GI PREP QUESTIONS
Intussusception Intussusception, the invagination of one portion of the intestine into another, usually occurs in the second half of the first year of life. Children with this disorder suddenly draw up their legs and cry as if they are in severe pain; they may vomit. After the peristaltic wave that caused the discomfort passes, they are symptom-free and play happily. In approximately 15 minutes, however, the same phenomenon of intense abdominal pain strikes again. After approximately 12 hours, blood appears in the stool and possibly in vomitus, described as a "currant jelly" appearance. Volvulus with malrotation and necrotizing enterocolitis typically occur in the first 6 months of life and do not match the symptoms described above. Short-bowel/short-gut syndrome typically occurs when a large portion of the intestine has been removed due to a previous disease or trauma.
A 9-month-old girl is brought to the emergency room with what appears to be bouts of intense abdominal pain 15 minutes apart in which she draws up her legs and cries, often accompanied by vomiting. In between the bouts, the child recovers and appears to be without symptoms. Blood is found in the stool. What condition should the nurse suspect in this case? Intussusception Celiac disease Enterocolitis Gastroentercolitis
c) Pyloric stenosis
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 condition should the nurse suspect in this child? a) Gastroesophageal reflux b) Appendicitis c) Pyloric stenosis d) Peptic ulcer disease
b. encouraging and helping mother to breastfeed. The mother who wishes to breastfeed may need encouragement and support because the defect does present some logistical issues. The nipple must be positioned and stabilized well back in the infant's oral cavity so that the tongue action facilitates milk expression. Because breastfeeding is an option, if the mother wishes to breastfeed, medications should not be given to suppress lactation. Because breastfeeding can usually be accomplished, gavage feedings are not indicated. The suction required to stimulate milk, absent initially, may be useful before nursing to stimulate the let-down reflex.
A mother who intended to breastfeed has given birth to an infant with a cleft palate. Nursing interventions should include: a. giving medication to suppress lactation. b. encouraging and helping mother to breastfeed. c. teaching mother to feed breast milk by gavage. d. recommending use of a breast pump to maintain lactation until infant can suck.
Hirschsprung disease
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?
B) Encouraging her to express her feelings. The mother needs to be able to express her feelings before she can accept her child.
A newborn was admitted to the nursery with a complete bilateral cleft lip and palate. The physician explained the plan of therapy and its expected good results. However, the mother refuses to see or hold her baby. What is the initial therapeutic approach for the mother? A) Restating what the physician has told her about plastic surgery. B) Encouraging her to express her feelings. C) Emphasizing the normalcy of her baby and the baby's need for mothering. D) Recognizing that negative feelings toward the child continue throughout childhood.
"My daughter can eat any kind of fruit." While most fruits and fruit juices are allowed, the nurse needs to make sure the mother knows that some fruit pie fillings and dried fruit may contain gluten.
A nurse is caring for a 6-year-old girl recently diagnosed with celiac disease and is discussing dietary restrictions with the girl's mother. Which response indicates a need for further teaching? "My daughter is eating more vegetables." "There is gluten hidden in unexpected foods." "There are many types of flour besides wheat." "My daughter can eat any kind of fruit."
High carbohydrate, high protein
A nurse prepares a menu for a client with Crohn disease. What is the focus of dietary management for this disease? High carbohydrate, high protein Low calorie, high carbohydrate High calorie, high fiber Low fiber, low calorie
3."Is the child unresponsive when given directions?" Unresponsiveness may be an indication of hearing loss. A child who has a history of cleft palate should be routinely checked for hearing loss.
A preschooler with a history of cleft palate repair comes to the clinic for a routine well-child checkup. To determine if this child is experiencing a long-term effect of cleft palate, which question should the nurse ask? 1."Was the child recently treated for pneumonia?" 2."Does the child play with an imaginary friend?" 3."Is the child unresponsive when given directions?" 4."Has the child had any difficulty swallowing food?"
4.Prepare the family for surgery for the child. Infants with projectile vomiting after feeding that are fussy should be suspected of pyloric stenosis. The treatment for this diagnosis is surgery. The other options are treatment measures that may be prescribed for gastroesophageal reflux.
An infant is seen in the health care provider's office for complaints of projectile vomiting after feeding. Findings indicate that the child is fussy and is gaining weight but seems never to get enough to eat. Pyloric stenosis is suspected. Which prescription would the nurse anticipate having the highest priority in the care of this child? 1.Monitor intake and output. 2.Administer predigested formula. 3.Administer omeprazole before feeding. 4.Prepare the family for surgery for the child.
