Peds gastro
A 13-year-old adolescent may have appendicitis. Which finding is a reliable indicator of appendicitis? A-the severity, location, and movement of pain B-fever C-a history of vomiting and diarrhea if present D-a history of irritability and lethargy
A
A child, age 4, with a recent history of nausea, vomiting, and diarrhea is admitted to the pediatric unit with a diagnosis of gastroenteritis. During the physical examination, the nurse detects tenting. This finding supports a nursing diagnosis of A-deficient fluid volume related to dehydration. B-risk for injury related to capillary fragility. C-ineffective peripheral tissue perfusion related to peripheral cyanosis. D-activity intolerance related to hypoxia.
A
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of: A-water and sodium retention secondary to a severe decrease in the glomerular filtration rate. B-a decreased serum phosphate level secondary to kidney failure. C- an increased serum calcium level secondary to kidney failure. D-metabolic alkalosis secondary to retention of hydrogen ions.
A
A client with appendicitis is experiencing excruciating abdominal pain. An abdominal X-ray film reveals intraperitoneal air. What should the nurse prepare the client for? A-surgery B-colonoscopy nasogastric (NG) tube insertion C-barium D-enema
A
A nasogastric tube inserted during surgical correction of infant's intussusception is no longer freely removing gastric secretions. What should the nurse do next? A-Verify the tube placement. B-Irrigate the tube. C-Increase the level of suction. D-Rotate the tube.
A
A neonate returns from the operating room after surgical repair of a tracheoesophageal fistula and esophageal atresia. What is the nurse's priority intervention? A-maintaining nasogastric tube patency B-administering and monitoring parenteral nutrition C-testing the neonate's gag and swallowing reflex D-frequent endotracheal suctioning to protect the airway
A
A nurse is caring for a child with intussusception. What is an expected outcome for a goal to relieve acute pain from abdominal cramping? A-The child exhibits no manifestations of discomfort. B-The child is very still. C-The child has a normal bowel movement. D-The child has not vomited in 3 hours.
A
A nurse is teaching a new mother about intussusception. Which signs and symptoms should the nurse include? A-abdominal distension and vomiting B-hard black stools C-high fever and loss of appetite D-loss of bowel sounds
A
An adolescent client scheduled for an emergency appendectomy is to be transferred directly from the emergency department to the operating room. Which statement by the client should the nurse interpret as most significant? A_"All of a sudden it does not hurt at all." B-"The pain is centered around my navel." C-"I feel like I am going to throw up." D-"It hurts when you press on my stomach."
A
An infant undergoes surgery to correct an esophageal atresia and tracheoesophageal fistula. Which nursing diagnosis has the highest priority during the first 24 hours postoperatively? A-ineffective airway clearance B-imbalanced nutrition: C-less than body requirements impaired tissue perfusion D-risk for aspiration
A
Parents bring their infant to the clinic, seeking treatment for vomiting and diarrhea that has lasted for 2 days. On assessment, the nurse detects dry mucous membranes and lethargy. What other finding suggests a fluid volume deficit? A-sunken fontanel B-decreased pulse rate C-increased blood pressure D-low urine specific gravity
A
The mother of a toilet-trained toddler who was admitted to the hospital for severe gastroenteritis and subsequent dehydration and is now at home asks the nurse why the child still wets the bed. What would be the nurse's best response? A- "Hospitalization is a traumatic experience for children. Regression is common, and it takes time for them to return to their former behavior." B-"The stress of hospitalization is hard for many children, but usually they have no problems when they return home." C-"After returning home from being hospitalized, children still feel they should be the center of attention." D-"Children do not feel comfortable in their home surroundings once they return home from being hospitalized."
A
The nurse is caring for a preterm neonate in the neonatal intensive care unit receiving enteral feedings. The nurse notes an increase in respiratory rate, increase in regurgitation of feeding solution, and moderate abdominal distention. What action does the nurse take based on these findings? A-stop the enteral feeding B-check the feeding tube placement C-notify the healthcare provider D-document findings and reassess in 15 to 20 minutes
A
The nurse is providing teaching to the mother of a newborn with early jaundice about the condition's progression. The nurse knows that the teaching regarding hyperbilirubinemia was successful when the mother makes which response? A-"Kernicterus is a consequence of elevated bilirubin levels and has possible lifelong effects." B-"My baby should not get hyperbilirubinemia if I place him near a window in the sun light." C-"My baby will be 3 days old at discharge, and I will not need to worry about hyperbilirubinemia." D-"Since I'm exclusively breastfeeding, the risk of my baby having hyperbilirubinemia is very low."
