NURS 341 exam 1
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) Chronic diarrhea b) Vomiting about 2 hours after feeding c) Vomiting immediately after feeding d) Refusal to eat
Vomiting immediately after feeding Explanation: A narrowing of the pyloric valve leads to projectile vomiting soon after eating.
hypospadias
abnormal congenital opening of the male urethra on the undersurface of the penis
Prednisone (Deltasone)
anti-inflammatory
gastroesophageal reflux disease (GERD)
backflow of contents of the stomach into the esophagus, often resulting from abnormal function of the lower esophageal sphincter, causing burning pain in the esophagus
Crohn disease (Crohn's)
chronic inflammation of the intestinal tract (terminal ileum and colon)
cleft lip and palate
congenital split of the lip and roof of the mouth (cleft indicates a fissure)
The nurse is reinforcing teaching with the caregiver of 5-year-old twins regarding urinary tract infections (UTIs). The caregiver is puzzled about why her daughter has had three urinary tract infections but her son has had none. She reports that their diets and fluid intake is similar. Which statement would be accurate for the nurse to tell this mother? a) "Girls need more vitamin C than boys to keep their urinary tract healthy, so your daughter may be deficient in vitamin C." b) "It is unlikely that your daughter is practicing good cleaning habits after she voids." c) "Girls tend to urinate less frequently than boys, making them more susceptable to UTI's." d) "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily."
d) "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily."
acute glomerulonephritis
inflammation of the capillary loops of the renal glomeruli
pancreatitis
inflammation of the pancreas
enuresis
involuntary discharge of urine, usually referring to a lack of bladder control
pyloric stenosis
narrowing of the opening of the stomach to the duodenum
In caring for an infant diagnosed with pyloric stenosis, the nurse would anticipate that she would:
prepare the infant for surgery. A surgical procedure called a pyloromyotomy (also known as a Fredet-Ramstedt operation) is the treatment of choice for pyloric stenosis.
Salicylates
relieve mild to moderate pain and reduce inflammation
hemodialysis
the process by which waste products are filtered directly from the patient's blood
ridicule
to make fun of
gastrostomy tube (G-tube)
tube placed through the abdomen directly into the stomach and used to provide nourishment
Hepatitis B Virus (HBV)
virus that causes inflammation of the liver; transmitted through any body fluid, including vaginal secretions, semen, and blood
cystourethrogram
x-ray image during voiding to show structure and function of bladder and urethra
Candida albicans
yeast infection
The mother of an infant tells the nurse during a routine visit to the clinic that she often notices a bulging mass in the lower abdominal and groin area when her baby cries. She asks the nurse if this is normal. How should the nurse respond?
"I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately." The mother is describing common symptoms of an inguinal hernia. It may be possible to visualize the mass, but often the mass is seen only during crying or straining, making it difficult to actually identify in the clinic setting. It is important to notify the physician so treatment can be initiated.
The nurse is caring for an infant recently diagnoses with thrush and was prescribed nystatin. Which statement by the infant's mother would suggest a need for further education?
"I will add the nystatin to her bottle four times per day." Administer nystatin suspension four times per day following feeding, not mixed in the bottle, to allow the medication to remain in contact with the lesions. In the younger infant, apply nystatin to the lesions with a cotton-tipped applicator. Infants and young children often mouth their toys, so it is important to clean them appropriately. Explain to parents of infants with thrush the importance of reporting diaper rash because fungal infections in the diaper area often occur concomitantly with thrush and also need to be treated.
The nurse is performing discharge teaching for a 16-year-old diagnosed with peptic ulcer disease. Which statements by the parents and client demonstrate learning has occurred?
"I will need to make sure to take all of the antibiotic prescribed." "It's important to take my histamine agonist medication at the appropriate time." "The prednisone that I take for my rheumatoid arthritis may be a cause of my peptic ulcer disease." If Helicobacter pylori (H. pylori was detected as a cause of the peptic ulcer disease (PUD), the client will be prescribed an antibiotic and should take all of the medication. Histamine agonists and/or proton pump inhibitors should be taken routinely as prescribed. Risk factors include a family history of PUD or other GI diseases, or chronic salicylate or prednisone use.
A physician recommends a gastrostomy for a 4-year-old patient with an obstruction. The parents ask the certified wound, ostomy, and continence nurse (CWOCN) what the surgery entails. What is the nurse's best response? a) "The surgery will create an opening to the large intestine." b) "The surgery will create an opening to the small intestine." c) "The surgery creates an opening between the stomach and abdominal wall." d) "The surgery is performed to create an opening between the esophagus and the neck."
