Exam #2-Pediatric GI Disorders

A 14-year-old boy is brought into the emergency department with a diagnosis of rule out appendicitis. He states he is having right lower quadrant pain. The nurse's most appropriate action to assist in managing his pain would be to: Apply an ice bag. Insert a rectal tube. Administer an intravenous antispasmodic agent. Apply a heating pad.

Apply an ice bag An ice bag may help relieve his pain. A rectal tube is contraindicated because it stimulates bowel motility, which would increase the pain. A heating pad is contraindicated because it increases the flow of blood to the appendix and may lead to rupture. An antispasmodic agent would not be beneficial for the pain associated with appendicitis. Antispasmodic agents are typically used to inhibit smooth muscle contractions.

The nurse recognizes which symptoms as typical signs of dehydration? Select all that apply. Little to no urine output Crying without tears Urine specific gravity of 1.005 Sunken fontanel Heart palpitations

Little to no urine output Crying without tears Sunken fontanel

The nurse is talking to a group of adolescents who are overweight. Which verbalized behavior is an example of the best exercise plan for weight loss? Walking for 30 minutes 6 or 7 days/week Playing soccer for an hour on the weekend Lifting weights 15 minutes a day, 3 times a week Playing an interactive video game every day for an hour

Walking for 30 minutes 6 or 7 days/week

Which should be included in the plan of care for a 14-month-old whose cleft palate was repaired 12 hours ago? Select all that apply. Allow the infant to have familiar items of comfort such as a favorite stuffed animal and a "sippy" cup. Once liquids have been tolerated, encourage a bland diet such as soup, Jell-O, and saltine crackers. Administer pain medication on a regular schedule, as opposed to an as-needed schedule. Use a Yankauer suction catheter on the infant's mouth to decrease the risk of aspiration of oral secretions. When discharged, remove elbow restraints.

1, 3. The child should not be allowed to use anything that creates suction in the mouth, such as pacifiers or straws. "Sippy" cups are acceptable. Pain medication should be administered regularly to avoid crying, which places stress on the suture line.

A 4-year-old child is seen at the primary health-care provider's offi ce with vomiting and diarrhea for the past 24 hours. Th e primary health-care provider orders a number of interventions. If ordered, the nurse should question the administration of which of the following medications for the child? 1. Lomotil (diphenoxylate/atropine) 2. Zofran (ondansetron) 3. Reglan (metoclopramide) 4. Dramamine (dimenhydrinate)

1. Although the child does have diarrhea, Lomotil (diphenoxylate/ atropine) is not recommended to be given to children. TEST-TAKING TIP: If ordered, the nurse should question the administration of an antidiarrhea medication for the child (e.g., Lomotil). Antiemetics often are needed to reduce children's vomiting episodes, but it is recommended that antidiarrhea medications not be administered to young children

The nurse is caring for an infant diagnosed with Hirschsprung disease. The mother states she is pregnant with a boy and wants to know if her new baby will likely have the disorder. Select the nurse's best response. "Genetics play a small role in Hirschsprung disease, so there is a chance the baby will develop it as well." "There is no evidence to support a genetic link, so it is very unlikely the baby will also have it." "It is rarely seen in boys, so it is not likely your new baby will have Hirschsprung disease." "Hirschsprung disease is seen only in girls, so your new baby will not be at risk."

1. There is a genetic component to Hirschsprung disease, so any future siblings are also at risk.

The nurse is caring for an infant newly diagnosed with Hirschsprung disease. What does the nurse understand about this infant's condition? There is a lack of peristalsis in the large intestine and an accumulation of bowel contents, leading to abdominal distention. There is excessive peristalsis throughout the intestine, resulting in abdominal distention. There is a small-bowel obstruction leading to ribbon-like stools. There is inflammation throughout the large intestine, leading to accumulation of intestinal contents and abdominal distention.

1.In Hirschsprung disease, a portion of the large intestine has an area lacking in ganglion cells. This results in a lack of peristalsis as well as an accumulation of bowel contents and abdominal distention.

A parent brings an 18-month-old toddler to the pediatric emergency department for abdominal pain and stool mixed with blood and mucus. The pain is recurring three to four times an hour. Which intervention will the nurse initiate first? 1.Assess laboratory results. 2.Initiate intravenous access. 3.Maintain strict intake and output. 4.Prepare for ultrasound studies.

2-This is correct. The nurse recognizes the existence of an emergency based on the toddler's presenting symptoms. The nurse will first initiate intravenous access in order to have a route established for medications and/or emergency interventions.

Which child can be discharged without further evaluation? A 2-year-old who has had 24 hours of watery diarrhea that has changed to bloody diarrhea in the past 12 hours. A 2-year-old who had a relapse of one diarrhea episode after restarting a normal diet. A 6-year-old who has been having vomiting and diarrhea for 2 days and has decreased urine output. A 10-year-old who has just returned from a Scout camping trip and has had several episodes of diarrhea.

2. It is common for children to have a relapse of diarrhea after resuming a regular diet

Which is the best position for an 8-year-old who has just returned to the pediatric unit after an appendectomy for a ruptured appendix? Semi-Fowler. Prone. Right side-lying. Left side-lying.

2.A positive Rovsing sign occurs when the left lower quadrant is palpated and pain is felt in the right lower quadrant.

The nurse in a pediatric clinic is obtaining information about a 7-month-old infant with GI symptoms. The parent informs the nurse that bloating, flatulence, and foul-smelling stools occurred with the introduction of wheat cereal. Which additional information will cause the nurse to initiate emergency care? 1.Dental enamel defects of the teeth 2.Presence of dermatitis herpetiformis 3.Severe vomiting and diarrhea 4.Weight loss indicated by thinness of extremities

3-This is correct. If additional health information includes severe vomiting and diarrhea, the nurse will suspect dehydration; the manifestations together will cause the nurse to initiate emergency care.

13. A school nurse is monitoring the eating patterns of a child with celiac disease. The nurse counsels the child to choose an alternate lunch when the child picks which of the following foods to put on the lunch tray? 1. Corn taco with refried beans 2. Rice noodles with beef and broccoli 3. Turkey meatloaf with baked potato 4. Roast pork with applesauce

3. Th e nurse should counsel a child with celiac disease who chooses meatloaf for lunch.

A child is severely dehydrated from a diarrheal illness. Th e nurse assesses the child's laboratory results. Which of the following results would the nurse expect to fi nd? 1. Hematocrit (Hct) 30% 2. Partial pressure of oxygen (Po2) 60 mm Hg 3. Potassium (K) 3.0 mEq/L 4. Platelet (Plt) count 100,000 cells/mm3

3. Th e nurse would expect to see a lab report that shows hypokalemia. TEST-TAKING TIP: The child has diarrhea, therefore the child is losing fl uids. If the child becomes moderately or severely dehydrated, the nurse would expect the Hct to rise. There should be no change in the PO2 or the Plt count. The nurse would, however, expect that the K level could be low

The nurse is informing a new mother of the concern about her newborn who is 36 hours old and has not passed any meconium. The nurse shares a suspicion of Hirschsprung's disease. The mother asks the nurse multiple questions about the condition. Which information will the nurse provide? 1.Retained meconium is a source of severe infection in newborns. 2.A positive diagnosis indicates the newborn is terminally ill. 3.The absence of nerves in the colon also indicates mobility issues. 4.The condition is congenital and causes blockage of the intestines.

