CHAPTER 23: GASTROINTESTINAL ALTERATIONS My Nursing Test Banks

CHAPTER 23: GASTROINTESTINAL ALTERATIONS

MULTIPLE CHOICE

1.Sucking and swallowing are automatic reflexes at birth, but they come under voluntary control by how many weeks of age?

a.

2

c.

6

b.

4

d.

8

ANS: C

Feedback

A

Incorrect. Sucking and swallowing do not come under voluntary control by 2 weeks of age.

B

Incorrect. Sucking and swallowing do not come under voluntary control by 4 weeks of age.

C

Correct. Sucking and swallowing are automatic reflexes at birth, but they come under voluntary control by 6 weeks of age as the nerves and muscles develop.

D

Incorrect. Sucking and swallowing do not come under voluntary control by 8 weeks of age.

PTS: 1 REF: p. 740 Alterations in Motility OBJ: Cognitive Level: Knowledge

2.The nurse will teach the caregivers about the need for small, frequent feedings by explaining to them that newborns and infants have:

a.

a slower metabolic rate than adults

b.

slower peristalsis

c.

decreased emptying rate

d.

a 10- to 20-milliliter stomach capacity at birth

ANS: D

Feedback

A

Incorrect. Newborns and infants have a faster metabolic rate than adults.

B

Incorrect. Newborns and infants have greater peristalsis.

C

Incorrect. Newborns and infants have increased stomach emptying rate.

D

Correct. Newborns and infants need for small, frequent feedings because they have a 10- to 20-milliliter stomach capacity at birth.

PTS: 1 REF: p. 740 Alterations in Motility OBJ: Cognitive Level: Knowledge

3.A parent tells the pediatric nurse about her baby spitting up. The nurse will explain that regurgitation by infants is:

a.

unusual and must be checked out by the pediatrician

b.

common because the lower esophageal sphincter tone is decreased

c.

unusual if it occurs more than twice a day for a period of a week

d.

common because the baby has a shorter esophageal tube

ANS: B

Feedback

A

Incorrect. Regurgitation by infants is common.

B

Correct. Regurgitation by infants is common because the lower esophageal sphincter tone is decreased or relaxed.

C

Incorrect. Regurgitation by infants is common.

D

Incorrect. Regurgitation by infants is common because the lower esophageal sphincter tone is decreased or relaxed.

PTS:1REF:p. 740 Alterations in Motility

OBJ: Cognitive Level: Comprehension

4.A parent asks why infants have so many soft stools. The nurse explains that this is caused by infants:

a.

secreting proportionately more fluids and absorbing less fluids than adults do

b.

having a totally liquid diet with no bulk or solids of any kind

c.

having a more sensitive bowel with greater peristaltic waves after any intake

d.

needing to take milk at such frequent intervals with stools following intake intervals

ANS: A

Feedback

A

Correct. Infants have so many soft stools because they secrete proportionately more fluids and absorb less fluids than adults due to having a proportionately shorter large intestine.

B

Incorrect. Infants do not have so many soft stools because they have a totally liquid diet with no bulk or solids of any kind.

C

Incorrect. Infants do not have so many soft stools because they have a more sensitive bowel with greater peristaltic waves after any intake.

D

Incorrect. Infants do not have so many soft stools because they need to take milk at such frequent intervals with stools following intake intervals.

PTS:1REF:p. 740 Alterations in Motility

OBJ: Cognitive Level: Comprehension

5.A mother wants to know why she cant give her 1-month-old child cereal as the child seems hungry all the time. Which of the following is the nurses best response?

a.

Until 4 to 6 months of age, babies have insufficient amounts of the pancreatic enzyme amylase, the enzyme that initially digests carbohydrate.

b.

The baby would not drink enough milk if he filled his stomach up with cereal, and he would not thrive as well.

c.

Infants are allergic to all food substances except milk until they are 6 months of age and develop sufficient antibodies.

d.

Infants get too fat if they are started on cereal before 4 to 5 months of age, and then they have a tendency to remain fat throughout life.

ANS: A

Feedback

A

Correct. A 1-month-old child should not be fed cereal because babies have insufficient amounts of the pancreatic enzyme amylase, the enzyme that initially digests carbohydrates until 4 to 6 months of age.

B

Incorrect: Introduction of solid foods before 4 to 6 months of age can contribute to food allergies; increased calorie intake, resulting in an overweight infant; and the danger of choking.

C

Incorrect. Infants are not allergic to all food substances except milk until they are 6 months of age and develop sufficient antibodies. They may be allergic to some solid foods; therefore, introduction of solid foods before 4 to 6 months of age can contribute to food allergies.

D

Incorrect. Introduction of solid foods before 4 to 6 months of age can contribute to increased calorie intake, resulting in an overweight infant.

PTS:1REF:p. 740 Alterations in Motility

OBJ: Cognitive Level: Application

6.Infants can absorb the fat in breast milk more readily than fat in formula because human breast milk:

a.

is a more constant and agreeable temperature

b.

contains vitamins

c.

contains lipase

d.

contains no fat

ANS: C

Feedback

A

Incorrect. The temperature of the milk, whether breast or formula, is not related to the absorption of fat.

B

Incorrect. The presence of vitamins in milk is not related to the absorption of fat.

C

Correct. Infants can absorb the fat in breast milk more readily than fat in formula because human breast milk contains lipase. Digestion and absorption of fats in infants is impaired because of low levels of the enzyme lipase.

D

Incorrect. Breast milk does contain fats, thus, this is an incorrect response.

PTS:1REF:p. 740 Alterations in Motility

OBJ: Cognitive Level: Comprehension

7.Which of the following is the initial symptom of hypertrophic pyloric stenosis?

a.

nonbilious vomiting starting between the 2nd and 4th week of life

b.

cramping and abdominal pain starting around the 3rd day after birth

c.

refusal to take the bottle or nurse

d.

a high-pitched and unusual cry

ANS: A

Feedback

A

Correct. Nonbilious vomiting starting between the 2nd and 4th week of life is the initial symptom of hypertrophic pyloric stenosis.

B

Incorrect. Cramping and abdominal pain starting around the 3rd day after birth is not the initial symptom of hypertrophic pyloric stenosis.

C

Incorrect. Refusal to take the bottle or nurse is not the initial symptom of hypertrophic pyloric stenosis. The infant is hungry and wants to be fed again, in spite of feeding and vomiting.

D

Incorrect. A high-pitched and unusual cry is not the initial symptom of hypertrophic pyloric stenosis.

PTS:1REF:p. 741 Inflammatory Disorders

OBJ: Cognitive Level: Comprehension

8.The infant with hypertrophic pyloric stenosis will eventually:

a.

experience spontaneous recovery in 75% of cases

b.

stop eating and go into a life-threatening decline

c.

have projectile vomitus propelled up to several feet

d.

pass an unusually large bowel movement

ANS: C

Feedback

A

Incorrect. The infant with hypertrophic pyloric stenosis will not eventually experience spontaneous recovery in 75% of cases. Treatment for pyloric stenosis is a surgical procedure called a pyloromyotomy.

B

Incorrect. The infant with hypertrophic pyloric stenosis is hungry and wants to be fed again, in spite of feeding and vomiting.

C

Correct. The infant with hypertrophic pyloric stenosis will eventually have projectile vomitus propelled up to several feet.

D

Incorrect. Because food does not pass through the pylorus, bowel movements are small.

PTS:1REF:p. 741 Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

9.Which of the following is an early warning sign of hypertrophic pyloric stenosis?

a.

the infant looking and acting somewhat sick

b.

the infant being hungry and wanting to feed again very soon after vomiting

c.

milk running out of the infants mouth periodically during the feeding

d.

unusually loud burping sounds

ANS: B

Feedback

A

Incorrect. The infant with hypertrophic pyloric stenosis does not act or look sick.

B

Correct. An early warning sign of hypertrophic pyloric stenosis is the infant being hungry and wanting to be fed again very soon after vomiting.

C

Incorrect. An early warning sign of hypertrophic pyloric stenosis is not milk running out of the infants mouth periodically during the feeding. The infant experiences vomiting which eventually becomes projectile, being propelled up to several feet.

D

Incorrect. An early warning sign of hypertrophic pyloric stenosis is not unusually loud burping sounds.

PTS:1REF:p. 742 Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

10.Diagnosis of hypertrophic pyloric stenosis can be made on history and what other finding?

a.

epigastric tenderness over several days

c.

failure to gain weight

b.

crying without producing any tears

d.

olive-shaped mass in the epigastrium

ANS: D

Feedback

A

Incorrect. Epigastric tenderness over several days is not a manifestation of hypertrophic pyloric stenosis.

B

Incorrect. Crying without producing any tears is a sign of dehydration.

