Chapter 23 GastroIntestinal disorders
The nurse is providing instructions to the parents of a 10-year-old boy who has undergone a barium swallow/upper and lower GI for suspected inflammatory bowel disease. Which of the following instructions is most important? "Your child might have lighter stools for the next few days." "Your child could have diarrhea for several days afterward." "It is very important to drink lots of water and fluids after the test is finished." "Please be aware of any signs of infection."
"It is very important to drink lots of water and fluids after the test is finished."
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." "My daughter can eat any kind of fruit." "There are many types of flour besides wheat."
"My daughter can eat any kind of fruit." Explanation: 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 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? "Your child will receive counseling so the underlying concerns will be addressed." "We will give enemas until clear and then teach you how to do these at home." "The treatment for the disorder will be a surgical procedure." "Your child will be treated with oral iron preparations to correct the anemia."
"The treatment for the disorder will be a surgical procedure." Explanation: Treatment of congenital aganglionic megacolon involves surgery with the ultimate resection of the aganglionic portion of the bowel.
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 an ultrasound evaluation." "You will most likely be tested for ammonia levels." "You will most likely have viral studies." "You will most likely have a blood test to check for certain antibodies."
"You will most likely have a blood test to check for certain antibodies."
A nurse is providing education to a family about why their child needs parenteral nutrition (PN). Which of the following would be included in the discussion? "Your child will receive PN for intensive therapy in the next 4 days only." "Your child will receive PN for severe dehydration." "Your child is will receive PN due to the fact they need more nutritional therapy with the type of cancer they have." "Your child will need the PN for the period immediately following surgery."
"Your child is will receive PN due to the fact they need more nutritional therapy with the type of cancer they have."
The nurse is determining maintenance fluid requirements for a child who weighs 25 kg (55 lb). How much fluid would the child need per day? 1,650 ml 1,600 ml 1,700 ml 1,560 ml
1,600 ml Explanation: Using the following formula of 100 ml/kg for the first 10 kg, plus 50 ml/kg for the next 10 kg, and then 20 ml/kg for the remaining kg, the child would require (100 × 10) + (50 × 10) + (20 × 5) = 1,000 + 500 + 100 = 1,600 mL in 24 hours.
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?
In this disorder the sphincter that leads into the stomach is relaxed.
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? Short-bowel/short-gut syndrome Intussusception Necrotizing enterocolitis Volvulus with malrotation
Intussusception Explanation: Intussusception, the invagination of one portion of the intestine into another, usually occurs in the second half of the first year of life. Children with this disorder suddenly draw up their legs and cry as if they are in severe pain; they may vomit. After the peristaltic wave that caused the discomfort passes, they are symptom-free and play happily. In approximately 15 minutes, however, the same phenomenon of intense abdominal pain strikes again. After approximately 12 hours, blood appears in the stool and possibly in vomitus, described as a "currant jelly" appearance.
The nurse should monitor which laboratory values for the child who has had a nasogastric (NG) tube placed for decompression of the gastrointestinal tract with suction? Serum sodium and potassium Blood glucose Hematocrit Urine ketones
Serum sodium and potassium Explanation: NG suction is a major cause of hyponatremia in children. Potassium is also lost through this route. Replacement of these electrolytes may be necessary via IV fluid.
An infant is on continuous parenteral nutrition (PN) and pulls out the nasoduodenal (ND) tube. After verifying that the ND tube is back in place with an x-ray, which of the following would be the appropriate nursing intervention? Encourage fluids by mouth and through the ND tube. Increase the infusion rate to make up for the amount of fluid lost while the ND was out. A higher calorie formula should be administered via ND to make up for the losses. The infusion of parenteral nutrition should be restarted at previous rate.
The infusion of parenteral nutrition should be restarted at previous rate. Explanation: During continuous infusion, maintain a fairly constant PN infusion rate to avoid glucose overload. Never abruptly increase or decrease the infusion rate in an attempt to "even out" the infusion, unless otherwise ordered.