4 This is correct. Hirschsprung's disease is a congenital condition that causes blockage of the intestine because of a lack of nerves in the bottom segment of the colon. These nerves normally allow the muscles in the wall of the bowel to contract and move digested material toward the anus to be eliminated.

The nurse is caring for a 14-year-old with celiac disease. The nurse knows that the patient understands the diet instructions by ordering which of the following meals? Eggs, bacon, rye toast, and lactose-free milk. Pancakes, orange juice, and sausage links. Oat cereal, breakfast pastry, and nonfat skim milk. Cheese, banana slices, rice cakes, and whole milk.

4.Cheese, banana slices, rice cakes, and whole milk do not contain gluten.

A 4-month-old is brought to the emergency department with severe dehydration. The heart rate is 198, and her blood pressure is 68/38. The infant's anterior fontanel is sunken. The nurse notes that the infant does not cry when the intravenous line is inserted. The child's parents state that she has not "held anything down" in 18 hours. The nurse obtains a finger-stick blood sugar of 94. Which would the nurse expect to do immediately? Administer a bolus of normal saline. Administer a bolus of D10W. Administer a bolus of normal saline with 5% dextrose added to the solution. Offer the child an oral rehydrating solution such as Pedialyte.

4.Dehydration is corrected with the administration of an isotonic solution, such as normal saline or lactated Ringer solution

The nurse will soon receive a 4-month-old who has been diagnosed with intussusception. The infant is described as very lethargic with the following vital signs: T 101.8°F (38.7°C), HR 181, BP 68/38. The reporting nurse states the infant's abdomen is very rigid. Which is the most appropriate action for the receiving nurse? Prepare to accompany the infant to a computed tomography scan to confirm the diagnosis. Prepare to accompany the infant to the radiology department for a reducing enema. Prepare to start a second intravenous line to administer fluids and antibiotics. Prepare to get the infant ready for immediate surgical correction.

4.Intussusception with peritonitis is a surgical emergency, so preparing the infant for surgery is the nurse's top priority.

A nurse is describing nursing interventions for a client that is obese. Which interventions would be accurate? Select all that apply. Educating client for symptoms of heart disease Monitoring for uncontrolled hypertension Checking blood sugars only if there is a family history of diabetes Suggesting a sleep study Urging parents to give children whatever they want to eat when they become upset in order to enhance emotional well-being

Educating client for symptoms of heart disease Monitoring for uncontrolled hypertension Suggesting a sleep study

A parent visits the clinic and tells the nurse that her 5-week-old male infant has had projectile vomiting that smells sour for the past two days. The nurse should refer the family to a health care provider for a possible diagnosis of: Pyloric stenosis Hiatal hernia Peptic ulcer Intestinal atresia

Pyloric stenosis

The nurse is educating a client with celiac disease about nutrition. Which diet would be the best choice? Tuna on wheat toast Ham and Swiss cheese on rye bread Rice and beans Chicken salad on a croissant

Rice and beans

The nurse is reviewing nursing notes and sees a notation of "ESSR" in the medical record of a child with a cleft lip and palate. The nurse interprets that the notation of "ESSR" is referring to which of the following? The procedure for repair. The positioning of the infant. The feeding method. The suture maintenance tool.

The feeding method. ESSR feeding technique for cleft lip or palate: Enlarge nipple; Stimulate suck reflex; Swallow fluid; Rest after each swallow. It has nothing to do with a suture maintenance tool, the surgical procedure, or a method of positioning the infant.

The nurse is educating a new mother of a child born with both a cleft lip and a cleft palate regarding formula feeding. Which of the following actions should the nurse include in her teaching session? Select all that apply. 1. Instruct the mother to add rice cereal to the formula. 2. Encourage the mother to cup feed her baby rather than to bottle feed. 3. Advise the mother to hold the baby in an upright position during feedings. 4. Advise the mother to feed the baby slowly to allow the baby time to swallow and to rest. 5. Notify the mother of the importance of giving the baby pain medicine before each feeding.

3. Th e mother should be advised to hold the baby in an upright position during feedings. 4. Th e mother should be advised to feed the baby slowly to allow the baby time to swallow and to rest TEST-TAKING TIP: Babies with cleft lip and palate must work hard to remove formula from a bottle. Often, alternate feeding methods may be needed, including soft nipples or Breck feeders, but there is rarely a need to cup feed the babies. Because of the difficulty, babies become very tired. They must be given sufficient time to suckle and to swallow. In addition, because of their high risk for ear infections, they should be fed in an upright position.

Which would the nurse expect to be included in the diagnostic workup of a child with suspected celiac disease? Obtain complete blood count and serum electrolytes. Obtain complete blood count and stool sample; keep child NPO. Obtain stool sample and prepare child for jejunal biopsy. Obtain complete blood count and serum electrolytes; monitor child's response to gluten-containing diet.

3.A stool sample for analysis of fat and a jejunal biopsy can confirm the diagnosis.

The nurse is caring for a 3-month-old being evaluated for possible Hirschsprung disease. His parents call the nurse and show her his diaper containing a large amount of mucus and bloody diarrhea. The nurse notes that the infant is irritable and his abdomen appears very distended. Which should be the nurse's next action? Reassure the parents that this is an expected finding and not uncommon. Call a code for a potential cardiac arrest, and stay with the infant. Immediately obtain all vital signs with a quick head-to-toe assessment. Obtain a stool sample for occult blood.

3.All vital signs need to be evaluated because the child with enterocolitis can quickly progress to a state of shock. A quick head-to-toe assessment will allow the nurse to evaluate the child's circulatory system.

The nurse is caring for a 9-month-old with diarrhea secondary to rotavirus. The child has not vomited and is mildly dehydrated. Which is likely to be included in the discharge teaching? Administer Imodium as needed. Administer Kaopectate as needed. Continue breastfeeding per routine. The infant may return to day care 24 hours after antibiotics have been started.

3.Breastfeeding is usually well tolerated and helps prevent death of intestinal villi and malabsorption.

The nurse is caring for a 5-month-old infant with a diagnosis of intussusception. The infant has periods of irritability during which the knees are brought to chest and the infant cries, alternating with periods of lethargy. Vital signs are stable and within age-appropriate limits. The physician elects to give an enema. The parents ask the purpose of the enema. Select the nurse's most appropriate response. "The enema will confirm the diagnosis. If the test result is positive, your child will need to have surgery to correct the intussusception." "The enema will confirm the diagnosis. Although very unlikely, the enema may also help fix the intussusception so that your child will not immediately need surgery." "The enema will help confirm the diagnosis and has a good chance of fixing the intussusception." "The enema will help confirm the diagnosis and may temporarily fix the intussusception. If the bowel returns to normal, there is a strong likelihood that the intussusception will recur."

