Chapter 43: The Child with a Gastrointestinal Alteration McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition

What food choice by the parent of a 2-year-old child with celiac disease indicates a need for further teaching? a. Oatmeal b. Rice cake c. Corn muffin d. Meat patty

ANS: A The child with celiac disease is unable to fully digest gluten, the protein found in wheat, barley, rye, and oats. Oatmeal contains gluten and is not an appropriate food selection. Rice, corn, and meat are appropriate selections. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating

Which nursing interventions are significant for a child with cirrhosis who is at risk for bleeding? (Select all that apply.) a. Guaiac all stools b. Provide a safe environment c. Administer vitamin K d. Inspect skin for pallor and cyanosis e. Monitor serum liver panels

ANS: A, B, C Identification of bleeding includes stool guaiac testing, which can detect if blood is present in the stool; protecting the child from injury by providing a safe environment; administering vitamin K to prevent bleeding episodes; and avoiding injections. PTS: 1 DIF: Cognitive Level: Application/Applying

Which interventions should a nurse implement when caring for a child with hepatitis? (Select all that apply.) a. Provide a well-balanced low-fat diet. b. Schedule playtime in the playroom with other children. c. Teach parents not to administer any over-the-counter medications. d. Arrange for home schooling because the child will not be able to return to school. e. Instruct parents on the importance of good handwashing.

ANS: A, C, E The child with hepatitis should be placed on a well-balanced low-fat diet. Parents should be taught to not give over-the-counter medications because of impaired liver function. Hand hygiene is the most important preventive measure for the spread of hepatitis. The child will be in contact isolation in the hospital so playtime with other hospitalized children is not scheduled. The child will be on contact isolation for a minimum of 1 week after the onset of jaundice. After that period, the child will be allowed to return to school. PTS: 1 DIF: Cognitive Level: Application/Applying

Which statement about Crohn disease is the most accurate? a. The signs and symptoms of Crohn disease are usually present at birth. b. Signs and symptoms of Crohn disease include cramping, diarrhea, and weight loss. c. Edema usually accompanies this disease. d. Symptoms of Crohn disease usually disappear by late adolescence.

ANS: B Common manifestations of Crohn disease include abdominal cramping, diarrhea, and weight loss. Signs and symptoms are not usually present at birth. Edema does not accompany this disease. Symptoms do not typically disappear by adolescence.

Which assessment finding should the nurse expect in an infant with Hirschsprung disease? a. "Currant jelly" stools b. Constipation with passage of foul-smelling, ribbon-like stools c. Foul-smelling, fatty stools d. Diarrhea

ANS: B Constipation results from absence of ganglion cells in the rectum and colon and is present since the neonatal period with passage of frequent foul-smelling, ribbon-like, or pellet-like stools. "Currant jelly" stools are associated with intussusception. Foul-smelling, fatty stools are associated with cystic fibrosis and celiac disease. Diarrhea is not typically associated with Hirschsprung disease but may result from impaction.

A child has irritable bowel syndrome. The nurse is teaching the parents about the pathophysiology associated with the symptoms their child is experiencing. Which response indicates to the nurse that teaching has been effective? a. "My child has an absence of ganglion cells in the rectum causing alternating diarrhea and constipation." b. "The cause of my child's diarrhea and constipation is disorganized intestinal contractility." c. "My child has an intestinal obstruction; that's why he has abdominal pain." d. "My child has an intolerance to gluten, and this causes him to have abdominal pain."

ANS: B Disorganized contractility and increased mucous production are precipitating factors of irritable bowel disease. The absence of ganglion cells in the rectum is associated with Hirschsprung disease. Intestinal obstruction is associated with pyloric stenosis. Intolerance to gluten is the underlying cause of celiac disease. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating

What is the most important action to prevent the spread of gastroenteritis in a daycare setting? a. Administering prophylactic medications to children and staff b. Frequent handwashing c. Having parents bring food from home d. Directing the staff to wear gloves at all times

ANS: B Handwashing is the most the important measure to prevent the spread of infectious diarrhea. Prophylactic medications are not helpful in preventing gastroenteritis. Bringing food from home will not prevent the spread of infectious diarrhea. Gloves should be worn when changing diapers, soiled clothing, or linens. They do not need to be worn for interactions that do not involve contact with secretions. Handwashing after contact is indicated.