Encourage the mother to provide care for her infant. Providing care to the infant is the best means for the mother to begin bonding with her baby. Activities such as feeding, diapering and bathing will be helpful. Encouraging the mother to avoid looking at the cleft lip will not assist her in the process of accepting it. While surgery will be performed it will not take place for a few months making it vital that she begin bonding with her infant. Telling the parent she will get used to it minimizes her concerns and is not the most therapeutic response by the nurse.
The mother of a newborn with a cleft lip reports she is having a hard time looking her baby. What is the best action by the nurse? Explain that surgery will make this better in the future. Encourage the mother to provide care for her infant. Encourage the child's mother to hold her infant against her shoulder to provide closeness while avoiding visualizing the defect. Tell the mother that while this is difficult it will get easier.
"I have to be careful because I am prone to not absorbing nutrients."
The nurse has performed client teaching to a 15-year-old boy with Crohn disease, and his parents, regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning occurred?
1,2,4,5 Appendicitis is an inflammation of the appendix. When the appendix becomes inflamed or infected, perforation may occur within a matter of hours, leading to peritonitis, sepsis, septic shock, and potential death. IV fluids would be started, and the child would be NPO while awaiting surgery. Usually antibiotics are administered because of the risk of perforation. Prescribed preoperative medications most likely would be administered on call to the operating room. In the preoperative period, enemas or laxatives should not be administered. Additionally, heat is not applied to the abdomen. Any of these interventions can cause rupture of the appendix and resultant peritonitis.
The nurse is assigned to care for a child who is scheduled for an appendectomy. Select the prescriptions that the nurse anticipates will be prescribed. Select all that apply. 1.Initiate an IV line. 2.Maintain an NPO status. 3.Administer a Fleet enema. 4.Administer intravenous antibiotics. 5.Administer preoperative medications. 6.Place a heating pad on the abdomen to decrease pain.
b. Allow to assume position of comfort. The child should be allowed to take a position of comfort, usually with the legs flexed.
The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. Which is appropriate to relieve the abdominal discomfort? a. Place in Trendelenburg position. b. Allow to assume position of comfort. c. Apply moist heat to the abdomen. d. Administer a saline enema to cleanse bowel.
The nurse will administer 1230 milligrams to this child is 24 hours. To calculate, first determine how many milligrams are given per dose by multiplying the child's weight (kg) by 15 mg. 15 mg x 20.5 kg = 307.5 mg per dose. The child is prescribed a dose every 6 hours. To determine how many doses the child will get in 24 hours, divide 24 by 6. 24/6 = 4. Now, multiply the number of doses given a day by the milligrams given in each dose to determine the total milligrams given in 24 hours. 4 x 307.5 mg = 1230 mg in 24 hours.
The nurse is caring for a child prescribed vancomycin 15 mg/kg IV every 6 hours for peritonitis. The child weights 45 lb (20.5 kg). How many milligrams will the nurse administer to this child in 24 hours?
Improving hydration
The nurse is caring for a child with a diagnosis of pyloric stenosis during the preoperative phase of the child's treatment. What is the highest priority at this time?
c) Improving hydration
The nurse is caring for a child with a diagnosis of pyloric stenosis during the preoperative phase of the child's treatment. What is the highest priority at this time? a) Maintaining skin integrity b) Promoting comfort c) Improving hydration d) Preparing family for home care
b. cleansing the suture line, supine and side-lying positions, arm restraints. The suture line should be cleansed gently after feeding. The child should be positioned on the back, on the side, or in an infant seat. Elbows are restrained to prevent the child from accessing the operative site.
The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's postoperative care include: a. arm restraints, postural drainage, mouth irrigations. b. cleansing the suture line, supine and side-lying positions, arm restraints. c. mouth irrigations, prone position, cleansing suture line. d. supine and side-lying positions, postural drainage, arm restraints.
