Chapter 38 - The Child With a Gastrointestinal / Endocrine Disorder

The nurse is collecting data from the caregivers of a child who is suspected of having a food allergy. Which of the following clinical manifestations would likely have been noted in this child? A) Restlessness and irritability B) Blinking and twitching of the mouth C) Nasal discharge and sneezing D) Urticaria and pruritus

Ans: D Feedback: Common symptoms are urticaria (hives), pruritus (itching), stomach pains, and respiratory symptoms. Some of the symptoms may appear quickly after the child has eaten the offending food, but other foods may cause a delayed reaction. Restlessness and irritability may be seen in children with seizure disorders, blinking and twitching of the mouth are seen with absence seizures, and nasal discharge and sneezing are seen with allergic rhinitis.

The nurse is collecting data on a 2 ½ year-old child admitted with a diagnosis of gastroenteritis. When interviewing the caregivers, which of the following questions would be most important for the nurse to ask? A) "How many times a day does your child urinate?" B) "How long has your child been toilet trained?" C) "Tell me about the types of stools you child has been having." D) "What foods has your child eaten during the last few days."

Ans: D Feedback: For the child with gastroenteristis, the interview with the family caregiver must include spe cific information about the history of bowel patterns and the onset of diarrheal stools, with details on number and type of stools per day. Recent eating patterns, if the child is toilet trained, and how many times a day the child urinates are important questions, but the highest priority is gathering data regarding the stools and stool pattern.

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of gastroesophageal reflux? A) A partial or complete intestinal obstruction occurs. B) 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.

Ans: D Feedback: 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.

When collecting data on a child diagnosed with diabetes mellitus, the nurse notes that the child has had weight loss and other symptoms of the disease. The nurse would anticipate which of the following findings in the child's fasting glucose levels? A) 60 mg/dL B) 120 mg/dL C) 180 mg/dL D) 240 mg/dL

Ans: D Feedback: If the blood glucose level is elevated or ketonuria is present, a fasting blood sugar (FBS) is performed. An FBS result of 200 mg/dL or higher almost certainly is diagnostic for diabetes when other signs such as polyuria and weight loss, despite polyphagia, are present.

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

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

The nurse is caring for an infant immediately after a pyloromyotomy surgery has been performed to treat pyloric stenosis. The infant's parents are understandably anxious about their child. Given the situation, what is the most appropriate way for the nurse to position the infant during the anesthesia recovery period? The nurse should A) Allow the parents to hold him B) Place the infant on his back C) Lay the infant on his stomach D) Support him and place him on his side

Ans: D Feedback: Postoperatively the child should be placed on his side to prevent aspiration of mucus or vomitus, especially during the anesthesia recovery period. After fully waking from the surgery, he can be held by a family caregiver in a position that does not interfere with IV infusions and is comforting to both caregiver and child.

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

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

The major role of the endocrine system is to do which of the following? A) Regulate insulin B) Produce enzymes C) Absorb nutrients D) Secrete hormones

Ans: D Feedback: The hormones secreted by the endocrine system are circulated through the bloodstream to control and regulate most of the activities and functions in the body. Regulating metabolism, growth, development, and reproduction are all functions of hormones. The pancreas secretes, not regulates, insulin. The liver and pancreas secrete enzymes and the GI tract absorbs nutrients.

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

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

A nurse stops at her friend's house one evening to visit. Her friend isn't home but a teenager watching TV says she is baby-sitting for the family's three children. The nurse notices that one of the children is chewing several pieces of something white. He is also drooling and crying. A container that looks like an empty pill bottle is on the floor. The first action by the nurse would be to A) Call 911 for emergency help B) Ask the poison control center about an antidote C) Give the child syrup of ipecac to induce vomiting D) Remove the substance from the child's mouth

Ans: D Feedback: Treatment steps in order of importance for poisoning: Remove the obvious remnants of the poison. Call 911 for emergency help if the child has collapsed or stopped breathing. If the child is conscious and alert, call the poison control center and follow their instructions. Administer the appropriate antidote if recommended. Administer general supportive and symptomatic care. The American Academy of Pediatrics no longer recommends administering syrup of ipecac because it hasn't been proven that inducing vomiting prevents poisoning. Because of the potential for misuse, the AAP also recommends safely disposing of any syrup of ipecac already in the home. In an emergency care setting, gastric lavage may be used to empty the stomach of toxic substances.