"The surgery creates an opening between the stomach and abdominal wall." Explanation: Ostomies can be created at various sites in the GI tract, depending on the child's clinical condition. A gastrostomy provides an opening between the stomach and the abdominal wall and an esophagostomy communicates between the esophagus and an external site on the neck. Ostomies may be created at various sites in the small intestine (e.g., jejunostomy, ileostomy) or in the large intestine (e.g., colostomy)
The nurse is conducting a presentation for a group of nurses who work with adolescents. The group of nurses discusses dysmenorrhea. Which of the following statements is most accurate related to dysmenorrhea? a) Dysmenorrhea can result from diaphragms or tampons being left in place too long. b) Common symptoms of dysmenorrhea are weight gain and mood swings. c) Genetic abnormalities are the most common cause of dysmenorrhea. d) A contributing factor in dysmenorrhea is the increased secretion of prostaglandins.
A contributing factor in dysmenorrhea is the increased secretion of prostaglandins. Correct Explanation: The increased secretion of prostaglandins, which occurs in the last few days of the menstrual cycle, is thought to be a contributing factor in primary dysmenorrhea.
Herpangina
Coxsachie A virus = hand, foot, mouth disease Ssx: multiple small ulcers/vesicles on posterior pharynx and on fingers + FVR, dysphagia RF: fecal-oral transmission from swimming pools / water parks self-limiting. no complications
The nurse is caring for a 6-month-old infant who was admitted to the emergency room 24 hours ago with signs of severe diarrhea. The infant's rectal temperature is 104° F, with weak and rapid pulse and respirations. The skin is pale and cool. The child is on IV rehydration therapy, but the diarrhea is persisting. The infant has not voided since being admitted. Which of the following is the priority nursing intervention? a) Take a stool culture b) Feed the child a cracker c) Administer antibiotic therapy d) Administer IV potassium
Take a stool culture Explanation: Treatment of severe diarrhea focuses on regulating electrolyte and fluid balance by initiating a temporary rest for the GI tract, oral or IV rehydration therapy, and discovering the organism responsible for the diarrhea. All children with severe diarrhea or diarrhea that persists longer than 24 hours should have a stool culture taken to determine if bacteria are causing the diarrhea, and if so, a definite antibiotic therapy can be prescribed. Because a side effect of many antibiotics is diarrhea, antibiotics should not routinely be used to treat diarrhea without an identifiable bacterial cause. Before the initial IV fluid is changed to a potassium solution, be certain the infant or child has voided—proof that the kidneys are functioning; in this case, the child is not voiding yet. The child should not be fed a cracker, as the GI tract should be rested until the diarrhea stops.
The nurse is caring for a child admitted with acute glomerulonephritis. Which clinical manifestation would likely have been noted in the child with this diagnosis? a) Jaundiced skin b) Tea-colored urine c) Loose, dark stools d) Strawberry red tongue
Tea-colored urine
A nurse is discussing with a family the various causes of their child's vulvovaginitis. What would be included in the education? a) Fevers often occur with vulvovaginitis. b) Constipation is a common cause of vulvovaginitis. c) The use of cleansing towelettes may have caused the vulvovaginitis. d) Child protective services will be called since this is a sign of abuse.
The use of cleansing towelettes may have caused the vulvovaginitis.
The nurse is caring for a 2-year-old girl with suspected vulvovaginitis. The nurse suspects the cause as Candida albicans based on which finding? a) Irritation of labia and vaginal opening b) White cottage cheese-like discharge c) Foul yellow-gray discharge d) Thin gray vaginal discharge with fishy odor
White cottage cheese-like discharge Correct Explanation: White cottage cheese-like discharge indicates C. albicans. Thin gray discharge with a fishy odor points to Bordetella or Gardnerella. Foul yellow-gray discharge indicates Trichomonas vaginalis. Irritation of the labia and vaginal opening is commonly found with poor hygiene.
Hirschsprung's disease (congenital megacolon)
absence at birth of the autonomic ganglia in a segment of the intestinal smooth muscle wall that normally stimulates peristalsis
Hirschsprung disease
absent ganglion cells in submucosal/myenteric plexus rectosigmoid
Crohn disease (Crohn's)
chronic inflammation of the intestinal tract
An adolescent girl and her caregiver present at the pediatrician's office. The adolescent reports severe abdominal pain. A diagnosis of pelvic inflammatory disease (PID) is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. The most appropriate action by the nurse would be to: a) talk to the child and caregiver together and explain that the condition is often a result of a sexually transmitted disease and discuss the importance of safe sex practices. b) contact the necessary authorities to report a suspected case of sexual abuse. c) take the caregiver to a private room and tell her that the child's diagnosis can only come from sexual activity. d) take the child to a private room and interview her regarding her sexual history and partners.