3.In most cases of intussusception in young children, an enema is successful in reducing the intussusception.

The nurse is caring for an 8-week-old infant being evaluated for pyloric stenosis. Which statement by the parent would be typical for a child with this diagnosis? "The baby is a very fussy eater and just does not want to eat." "The baby tends to have a very forceful vomiting episode about 30 minutes after most feedings." "The baby is always hungry after vomiting so I refeed." "The baby is happy in spite of getting really upset after spitting up."

3.Infants with pyloric stenosis are always hungry and often appear malnourished.

The nurse is caring for an infant with pyloric stenosis. The parent asks if any future children will likely have pyloric stenosis. Select the nurse's best response. "You seem worried; would you like to discuss your concerns?" "It is very rare for a family to have more than one child with pyloric stenosis." "Pyloric stenosis can run in families. It is more common among males." "Although there can be a genetic link, it is very unusual for girls to have pyloric stenosis."

3.Pyloric stenosis can run in families, and it is more common in males.

A 4-month-old has had vomiting and diarrhea for 24 hours. The infant is fussy, and the anterior fontanel is sunken. The nurse notes the infant does not produce tears when crying. Which task will help confirm the diagnosis of dehydration? Urinalysis obtained by bagged specimen. Urinalysis obtained by sterile catheterization. Analysis of serum electrolytes. Analysis of cerebrospinal fluid.

3.The analysis of serum electrolytes offers the most information and assists with the diagnosis of dehydration

The nurse is caring for a 4-month-old who has just had an isolated cleft lip repaired. Select the best position for the child in the immediate post-operative period. Right side-lying. Left side-lying. Supine. Prone.

3.The supine position is preferred because there is decreased risk of the infant rubbing the suture line.

A baby is admitted with a diagnosis of intussusception. Which of the following signs/ symptoms would the nurse expect to see? 1. Projective vomiting 2. Acute constipation 3. Explosive fl atus 4. Currant jelly stools

4. Currant jelly stools oft en are seen in babies with intussusception. TEST-TAKING TIP: When the bowel invaginates, a narrowing of the lumen results. The fecal material builds up and presses against the intestinal wall. The wall becomes ischemic and begins to break down, resulting in blood mixing with the stool (i.e., currant jelly stools).

17. Th e parent of a 6-month-old calls the child's primary health-care provider and states, "My child has had 5 loose stools since she woke up this morning. What should I do?" Th e mother is exclusively breastfeeding her baby. Which of the following responses by the nurse is appropriate? 1. "Let's fi gure out what you may have eaten during the last day that could have caused the diarrhea." 2. "Continue to feed the baby breast milk and give oral rehydration therapy aft er each feeding." 3. "Th at's not that unusual for babies who are breastfed but do call again if the stools turn a green color." 4. "Bring the baby in for an appointment with the doctor so that we can weigh and check over the baby."

4. Th e baby does need to be weighed to determine whether the baby is dehydrated. TEST-TAKING TIP: Percentage of weight loss is the best way to determine the severity of dehydration. The baby should be weighed and the percentage of weight loss calculated. If the baby has mild dehydration, the mother likely will be advised to continue to breastfeed and to give oral rehydration therapy after each feeding. However, if the child is severely dehydrated, the child likely will need IV therapy

The nurse is caring for an 8-week-old male who has just been diagnosed with Hirschsprung disease. The parents ask what they should expect. Select the nurse's best response. "It is really an easy disease to manage. Most children are placed on stool softeners to help with constipation until it resolves." "A permanent stool diversion, called a colostomy, will be placed by the surgeon to bypass the narrowed area." "Daily bowel irrigations will help your child maintain regular bowel habits." "Although your child will require surgery, there are different ways to manage the disease, depending on how much bowel is involved."

4. The aganglionic portion needs to be removed. Although most children have a temporary colostomy placed, many infants are able to bypass the colostomy and have the bowel immediately reattached.

The nurse is to receive a 4-year-old from the recovery room after an appendectomy. The parents have not seen the child since surgery and ask what to expect. Select the nurse's best response. "Your child will be very sleepy, have an intravenous line in the hand, and have a nasal tube to help drain the stomach. If your child needs pain medication, it will be given intravenously." "Your child will be very sleepy, have an intravenous line in the hand, and have white stockings to help prevent blood clots. If your child needs pain medication, we will give it intravenously or provide a liquid to swallow." "Your child will be wide awake and will have an intravenous line in the hand. If your child needs pain medication, we will give it intravenously or provide a liquid to swallow." "Your child will be very sleepy and have an intravenous line in the hand. If your child needs pain medication, we will give it intravenously."

4.In the immediate post-operative period, the child is usually sleepy but can be roused. The child usually has an intravenous line for hydration and pain medication

The nurse receives a call from the parent of a 10-month-old who has vomited three times in the past 8 hours. The parent describes the baby as playful and wanting to drink. The parent asks the nurse what to give the child. Select the nurse's best response. "Replace the next feeding with regular water, and see if that is better tolerated." "Do not allow your baby to eat any solids; give half the normal formula feeding, and see if that is better tolerated." "Do not let your baby eat or drink anything for 24 hours to give the stomach a chance to rest."

4.Offering small amounts of clear liquids is usually well tolerated. If the child vomits, make NPO to allow the stomach to rest and then restart fluids. The child in this scenario is described as playful and therefore does not appear to be at risk for dehydration.

The parents of a newborn diagnosed with a cleft lip and palate ask the nurse when their child's lip and palate will most likely be repaired. Select the nurse's best response. "The palate and the lip are usually repaired in the first few weeks of life so that the baby can grow and gain weight." "The palate and the lip are usually not repaired until the baby is approximately 6 months old so that the mouth has had enough time to grow." "The lip is repaired in the first few months of life, but the palate is not usually repaired until the child is 3 years old." "The lip is repaired in the first few weeks of life, but the palate is not usually repaired until the child is 18 months old."

4.The lip is repaired in the first few weeks of life, but the palate is not usually repaired until the child is 18 months old.

The parents of a child being evaluated for appendicitis tell the nurse the physician said their child has a positive Rovsing sign. They ask the nurse what this means. Select the nurse's best response. "Your child's physician should answer that question." "A positive Rovsing sign means the child feels pain in the right side of the abdomen when the left side is palpated." "A positive Rovsing sign means pain is felt when the physician removes the hand from the abdomen." "A positive Rovsing sign means pain is felt in the right lower quadrant when the child coughs."

4.The physician should be notified immediately, as a sudden change or loss of pain often indicates a perforated appendix.