The nurse caring for a child with suspected appendicitis should question which order from the physician? a. Keep patient NPO. b. Start IV of D5/0.45 normal saline at 60 mL/hr. c. Apply K-pad to abdomen prn for pain. d. Obtain CBC on admission to nursing unit.

ANS: C A K-pad (moist heat device) is contraindicated for suspected appendicitis because it may contribute to the rupture of the appendix. NPO status, an IV, and a CBC are all appropriate for this child. PTS: 1 DIF: Cognitive Level: Application/Applying

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

ANS: C Corticosteroids, such as prednisone and prednisolone, are used in short bursts to suppress the inflammatory response in inflammatory bowel disease. Antacids and antidiarrheals are not used. Antibiotics may be used to treat complications.

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

ANS: C Rotavirus is the most frequent viral pathogen that causes diarrhea in young children. The other organisms are bacterial.

What goal has the highest priority for a child with malabsorption associated with lactose intolerance? a. The child will experience no abdominal spasms. b. The child will not experience constipation and malabsorption syndrome. c. The child will not experience diarrhea associated with malabsorption syndrome. d. The child will receive adequate nutrition as evidenced by a weight gain of 1 kg/week.

ANS: C The child with lactose intolerance will have diarrhea and malabsorption, so a good goal would be no longer having these manifestations. A child usually has abdominal cramping pain and distention rather than spasms. The child usually has diarrhea, not constipation. One kilogram every week may or may not be appropriate depending on the child's age and how long the goal is in place for. PTS: 1 DIF: Cognitive Level: Application/Applying

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

ANS: D A strangulated hernia is one in which the blood supply to the herniated organ is impaired. A hiatal hernia is the intrusion of an abdominal structure, usually the stomach, through the esophageal hiatus. An incarcerated hernia is a hernia that cannot be reduced easily. Omphalocele is the protrusion of intraabdominal viscera into the base of the umbilical cord. The sac is covered with peritoneum and not skin.

Therapeutic management of most children with Hirschsprung disease is primarily a. daily enemas b. low-fiber diet c. permanent colostomy d. surgical removal of the affected section of the bowel

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

Which description of a stool is characteristic of intussusception? a. ribbon-like stools b. Hard stools positive for guaiac c. "Currant jelly" stools d. Loose, foul-smelling stools

ANS: C The characteristic stool of intussusception is described as "currant jelly." Ribbon-like stools are characteristic of Hirschsprung disease. With intussusception, passage of bloody mucous stools occurs. Stools will not be hard. Loose, foul-smelling stools may indicate infectious gastroenteritis.

What is the major focus of the therapeutic management for a child with lactose intolerance? a. Compliance with the medication regimen b. Providing emotional support to family members c. Teaching dietary modifications d. Administration of daily normal saline enemas

ANS: C Simple dietary modifications are effective in management of lactose intolerance. Symptoms of lactose intolerance are usually relieved after instituting a lactose-free diet. Medications are not typically ordered in the management of lactose intolerance. Providing emotional support to family members is not specific to this medical condition. Diarrhea is a manifestation of lactose intolerance. Enemas are contraindicated for this alteration in bowel elimination.

The nurse notes on assessment that a 1-year-old child is underweight, with abdominal distention, thin legs and arms, and foul-smelling stools. The nurse suspects failure to thrive is associated with a. Celiac disease b. Intussusception c. Irritable Bowel Syndrome d. Imperforate Anus

ANS: A These are classic symptoms of celiac disease. They are not related to intussusception, irritable bowel syndrome, or an imperforate anus.

What is an appropriate statement for the nurse to make to parents of a child who has had a barium enema to correct an intussusception? a. "I will call the physician when the baby passes his first stool." b. "I am going to dilate the anal sphincter with a gloved finger to help the baby pass the barium." c. "Your baby can't have anything to eat or drink until bowel function returns." d. "Add cereal to the baby's formula to help him pass the barium."

