Chapter 27: The Child With a Gastrointestinal Condition My Nursing Test Banks

Chapter 27: The Child With a Gastrointestinal Condition

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier Inc.

MULTIPLE CHOICE

1. The finding in a newborn assessment suggestive of tracheoesophageal fistula is:

a.

Failure to pass meconium in 24 hours

b.

Choking on the first feeding

c.

Palpable mass in the sternal area

d.

Visible peristalsis across abdomen

ANS: B

After birth, a newborn with tracheoesophageal fistula will vomit and choke when the first feeding is introduced.

DIF: Cognitive Level: Analysis REF: 635 OBJ: 2

TOP: Esophageal Atresia KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

2. A child is brought to the pediatric clinic because he has been vomiting for the past 2 days. An acid-base imbalance that the nurse would expect to occur from this persistent vomiting is:

a.

Hyperkalemia

b.

Hypernatremia

c.

Acidosis

d.

Alkalosis

ANS: D

Hydrochloric acid and sodium chloride from the stomach are lost from persistent vomiting. This results in alkalosis.

DIF: Cognitive Level: Analysis REF: 641 OBJ: N/A

TOP: Vomiting KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. On the second day of hospitalization for a 3-month-old brought in for treatment for gastroenteritis, the nurse makes all of the assessments listed below. The assessment that indicates that the treatment is not effective is:

a.

Weight loss of 4 ounces

b.

Dry mucous membranes

c.

Decreased skin turgor

d.

Depressed fontanelle

ANS: A

Weight loss is the most significant indicator of dehydration.

DIF: Cognitive Level: Analysis REF: 647-648 OBJ: 5

TOP: Dehydration KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. The nurse is aware that rapid respirations are a possible cause of dehydration because they:

a.

Prevent the child from drinking

b.

Increase circulation, thus increasing urine production

c.

Cause evaporation of fluid on the mucous membranes

d.

Often lead to vomiting

ANS: C

Rapid respirations cause increased insensible fluid loss.

DIF: Cognitive Level: Comprehension REF: 647 OBJ: 5

TOP: Dehydration KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. An appropriate intervention for a 3-month-old infant who has gastroesophageal reflux is to:

a.

Position the infant in the crib on its abdomen, with the head elevated.

b.

Administer medication as ordered to stimulate the pyloric sphincter.

c.

Give thin rice cereal with formula before feeding solid foods.

d.

Place the infant in an infant seat after feedings.

ANS: A

After feedings, the infant is placed in a prone position to avoid increased intraabdominal pressure.

DIF: Cognitive Level: Application REF: 642 OBJ: 3

TOP: Gastroesophageal Reflux KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

6. The nurse interviewing parents of an infant with pyloric stenosis would expect the parents to report the infant has had:

a.

Diarrhea

b.

Projectile vomiting

c.

Poor appetite

d.

Constipation

ANS: B

Vomiting is the outstanding symptom of pyloric stenosis. Food is ejected with considerable force, which is described as projectile vomiting.

DIF: Cognitive Level: Application REF: 636 OBJ: 2

TOP: Pyloric Stenosis KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

7. A parent reports that her child has been scratching the anal area and complaining of itching. Based on this information, the nurse might suspect this child has:

a.

Pinworms

b.

Giardiasis

c.

Ringworm

d.

Roundworm

ANS: A

With pinworms, the nurse or parent may notice that the child scratches the anal area and complains of itchiness. The other choices do not cause this reaction.

DIF: Cognitive Level: Analysis REF: 652 OBJ: 7

TOP: Worms KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

8. The nurse that is teaching a parent about pyrvinium (Povan) would include the information that the drug will cause:

a.

Diarrhea

b.

Skin rash

c.

Red stool

d.

Metallic taste

ANS: B

The nurse should advise parents that Povan stains and turns stools red.

DIF: Cognitive Level: Application REF: 652 OBJ: 7

TOP: Worms KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

9. The instruction the nurse would give to parents about preventing the spread and reinfection of pinworms is:

a.