A child is being followed at the pediatric clinic for poor weight gain. What exemplifies that a child may have non-organic failure to thrive (FTT)? A child that has food rituals Abdominal distention Diarrhea Vomiting of feeds

A child that has food rituals

A one-month-old baby has been admitted to the pediatric unit with a diagnosis of pyloric stenosis. Which of the following assessments is highest priority for the nurse to report to the baby's primary health-care provider? 1. Sunken fontanel 2. Undigested emesis 3. Apical heart rate of 156 bpm 4. Serum potassium of 3.6 mEq/dL

ANSWER: 1 Rationale: 1. It is highest priority for the nurse to report a sunken fontanel. TEST-TAKING TIP: A baby with a sunken fontanel is exhibiting signs of dehydration. The physician must be notifi ed. All other fi ndings are within expectations: babies with pyloric stenosis do vomit undigested formula; an apical heart rate of 156 bpm is within normal limits, albeit high normal; and a serum potassium of 3.6 mEq/dL is within normal limits, albeit low normal.

A 2-month-old infant with a cleft lip is transferred to the pediatric floor immediately following surgical repair of the defect. Which of the following interventions should the nurse perform? 1. Assess placement of the elbow restraints. 2. Assess placement of the gastrostomy tube. 3. Monitor the child for signs of hypokalemia. 4. Monitor the child for passage of tarry stools.

ANSWER: 1 Rationale: 1. The nurse should assess placement of the elbow restraints.

14. A child has just been diagnosed with celiac disease. Which of the following signs and symptoms would the nurse expect the parents to report in the child's history? Select all that apply. 1. Irritability 2. Failure to thrive 3. Abdominal pain 4. Excessive hunger 5. Recurring diarrhea

ANSWER: 1, 2, 3, and 5 Rationale: 1. Th e nurse would expect the parents to report that the child was irritable. 2. Th e nurse would expect the parents to report that the child experienced failure to thrive. 3. Th e nurse would expect the parents to report that the child had abdominal pain. 4. Th e nurse would not expect the parents to report that the child had been excessively hungry. In fact, the child would likely have been anorexic. 5. Th e nurse would expect the parents to report that the child had recurring diarrhea. TEST-TAKING TIP: Those with celiac disease can exhibit a variety of signs and symptoms. Children usually exhibit the most common of these: "failure to thrive, chronic diarrhea/constipation, recurring abdominal bloating and pain, fatigue and irritability"

A child has been diagnosed with Hirschsprung's disease. Which of the following findings would the nurse expect the parents to report in the child's history? Select all that apply. 1. Ribbon-like stools 2. Chronic constipation 3. Black and tarry stools 4. Distended abdomen 5. Delayed meconium passage

ANSWER: 1, 2, 4, and 5 Rationale: 1. The nurse would expect the parents to report that the child has ribbon-like stools. 2. Th e nurse would expect the parents to report that the child has chronic constipation. 3. The nurse would not expect the parents to report that the child has black and tarry stools. 4. Th e nurse would expect the parents to report that the child has a distended abdomen. 5. Th e nurse would expect the parents to report that the child has delayed meconium passage. TEST-TAKING TIP: The lack of enervation to the rectum and/or lower intestine results in the absence of peristalsis in the affected bowel. As a result, in the neonatal period, meconium is passed very late. If the disease remains undiagnosed, the child develops a distended abdomen and chronic constipation with pellet or ribbon-like stool

A 7-month-old child who has yet to have a cleft palate repaired is saying a few words. The child's lip is intact. Which of the following words would the nurse expect the child to have the most difficulty saying? 1. "Ma ma" 2. "Da da" 3. "Ba ba" 4. "Pa pa"

ANSWER: 2 Rationale: 2. The child would have marked difficulty saying, "Da da." TEST-TAKING TIP: When a person makes a number of consonant sounds (e.g., "d," "t," "n") the person must touch the roof of the mouth with his or her tongue. Because a child with a cleft palate has no roof of the mouth, it is virtually impossible for him or her accurately to make those sounds

A baby, with a history of cystic fibrosis, is admitted to the emergency department. The baby is crying loudly and drawing his legs up toward his abdomen. A diagnosis of intussusception is made. Which of the following orders would the nurse expect to receive at this time? 1. To administer a corticosteroid medication 2. To prepare the baby for abdominal surgery 3. To prepare the baby for an air enema 4. To administer an antispasmodic medication

ANSWER: 3 Rationale: 3. The nurse would expect to prepare the baby for an air enema. TEST-TAKING TIP: An air or other type of enema is the usual therapy for a baby with intussusception. Babies with cystic fibrosis are at high risk for the complication.

The nurse is teaching home feeding guidelines to the mother of a child with nonorganic failure to thrive. Essential information for the nurse to include would be the importance of which item? Allowing the child to snack on finger foods, such as circular oat cereal and bananas Allowing the child to eat alone to minimize distraction Restricting eating except at mealtimes A relaxed mealtime with few limits on behavior

Allowing the child to snack on finger foods, such as circular oat cereal and bananas The parent should be taught to encourage increased food intake, including between meal snacks. The child does not need to eat alone; instead mealtimes should be structured family events. Finger foods are helpful in encouraging children with failure to thrive to increase food intake. Although a relaxed atmosphere is good, there can be limits on behavior during mealtimes to provide structure.

The nurse instructed a 7-year-old child about dietary restrictions related to a new diagnosis of celiac disease. After teaching, the child is allowed to choose a meal from the hospital menu. The nurse evaluates that teaching was effective when the child chooses which food selections? Beef patty on a hamburger bun and home fries Baked chicken, green beans, and a slice of cornbread Beef and barley soup, rice cakes, and celery Ham and cheese sandwich with lettuce and tomato on rye toast

Baked chicken, green beans, and a slice of cornbread Celiac disease is characterized by intolerance for gluten. Gluten is found in wheat, barley, rye, and oats. This includes bread, cake, doughnuts, cookies, and crackers, as well as processed foods that contain gluten as filler. Baked chicken and green beans are gluten free. Corn bread is made from ground corn which does not contain gluten

Which sign would the nurse recognize as an indication of moderate dehydration in a preschooler? Decreased urine specific gravity Sunken fontanel Dry mucous membranes Diaphoresis

Dry mucous membranes Mucous membranes typically appear dry when moderate dehydration is observed. Other typical findings associated with moderate dehydration include restlessness with periods of irritability (especially infants and young children), rapid pulse, poor skin turgor, delayed capillary refill, and decreased urine output. Both anterior and posterior fontanels are closed on a preschool-age child. The skin is usually dry with decreased elasticity, not diaphoretic. Urine specific gravity increases with decreased urine output associated with dehydration.

A child has been diagnosed with non-organic failure to thrive. In addition to poor weight gain, the nurse would expect the child to exhibit which of the following? Select all that apply. Diarrhea Erratic sleep patterns Food refusal Developmental delays Irritability and being difficult to soothe

Erratic sleep patterns Food refusal Irritability and being difficult to soothe Non-organic failure to thrive is not due to metabolic or organic problems or the absence of food availability. Children with this form of malnutrition often display other non-specific symptoms related to the emotional illness.

