Exam Chapter 38 (PEDS)

The nurse is determining maintenance fluid requirements for a child who weighs 25 kg. How much fluid would the child need per day? a) 1,560 mL b) 1,600 mL c) 1,700 mL d) 1,650 mL

1,600 mL

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

240 mg/dL

Fill in the blank (with a number) question - Enter the answer in the space provided. Your answer should contain only numbers and, if necesary, a decimal point. The child has been diagnosed with severe dehydration. The physician has ordered the nurse to administer a bolus of 20 mL/kg of normal saline over a 2-hour period. The child weighs 63.5 lb (28.8 kg). At which mL/hour should the nurse set the child's intravenous administration pump? Record your answer using a whole number. mL/hour

289

Fill in the blank (with a number) question - Enter the answer in the space provided. Your answer should contain only numbers and, if necesary, a decimal point. The infant is listless with sunken fontanels and has been diagnosed with dehydration. The infant is still producing at least 1 mL/kg each hour of urine. The infant weighs 13.2 lb (6 kg). At the minimum, how many milliliters of urine will the infant produce during the next 8-hour shift? Record your answer using a whole number. mL

48

A child is diagnosed with intussusception. The nurse anticipates that which of the following would be attempted first to reduce this condition? a) Surgery b) Upper endoscopy c) Barium enema d) Endoscopic retrograde cholangiopancreatography

Barium enema

The nurse is administering 10 units of NPH insulin to a child at 8 a.m. The nurse would expect this insulin to begin acting at which time? a) Between 9 and 11 a.m. b) Around 12 noon c) Between 8:30 and 9 a.m. d) By 8:15 a.m.

Between 9 and 11 a.m.

A child with diabetes reports that he is feeling a little shaky. Further assessment reveals that the child is coherent but with some slight tremors and sweating. A fingerstick blood glucose level is 70 mg/dL. Which of the following would the nurse do next? a) Give 10 to 15 grams of a simple carbohydrate b) Offer a complex carbohydrate snack c) Administer a sliding-scale dose of insulin d) Administer glucagon intramuscularly

Give 10 to 15 grams of a simple carbohydrate

The parents of a boy diagnosed with Hirschsprung disease are anxious and fearful of the upcoming surgery. The mother states, "I'm worried about having to care for our son's ostomy." Which intervention would be most helpful for the parents? a) Teaching them about the medications used to slow stool output b) Explaining to them about the diagnosis and surgery c) Having a wound, ostomy, and continence nurse meet with them d) Reinforcing that the ostomy will be temporary

Having a wound, ostomy, and continence nurse meet with them

A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. Which of the following would the nurse expect to administer? a) NPH b) Regular insulin c) Detemir d) Lispro

Regular insulin

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

Remove the substance from the child's mouth

Which finding would lead the nurse to suspect that a child is experiencing moderate dehydration? a) Sunken fontanels b) Hypotension c) Tenting of skin d) Dusky extremities

Sunken fontanels

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

The stools of the infant are called currant jelly stools and consist of blood and mucuous.

The nurse, speaking to the parent of a 3-year-old child who has mild diarrhea, would advise the dietary modification of: a) small amounts of clear fluids such as gelatin. b) chicken soup because it is high in sodium. c) soft foods with rice, bananas, toast, and applesauce. d) an oral rehydrating solution, such as Pedialyte.

an oral rehydrating solution, such as Pedialyte.

Choice Multiple question - Select all answer choices that apply. The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which of the following foods would be permitted in the diet of the child with celiac syndrome? (Select all that apply) a) Corn flakes b) Skim milk c) Bananas d) Oatmeal e) Rye bread f) Applesauce

• Skim milk • Applesauce • Bananas

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

"Tell me about the types of stools you child has been having."

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

"The treatment for the disorder will be a surgical procedure."

An older infant is scheduled to have a cleft palate repair. The mother asks if she will still be able to breastfeed the baby during the postoperative phase. What is the best response by the nurse? a) "No, you will have to put the baby on regular formula." b) "Yes, the surgery will not interfere with breastfeeding your child." c) "You will not be able to breastfeed but immediately after, but you can pump and feed the child with a cup." d) "Yes, you will be able to breastfeed but will have to interrupt the feedings frequently."

