Chapter 43: The Child with a Gastrointestinal Alteration My Nursing Test Banks

Chapter 43: The Child with a Gastrointestinal Alteration

Test Bank

MULTIPLE CHOICE

1. What is the best response by the nurse to a mother asking about the cause of her infants bilateral cleft lip?

a.

Did you use alcohol during your pregnancy?

b.

Do you know of anyone in your family or the babys fathers family who was born with cleft lip or palate problems?

c.

This defect is associated with intrauterine infection during the second trimester.

d.

The prevalent of cleft lip is higher in Caucasians

ANS: B

Feedback

A

Tobacco during pregnancy has been associated with bilateral cleft lip.

B

Cleft lip and palate result from embryonic failure resulting from multiple genetic and environmental factors. A genetic pattern or familial risk seems to exist.

C

The defect occurred at approximately 6 to 8 weeks of gestation. Second-trimester intrauterine infection is not a known cause of bilateral cleft lip.

D

The prevalence of cleft lip and palate is higher in Asian and Native American populations.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 1069-1070

OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

2. The postoperative care plan for an infant with surgical repair of a cleft lip includes

a.

A clear liquid diet for 72 hours

b.

Nasogastric feedings until the sutures are removed

c.

Elbow restraints to keep the infants fingers away from the mouth

d.

Rinsing the mouth after every feeding

ANS: C

Feedback

A

The infants diet is advanced from clear liquid to soft foods within 48 hours of surgery.

B

After surgery, the infant can resume preoperative feeding techniques.

C

Keeping the infants hands away from the incision reduces potential complications at the surgical site.

D

Rinsing the mouth after feeding is an inappropriate intervention. Feeding a small amount of water after feedings will help keep the mouth clean. A cleft lip repair site should be cleansed with a wet sterile cotton swab after feedings.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1073

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

3. The nurse is caring for a neonate with a suspected tracheoesophageal fistula (TEF). Nursing care should include

a.

Elevating the head but give nothing by mouth

b.

Elevating the head for feedings

c.

Feeding glucose water only

d.

Avoiding suction unless infant is cyanotic

ANS: A

Feedback

A

When a newborn is suspected of having TEF, the most desirable position is supine with the head elevated on an incline plane of at least 30 degrees. It is imperative that any source of aspiration be removed at once; oral feedings are withheld.

B

Feedings should not be given to infants suspected of having TEF.

C

Feedings should not be given to infants suspected of having TEF.

D

The oral pharynx should be kept clear of secretion by oral suctioning. This is to avoid cyanosis that is usually the result of laryngospasm caused by overflow of saliva into the larynx.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1074

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

4. A nurse is teaching a group of parents about TEF. Which statement made by the nurse is accurate about TEF?

a.

This defect results from an embryonal failure of the foregut to differentiate into the trachea and esophagus.

b.

It is a fistula between the esophagus and stomach that results in the oral intake being refluxed and aspirated.

c.

An extra connection between the esophagus and trachea develops because of genetic abnormalities.

d.

The defect occurs in the second trimester of pregnancy.

ANS: A

Feedback

A

When the foregut does not differentiate into the trachea and esophagus during the fourth to fifth week of gestation, a TEF occurs.

B

TEF is an abnormal connection between the esophagus and trachea.

C

There is no connection between the trachea and esophagus in normal fetal development.

D

This defect occurs early in pregnancy during the fourth to fifth week of gestation.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1071

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

5. What maternal assessment is related to an infants diagnosis of TEF?

a.

Maternal age more than 40 years

b.

First term pregnancy for the mother

c.

Maternal history of polyhydramnios

d.

Complicated pregnancy

ANS: C

Feedback

A

Advanced maternal age is not a risk factor for TEF.

B

The first term pregnancy is not a risk factor for an infant with TEF.

C

A maternal history of polyhydramnios is associated with TEF.

D

Complicated pregnancy is not a risk factor for TEF.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1071

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

6. What clinical manifestation should a nurse be alert for when suspecting a diagnosis of esophageal atresia?

a.

A radiograph in the prenatal period indicates abnormal development.

b.