C

Incorrect. Failure to gain weight accompanies hypertrophic pyloric stenosis but is not a diagnostic indicator.

D

Correct. Diagnosis of hypertrophic pyloric stenosis can be made on history and palpation of an olive-shaped mass in the epigastrium.

PTS:1REF:p. 742 Gastrointestinal Alterations

OBJ: Cognitive Level: Application

11.A preferred and highly accurate method of diagnosing hypertrophic pyloric stenosis is:

a.

ultrasonography with delay in gastric emptying and one or two narrow pyloric channels

b.

upper gastrointestinal series with delay in gastric emptying and one or two narrow pyloric channels.

c.

passing a lighted tube from the mouth into the stomach

d.

doing a pH test on the stomach contents collected over a 48-hour period

ANS: A

Feedback

A

Correct. A preferred and highly accurate method of diagnosing hypertrophic pyloric stenosis is ultrasonography with direct visualization of the hypertrophied muscle and the pyloric channel.

B

Incorrect. The upper gastrointestinal series with delay in gastric emptying and one or two narrow pyloric channels is not the diagnostic method of choice.

C

Incorrect. Passing a lighted tube from the mouth into the stomach is not a method of diagnosing hypertrophic pyloric stenosis.

D

Incorrect. Doing a pH test on the stomach contents collected over a 48-hour period is a method of diagnosing gastroesophageal reflux.

PTS:1REF:p. 742 Gastrointestinal Alterations

OBJ: Cognitive Level: Application

12.Postoperative nursing care of the baby who has had surgery to correct hypertrophic pyloric stenosis will focus on which of the following activities?

a.

feeding that is sufficient to get the baby to gain weight right away

b.

parents holding and comforting the baby

c.

rehydration and correction of electrolyte imbalance

d.

assessing the bowel sounds and the functioning of the bowel

ANS: C

Feedback

A

Incorrect. Postoperatively feedings of an electrolyte solution are begun 4 to 6 hours after surgery if bowel sounds are normal but is not the main focus of nursing care.

B

Incorrect. Encouraging the parents to hold and comfort the baby postoperatively is important but is not the main focus of nursing care.

C

Correct. Postoperative nursing care of the baby who has had surgery to correct hypertrophic pyloric stenosis will mainly focus on rehydration and correction of electrolyte imbalance.

D

Incorrect. Assessing the bowel sounds and the functioning of the bowel is an aspect of postoperative nursing care but not the main focus.

PTS:1REF:p. 742 Gastrointestinal Alterations

OBJ: Cognitive Level: Application

13.Following surgical correction of hypertrophic pyloric stenosis, the nurse will teach the family members to save diapers for which of the following reasons?

a.

to check the color of the urine as an indicator of bladder functioning

b.

to determine the number of soaked diapers per shift

c.

to measure urine output by weighing the diapers

d.

to test the urine for sugar and ketones

ANS: C

Feedback

A

Incorrect. The nurse will not teach the family members to save diapers to check the color of the urine as an indicator of bladder functioning.

B

Incorrect. The nurse will not teach the family members to save diapers to determine the number of soaked diapers per shift. It is important to monitor hydration status, however, the nurse would measure intake and output. Weighing the diapers is a more accurate method of determining output than counting the number of soaked diapers.

C

Correct. Following surgical correction of hypertrophic pyloric stenosis, the nurse will teach the family members to save diapers to measure urine output by weighing the diapers.

D

Incorrect. The nurse will not teach the family members to save diapers to test the urine for sugar and ketones.

PTS:1REF:p. 743 Gastrointestinal Alterations

OBJ: Cognitive Level: Application

14.The infant who has had a pyloromyotomy may still vomit after surgery. The nurse will instruct the caregivers to notify the health care provider if vomiting persists for more than:

a.

48 hours

c.

1 week

b.

5 days

d.

1 month

ANS: A

Feedback

A

Correct. The nurse will instruct the caregivers to notify the health care provider if vomiting persists for more than 48 hours.

B

Incorrect. The nurse will not instruct the caregivers to notify the health care provider if vomiting persists for more than 5 days. That is too long to wait to notify the health care provider.

C

Incorrect. The nurse will not instruct the caregivers to notify the health care provider if vomiting persists for more than 1 week. That is too long to wait to notify the health care provider.

D

Incorrect. The nurse will not instruct the caregivers to notify the health care provider if vomiting persists for more than 1 month. That is too long to wait to notify the health care provider.

PTS:1REF:p. 743 Anatomy and Physiology

OBJ: Cognitive Level: Application

15.The incidence of cleft lip or cleft palate is highest in which of the following groups?

a.

Caucasians

c.

American Indians

b.

Afro-Americans

d.

Asians

ANS: D

Feedback

A

Incorrect. The incidence of cleft lip or cleft palate is second highest in Caucasians.

B

Incorrect. The incidence of cleft lip or cleft palate is lowest in Afro-Americans.

C

Incorrect. The incidence of cleft lip or cleft palate is not highest in American Indians.

D

Correct. The incidence of cleft lip or cleft palate is highest in Asians.

PTS: 1 REF: p. 746 Anatomy and Physiology OBJ: Cognitive Level: Knowledge

16.Which of the following is most often the first sign then cleft palate is not diagnosed at birth?

a.

inability to nurse or take the bottle

b.

coughing then given formula or breast milk

c.

choking during feedings

d.

formula coming from the nose

ANS: D

Feedback

A

Incorrect. Inability to nurse or take the bottle is not most often the first sign then cleft palate is not diagnosed at birth.

B

Incorrect. Coughing then given formula or breast milk is not most often the first sign then cleft palate is not diagnosed at birth.

C

Incorrect. Choking during feedings is not most often the first sign then cleft palate is not diagnosed at birth.

D

Correct. Most often the first sign then cleft palate is not diagnosed at birth is formula coming from the nose.

PTS:1REF:p. 746 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

17.The parents of a newborn who was born with a cleft lip asks the nurse then surgery is usually performed on this condition. The nurse will inform the parents that closure of the lip is usually performed then the infant is:

a.

2 weeks old or at least 10 pounds

c.

1 year old or 20 pounds

b.

3 months of age or 12 pounds

d.

18 months old or 20 pounds

ANS: B

Feedback

A

Incorrect. Closure of a cleft lip is not usually performed then the infant is 2 weeks old or at least 10 pounds.

B

Correct. The nurse will inform the parents of a newborn who was born with a cleft lip that closure of the lip is usually performed then the infant is 3 months of age or 12 pounds.

C

Incorrect. Closure of a cleft lip is not usually performed then the infant is 1 year old or 20 pounds. Closure of the hard or soft palate is performed at approximately 1 year of age.

D

Incorrect. Closure of a cleft lip is not usually performed then the infant is 18 months old or 20 pounds.

PTS:1REF:p. 746 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Application

18.When the nurse talks with parents of a newborn who was born with a cleft palate, the nurse keeps in mind that surgery for clefts of the hard or soft palate are surgically closed at approximately what age?

a.

3 months

c.

1 year

b.

6 months

d.

1-1/2 years

ANS: C

Feedback

A

Incorrect. Surgery for closure of the hard or soft palate is not performed at 3 months of age.

B

Incorrect. Surgery for closure of the hard or soft palate is not performed at 6 months of age.

C

Correct. Surgery for closure of the hard or soft palate is performed at approximately 1 year of age to assist in feeding and to promote speech and language development.

D

Incorrect. Surgery for closure of the hard or soft palate is not performed at 1-1/2 years.

PTS:1REF:p. 747 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Application

19.During the newborn assessment, the nurse will examine the palate:

a.

using a tongue blade

b.

by palpation with a gloved finger

c.

with a cotton ball saturated with normal saline

d.

by visualization only, not by palpation

ANS: B

Feedback

A

Incorrect. During the newborn assessment, the nurse will not examine the palate by using a tongue blade.

B

Correct. During the newborn assessment, the nurse will examine the palate by palpation with a gloved finger.

C

Incorrect. During the newborn assessment, the nurse will not examine the palate with a cotton ball saturated with normal saline.

D

Incorrect. During the newborn assessment, the nurse will examine the palate by visualization only, not by palpation.

PTS:1REF:p. 748 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Application

20.Which of the following is most often the initial reaction of parents who have a baby with craniofacial anomalies?

a.

pity

c.

shock

b.

love

d.

anger

ANS: C

Feedback

A

Incorrect. Most often the initial reaction of parents who have a baby with craniofacial anomalies is not pity.

B

Incorrect. Most often the initial reaction of parents who have a baby with craniofacial anomalies is not love.

C

Correct. Most often the initial reaction of parents who have a baby with craniofacial anomalies is shock.

D

Incorrect. Most often the initial reaction of parents who have a baby with craniofacial anomalies is not anger.