A newborn has been diagnosed with Hirschsprung's disease. The parents are confused and ask the nurse what symptoms lead to this diagnosis. The nurse should explain the most common symptoms as: Development of acute diarrhea and dehydration Currant, jelly-like gelatinous stools Severe projectile vomiting and electrolyte imbalance Failure to pass a meconium stool with abdominal distention

Failure to pass a meconium stool with abdominal distention

A nurse is caring for an infant admitted with pyloric stenosis. What are some of the assessment findings the nurse would expect? Select all that apply. Bilious vomiting Failure to thrive (FTT) Irritability Metabolic alkalosis Diarrhea

Failure to thrive (FTT) Irritability Metabolic alkalosis

A 3-year-old child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting from gastroenteritis. The child is listless and lethargic. What action by the nurse would assist in the management of the child's condition? Administer oral rehydration solutions Administer clear liquids by mouth, 1 to 2 ounces at a time Initiate intravenous (IV) fluids Administer of antidiarrheal medications

Initiate intravenous (IV) fluids

A child has been admitted to the hospital with dehydration. Which assessment measures would the nurse expect to be included in the plan of care? Select all that apply. Stool ova and parasites 72-hour fecal fat collection Intake and output Upper-gastrointestinal (GI) series Urine specific gravity

Intake and output Urine specific gravity Explanation: Urine specific gravity is a measurement of the concentration of urine and provides information regarding hydration. Urine specific gravity is elevated in dehydration. Sending a stool for ova and parasites evaluation could be indicated if this was suspected as a cause of diarrhea, but the child is not known to have diarrhea. An upper GI series would help to diagnose GI disorders. Stool evaluation for fecal fat would help to diagnose GI disorders. Careful measurement of intake and output will indicate the child's hydration status.

A young child is suspected of having intussusception. Which assessment findings correlate with this condition? Legs extended when crying Severe gastroesophageal reflux Irritability Bloody diarrhea

Irritability

The nurse is caring for a child with a history of severe diarrhea. Which acid-base abnormality would the nurse assess for in arterial blood gas results as a possible consequence of the diarrhea? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis

Metabolic acidosis The nature of the problem is metabolic rather than respiratory. In severe diarrhea, excess bicarbonate is lost. There is also carbohydrate malabsorption and depletion of glycogen stores, resulting in fat metabolism, yielding ketoacids as byproducts. For both reasons, the client can develop acidosis that is metabolic in nature. The nature of the problem is acidosis rather than alkalosis.

An infant returns from the initial surgery for Hirschsprung's disease. Because of the type of surgery this child had, the nurse would eliminate which routine postoperative nursing intervention from the standardized care plan? Monitoring rectal temperature every 4 hours Reuniting the parents with the child as soon as possible Assessing the surgical site every 2 hours Maintaining the child NPO until bowel sounds return

Monitoring rectal temperature every 4 hours Maintaining NPO status until bowel sounds return is a universal intervention that should remain on the care plan. The corrective surgery for Hirschsprung's disease requires pulling the end of the normal bowel through the muscular sleeve of the rectum. With this type of procedure, rectal temperatures and any invasive procedure would be avoided to allow proper healing to occur. Reuniting the child with parents is a universal intervention that should remain on the care plan. Assessing the surgical site is a universal intervention that should remain on the care plan.

The nurse is admitting a child with a diagnosis of "rule out appendicitis." The nurse assesses this client for which manifestations? Select all that apply. Pain localizing in right lower quadrant Elevated white blood cell count Generalized abdominal pain Indigestion Fatty stools

Pain localizing in right lower quadrant Elevated white blood cell count Generalized abdominal pain Manifestations of appendicitis often begin with generalized abdominal pain. As abdominal pain progressively worsens, it tends to localize in the right lower quadrant at McBurney's point. Fatty stools are not part of the clinical picture. Elevated WBC count can elevate to 15,000 to 20,000 cells/mm3 because of the inflammatory response. Indigestion is not typical, although the client may have nausea and vomiting, fever, chills, anorexia, diarrhea, or acute constipation.

6. The parent of a 5-year-old states that the child has been having diarrhea for 24 hours, vomited twice 2 hours ago, and now claims to be thirsty. The parent asks what to offer the child because the child is refusing Pedialyte. Select the nurse's most appropriate response. "You can offer clear diet soda such as Sprite and ginger ale." "Pedialyte is really the best thing for your child, who, if thirsty enough, will eventually drink it." "Pedialyte is really the best thing for your child. Allow your child some choice in the way to take it by offering small amounts in a spoon, medicine cup, or syringe." "It really does not matter what your child drinks as long as it is kept down. Try offering small amounts of fluids in medicine cups."

Pedialyte is the first choice, as recommended by the American Academy of Pediatrics. Offering the child appropriate choices may allow the child to feel empowered and less likely to refuse the Pedialyte. Small, frequent amounts are usually better tolerated.

While gathering admission data on a 16-month-old child, the nurse notes the following abnormal findings. Which finding is related to a diagnosis of Hirschsprung's disease? Select all that apply. Poor weight gain since birth Decreased urine output Bile-stained vomitus Intermittent sharp pain Alternating constipation and diarrhea

Poor weight gain since birth Bile-stained vomitus Alternating constipation and diarrhea Infants with Hirschsprung's disease usually display failure to thrive, poor weight gain, and delayed growth. Vomiting is usually bile stained. The child will demonstrate alternating constipation and diarrhea, but the stools are not bloody. Decreased urine output and intermittent sharp pain are nonspecific symptoms that can be associated with many different diseases and disorders.

The nurse is caring for a 2-year-old child who was admitted to the pediatric unit for moderate dehydration due to vomiting and diarrhea. The child is restless, with periods of irritability. The child is afebrile with a heart rate of 148 and a blood pressure of 90/42. Baseline laboratory tests reveal the following: Na 152, Cl 119, and glucose 115. The parents state that the child has not urinated in 12 hours. After establishing a saline lock, the nurse reviews the physician's orders. Which order should the nurse question? Administer a saline bolus of 10 mL/kg, which may be repeated if the child does not urinate. Recheck serum electrolytes in 12 hours. After the saline bolus, begin maintenance fluids of D5 1/4 NS with 10 mEq KCl/L. Give clear liquid diet as tolerated.

Potassium is contraindicated because the child has not yet urinated. Potassium is not added to the maintenance fluid until kidney function has been verified.

The nurse is discussing treatments for intussusception with a client. Which statement made by the nurse is correct? Select all that apply. "Intussusception most often resolves on its own without intervention." "Reduction may be performed with barium or air insufflation." "Intussusception can block blood supply to the affected portion of the intestine." "This is the most common cause of intestinal obstruction in children less than 3 years of age." "Surgical intervention may be required if the initial attempt at reduction fails."