The nurse is collecting data on a child who has been nutritionally deprived. The nurse notes that the child is irritable and listless. The foster caregiver reports that the child says she is not hungry and has been vomiting. It is discovered that the child has beriberi. This disease is due to a deficiency in which of the following? A) Thiamine B) Vitamin C C) Niacin D) Iron

Ans: A Feedback: Children whose diets are deficient in thiamine exhibit irritability, listlessness, loss of appetite, and vomiting. A severe lack of thiamine in the diet causes beriberi, a disease characterized by cardiac and neurologic symptoms. Beriberi does not occur when balanced diets that include whole grains are eaten. Lack of vitamin C causes scurvy, lack of niacin causes pellagra, and lack of iron causes anemia.

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.

Ans: A Feedback: 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 digestive process begins in which of the following organs of the gastrointestinal system? A) Mouth B) Stomach C) Small intestine D) Large intestine

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

The caregivers of a child just diagnosed with diabetes express concern that they won't remember the different signs and symptoms of hyperglycemia and hypoglycemia. As a result, they are afraid they won't handle an emergency correctly. The best initial response by the nurse would be to A) Instruct them to treat the reaction as if it's hypoglycemia, which is more likely B) Repeat the signs and symptoms over and over until they seem to understand C) Suggest that the child wear an insulin pump for continuous insulin administration D) Give the caregivers educational pamphlets and videos about diabetes

Ans: A Feedback: Hypoglycemia is much more likely to occur than hyperglycemia; so if there is any doubt as to whether the child is having a hypoglycemic or hyperglycemic reaction, it should be treated as hypoglycemia. While the pump may offer continuous insulin, it does not sense blood glucose level; insulin reactions can still occur. Careful monitoring of blood glucose is still needed. While repeating signs and symptoms may be helpful, caregivers of a recently diagnosed child have lots of information to absorb and the repetition may create more anxiety. Assuming that the caregivers can read and understand them, written materials and videos may be helpful but they should not take the place of an initial teaching session with a nurse.

The nurse working with the child diagnosed with Type 2 Diabetes Mellitus recognizes that most often the disorder can be managed by which of the following? A) Taking oral hypoglycemic agents B) Increasing protein in the diet, especially in the evening C) Conserving energy with rest periods during the day D) Decreasing amounts of daily insulin

Ans: A Feedback: If the child presents with diabetic ketoacidosis, initial treatment is insulin administration, but then oral hypoglycemic agents such as metformin are often effective for controlling blood glucose levels. Lifestyle changes such as weight loss and increased exercise are important aspects of treatment for the child.

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

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

The most common source of lead poisoning in children comes from which of the following sources? A) Paint used in older homes B) Juice stored in glass jars C) Water purchased in plastic jugs D) Toys painted with spray paint

Ans: A Feedback: Lead poisoning has other causes, but the most common cause has been the lead in paint, especially paint used on the outside or the inside of older houses. Other sources of lead are toys painted with lead-containing paint, drinking water contaminated by lead pipes or copper pipes with lead-soldered joints, and fruit juices or other food in improperly stored in glazed earthenware.

The nurse recognizes that in the disorder referred to as Rickets, the child has a lack of vitamin D. Because of the lack of vitamin D the absorption of which of the following is decreased? A) Calcium and phosphorus B) Vitamin C and thiamine C) Riboflavin and niacin D) Iron and potassium

Ans: A Feedback: Rickets, a disease affecting the growth and calcification of bones, is caused by a lack of vitamin D. The absorption of calcium and phosphorus is diminished because of the lack of vitamin D, which is needed to regulate the use of these minerals. The absorption of the other nutrients is not affect by the lack of vitamin D.

The nurse is interviewing the caregivers of a child admitted with a diagnosis of Type 1 Diabetes Mellitus. The caregiver states, "The teacher tells us that our child has to use the restroom many more times a day than other students do." The caregiver's statement indicates the child most likely has which of the following? A) Polyuria B) Pica C) Polyphagia D) Polydipsia

Ans: A Feedback: Symptoms of Type 1 Diabetes Mellitus include polyuria (dramatic increase in urinary output, probably with enuresis), polydipsia (increased thirst), and polyphagia (increased hunger and food consumption). Pica is eating nonfood substances.