d) take the child to a private room and interview her regarding her sexual history and partners.
polyhydramnios
excessive amniotic fluid
Esophageal atresia (EA)
failure of the esophagus to develop a continuous passage
Meckel Diverticulum etiology
failure of vitelline duct to involute
The nurse is teaching the mother of an infant with a temporary ileostomy about stoma care. Which of the following is the most important instruction to emphasize to the mother to avoid an emergency situation? a) "You may need adhesive remover to ease pouch removal." b) "Call the doctor immediately if the stoma is not pink/red and moist." c) "You must be meticulous in caring for the surrounding skin." d) "Gather all of your supplies before you begin."
"Call the doctor immediately if the stoma is not pink/red and moist." Explanation: A healthy stoma is pink and moist. If the stoma is dry or pale, the mother must notify the doctor immediately because it could indicate compromised circulation
The nurse is caring for a 2-year-old boy with an umbilical hernia and is teaching the mother about this condition. Which of the following responses from the mother indicates a need for further teaching? a) "I can tape a quarter over the hernia to reduce it." b) "I need to watch for pain, tenderness, or redness." c) "My son could have some appearance-related self-esteem issues." d) "Incarceration is rare, but it can occur."
"I can tape a quarter over the hernia to reduce it." Explanation: The use of home remedies to reduce an umbilical hernia should be discouraged because of the risk of bowel strangulation. The mother needs to be aware that strangulation can occur, but it is rare with an umbilical hernia. Pain, tenderness, or redness indicates incarceration, which although rare with umbilical hernias, can occur. She needs to understand the signs of strangulation and understand that some children have self-esteem issues related to the large protrusion of the unrepaired umbilical hernia. Physical needs of the child have priority over any types of potential psychosocial issues. Self-esteem issues may arise due to a large protrusion of an unrepaired umbilical hernia.
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?
"I have to be careful because I am prone to not absorbing nutrients." Crohn disease typically effects the small intestine more than the large intestine and it's onset is between the ages of 10 to 20 years. The cobblestone lesions in the small intestine prevents absorption of nutrients that normally occurs. The diarrhea is not directly related to the cobblestone lesions, and ulcerative colitis is characterized by the disease effecting the intestine(s) in a continuous pattern.
A nurse caring for Paulo, an infant born with a cleft palate, notices that the parents rarely interact with their child. The nurse overhears the mother telling her husband that she "feels like crying" every time she looks at their son. Which of the following would be the best response from the nurse? a) "Your son needs you right now. You should put your negative feelings about his condition aside for his sake." b) "I sense you could use more information on caring for a cleft palate. Would you be interested in meeting with other parents who have dealt with this?" c) "Keep in mind that your son's condition is not life-threatening and can be corrected eventually." d) "Many infants are born with this condition. Your son's palate is not nearly as bad as some cases."
"I sense you could use more information on caring for a cleft palate. Would you be interested in meeting with other parents who have dealt with this?" Explanation: The nurse should support the family's adjustment to a child's condition by demonstrating an accepting, caring attitude toward the child and family and providing the parents with opportunities and support for normal infant-parent interactions.
The mother of a young child, who has been treated for a bacterial urinary tract infection, tells the nurse her daughter has a white thick covering over her tongue. The mother states that she "has tried everything to get it off my child's tongue." How should the nurse respond?
"It's not unusual for a fungal infection to occur while taking an antibiotic for an infections. I will let your primary care provider know so we can get it treated."
The caregiver of a 1-year-old son calls the nurse, upset that his wife has just told him that their son is being given a hormone. His wife says that the pediatrician called it human chorionic gonadotropic hormone but that is all she understood. The nurse most accurately clarifies the caregiver's question by making which of the following statements regarding the son's treatment? a) "Without the hormone your son will have fluid that will collect in his scrotum." b) "Your child's testes have not dropped, so the hormone is being administered to avoid causing degeneration until they do." c) "The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place." d) "Without the treatment your child's gonads will not reach normal size."
"The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place."