A sausage-shaped mass in the upper midabdomen
The nurse is conducting a physical examination of an 18-month-old with suspected intussusception. Which finding would the nurse identify as the hallmark of this condition?
d) A sausage-shaped mass in the upper midabdomen
The nurse is conducting a physical examination of an 18-month-old with suspected intussusception. Which finding would the nurse identify as the hallmark of this condition? a) Skin tenting b) Perianal skin tags c) Abdominal pain and guarding d) A sausage-shaped mass in the upper midabdomen
Hard, moveable "olive-like mass" in the upper right quadrant
The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis?
d) Hard, moveable "olive-like mass" in the upper right quadrant
The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis? a) Sausage-shaped mass in the upper mid abdomen b) Perianal fissures and skin tags c) Abdominal pain and irritability d) Hard, moveable "olive-like mass" in the upper right quadrant
B) Projectile vomiting
The nurse is interviewing parents of an infant with pyloric stenosis.What would the nurse expect the parents to report? A) Diarrhea B) Projectile vomiting C) Poor appetite D) Constipation
4.Decreased blood pressure and tachycardia Hirschsprung's disease is also known as congenital aganglionosis or megacolon. It is the result of an absence of ganglion cells in the rectum and, to varying degrees, upward in the colon. Nursing care management includes assessing for signs of enterocolitis, shock, fluid and electrolyte problems, and signs of bowel perforation
The nurse is preparing an infant for surgery to treat Hirschsprung's disease. Which assessment finding is priority to identify and treat? 1.Vomiting and irritability 2.Malnourishment and lethargy 3.Abdominal distension and tenderness 4.Decreased blood pressure and tachycardia
"She loves hot dogs, and we always cut hers up into small pieces." Commercially canned creamed soups, cold cuts, frankfurters, and pudding mixes generally contain wheat products and should not be included in the diet of the child with celiac syndrome. This caregiver needs further teaching regarding giving her child hot dogs, even if they are cut into small pieces. The other choices show an understanding of the dietary restrictions.
The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. The caregivers make the following statements. Which statement indicates a need for further teaching regarding the dietary restrictions for the child with celiac syndrome? "The soup we eat at our house is all made from scratch." "She loves hot dogs, and we always cut hers up into small pieces." "I have learned to make my own bread with no gluten." "Even though milk and pudding are good for her, we don't give her those foods."
Bananas Skim milk Applesauce The child is usually started on a gluten-free, low-fat diet. Skim milk and bananas are usually well tolerated. Lean meats, puréed vegetables, and fruits are gradually added to the diet. Wheat, rye, oats (unless specifically gluten free), corn flour (corn itself is okay), and cornmeal are not included in the diet.
The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which foods would be permitted in the diet of the child with celiac syndrome? Select all that apply. Corn flakes Bananas Skim milk Rye bread Wheat bread Applesauce
Rice
The nurse provides home care instructions to the parents of a child with celiac disease. The nurse should teach the parents to include which food item in the child's diet? 1.Rice 2.Oatmeal 3.Rye toast 4.Wheat bread
"I will make sure there is plenty of orange juice available. It's her favorite juice." Proper interventions for children at risk for fluid volume deficit include maintaining IV line and administer IV fluid as ordered to maintain fluid volume. Offer small amounts of oral rehydration solution frequently to maintain fluid volume. Small amounts are usually well tolerated by children with diarrhea and vomiting. Avoid high-carbohydrate fluids such as Kool-Aid and fruit juice, as they are low in electrolytes, and increased simple carbohydrate consumption can decrease stool transit time. Daily weights are one of the best indicators of fluid volume status in children.
The student nurse is caring for a child with the nursing diagnosis "Risk for fluid volume deficit related to inadequate oral intake". Which statement by the student would indicate a need for further education by the nursing instructor? "I will monitor her IV line to help maintain her fluid volume." "I will teach her mother to give her small drinks frequently." "I will make sure there is plenty of orange juice available. It's her favorite juice." "I will weigh her every morning at the same time."
B) Hypertrophy of the pyloric muscle Hypertrophic pyloric stenosis occurs when the circumferential muscle of the pyloric sphincter becomes thickened, resulting in elongation and narrowing of the pyloric channel. Dilation of the pylorus, hypotonicity of the pyloric muscle, and reduction of tone in the pyloric muscle are not the definition of pyloric stenosis.
What is the best description of pyloric stenosis? A) Dilation of the pylorus B) Hypertrophy of the pyloric muscle C) Hypotonicity of the pyloric muscle D) Reduction of tone in the pyloric muscle
D) Abdominal pain that is most intense at McBurney point Pain is the cardinal feature. It is initially generalized, usually periumbilical. The pain localizes to the right lower quadrant at McBurney point. Rebound tenderness is not a reliable sign and is extremely painful to the child. Bright red or dark red rectal bleeding and abdominal pain that is relieved by eating are not signs of acute appendicitis.
