Chapter 15: Gastrointestinal Disorders My Nursing Test Banks

Chapter 15: Gastrointestinal Disorders

Multiple Choice

  1. 1. What is being assessed when auscultating the gastrointestinal system?
    1. 1. Changes in the abdominal appearance
    2. 2. Presence or absence of bowel sounds
    3. 3. Distension as well as spleen and liver size
    4. 4. Presence of a hernia

ANS: 2

Feedback
1. A visual inspection is done or this.
2. Auscultation allows the examiner to assess the bowel sounds and assess for any changes that may occur in the bowel sounds due to a GI problem.
3. Palpation assesses the distension and size.
4. Presence of a hernia is detected with palpation and a visual inspection.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Adaptation | Cognitive Level: Comprehension | REF: CHAPTER 15 | Type: Multiple Choice

  1. 2. Which of the following symptoms may be found in Celiac Disease?
    1. 1. Abdominal pain with bloating
    2. 2. Weight gain with very skinny extremities
    3. 3. Small, hard stools
    4. 4. Normal growth

ANS: 1

Feedback
1. The most common complaint of celiac patients is abdominal bloating that is usually painful.
2. Patients with this disorder usually appear skinny with thin extremities.
3. Patients with this disorder tend to have diarrhea and foul smelling stools.
4. This can affect growth because of villi damage due to gluten intolerance.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Adaption | Cognitive Level: Comprehension | REF: CHAPTER 15 | Type: Multiple Choice

  1. 3. When teaching the family about a gluten-free diet, what are the recommendations for the family about diet?
    1. 1. Many gluten-free products are available, so it is important to read labels.
    2. 2. Participation in a support group may help with identifying stores that carry gluten-free food.
    3. 3. Communion wafers contain gluten and may need to be avoided.
    4. 4. All of the above.

ANS: 4

Feedback
1. Reading labels will help identify food that can cause difficulty, as well as make the family aware of foods that the child will not tolerate.
2. Support groups are excellent resources for information about gluten-free foods and stores in the area that carry these products.
3. Speaking with the clergy may be important due to the gluten in communion wafers.
4. All are important factors for teaching about a gluten-free diet.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Teaching/Learning | Cognitive Level: Comprehension | REF: CHAPTER 15 | Type: Multiple Choice

  1. 4. Appendicitis may have abdominal pain as a symptom. Where does the abdominal pain occur?
    1. 1. Left upper quadrant
    2. 2. Right lower quadrant
    3. 3. Periumbilical
    4. 4. 2 and 3 only

ANS: 4

Feedback
1. Pain usually is not in the upper left quadrant.
2. Advances to the right lower quadrant
3. Begins in the periumbilical area
4. Pain usually is not in the upper left quadrant. It begins in the periumbilical area.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Adaptation | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

  1. 5. The most commonly used measure to diagnose obesity is:
    1. 1. Body mass index.
    2. 2. Ultrasound.
    3. 3. Weight measurement.
    4. 4. Cholesterol measurement.

ANS: 4

Feedback
1. Body mass index is the most commonly used measurement for diagnosing obesity. The CDC web site allows for the computation of body mass index for children and adults.
2. Ultrasounds do not assess obesity.
3. Weight measurements may be part of the diagnosis, but are not as definitive as the body mass index.
4. Cholesterol measurements may be part of the diagnosis, but are not as definitive as the body mass index.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Adaptation | Cognitive Level: Analysis | REF: CHAPTER 15 | Type: Multiple Choice

  1. 6. Gallstones are occurring more often in children. Which of the following is not a treatment for children with gallstones?
    1. 1. Surgery is always the treatment for gallstones.
    2. 2. Infants do not need treatment.
    3. 3. Crohns patients may have an ERCP, only without surgery.
    4. 4. Laser lithotripsy may be an effective option.

ANS: 1

Feedback
1. Surgery is not the only treatment for gallstones.
2. Infants usually resolve gallstones on their own.
3. Children with Crohns disease need a functioning gallbladder, and an ERCP may help them retain the gallbladder while removing the stones.
4. Laser lithotripsy has been found to be an effective treatment and is being used in children as an alternative treatment.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Adaptation | Cognitive Level: Comprehension | REF: CHAPTER 15 | Type: Multiple Choice

  1. 7. The first symptom in an infant of the gastrointestinal manifestation of cystic fibrosis is:
    1. 1. Constipation.
    2. 2. Meconium ileus.
    3. 3. Rapid weight gain.
    4. 4. Inability to breastfeed.

ANS: 2

Feedback
1. Newborns with cystic fibrosis fail to pass meconium in the first 48 hours.
2. Newborns with cystic fibrosis fail to pass meconium in the first 48 hours and develop meconium ileus. That may be followed by diarrhea and poor weight gain.
3. Rapid weight loss may occur due to diarrhea and poor weight gain.
4. Mothers of children with cystic fibrosis are encouraged to breastfeed because children with cystic fibrosis can breastfeed.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Adaptation | Cognitive Level: Analysis | REF: CHAPTER 15 | Type: Multiple Choice

  1. 8. Treatment for a child with cystic fibrosis with gastrointestinal symptoms may include:
    1. 1. Pancreatic enzymes.
    2. 2. Fat-soluble vitamins.
    3. 3. No immunizations.
    4. 4. 1 and 2.

ANS: 4

Feedback
1. A child with cystic fibrosis will require replacement pancreatic enzymes.
2. A child with cystic fibrosis will require fat-soluble vitamins for proper growth and nutrition.
3. Regular immunizations are recommended.
4. More than one answer applies.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Adaptation | Cognitive Level: Synthesis | REF: CHAPTER 15 | Type: Multiple Choice

  1. 9. Symptoms of Biliary Atresia would include which of the following?
    1. 1. Prolonged jaundice (appearing for longer than two weeks)
    2. 2. Elevated direct bilirubin (greater than 20 percent of the total bilirubin measurement)
    3. 3. Very dark stools
    4. 4. 1 and 2

ANS: 4

Feedback
1. Biliary Atresia causes prolonged jaundice, lasting well past two weeks.
2. The direct bilirubin remains elevated and is always greater than 20% of the total bilirubin measurement.
3. Stools become light and urine becomes dark.
4. Biliary Atresia causes a prolonged jaundice, lasting well past two weeks. The direct bilirubin remains elevated and is always greater than 20% of the total bilirubin measurement.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Adaptation | Cognitive Level: Synthesis | REF: CHAPTER 15 | Type: Multiple Choice

  1. 10. The main complication of neonatal jaundice is:
    1. 1. Lack of voiding and stooling.
    2. 2. Bilirubin encephalopathy.
    3. 3. The need to immediately stop breastfeeding.
    4. 4. Increased risk of infection.