A 3-year-old child has been brought to the clinic for assessment because of frequent episodes of constipation. After ruling out an organic cause, what will the nurse prioritize in the child's plan of care? teaching the child habits that promote normal bowel function teaching the child's caregivers the need to toilet the child hourly during the day administering over-the-counter stool softeners but for no longer than 1 week teaching the child's caregivers how to safely administer an enema
administering over-the-counter stool softeners but for no longer than 1 week
Nurses will need to teach the parents of the infant being treated for Hirschsprung disease (aganglionic megacolon) to: carefully monitor heart rate. thicken formula feedings. care for a temporary colostomy. avoid use of a pacifier.
care for a temporary colostomy.
The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is: painless rectal bleeding. dehydration. respiratory distress. ischemia.
painless rectal bleeding. Rationale: 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.
The toddler with sudden, severe abdominal pain and currant jelly stools will be treated with a hydrostatic enema. The nurse explains the therapy in this way. The enema will: seal the bleeding vessels and stop the mucus production in the stool. unfold the intestine that is pushed in on itself to resolve the obstruction. push out the stool that is blocking the intestine. soothe the irritated and inflamed intestine and treat the pain.
unfold the intestine that is pushed in on itself to resolve the obstruction.
The nurse is providing teaching for the mother of an infant who receives all of his nutrition through a tube. The nurse is reviewing interventions to promote growth and development. Which response from the mother indicates a need for further teaching? "We need to make sure he doesn't lose the desire to eat by mouth." "I will give him a pacifier during feeding time." "We need to keep feeding time very quiet." "Sucking produces saliva, which aids in digestion."
"We need to keep feeding time very quiet."
The nurse is providing care for a child who has been diagnosed with rickets. What is the nurse's priority intervention?
Administration of adequate vitamin D
The nurse observes the interactions of parents with their infant who was born with a cleft lip. The mother is attempting to feed the baby, but does not make eye contact. The father is watching television with his back turned to the mother and baby. What psychosocial nursing intervention would be most helpful to this family? Teach the mother the appropriate technique for breastfeeding an infant with cleft lip. Ask the parents if they have any questions regarding the care of their child. Refer the family to a social worker or mental health practitioner. Explain to the parents that surgical intervention will fix the defect in the baby's lip.
Ask the parents if they have any questions regarding the care of their child.
The nurse is educating a family on celiac syndrome. Which is conclusive and confirms the diagnosis?
Biopsy of the jejunum through endoscopy showing changes in villi
The caregiver of a child diagnosed with celiac disease tells the nurse that the child has large amounts of bulky stools and what looks like fat in the stools. The clinical manifestation this caregiver is describing is: currant jelly stools. severe diarrhea. projectile stools. steatorrhea.
Celiac disease is an immunologic response to gluten, which causes damage to the small intestine. Steatorrhea (fatty stools) is a classic symptom of celiac disease. Symptoms also include abdominal distention or bloating, constipation, and nutritional deficiencies.
A child is diagnosed with an enterovirus infection. Which type of infection control precaution would be most important for the nurse to use? Standard Droplet Contact Airborne
Contact
A child is diagnosed with gastroesophageal reflux disease and is prescribed drug therapy. The primary health care provider prescribes medication that suppresses acid secretion. The nurse would anticipate administering which of the following? Ranitidine Famotidine Esomeprazole Metoclopramide
Esomeprazole Explanation: Proton pump inhibitors (esomeprazole, lansoprazole) are effective acid-suppressing agents and are superior in relieving symptoms. Antacid preparations and H2 blocking agents (e.g., famotidine, ranitidine) are used to provide symptomatic relief of esophagitis and to reduce the damaging effects of refluxed gastric contents on the esophageal mucosa. Prokinetic agents such as metoclopramide are used to enhance gastric emptying.
A nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. The nurse would be especially alert for which of the following in the newborn?
Esophageal atresia
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? Short bowel syndrome (SBS) Hirschsprung disease Ulcerative colitis (UC) Gastroenteritis
Hirschsprung disease
A nurse is working in the emergency room and a child comes in for vomiting and diarrhea. Which of the following assessment data would alert the nurse that the child is having severe dehydration? Increased heart rate and an impalpable pulse Irritability and dry mucous membranes Low blood pressure and decreased heart rate Decreased heart rate and impalpable pulse
Increased heart rate and an impalpable pulse
An infant brought to the emergency department has been vomiting for 2 days. The nurse assesses the infant and finds sunken fontanels, tenting skin, dry mucus membranes and no urine output for 12 hours. Which intervention(s) will the nurse complete as first-line care for this infant? Select all that apply. Insert a peripheral IV. Start oral rehydration. Administer an antiemetic. Administer a prescribed IV fluid bolus. Begin maintenance IV fluids.
Insert a peripheral IV. Administer a prescribed IV fluid bolus. Administer an antiemetic.
The nurse is caring for a 3-year-old with repeated diarrhea. The client is listless and clings to the parent. The nurse reviews the lab work which reports a pH- 7.33, HCO3- 21, PaCO2- 42. Which would be documented? Metabolic acidosis Metabolic alkalosis High serum pH Normal serum pH
Metabolic acidosis
A child is diagnosed with giardiasis. The physician prescribes medication to treat the infection. Which of the following would the nurse anticipate being prescribed? Metronidazole Griseofulvin Clotrimazole Mebendazole
Metronidazole Explanation: Treatment of giardiasis is with metronidazole for 7 days.
Which type of nutrition does the nurse anticipate initiating when an infant with gastroenteritis and dehydration begins solid foods? Clear liquids The normal formula Oral rehydration solutions Half strength infant formula
Oral rehydration solutions
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? Encourage fluid intake. Administer antacids as ordered. Assess the child's usual urinary voiding pattern. Prepare the child for admission to the hospital.
Prepare the child for admission to the hospital. Explanation: 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.
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?
Projectile vomiting
A male infant presents with the signs and symptoms of an anal malformation. The nurse tells the parents of the child that tests will be performed to determine the presence and/or the extent of the malformation. Which of the following tests is commonly performed to differentiate a high lesion from a low lesion? Radiopaque dye studies Computed tomography Urinalysis Radiograph
Radiograph Explanation: Radiologic evaluation is necessary to determine the extent of the anal malformation; a cross-table lateral radiograph, with the infant positioned prone with the pelvis elevated, can be used to differentiate a high lesion from a low lesion.
The nurse is positioning an infant who has just had his left-sided cleft lip repaired. What positions are acceptable for this infant? Select all that apply. High fowlers Prone Supine Left side lying Right side lying
Right side lying Supine
A child is diagnosed with intussusception. The nurse would prepare the child and family for which of the following? Surgery Barium swallow Abdominal computed tomography Upper endoscopy
Surgery Explanation: Intussusception is a surgical emergency and must be promptly reduced either by instillation of a water-soluble solution, barium enema, or air into the bowel, or surgery to reduce the invagination before necrosis of the affected portion of the bowel occurs.
What occurs in the gastrointestinal system of the child with Hirschsprung disease? There is an invagination or telescoping of one portion of the bowel into a distal portion. There is a partial or complete mechanical obstruction in the intestine. There is a severe narrowing of the lumen of the pylorus. There is a relaxed sphincter in the lower portion of the esophagus.