"You will not be able to breastfeed but immediately after, but you can pump and feed the child with a cup."

A 5-year-old child with type 1 diabetes is brought to the clinic by his mother for a follow-up visit after having his hemoglobin A1C level drawn. Which result would indicate to the nurse that the child is achieving long-term glucose control? a) 8.2% b) 7.3% c) 6.9% d) 9.0%

8.2%

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of congenital aganglionic megacolon? a) A thickened, elongated muscle causes an obstruction at the end of the stomach. b) A partial or complete intestinal obstruction occurs. c) In this disorder the sphincter that leads into the stomach is relaxed. d) There are recurrent paroxysmal bouts of abdominal pain.

A partial or complete intestinal obstruction occurs.

The nurse is conducting a physical examination of an 18-month-old with suspected intussusception. Which of the following findings would the nurse identify as the hallmark of this condition? a) Perianal skin tags b) Abdominal pain and guarding c) Skin tenting d) A sausage-shaped mass in the upper midabdomen

A sausage-shaped mass in the upper midabdomen

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of pyloric stenosis? a) A partial or complete intestinal obstruction occurs. b) In this disorder the sphincter that leads into the stomach is relaxed. c) A thickened, elongated muscle causes an obstruction at the end of the stomach. d) There are recurrent paroxysmal bouts of abdominal pain.

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

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

Administer subcutaneous glucagon

The nurse observes the interactions of parents with their infant who was born with a cleft lip. The mother is attempting to feed the baby, but does not make eye contact. The father is watching television with his back turned to the mother and baby. What psychosocial nursing intervention would be most helpful to this family? a) Refer the family to a social worker or mental health practitioner. b) Teach the mother the appropriate technique for breast-feeding an infant with cleft lip. c) Ask the parents if they have any questions regarding the care of their child. d) Explain to the parents that surgical intervention will fix the defect in the baby's lip.

Ask the parents if they have any questions regarding the care of their child.

In treating the child with lead poisoning which of the following is used to remove the lead from the child's system? a) Chelating agents b) Laxatives c) Emetics d) Diuretics

Chelating agents

Choice Multiple question - Select all answer choices that apply. A nurse is assessing an infant who has been vomiting and experiencing diarrhea. Which of the following would indicate to the nurse that the infant is experiencing severe dehydration? Select all that apply. a) Pink moist oral mucosa b) Bradycardia c) Sunken fontanels d) Slightly decreased urine output e) Cool mottled extremities

Cool mottled extremities • Bradycardia • Sunken fontanels

The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which of the following clinical manifestations would likely be seen in this child? a) Forceful vomiting followed by the child being eager to eat again. b) Severe constipation with occasional ribbon-like stools c) Effortless vomiting just after the child has eaten. d) Bouts of diarrhea with failure to gain weight

Effortless vomiting just after the child has eaten.

A preschooler has celiac disease. Her mother is preparing a gluten-free diet. By preparing which breakfast foods would you believe she understands the diet? a) Eggs and orange juice b) Cheerios (oat cereal) and skim milk c) Wheat toast and grape jelly d) Rye toast and peanut butter

Eggs and orange juice

A nurse examining a neonate is unable to identify the fetal stomach. The nurse knows that this sign strongly indicates which of the following conditions? a) Esophageal atresia (EA) b) Duodenal atresia c) Hernia d) Pyloric stenosis

Esophageal atresia (EA)

A nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. What GI condition might this history precipitate? a) Esophageal atresia (EA) b) Cleft palate c) Hernia d) Pyloric stenosis

Esophageal atresia (EA)

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

Follow standard precautions

A father brings Jacob, age 2, to the health clinic with complaints of diarrhea, vomiting, and abdominal pain. The father tells the nurse that he is a single parent and Jacob is enrolled in a local daycare center. Based on this information, what gastrointestinal condition might the nurse suspect? a) Hirschsprung disease b) Appendicitis c) Pancreatitis d) Gastroenteritis