ANS: 2

Feedback
1. Jaundice does not affect voiding and stooling, but lack of voiding and stooling may increase the jaundice level.
2. Bilirubin encephalopathy can cause hypotonia, opisthotonic posturing, and brain damage at high levels of jaundice, which make early intervention important.
3. Moms may continue to breastfeed if the baby is jaundiced, but may sometimes need to supplement if intake or output is poor.
4. Babies with an infection may have a higher jaundice level, but jaundice does not cause the infection.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Adaptation | Cognitive Level: Synthesis | REF: CHAPTER 15 | Type: Multiple Choice

  1. 11. Which of the following statements about gastroschisis and omphalocele is true?
    1. 1. Only omphalocele has a malrotation.
    2. 2. Omphalocele contain stomach and intestines within a sac of amnion and is associated with anomalies.
    3. 3. Gastroschisis opens to the left of the umbilical cord, contains the liver, and is associated with anomalies.
    4. 4. 1 and 2

ANS: 2

Feedback
1. Both defects are associated with malrotation.
2. Omphalocele may have the stomach and intestines, as well as other GI organs, and is covered by a sac that may rupture in utero. Both defects are associated with malrotation.
3. Gastroschisis arises to the right of the umbilical cord and has the stomach and intestines, but rarely the liver. It is also rarely associated with other anomalies.
4. Both defects are associated with malrotation. Omphalocele may have the stomach and intestines, as well as other GI organs, and is covered by a sac that may rupture in utero.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Adaptation | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

  1. 12. When caring for a newborn with an abdominal wall defect at birth, it is important to do all of the following except:
    1. 1. Wrap and support the defect to prevent rupture.
    2. 2. Start immediate feedings to support nutrition.
    3. 3. Insert an orogastric tube to decompress the stomach.
    4. 4. Provide parenteral nutrition.

ANS: 2

Feedback
1. Keeping the defect moist and supported helps to prevent a rupture.
2. Feeding will distend the abdomen and could cause damage.
3. An orogastric tube will help keep the stomach decompressed and help prevent a rupture.
4. Parenteral nutrition is needed for caloric intake and growth.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Adaptation | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

 

  1. 13. What serologic tests in Hepatitis B would indicate the presence of a chronic infection?
    1. 1. Hepatitis B surface antigen (HBsAg)
    2. 2. Anti-HBe
    3. 3. Anti-HBc subtotal
    4. 4. HB surface antibody (anti-HBs Ag)

ANS: 1

Feedback
1. Hepatitis B surface antigen with AntiHBc total indicates a chronic infection.
2. HB surface antibody indicates recovery from an infection.
3. Anti-HBe indicates decreasing infectivity, and recovery from infection gives a total, not a subtotal.
4. HB surface antibody indicates recovery from an infection.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Adaptation | Cognitive Level: Knowledge | REF: CHAPTER 15 | Type: Multiple Choice

  1. 14. Gastroesophageal reflux should be treated when a child or infant exhibits all of the following except:
    1. 1. When a baby spits up frequently.
    2. 2. If a baby develops a chronic cough or pneumonia.
    3. 3. When a baby has excessive irritability after meals.
    4. 4. When a child has a persistent sore throat without illness.

ANS: 1

Feedback
1. All babies spit up, but can have reflux that needs treatment.
2. Infants or children with respiratory symptoms should be treated.
3. Infants or children with excessive irritability should be treated.
4. Infants or children with persistent sore throat should be treated, as this makes eating difficult and will affect nutrition.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Adaptation | Cognitive Level: Knowledge | REF: CHAPTER 15 | Type: Multiple Choice

  1. 15. What are symptoms that may indicate an inguinal hernia?
    1. 1. Right lower quadrant pain with rebound tenderness
    2. 2. A feeling of weakness or pressure in the groin
    3. 3. The lack of a hydrocele in a newborn
    4. 4. Pain after internal rotation of a flexed thigh

ANS: 2

Feedback
1. Right lower quadrant pain with rebound and pain with internal rotation are indicative of an appendicitis.
2. Weakness and pressure in the groin area is common.
3. An infant with hydroceles should be examined for possible inguinal hernias.
4. Pain with an internal rotation of flexed thigh is not a sign of a hernia.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Adaptation | Cognitive Level: Comprehension | REF: CHAPTER 15 | Type: Multiple Choice

  1. 16. What information should be taught to parents of children with peptic ulcers?
    1. 1. Stress reduction techniques, such as relaxation
    2. 2. Minimal consumption of food that may aggravate condition
    3. 3. Child may stop medication when symptoms are gone.
    4. 4. The child may use Motrin for headaches.

ANS: 1

Feedback
1. Children should use appropriate relaxation techniques to reduce stress. This may include visualization and hypnosis.
2. Children should learn the foods that may aggravate the condition and avoid foods that can cause aggravation.
3. The course of medication for an ulcer should be completed and not stopped prematurely because of symptom abatement.
4. NSAIDS should not be used by children with ulcers as it aggravates the condition.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Teaching/Learning | Client Need: Physiological Adaption | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

  1. 17. What does an Irritable Bowel Syndrome (IBS) patient need to know to help reduce his/her symptoms?
    1. 1. Keep a food diary to identify triggers for symptoms
    2. 2. Decrease the amount of fiber in his/her diet
    3. 3. Fewer larger meals may reduce incidence of symptoms
    4. 4. Avoid supplements, such as fiber supplements or probiotics

ANS: 1

Feedback
1. IBS patients should keep a food diary to identify the foods that aggravate their condition.
2. IBS patients should also increase the amount of fiber in their diet.
3. IBS patients should eat more frequent, smaller meals.
4. Fiber and probiotic supplements are encouraged.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Teaching/Learning | Client Need: Physiological Adaptation | Cognitive Level: Knowledge | REF: CHAPTER 15 | Type: Multiple Choice

    1. 18. Crohns disease may present with which of the following symptoms?
    1. 1. Right lower quadrant pain
    2. 2. Joint pain
    3. 3. Increased growth
    4. 4. Skin lesions

ANS: 1

Feedback
1. Crohns disease may mimic appendicitis with right lower quadrant pain. It is manifested by diarrhea, usually bloody, not constipation.
2. Joint pain is a symptom seen in ulcerative colitis, not Crohns disease.
3. Growth is slow due to malabsorption of nutrients
4. Skin lesions are a symptom usually seen in ulcerative colitis.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Adaptation | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

19. What is the recommended treatment for gastroenteritis?

    1. 1. Child should drink to thirst to replace fluids.
    2. 2. Child should take Imodium and Pepto-Bismol to stop diarrhea.
    3. 3. Mothers should stop breastfeeding until the illness is gone.
    4. 4. The child should have a bland diet for 24 hours after the vomiting stops, then return to a regular diet.