There is a partial or complete mechanical obstruction in the intestine. Explanation: Congenital aganglionic megacolon, also called Hirschsprung disease, is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin
The nurse is caring for a client with Crohn disease. Which long-term complications require monitoring? Select all that apply. gallstones short-bowel syndrome intra-abdominal abscess formation a fistula pancreatitis a stricture
a stricture a fistula intra-abdominal abscess formation short-bowel syndrome
The nurse is assessing a newborn in the delivery room and determines the umbilical cord has a single artery. What further assessment(s) should the nurse complete based on this finding? Select all that apply. cyanosis extra digits dysmorphic facial features anal patency cardiac murmurs
anal patency cardiac murmurs extra digits cyanosis
The nurse cares for a newborn diagnosed with choanal atresia. What nursing intervention(s) will be important for the nurse to implement? Select all that apply. insert a nasogastric tube elevate the head of the bed allow nonnutritive sucking insert a peripheral IV initiate aspiration precautions
elevate the head of the bed initiate aspiration precautions allow nonnutritive sucking insert a peripheral IV
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
The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis? abdominal pain and irritability hard, moveable "olive-like mass" in the upper right quadrant sausage-shaped mass in the upper mid abdomen perianal fissures and skin tags
hard, moveable "olive-like mass" in the upper right quadrant
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
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. occurs with feeding followed by dry retching no appearance of distress forceful expulsion of stomach contents timing unrelated to feeding
occurs with feeding no appearance of distress
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: failure to thrive. risk for fluid volume deficit. malabsorption syndrome. severe dehydration.
severe dehydration.
Which assessment finding would suggest that a child's postoperative feeding schedule following pyloric stenosis surgery should be slowed?
vomiting
A grandmother suggests that boiled skim milk should be used to treat her young grandchild's diarrhea. This is an inexpensive, convenient, and often-suggested home remedy. How should the nurse respond? "Jell-O or apple juice would taste better and will more likely be accepted by your grandchild." "Cool tea is a home remedy that will help firm the stool, and it is one that the child will enjoy." "Flat cola that has the fizz removed will taste good to your little one and will replace fluid rapidly." "Boiled skim milk should not be used. It contains more salt than your grandchild should have."
"Boiled skim milk should not be used. It contains more salt than your grandchild should have."
The student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply. "Most children with celiac disease are diagnosed within the first year of life." "Gluten is found in most wheat products, rye, barley and possibly oats." "The only treatment for celiac disease is a strict gluten-free diet." "Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "The entire family will need to eat a gluten-free diet."
"Gluten is found in most wheat products, rye, barley and possibly oats." "The only treatment for celiac disease is a strict gluten-free diet." "Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders."
The nurse is advising a group of new parents on how to care for their infant at home if the baby develops mild diarrhea. Which statement indicates that teaching has been effective? "I should offer Pedialyte after 1 hour and frequently thereafter to prevent dehydration." "I could give Kaopectate as long as I follow the directions on the bottle." "I should offer milk after each episode of diarrhea." "I should take the baby's temperature and call my physician."
"I should offer Pedialyte after 1 hour and frequently thereafter to prevent dehydration.
The nurse is caring for a child with celiac disease. The parents and the child have attended a class with a group of other clients with the disorder. Which statements by the child or the parents indicates the need for further teaching? Select all that apply. "Celiac disease is the same as gluten intolerance that everyone is talking about these days." "My brother and sister are more likely to develop celiac disease since I have it." "I love pasta, so as long as I only eat it occasionally I should be fine." "I must be careful to eat only 100% whole grain foods." "I hope they find a cure for celiac disease someday."
"Celiac disease is the same as gluten intolerance that everyone is talking about these days." "I love pasta, so as long as I only eat it occasionally I should be fine." "I must be careful to eat only 100% whole grain foods."
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?
"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?"
A neonatal nurse examines an infant born with a congenital diaphragmatic hernia (CDH). The nurse is prepared for what condition associated with CDH that generally occurs at birth or within the first few hours of life? Respiratory distress Anemia Intussusception Malrotation
Respiratory distress Rationale: Most infants with CDH experience respiratory distress at birth or within the first few hours of life. As the infant swallows air, the herniated segment distends and further compromises lung and diaphragm excursion.