Gastroenteritis

The parents of a 6-week-old boy come to the clinic for evaluation because the infant has been vomiting. The parents report that the vomiting has been increasing in frequency and forcefulness over the last week. The mother says, "Sometimes, it seems like it just bursts out of his mouth." A diagnosis of hypertrophic pyloric stenosis is suspected. When performing the physical examination, which of the following would the nurse most likely find? a) Sausage-shaped mass in the upper midabdomen b) Hard, moveable, olive-shaped mass in the right upper quadrant c) Tenderness over the McBurney point in the right lower quadrant d) Abdominal pain in the epigastric or umbilical region

Hard, moveable, olive-shaped mass in the right upper quadrant

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

Hirschsprung disease

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

Improving hydration

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of gastroesophageal reflux? a) A partial or complete intestinal obstruction occurs. b) A thickened, elongated muscle causes an obstruction at the end of the stomach. c) There are recurrent paroxysmal bouts of abdominal pain. d) In this disorder the sphincter that leads into the stomach is relaxed.

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

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

Intussusception

A 10-year-old girl with an intestinal virus has been vomiting and has become dehydrated. She says she is mildly thirsty, her skin turgor is poor, and her skin is dry and cool. Her serum sodium level is normal. The nurse recognizes that she has which type of dehydration? a) Acidotic b) Hypertonic c) Hypotonic d) Isotonic

Isotonic

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

It is important to increase the intake of protein for these children."

A young child has presented to the pediatric unit with a swollen abdomen, edema, thin patchy hair, and irritability with growth retardation and muscle wasting. The nurse suspects a malnutrition disorder. The nurse identifies this child to most likely have which of the following? a) Thiamine deficiency b) Marasmus c) Vitamin C deficiency d) Vitamin D deficiency e) Kwashiorkor

Kwashiorkor

Before their infant is admitted for cleft palate surgery, in an effort to help the infant adjust after surgery, it would be helpful for the nurse to encourage the family to a) Train the infant to drink from a glass or cup b) Feed the infant with a drinking straw c) Let the infant become accustomed to being in elbow restraints d) Feed the infant with a rubber covered spoon

Let the infant become accustomed to being in elbow restraints

A child is diagnosed with gastroesophageal reflux disease and is prescribed drug therapy. The primary health care provider prescribes medication that suppress acid secretion. The nurse would anticipate administering which of the following? a) Ranitidine b) Omeprazole c) Famotidine d) Metoclopramide

Omeprazole

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

Paint used in older homes

A mother is alarmed because her 6-week-old boy has begun vomiting almost immediately after every feeding. In the past week, the vomiting has grown more forceful, with the vomit projecting several feet from his mouth. He is always hungry again just after vomiting. At the physician's office, the nurse holds the child and gives him a bottle of water. While he drinks, she notes an olive-size lump in his right abdomen. Which of the following conditions should the nurse suspect in this child? a) Appendicitis b) Pyloric stenosis c) Peptic ulcer disease d) Gastroesophageal reflux

Pyloric stenosis

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

Rapid-acting insulin

In caring for the child with esophageal atresia the nurse recognizes the highest concern for this child is the possibility of which of the following? a) Respiratory distress b) Cardiac anomalies c) Feeding difficulty d) Excess bleeding

Respiratory distress

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

Support him and place him on his side

A mother brings her 3-month-old infant to the community clinic with complaints of diarrhea for the past week. The infant's vital signs are normal and there are no signs of dehydration. When questioned about her baby's diet, the mother who is bottle-feeding states that she has been giving her baby some baby cereal at night to help her sleep through the night. What teaching intervention would be appropriate for this mother? a) Teach the mother that she should offer her infant cereal in the morning hours so that it can be metabolized in the active period. b) Tell the mother to gradually add pureed fruit to the cereal to increase the infant's tolerance to solid foods. c) Teach the mother that infants are relatively intolerant of starches and may have diarrhea if cereal is offered too soon. d) Check the type of formula the mother is feeding the infant and how she is preparing it. Suggest switching to a soy-milk formula.

Teach the mother that infants are relatively intolerant of starches and may have diarrhea if cereal is offered too soon

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

The child cannot break down and use complex carbohydrates in the same way the adult can.