Gastroesophageal reflux (GER)
Affects half of all children Peak age 1-4 months Children frequently hungry and irritable ( eat often but still lose weight) Lower esophageal sphincter relaxes Allows passive regurgitation of stomach contents into esophagus May also enter airway (aspiration)
The nurse is collecting data on a 6-year-old child admitted with acute glomerulonephritis. Which vital sign would the nurse anticipate with this child's diagnosis? a) Pulse oximetry 93% on room air b) Respirations 24 per minute c) Pulse rate 112 bpm d) Blood pressure 136/84
Blood pressure 136/84
Tracheoesophageal fistula (TEF)
Congenital defect resulting in a connection between the esophagus and trachea
A school nurse is trying to prevent poststreptococcal glomerulonephritis in children. Which of the following would be the best way to prevent this? a) Encourage the child to take all the antibiotics if diagnosed with strep throat. b) Tell parents to give ibuprofen if their child has a sore throat. c) Prophylactic antibiotics after strep throat are important. d) All children in the child's class should be tested for strep throat if there is a positive.
Encourage the child to take all the antibiotics if diagnosed with strep throat. Explanation: Encouraging the child to take all the antibiotics if diagnosed with strep throat is important. It is not necessary to test the people in the community that the child came in contact with unless they are symptomatic. Ibuprofen does not cure strep throat and that is what usually causes poststreptococcal glomerulonephritis. Prophylactic antibiotics after a strep infection are not necessary.
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?
Esophageal atresia (EA) A maternal history of polyhydramnios is usually present in one-third of cases of EA and in some cases of tracheoesophageal fistula (TEF).
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) Short bowel syndrome (SBS) b) Gastroenteritis c) Hirschsprung disease d) Ulcerative colitis (UC)
Hirschsprung disease Explanation: The nurse should suspect Hirschsprung disease when the newborn does not pass meconium in the first 24 hours after birth, and has bilious vomiting or abdominal distention and feeding intolerance with bilious aspirates and vomiting. Typical signs and symptoms of gastroenteritis include diarrhea, nausea, vomiting, and abdominal pain. The characteristic GI manifestation of UC is bloody diarrhea accompanied by crampy, typically left-sided lower abdominal pain. Clinical manifestations of untreated SBS include profuse watery diarrhea, malabsorption, and failure to thrive.
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) Improving hydration d) Maintaining skin integrity
Improving hydration Explanation: Preoperatively the highest priority for the child with pyloric stenosis is to improve nutrition and hydration.
The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is: a) Obtaining a clean catch voided urine b) Placing an indwelling urinary catherter c) Performing a suprapubic aspiration d) Placing a cotton ball in the underwear to catch urine
Obtaining a clean catch voided urine
The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is: a) Painless rectal bleeding b) Dehydration c) Respiratory distress d) Ischemia
Painless rectal bleeding Explanation: With Meckel diverticulum, most symptomatic children present younger than age 2 years. Intermittent, painless rectal bleeding is the most common clinical manifestation of Meckel diverticulum. The blood is most often bright red or maroon and may be passed independent of stool due to ulceration at the junction of the ectopic tissue and the normal ileal mucosa.
The nurse is doing a presentation for a group of nursing students about the topic of menstrual disorders. After discussing the disorder secondary amenorrhea, the students make the following statements. Which statement made by the nursing students is the most accurate regarding the cause of secondary amenorrhea? a) "It is caused from taking birth control pills when a girl is younger than 13 years old." b) "This is what happens if a 16-year-old girl has never had any periods at all." c) "This disorder is usually seen after a girl has had a spontaneous abortion." d) "Emotional stress can be a cause of this disorder."
"Emotional stress can be a cause of this disorder."
The nurse is collecting data on a 2-year-old child admitted with a diagnosis of urinary tract infection. when interviewing the caregivers, which question would be most important for the nurse to ask?
"Has your child complained of pain?"
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 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.
The nurse is caring for a 4-year-old with oral vesicles and ulcers from herpangina. The child is refusing fluids due to the pain and the mother is concerned about his hydration status. Which of the suggestions would be most appropriate? a) "Try some Anbesol or Kank-A." b) "Offer him some orange juice." c) "Offer 'magic mouthwash' followed by a popsicle." d) "Encourage him to have some soda."
"Offer 'magic mouthwash' followed by a popsicle." Explanation: Children are more likely to cooperate with interventions if play is involved. "Magic" analgesic mouthwash followed by a popsicle is most likely to alleviate some pain and then provide hydration. Soda should be avoided because it can cause stinging and burning. Orange juice should be avoided because it can cause stinging and burning. Anbesol might be helpful but it will likely be difficult to apply. Additionally, oral analgesics are often necessary.
The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which of the following statements is the best explanation of the treatment for this diagnosis? a) "The treatment for the disorder will be a surgical procedure." b) "Your child will be treated with oral iron preparations to correct the anemia." c) "We will give enemas until clear and then teach you how to do these at home." d) "Your child will receive counseling so the underlying concerns will be addressed."