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

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

The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which of the following statements is the best explanation of the treatment for this diagnosis? A) "The treatment for the disorder will be a surgical procedure." B) "Your child will be treated with oral iron preparations to correct the anemia." C) "We will give enemas until clear and then teach you how to do these at home." D) "Your child will receive counseling so the underlying concerns will be addressed."

Ans: A Feedback: 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.

A group of nursing students is discussing the diagnosis of vitamin C deficiency, and one of the students asks which foods would help increase the child's intake of vitamin C. Which of the following foods are high in vitamin C? (select all that apply) A) Strawberries B) Potatoes C) Peas D) Fish sticks E) Cottage cheese F) Bagels

Ans: A, B, C Feedback: A variety of fresh vegetables and fruits supplies vitamin C for the older infant and child. Strawberries, potatoes, and peas are high in vitamin C content. Meat, dairy and grain foods have little vitamin C content.

The nurse is presenting a post-conference to a group of nursing students discussing the topic of children and poisoning. One student asks what steps you should take if you observe a child eating a substance you believe to be poisonous. Place the following steps to be completed in the order of importance. A) Call 911 for emergency help if the child has collapsed or stopped breathing. B) Follow instructions given by the poison help line personnel. C) Administer general supportive and symptomatic care. D) Remove the obvious remnants of the poison. E) Call the poison help line if child is conscious and alert. F) Administer appropriate antidote if recommended.

Ans: A, B, C, D, E, F Feedback: The treatment steps in order of importance are as follows: 1. Remove the obvious remnants of the poison. 2. Call 911 for emergency help if child has collapsed or stopped breathing. 3. Call the poison help line if the child is conscious and alert. The universal poison control number is (800) 222-1222. 4. Follow instructions given by the poison help line personnel. 5. Administer appropriate antidote if recommended. 6. Administer general supportive and symptomatic care.

In working with children who have food allergies the nurse recognizes that which of the following foods are frequently the cause of a food allergy. (Select all that apply) A) Eggs B) Broccoli C) Corn D) Oranges E) Grapes F) Soybeans

Ans: A, C, D, F Feedback: Among the foods most likely to cause allergic reactions are milk, eggs, wheat, corn, legumes (including peanuts and soybeans), oranges, strawberries, and chocolate. Vegetables other than corn are less likely to cause allergies. Citric fruits are more often the cause of allergies.

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. The caregivers make the following statements. Which statement indicates a need for further teaching regarding the dietary restrictions for the child with celiac syndrome? A) "The soup we eat at our house is all made from scratch." B) "She loves hotdogs, 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."

Ans: B Feedback: 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 hotdogs, even if they are cut into small pieces. The other choices show an understanding of the dietary restrictions.

The nurse is caring for a child admitted to the emergency center in diabetic ketoacidosis. Which of the following clinical manifestations would the nurse most likely note in this child? A) Pale and moist skin B) Red lips and fruity odor to breath C) Hyperactive and restless behavior D) Slow pulse and elevated blood pressure

Ans: B Feedback: Diabetic ketoacidosis is characterized by drowsiness, dry skin, flushed cheeks and cherry-red lips, acetone breath with a fruity smell, and Kussmaul breathing (abnormal increase in the depth and rate of the respiratory movements). Nausea and vomiting may occur. If untreated, the child lapses into coma and exhibits dehydration, electrolyte imbalance, rapid pulse, and subnormal temperature and blood pressure.

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

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

The nurse admits an infant who is nutritionally deprived. The infant is weak and seems somewhat uninterested in food. In developing the infant's plan of care, how often will the nurse most likely plan to feed this infant? A) Every hour B) Every 2 or 3 hours C) Every 4 hours D) On demand

Ans: B Feedback: For the child who is nutritionally deprived, scheduling feedings every 2 or 3 hours is best because most weak babies can handle frequent, small feedings better than feedings every 4 hours. Feeding every hour would not give the weak child an adequate amount of time to rest and sleep between feedings.

The nurse is doing teaching with the caregivers of toddler and preschool age children. One of the caregivers tells the group that her child had diarrhea and she was told that it was caused by giardiasis. Which of the following statements made by the caregiver indicates the most likely situation in which the child contacted the disorder? A) "My son went to the mountains to fish with my husband before he got sick." B) "He attends a day care center four days a week while I am at work." C) "I won't let his sister take bubble baths but I do let him take one a few times a week." D) "My mother is in a nursing home but I always make the kids wash their hands before we leave her."