ANS: 4

Feedback
1.  The child should only have small amounts of fluid, as large amounts may cause more vomiting.
2. Pepto-Bismol and Imodium should not be used for gastroenteritis in children.
3. Breastfeeding can continue even with gastroenteritis.
4. After vomiting stops and the child is tolerating fluids, then a bland diet is recommended with a return to regular diet in another 24 hours.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Adaptation | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

20. Treatment for constipation may be difficult. What is a strategy that may be included in the treatment of constipation?

1. Use of a reward system for successful toileting.

2. The child uses the toilet whenever he/she feels the urge.

3. Have the parents make a mental note about when the child uses the toilet.

4. None of the above are correct.

ANS: 1

Feedback
1. The child should have a record to keep track of taking his/her medication and his/her success with having a stool.
2. A child needs a regular schedule to sit on the toilet. He/she needs a regular time to sit on the toilet, usually twice a day, not just when the urge hits him/her.
3. The child should have a consistent reward system for successful toileting. He/she needs a regular time to sit on the toilet, usually twice a day, not just when the urge hits him/her.
4. One answer is correct.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Teaching /Learning | Client Need: Physiological Adaptation | Cognitive Level: Comprehension | REF: CHAPTER 15 | Type: Multiple Choice

    1. 21. Hirschsprungs Disease may present with which of the following symptoms?
    1. 1. No meconium passage in the first 24 hours
    2. 2. Persistent diarrhea
    3. 3. Excellent weight gain with little stooling
    4. 4. Hard, pellet-like stools

ANS: 1

Feedback
1.  Newborns with Hirschsprungs Disease may not pass meconium until well after the first 24 hours. The stools are thin and ribbon-like, and the child suffers from constipation. The child usually has poor weight gain.
2. The stools are thin and ribbon-like and the child suffers from constipation.
3. The child usually has poor weight gain.
4. The stools are thin and ribbon-like and the child suffers from constipation.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Adaptation | Cognitive Level: Comprehension | REF: CHAPTER 15 | Type: Multiple Choice

    1. 22. What are recommended interventions for a patient with Fatty Liver Disease?
    1. 1. Rapid weight loss
    2. 2. Metformin administration
    3. 3. Group-based therapy
    4. 4. 2 and 3

ANS: 4

Feedback
1. Slow, measured weight loss is better than a rapid dropping of weight.
2. Metformin is an effective therapy for this condition.
3. Group-based therapy with the adolescent age group for weight loss as support during this process is beneficial and effective.
4. Group-based therapy with the adolescent age group for weight loss as support during this process is beneficial and effective. Slow, measured weight loss is better than a rapid dropping of weight. Metformin is an effective therapy for this condition.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Teaching/Learning | Client Need: Physiological Adaptation | Cognitive Level: Comprehension | REF: CHAPTER 15 | Type: Multiple Choice

    1. 23. Intestinal obstruction can be caused by an Intussusception or a Volvulus. What are the important points to know about these conditions?

1. Intussusception and Volvulus are both immediately treated with surgery.

2. Intussusception cannot be reduced with a barium enema.

3. Both conditions present with continuous pain.

4. Both Intussusception and Volvulus may first be present with bilious vomiting.

ANS: 4

Feedback
1. Intussusception may be reduced with a barium enema or air insufflations.
2. Intussusception may be reduced with a barium enema or air insufflation, saving the baby from a surgical intervention.
3. Because of Malrotation, the conditions result in cramping pains.
4. Volvulus is always treated with surgery. Both conditions may have bilious vomiting as the presenting symptom. The pain in Volvulus is continuous; it may be intermittent with increasing frequency in an Intussusception.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Adaptation | Cognitive Level: Synthesis | REF: CHAPTER 15 | Type: Multiple Choice

24. A neonate has been taken to the nursery because of a cyanotic event while feeding due to choking. As the baby lies on the warmer bed, he/she is noted to have froth around the mouth. The priority action by the nurse would be to:

1. Assess vital signs.

2. Use suction to remove the secretions.

3. Hold the neonate in an upright position.

4. Feed the neonate.

ANS: 2

Feedback
1. Vital signs will need to be taken prior to informing the doctor, but is not the priority at this time.
2. Suctioning the secretions to maintain an open airway is the priority at this time.
3. Holding the neonate upright will force secretions down because of gravity and increase the risk for aspiration.
4. Feeding the neonate could increase the risk for aspiration. The child needs an evaluation before feedings are continued.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Synthesis | REF: CHAPTER 15 | Type: Multiple Choice

25. An infant is brought to the emergency department with the following clinical manifestations: poor skin turgor, weight loss, lethargy, tachycardia, and tachypnea. This is suggestive of which of the following?

1. Water excess

2. Sodium excess

3. Water depletion

4. Potassium excess

ANS: 3

Feedback
1. Water excess would cause crackles in the lungs and a doughy skin turgor with weight gain.
2. Sodium excess would cause the child to have sunken eyes and gain weight.
3. Water depletion will cause these signs and symptoms.
4. Potassium excess will cause irregular heart rhythms and nausea.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Synthesis | REF: CHAPTER 15 | Type: Multiple Choice

26. Clinical manifestations of sodium excess (hypernatremia) include which of the following?

1. Hyperreflexia

2. Abdominal cramps

3. Cardiac dysrhythmias

4. Dry, sticky mucous membranes

ANS: 4

Feedback
1. Hyperreflexia occurs with high magnesium levels.
2. Abdominal cramping may occur with high potassium levels.
3. Cardiac dysrhythmias will occur with hypercalcemia.
4. High sodium concentrations cause water loss and create dry, sticky mucous membranes.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: CHAPTER 15 | Type: Multiple Choice

27. A 7 year old with acute diarrhea and mild dehydration is being given oral rehydration. The childs mother calls the clinic nurse because he is also occasionally vomiting. The nurse should recommend which of the following?