PTS:1REF:p. 747 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

21.The nurse is working with the family of a baby born with a cleft lip and cleft palate. The family has shown a lot of negative feelings toward the baby and seems preoccupied with the babys appearance. Which of the following actions by the nurse would be best?

a.

Provide support, model accepting behaviors, and encourage touching and holding.

b.

Tell the family that this is a time then they must stand strong and help their baby.

c.

Suggest that there have been worse cases than this one, which is not all that bad.

d.

Ask the family to think about the fact that at least they have a baby even if it is not perfect.

ANS: A

Feedback

A

Correct. The best actions by the nurse are to provide support, model accepting behaviors, and encourage touching and holding. Negative feelings by the caregivers may disrupt or delay attachment. The familys reactions are normal, but the nurse can aid in the bonding process by demonstrating acceptance of the baby.

B

Incorrect. Telling the family that this is a time then they must stand strong and help their baby is not a helpful action by the nurse, nor is it the best.

C

Incorrect. Suggesting that there have been worse cases than this one, which is not all that bad, negates their feelings and is not the best nursing intervention. Pointing out the babys positive attributes can help decrease the focus of the defect.

D

Incorrect. Asking the family to think about the fact that at least they have a baby even if it is not perfect is not an appropriate response from the nurse.

PTS:1REF:p. 747 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Application

22.For several days, the nurse has been working with the parents of a baby with a cleft lip and cleft palate. The parents seem to have a lot of fears related to the care of their child and the childs future. How could the nurse best help these parents?

a.

Talk to them about how their fears are unnecessary, and encourage them to stop being afraid.

b.

Tell the parents about any personal family experiences with cleft lip or cleft palate or about experiences with other parents having a baby with similar problems.

c.

Show some before and after photographs of successful surgical repairs, and offer to arrange for them to talk with other parents of children with a cleft lip or cleft palate.

d.

Take over more of the care of the infant to give the parents time to adjust to having a baby with deformities.

ANS: C

Feedback

A

Incorrect. Talking to them about how their fears are unnecessary, and encourage them to stop being afraid denies their fears and is not a helpful response. The nurse should encourage parents to verbalize their feelings and fears because talking and sharing may decrease anxiety.

B

Incorrect. Telling the parents about any personal family experiences with cleft lip or cleft palate or about experiences with other parents having a baby with similar problems is not a helpful intervention.

C

Correct. The nurse could best help these parents by showing some before and after photographs of successful surgical repairs, and offering to arrange for them to talk with other parents of children with a cleft lip or cleft palate. This may allay their fears. Sharing with others in a similar situation facilitates acceptance and adaptation.

D

Incorrect. Taking over more of the care of the infant to give the parents time to adjust to having a baby with deformities does not help them begin to adjust and bond to their infant. Parents need to be involved in the care of their baby, even if it only involves holding, touching, stroking and nurturing behaviors.

PTS:1REF:p. 747 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Application

23.The mother of a newborn with a cleft lip says to the nurse, Well, I guess I will have to give up the idea of breastfeeding and do bottle feeding. Which of the following is the nurses best response?

a.

How do you feel about giving up breastfeeding and going to bottle feeding?

b.

The breast will mold to the shape of the babys lips, will fill the opening in the lip, and your baby will probably have no more difficulty breastfeeding than any other baby.

c.

It will help to not dwell on having to give up breastfeeding, and perhaps you can breastfeed your next baby.

d.

Lets talk about all the advantages of bottle feeding such as having someone else get up and give the baby the night bottle so you can catch up on needed rest and sleep.

ANS: B

Feedback

A

Incorrect. How do you feel about giving up breastfeeding and going to bottle feeding? is not the best response because breastfeeding is an option for a newborn with a cleft lip.

B

Correct. The nurses best response is The breast will mold to the shape of the babys lips, will fill the opening in the lip, and your baby will probably have no more difficulty breastfeeding than any other baby.

C

Incorrect. It will help to not dwell on having to give up breastfeeding, and perhaps you can breastfeed your next baby is not an appropriate response because breastfeeding is possible.

D

Incorrect. Lets talk about all the advantages of bottle feeding such as having someone else get up and give the baby the night bottle so you can catch up on needed rest and sleep is not the best response.

PTS:1REF:p. 748 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Application

24.A mother wants to breastfeed her baby born with a cleft lip and a cleft palate and asks the nurse if this will be possible. Which of the following is the nurses best response?

a.

It will be easier on you and the baby will get better nutrition if you bottle feed.

b.

I wish you could breastfeed, but in this case it is going to be impossible.

c.

It may be possible to breastfeed your baby. I will help you. If it does not work out, you can use a breast pump and feed breast milk using a bottle and special nipples.

d.

It is done in rare cases there a mother is determined to breastfeed and willing to keep offering the breast for several days even then the baby is not nursing well.

ANS: C

Feedback

A

Incorrect. It will be easier on you and the baby will get better nutrition if you bottle feed is not the best response. Saying the baby will get better nutrition if she bottle feeds is not necessarily true. Breast milk has many advantages over formula. It contains immunologic and antibacterial components not present in formula. Breast milk protein is a more complete protein and is more easily digested than the protein in formula.

B

Incorrect. I wish you could breastfeed, but in this case it is going to be impossible may be inaccurate because breastfeeding may be possible.

C

Correct. The nurses best response is It may be possible to breastfeed your baby. I will help you. If it does not work out, you can use a breast pump and feed breast milk using a bottle and special nipples. Breastfeeding may be possible if the baby has a small cleft lip and palate.

D

Incorrect. This is not the nurses best response.

PTS:1REF:p. 748 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Application

25.In working with the breastfeeding mother of an infant with a cleft lip or cleft palate, the nurse will teach the mother to do which of the following before having the infant latch on?

a.

Place a warm washcloth on the breast.

c.

Pump part of the milk from the breast.

b.

Place ice packs on the breast.

d.

Give a little water from a bottle first.

ANS: A

Feedback

A

Correct. The infant usually feeds best then the breast is full. Therefore, teach the mother to place a warm washcloth on the breast to encourage the milk let-down prior to having the infant latch on.

B

Incorrect. Ice packs will decrease blood flow to the breast and be counterproductive to effective breastfeeding.

C

Incorrect. Pumping part of the milk from the breast before the baby latches on would be inappropriate. In preparation for latch on it may be helpful for the mother to manually express a few drops of milk and spread it over the nipple. This may entice the baby to open the mouth as the milk is tasted.

D

Incorrect. Giving a little water from a bottle first is not advisable because the baby may become confused going from bottle to breast then breastfeeding is first initiated. Many practitioners recommend that bottles be avoided until breastfeeding is well established, usually after 3 to 4 weeks.

PTS:1REF:p. 749 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Application

26.When the mother of a newborn with a cleft lip or a cleft palate decides to bottle feed, the nurse will have the mother to first try:

a.

the breast

c.

a special nipple designed for clefts

b.

a regular nipple and bottle

d.

a special bottle

ANS: B

Feedback

A

Incorrect. If the mother decides to bottle feed, it would be inappropriate to first try the breast. This might confuse the infant.

B

Correct. The mother should first try a regular nipple and bottle since some infants with small clefts may feed satisfactorily without special adaptations.

C

Incorrect. The mother should first try a regular nipple and bottle since some infants with small clefts may feed satisfactorily without special adaptations.

D

Incorrect. The mother should first try a regular nipple and bottle since some infants with small clefts may feed satisfactorily without special adaptations.

PTS:1REF:p. 748 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Application

27.When the caregiver uses standard nipples and bottles for a baby with cleft lip and cleft palate, the nurse will teach the ESSR method. The ESSR method involves:

a.

enter, swish, swallow, and recover

c.

enter, stimulate, swallow, and retry

b.

engage, start, swallow, and restart

d.

enlarge, stimulate, swallow, and rest

ANS: D

Feedback

A

Incorrect. The ESSR method does not involve enter, swish, swallow, and recover.

B

Incorrect. The ESSR method does not involve engage, start, swallow, and restart.

C

Incorrect. The ESSR method does not involve enter, stimulate, swallow, and retry.

D

Correct. The ESSR method involves enlarge, stimulate, swallow, and rest. This method uses standard nipples and bottles and is inexpensive and convenient. It includes enlarging the nipple hole by making a cross-cut so the infant will receive formula in the back of the throat for swallowing, thus bypassing the sucking problem. The next step refers to stimulating the sucking reflex by rubbing the nipple on the lower lip. The infant swallows the formula normally. The last step is a rest.