Ans: B Feedback: Giardiasis is caused by the protozoan parasite Giardia lamblia. It is a common cause of diarrhea and is prevalent in children who attend day care centers and other types of residential facilities; it may be found in contaminated mountain streams or pools frequented by diapered infants. Bubble baths can lead to urinary tract infections, but are not the cause of Giardiasis infestations.

The child who has insufficient calcium in the diet is at risk for having hypocalcemia. Which of the following may be caused by hypocalcemia? A) Cardiac arrhythmias B) Neurologic damage C) Kidney failure D) Urinary tract disorders

Ans: B Feedback: Hypocalcemia (insufficient calcium) causes neu rologic damage, including mental retardation. Calcium is necessary for bone and tooth formation, and is also needed for proper nerve and muscle function. Hypokalemia can cause cardiac issues. Kidney and urinary disorders are not likely to be caused by insufficiencies in the diet.

The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which of the following actions would be the most appropriate for the school nurse to do? A) Request that someone call 911 B) Administer subcutaneous glucagon C) Anticipate that the child will need intravenous glucose D) Dissolve a piece of candy in the child's mouth

Ans: B Feedback: If the child having an insulin reaction cannot take a sugar source orally, glucagon should be administered subcutaneously to bring about a prompt increase in the blood glucose level. This treatment prevents the long delay while waiting for a physician to administer IV glucose or for an ambulance to reach the child.

The nurse is doing teaching with a group of caregivers of children diagnosed with diabetes mellitus. The nurse is explaining insulin shock and the caregivers make the following statements. Which statement indicates the best understanding of a reason an insulin reaction might occur? A) "If my child's eats as much as her older brother eats she could have an insulin reaction." B) "He measures his own medication but we watch closely to make sure he gets the correct amount so he doesn't have an insulin reaction." C) "She monitors her glucose levels because when it goes too high she has an insulin reaction." D) "On the weekends we encourage him to participate in lots of sports activities and stay busy so he doesn't have an insulin reaction."

Ans: B Feedback: Insulin reaction (insulin shock, hypoglycemia) is caused by insulin overload, resulting in too-rapid metabolism of the body's glucose. This may be attributable to a change in the body's requirement, carelessness in diet (such as failure to eat proper amounts of food), an error in insulin measurement, or excessive exercise.

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with Kwashiorkor. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of Kwashiorkor? A) "These children have a severe deficiency of vitamin D." B) "It is important to increase the intake of protein for these children." C) "The highest incidence of this disease is seen in children who are adolescents." D) "The cause of this disease can be treated very simply."

Ans: B Feedback: Kwashiorkor results from severe deficiency of protein with an adequate caloric intake. It accounts for most of the malnutrition in the world's children today. The highest incidence is in children 4 months to 5 years of age. Although strenuous efforts are being made around the world to prevent this condition, its causes are complex.

The teeth, tongue, gallbladder, appendix, salivary glands, liver, and pancreas are referred to as accessory organs, and the purpose of these is which of the following? A) To secrete liquids that helps the food to be tasted as a person eats B) To aid in and to produce substances that aid in the digestive process C) To cushion and protect the digestive organs D) To decrease the secretion of acids in the digestive organs

Ans: B Feedback: Other organs, called accessory organs, include structures that aid in the digestive process, as well as glands that secrete substances that further aid in digestion. These accessory organs include the teeth, tongue, gallbladder, appendix, salivary glands, liver, and pancreas. These organs do not affect the taste of food. The cerebral spinal fluid cushions and protects the nerve cells. These organs do not decrease the secretion of acids.

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of pyloric stenosis? A) A partial or complete intestinal obstruction occurs. B) 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.

Ans: B Feedback: 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 nurse is caring for a child admitted with acute appendicitis. Prior to the child going to the operating room for emergency surgery, which of the following nursing interventions would the nurse most likely perform? A) The nurse gives the child laxatives to evacuate the colon. B) The nurse encourages the child and family to express their fears. C) The nurse administers oral fluids to prevent dehydration. D) The nurse applies a heating pad to the abdomen to manage pain.

Ans: B Feedback: The child facing an emergency surgery may be extremely frightened and also may be in considerable pain. The family caregiver may be apprehensive about impending surgery. Explain to the child and the family what is hap pening and why, and encourage them to express their fears. Laxatives and enemas are contraindicated because they increase peristalsis, which increases the possibility of rupturing an inflamed appendix. Oral fluids are withheld and the child is NPO before surgery. A heating pad is contraindicated because of the danger of rupture of the appendix.