1. Bring the child to the hospital as soon as possible for IV fluids

2. Alternate between oral rehydration and soda pop

3. Continue giving the oral rehydration in small amounts

4. Do not allow the child to drink anything for the next eight hours, then restart fluids if the vomiting has stopped.

ANS: 3

Feedback
1. Because this is acute and only occasional vomiting, the child can be taken care of at home with close monitoring.
2. Soda has sodium and can contribute to the electrolyte imbalance.
3. Small amounts of fluids will decrease the urge to vomit because it is not filling the entire stomach, and the hydration will help the electrolytes find balance.
4. Waiting eight hours can further the dehydration and cause more issues with vomiting because the electrolyte imbalance is not being addressed.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

28. A newborn has been diagnosed with tracheoesophageal fistula. The nurse should ask for clarification of the doctors orders if the chart states to:

1. Place an IV for fluids and antibiotics.

2. Use an NG tube placed into the proximal pouch.

3. Take aspiration precautions.

4. Place the newborn in the prone position with his/her head elevated.

ANS: 4

Feedback
1. IV fluids will be needed to maintain electrolyte balance because the newborn will not be receiving oral feedings.
2. The NG will help drain any secretions in the pouch.
3. The newborn is at high risk for aspiration because of the lack of connection to the stomach.
4. The newborn should be in a supine position to prevent aspiration and allow for the secretions to drain.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Communication/Documentation | Client Need: Safe and Effective Care Environment | Cognitive Level: Synthesis | REF: CHAPTER 15 | Type: Multiple Choice

29. Comfort care for a neonate with a new diagnosis of tracheoesophageal fistula would consist of all of the following except:

1. Holding the neonate.

2. Swaddling the neonate.

3. Nonnutritive sucking on a pacifier.

4. Placing sucrose on a pacifier for the baby to have nonnutritive sucking.

ANS: 4

Feedback
1. Neonates are comforted when being held.
2. Swaddling helps a neonate find his/her boundaries and allows for him/her to feel comfort.
3. The sucking is a normal reaction and soothes the newborn.
4. The neonate should remain NPO to prevent chances for aspiration.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: CHAPTER 15 | Type: Multiple Choice

30. A family has just received the diagnosis of Celiac Disease for their 5-year-old son. The nurse knows that the family understands the teaching when the father states:

1. We will need to read labels, and anything with white flour should be avoided.

2. My child will not be able to participate in hockey anymore because of the diagnosis.

3. The family will need to change its eating out habits and only cook at home.

4. We will need to notify the school so that other children will not catch the disease.

ANS: 1

Feedback
1. White flour contains gluten, which is the allergy issue for Celiac Disease.
2. A child can participate in any sports with this disease.
3. The family will need to modify what is ordered when eating out.
4. Celiac Disease is not contagious.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance | Cognitive Level: Evaluation | REF: CHAPTER 15 | Type: Multiple Choice

31. An appendectomy has been performed on an 8-year-old boy. When the child arrives to the pediatric unit, the top nursing priority will be:

1. Measuring the childs urine output.

2. Making the parents comfortable in the room.

3. Starting the child on a liquid diet.

4. Monitoring for pain.

ANS: 4

Feedback
1. Kidney function will be assessed after the patient has adequate pain management.
2. The parents will need to be comfortable in the room, but this is not the top priority for the boy.
3. The child will remain NPO for a few hours after the surgery.
4. Pain management will be the top priority because of the surgical site.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Synthesis | REF: CHAPTER 15 | Type: Multiple Choice

32. A child that is exhibiting signs of appendicitis will have:

1. Pain after internal rotation of a flexed thigh.

2. Rebound pain on the left quadrant.

3. A high fever.

4. Acute pain episodes for 3 to 4 days in a row.

ANS: 1

Feedback
1. Rotation of the leg may cause pain in a child with appendicitis.
2. Rebound pain happens in the left quadrant.
3. A high fever is usually not noted in appendicitis until rupture occurs.
4. Acute pain is short in duration.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: CHAPTER 15 | Type: Multiple Choice

33. A 3-month-old infant has had surgery to repair an inguinal hernia. The nurse is giving discharge instructions for care of the surgical site. Instructions should include:

1. Cleansing the surgical site by placing the infant in a bathtub twice a day.

2. After each diaper change, check to make sure the area is clean and dry.

3. Apply a dressing to the area to keep it clean.

4. Remove the stitches in one week.

ANS: 2

Feedback
1. Placing the child in the bathtub may saturate the site and increase the risk for infection.
2. Keeping the site clean and dry will aid in healing without infection.
3. A dressing may keep the area moist and not facilitate healing.
4. The stitches may need to be removed by a health-care provider.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance | Cognitive Level: Comprehension | REF: CHAPTER 15 | Type: Multiple Choice

34. When palpating an inguinal hernia, a nurse would be concerned when feeling:

1. Crepitus.

2. Normal skin.

3. An edematous area surrounding the hernia.

4. A lump with erythema and edema.

ANS: 4

Feedback
1. Crepitus is not noted when palpating an inguinal hernia.
2. Normal skin will not be noted with an inguinal hernia.
3. The area will have edema along with erythema.
4. Erythema and edema would be cause for concern with an inguinal hernia. It may indicate strangulation of tissue or loss of circulation.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: CHAPTER 15 | Type: Multiple Choice

35. A nurse working on a pediatric floor has three patients. Which patient should be seen first?

1. A four hour old post-op appendectomy with IV fluids and an antibiotic due

2. The child with abdominal pain and rectal bleeding with IV fluids.

3. An infant that had hernia repair surgery yesterday.

4. A family needing teaching about diet restrictions related to Celiac Disease

ANS: 2

Feedback
1. The patient is beyond the crucial two hour time frame after surgery.
2. This patient should be seen first because of the active bleeding.
3. The hernia repair assessment can be done at any time because the patient is not exhibiting risk factors.
4. Teaching can be done at various times throughout the childs inpatient stay and is not a top priority at this time.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: CHAPTER 15 | Type: Multiple Choice

36. A pediatric patient with ulcerative colitis is receiving long-term corticosteroid therapy. A side effect of this type of therapy can include all of the following except:

1. A higher than average heart rate.

2. Mood swings.

3. Easy bruising.

4. A moon face.

ANS: 1

Feedback
1. The heart rate is not affected by the long-term use.
2. Mood swings are apparent in children with long-term use.
3. Easily bruising occurs with long-term use.
4. The moon face is a side effect of long-term corticosteroid therapy.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: CHAPTER 15 | Type: Multiple Choice

37. A common sign of an infant having a peptic ulcer is:

1. Abdominal distension.

2. Frequent stools.

3. Anorexia.

4. Gastritis.

ANS: 1

Feedback
1. This is a common sign of peptic ulcer disease.
2. This is seen in Crohns disease.
3. The infant will want to eat and can digest foods, so they do not have a wasted appearance.
4. The infant will not have inflammation of the GI tract.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: CHAPTER 15 | Type: Multiple Choice

38. The mother of a teen with Irritable Bowel Syndrome is asking what types of food should be part of his diet. Identify a food that would be appropriate for the teen.