PTS:1REF:p. 748 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

28.When infants with a cleft lip or cleft palate are nursing from a bottle, they will signal a need for a rest before they choke or gag. Which of the following is a signal from the infant to take a break?

a.

elevating eyebrows and wrinkling the forehead

b.

a slight lifting of the ears

c.

puckering the lips tightly and blinking the eyes

d.

clenching the fists and a jerking of the arms

ANS: A

Feedback

A

Correct. A signal from the infant to take a break involves elevating the eyebrows and wrinkling the forehead.

B

Incorrect. A signal from the infant to take a break does not involve a slight lifting of the ears.

C

Incorrect. A signal from the infant to take a break does not involve puckering the lips tightly and blinking the eyes.

D

Incorrect. A signal from the infant to take a break does not involve clenching the fists and a jerking of the arms.

PTS:1REF:p. 748 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

29.When a caregiver has tried standard nipples, preemie nipples, and all kinds of special nipples without much success, the best plan is to teach feeding with which of the following types of equipment?

a.

spoon

c.

Asepto syringe with a rubber tip

b.

sippy cup

d.

special straw for drawing fluid up

ANS: C

Feedback

A

Incorrect. When a caregiver has tried standard nipples, preemie nipples, and all kinds of special nipples without much success, the best plan is not to teach feeding with a spoon. If the child had surgery for repair of a cleft palate, hard objects should not be allowed in the childs mouth until healing has adequately progressed.

B

Incorrect. When a caregiver has tried standard nipples, preemie nipples, and all kinds of special nipples without much success, the best plan is not to teach feeding with a sippy cup. This cup requires stronger, more forceful sucking than any nipple.

C

Correct. When a caregiver has tried standard nipples, preemie nipples, and all kinds of special nipples without much success, the best plan is to teach feeding with an Asepto syringe with a rubber tip.

D

Incorrect. When a caregiver has tried standard nipples, preemie nipples, and all kinds of special nipples without much success, the best plan is not to teach feeding with a special straw for drawing fluid up. If the infant cannot successfully feed with special nipples, a special straw will probably not be effective.

PTS:1REF:p. 748 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Application

30.Which of the following is the first question the nurse asks on accepting an assignment to care for a mother and a baby who has a cleft lip and a cleft palate?

a.

Is my care affected by the childs appearance?

b.

How does the mother feel about this baby?

c.

Is the father going to help with this babys care?

d.

How bad are the cleft lip and the cleft palate?

ANS: A

Feedback

A

Correct. The first question the nurse asks on accepting an assignment to care for a mother and a baby who has a cleft lip and a cleft palate should be Is my care affected by the babys appearance? It is important for the nurse to be aware of her or his feelings about caring for a baby with a facial disfigurement. The nurse may unconsciously consider the disfigured baby as less desirable and may spend less time interacting with this baby.

B

Incorrect. The first question the nurse asks on accepting an assignment to care for a mother and a baby who has a cleft lip and a cleft palate is not How does the mother feel about this baby?

C

Incorrect. The first question the nurse asks on accepting an assignment to care for a mother and a baby who has a cleft lip and a cleft palate is not Is the father going to help with this babys care?

D

Incorrect. The first question the nurse asks on accepting an assignment to care for a mother and a baby who has a cleft lip and a cleft palate is not How bad are the cleft lip and the cleft palate?

PTS:1REF:p. 749 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Application

31.In the period immediately after a baby has had surgery for cleft lip repair, the nurse will do which of the following things?

a.

Place the baby in a prone position lying flat.

b.

Remove the elbow restraints.

c.

Hold the pain medication.

d.

Apply a Logan bow or a butterfly adhesive.

ANS: D

Feedback

A

Incorrect. In the period immediately after a baby has had surgery for cleft lip repair, the nurse will not place the baby in a prone position lying flat. The infant should only be placed on the back or side to protect the operative site.

B

Incorrect. In the period immediately after a baby has had surgery for cleft lip repair, the nurse will not remove the elbow restraints. These restraints are used to prevent the infant from touching or pulling the site. They should be removed periodically to exercise the arms.

C

Incorrect. In the period immediately after a baby has had surgery for cleft lip repair, the nurse will not hold the pain medication. Adequate pain medication needs to be administered to minimize crying and stress on the suture line.

D

Correct. In the period immediately after a baby has had surgery for cleft lip repair, the nurse will apply a Logan bow or a butterfly adhesive to prevent tension on the suture line.

PTS:1REF:p. 749 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Application

32.The nurse will teach the family of an infant who has had a cleft lip repair how to clean the suture line after feeding. The nurse will instruct the family to:

a.

use a damp, soft washcloth to gently wash the suture line

b.

clean the suture line with cotton-tipped applicators dipped in diluted hydrogen peroxide

c.

gently clean with cotton balls saturated with sterile normal saline solution or sterile water

d.

use an Asepto syringe or a bulb syringe to flush water thoroughly over the surgical site

ANS: B

Feedback

A

Incorrect. The nurse will not instruct the family to use a damp, soft washcloth to gently wash the suture line.

B

Correct. The nurse will teach the family of an infant who has had a cleft lip repair to clean the suture line after feeding with cotton-tipped applicators dipped in diluted hydrogen peroxide.

C

Incorrect. The nurse will not instruct the family to gently clean with cotton balls saturated with sterile normal saline solution or sterile water.

D

Incorrect. The nurse will not instruct the family to use an Asepto syringe or a bulb syringe to flush water thoroughly over the surgical site.

PTS:1REF:p. 749 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Application

33.The mother of a newborn with esophageal atresia asks the nurse to explain this condition to her. The best response by the nurse would be to say that esophageal atresia is:

a.

characterized by incomplete formation of the esophagus so it ends before it gets to the stomach

b.

an extreme narrowing of the esophagus so that no liquids can get through the opening

c.

an outpouching of the esophagus just before it reaches the top of the stomach

d.

a narrowing of the top of the esophagus with a ballooning out in the middle and narrowing at the bottom

ANS: A

Feedback

A

Correct. The best response by the nurse would be to say that esophageal atresia is characterized by incomplete formation of the esophagus so it ends before it gets to the stomach.

B

Incorrect. Esophageal atresia is not an extreme narrowing of the esophagus so that no liquids can get through the opening.

C

Incorrect. Esophageal atresia is not an outpouching of the esophagus just before it reaches the top of the stomach.

D

Incorrect. Esophageal atresia is not a narrowing of the top of the esophagus with a ballooning out in the middle and narrowing at the bottom.

PTS:1REF:p. 750 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

34.Infants born with esophageal atresia with tracheoesophageal fistula are more often:

a.

male

c.

lower-than-average birth weight

b.

female

d.

of American Indian heritage

ANS: C

Feedback

A

Incorrect. Esophageal atresia with tracheoesophageal fistula occurs with an equal incidence in the sexes.

B

Incorrect. Esophageal atresia with tracheoesophageal fistula occurs with an equal incidence in the sexes.

C

Correct. Infants born with esophageal atresia with tracheoesophageal fistula are more often lower-than-average birth weight. This congenital anomaly has been associated with prematurity.

D

Incorrect. Ethnicity is not a factor in the incidence of esophageal atresia with tracheoesophageal fistula.

PTS:1REF:p. 750 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Knowledge

35.When the nurse is working with a new mother whose child was born with esophageal atresia with tracheoesophageal fistula, the mother says: He looks perfect, and I am glad he only has these two things wrong because they can be fixed. In responding therapeutically to the mother, the nurse keeps in mind which of the following as a finding with babies born with esophageal atresia and tracheoesophageal fistula?

a.

It is rare for children born with this condition to have other anomalies.

b.

One-half of the children born with this condition have other anomalies.

c.

The only other defects found in children with this condition are rectal anomalies.

d.

These children rarely live to be older than 5 or 6 years old.

ANS: B

Feedback

A

Incorrect. It is not rare for children born with this condition to have other anomalies.

B

Correct. One-half of the children born with esophageal atresia with tracheoesophageal fistula have other anomalies. Other anomalies seen in these children are vertebral, anorectal, cardiac, renal, and limb defects.

C

Incorrect. It is incorrect that the only other defects found in children with this condition are rectal anomalies. Other anomalies are vertebral, cardiac, renal, and limb defects.

D

Incorrect. Before the performance of the first successful repair in 1939, this condition was fatal. However, over the past 50 years, refinements in neonatal surgical technique, preoperative support, anesthesia, and neonatal intensive care have improved the outcome.

PTS:1REF:p. 750 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Application

36.In assessing a newborn, the nurse notices a large amount of fine, frothy bubbles of mucus in the mouth. Even then the nurse suctions the bubbles, they soon return. The baby has a rattling sound to the respirations and has a choking episode and becomes a little cyanotic. Which of the following conditions will the nurse suspect?

a.

cleft lip

c.

esophageal atresia

b.

cleft palate

d.

intussusception

ANS: C

Feedback

A

Incorrect. With these manifestations, the nurse would not suspect cleft lip.