Which clinical manifestation would be the most suggestive of acute appendicitis? A) Rebound tenderness B) Bright red or dark red rectal bleeding C) Abdominal pain that is relieved by eating D) Abdominal pain that is most intense at McBurney point
A) Position the infant in the crib on his or her abdomen,with the head elevated. After feedings, the infant is placed in a prone position to avoid increased intraabdominal pressure.
Which is the most appropriate intervention for a 3-month-old infant who has gastroesophageal reflux? A) Position the infant in the crib on his or her abdomen,with the head elevated. B) Administer medication as ordered to stimulate the pyloric sphincter. C) Give thin rice cereal with formula before feeding solid foods. D) Place the infant in an infant seat after feedings.
C) Corticosteroids Corticosteroids, such as prednisone and prednisolone, are used in short bursts to suppress the inflammatory response in inflammatory bowel disease.
Which is used to treat moderate to severe inflammatory bowel disease? A) Antacids B) Antibiotics C) Corticosteroids D) Antidiarrheal medications
C) Palpable olive-like mass The diagnosis of pyloric stenosis is often made after the history and physical examination. The olive-like mass is easily palpated when the stomach is empty, the infant is quiet, and the abdominal muscles are relaxed. Abdominal rigidity and substernal retraction are usually not present. The upper abdomen, not lower abdomen, is distended.
Which observation made of the exposed abdomen is most indicative of pyloric stenosis? A) Abdominal rigidity B) Sausage like mass C) Palpable olive-like mass D) Marked distention of lower abdomen
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 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 therapeutic management treatment is implemented for children with Hirschsprung disease? a. Daily enemas b. Low-fiber diet c. Permanent colostomy d. Surgical removal of affected section of bowel
It is a condition in which a proximal segment of the bowel prolapses into a distal segment of the bowel."
A 1-year-old child is diagnosed with intussusception, and the mother of the child asks the student nurse to describe the disorder. Which statement by the student nurse indicates correct understanding of this disorder? 1."It is an acute bowel obstruction." 2."It is a condition that causes an acute inflammatory process in the bowel." 3."It is a condition in which a distal segment of the bowel prolapses into a proximal segment of the bowel." 4."It is a condition in which a proximal segment of the bowel prolapses into a distal segment of the bowel."
3.Placing the adolescent in a fetal position, side-lying with legs drawn up to chest A client with appendicitis is more comfortable when lying in what is traditionally known as the fetal position, with the legs drawn up toward the chest. This flexed positioning assists in decreasing the pain that comes with appendicitis by decreasing the pressure on the abdominal area. A heating pad is contraindicated because heat can lead to a ruptured appendix. Pain medications are not given to the client with acute appendicitis because they may mask the symptoms that accompany a ruptured appendix. A nasogastric tube may be necessary postoperatively for gastric decompression, or preoperatively if perforation occurs. There are no data in the question that support perforation.
A 12-year-old girl is admitted to the hospital with suspected appendicitis. What nursing interventions should be implemented preoperatively? 1.Applying a heating pad for 5-minute intervals as prescribed 2.Administering acetaminophen as needed for pain, as prescribed 3.Placing the adolescent in a fetal position, side-lying with legs drawn up to chest 4.Inserting a nasogastric tube and attaching it to low intermittent suction; measuring drainage as prescribed
severe dehydration. A loss of more than 10% of body weight in a day is a sign of severe dehydration. Failure to thrive and malabsorption syndrome are long-term conditions, not objectively defined by a 24-hour weight change. This child is no longer at risk for a fluid volume deficit but is showing signs of dehydration.
A 3-month-old is admitted with severe diarrhea. Yesterday, the infant weighed 11 pounds (5 kg). Today, this infant weighs 9 pounds, 8 ounces (4.3 kg). Based on this information the nurse documents that the infant has: severe dehydration. failure to thrive. malabsorption syndrome. risk for fluid volume deficit.
B) Thicken formula with rice cereal. Small, frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice cereal per ounce of formula has 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 GER disease. Placing the child in a Trendelenburg position would increase the reflux. Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive.