1. Wheat Chex cereal

2. Hamburger

3. Spinach

4. Peaches

ANS: 1

Feedback
1. High fiber should be part of the diet to help with bowel movements.
2. A hamburger does not provide the needed fiber content for bowel movements. The protein can be irritating to the stomach.
3. The spinach does not have the high fiber content needed.
4. The peaches do not have the high fiber content needed.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

39. When assessing an emesis of an infant, it is important to note which of the following?

1. Curdled milk

2. Amount

3. The timing of the emesis

4. All of the above should be documented.

ANS: 4

Feedback
1. Curdled milk is an indication of the digestion process.
2. The amount can indicate the adoption of the previous intake.
3. The timing may indicate what the infant is doing to cause the emesis.
4. Curdled milk, amount, and timing can give indications as to how to treat the infants condition.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

40. A 6 month old is exhibiting signs of gastroesophageal reflux. A nursing intervention to aid in decreasing pain would be:

1. Elevating the head of the bed 30 degrees.

2. Providing large amounts of formula every three hours.

3. Thinning formula so it decreases occurrences.

4. Keep the baby held upright for an hour after feedings.

ANS: 1

Feedback
1. Elevating the head of the bed will help take pressure off of the diaphragm.
2. Small amounts of food decrease the occurrence of gastroesophageal reflux.
3. Thinning formula decreases the calories needed and does not decrease the occurrence of gastroesophageal reflux.
4. Keeping a baby upright for an hour is not a realistic expectation.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

41. A new baby has been diagnosed with gastroesophageal reflux. As the nurse is feeding the baby, she notes that the baby is twisting and arching. The nurse knows that the baby is exhibiting:

1. Torsion.

2. Flexion.

3. Sandifers Syndrome.

4. Hashimoto Disease.

ANS: 3

Feedback
1. Torsion is the twisting of the gut.
2. Flexion is the extension of the body. The baby is arching.
3. The infant is exhibiting Sandifers Syndrome with the twisting and arching.
4. Hashimoto Disease is a thyroid disorder.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: CHAPTER 15 | Type: Multiple Choice

42. A previously healthy 3-week-old baby has been admitted to the pediatric unit for pyloric stenosis. On admission, what would the nurse anticipate being told?

1. History of watery stools

2. History of projectile vomiting

3. History of increased stools

4. History of vomiting with large amount of bile

ANS: 2

Feedback
1. Normal stools are present with pyloric stenosis.
2. The projectile vomiting is an indication that the pyloric sphincter is not holding the stomach contents in properly.
3. The infant may have decreased stools.
4. The vomiting consists of formula/milk that appears similar to what was in the bottle.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: CHAPTER 15 | Type: Multiple Choice

43. A child with unresolved pyloric stenosis may exhibit signs of:

1. Crying.

2. Irritability.

3. Poor weight gain.

4. Tachycardia.

ANS: 3

Feedback
1. The baby may cry because he/she is hungry, but this is not the major, long-term issue.
2. The baby may be irritable because he/she is hungry, but this is not the major, long-term issue
3. Poor weight gain is a major, long-term issue that needs to be resolved quickly so that there are no neurological effects.
4. Tachycardia is not common with long-term pyloric stenosis issues.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: CHAPTER 15 | Type: Multiple Choice

44. The nurse is assessing an infant with a history of projectile vomiting. The nurse is palpating the abdomen and notes an olive sign in the upper abdomen. This is the cardinal sign of:

1. Pyloric stenosis.

2. GERD.

3. Intussusception.

4. Hirschsprungs disease.

ANS: 1

Feedback
1. The olive sign is the actual shape of the pyloric sphincter and the stomach meeting.
2. Palpation does not help diagnose GERD.
3. Intussusception is noted by a raised bowel in the lower abdomen.
4. Palpation for Hirschsprungs will note an obtunded abdomen, not the olive sign.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: CHAPTER 15 | Type: Multiple Choice

45. The nurse has received orders for a 4 month old with a diagnosis of Volvulus. To provide comfort for the infant, the nurse should:

1. Encourage the mother to hold the infant and provide a pacifier.

2. Keep the infant swaddled tightly.

3. Place the infant in a prone position.

4. Assess the pain level of the infant using the FACES scale.

ANS: 1

Feedback
1.  The holding will place the patient in a position to take pressure off of the abdomen, and the pacifier may help with decreasing the need for food.
2. Swaddling the baby may cause more distress because of the constriction around the abdomen.
3. The prone position will place too much pressure on the abdomen.
4. FACES is used for assessing pain, not providing a source of comfort.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Caring | Client Need: Physiological Integrity | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

46. An infant with intussusception has returned to the pediatric unit from the operating room. The nurse should anticipate providing all of the following care except:

1. Maintaining an IV.

2. Starting gradual oral feedings right away.

3. Monitoring for pain.

4. Maintaining the nasogastric tube.

ANS: 2

Feedback
1. The infant will not be taking in large amounts of fluids, so IV fluid maintenance will be important.
2. The infants intestinal tract will need time to heal prior to starting feedings.
3. Pain management will be needed for healing.
4. The NG tube will help with draining gastric contents and air to decrease the risk for an upset stomach.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

47. Megan is caring for a neonate. Megan assesses the possibility of necrotizing enterocolitis (NEC) because the premie is exhibiting the generalized assessment of:

1. Hypertonia, tachycardia, and metabolic alkalosis.

2. Abdominal distention, temperature instability, and bloody stools.

3. Hypertension, apnea, and ruddy skin color.

4. No residual feedings and increased urinary output.

ANS: 2

Feedback
1. Metabolic alkalosis cannot be seen in a generalized assessment.
2. These are the cardinal signs of a neonate with a generalized assessment of necrotizing enterocolitis.
3. Hypotension usually occurs, along with the neonate appearing gray or pale in color.
4. Feedings will have a high residual and a decreased urinary output when necrotizing enterocolitis is developing.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: CHAPTER 15 | Type: Multiple Choice

48. A toddler has been diagnosed with short bowel syndrome because of a past history of necrotizing enterocolitis. The nurse should encourage the parents to do all of the following except:

1. Give the child juice at least once a day to help with Vitamin C consumption.

2. Give enteral feedings.

3. Introduce solid food.

4. Keep follow-up appointments.

ANS: 1

Feedback
1. Juice may cause more diarrhea and should be avoided.
2. The child may need to have enteral feedings to increase the calorie content for growth because of the lack of absorption in the GI tract.
3. Solid food should be started slowly and be in higher calorie content because of the lack of absorption for the GI tract.
4. Appointments are needed to make sure the child is growing and receiving the proper nutritional content.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

59. Which of the following conditions is often associated with severe diarrhea of gastroenteritis?

1. Metabolic acidosis

2. Metabolic alkalosis

3. Respiratory acidosis

4. Respiratory alkalosis

ANS: 1

Feedback
1. The body is in an acidic state and because of the electrolyte imbalance in the GI tract, it is metabolic acidosis.
2. Alkalosis is not occurring because of the lack of fluid.
3. The condition is not affecting the respiratory tract.
4. The condition is not affecting the respiratory tract.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: CHAPTER 15 | Type: Multiple Choice

50. A nurse taking care of a child with severe gastroenteritis knows that compensation for fluid loss will occur. What causes the compensation to occur?

1. Vasodilation of the peripheral vascular system increases the perfusion.

2. Fluid shifts from the interstitial space to the intravascular space

3. The renal-aldosterone system is activated.

4. The body reserves the fluid in the vasculature so that the heart does not have an increased workload.

ANS: 2

Feedback
1. Vasoconstriction can occur because of the lack of fluid.
2. The fluid shift occurs because the cells are dehydrated and want the fluid.
3. The renal-aldosterone system is not activated at this time.
4. The heart has an increased workload because the blood becomes thicker. The thickening occurs because of the lack of fluid.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

51. An infant is brought to the emergency department with the following clinical signs: poor skin turgor, weight loss, lethargy, tachycardia, and tachypnea. This is suggestive of which of the following?

1. Sodium excess

2. Water depletion

3. Potassium Excess

4. Fluid overload

ANS: 2

Feedback
1. An infant with sodium excess would have weight gain because of fluid retention as well as a doughy skin turgor.
2. The weight loss and poor skin turgor indicate the lack of fluid in the body. The high heart and respiratory rates are because the blood is thicker, making the heart and lungs work harder.
3. The infant is not exhibiting cardiac arrhythmias that are part of hyperkalemia.
4. The infant would have increased weight, a doughy skin turgor, and a sluggish pulse if fluid overload was occurring.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: CHAPTER 15 | Type: Multiple Choice

52. A preschooler that is being potty trained is refusing to have bowel movements. The mother brought the child to the clinic because now the child has constipation. The nurse speaks to the mother about behavior modification efforts to have the preschooler defecate. All of the following may help except:

1. Rewarding the child for defecating in the toilet.

2. Identifying when the child usually defecated prior to potty training, then attempting to use the toilet at that time.

3. Create regular times to use the potty, especially 5 to 10 minutes after a meal.

4. Rewarding the child for defecating in a diaper, then trying to retrain using the toilet.

ANS: 4

Feedback
1. Incentives for defecation may be the reason some children will have success because the urge for a treat is important to the child.
2. Timing can help create a known pattern so that the child understands the expectations at particular times throughout the day.
3. Food that is consumed helps to put pressure on the bowel, which may lead to defecation if the child does not have to hold it.
4. Reverting back to diapers may make the child refuse to use a toilet because of the convenience.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: CHAPTER 15 | Type: Multiple Choice

53. A child has been prescribed to use Senna to help reduce constipation. The nurse should include which of the following in her teaching?

1. Senna can be used long term.

2. Increasing the amount of fluid intake will be important to help Senna work effectively.

3. Senna should be used after an enema has been given.

4. Senna should also be used with milk of magnesium to improve the outcomes.

ANS: 2

Feedback
1. Senna should only be taken short term so that the bowel does not come to depend on the medication for defecation.
2. Fluid is important to help loosen stool and help Senna create the need for defecation.
3. Senna should be used prior to the use of an enema to try to defecate as much as possible in the least invasive manner possible.
4. Senna and Milk of Magnesium should not be used at the same time.

KEY: Content Area: Gastrointestinal Disorders/Pharmacology | Integrated Processes: Teaching/Documentation | Client Need: Safe and Effective Care Environment | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

54. A child with issues of constipation should include which of the following foods in his/her diet to facilitate defecation?

1. Skittles

2. Apples

3. White bread

4. Grilled chicken breast

ANS: 2

Feedback
1. A candy may increase constipation because of the sodium content.
2. Apples will increase the amount of fiber, thus making the bowel act to defecate.
3. White bread lacks fiber and is not effective for constipation.
4. Chicken breasts lack the fiber that is needed for the defecation.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: CHAPTER 15 | Type: Multiple Choice

55. A cardinal sign of Hirschsprungs Disease in neonates is:

1. A thin abdomen.

2. Constipation since birth.

3. Dry, pebble-like stools.

4. Crying every time the neonate is fed.

ANS: 2

Feedback
1. The abdomen becomes obtunded because of the collection of stool in the colon.
2. Constipation is present because of the collection of stool in a particular portion of the colon.
3. The stool is thin and ribbon-like in appearance.
4. The neonate tends to vomit after eating because the food cannot move through the digestive tract.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: CHAPTER 15 | Type: Multiple Choice

56. The family of a child with suspected Hirschsprungs Disease is asking the nurse about the preparation for confirming the diagnosis. The nurse should explain which of the following procedures to the family?

1. A barium enema

2. A rectal biopsy

3. A transabdominal ultrasound

4. A bronchoscope

ANS: 2

Feedback
1. Not advised because there is blockage in the colon
2. Will indicate if Hirschsprungs Disease is present
3. Does not provide a clear view of the diseased tissue
4. The test looks at the lungs, not the intestines.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Communication/Documentation | Client Need: Health Promotion and Maintenance | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

57. The nurse is assessing a child with a history of Hirschsprungs Disease. The nurse should expect to have assessment findings of:

1. Frequent bloody stools.

2. Abdominal cramping and fecal soiling in the childs underwear.

3. A low hematocrit.

4. Thin, ribbon-like, foul smelling stool and a distended abdomen

ANS: 4

Feedback
1. Few stools occur with a child with this disease.
2. Abdominal cramping may occur, but the child is able to use the toilet.
3. There is no bleeding involved in the disease process, so a low hematocrit is rare.
4. The thin, ribbon-like stools occur because of the small passageway for stool to move through the affected area. The abdomen is distended because of the gas and fecal buildup in the affected area.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: CHAPTER 15 | Type: Multiple Choice

58. A neonate has been born with a known diagnosis of an omphalocele. The nurse should provide all of the following cares for the neonate except:

1. Swaddling the baby in blankets to keep body temperature stable.

2. Providing nonnutritive sucking.

3. Maintaining IV access for fluids.

4. Keeping the omphalocele moist and on a warmer bed to keep the body temperature stable.

ANS: 1

Feedback
1. The swaddling will introduce material onto the omphalocele and dry out the area, increasing the risk for infection.
2. Nonnutritive sucking will soothe the neonate.
3. IV access will be needed to maintain a fluid balance because of the NPO status.
4. Keeping the omphalocele moist and warm will help keep the body stable.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: CHAPTER 15 | Type: Multiple Choice

59. A neonate is born with gastroschisis. The nurse should be the most concerned about which of the following when caring for the child?