A
Twenty-four hours after birth, a neonate has not passed meconium. The infant's abdomen is firm with hypoactive bowel sounds. The nurse anticipates the healthcare provider will diagnose which condition? A_Hirschsprung's disease B-celiac disease C-intussusception D-abdominal wall defect
A
When an infant with pyloric stenosis is admitted to the hospital, which aspect of the plan of care should the nurse implement first? A_Weigh the infant. B-Begin an intravenous infusion. C-Switch the infant to an oral electrolyte solution. D-Orient the mother to the hospital unit.
A
When obtaining the nursing history from the mother of an infant with suspected intussusception, which question would be most helpful? A-"What do the stools look like?" B-"When was the last time your child urinated?" C-"Is your child eating normally?" D-"Has your child had any episodes of vomiting?"
A
Which dietary measure would be useful in preventing esophageal reflux? A-eating small, frequent meals B-increasing fluid intake C-avoiding air swallowing with meals D-adding a bedtime snack to the dietary plan
A
Which nursing intervention is a priority for an infant during the first 24 hours following surgery for cleft lip repair? A-Carefully clean the suture line after feedings to reduce the risk of infection. B-Position the infant in the prone position after feedings to promote drainage. C-Allow the infant to cry to promote lung expansion. D-Encourage the infant to use a pacifier to satisfy the urge to suck.
A
While assessing a term neonate on a home visit to a primiparous client 2 weeks after a vaginal birth, the nurse observes that the neonate is slightly jaundiced and the stool is a pale, light color. The nurse notifies the health care provider because these findings indicate which problem? A-biliary atresia B-Rh isoimmunization C-ABO incompatibility D-esophageal varices
A
A client reports having bloody stools to the nurse. What question(s) will the nurse ask the client? Select all that apply. a-"Are you having constipation?" B-"Do you have a history of hemorrhoids?" C-"When is the last time you had a colonoscopy?" D-"Are you voiding in the middle of the night?" E-"How often do you void during the day?"
A B C
The nurse is developing a plan of care for a neonate who is to undergo gastroschisis surgery. What should be included? Select all that apply. A-prevention of hypothermia B-maintenance of fluid and electrolyte balance C-controlling pre-operative pain D-prevention of infection E-providing developmental care
A B D
The nurse should assess a newborn with esophageal atresia and tracheoesophageal fistula (TEF) for which complications? Select all that apply. A-copious frothy mucus B-episodes of cyanosis C-several loose stools D-distended abdomen E-poor gag reflex
A B D
The caregivers of a school-aged client with a new diagnosis of ulcerative colitis ask the nurse how to manage the condition at school. How should the nurse respond? Select all that apply. A-"Work with the school nurse to develop a plan." B-"The condition should not affect the child's schooling." C-"Your child will need to drink plenty of liquids at school." D-"Your child should keep a change of clothing at school." E-"You should encourage your child to not eat lunch at school."
A C D
When developing a nursing care plan for an infant receiving phototherapy, the nurse should include what information in the plan of care? Select all that apply. A-adequate skin exposure to phototherapy B-allowing mother to hold infant as much as she wishes C-eye protection supplemental D-water between feedings E-thermoregulation
A C E
An infant is admitted to the hospital's pediatric unit with gastroenteritis. The nurse will include what nursing actions in the plan of care? Select all that apply. A-Begin prescribed rehydration measures. B-Establish intake and output. C-Weigh the infant. D-Review arriving laboratory reports. E-Protect skin from diarrheal stool. F-Provide time for the parents to hold infant.
All
A 9-month-old infant whose parents have emigrated to the country presents in the clinic with severe dehydration from vomiting. The infant was seen in the clinic just 3 days ago for a well-child visit, but now the family seems very distrustful of the health care team. What should the nurse ask the parents? A-"Have you been speaking with a healer?" B-"Did anything concern you about your last visit?" C-"Has immigration been causing you problems?" D-"Are you afraid your baby will be taken from you?"
B
A child, age 3, is admitted to the pediatric unit with dehydration after 2 days of nausea and vomiting. The parent tells the nurse that the child's illness "is all my fault." How should the nurse respond? A_"Maybe next time you'll bring the child in sooner." B-"Tell me why you think this is your fault." C-"Try not to cry in front of the child. It'll only upset the child." D-"Don't be so upset. Your child will be fine."
B
A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note A-severe abdominal pain radiating to the shoulder. B-anorexia, nausea, and vomiting. C-eructation and constipation. D-abdominal ascites.
B
A nurse is caring for a neonate with a suspected diaphragmatic hernia. The nurse should question an order for A-chest x-ray. B-mask ventilation. C-placement of an orogastric tube. D-immediate endotracheal intubation.