B

Incorrect. With these manifestations, the nurse would not suspect cleft palate.

C

Correct. The newborn with esophageal atresia has fine, frothy bubbles of mucus in the mouth and nose. Even then the nurse suctions the bubbles, they soon return. The baby has a rattling sound to the respirations and has a choking, drooling, and coughing. The infant may become cyanotic and apneic because of aspiration of saliva or formula.

D

Incorrect. With these manifestations, the nurse would not suspect intussusception.

PTS:1REF:p. 751 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

37.The nurse is with a newborn that is having radiographic studies to determine if the newborn has esophageal atresia and if the newborn also has tracheoesophageal fistula. When the radiopaque nasogastric tube is passed through the nose to the stomach, it stops at 10 centimeters and the radiographic studies show air in the stomach. The nurse is aware that these finding indicate which of the following conditions?

a.

normal esophagus and stomach

b.

abnormal esophagus and normal stomach

c.

esophageal atresia without tracheoesophageal fistula

d.

esophageal atresia with tracheoesophageal fistula

ANS: D

Feedback

A

Incorrect. These findings do not indicate a normal esophagus and stomach.

B

Incorrect. These findings do not indicate an abnormal esophagus and normal stomach. The esophagus is abnormal because it should be connected to the stomach. However, in this anomaly it terminates before reaching the stomach. The stomach is filled with air because there is a fistula between the esophagus and trachea, so the stomach is also abnormal.

C

Incorrect. In esophageal atresia without tracheoesophageal fistula air would not be in the stomach.

D

Correct. These findings indicate esophageal atresia with tracheoesophageal fistula. In infants with esophageal atresia a nasogastric tube passed through the nose to the stomach typically stops at 10-12 cm. The normal distance is 17 cm. If tracheoesophageal fistula is present, air will be seen in the stomach because of the connection between the esophagus and trachea.

PTS:1REF:p. 751 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

38.Prior to the surgical repair of an esophageal atresia with tracheoesophageal fistula, the nursing interventions are mainly focused on which of the following things?

a.

getting as much weight gain as possible

c.

preventing aspiration pneumonia

b.

family education regarding care

d.

discharge planning

ANS: C

Feedback

A

Incorrect. The preoperative nursing interventions are not mainly focused on getting as much weight gain as possible. The infant is NPO and receives intravenous fluids to maintain hydration status.

B

Incorrect. Family education regarding care is an important nursing intervention which would occur postoperatively.

C

Correct. Prior to the surgical repair of an esophageal atresia with tracheoesophageal fistula, the nursing interventions are mainly focused on the prevention of aspiration of secretions from the upper esophageal pouch and prevention of regurgitation of stomach contents through the fistula into the trachea, i.e., prevention of aspiration pneumonia.

D

Incorrect. Discharge planning should begin as soon as the infant is admitted, but it is not the main focus of nursing interventions.

PTS:1REF:p. 751 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Application

39.The nurse is caring for a baby who has just had a surgical repair of an esophageal atresia with tracheoesophageal fistula. It is most important for the nurse to position the gastrostomy tube in which of the following ways?

a.

pinned to the bed sheet

c.

even with the bed

b.

elevated

d.

lowered

ANS: B

Feedback

A

Incorrect. The nurse would not pin the gastrostomy tube to the bed sheet.

B

Correct. The nurse is caring for a baby who has just had a surgical repair of an esophageal atresia with tracheoesophageal fistula. It is most important for the nurse to elevate the gastrostomy tube to allow gastric secretions to flow into the small intestine and air to escape. This position promotes comfort and decreases the risk of leakage at the anastomosis.

C

Incorrect. The nurse would not position the gastrostomy tube even with the bed.

D

Incorrect. The nurse would not position the gastrostomy tube in a lowered position.

PTS:1REF:p. 751 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Application

40.The nurse, assessing a baby who is in the immediate postoperative period after a surgical repair of an esophageal atresia with tracheoesophageal fistula, is observing for early signs of airway obstruction. In addition to abnormal breath sounds, what would the nurse find if the baby begins to have airway obstruction?

a.

anxious expression and tachypnea

b.

high-pitched cry and slowed respirations

c.

loss of consciousness and turning blue

d.

clutching the air and crying loudly

ANS: A

Feedback

A

Correct. Early signs of airway obstruction include abnormal breath sounds, an anxious expression on the infants face, and tachypnea.

B

Incorrect. Early signs of airway obstruction include abnormal breath sounds but not a high-pitched cry and slowed respirations.

C

Incorrect. Early signs of airway obstruction include abnormal breath sounds but not loss of consciousness and turning blue. These would be late signs of airway obstruction.

D

Incorrect. Early signs of airway obstruction include abnormal breath sounds but not clutching the air and crying loudly.

PTS:1REF:p. 751 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Application

41.Which of the following conditions is the most frequent cause of intestinal obstruction in infants and young children?

a.

cancer

c.

benign tumors

b.

Hirschsprungs disease

d.

intussusception

ANS: D

Feedback

A

Incorrect. Cancer is not the most frequent cause of intestinal obstruction in infants and young children.

B

Incorrect. Hirschsprungs disease is not the most frequent cause of intestinal obstruction in infants and young children.

C

Incorrect. Benign tumors are not the most frequent cause of intestinal obstruction in infants and young children.

D

Correct. Intussusception is the most frequent cause of intestinal obstruction in infants and young children.

PTS:1REF:p. 752 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Knowledge

42.A newborn has been diagnosed as having intussusception. The mother is worried that she caused this by something she did or did not do during pregnancy. The nurse will tell the mother that in most cases the cause of intussusception is due to:

a.

unknown causes

c.

viruses

b.

polyps

d.

drug use in pregnancy

ANS: A

Feedback

A

Correct. In most cases the cause of intussusception is due to unknown causes.

B

Incorrect. In most cases the cause of intussusception is not due to polyps.

C

Incorrect. In most cases the cause of intussusception is not due to viruses.

D

Incorrect. In most cases the cause of intussusception is not due to drug use in pregnancy.

PTS:1REF:p. 752 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

43.Which of the following statements best describes intussusception?

a.

a hernia of the small intestine into the abdominal cavity

b.

an outpouching of the bowel anywhere along the entire bowel

c.

a condition in which one segment of the bowel telescopes into the lumen of an adjacent segment

d.

a segment of the bowel is not innervated to any extent, and it becomes inactive and for all purposes is dead

ANS: C

Feedback

A

Incorrect. Intussusception is not best described as a hernia of the small intestine into the abdominal cavity.

B

Incorrect. Intussusception is not best described as an outpouching of the bowel anywhere along the entire bowel.

C

Correct. Intussusception is best described as a condition in which one segment of the bowel telescopes into the lumen of an adjacent segment.

D

Incorrect. Intussusception is not best described as a segment of the bowel is not innervated to any extent, and it becomes inactive and for all purposes is dead.

PTS:1REF:p. 752 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

44.The nurse assessing an infant for intussusception will look for three classic signs and symptoms: colicky intermittent abdominal pain, vomiting, and which kind of stool?

a.

mustard or clay-colored

c.

frothy stools that float

b.

currant-jelly-like stools

d.

black tar-colored stools

ANS: B

Feedback

A

Incorrect. Three classic signs and symptoms of intussusception are: colicky intermittent abdominal pain, vomiting, but not mustard or clay-colored stool.

B

Correct. The nurse assessing an infant for intussusception will look for three classic signs and symptoms: colicky intermittent abdominal pain, vomiting, and currant-jelly-like stools. The stool contains blood and mucus because the involved intestine becomes edematous and inflamed.

C

Incorrect. Three classic signs and symptoms of intussusception are: colicky intermittent abdominal pain, vomiting, but not frothy stools that float.

D

Incorrect. Three classic signs and symptoms of intussusception are: colicky intermittent abdominal pain, vomiting, but not black tar-colored stools.

PTS:1REF:p. 752 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

45.The treatment of choice and the safest treatment for intussusception is which of the following treatments?

a.

a three-stage surgery involving a temporary colostomy opening

b.

hydrostatic reduction with barium

c.

hydrostatic reduction with an air or a water-soluble contrast agent

d.

external massage and rotation

ANS: C

Feedback

A

Incorrect. The treatment of choice and the safest treatment for intussusception is not a three-stage surgery involving a temporary colostomy opening.

B

Incorrect. The treatment of choice and the safest treatment for intussusception is not hydrostatic reduction with barium.

C

Correct. The treatment of choice and the safest treatment for intussusception is hydrostatic reduction with an air or a water-soluble contrast agent. This method is believed to be safer than using barium, with less risk of bowel perforation.

D

Incorrect. The treatment of choice and the safest treatment for intussusception is not external massage and rotation.