Reduction may be performed with barium or air insufflation." "Intussusception can block blood supply to the affected portion of the intestine." "This is the most common cause of intestinal obstruction in children less than 3 years of age." "Surgical intervention may be required if the initial attempt at reduction fails."

A child with Hirschsprung's disease is being discharged after Soave endorectal pull-through procedure for colostomy closure. Which item should the nurse include in the discharge teaching plan? It will be necessary to perform weekly rectal irrigations for approximately 6 weeks. Report fever, increasing pain or discomfort, or redness of the incision to the surgeon. Stools may be infrequent and uncomfortable for the first few weeks. Stools will be fatty for a week or so and then gradually return to normal.

Report fever, increasing pain or discomfort, or redness of the incision to the surgeon. After the Soave procedure, normal bowel function is expected. No rectal irrigations are necessary. It is important that any signs of infection be reported at once. Stools are not fatty for a week or so following the Soave procedure.

A school-age child with acute diarrhea from gastroenteritis has mild dehydration and is being given oral rehydration solutions (ORS). The client's parent calls the clinic nurse because their child is also occasionally vomiting. The nurse should recommend which intervention to the parent? "Bring the child to the hospital immediately for intravenous fluids." "Alternate between giving oral rehydration solutions (ORS) and carbonated drinks, as they soothe the stomach." "Continue to give oral rehydration solutions (ORS) frequently in small amounts." "Recommend making the child nothing by mouth (NPO) for 8 hours and resume oral rehydration solutions (ORS) if vomiting has subsided."

"Continue to give oral rehydration solutions (ORS) frequently in small amounts."

A child who underwent cleft palate repair has just returned from surgery with elbow restraints in place. The parents question why their child must have the restraints. The nurse would give which best explanation to the parents? "This device is frequently used postoperatively to protect the IV site in small children." "Elbow restraints are used postoperatively to keep children's hands away from the surgical site." "The restraints will help us maintain proper body alignment." "The restraints help maintain the child's NPO status."

"Elbow restraints are used postoperatively to keep children's hands away from the surgical site." Elbow restraints are used to keep hands away from the mouth after cleft palate surgery. This precaution will be maintained at home until the palate is healed, usually 4 to 6 weeks. They are not used to protect the IV site, maintain NPO status, or maintain body alignment.

The nurse is assessing a child who presents with diarrhea. Which questions would be important to ask the caregivers? Select all that apply. "How frequent is the diarrhea?" "Are the stools bloody?" "Did you insert anything in the rectum to cause this?" "Is the stool watery?" "Don't you make your child wash their hands so they don't get sick?"

"How frequent is the diarrhea?" "Are the stools bloody?" "Is the stool watery?"

A 4-month-old infant is admitted to the nursing unit with moderate dehydration. Which of the following symptoms does the nurse suspect led to the diagnosis of moderate dehydration in this child? Select all that apply. Slow capillary refill Weight gain Polyuria Elevated heart rate Urine specific gravity of 1.038

Slow capillary refill Elevated heart rate Urine specific gravity of 1.038 The nurse would expect an increased desire to drink fluids and a higher specific gravity caused by the concentration of urine. The heart rate would be elevated, and the fontanels sunken. The degree of dehydration is based on the percent of weight loss, so a weight gain would not be likely. Diminished urine output with elevated specific gravity is an expected normal finding in dehydration. Capillary refill is slowed, especially in children under 2 years of age.

After an infant undergoes a pyloromyotomy, the nurse teaches the parents about postoperative feeding. Which action made by the parents indicates an understanding of the instructions provided? Maintain the infant on antiemetics to prevent vomiting. Rock the baby to sleep after feeding to keep the infant calm. Slowly increase the volume offered according to the physician's orders. Avoid burping the baby after feeding to prevent vomiting.

Slowly increase the volume offered according to the physician's orders. Burping is essential after feeding. Rocking is avoided as this might increase vomiting. The goal after pyloromyotomy is to slowly increase the volume of feeding while preventing vomiting. Antiemetics are not helpful as the vomiting is not associated with nausea.

A nurse is caring for a severely dehydrated child. The child has had nausea and vomiting for three days. The health care provider orders a 20 ml/kg bolus of intravenous (IV) fluid of an isotonic crystalloid. Which IV fluid would be the best choice? Sodium Chloride 0.9% (normal saline) Dextrose 10% and water (D10W) Dextrose 5% and 0.45% normal saline (D5 ½ NSS) Dextrose 5% and 0.9% normal saline (D5NSS)

Sodium Chloride 0.9% (normal saline)

The nurse obtains a nursing history from the mother of a child experiencing a flare-up of celiac disease. Which manifestation should the nurse expect the mother to report? Soft, formed stools Increased appetite Excessive sleepiness Steatorrhea

Steatorrhea Acute episodes of celiac disease are characterized by fatty stools (steatorrhea) because of malabsorption. The client would experience anorexia rather than increased appetite. The client may experience irritability but would not have excessive sleepiness. The client would experience bulky, frothy stools rather than soft, formed stools

A child with Hirschsprung's disease is being discharged after Soave endorectal pull-through procedure for colostomy closure. Whichmeasure should the nurse include in the home care plan? Teach parents signs and symptoms of infection Refer the parents to an enterostomal therapist for ostomy care Teach parents how to perform weekly rectal irrigations Teach parents PCA pain-control methods

Teach parents signs and symptoms of infection After the Soave procedure, the colostomy is closed. After the Soave procedure, the colostomy is usually closed. It is important that any signs of infection be reported at once. PCA is unnecessary for pain management by the time of discharge.

A 10-year-old boy has been admitted with a diagnosis of "rule out appendicitis." While the nurse is conducting a routine assessment, the boy states, "It doesn't hurt anymore." What should the nurse suspect? The boy is afraid of going to surgery. The appendix has ruptured. The boy is having difficulty expressing his pain adequately. This is a method the boy uses to receive attention.

The appendix has ruptured. Signs and symptoms of a ruptured appendix include fever, sudden relief from abdominal pain, guarding, abdominal distention, rapid shallow breathing, pallor, chills, and irritability.

The mother of a child undergoing an emergency appendectomy tells the nurse, "If I had brought him in yesterday when he complained of an upset stomach, this wouldn't have happened." What is the best response by the nurse? "It's okay; you got him here just in time before it ruptured." "It is often difficult to predict when a simple complaint will become more serious." "Sometimes parents can make a mistake without meaning to do so." "Next time he seems sick, you should bring him in immediately."

"It is often difficult to predict when a simple complaint will become more serious." Telling the parent "it's OK" ignores the parent's feelings. Parents often react to a child's illness with feelings of guilt for not recognizing the severity of the condition sooner. A response that provides emotional support and reduces parental anxiety encourages parents to feel confident in their abilities as caregiver. Directing the parent to seek care immediately next time adds to the parent's stress. Using the word "mistake" adds to the parent's perceived guilt.

