bananas skim milk rye bread wheat bread

applesauce bananas skim milk The child is usually started on a gluten-free, low-fat diet. Skim milk and bananas are usually well tolerated. Lean meats, puréed vegetables, and fruits are gradually added to the diet. Wheat, rye, and oats (unless specifically gluten free) are not included in the diet.

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac disease. The caregivers make the following statements. Which statement indicates a need for further teaching regarding the dietary restrictions for the child with celiac disease? a. "The soup we eat at our house is all made from scratch." b. "She loves hot dogs, and we always cut hers up into small pieces." c. "I have learned to make my own bread with no gluten." d. "Even though milk and pudding are good for her, we don't give her those foods."

b. "She loves hot dogs, and we always cut hers up into small pieces." Explanation: Commercially canned creamed soups, cold cuts, frankfurters, and pudding mixes generally contain wheat products and should not be included in the diet of the child with celiac syndrome. This caregiver needs further teaching regarding giving her child hot dogs, even if they are cut into small pieces. The other choices show an understanding of the dietary restrictions.

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

b. A thickened, elongated muscle causes an obstruction at the end of the stomach. 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.

The mother of a newborn with a cleft lip reports she is having a hard time looking her baby. What is the best action by the nurse? a. Explain that surgery will make this better in the future. b. Encourage the mother to provide care for her infant. c. Encourage the child's mother to hold her infant against her shoulder to provide closeness while not looking at the defect. d. Tell the mother that while this is difficult it will get easier.

b. Encourage the mother to provide care for her infant. Explanation: Providing care to the infant is the best means for the mother to begin bonding with her baby. Activities such as feeding, diapering and bathing will be helpful. Encouraging the mother to avoid looking at the cleft lip will not assist her in the process of accepting it. While surgery will be performed it will not take place for a few months. making it vital that she begin bonding with her infant. Telling the parent she will get used to it minimizes her concerns and is not the most therapeutic response by the nurse.

Which assessment finding 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

b. Vomiting Explanation: Vomiting after a feeding suggests the pyloric valve is not yet able to accommodate feedings well, possibly from edema. Flatulence and semi-formed stools would be positive signs that motility is active and digestion is occurring. Falling asleep is a sign that the child is full and satisfied.

A 3-year-old child has been brought to the clinic for assessment of chronic constipation. After ruling out an organic cause, what will the nurse prioritize in the child's plan of care? a. teaching the child's caregivers the need to toilet the child hourly during the day b. administering over-the-counter stool softeners but for no longer than 1 week c. teaching the child habits that promote normal bowel function d. teaching the child's caregivers how to safely administer an enema

b. administering over-the-counter stool softeners but for no longer than 1 week Explanation: Once any organic process is ruled out as a cause, constipation may initially be managed with dietary manipulation such as increasing fiber and fluids. However, behavior modification is necessary for most children. Children with severe constipation and withholding behavior may require laxative therapy until they relearn proper bowel habits and dietary measures begin to work. Over-the-counter stool softeners can be taken for constipation but should be based on the recommendation of the health care provider. The health care provider must be notified if symptoms persist despite taking the stool softener. Teaching specific interventions like the safe application of enema is only appropriate if the health care provider has recommended or prescribed a specific form of enema to be used. There are many forms of enema and teaching the parents without the health care provider's prescription can cause more harm than good. Frequent toileting may or may not be beneficial.

A child is hospitalized with dehydration as a result of rotavirus. When reviewing the plan of treatment, what can the nurse anticipate will be included? Select all that apply. a. antidiarrheal agents b. antibiotic therapy c. IV fluid administration d. monitor of intake and output e. daily weight assessment

c. IV fluid administration d. monitor of intake and output e. daily weight assessment Explanation: Rotavirus is viral in nature. Antibiotic therapy is not used in the care and treatment of a viral infection. Antidiarrhea medications are not utilized as they are not effective. Intake and output will be observed. Daily weight will aid in the determination of hydration status. IV fluids may be indicated in the rehydration process.

The nurse is obtaining the history of an infant with a suspected intestinal obstruction. Which response regarding newborn stool patterns would indicate a need for further evaluation for Hirschsprung disease? a. passed a meconium stool in the first 24 to 48 hours of life b. has had diarrhea for 3 days c. constipated and passing gas for 2 days c. passed a meconium plug

c. passed a meconium plug Explanation: If the parent reports that the child passed a meconium plug, the infant should be evaluated for Hirschsprung disease. Constipation, not diarrhea, is associated with this condition; however, constipation alone would not necessarily warrant further evaluation for Hirschsprung disease. Passing a meconium stool in the first 24 to 48 hours of life is normal.

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. "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." b. "Continue breastfeeding as you have been doing. The fluid from the breast milk is important to maintain fluid balance." c. "Give a clear pediatric electrolyte replacement for the next few hours, then call back to report on how your child is doing." d. "Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment."

d. "Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." Explanation: An infant's body comprises 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.