ANS: C Post procedure, the child is kept NPO until bowel function returns. The physician does not need to be notified when the infant passes the first stool. Dilating the anal sphincter is not appropriate for the child after a barium enema. PTS: 1 DIF: Cognitive Level: Application/Applying

What information should the nurse include when teaching the parents of a 5-week-old infant about pyloromyotomy? a. The infant will be in the hospital for a week b. The surgical procedure is routine and "no big deal" c. The prognosis for complete correction with surgery is good d. They will need to ask the physician about home care nursing

ANS: C Pyloromyotomy is the definitive treatment for pyloric stenosis. Prognosis is good with few complications. These comments reassure parents. The infant will remain in the hospital for a day or two postoperatively. Although the prognosis for surgical correction is good, telling the parents that surgery is "no big deal" minimizes the infant's condition. Home care nursing is not necessary after a pyloromyotomy.

A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with GER. What is the purpose of these drugs? a. prevent reflux b. prevent hematemesis c. reduce gastric acid production d. increase gastric acid production

ANS: C The mechanism of action of histamine-receptor antagonists is to reduce the amount of acid present in gastric contents and to prevent esophagitis.

What should the nurse stress in a teaching plan for the mother of an 11-year-old boy with ulcerative colitis? a. Preventing the spread of illness to others b. Nutritional guidance and preventing constipation c. Teaching daily use of enemas d. Coping with stress and avoiding triggers

ANS: D Coping with the stress of chronic illness and the clinical manifestations associated with ulcerative colitis (diarrhea, pain) are important teaching foci. Avoidance of triggers can help minimize the impact of the disease and its effect on the child. Ulcerative colitis is not infectious. Enemas are not used in this disease.

Which order should the nurse question when caring for a 5-year-old child after surgery for Hirschsprung disease? a. Monitor rectal temperature every 4 hours. b. Assess stools after surgery. c. Keep the child NPO until bowel sounds return. d. Maintain IV fluids at ordered rate.

ANS: A Rectal temperatures should not be taken after this surgery. Rectal temperatures are generally not the route of choice for children because of the route's traumatic nature. The other interventions are all appropriate after this operation. PTS: 1 DIF: Cognitive Level: Application/Applying

Therapeutic management of the child with acute diarrhea and dehydration usually begins with a. Clear liquids b. IV solutions while the child is NPO c. Oral rehydration solution (ORS) d. antidiarrheal medications

ANS: C Orally administered rehydration solution is the first treatment for acute diarrhea. Clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea. The child might need an IV but would not be NPO. Antidiarrheals are not recommended because they do not get rid of pathogens.

The earliest clinical manifestation of biliary atresia is a. Jaundice b. Vomiting c. Hepatomegaly d. Absence of stooling

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

What is an expected outcome for the child with irritable bowel disease? a. decreasing symptoms b. adherence to a low-fiber diet c. increasing milk products in the diet d. adapting the lifestyle to the lifelong problem

ANS: A Management of irritable bowel disease is aimed at identifying and decreasing exposure to triggers and decreasing bowel spasms, which will decrease symptoms. Management includes maintenance of a healthy, well-balanced, moderate-fiber, lower fat diet. A moderate amount of fiber in the diet is indicated for the child with irritable bowel disease. No modification in dairy products is necessary unless the child is lactose intolerant. Irritable bowel syndrome is typically self-limiting and resolves by age 20 years.

What is an expected outcome for the parents of a child with encopresis? a. The parents will give the child an enema daily for 3-4 months b. The family will develop a plan to achieve control over incontinence c. The parents will have the child launder soiled clothes d. The parents will supply the child with a low-fiber diet

ANS: B Parents of the child with encopresis often feel guilty and believe that encopresis is willful on the part of the child. The family functions effectively by openly discussing problems and developing a plan to achieve control over incontinence. Stool softeners or laxatives, along with dietary changes, are typically used to treat encopresis. Enemas are indicated when a fecal impaction is present. This action is a punishment and will increase the child's shame and embarrassment. The child should not be punished for an action that is not willful. Increasing fiber in the diet and fluid intake results in greater bulk in the stool, making it easier to pass.