Keep childrens nails short

b.

Dress child in loose-fitting underwear

c.

Clean the bathroom with bleach solution

d.

Wash bed linens in cold water

ANS: A

One intervention to prevent the further spread of pinworms is to keep the childs fingernails short. Pinworms are not spread from person to person.

DIF: Cognitive Level: Application REF: 653 OBJ: 7

TOP: Worms KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

10. A parent reports that her 2-year-old child experiences constipation frequently. The nurse would recommend to the mother to include in the childs diet:

a.

Cooked vegetables

b.

Pretzels

c.

Whole-grain cereal

d.

Yogurt

ANS: C

Dietary modifications for constipation include eating more high-roughage foods such as whole-grain breads and cereals.

DIF: Cognitive Level: Application REF: 643 OBJ: N/A

TOP: Constipation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

11. Intussusception would be suspected when parents describe the childs stools as:

a.

Currant jelly

b.

Black and tarry

c.

Green liquid

d.

Greasy and foul-smelling

ANS: A

Bowel movements of blood and mucus that contain no feces (currant jelly stools) are common about 12 hours after the onset of the obstruction.

DIF: Cognitive Level: Comprehension REF: 640 OBJ: N/A

TOP: Intussusception KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

12. The nurse explains that the treatment of choice for a child with intussusception is:

a.

A barium enema

b.

Immediate surgery

c.

IV fluids until the spasms subside

d.

Gastric lavage

ANS: A

A barium enema is the treatment of choice for intussusception because the passage of the barium frequently un-telescopes the bowel. Surgery is scheduled only if reduction is not achieved.

DIF: Cognitive Level: Knowledge REF: 640 OBJ: N/A

TOP: Intussusception KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

13. Parents ask the nurse how their infant developed a Meckels diverticulum. The nurses response is based on the knowledge that this condition occurs when:

a.

The yolk sac remains connected to the intestine.

b.

There is inflammation of the ileocecal valve.

c.

A pouch forms when the vitelline duct fails to disappear.

d.

There is a weakness in the abdominal wall.

ANS: C

If the vitelline duct fails to disappear completely after birth, a blind pouch may form.

DIF: Cognitive Level: Knowledge REF: 640 OBJ: 2

TOP: Meckels Diverticulum KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

14. An infant is admitted to the hospital with severe isotonic dehydration. In planning the infants care, the nurse is aware the infant is at risk for:

a.

Metabolic alkalosis

b.

Hypocalcemia

c.

Sepsis

d.

Shock

ANS: D

Shock is the greatest threat to life in isotonic dehydration.

DIF: Cognitive Level: Analysis REF: 647 OBJ: 5

TOP: Dehydration KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

15. A child is brought to the emergency department because he ingested an unknown quantity of Tylenol. After gastric lavage is completed, the nurse might expect this child to receive:

a.

Activated charcoal

b.

N-Acetylcysteine

c.

Vitamin K

d.

Syrup of ipecac

ANS: B

Gastric lavage is followed by N-acetylcysteine (Mucomyst), the antidote for acetaminophen.

DIF: Cognitive Level: Application REF: 654 OBJ: 10

TOP: Poisoning KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

16. The nurse, planning a parent education program about lead poisoning prevention, would include the information that the sources of lead in the community are most likely:

a.

Increased lead content of air

b.

Use of aluminum cookware

c.

Deteriorating paint in older buildings

d.

Inhaling smog

ANS: C

The primary source of lead is paint from old, deteriorating buildings.

DIF: Cognitive Level: Knowledge REF: 656 OBJ: 11

TOP: Lead Poisoning KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity

17. A frightened mother calls a neighbor because her child swallowed dishwashing detergent. The most appropriate action that the neighbor can advise is:

a.

Induce vomiting by giving the child syrup of ipecac.

b.

Take the child to the local emergency department.

c.

Give the child activated charcoal mixed with juice.

d.

Give the child milk to soothe affected mucous membranes.