1. Keeping the organs dry and warm

2. Assessing the organs to make sure that there is no vascular compromise

3. Starting oral feedings so that the stomach and intestines can start working

4. Maintaining an IV

ANS: 2

Feedback
1. The organs should be kept warm and as moist as possible to prevent drying, cracking, and increasing the risk for infection.
2. Vascular compromise is of concern, so positioning will be important.
3. The child will remain NPO until the gut can be further examined.
4. Maintaining IV access is needed, but not the top priority at this time.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Safe and Effective Care Environment | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

60. A home care nurse is visiting a 5-day-old male infant for a scheduled follow-up appointment to ensure that he is responding to home phototherapy for treatment of jaundice. After completing a thorough assessment and obtaining a history from the parents, the nurse recognizes that this infant is in the first phase of encephalopathy when he exhibits:

1. A high-pitched cry when touched.

2. Severe muscle spasms.

3. Fever and seizures.

4. Hypotonia, lethargy, and a poor suck when feeding.

ANS: 4

Feedback
1. A high-pitched cry occurs in later phases of the encephalopathy.
2. Muscle spasms are not present with this diagnosis.
3. Fevers are rare in neonates with encephalopathy. The seizures can occur if the levels continue to climb.
4. Hypotonia, lethargy, and poor feedings are the first symptoms to occur in the first phase of encephalopathy caused by jaundice.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: CHAPTER 15 | Type: Multiple Choice

61. A mother is asking the nurse if her infant will be able to still breastfeed even though the infant is on phototherapy. Feedings for the infant:

1. Should be minimal while under phototherapy.

2. Should be done through a bottle because the baby will be too lethargic to breastfeed.

3. Should be stopped until the bilirubin levels have dropped into normal limits.

4. Should be frequent to promote bowel movements to rid the body of the bilirubin.

ANS: 4

Feedback
1 Feeding is important because the bilirubin binds to the fecal matter for excretion.
2. The baby can breastfeed even though the bilirubin level is elevated.
3. Feedings should continue because the bilirubin binds to the fecal matter for excretion.
4. Frequent feedings will help promote bowel movements. The bilirubin binds to the fecal matter for excretion.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Teaching/Learning | Client Need: Physiological Integrity | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

62. A child with a known diagnosis of biliary atresia is not able to absorb:

1. Minerals.

2. Fat-soluble vitamins.

3. Calcium.

4. Sodium.

ANS: 2

Feedback
1. The childs body can absorb minerals without difficulty.
2. The childs body cannot absorb enough fat-soluble vitamins and may need supplementation.
3. The childs body can absorb the adequate amount of calcium.
4. The childs body can absorb the adequate amount of sodium.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: CHAPTER 15 | Type: Multiple Choice

63. A mother is being taught about the emergency situations for her child that has a diagnosis of biliary atresia. Emergency care should be provided if the child exhibits all of the following except:

1. Gray stools.

2. Jaundiced for 18 days.

3. Ruddy cheeks.

4. Pale skin.

ANS: 2

Feedback
1. Gray stools are a common characteristic of biliary atresia.
2. A child should not be jaundiced for this long. This symptom can indicate liver failure.
3. Ruddy cheeks are a common characteristic of biliary atresia.
4. Pale skin is a common characteristic of biliary atresia because of the liver function.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: CHAPTER 15 | Type: Multiple Choice

64. A common medication that is used for children with Fatty Liver disease is:

1. Metformin.

2. Vitamin C.

3. Prilosec.

4. Probiotics.

ANS: 1

Feedback
1. Metformin helps reverse the effects of Fatty Liver Disease on the body.
2. Vitamin C can be absorbed by the body through foods and does not need to have a supplement.
3. Prilosec is not a medication used to treat Fatty Liver Disease.
4. Probiotics are used for the intestinal tract, not Fatty Liver Disease.

KEY: Content Area: Gastrointestinal Disorders/Pharmacology | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: CHAPTER 15 | Type: Multiple Choice

65. A mother calls the clinic to ask which immunizations her child, who has cystic fibrosis, can have at the next checkup. Which statement would be an appropriate response from the nurse?

1. The immunization schedule will need to be altered.

2. Your child should not receive the Hepatitis series.

3. Your child should not receive the Polio vaccine.

4. Your child can receive all of the basic immunizations to help maintain immunity.

ANS: 4

Feedback
1. A child with cystic fibrosis can receive immunizations on the same schedule as any other child.
2. A child with cystic fibrosis should receive the Hepatitis series to help reduce the risk for contracting the disease.
3. The child can receive the vaccine because it is a basic immunization.
4. All basic immunizations should be given to a child with cystic fibrosis to maintain immunity.

KEY: Content Area: Cystic Fibrosis | Integrated Processes: Teaching and Learning | Client Need: Health Promotion/Maintenance | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

66. A child with cystic fibrosis is at risk for rectal prolapse because:

1. The body lacks enzymes to break down food.

2. Coughing attacks can weaken the muscle of the rectum.

3. Large bowel movements can cause the prolapse.

4. Of muscle atrophy throughout the body.

ANS: 2

Feedback
1. The lack of particular enzymes does not contribute to the prolapsed.
2. The coughing attacks cause muscle weakness in the rectum, thus causing a prolapse.
3. A child with cystic fibrosis may have larger bowel movements, but this does not cause the prolapse.
4. Muscle atrophy does not occur in the rectum, and thus is not the reason for the rectal prolapse.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

67. Long-term goals for education for a child with cystic fibrosis should consist of:

1. Taking enzyme medication before bed.

2. Only receiving immunizations when healthy.

3. Learning foods that do not need to have enzyme therapy applied.

4. Not mixing enzymes with soft acidic foods.

ANS: 3

Feedback
1. The enzyme medication should be taken with meals throughout the day.
2. Immunizations should be received when scheduled.
3. Certain foods do not need the enzyme therapy applied because they already have the needed enzymes for digestion.
4. Enzymes can be mixed with acidic foods and not cause harm to the child.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Choice

68. A nurse has received orders to obtain laboratory tests for a child to rule out gallstones. The nurse should question which order?