PTS:1REF:p. 753 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

46.Discharge instructions to the parents of an infant who was treated for intussusception most need to include information on observing for signs of:

a.

intestinal obstruction and recurrence

c.

adjustment to being at home

b.

vitamin and mineral deficiencies

d.

abnormal vital signs

ANS: A

Feedback

A

Correct. Discharge instructions to the parents of an infant who was treated for intussusception most need to include information on observing for signs of intestinal obstruction and recurrence. Recurrence occurs in about 10% of children following hydrostatic reduction. These signs include increasing abdominal pain, abdominal distention, blood in the stools, bile-stained vomiting, and decreased or absent stools.

B

Incorrect. Discharge instructions to the parents of an infant who was treated for intussusception do not most need to include information on observing for signs of vitamin and mineral deficiencies.

C

Incorrect. Discharge instructions to the parents of an infant who was treated for intussusception do not most need to include information on observing for signs of adjustment to being at home.

D

Incorrect. Discharge instructions to the parents of an infant who was treated for intussusception do not most need to include information on observing for abnormal vital signs.

PTS:1REF:p. 753 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Application

47.Hirschsprungs disease (HD) involves which of the following problems?

a.

a lack of gastric acid

b.

absence of parasympathetic ganglion cells in the large intestine

c.

shortened bowel, providing less bowel surface for absorption

d.

a large number of polyps

ANS: B

Feedback

A

Incorrect. Hirschsprungs disease (HD) does not involve a lack of gastric acid.

B

Correct. Hirschsprungs disease (HD) involves absence of parasympathetic ganglion cells in the large intestine.

C

Incorrect. Hirschsprungs disease (HD) does not involve a shortened bowel, providing less bowel surface for absorption. This is a description of short bowel syndrome.

D

Incorrect. Hirschsprungs disease (HD) does not involve a large number of polyps.

PTS:1REF:p. 753 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

48.In Hirschsprungs disease the normal portion of the bowel:

a.

becomes atrophied and shrinks

c.

becomes hypertrophied and dilated

b.

loses function

d.

functions normally

ANS: C

Feedback

A

Incorrect. In Hirschsprungs disease the normal portion of the bowel does not become atrophied and shrink.

B

Incorrect. In Hirschsprungs disease the normal portion of the bowel does not lose function.

C

Correct. In Hirschsprungs disease the normal portion of the bowel becomes hypertrophied and dilated. The affected bowel (absence of ganglion cells) is unable to transmit coordinated peristaltic waves and to pass fecal contents along its length, resulting in an accumulation of fecal material and distention proximal to the defect.

D

Incorrect. In Hirschsprungs disease the normal portion of the bowel does not function normally.

PTS:1REF:p. 753 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

49.The nurse assessing newborn babies and infants after birth will notice which of the following symptoms as a primary manifestation of Hirschsprungs disease?

a.

failure to pass meconium during the first 24 to 48 hours after birth

b.

high-grade fever

c.

the skin turns yellow and then brown over the first 48 hours of life

d.

a fine rash over the trunk

ANS: A

Feedback

A

Correct. The nurse assessing newborn babies and infants after birth will notice failure to pass meconium during the first 24 to 48 hours as a primary manifestation of Hirschsprungs disease.

B

Incorrect. The nurse will not notice a high-grade fever as a primary manifestation of Hirschsprungs disease.

C

Incorrect. The nurse will not notice skin turns yellow and then brown over the first 48 hours of life as a primary manifestation of Hirschsprungs disease.

D

Incorrect. The nurse will not notice a fine rash over the trunk as a primary manifestation of Hirschsprungs disease.

PTS:1REF:p. 754 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

50.Which of the following is the major cause of death in Hirschsprungs disease?

a.

widespread infection in the body

c.

bacterial endocarditis and heart failure

b.

failure to take in enough nourishment

d.

enterocolitis, sepsis, or bowel perforation

ANS: D

Feedback

A

Incorrect. The major cause of death in Hirschsprungs disease is not widespread infection in the body.

B

Incorrect. The major cause of death in Hirschsprungs disease is not failure to take in enough nourishment.

C

Incorrect. The major cause of death in Hirschsprungs disease is not bacterial endocarditis and heart failure.

D

Correct. The major cause of death in Hirschsprungs disease is enterocolitis, sepsis, or bowel perforation. Enterocolitis is an inflammation of the large intestine which may progress rapidly with perforation of the bowel and sepsis. It may occur before, during, or after surgery.

PTS:1REF:p. 754 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

51.When is Hirschsprungs disease diagnosed?

a.

100% at birth

b.

75% at birth and 25% by 1 week

c.

15% within the first month of life and 80% by 1 year

d.

80% within the first 6 months of life

ANS: C

Feedback

A

Incorrect. Hirschsprungs disease is not diagnosed in 100% of infants at birth.

B

Incorrect. Hirschsprungs disease is diagnosed in 75% of infants at birth and 25% by 1 week.

C

Correct. Hirschsprungs disease is diagnosed in 15% of infants within the first month of life and 80% by 1 year.

D

Incorrect. Hirschsprungs disease is not diagnosed in 80% of infants within the first 6 months of life.

PTS:1REF:p. 754 Upper Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

52.The nurse assessing an older infant or child will suspect Hirschsprungs disease then the child has a history of which of the following symptoms?

a.

chronic constipation

c.

chronic vomiting

b.

blood in the stools

d.

clay-colored stools

ANS: A

Feedback

A

Correct. The nurse assessing an older infant or child will suspect Hirschsprungs disease then the child has a history of chronic constipation.

B

Incorrect. The nurse assessing an older infant or child will not suspect Hirschsprungs disease then the child has blood in the stools.

C

Incorrect. The nurse assessing an older infant or child will not suspect Hirschsprungs disease then the child has chronic vomiting.

D

Incorrect. The nurse assessing an older infant or child will not suspect Hirschsprungs disease then the child has clay-colored stools.

PTS:1REF:p. 754 Lower Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

53.Which of the following is the most current treatment for Hirschsprungs disease?

a.

a two-stage surgery using first a temporary colostomy to provide bowel rest and second a pull-through procedure

b.

a one-stage pull-through without a temporary colostomy

c.

the laparoscopic-assisted pull-through procedure with anal entry thus eliminating major abdominal surgery

d.

a laser surgery that is done on an outpatient basis and requires no incision at all

ANS: C

Feedback

A

Incorrect. The most current treatment for Hirschsprungs disease is not a two-stage surgery using first a temporary colostomy to provide bowel rest and second a pull-through procedure. This procedure has been replaced by the laparoscopic-assisted pull-through.

B

Incorrect. The most current treatment for Hirschsprungs disease is not a one-stage pull-through without a temporary colostomy. This surgical procedure has also been replaced by the laparoscopic-assisted pull-through.

C

Correct. The most current treatment for Hirschsprungs disease is the laparoscopic-assisted pull-through procedure with anal entry, thus eliminating major abdominal surgery. This procedure requires only a few small incisions, has decreased the length of hospitalization, leaves minimal scarring, and reduced complications.

D

Incorrect. The most current treatment for Hirschsprungs disease is not a laser surgery that is done on an outpatient basis and requires no incision at all.

PTS:1REF:p. 754 Lower Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

54.The nurse caring for the child who is going to have surgery related to Hirschsprungs disease knows that assessment of the infants fluid and electrolyte status is necessary for which of the following reasons?

a.

There will be extensive bowel cleansing with repeated saline enemas.

b.

The childs extreme constipation will throw the electrolytes off.

c.

The child will be nothing by mouth (NPO) for a very long period of time.

d.

Vomiting and diarrhea are not unusual in these cases.

ANS: A

Feedback

A

Correct. The nurse caring for the child who is going to have surgery related to Hirschsprungs disease knows that assessment of the infants fluid and electrolyte status is necessary because there will be extensive bowel cleansing with repeated saline enemas. Saline enemas will cause an imbalance in fluid and electrolyte status.

B

Incorrect. The major reason for assessment of the infants fluid and electrolyte status preoperatively is not that the childs extreme constipation will throw the electrolytes off.

C

Incorrect. The major reason for assessment of the infants fluid and electrolyte status preoperatively is not that the child will be nothing by mouth (NPO) for a very long period of time. The child will be NPO until bowel sounds return and stool is passed, and the length of time would vary with each individual.

D

Incorrect. Vomiting can be a clinical manifestation in the older child but not diarrhea. Ribbon like or pellet shaped, foul smelling stools are common. Thus, this is not the major reason for assessment of the infants fluid and electrolyte status preoperatively.

PTS:1REF:p. 754 Lower Gastrointestinal Alterations

OBJ: Cognitive Level: Application

55.Which of the following anorectal malformations do not require surgery?

a.

imperforate anus

c.

rectal atresia

b.

anal stenosis

d.

anal agenesis

ANS: B

Feedback

A

Incorrect. Imperforate anus does require surgery.