ANS: B

Inducing vomiting is no longer recommended because it may pose additional problems. The child should be taken immediately to the nearest emergency department.

DIF: Cognitive Level: Knowledge REF: 653 OBJ: 9

TOP: Poisoning KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

18. A child has been diagnosed with ascariasis (roundworm). The statement made by her mother that may suggest a cause for her condition is:

a.

Ive been airing out the house on these nice breezy days.

b.

My child often goes out to the garden and pulls up a carrot to eat.

c.

She runs barefoot so much I have to wash her feet at least twice a day.

d.

We just remodeled our bathroom at home.

ANS: B

The child can ingest roundworm eggs from contaminated soil.

DIF: Cognitive Level: Analysis REF: 653 OBJ: N/A

TOP: Worms KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

19. The nurse would expect the stools of a child with celiac disease to have which appearance?

a.

Ribbonlike

b.

Hard, constipated

c.

Bulky, frothy

d.

Loose, foul-smelling

ANS: C

Celiac disease causes malabsorption. Stools that are large, bulky, and frothy may indicate malabsorption.

DIF: Cognitive Level: Analysis REF: 638 OBJ: N/A

TOP: Celiac Disease KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

20. After reviewing dietary restrictions for celiac disease, the nurse determines that a parent understands the information when she states that a grain that can be eaten by a child with celiac disease is:

a.

Wheat

b.

Oats

c.

Barley

d.

Rice

ANS: D

Rice is a gluten-free grain that can be eaten by children afflicted with celiac disease.

DIF: Cognitive Level: Knowledge REF: 638 OBJ: N/A

TOP: Celiac Disease KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

21. A 7-month-old infant is admitted to the hospital with a diagnosis of acute gastroenteritis. The priority goal of the infants care is to prevent:

a.

Fluid and electrolyte imbalance

b.

Nutritional deficiency

c.

Skin breakdown

d.

Malabsorption

ANS: A

The priority goal of care in gastroenteritis is preventing fluid and electrolyte imbalance.

DIF: Cognitive Level: Comprehension REF: 641 OBJ: N/A

TOP: Gastroenteritis KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

22. The nurse, speaking to the parent of a 3-year-old child who has mild diarrhea, would advise the dietary modification of:

a.

Soft diet with rice, bananas, toast, and applesauce

b.

Small amounts of clear fluids such as gelatin

c.

An oral rehydrating solution such as Pedialyte

d.

Chicken soup because it is high in sodium

ANS: C

An oral rehydrating solution is recommended to replace fluids and electrolytes lost from frequent bowel movements.

DIF: Cognitive Level: Application REF: 663 OBJ: 6

TOP: Diarrhea KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

23. The nurse would expect a child admitted to the hospital for nonorganic failure to thrive to:

a.

Cry to be picked up

b.

Be limp like a rag doll

c.

Be responsive to cuddling

d.

Weigh in the 10th percentile for age

ANS: B

Some children with failure to thrive have rag-doll limpness (hypotonia) and appear wary of their caregivers.

DIF: Cognitive Level: Analysis REF: 649 OBJ: N/A

TOP: Failure to Thrive KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

24. Nursing interventions for the mother of a 10-month-old infant with nonorganic failure to thrive would include:

a.

Pointing out errors that the nurse observes when the mother is caring for the infant

b.

Discussing negative characteristics of the infant with the mother

c.

Having the nurse provide as much of the infants care as possible

d.

Teaching the mother about the developmental milestones to expect in the next few months

ANS: D

The nurse can increase parents knowledge of growth and development by providing anticipatory guidance about normal developmental milestones.

DIF: Cognitive Level: Application REF: 650 OBJ: N/A

TOP: Failure to Thrive KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

25. The statement by a mother that may indicate a cause of her sons vitamin C deficiency is:

a.

We get our fruits from homemade preserves.

b.

We use milk from our own goats.

c.

We raise all our own vegetables.

d.

Were not big meat eaters.

ANS: A

Vitamin C is destroyed by heat.