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

d. Lower right 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 inches (3.8 to 5 cm) in from the right anterior superior iliac spine along a line extending to the umbilicus.

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

d. acute upper GI bleeding 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 conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis? a. sausage-shaped mass in the upper mid abdomen b. perianal fissures and skin tags c. abdominal pain and irritability d. hard, moveable "olive-like mass" in the upper right quadrant

d. hard, moveable "olive-like mass" in the upper right quadrant Explanation: 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.

A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason? detect Helicobacter pylori evaluate gastric pH confirm pancreatitis determine esophageal contractility

detect Helicobacter pylori 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 labor and delivery nurse is caring for a mother who has demonstrated polyhydramnios upon delivery. The newborn displays copious, frothy bubbles of mucus in the mouth and nose, as well as drooling. The nurse is concerned that the infant has what disorder? esophageal atresia omphalocele gastroschisis hiatal hernia

esophageal atresia Esophageal atresia refers to a congenitally interrupted esophagus where the proximal and distal ends do not communicate; the upper esophageal segment ends in a blind pouch and the lower segment ends a variable distance above the diaphragm. Polyhydramnios is often the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. Omphalocele and gastroschisis are congenital anomalies of the anterior abdominal wall. Hiatal hernia involves a weakened diaphragm.

A nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. What GI condition might this history precipitate? esophageal atresia (EA) cleft palate pyloric stenosis hernia

esophageal atresia (EA) A maternal history of polyhydramnios is usually present in one-third of cases of EA and in some cases of tracheoesophageal fistula (TEF).

The parent reports that the health care provider said that the infant had a hernia but cannot remember which type. When recalling what the health care provider said, the parent said that a surgeon will repair it soon and there is no problem with the testes. Which hernia type is anticipated? diaphragmatic hernia umbilical hernia inguinal hernia hiatal hernia

inguinal hernia An inguinal hernia occurs primarily in males and allows the intestine to slip into the inguinal canal, resulting in swelling. If the intestine becomes trapped and circulation is impaired, surgery is indicated within a short period of time. The diaphragmatic hernia has implications with the respiratory system. An umbilical hernia typically spontaneously closes by age 3. A hiatal hernia produces digestive issues.

The nurse is reviewing the medical record of a child with a cleft lip and palate. When reviewing the child's history, what would the nurse identify as a risk factor for this condition? mother age 42 with pregnancy maternal use of acetaminophen in third trimester preterm birth history of hypoxia at birth

mother age 42 with pregnancy Advanced maternal age is a risk factor for cleft lip and palate. Drugs such as anticonvulsants, steroids, and other medications during early pregnancy are considered risk factors. Acetaminophen is not associated with an increased risk for cleft lip and palate. Preterm birth is not a risk factor for the development of cleft lip and palate. Hypoxia or anoxia is a risk factor for the development of necrotizing enterocolitis.

The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is: respiratory distress. painless rectal bleeding. dehydration. ischemia.

painless rectal bleeding. 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.

A parent brings a 10-year-old child to the emergency room with reports of abdominal pain. The nurse performing a physical assessment notes the following symptoms: upper right quadrant pain that radiates to the back; fever; nausea; and abdominal distention. Which disease would the nurse suspect? pancreatitis appendicitis Crohn disease ulcerative colitis

pancreatitis The child admitted with the suspicion of pancreatitis typically reports acute onset of persistent abdominal pain. It can be mid-epigastric or periumbilical with radiation to the back or the chest. 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. Appendicitis pain and tenderness would be localized to the right lower quadrant. Crohn disease is a chronic bowel disorder causing frequent, recurring diarrhea. Ulcerative colitis is a chronic bowel disease affecting the large intestine and the rectum.

A mother is alarmed because her 6-week-old boy has begun vomiting almost immediately after every feeding. In the past week, the vomiting has grown more forceful, with the vomit projecting several feet from his mouth. He is always hungry again just after vomiting. At the physician's office, the nurse holds the child and offers him a bottle. While he drinks, the nurse notes an olive-size lump in his right abdomen. Which condition should the nurse suspect in this child? pyloric stenosis peptic ulcer disease gastroesophageal reflux appendicitis

pyloric stenosis 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 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 child with liver cirrhosis is admitted to the acute care facility in preparation for a liver transplant. What finding(s) would the nurse document after completing this child's assessment? Select all that apply. yellow skin and sclera liver palpable palms of hands reddened confused mental status fatty, foul-smelling stool

yellow skin and sclera liver palpable palms of hands reddened confused mental status A child with cirrhosis would have symptoms of nausea and vomiting, jaundice, palmar erythema, ascites, weight loss, and an enlarged liver. The child's mental status could be clear or it could be confused if hepatic encephalopathy is present. The nurse would document the findings as to the amount of jaundice present, the weight of the child, the measurement of the abdomen to determine ascites, the amount of redness in the palms, and whether the liver is palpable or not. Fatty, foul-smelling stools are not seen with cirrhosis. These would be more likely in conditions like cystic fibrosis or celiac disease.