B

Correct. Anal stenosis is an anorectal malformation that does not require surgery. Anal stenosis is managed with repeated manual dilatation of the anus. All the other malformations require surgery.

C

Incorrect. Rectal atresia does require surgery.

D

Incorrect. Anal agenesis does require surgery.

PTS:1REF:p. 755 Lower Gastrointestinal Alterations

OBJ: Cognitive Level: Knowledge

56.On assessment of a newborn, the nurse finds meconium in the urine. The nurse realizes that this is indicative of which of the following conditions?

a.

a bladder that is wrapped around the intestine

b.

imperforate anus

c.

anal agenesis

d.

a fistula between the bowel and the urinary tract

ANS: D

Feedback

A

Incorrect. Meconium in the urine in a newborn is not indicative of a bladder that is wrapped around the intestine.

B

Incorrect. Meconium in the urine in a newborn is not indicative of imperforate anus.

C

Incorrect. Meconium in the urine in a newborn is not indicative of anal agenesis.

D

Correct. On assessment of a newborn, the nurse finds meconium in the urine. The nurse realizes that this is indicative of a fistula between the bowel and the urinary tract.

PTS:1REF:p. 755 Lower Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

57.Which of the following interventions is most important then the baby has surgery to correct a low anorectal malformation?

a.

meticulous skin care

c.

keeping the anal area covered

b.

pushing fluids

d.

high-fiber diet

ANS: A

Feedback

A

Correct. Low anorectal malformations are corrected by creating an anal opening followed by anal dilatation to prevent stenosis. The most important postoperative intervention is preventing infection of the perineal and anal wounds by meticulous skin care. The surgical incisions are at high risk for infection from urine and stool.

B

Incorrect. Pushing fluids is not the most important postoperative intervention although adequate fluid intake will help the child achieve normal bowel activity.

C

Incorrect. Keeping the anal area covered is not the most important postoperative intervention.

D

Incorrect. A high-fiber diet is not the most important postoperative intervention although adequate fiber will help the child achieve normal bowel activity.

PTS:1REF:p. 755 Lower Gastrointestinal Alterations

OBJ: Cognitive Level: Application

58.The nurse is providing some teaching to the parents of a 2-year-old child who has had surgery to correct an anorectal malformation. The nurse will advise the parents or caregivers that toilet training will:

a.

likely be delayed

c.

be no different than for other toddlers

b.

require help from an expert

d.

be easier

ANS: A

Feedback

A

Correct. The nurse is providing some teaching to the parents of a 2-year-old child who has had surgery to correct an anorectal malformation. The nurse will advise the parents or caregivers that toilet training will likely be delayed and children may have trouble with this developmental task. Their patience and understanding of the child is essential at this time.

B

Incorrect. The nurse will advise the parents or caregivers that toilet training will probably not require help from an expert.

C

Incorrect. The nurse will advise the parents or caregivers that toilet training will be different than for other toddlers.

D

Incorrect. The nurse will advise the parents or caregivers that toilet training will not be easier.

PTS:1REF:p. 756 Lower Gastrointestinal Alterations

OBJ: Cognitive Level: Application

59.Which of the following statements best defines gastroesophageal reflux (GER)?

a.

Stomach contents are returned into the lower esophagus through the lower esophageal sphincter.

b.

Formula or other intake is routed to an outpouching in the esophagus and then squeezed out and back to the esophagus.

c.

The stomach is too small, and it cant handle the large amount of formula that some caregivers give in one feeding.

d.

The esophagus is too narrow in its entire length, and it shoots back up and out the mouth.

ANS: A

Feedback

A

Correct. Stomach contents are returned into the lower esophagus through the lower esophageal sphincter best defines gastroesophageal reflux (GER).

B

Incorrect. Formula or other intake is routed to an outpouching in the esophagus and then squeezed out and back to the esophagus is not an accurate definition of GER.

C

Incorrect. The stomach is too small, and it cant handle the large amount of formula that some caregivers give in one feeding is not an accurate definition of GER.

D

Incorrect. The esophagus is too narrow in its entire length, and it shoots back up and out the mouth is not an accurate definition of GER.

PTS:1REF:p. 756 Lower Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

60.Which of the following conditions is the most common esophageal disorder found in infants and is most frequently referred to a pediatric gastroenterologist?

a.

hypertrophic pyloric stenosis

c.

gastroesophageal reflux (GER)

b.

esophageal stricture

d.

intestinal malrotation

ANS: C

Feedback

A

Incorrect. Hypertrophic pyloric stenosis is not the most common esophageal disorder found in infants and is most frequently referred to a pediatric gastroenterologist.

B

Incorrect. Esophageal stricture is not the most common esophageal disorder found in infants and is most frequently referred to a pediatric gastroenterologist.

C

Correct. Gastroesophageal reflux (GER) is the most common esophageal disorder found in infants and is most frequently referred to a pediatric gastroenterologist.

D

Incorrect. Intestinal malrotation is not the most common esophageal disorder found in infants and is most frequently referred to a pediatric gastroenterologist.

PTS:1REF:p. 756 Lower Gastrointestinal Alterations

OBJ: Cognitive Level: Comprehension

61.A nurse is working with a caregiver of an infant with gastroesophageal reflux. The infant has poor weight gain, cries then awake, and is vomiting or regurgitating with feedings. Given these symptoms, which of the following interventions would be best for the nurse to recommend to the caregiver?

a.

Give small, frequent feedings.

b.

Feed the infant with the infants body in a horizontal position.

c.

Hold the baby in an upright position for an hour after feedings.

d.

Thicken the formula with a little rice cereal.

ANS: D

Feedback

A

Incorrect. Giving small, frequent feedings is not the best intervention for the nurse to recommend to the caregiver. This recommendation can cause additional stress on caregivers. Therefore, they need to know that higher volume and less frequent feedings can be tolerated as the infant grows.

B

Incorrect. Feeding the infant with the infants body in a horizontal position is not the best intervention for the nurse to recommend. The infant should be fed with the head elevated to minimize reflux.

C

Incorrect. Holding the baby in an upright position for an hour after feedings is not a reasonable recommendation. If the health care provider has recommended the head elevated prone position after feedings, this position can be achieved by using a wedge, sling, harness, and towel rolls.

D

Correct. Thickening the formula with a little rice cereal is the best intervention for the nurse to recommend to the caregiver. This increases the consistency and retention, and supplies the needed calories for the infant who vomits frequently.

PTS:1REF:p. 757 Lower Gastrointestinal Alterations

OBJ: Cognitive Level: Application

62.The parents of an infant with gastroesophageal reflux (GER) ask the nurse about the advisability of the side-lying or supine position for prevention of sudden infant death syndrome (SIDS) for their infant. The nurses best response would be:

a.

Yes, prevention of SIDS is extremely important and the side-lying or supine position is currently recommended.

b.

Currently the prone or head-elevated prone position is recommended for GER, and with the elimination of puffy bedding from the crib you can decrease chances of SIDS.

c.

The side-lying or supine position will work just fine as long as you elevate the head of the bed so that the infant is sleeping nearly sitting up.

d.

SIDS is something you cannot really protect against for certain, so get some baby monitors and let your baby seek whatever position is most comfortable.

ANS: B

Feedback

A

Incorrect. The nurses best response would not be Yes, prevention of SIDS is extremely important and the side-lying or supine position is currently recommended.

B

Correct. The nurses best response would be Currently the prone or head-elevated prone position is recommended for GER, and with the elimination of puffy bedding from the crib you can decrease chances of SIDS. The American Academy of Pediatrics recommends that infants be placed supine or side-lying for sleep to minimize the risk for SIDS. However, infants with GER are exempt.

C

Incorrect. The nurses best response would not be The side-lying or supine position will work just fine as long as you elevate the head of the bed so that the infant is sleeping nearly sitting up.

D

Incorrect. The nurses best response would not be SIDS is something you cannot really protect against for certain, so get some baby monitors and let your baby seek whatever position is most comfortable.

PTS:1REF:p. 757 Lower Gastrointestinal Alterations

OBJ: Cognitive Level: Application

63.The parent of an infant with gastroesophageal reflux asks the nurse why the specialist wants the infant on omeprazole (Prilosec), which is not covered by her health maintenance organization (HMO), instead of metoclopramide (Reglan), which is covered. Which of the following is the nurses best answer?

a.

Physicians tend to prescribe the same drug regardless of what the HMO covers, because they understand that drug best.

b.

You need to let your doctor know that your HMO will not cover this drug and tell the doctor you need a prescription for Reglan.

c.

Prilosec has become a preferred choice for infants because current research does not support the use of Reglan in managing the symptoms of gastroesophageal reflux in infants and children.

d.