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

ANS: B Small frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice cereal per ounce of formula have been recommended. Milk thickening agents have been shown to decrease the number of episodes of vomiting and to increase the caloric density of the formula. This may benefit infants who are underweight as a result of GERD. Placing the child in a Trendelenburg position increases the reflux. Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive. Smaller, more frequent feedings are recommended in reflux. PTS: 1 DIF: Cognitive Level: Application/Applying

Which assessment finding is the most significant to report to the physician for a child with cirrhosis? a. Weight loss b. Change in level of consciousness c. Skin with pruritus d. Black, foul-smelling stools

ANS: B The child with cirrhosis must be assessed for encephalopathy, which is characterized by a change in level of consciousness. Encephalopathy can result from a buildup of ammonia in the blood from the incomplete breakdown of protein. One complication of cirrhosis is ascites. The child needs to be assessed for increasing abdominal girth and edema. A child who is retaining fluid will not exhibit weight loss. Biliary obstruction can lead to pruritus, which is a frequent finding. An alteration in the level of consciousness is of higher priority. Black, tarry stools may indicate blood in the stool. This needs be reported to the physician. This is not a higher priority than a change in level of consciousness. PTS: 1 DIF: Cognitive Level: Application/Applying

The nurse has educated the parents of a child with celiac disease on diet modifications. Which food choices by the child's parents indicate understanding of teaching? (Select all that apply.) a. Oatmeal b. Steamed rice c. Corn on the cob d. Baked chicken e. Peanut butter and jelly sandwich on wheat bread

ANS: B, C, D Rice, corn, and chicken do not contain gluten and so are appropriate choices. Oatmeal and wheat bread are not. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating

The nurse is providing home care instructions to the parents of an infant being discharged after repair of a bilateral cleft lip. Which instructions should the nurse include? (Select all that apply.) a. Acetaminophen (Tylenol) should not be given to your infant. b. Feed your infant in an upright position. c. Place your infant prone for a period of time each day. d. Burp your child frequently during feedings. e. Apply antibiotic ointment to the lip as prescribed.

ANS: B, D, E After cleft lip surgery the parents are taught to feed the infant in an upright position to decrease the chance of choking. The parents are taught to burp the infant frequently during feedings because excess air is often swallowed. Parents are taught to cleanse the suture line area with a cotton swab using a rolling motion and apply antibiotic ointment with the same technique. Tylenol is used for pain, and the child should never be placed prone as this position can damage the suture line. PTS: 1 DIF: Cognitive Level: Application/Applying

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

ANS: C Giardiasis a parasite that represents 15% of nondysenteric illness in the United States. The other organisms are bacterial.

Careful handwashing before and after contact can prevent the spread of which condition in daycare and school settings? a. Irritable Bowel Syndrome b. Ulcerative colitis c. Hepatic cirrhosis d. Hepatitis A

ANS: D Hepatitis A is spread person to person, by the fecal-oral route, and through contaminated food or water. Good handwashing is critical in preventing its spread. The virus can survive on contaminated objects for weeks. The other conditions are not contagious.

After an infant is born the nurse notices that the child has herniation of abdominal viscera into the base of the umbilical cord. What will the nurse document about this condition? a. Diaphragmatic hernia b. Umbilical hernia c. Gastroschisis d. Omphalocele

ANS: D Omphalocele is the herniation of the abdominal viscera into the base of the umbilical cord. This does not describe a diaphragmatic hernia, umbilical hernia, or gastroschisis.

The child with lactose intolerance is most at risk for which imbalance? a. Hyperkalemia b. Hypoglycemia c. Hyperglycemia d. Hypocalcemia

ANS: D Because high-calcium dairy products containing lactose are restricted from the child's diet, alternative sources such as egg yolk, green leafy vegetables, dried beans, and cauliflower must be provided to prevent hypocalcemia. The child with lactose intolerance is not at risk for hyperkalemia. Lactose intolerance does not affect glucose metabolism. Hyperglycemia does not result from ingestion of a lactose-free diet.