"The treatment for the disorder will be a surgical procedure." Explanation: Treatment of congenital aganglionic megacolon involves surgery with the ultimate resection of the aganglionic portion of the bowel.
A single male caregiver of a 14-year-old girl accompanies his daughter to her pre-high school physical. In the course of discussion about how his daughter is developing, he remarks, "She's terrific most of the time. Of course when she gets her period, she's miserable and mean, but I tell her that's just what it's like to be a woman." Of the following statements, which would be the most appropriate response by the nurse? a) "PMS is a problem for a lot of women, but sometimes it's worse in the beginning. She might outgrow it." b) "There are nutritional and medical things she can do to lessen the symptoms; I'll give both of you information about some strategies and we'll track her for a few months." c) "That doesn't make being a woman sound very good. It would probably be easier for her if you could be more supportive." d) "That must be hard on you, especially because you are raising her by yourself."
"There are nutritional and medical things she can do to lessen the symptoms; I'll give both of you information about some strategies and we'll track her for a few months."
Prostaglandins
A group of bioactive, hormone-like chemicals derived from fatty acids that have a wide variety of biological effects including roles in inflammation, platelet aggregation, vascular smooth muscle dilation and constriction, cell growth, protection of from acid in the stomach, and many more.
The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also complains of a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100 degrees Fahrenheit. The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have a) A urinary tract infection b) Lipoid nephrosis (idiopathic nephrotic syndrome) c) Rheumatic fever d) Acute glomerulonephritis
Acute glomerulonephritis
Urinary tract infections are usually successfully treated by which of the following? a) Administering diuretics b) Increasing fluids, such as cranberry juice c) Administering antibiotics d) Performing bladder irrigations
Administering antibiotics Explanation: UTIs may be treated with antibiotics (usually sulfisoxazole or ampicillin) at home. Fluids are encouraged, but they do not treat the infection. Bladder irrigations and diuretics are not used in the treatment of urinary tract infections
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) Teach the mother the appropriate technique for breast-feeding an infant with cleft lip. b) Refer the family to a social worker or mental health practitioner. 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. Explanation: The family's emotional response to the birth of a child with cleft lip, palate, or both may range from grief to anger to denial. The nurse should encourage the parents to express their feelings and provide the parents with opportunities and support for normal infant-parent interactions.
The nurse is doing dietary teaching with the caregivers of a child diagnosed with idiopathic celiac disease. Of the following foods, which would most likely be appropriate in the child's diet? a) Oatmeal b) Potatoes c) Toast d) Bananas
Bananas Correct Explanation: The young child should be started on a starch-free, low-fat diet. Bananas contain invert sugar and are usually well tolerated. Products that contain wheat, rye, or oats should be excluded
A child is diagnosed with intussusception. The nurse anticipates that which of the following would be attempted first to reduce this condition? a) Endoscopic retrograde cholangiopancreatography b) Surgery c) Upper endoscopy d) Barium enema
Barium enema Explanation: 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 needs to collect urine for 24 hours and the nurse explains that this test assesses glomerular filtration rate and how the kidneys are functioning. Which of the following would be indicative of this type of test? a) Microscopic studies for RBC casts b) Urine culture and sensitivity c) Urinalysis for casts and bacteria d) Creatinine clearance
Creatinine clearance Correct Explanation: A 24-hour urine collection is performed to obtain information about the creatinine clearance. This demonstrates information about the glomerular filtration rate.
he condition in which one or both of the testes does not descend in the male infant is referred to as which of the following? a) Enuresis b) Hydrocele c) Cryptorchidism d) Orchiopexy
Cryptorchidism Explanation: When one or both of the testes do not descend, the condition is called cryptorchidism.
A parent is asking how she can help her son deal with the peer ridicule at school in regards to enuresis. What is the best response by the nurse? a) Discuss how child can continue to go to the bathroom instead of in the underwear. b) Demonstrate love and acceptance at home. c) Take away a toy every time the child urinates in their pants. d) Demonstrate how to urinate in the bathroom every time.
Demonstrate love and acceptance at home. Explanation: Demonstrating love and acceptance at home will help counteract the ridicule the child is getting at school.
A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason? a) Confirm pancreatitis b) Evaluate gastric pH c) Determine esophageal contractility d) Detect Helicobacter pylori
Detect Helicobacter pylori Explanation: Urea breath test is used to detect the presence of H. pylori in the exhaled breath. This test does not evaluate gastric pH. Serum amylase and lipase levels are used to confirm pancreatitis. Esophageal manometry is used to evaluate esophageal contractile activity and effectiveness.