Reglan is a less-expensive drug and has only slightly more side effects, so talk with the pharmacist and see if you would be better off with Reglan.

ANS: C

Feedback

A

Incorrect. The nurses best answer is not Physicians tend to prescribe the same drug regardless of what the HMO covers, because they understand that drug best.

B

Incorrect. The nurses best answer is not You need to let your doctor know that your HMO will not cover this drug and tell the doctor you need a prescription for Reglan.

C

Correct. The nurses best answer is Prilosec has become a preferred choice for infants because current research does not support the use of Reglan in managing the symptoms of gastroesophageal reflux in infants and children.

D

Incorrect. The nurses best answer is not Reglan is a less-expensive drug and has only slightly more side effects, so talk with the pharmacist and see if you would be better off with Reglan.

PTS:1REF:p. 757 Lower Gastrointestinal Alterations

OBJ: Cognitive Level: Application

64.The nurse on the pediatric unit is assigned to an infant with gastroesophageal reflux. The infant has had episodes of pneumonia and is not gaining weight. The infant has not responded well to 6 weeks of medical management and is being considered for surgery. At the beginning of the shift, after receiving report on this infant, the nurse will first:

a.

read the infants chart or computer record

b.

weigh the infant

c.

assess respiratory status

d.

check the medication administration record and set up medications

ANS: C

Feedback

A

Incorrect. At the beginning of the shift, after receiving report on this infant, the nurse will not first read the infants chart or computer record

B

Incorrect. At the beginning of the shift, after receiving report on this infant, the nurse will not first weigh the infant.

C

Correct. At the beginning of the shift, after receiving report on this infant, the nurse will first assess respiratory status. Infants with GER are at high risk for aspiration; therefore, assessment of a baseline respiratory status is imperative, such as lung sounds, respiratory rate, and effort. Additionally, this infant has previously had episodes of pneumonia.

D

Incorrect. At the beginning of the shift, after receiving report on this infant, the nurse will not first check the medication administration record and set up medications.

PTS:1REF:p. 758 Lower Gastrointestinal Alterations

OBJ: Cognitive Level: Application

65.The nurse in the pediatric clinic receives a telephone call from the mother of an infant. The mother is concerned that her baby has constipation. To arrive at the cause of the constipation and to determine the intervention, the nurse will most likely ask:

a.

What type of milk are you feeding, how much at each feeding, and how many feedings?

b.

How much does your baby sleep during the day and during the night?

c.

Is there a family history of constipation or bowel disorders in your family?

d.

Are you giving your child any constipating foods to eat?

ANS: A

Feedback

A

Correct. To arrive at the cause of the constipation and to determine the intervention, the nurse will most likely ask What type of milk are you feeding, how much at each feeding, and how many feedings? Constipation in infancy is rare and usually caused by excessive milk intake or the transition from formula to cows milk.

B

Incorrect. To arrive at the cause of the constipation and to determine the intervention, the nurse will not most likely ask How much does your baby sleep during the day and during the night? This has no relevance for determining the cause of constipation.

C

Incorrect. To arrive at the cause of the constipation and to determine the intervention, the nurse will not most likely ask Is there a family history of constipation or bowel disorders in your family?

D

Incorrect. To arrive at the cause of the constipation and to determine the intervention, the nurse will not most likely ask Are you giving your child any constipating foods to eat? Since this is an infant, foods that are constipating should not be included in the diet.

PTS:1REF:p. 758 Lower Gastrointestinal Alterations

OBJ: Cognitive Level: Application

66.The nurse is working with the parents of a child who has chronic constipation. The nurse will teach the parents how to establish a regular pattern of defecation. The nurse will evaluate that the parents understood the teaching then they report back to the nurse with which of the following statements?

a.

Our child has not been given any dessert unless she has had a bowel movement the previous day.

b.

We take turns making sure she sits on the toilet until she has a bowel movement, even if it is an hour.

c.

She gets to flush the toilet herself and wave bye-bye to the stools in the toilet, and we pat her head and say good girl.

d.

She sits on the toilet after a meal for 5 to 10 minutes and usually has a bowel movement. Then we give her a star for the prize chart.

ANS: D

Feedback

A

Incorrect. This statement does not indicate that the parents understood the nurses teaching.

B

Incorrect. This statement does not indicate that the parents understood the nurses teaching.

C

Incorrect. This statement does not indicate that the parents understood the nurses teaching.

D

Correct. The nurse will evaluate that the parents understood the teaching then they report back to the nurse She sits on the toilet after a meal for 5 to 10 minutes and usually has a bowel movement. Then we give her a star for the prize chart. Establishing a regular pattern of defecation is accomplished by requiring the child to sit on the toilet for a reasonable amount of time after a meal. Positive reinforcement with stars or prizes can be used to reinforce success.

PTS:1REF:p. 758 Lower Gastrointestinal Alterations

OBJ: Cognitive Level: Application

67.The nurse is assessing a child admitted to the hospital for abdominal pain. Which of the following findings by the nurse would be typical of those seen in appendicitis?

a.

anorexia, nausea, and vomiting preceded the pain according to the history provided by the caregivers

b.

a subnormal temperature for the last 2 days

c.

pain that was vague and somewhat localized to the periumbilical area and gradually migrated to the right lower quadrant

d.

night time chills for 1 week

ANS: C

Feedback

A

Incorrect. Anorexia, nausea, and vomiting preceding the pain according to the history provided by the caregivers is not the typical finding seen in appendicitis.

B

Incorrect. A subnormal temperature for the last 2 days is not the typical finding seen in appendicitis.

C

Correct. Pain that was vague and somewhat localized to the periumbilical area and gradually migrated to the right lower quadrant is the typical finding seen in appendicitis.

D

Incorrect. Night time chills for 1 week is not the typical finding seen in appendicitis.

PTS:1REF:p. 760 Lower Gastrointestinal Alterations

OBJ: Cognitive Level: Application

68.The nurse is working with a parent whose child had a perforation of the appendix. The nurse shares with the parents why appendicitis frequently progresses to perforation in children by saying:

a.

The appendix is usually near the perforation state by the time children will say anything for fear they have done something wrong.

b.

Young children have a thinner appendiceal wall than adults, so they progress to perforation much quicker than adults.

c.

Children tolerate pain much better than adults, so they are in a lot of pain by the time they tell caregivers.

d.

The appendix in children is smaller and therefore much easier to rupture.

ANS: B

Feedback

A

Incorrect. This statement is an incorrect rationale for why appendicitis frequently progresses to perforation in children.

B

Correct. Appendicitis frequently progresses to perforation in children because they have a thinner appendiceal wall than adults, so progress from inflammation to perforation is more rapid than in adults.

C

Incorrect. This is a false statement because children feel pain similarly to adults.

D

Incorrect. Although the appendix may be smaller in a child, this is not the rationale for why appendicitis frequently progresses to perforation.

PTS:1REF:p. 760 Alterations in Motility

OBJ: Cognitive Level: Application

MULTIPLE RESPONSE

1.A pediatric client presents to the emergency department with acute abdominal pain followed by anorexia and nausea. The nurse suspects appendicitis. Upon palpation, the nurse anticipates identifying pain localized in which area(s) of the abdomen? Select all that apply.

a.

costovertebral angle

c.

left lower quadrant

b.

right lower quadrant

d.

periumbilical area

ANS: B, D

Feedback

Correct

The pain associated with appendicitis typically is localized at the periumbilical area, gradually migrating to the right lower quadrant.

The pain associated with appendicitis typically is localized at the periumbilical area, gradually migrating to the right lower quadrant.

Incorrect

The pain of appendicitis is not associated with discomfort in the costovertebral angle.

The pain of appendicitis is not associated with discomfort in the left lower quadrant.

PTS:1REF:p. 760 Alterations in Motility

OBJ: Cognitive Level: Application

2.A child is expected to require prolonged corticosteroid therapy for inflammatory bowel disease. The nurse is providing discharge instructions to the childs caregiver. Which of the following statements made by the nurse is most accurate regarding corticosteroid therapy? Select all that apply.

a.

You will need to weigh your child regularly due to the high risk for weight loss.

b.

Your childs appetite will likely be poor while taking the medication.

c.

It is recommended that your child avoid large crowds while taking the medication.

d.

Your child is at risk for changes in personality, so monitor the childs mood regularly.

ANS: C, D

Feedback

Correct

Corticosteroid therapy is associated with increased susceptibility to infections, thus it is desirable for the child to avoid large crowds.

Personality changes are associated with corticosteroid use.

Incorrect

Corticosteroid use is associated with increased appetite and weight gain.

PTS:1REF:p. 766 Alterations in Motility

OBJ: Cognitive Level: Application

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