In treating the child with lead poisoning which of the following is used to remove the lead from the child's system? A) Diuretics B) Chelating agents C) Laxatives D) Emetics

Ans: B Feedback: The use of a chelating agent (an agent that binds with metal) increases the urinary excretion of lead. Diuretics, laxatives, and emetics are not used in the treatment of lead poisoning.

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

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

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which of the following foods would be permitted in the diet of the child with celiac syndrome? (Select all that apply) A) Corn flakes B) Bananas C) Skim milk D) Rye bread E) Oatmeal F) Applesauce

Ans: B, C, F Feedback: The child is usually started on a gluten-free, low-fat diet. Skim milk, banana flakes and bananas are usually well tolerated. Lean meats, puréed vegetables, and fruits are gradually added to the diet. Wheat, rye, oat products, corn flour and cornmeal are not included in the diet.

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 colic? 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.

Ans: C Feedback: Colic consists of recurrent paroxysmal bouts of abdominal pain and is fairly common in young infants. Congenital aganglionic megacolon 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. 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 caring for a child admitted with congenital aganglionic megacolon. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? A) Prolonged bleeding B) Chronic cough C) Persistent constipation D) Irregular breathing

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

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

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

A young child has been admitted with a diagnosis of enterobiasis (pinworm infection). This child will most likely have a history of which of the following? A) Bedwetting B) Restlessness C) Perianal itching D) Malnutrition

Ans: C Feedback: Intense perianal itching is the primary symptom of pinworm infection, enterobiasis. Young children who cannot clearly verbalize their feelings may be restless, sleep poorly, or have episodes of bedwetting. Pinworm infestation is as common as an infection or cold, making a history of malnutrition less likely. Chronic hookworm infestation can cause malnutrition, however.

The nurse is collecting data for a child with idiopathic celiac disease. The caregiver tells the nurse that her child has bulky and greasy stools. The nurse recognizes that the child has which of the following? A) Pica B) Invagination C) Steatorrhea D) Polyuria

Ans: C Feedback: Intestinal malabsorption with steatorrhea (fatty stools) is a condition brought about by various causes, one being idiopathic celiac disease. Pica is the ingestion of nonfood substances, invagination is the telescoping of a portion of the bowel, and polyuria is a dramatic increase in the urinary output.

The school nurse is working with a group of teachers who teach in classrooms of children who are nutritionally deprived. As the teachers are talking with the nurse they make the following statements. Which statement most indicates a problem related to decreased nutrition? A) "One of my students is taller than several of the other children in the class." B) "I am really glad that during this quarter the absence rate in my classroom has dropped." C) "Several of the children in my class have such a hard time concentrating." D) "The grades of the children in my class are higher than in the classroom next to me."

Ans: C Feedback: Malnour ished children grow at a slower rate, have a higher rate of illness and infection, and have more difficulty concentrating and achieving in school.

In understanding the disease of Marasmus when seen in children, the nurse recognizes that the disease is caused because of which of the following? A) Deficiency of vitamin C and iron B) Excess of vitamin C and iron C) Deficiency of protein and calories D) Excess of protein and calories

Ans: C Feedback: Marasmus is a deficiency in calories as well as protein. Scurvy is caused by inadequate intake of vitamin C, and anemia is caused by lack of iron. Excess calories add to the concern of obesity in children. Excess vitamin C is excreted, and it is unusual to have an excess of iron or protein in the diet of children; those nutrients are more often inadequate in children's diets.

The nurse is discussing the disease known as pellagra. This disease is due to a deficiency in which of the following? A) Thiamine B) Vitamin C C) Niacin D) Iron

Ans: C Feedback: Niacin insufficiency in the diet causes a disease known as pellagra, which presents with GI and neurologic symptoms. A diet deficient in thiamine causes beriberi. Lack of vitamin C causes scurvy, and lack of iron causes anemia.

The nurse is collecting data for a child who is having a routine checkup. The caregiver tells the nurse that her child eats things such as laundry starch, clay, paper, and paint. The nurse recognizes that the child's behavior indicates that the child likely has which of the following? A) Pica B) Invagination C) Steatorrhea D) Polyuria

Ans: C Feedback: Pica is the ingestion of nonfood substances, such as laundry starch, clay, paper, and paint. Invagination is the telescoping of a portion of the bowel. Steatorrhea (fatty stools) is a condition seen in idiopathic celiac disease, and polyuria is a dramatic increase in the urinary output.