A baby is scheduled for abdominal surgery for hypertrophic pyloric stenosis and has an NG tube to intermittent suction. When the family asks why the child has the tube, what response by the nurse is best? a. "The nasogastric tube decompresses the abdomen and decreases vomiting." b. "We can keep a more accurate measure of intake and output with the tube." c. "The tube is used to decrease postoperative diarrhea." d. "The nasogastric tube makes the baby more comfortable after surgery."

ANS: A The nasogastric tube provides decompression and decreases vomiting. A nursing responsibility when a patient has a nasogastric tube is measurement of accurate intake and output, but this is not why nasogastric tubes are inserted. Nasogastric tube placement does not decrease diarrhea. The presence of a nasogastric tube can be perceived as a discomfort by the patient.

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

ANS: A This combination of drug therapy is effective in the treatment of H. pylori, the most common cause of ulcers in children.

A nurse is teaching a group of parents about TEF. Which statement made by the nurse is accurate about TEF? a. This defect results from an embryonal failure of the foregut to differentiate into the trachea and esophagus. b. It is a fistula between the esophagus and stomach that results in the oral intake being refluxed and aspirated. c. An extra connection between the esophagus and trachea develops because of genetic abnormalities. d. The defect occurs in the second trimester of pregnancy.

ANS: A When the foregut does not differentiate into the trachea and esophagus during the fourth to fifth week of gestation, a TEF occurs. A TEF is an abnormal connection between the esophagus and trachea. There is no connection between the trachea and esophagus in normal fetal development. This defect occurs early in pregnancy during the fourth to fifth week of gestation.

What maternal assessment is related to an infant's diagnosis of TEF? a. Maternal age more than 40 years b. First term pregnancy for the mother c. Maternal history of polyhydramnios d. Complicated pregnancy

ANS: C A maternal history of polyhydramnios is associated with TEF. Advanced maternal age, first term pregnancy, or complicated pregnancy are not related.

What clinical manifestation should a nurse be alert for when suspecting a diagnosis of esophageal atresia? a. A radiograph in the prenatal period indicates abnormal development b. It is visually identified at the time of delivery c. A nasogastric tube fails to pass at birth d. The infant has a low birth weight

ANS: C Atresia is suspected when a nasogastric tube fails to pass 10 to 11 cm beyond the gum line. Abdominal radiographs will confirm the diagnosis. Prenatal radiographs do not provide a definitive diagnosis. The defect is not externally visible. Bronchoscopy and endoscopy can be used to identify this defect. Infants with esophageal atresia may have been born prematurely and with a low birth weight, but neither is suggestive of the presence of an esophageal atresia.

What is a priority concern for a 14-year-old child with inflammatory bowel disease? a. Compliance with antidiarrheal medication therapy b. Long-term complications c. Dealing with the embarrassment and stress of diarrhea d. Home schooling due to extreme absenteeism

ANS: C Embarrassment and stress from chronic diarrhea are real concerns for the adolescent with inflammatory bowel disease. Antidiarrheal medications are not typically ordered for a child with inflammatory bowel disease. Long-term complications are not a priority concern for the adolescent with inflammatory bowel disease. Exacerbations may interfere with school attendance, but home schooling is not a usual consideration for the adolescent with inflammatory bowel disease.

A nurse has admitted a child to the hospital with a diagnosis of "rule out" peptic ulcer disease. Which test will the nurse expect to be ordered to confirm the diagnosis of a peptic ulcer? a. A dietary history b. A positive Hematest result on a stool sample c. A fiberoptic upper endoscopy d. An abdominal ultrasound

ANS: C Endoscopy provides direct visualization of the stomach lining and confirms the diagnosis of peptic ulcer. Dietary history may yield information suggestive of a peptic ulcer. Blood in the stool indicates a gastrointestinal abnormality, but it does not conclusively confirm a diagnosis of peptic ulcer. An abdominal ultrasound is used to rule out other gastrointestinal alterations such as gallstones, tumor, or mechanical obstruction.