A 4-month-old infant has been diagnosed with phenylketonuria (PKU). The child has eczema and sensitivity to sunlight. The mother asks the nurse why her child's skin is so sensitive. What is an appropriate explanation by the nurse? "The phenylketones in your baby's blood concentrate the sun's rays, making burning more likely. Children with PKU can never be in the sun." "Some children just have sensitive skin. There is no reason to be excessively concerned." "Your child has a deficiency in melanin because of decreased tyrosine. You will always have to take special care of his skin." "Your child will outgrow his sensitivity when he is 5 years old. Just use sunscreen for now."

"Your child has a deficiency in melanin because of decreased tyrosine. You will always have to take special care of his skin." Explanation: Decreased levels of tyrosine cause a deficiency of the pigment melanin, causing most children with PKU to have blond hair, blue eyes, and fair skin that is prone to eczema.

The nurse in a pediatric clinic is assessing an infant 2 months of age. The mother states, "He always spits up, but it has become so much worse. Vomit goes everywhere." Which additional assessment will help the nurse identify a possible diagnosis for the infant? 1.A hard mass is palpated in the mid-epigastrium. 2.Vomiting occurs both before and after eating. 3.Weight is normal even with frequent vomiting. 4.Normal skin turgor is noted over the sternum.

1-This is correct. Vomiting after eating that grows worse and evolves into projectile vomiting are signs of pyloric stenosis. If the nurse palpates the infant's mid-epigastrium and finds a pyloric mass, it is likely indicative of pyloric stenosis. This finding is called the olive sign.

A nurse who floats to the infant and toddler nursing unit asks the pediatric nurse about the notation "ESSR" on the care plan of a client. The nurse explains that this documentation refers to which item? The procedure for repair of Hirschsprung's disease The procedure for repair of pyloric stenosis The feeding method for children with cleft lip or palate The feeding method for children with gastroesophageal reflux

The feeding method for children with cleft lip or palate ESSR does not refer to a feeding method used in gastroesophageal reflux. ESSR is the abbreviation for the four key steps in feeding the infant or child with cleft lip or palate. These steps are to Enlarge nipple; Stimulate suck reflex; Swallow fluid; Rest after each swallow. ESSR does not refer to the treatment of pyloric stenosis. ESSR does not refer to the treatment of Hirschsprung's disease.

A grandmother brings a toddler to a pediatric clinic and states, "I am worried that my grandchild is not getting adequate care." The nurse is able to verify the child is underweight for height and age. Which findings will cause the nurse to initiate additional assessment? Select all that apply. 1.The grandmother cannot provide an adequate feeding history. 2.The toddler's weight for height is less than the 20th percentile. 3.The toddler repeatedly asks if the nurse will get some food. 4.The toddler's evaluation at birth indicates prematurity. 5.The mother is a single parent and lives alone with the toddler.

1. This is correct. A feeding assessment is performed when a child exhibits a low body weight. The nurse needs a feeding history including calorie intake, feeding behaviors, frequency, and intake. If the grandmother cannot supply the information, the nurse will initiate additional assessment by seeking information from the mother. 3. This is correct. When a toddler repeatedly asks the nurse for food, the nurse recognizes a behavior indicative of hunger. The nurse will further assess for information about when and what the toddler ate last. 4. This is correct. Prematurity may or may not be a cause of the toddler's current low weight. However, the nurse will need to further assess the prenatal, perinatal, neonatal, and postnatal health history. 5. This is correct. The nurse will perform additional assessment to ascertain the family and psychosocial environment of the toddler. Financial, educational, and mental health can all contribute to a failure to thrive condition.

The nurse is caring for an infant vomiting secondary to pyloric stenosis. The mother asks why the child's vomitus appears different from that of her other children when they have the flu. The nurse would explain that the emesis of an infant with pyloric stenosis does not contain bile for which reason? The obstruction is above the bile duct. The bile duct is obstructed. The GI system is still immature in newborns and infants. The emesis is from passive regurgitation.

The obstruction is above the bile duct. Explanation: In pyloric stenosis the pylorus muscle is hypertrophied which does not allow formula to pass into the small intestine. Since the obstruction is above the common bile duct, bile will not be seen in the emesis. :

The nurse in a pediatric clinic is performing a physical examination of a patient who is 8 years of age. The patient's weight is over the 95th percentile on the growth chart. The patient also expresses the presence of knee and abdominal pain. The patient's parent states, "He will outgrow it; all my boys start off like this." Which information does the nurse present to the parent? Select all that apply. 1.Obesity is related to the development of diabetes mellitus. 2.Being a social outcast can cause feelings of poor self-esteem. 3.Children with obesity are more likely to drop out of school. 4.There is a high risk for cardiac disease and hypertension. 5.Obesity adversely affects joint health and function.

1. This is correct. The child who is obese is at risk for developing diabetes mellitus, which is an associated condition. 4. This is correct. The obese child is at high risk for developing cardiac disease and/or hypertension, which can both cause serious and lifelong health problems. 5. This is correct. The patient is already experiencing knee pain. In addition, the patient is at risk for slipped capital femoral epiphysis, which can effect growth and function.

16. Th e nurse is educating the parents of a 2-month-old infant regarding the immunizations that the child will receive that day. Th e nurse should educate the parents that which of the following immunizations will protect the child from a serious gastrointestinal infection? 1. Rotavirus vaccine (RV) 2. Diphtheria, tetanus, and acellular pertussis (DTaP) 3. Haemophilus infl uenzae type b (Hib) 4. Pneumococcal conjugate (PCV13)

1. Rotavirus vaccine (RV) is the correct response TEST-TAKING TIP: At the 2-month well-baby visit, it is recommended that infants receive a number of vaccinations: rotavirus (RV); diphtheria, tetanus, and acellular pertussis (DTaP); Haemophilus infl uenzae type b (Hib); pneumococcal conjugate (PCV13); and inactivated poliovirus (IPV). Only one of the immunizations protects babies from gastrointestinal illness—the rotavirus vaccine.

The parent of a child being evaluated for celiac disease asks the nurse why it is important to make dietary changes. Select the nurse's best response. "The body's response to gluten causes damage to the mucosal cells in the intestine, leading to absorption problems." "The body's response to consumption of anything containing gluten is to create special cells called villi, which leads to more diarrhea." "The body's response to gluten causes the intestine to become more porous and hang on to more of the fat-soluble vitamins, leading to vitamin toxicity." "The body's response to gluten causes damage to the mucosal cells, leading to malabsorption of water and hard, constipated stools."

1.The inability to digest protein leads to an accumulation of an amino acid that is toxic to the mucosal cells and villi, leading to absorption problems.