DIF: Cognitive Level: Analysis REF: 651 OBJ: N/A

TOP: Scurvy KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

26. The nurse instructing a mother how to administer oral nystatin suspension, prescribed to treat thrush, would teach to:

a.

Pour the prescribed amount into a nipple and have the infant suck the medication.

b.

Squirt the prescribed dose into the back of the mouth and have the infant swallow.

c.

Give the medication mixed with a small amount of juice in a bottle.

d.

Use a sterile applicator to swab the medication on the oral mucosa.

ANS: D

An appropriate way to administer nystatin is to moisten a sterile applicator with the medication and then swab it on the inside of the mouth.

DIF: Cognitive Level: Application REF: 652 OBJ: N/A

TOP: Thrush KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

27. One reason that infants are more vulnerable to fluid and electrolyte imbalances than adults is that:

a.

They have a smaller surface area than adults in proportion to body weight.

b.

Water needs and losses per kilogram are lower than those for adults.

c.

A greater percentage of body water in infants is extracellular.

d.

Infants have a lower metabolic turnover of water.

ANS: C

A greater percentage of body water is contained in the extracellular compartment of children under 2 years of age.

DIF: Cognitive Level: Knowledge REF: 647 OBJ: 5

TOP: Dehydration KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

28. An infant is admitted to the hospital with severe dehydration. Laboratory results show pH 7.32, PaCO2 40, HCO3 21. The nurse interprets these values as:

a.

Metabolic acidosis

b.

Metabolic alkalosis

c.

Respiratory acidosis

d.

Respiratory alkalosis

ANS: A

A pH lower than 7.35 indicates acidosis. If the childs pH falls in the same line as the HCO3-, the problem is metabolic (see Table 27-4).

DIF: Cognitive Level: Application REF: 643 OBJ: N/A

TOP: Fluid and Electrolyte Imbalance KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

MULTIPLE RESPONSE

1. When feeding a child with pyloric stenosis, the nurse will:

Select all that apply.

a.

Give a formula thinned with water.

b.

Burp the baby before and during feeding.

c.

Give the feeding slowly.

d.

Refeed if the baby vomits.

e.

Position baby on left side after feeding.

ANS: B, C, D

Children with pyloric stenosis are given formula thickened with cereal; the baby is burped before and during feeding to get rid of any gas in the stomach; the baby is fed slowly and refed if vomiting occurs. The baby is positioned on the right side to allow the weight of the feeding to stay in the stomach against the pyloric valve.

DIF: Cognitive Level: Application REF: 636 OBJ: 4

TOP: Pyloric Stenosis KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

COMPLETION

1. The nurse, assessing an elevated erythrocyte sedimentation rate (ESR) for a baby with gastroenteritis, recognizes that this confirms the ____________________ process that is part of this disease.

ANS: inflammatory

DIF: Cognitive Level: Analysis REF: 633 OBJ: 6

TOP: Gastroenteritis KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

NOT: Rationale: The ESR elevates in the presence of an inflammatory response.

2. The nurse explains that because ____________________ drinks cause diuresis, they are not good choices for fluid replacement in a child who is dehydrated.

ANS:

cola

caffeinated

DIF: Cognitive Level: Application REF: 643 OBJ: 6

TOP: Dehydration KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

NOT: Rationale: Cola drinks or other caffeinated drinks cause diuresis and will further dehydrate an already dehydrated child.

3. The nurse explains that rickets, a deficiency disease that causes bony deformities, is caused by the inadequate supply of vitamin ____________________.

ANS: D

DIF: Cognitive Level: Knowledge REF: 651 OBJ: N/A

TOP: Rickets KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease NOT: Rationale: Rickets is caused by a deficiency of vitamin D.

4. The nurse reminds parents of a child allergic to cows milk that they should avoid foods that list ____________________ as part of their contents.

ANS: casein

DIF: Cognitive Level: Application REF: 641, Box 27-1

OBJ: 3 TOP: Casein KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease NOT: Rationale: Food labels that list casein contain cows milk.

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