A group of students are reviewing information about fluid balance and losses in children in comparison to adults. The students demonstrate a need for additional review when they identify which of the following? a) Fever plays a greater role in insensible fluid losses in infants and children. b) A higher metabolic rate plays a major role in increased insensible fluid losses. c) The infant's immature kidneys have a tendency to overconcentrate urine more. d) Children have a proportionately greater amount of body water than do adults.

The infant's immature kidneys have a tendency to overconcentrate urine more.

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

There is a partial or complete mechanical obstruction in the intestine.

The parents of a 7-year-old girl with type 1 diabetes has been recording her blood glucose measurements before meals and at bedtime for the past 4 days; they are as follows: Monday Tuesday Wednesday Thursday B: 120 mg/dL 135 mg/dL 124 mg/dL 200 mg/dL L: 110 mg/dL 120 mg/dL 140 mg/dL 220 mg/dL D: 90 mg/dL 140 mg/dL 130 mg/dL 200 mg/dL Bed: 110 mg/dL 110 mg/dL 160 mg/dL 240 mg/dL The parents bring the child in for a follow-up visit and show the nurse the results. Based on the results, the nurse would need to obtain additional information from the parents and child about which day?

Thursday

A child is brought to the emergency department because he ingested an unknown quantity of acetaminophen (Tylenol). After gastric lavage is completed, the nurse expects this child to receive: a) activated charcoal. b) syrup of ipecac. c) acetylcysteine( Mucomyst) d) vitamin K.

acetylcysteine( Mucomyst)

A child is brought to the pediatric clinic because he has been vomiting for the past 2 days. An acid-base imbalance that the nurse would expect to occur from this persistent vomiting is: a) hyperkalemia b) alkalosis c) acidosis d) hypernatremia

alkalosis

After surgery for pyloric stenosis, the nurse could anticipate that the infant will: a) remain NPO for 24-48 hours b) be fed formula within 4 hours c) be fed an electrolyte replacement solution within 4-6 hours d) have nasogastric suctioning for 24 hours

be fed an electrolyte replacement solution within 4-6 hours

What symptoms might lead a healthcare provider to suspect a tracheoesophageal fistual? a) excessive gaseous distension of the abdomen b) excessive respiratory distress without gastric distension c) excessive oral secretions and cyanosis with feedings d) excessive vomiting of stomach contents

excessive oral secretions and cyanosis with feedings

After cleft palate repair at 18 months, a child will begin a liquid diet. The best method of introducing this will be to a) feed the child small sips at a time from a spoon. b) offer the child small glasses of fluid at a time. c) give the child large glasses of fluid so that he drinks more. d) teach the child to use a straw so that drinking is fun.

offer the child small glasses of fluid at a time.

An appropriate intervention for a 3-month-old infant who has gastroesophageal reflux is to: a) place the infant upright in an infant seat after feedings. b) give thin rice cereal with formula before feeding solid foods. c) position the infant in the crib prone or on his/her right side, with the head elevated after feedings d) administer medication as ordered to stimulate the pyloric sphincter.

position the infant in the crib prone or on his/her right side, with the head elevated after feedings

Following surgery for pyloric stenosis, an infant should be well-bubbled following feedings primarily to prevent a) intestinal obstruction. b) contaminating flatulence. c) pressure on the incision line. d) abdominal discomfort.

pressure on the incision line.

Choice Multiple question - Select all answer choices that apply. A doctor orders an abdominal radiograph for a newborn to check for Hirschsprung's disease. When performing the physical exam on the newborn, which of the following would the nurse most likely assess? Select all that apply. a) Displaced anus b) Bilious vomiting c) Absence of stool in the rectum d) Abdominal distention e) Gas expelled from the urethra

• Abdominal distention • Absence of stool in the rectum • Bilious vomiting

Choice Multiple question - Select all answer choices that apply. You are caring for a child with a gastrointestinal disorder and measuring intake and output. The nurse observes that the child is demonstrating symptoms of adequate hydration when she/he has: (Select all that apply.) a) Oral intake. b) Pink and moist mucous membranes. c) Loose stools. d) Fontanels with normal tension. e) Adequate skin turgor.

• Fontanels with normal tension. • Adequate skin turgor. • Pink and moist mucous membranes.