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) Effortless vomiting just after the child has eaten. c) Severe constipation with occasional ribbon-like stools d) Bouts of diarrhea with failure to gain weight
Effortless vomiting just after the child has eaten. Explanation: Almost immediately after feeding, the child with gastroesophageal reflux vomits the contents of the stomach. The vomiting is effortless, not projectile in nature.
Noah is an 18-month-old who is brought to the ER with flu-like symptoms. He is diagnosed with pneumonia secondary to aspiration of stomach contents. The nurse explains to the parents that pneumonia is a condition that often occurs secondary to: a) Hirschsprung disease b) Cystic fibrosis c) Inflammatory bowel disease d) Gastroesophageal reflux disease
Gastroesophageal reflux disease Correct Explanation: The child with gastroesophageal reflux disease may present with the physical findings of pneumonia secondary to aspiration of refluxed stomach contents.
An adolescent boy is diagnosed with hepatitis A. Which problem should be considered when planning care? a) He will become fatigued easily. b) He will be very irritable and perhaps require sedation. c) Hypothermia is common. d) His urine will be dark and infectious.
He will become fatigued easily. Explanation: Most children with hepatitis are exhausted. Urine is not infectious.
A nurse prepares a menu for a patient with Crohn Disease. What is the focus of dietary management for this disease? a) High calorie, high protein b) High calorie, high fiber c) Low calorie, high carbohydrate d) Low fiber, low calorie
High calorie, high protein Explanation: The goal of nutritional intervention is to provide adequate nutrient intake to optimize normal growth and development—including pubertal development, which is frequently delayed—and to prevent and correct nutrient deficiencies. Dietary management focuses on enhancing protein and calorie intake. Generally, a high-protein, high-calorie diet is recommended.
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?
In this disorder the sphincter that leads into the stomach is relaxed. Gastroesophageal reflux (GER) occurs when the sphincter in the lower portion of the esophagus, which leads into the stomach, is relaxed and allows gastric contents to be regurgitated back into the esophagus. Congenital aganglionic megacolon is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Colic consists of recurrent paroxysmal bouts of abdominal pain. Pyloric stenosis is characterized by hypertrophy of the circular muscle fibers of the pylorus which leads to an obstruction at the distal end of the stomach.
A mother calls the doctor's office and tells the nurse that she is concerned because her 4-month-old keeps "spitting up" with every feeding. Which of the following would indicate that the child is regurgitating as opposed to vomiting? a) Is curdled and extremely sour smelling b) Only occurs with feeding c) Continues until stomach is empty d) Is projected 1 ft away from infant
Only occurs with feeding Explanation: Regurgitation typically occurs only with feeding, runs out of the mouth with little force, smells barely sour and is only slightly curdled, appears to cause no pain or distress, occurs only once per feeding, and amounts to only about 1 to 2 tsp.
A mother brings her 10-year-old son to the ER with complaints of abdominal pain. The nurse performing a physical assessment notes the following symptoms: upper right quadrant pain that radiates to the back; fever; nausea; and abdominal distention. Which of the following diseases would the nurse consider as a diagnosis? a) Crohn disease b) Appendicitis c) Pancreatitis d) Ulcerative colitis
Pancreatitis Explanation: The child admitted with the suspicion of pancreatitis typically has a complaint of abdominal pain, either epigastric, upper left, or upper right quadrant pain that may radiate to the back. Nausea and vomiting, fever, tachycardia, hypotension, and jaundice may be present. Abdominal signs such as abdominal distention, decreased bowel sounds, rebound tenderness, and guarding also may be noted.
A 12-year-old boy has just undergone a liver transplantation and is recovering. After performing a finger stick puncture and assessing the results, the nurse administers a 10% solution of dextrose IV. Which of the following is the correct rationale for this intervention? a) Maintenance of electrolyte balance b) Prevention of T-cell rejection of the transplanted liver c) Reduction of hypertension d) Prevention of hypoglycemia
Prevention of hypoglycemia Correct Explanation: Hypoglycemia is a major danger following liver transplantation because glucose levels are regulated by the liver, and the transplanted organ may not function efficiently at first. Assess serum glucose levels hourly by finger stick puncture. A 10% solution of dextrose IV may be necessary to prevent hypoglycemia. Careful tissue matching before the transplantation is needed to reduce the possibility of stimulating T-cell rejection. Sodium, potassium, chloride, and calcium levels are evaluated approximately every 6 to 8 hours to be certain electrolyte balance is maintained, but potassium is rarely added to IV solutions because of the risk that renal failure has occurred. IV therapy with hypotensive agents such as hydralazine (Apresoline) and nitroprusside may be needed to reduce hypertension.