B
A preschooler has vomiting, diarrhea, a potassium level of 3 mEq/L (3 mmol/L), and a sodium level of 137 mEq/L (137 mmol/L). Which prescribed treatment will the nurse implement first? A-promethazine topical gel 12.5 mg B-IV infusion of saline, dextrose, and potassium solution C-nasogastric tube to low intermittent suction D-loperamide 15 ml by mouth
B
The nurse is conducting a comprehensive assessment on a school-age child. Which parent statement would suggest to the nurse that a child may have celiac disease? A-"His urine is so dark in color." B-"His stools are large and smelly." C-"His belly is so small." D-"He is so short."
B
Total parenteral nutrition (TPN) is prescribed for a client who has recently had a small and large bowel resection and who is currently not taking anything by mouth. What should the nurse do to safely administer the TPN? A-Administer TPN through a nasogastric or gastrostomy tube. B-Handle TPN using strict aseptic technique. C-Auscultate for bowel sounds prior to administering TPN. D-Designate a peripheral IV site for TPN administration.
B
What is the most common assessment finding in a child with ulcerative colitis? A-intense abdominal cramps B-profuse diarrhea C-anal fissures D-abdominal distention
B
When developing the plan of care for a neonate who was diagnosed with an anorectal malformation and who subsequently underwent surgery, what intervention would be most helpful in facilitating parent-infant bonding? A-explaining to the parents that they can visit at any time B-encouraging the parents to hold their infant C-asking the parents to help monitor the infant's intake and output D-helping the parents plan for their infant's discharge
B
A client who has ulcerative colitis is taking sulfasalazine to treat inflammation. Which instructions related to drug therapy should the nurse include in the client's teaching plan? Select all that apply. A- Take the medication with meals. B-Avoid exposure to direct sunlight. C-Drink a full glass of water when taking the medication. D-Report any bruising or bleeding. E-Take the medication with an antacid to decrease gastrointestinal side effects.
B C D
A 10-year-old child presents to the emergency department with dehydration. A physician orders 1 L of normal saline solution be administered at a rate of 60 ml/hour. While preparing the infusion, a nurse notices that the I.V. pump's safety inspection sticker has expired. Which action should the nurse take next? A-After starting the fluids, contact the maintenance department and request a pump inspection. B-Hang the fluids without the pump, carefully calculating the drip rate by visual inspection. C-Take the pump out of commission and locate a pump with a valid inspection sticker. D-Begin the infusion of the fluids while looking for a pump with a valid inspection sticker.
C
A 14-year-old brought to the emergency department with right lower quadrant pain is tentatively diagnosed with acute appendicitis. The nurse should further assess the client for which sign or symptom? A-costovertebral angle tenderness B-widening pulse pressure C-low-grade fever D-gross hematuria
C
A client is suspected of having a slow gastrointestinal bleed. The nurse should evaluate the client for which sign? A-increased pulse B-nausea C-tarry stools D-abdominal cramps
C
A female neonate born vaginally at term with a cleft lip and cleft palate is admitted to the regular nursery. Which action should the nurse take the first time that the parents visit the neonate in the nursery? A_Explain the surgical interventions that will be performed. B-Stress that this defect is not life-threatening. C-Emphasize the neonate's normal characteristics. D-Reassure the parents about the success rate of the surgery.
C
A nurse is caring for an infant with dehydration and weight loss. The infant's parent states that the infant doesn't like to eat and the parent hates to make the infant eat. The nurse should A-contact the social worker on duty and give the social worker information about the situation. B-contact the physician to have the child put in isolation. C-request that a dietitian talk with the parent about infants and nutrition. D-contact the local police department to report suspected child abuse.
C
Parents who bring a 3-week-old neonate to the hospital report that the infant has been "throwing up after every feeding." A nurse notes projectile vomiting while assessing the neonate. X-rays confirm A-gastroschisis. B-diaphragmatic hernia. C-pyloric stenosis. D-imperforate anus.
C
The father of a neonate diagnosed with gastroschisis tells the nurse that his wife had planned on breastfeeding the neonate. Which information should the nurse include in the preoperative teaching plan about feeding the neonate? A-The neonate will remain on nothing-by-mouth (NPO) status until after surgery. B-An iron-fortified formula will be given before surgery. C-The neonate will need total parenteral nutrition for nourishment. D-The mother may breastfeed the neonate before surgery.
C
The health care provider prescribes an intramuscular injection of vitamin K for a term neonate. The nurse explains to the mother that this medication is used to prevent which problem? A-hypoglycemia B-hyperbilirubinemia C-hemorrhage D-polycythemia
C
The nurse is evaluating the laboratory results of a neonate. Which clinical finding would the nurse interpret as most suggestive of physiologic hyperbilirubinemia? A-clinical jaundice before 36 hours of age B-clinical jaundice lasting beyond 14 days C-total bilirubin levels of 12 mg/dL (205 µmol/L) 3 days after birth D-total bilirubin level increasing by more than 5 mg/dL (86 µmol/L) per day
C
The parents of a neonate with a cleft lip are shocked when they see their child for the first time. Which nursing action should the nurse include in the neonate's plan of care to help the parents accept their newborn's anomaly? A-Encourage the parents to visit more frequently. B-Reassure them that surgery will correct the defect. C-Show them pictures of babies before and after corrective surgery. D-Allow them to complete their grieving process before seeing the infant again.