47. The nurse receives a call from the mother of a 6-month-old who describes her child as alternately sleepy and fussy. She states that her infant vomited once this morning and had two episodes of diarrhea. The last episode contained mucus and a small amount of blood. She asks the nurse what she should do. Select the nurse's best response. "Your infant will need to have some tests in the emergency room to determine if anything serious is going on." "Try feeding your infant in about 30 minutes; in the event of repeat vomiting, bring the infant to the emergency room for some tests and intravenous rehydration." "Many infants display these symptoms when they develop an allergy to the formula they are receiving; try switching to a soy-based formula." "Do not worry about the blood and mucus in the stool; it is not unusual for infants to have blood in their stools because their intestines are more sensitive."

1.The infant is displaying signs of intus susception. This is an emergency that needs to be evaluated to prevent ischemia and perforation.

The nurse in a pediatric clinic is obtaining a health history on a child who is 9 years of age. The nurse learns the child exhibits a chronic cough, midsternal discomfort, and frequent sore throats without infection. Physical assessment indicates the child is on the 50th percentile on the height chart and on the 85th percentile for weight. Which recommendation does the nurse make? 1.Serve citrus juices instead of carbonated beverages. 2.Begin an age-appropriate weight loss program. 3.Initiate a practice of no eating or drinking after dinner. 4.Encourage lying on the left side after eating a meal.

2-This is correct. When a child is on the 50th percentile in height and the 85th percentile for weight, the child is overweight. The nurse needs to recommend an age-appropriate weight loss program.

The nurse is caring for a 3-year-old who had an appendectomy 2 days ago. The child has a fever of 101.8°F (38.8°C) and breath sounds are slightly diminished in the right lower lobe. Which action is most appropriate? Teach the child how to use an incentive spirometer. Encourage the child to blow bubbles. Obtain an order for intravenous antibiotics. Obtain an order for Tylenol (acetaminophen).

2.Blowing bubbles is a developmentally appropriate way to help the preschooler take deep breaths and cough.

The nurse is caring for a 7-week-old scheduled for a pyloromyotomy in 24 hours. Which would the nurse expect to find in the plan of care? Keep infant NPO; begin intravenous fluids at maintenance. Keep infant NPO; begin intravenous fluids at maintenance; place nasogastric tube (NGT) to low wall suction. Obtain serum electrolytes; keep infant NPO; do not attempt to pass NGT due to obstruction. Offer infant small frequent feedings; keep NPO 6 to 8 hours before surgery.

2.In addition to giving fluids intravenously and keeping the infant NPO, an NGT is placed to decompress the stomach.

The nurse is caring for a newborn with a cleft lip and palate. The mother states, "I will not be able to breastfeed my baby." Select the nurse's best response. "It sounds like you are feeling discouraged. Would you like to talk about it?" "Sometimes breastfeeding is still an option for babies with a cleft lip and palate. Would you like more information?" "Although breastfeeding is not an option, you have the option of pumping your milk and then feeding it to your baby with a special nipple." "We usually discourage breastfeeding babies with cleft lip and palate as it puts them at an increased risk for aspiration."

2.Some mothers are able to breastfeed their infants who have a cleft lip and palate. The breast can help fill in the cleft and help the infant create suction.

The nurse is providing discharge instructions to the parents of a child who had an appendectomy for a ruptured appendix 5 days ago. The nurse knows that further education is required when the parent states: "We will wait a few days before allowing our child to return to school." "We will wait 2 weeks before allowing our child to return to sports." "We will call the pediatrician's office if we notice any drainage around the wound." "We will encourage our child to go for walks every day."

2.The child should wait 6 weeks before returning to any strenuous activity.

A 10-year-old is being evaluated for possible appendicitis and complains of nausea and sharp abdominal pain in the right lower quadrant. An abdominal ultrasound is scheduled, and a blood count has been obtained. The child vomits, finds the pain relieved, and calls the nurse. Which should be the nurse's next action? Cancel the ultrasound, and obtain an order for oral Zofran (ondansetron). Cancel the ultrasound, and prepare to administer an intravenous bolus. Prepare for the probable discharge of the patient. Immediately notify the physician of the child's status.

2.This accurate description gives the parents information that is clear and concise.

The nurse in a pediatric clinic is working with a preschool patient and a parent about managing the child's functional constipation. Which is the most important information for the nurse to share? 1.The child is allowed to select a reward for having a bowel movement. 2.The child is informed of the treatments for constipation and/or impaction. 3.Parental action is required for the onset of vomiting or severe abdominal pain. 4.The parents expect the child to sit on the toilet for a period of time each day.

3-This is correct. The nurse needs to inform the parent of what actions to take if the child starts to vomit or has severe abdominal pain. Because the symptoms are indicative of a medical emergency, the caregiver should take the child to a medical facility for immediate evaluation.

An 18-month-old child with a history of cleft lip and palate has been admitted for palate surgery. The nurse would provide which explanation about why a toothbrush should not be used immediately after surgery? The toothbrush would be frightening to the child. The suture line could be interrupted. The child no longer has deciduous teeth. The child will be NPO.

The suture line could be interrupted. A toothbrush should be a familiar object to an 18-month-old child. Deciduous (primary) teeth are still present at this age and are replaced by permanent (secondary) teeth around 6 years of age. During the immediate postoperative period, protecting the operative site is a priority in the nursing care of this child. Oral care will be performed according to the physicians' orders but usually consists of cleansing the area with sterile water. Oral care will be performed according to the physicians' orders but usually consists of cleansing the area with sterile water.

The nurse has completed discharge teaching on the dietary regimen of a child with celiac disease. The nurse evaluates the discussion as effective when the mother states that the child must comply with the gluten-free diet for which time frame? Until the child has reached adolescence Until symptoms are resolved for one year Throughout life Until major developmental milestones are achieved

Throughout life Explanation: Discharge planning focuses on educating the parents in maintaining a gluten-free diet for the child. Dietary modifications are lifelong and should not be discontinued because symptoms will return if dietary restrictions are not maintained.

Which laboratory test would the nurse expect to be prescribed for a child with dehydration caused by vomiting and diarrhea? Select all that apply. Urine specific gravity Serum amylase Serum sodium Serum ammonia Blood urea nitrogen (BUN)

Urine specific gravity Serum sodium Blood urea nitrogen (BUN) Serum sodium would be expected to increase in a client with dehydration because of hemoconcentration. Measuring urine specific gravity provides data about the concentration of urine and provides information regarding hydration. Serum ammonia could be elevated in liver disease. Serum amylase could be elevated in pancreatic disorders. The BUN rises with dehydration and is therefore a general indicator of hydration status, although it also reflects kidney function.

The nurse is teaching the parents of a child with celiac disease about the dietary restrictions. The nurse would explain that the most appropriate diet for their child is a diet that is free of which of the following? Select all that apply. Wheat Rice Barley Corn Oats

Wheat Barley Oats Explanation: Most children who remain on a gluten-free diet remain healthy and free of symptoms and complications. Gluten is a protein found in wheat, barley, rye, and oats. For this reason, appropriate foods need to be free of these grains.