The nurse is interviewing the caregivers of a child admitted with a diagnosis of Type 1 Diabetes Mellitus. The caregiver states, "She is hungry all the time and eats everything, but she is losing weight." The caregiver's statement indicates the child most likely has which of the following? A) Polyuria B) Pica C) Polyphagia D) Polydipsia

Ans: C Feedback: Symptoms of Type 1 Diabetes Mellitus include polyphagia (increased hunger and food consumption), polyuria (dramatic increase in urinary output, probably with enuresis), and polydipsia (increased thirst), and. Pica is eating nonfood substances.

The nurse admits a 9-year-old who is complaining of pain in the lower right quadrant of the abdomen, nausea, and constipation. She also has a fever of 101 degrees Fahrenheit. Of the following nursing actions, which will most likely be done at this time for this child? The nurse will A) Give a laxative to alleviate constipation B) Place a heating pad or hot water bottle on her abdomen C) Help her find a comfortable position D) Give her an analgesic such as acetaminophen

Ans: C Feedback: The child's symptoms indicate that she may have appendicitis. When appendicitis is suspected, laxatives and enemas are contraindicated because they increase peristalsis, which increases the possibility of rupturing an inflamed appendix. Heat to the abdomen is also contraindicated because of the danger of rupture of the appendix. Preoperatively analgesics are not given because they may conceal signs of tenderness that are important for diagnosis. Comfort can be provided through positioning.

The nurse is caring for a 3-year-old diagnosed with diabetes mellitus. The child's eating patterns are unpredictable. One day the child will eat almost nothing, the next day the child eats everything on her tray. The nurse recognizes that which of the following types of insulin would most likely be used in treating this child? A) Long-acting insulin B) Regular insulin C) Rapid-acting insulin D) Intermediate-acting insulin

Ans: C Feedback: The introduction of rapid-acting insulin, such as lispro or humalog, has greatly changed insulin administration in children. The onset of action of rapid-acting insulin is less than 15 mi nutes. Rapid-acting insulin can even be used after a meal in children with un predic table eating habits. Regular, intermediate, and long-acting insulin all have a longer onset, peak, and duration than rapid acting insulin, and are more difficult to regulate in the child with unpredictable eating patterns.

The nurse is caring for a 7-year-old diagnosed with pinworms. The nurse talks with the child's caregiver about proper treatment and prevention of future infections. Which of the following statements made by the caregiver indicates a need for further teaching? A) "I always have to remind him to wash his hands before eating." B) "We just bought a washer and dryer, and the hot water works well." C) "Thank goodness my other children and I are not sick too." D) "He hates having his nails trimmed but I will insist they are kept short."

Ans: C Feedback: The life cycle of pinworms is 6 to 8 weeks. Clothing, bedding, food, toilet seats, and other articles become infected, and the infestation spreads to other members of the family. Pinworm eggs also can float in the air and be inhaled. Family members may be infected and not realize it. Because pinworms are so easily transmitted, the nurse should encourage all family members to be treated as well. Washing hands before eating and after using the toilet, frequent laundering of bedding and underclothes in hot water, and short, clean fingernails are all ways to prevent subsequent infections.

The treatment for children with a pinworm infection is to administer which of the following classifications of medications? A) Anticoagulants B) Anticonvulsants C) Anthelmintics D) Antipyretics

Ans: C Feedback: Treatment consists of the use of an anthelmintic (or vermifugal, a medication that expels intestinal worms). Anticoagulants are used to prevent clot formation and extension. Anticonvulsants are used for seizure disorders. Antipyretics are used to treat elevated temperatures.

The incidence of vitamin D deficiency in the United States is less than in many countries. The most likely reason for this is because of which of the following? A) Many children in the US take daily vitamin supplements B) The water in many towns and cities in the US has vitamin D added C) Some foods in the US have been fortified with vitamin D D) The amount of ultraviolet sunlight each day in the US is adequate to provide needed vitamin D.

Ans: C Feedback: Whole milk and evaporated milk fortified with 400 U of vitamin D per quart are available throughout the United States, which decreases the vitamin D deficiency of children in the US. Vitamin D can be administered orally in the form of fish liver oil or synthetic vitamin, but this is not common for children in the US. Water is not fortified with vitamin D, and some communities in the US do not get adequate sunshine to meet vitamin D needs.