C
What is the most important intervention for the nurse to implement while caring for a neonate with an omphalocele? A-Keep the omphalocele dry. B-Cover the omphalocele when parents visit. C-Carefully position and handle the omphalocele. D-Gently palpate the omphalocele to assess for changes.
C
Which nursing intervention is essential while caring for an infant with cleft lip or palate? A-Avoid encouraging breastfeeding. B-Cradle the infant horizontally while feeding. C-Involve the parents in feeding as soon as possible. D-Choose a regular nursery nipple for feedings.
C
A 6-week-old infant is brought to the clinic by his mother. The abdomen is distended, and the mother reports forceful vomiting with increasing frequency over the past 2 weeks and normal stools. On examination, the nurse notes a palpable mass to the right of the umbilicus. The nurse should suspect which condition? A-Crohn's B-volvulus C-intussusception D-pyloric stenosis
D
A client with acute appendicitis develops a fever, tachycardia, and hypotension. Based on these findings, the nurse should further assess the client for which complication? A-deficient fluid volume B-intestinal obstruction C-bowel ischemia D-peritonitis
D
A client with nausea, vomiting, and abdominal cramps and distention is admitted to the healthcare facility. Which test result is most significant? A-blood urea nitrogen (BUN) level of [29 mg/dl (10.4 mmol/L)] B-serum sodium level of [132 mEq/L 132 mmol/L)] C-urine specific gravity of 1.025 D-serum potassium level of [3 mEq/L (3.0 mmol/L)]
D
A new mother states, "My baby spits up after every feeding." Which interventions should the nurse teach to this mother first? A-Feed the baby smaller, more frequent feedings. B-Change the infant to a soy formula. C-Elevate the head of the crib to 30°. D-Burp the infant more frequently during each feeding.
D
A nurse is preparing for the discharge of a neonate with a cleft lip and palate. One of the nurse's major concerns is to A-institute ordered antibiotic therapy. B-administer supplemental vitamins. C_apply a sterile dressing to the lip. D-establish an adequate feeding pattern.
D
A nurse suspects an infant may have a tracheoesophageal fistula or esophageal atresia. What is the most important intervention by the nurse? A-Give oxygen. B-Tell the parents. C-Put the neonate in an isolette or on a radiant warmer. D-Report the suspicion to the health care provider.
D
After surgical repair of a cleft lip, an infant exhibits difficulty breathing. Which measure should the nurse institute first? A-Raise the infant's head. B-Turn the infant onto the abdomen. C-Administer oxygen by mask. D-Open the infant's airway.
D
At birth, a neonate weighs 7 lb, 3 oz (3,267 g). When assessing the neonate 1 day later, the nurse obtains a weight of 7 lb (3,182 g) and an axillary temperature of 98° F (36.7° C) and notes that the sclerae are slightly yellow. The neonate has been breast-feeding once every 2 to 3 hours. Based on these findings, the nurse should add which nursing diagnosis to the care plan? A-imbalanced nutrition: less than body requirements related to inadequate feeding B-hypothermia related to immature temperature regulation C-deficient fluid volume related to insensible fluid loss D-risk for injury related to hyperbilirubinemia
D
The nurse caring for a neonate observes excessive oral secretions, and suspects a tracheoesophageal atresia. Which priority intervention should the nurse perform? A_Place a nasogastric (NG) tube. B-Stop PO feedings. C_Administer oxygen. D-Suction the secretions.
D
The nurse is caring for an alert 2-month-old child and assesses a sunken fontanelle. Which action would be most appropriate for the nurse to take based on the assessment? A-Obtain the child's weight. B-Administer vitamin supplements. C-Assess for neurologic deficits. D-Monitor fluid intake and output.
D
What is a priority nursing goal for an infant with intussusception? A-Restore fluids. B-Control diarrhea. C-Protect the skin. D-Manage acute pain.
D
Which finding would be most important in an 8-month-old infant admitted with severe diarrhea? A_bowel sounds every 5 seconds B-pale yellow urine C-normal skin elasticity D- depressed anterior fontanel
D
While the nurse is caring for a neonate born at 32 weeks' gestation, which finding would most suggest the infant is developing necrotizing enterocolitis (NEC)? A-the presence of 1 mL of gastric residual before a gavage feeding B-jaundice appearing on the face and chest C-an increase in bowel peristalsis D-abdominal distention
D