The postoperative care plan for an infant with surgical repair of a cleft lip includes: a. A clear liquid diet for 72 hours b. Nasogastric feedings until the sutures are removed c. Elbow restraints to keep the infant's fingers away from the mouth. d. Rinsing the mouth after ever feeding

ANS: C Keeping the infant's hands away from the incision reduces potential complications at the surgical site. The infant's diet is advanced from clear liquid to soft foods within 48 hours of surgery. After surgery, the infant can resume preoperative feeding techniques. Rinsing the mouth after feeding is an inappropriate intervention. Feeding a small amount of water after feedings will help keep the mouth clean. A cleft lip repair site should be cleansed with a wet sterile cotton swab after feedings.

What is the most important information to be included in the discharge planning for an infant with gastroesophageal reflux? a. Teach parents to position the infant on the left side. b. Reinforce the parents' knowledge of the infant's developmental needs. c. Teach the parents how to do infant cardiopulmonary resuscitation (CPR). d. Have the parents keep an accurate record of intake and output.

ANS: C Risk of aspiration is a priority nursing diagnosis for the infant with gastroesophageal reflux. The parents must be taught infant CPR. Correct positioning minimizes aspiration. The correct position for the infant is supine for sleeping unless the risk of aspiration is great. Knowledge of developmental needs should be included in discharge planning for all hospitalized infants, but it is not the most important in this case. Keeping a record of intake and output is not a priority and may not be necessary. PTS: 1 DIF: Cognitive Level: Application/Applying

What should the nurse teach a school-age child and his parents about the management of ulcer disease? a. Eat a bland, low-fiber diet in small, frequent meals. b. Eat three balanced meals a day with no snacking between meals. c. The child needs to eat alone in a quiet spot to avoid stress. d. Do not give antacids 1 hour before or after antiulcer medications.

ANS: D Antacids can interfere with antiulcer medication if given less than 1 hour before or after antiulcer medications. A bland diet is not indicated for ulcer disease. The diet should be a regular diet that is low in caffeine, and the child should eat a meal or snack every 2 to 3 hours. The child should eat every 2 to 3 hours. Eating alone is not indicated.

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

ANS: D Easily digested foods such as cereals, cooked vegetables, and meats should be provided for the child. Early reintroduction of nutrients is desirable. Continued feeding or reintroduction of a regular diet has no adverse effects and actually lessens the severity and duration of the illness. Clear liquids and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic. The BRAT diet (bananas, rice, applesauce, and toast) is no longer recommended. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating

Which nursing diagnosis has the highest priority for the toddler with celiac disease? a. Disturbed Body Image related to chronic constipation b. Risk for Disproportionate Growth related to obesity c. Excess Fluid Volume related to celiac crisis d. Imbalanced Nutrition: Less than Body Requirements related to malabsorption

ANS: D Imbalanced Nutrition: Less than Body Requirements is the highest priority nursing diagnosis because celiac disease causes gluten enteropathy, a malabsorption condition. A psychosocial diagnosis (Disturbed Body Image) would not take priority over a physical diagnosis. Celiac disease causes disproportionate growth and development associated with malnutrition, not obesity. Celiac crisis causes deficient fluid volume. PTS: 1 DIF: Cognitive Level: Application/Applying

Which intervention should be included in the nurse's plan of care for a 7-year-old child with encopresis who has cleared the initial impaction? a. Have the child sit on the toilet for 30 minutes when he gets up in the morning and at bedtime. b. Increase caffeine in the child's diet to promote bowel elimination. c. Use a fleet enema daily d. Give the child a choice of beverage to mix with a laxative

ANS: D Offering realistic choices is helpful in meeting the school-age child's sense of control. To facilitate bowel elimination, the child should sit on the toilet for 5 to 10 minutes after breakfast and dinner. Caffeine to stimulate the bowels is not recommended. Daily Fleet enemas can result in hypernatremia and hyperphosphatemia and are used only during periods of fecal impaction.