A 4-month-old infant has gastroesophageal reflux (GER) but is thriving without other complications. Which should the nurse suggest to minimize reflux? A) Place in Trendelenburg position after eating. B) Thicken formula with rice cereal. C) Give continuous nasogastric tube feedings. D) Give larger, less frequent feedings.
Vomiting immediately after feeding
A 6-month-old boy is diagnosed with pyloric stenosis. When you take a health history from his mother, which symptom would you expect to hear her describe?
A) Prevent fluid and electrolyte imbalance. he priority goal of care in gastroenteritis is preventing fluid and electrolyte imbalance.
A 7-month-old infant is admitted to the hospital with a diagnosis of acute gastroenteritis.What will be the nurse's priority goal of the infant's care? A) Prevent fluid and electrolyte imbalance. B) Prevent nutritional deficiency. C) Prevent skin breakdown. D) Prevent malabsorption.
B, C, E
A child is brought into the ED with suspected appendicitis.What signs and symptoms does the nurse expect to assess? (Select all that apply. ) A) Left lower quadrant pain B) Guarding C) Rebound tenderness D) Decreased C-reactive protein E) Pain on lifting thigh when supine
Barium enema A barium enema is successful in reducing a large percentage of intussusception cases. Other cases are reduced surgically. Upper endoscopy is used to visualize the upper gastrointestinal tract from the mouth to the upper jejunum. Endoscopic retrograde cholangiopancreatography is used to view the hepatobiliary system.
A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition? Barium enema Surgery Upper endoscopy Endoscopic retrograde cholangiopancreatography
prepare the infant for surgery.
In caring for an infant diagnosed with pyloric stenosis, the nurse would anticipate that she would:
a) prepare the infant for surgery.
In caring for an infant diagnosed with pyloric stenosis, the nurse would anticipate that she would: a) prepare the infant for surgery. b) assist in doing a barium enema procedure on the infant. c) medicate the infant with analgesics. d) change the infant's diet to lactose-free.
b) Projectile vomiting
The nurse is caring for a child admitted with pyloric stenosis. Which clinical manifestation would likely have been noted in the child with this diagnosis? a) Frequent urination b) Projectile vomiting c) Explosive diarrhea d) Severe abdominal pain
4.Foul-smelling ribbon-like stool -Failure to pass meconium within the first 48 hours of life can cause chronic constipation which leads to foul smelling ribbon like stool and failure to thrive, poor feeding, chronic constipation, & Down syndrome
The clinic nurse reviews the record of an infant and notes that the health care provider has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which sign most likely led the mother to seek health care for the infant? 1.Diarrhea 2.Projectile vomiting 3.Regurgitation of feedings 4.Foul-smelling ribbon-like stool
Urine output should be calculated using weight in kilograms. 6 kg x 1 mL/kg = 6 mL/hour 6 mL x 8 hours = 48 mL/8-hour shift 48ML
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.
Effortless vomiting just after the child has eaten
The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child?
A) Currant jelly
What description of a child's stool characteristic leads the nurse to suspect intussusception? A) Currant jelly B) Black and tarry C) Green liquid D) Greasy and foul-smelling
C) Bulky,frothy Celiac disease causes malabsorption. Stools that are large, bulky, and frothy may indicate malabsorption.
What does the nurse expect the appearance of the stools of a child with celiac disease to be? A) Ribbon like B) Hard,constipated C) Bulky,frothy D) Loose,foul-smelling
b. Burp the infant before and during feeding. c. Give the feeding slowly. d. Refeed if the infant vomits. Children with pyloric stenosis are given formula thickened with cereal; the infant is burped before and during feeding to get rid of any gas in the stomach; the infant is fed slowly and refed if vomiting occurs. The infant is positioned on the right side to allow the weight of the feeding to stay in the stomach against the pyloric valve.
What interventions will the nurse perform when feeding a child with pyloric stenosis? (Select all that apply. ) A) Give a formula thinned with water. B) Burp the infant before and during feeding. C) Give the feeding slowly. D) Refeed if the infant vomits. E) Position infant on left side after feeding.
D) Intussusception
What is invagination of one segment of bowel within another called? A) Atresia B) Stenosis C) Herniation D) Intussusception
A) A barium enema
What is the treatment of choice for a child with intussusception? A) A barium enema B) Immediate surgery C) IV fluids until the spasms subside D) Gastric lavage