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) Gastroesophageal reflux c) Peptic ulcer disease d) Pyloric stenosis
Pyloric stenosis Correct Explanation: With pyloric stenosis, at 4 to 6 weeks of age, infants typically begin to vomit almost immediately after each feeding. The vomiting grows increasingly forceful until it is projectile, possibly projecting as much as 3 to 4 feet. Infants are usually hungry immediately after vomiting because they are not nauseated. A definitive diagnosis can be made by watching the infant drink. If a pyloric stenosis is present, the sphincter feels round and firm, approximately the size of an olive in the right abdomen. Peptic ulcer disease in neonates usually presents with hematemesis (blood in vomitus) or melena (blood in the stool). Gastroesophageal reflux involves a small (1-2 tsp) volume and is not forceful. Appendicitis typically begins with anorexia for 12 to 24 hours; children do not eat and do not act like their usual selves. Nausea and vomiting may then occur, followed by diffuse abdominal pain.
A child diagnosed acute glomerulonephritis will most likely have a history of which of the following? a) Hearing loss with impaired speech development b) Sibling diagnosed with the same disease c) Hemorrhage or history of bruising easily d) Recent illness such as strep throat
Recent illness such as strep throat Correct Explanation: Symptoms of acute glomerulonephritis often appear one to three weeks after the onset of a streptococcal infection such as strep throat.
The mother of 6-month-old girl is concerned about her daughter getting a urinary tract infection. Which of the following should the nurse mention to the mother to help prevent this condition? a) Bathe the child with bubble bath once a week b) Discontinue prescribed antibiotics once symptoms of UTI have disappeared c) Wipe from back to front when changing the girl's diaper d) Report any abnormally colored urine to the child's primary care provider
Report any abnormally colored urine to the child's primary care provider
If an adolescent has hepatitis B, what would be an important nursing action? a) Strict enforcement of standard precautions b) Strict calculation of caloric and vitamin B intake c) Close observation to detect cerebral hallucinations d) Conscientious collection of stool for ova and parasites
Strict enforcement of standard precautions Explanation: Hepatitis B is spread through contaminated blood. Standard precautions help prevent contact with this
A 16-year-old tells you she has terrible dysmenorrhea. Which action would be the best health teaching measure regarding this? a) Drink a minimum of fluid if having pain. b) Take acetaminophen beginning with the first day of a menstrual flow. c) Take over-the-counter ibuprofen for its prostaglandin action. d) Use ice to help in reducing inflammation and pain.
Take over-the-counter ibuprofen for its prostaglandin action.
The nurse knows which of the following is a description of peritoneal dialysis when compared to hemodialysis? a) The child must go into a facility to get peritoneal dialysis. b) There are strict diet and fluid restrictions. c) Therapy is only 3 to 4 days per week. d) The child can live a more normal lifestyle.
The child can live a more normal lifestyle. Correct Explanation: The child can live a more normal lifestyle with peritoneal dialysis. This is a 7-day-a-week procedure, but there are less diet restrictions and more freedom with this type of procedure. Peritoneal dialysis can be performed at home.
A caregiver brings her 7-year-old son to the pediatrician's office, concerned about the child's bedwetting after being completely toilet trained even at night for over 2 years. The caregiver further reports that the child has wet the bed every night since returning home from a one week fishing trip. The child refuses to talk about the bedwetting. The nurse notes the child is shy, skittish, and will not make eye contact. Further evaluation needs to be done to rule out which of the following? a) The child is out of the habit of waking himself up during the night to void b) The child has been sexually abused, maybe on the fishing trip c) The child did not want to go on the fishing trip and is now retaliating against being made to go d) The child has a urinary tract infection due to not bathing while on the fishing trip
The child has been sexually abused, maybe on the fishing trip
The nurse is collecting data for a child diagnosed with acute glomerulonephritis. What would the nurse likely find in this child's history? a) The child had a congenital heart defect. b) The child is being treated for asthma. c) The child has a sibling with the same diagnosis. d) The child recently had an ear infection.
The child recently had an ear infection.
A newborn is diagnosed with hypospadias and the parents want him to be circumcised. What would be the best response by the nurse? a) The foreskin is needed for repair. b) Circumcision is usually performed after 1 year old. c) Circumcision with a hypospadias will cause meatal stenosis. d) The circumcision may predispose the child to renal failure.
The foreskin is needed for repair. Explanation: A child's foreskin is not removed since it is needed to help repair a hypospadias. Once the hypospadias is repaired, a circumcision can be performed at the same time. Meatal stenosis has to do with the urethral opening diameter, not the placement.