1. CBC

2. Amylase

3. PT and PTT

4. Ultrasound

ANS: 3

Feedback
1. A CBC can indication infection within the body.
2. Amylase will indicate if the child can breakdown the carbohydrates in the body.
3. Gallstones do not cause clotting issues in the body.
4. An ultrasound can identify stones within the gallbladder, along with the size of the gallbladder.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Safe and Effective Care Environment | Cognitive Level: Synthesis | REF: CHAPTER 15 | Type: Multiple Choice

69. When caring for a child with Hepatitis, it is important for the nurse to do all of the following except:

1. Use standard precautions.

2. Provide information for the family to receive the Hepatitis A and B vaccines.

3. Schedule immunizations.

4. Teach proper nutrition to attempt to keep the body as nourished as possible.

ANS: 3

Feedback
1. Standard precautions should be used with every patient.
2. Information empowers the family to play an active role in the childs health care.
3. The family will need to schedule the immunizations based on the health-care providers recommendations.
4. Nutrition will be important to maintain a healthy lifestyle.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: CHAPTER 15 | Type: Multiple Choice

70. Diagnostic testing for hepatitis should include:

1. CBC.

2. Hepatitis B surface antigen.

3. Hemoglobin and hematocrit.

4. Liver antibodies.

ANS: 2

Feedback
1. A CBC will not give an indication of Hepatitis.
2. Testing for the Hepatitis antigen is needed to be able to make a diagnosis.
3. Hemoglobin and hematocrit do not give a diagnosis for Hepatitis.
4. Liver antibodies may indicate liver damage, but not Hepatitis.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: CHAPTER 15 | Type: Multiple Choice

True/False

71. Necrotizing enterocolitis is caused by infection or ischemia, causing decreased oxygenation to the bowel as well as tissue death.

ANS: T

Feedback
1. Infections cause decreased oxygenation to the bowel, which causes damage and necrosis with tissue death.
2. Infections cause decreased oxygenation to the bowel, which causes damage and necrosis with tissue death.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Adaptation | Cognitive Level: Knowledge | REF: CHAPTER 15 | Type: True/False

72. A cause of elevated bilirubin in a newborn is related to an abnormality in the

pancreas.

ANS: F

Feedback
1. Biliary atresia may cause elevated bilirubin due to the abnormality in the biliary tree, which can cause liver damage. The liver may be damaged and need eventual transplantation.
2. Biliary atresia may cause elevated bilirubin due to the abnormality in the biliary tree, which can cause liver damage. The liver may be damaged and need eventual transplantation.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Adaptation | Cognitive Level: Application | REF: CHAPTER 15 | Type: True/False

73. Laser lithotripsy is the safest treatment for children with gallstones.

ANS: F

Feedback
1. Because of the size of children, lithotripsy is not a chosen method of treatment.
2. Because of the size of children, lithotripsy is not a chosen method of treatment.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Safe and Effective Care Environment | Cognitive Level: Knowledge | REF: CHAPTER 15 | Type: True/False

Multiple Response

74. What are practices for the preventing the transmission of Hepatitis B? Select all that apply.

    1. 1. Infants should receive the Hepatitis B series of immunizations at birth, and at 2, 3, 4 and 6 months.
    2. 2. All mothers should be tested for Hepatitis B during pregnancy.
    3. 3. Needle stick prevention should be emphasized.
    4. 4. Teach good handwashing to prevent oral fecal transmission.
    5. 5. Avoid food that is contaminated with Hepatitis B.

ANS: 1, 2, 3

Feedback
1. Immunization is a preventative practice.
2. Testing for pregnant mothers is a preventative practice.
3. Prevention of needle sticks is a preventative practice.
4. It is not transferred by the oral fecal route.
5. Hepatitis B is not spread through contaminated food.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Teaching/Learning | Client Need: Safety and Effective Care Management | Cognitive Level: Knowledge | REF: CHAPTER 15 | Type: Multiple Response

75. What are important teaching points for a patient with ulcerative colitis? Select all that apply.

    1. 1. Stress reduction techniques, such as relaxation
    2. 2. Report any illness to the gastroenterologist for possible medication adjustment.
    3. 3. The child only needs appointments when the symptoms occur.
    4. 4. Importance of the regular medication use and possible side effects
    5. 5. Teach about the proper cleansing material.

ANS: 1, 2, 3

Feedback
1. Stress reduction may help to decrease some exacerbations of the disease.
2. Medication would need adjustment if the child becomes ill.
3. A child with ulcerative colitis needs to have regular follow-up visits, whether symptomatic or not.
4. A child with ulcerative colitis needs to have regular follow-up visits, whether symptomatic or not. Medication would need adjustment if the child becomes ill. The parents and child need to know about the medications and the side effects to report. Stress reduction may help to decrease some exacerbations of the disease.
5. Cleansing the area will not decrease the occurrence of exacerbation.

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Teaching/Learning | Client Need: Physiological Adaptation | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Response

76. Triple therapy has been prescribed for a 13 year old with peptic ulcer disease. Identify the medications that are part of the therapy Select all that apply.

1. Polyethylene Glycol

2. Omeprazole

3. Prevacid

4. Pantoprazole

5. Ranitidine

ANS: 2, 3

Feedback
1. This medication is otherwise known as Mirlax and is not used for peptic ulcers.
2. A common treatment for peptic ulcers
3. An over-the-counter treatment for peptic ulcers
4. Used for gastroesophageal reflux, not peptic ulcers
5. Used for gastroesophageal reflux, not peptic ulcers

KEY: Content Area: Gastrointestinal Disorders/Pharmacology | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: CHAPTER 15 | Type: Multiple Response

Matching

77. A new nurse is assessing a 7 year old with a history of abdominal issues. The nurse knows that she should complete the assessment in which order? (Number the sequence.)

__ Palpation

__ Auscultation

__ Percussion

__ Visual

ANS: 3, 2, 4, 1

KEY: Content Area: Gastrointestinal Disorders | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: CHAPTER 15 | Type: Matching

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