The nurse is caring for a 6-month-old girl with diarrhea and dehydration. The mother is concerned because the girl has some patches on her tongue. Which of the following features indicates a geographic tongue rather than thrush? a) The patches are thick and white plaques on the tongue. b) There are white patches on the erupted teeth. c) There are plaques on the buccal mucosa. d) The patches are light in color on the tongue.
The patches are light in color on the tongue. Explanation: A geographic tongue is a benign, noncontagious condition characterized by a reduction in the filiform papillae. Thrush is characterized by thick white plaques that form on the tongue. With thrush, plaques also appear on the buccal mucosa and often occur concomitantly in the diaper area. There would not be any patches on the few teeth the child might have by that age
A parent asks if their newborn's undescended testicles will need surgery to repair. What is the best response by the nurse? a) Surgery is not needed for this type of problem. b) There is a chance the testicles will descend on their own. c) This problem needs to be corrected immediately in the newborn period. d) If the infant is having swelling or pain, then surgery will be performed.
There is a chance the testicles will descend on their own. Explanation: The AAP recommends surgery at 1 year of age if the testicles have not descended on their own. There is a chance they may descend on their own prior to 1 year old. This problem does not cause pain or swelling.
What occurs in the gastrointestinal system of the child with Hirschsprung disease?
There is a partial or complete mechanical obstruction in the intestine. Congenital aganglionic megacolon, also called Hirschsprung disease, is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin.
An adolescent comes to the clinic reporting vaginal discharge. When assessing the vaginal discharge, which of the following would lead the nurse to suspect that the adolescent has candidiasis? a) Frothy, gray-green discharge b) Thick, white cheese-like discharge c) Milky, gray, fishy-odor discharge d) Yellow-green discharge
Thick, white cheese-like discharge Explanation: With candidiasis, the vaginal discharge is thick, white, and cheese-like. A frothy, gray-green discharge is noted with trichomoniasis. A milky, gray discharge with a fishy odor suggests gardnerella. A yellow-green vaginal discharge suggests gonorrhea.
Vulvovaginitis in Child
This is acute, nonspecific vulvovaginitis. Causes in the prepubertal child include infection from a respiratory or bowel pathogen, STI, presence of a foreign body, or Candida albicans in a child with diabetes.
Constipation may be initially caused by psychological problems. a) True b) False
True Explanation: Some children begin holding stool for psychological reasons. Once the process begins, however, the hardened stool, the anal fissures, and the pain on defecation soon occur, and what began for an emotional reason becomes a physical ailment. This is important to understand, because with these children, therapy involves both counseling to correct the initial problem and treatment of the physical symptoms
Which of the following assessments would suggest that a child's postoperative feeding schedule following pyloric stenosis surgery should be slowed? a) Flatulence b) Vomiting c) Semiformed bowel movements d) Falling asleep at each feeding
Vomiting Explanation: Vomiting after a feeding suggests the pyloric valve is not yet able to accommodate feedings well, possibly from edema.
In caring for a child with nephrotic syndrome, which of the following interventions will be included in the child's plan of care? a) Weighing on the same scale each day b) Testing the urine for glucose levels regularly c) Increasing fluid intake by 50 cc an hour d) Ambulating three to four times a day
Weighing on the same scale each day Explanation: The child with nephrotic syndrome is weighed every day using the same scale to accurately monitor the child's fluid gain and loss.
Ostomy care
chk for skin irritation if red around area when stoma is out its bad where you put the actual bag you cut 1/16 to 1/18 bigger than stoma if stoma looks purple or brown report normal is red beefy to empty the pouch from 1/3-1/2
ulcerative colitis
chronic inflammation of the colon with presence of ulcers
celiac disease
disease caused by sensitivity to gluten
Nonmaleficence
do no harm
Vulvovaginitis in Child
infection caused by candida albicans in diabetic child. S/s: pruritus and burning when urine touch excoriated area. Red shiny edematous vulva vaginal discharge excoriated area from scratching
You care for a 12-year-old girl with Crohn disease. A primary assessment you would want to make when caring for her would be to note if:
she has a temperature. Because Crohn disease leads to patches of inflammation in the bowel, the temperature increases if more patches become involved.
A 4-year-old girl with a urinary tract infection is scheduled to have a voiding cystourethrogram. When preparing her for this procedure, you would want to prepare her to a) void during the procedure. b) anticipate a headache afterward. c) drink three glasses of water during the procedure. d) have a local anesthetic injected prior to the procedure.
void during the procedure. Explanation: A voiding cystourethrogram requires the child to void during the procedure so that bladder emptying and urethra flow can be assessed.