It is visually identified at the time of delivery.

c.

A nasogastric tube fails to pass at birth.

d.

The infant has a low birth weight.

ANS: C

Feedback

A

Prenatal radiographs do not provide a definitive diagnosis.

B

The defect is not externally visible. Bronchoscopy and endoscopy can be used to identify this defect.

C

Atresia is suspected when a nasogastric tube fails to pass 10 to 11 cm beyond the gum line. Abdominal radiographs will confirm the diagnosis.

D

Infants with esophageal atresia may have been born prematurely and with a low birth weight, but neither is suggestive of the presence of an esophageal atresia.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1071

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

7. What is the most important information to be included in the discharge planning for an infant with gastroesophageal reflux?

a.

Teach parents to position the infant on the left side.

b.

Reinforce the parents knowledge of the infants developmental needs.

c.

Teach the parents how to do infant cardiopulmonary resuscitation (CPR).

d.

Have the parents keep an accurate record of intake and output.

ANS: C

Feedback

A

Correct positioning minimizes aspiration. The correct position for the infant is on the right side after feeding and supine for sleeping.

B

Knowledge of developmental needs should be included in discharge planning for all hospitalized infants, but it is not the most important in this case.

C

Risk of aspiration is a priority nursing diagnosis for the infant with gastroesophageal reflux. The parents must be taught infant CPR.

D

Keeping a record of intake and output is not a priority and may not be necessary.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1081

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

8. What information should the nurse include when teaching the parents of a 5-week-old infant about pyloromyotomy?

a.

The infant will be in the hospital for a week.

b.

The surgical procedure is routine and no big deal.

c.

The prognosis for complete correction with surgery is good.

d.

They will need to ask the physician about home care nursing.

ANS: C

Feedback

A

The infant will remain in the hospital for a day or two postoperatively.

B

Although the prognosis for surgical correction is good, telling the parents that surgery is no big deal minimizes the infants condition.

C

Pyloromyotomy is the definitive treatment for pyloric stenosis. Prognosis is good with few complications. These comments reassure parents.

D

Home care nursing is not necessary after a pyloromyotomy.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1095

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

9. A nurse has admitted a child to the hospital with a diagnosis of rule out peptic ulcer disease. Which test will the nurse expect to be ordered to confirm the diagnosis of a peptic ulcer?

a.

A dietary history

b.

A positive Hematest result on a stool sample

c.

A fiberoptic upper endoscopy

d.

An abdominal ultrasound

ANS: C

Feedback

A

Dietary history may yield information suggestive of a peptic ulcer, but the diagnosis is confirmed through endoscopy.

B

Blood in the stool indicates a gastrointestinal abnormality, but it does not conclusively confirm a diagnosis of peptic ulcer.

C

Endoscopy provides direct visualization of the stomach lining and confirms the diagnosis of peptic ulcer.

D

An abdominal ultrasound is used to rule out other gastrointestinal alterations such as gallstones, tumor, or mechanical obstruction.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1085

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

10. What should the nurse teach a school-age child and his parents about the management of ulcer disease?

a.

Eat a bland, low-fiber diet in small, frequent meals.

b.

Eat three balanced meals a day with no snacking between meals.

c.

The child needs to eat alone to avoid stress.

d.

Do not give antacids 1 hour before or after antiulcer medications.

ANS: D

Feedback

A

A bland diet is not indicated for ulcer disease. The diet should be a regular diet that is low in caffeine, and the child should eat a meal or snack every 2 to 3 hours.

B

The child should eat every 2 to 3 hours.

C

Eating alone is not indicated.

D

Antacids can interfere with antiulcer medication if given less than 1 hour before or after antiulcer medications.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1086

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

11. What is the major focus of the therapeutic management for a child with lactose intolerance?

a.

Compliance with the medication regimen.

b.

Providing emotional support to family members.

c.

Teaching dietary modifications.

d.

Administration of daily normal saline enemas.

ANS: C

Feedback

A

Medications are not typically ordered in the management of lactose intolerance.

B

Providing emotional support to family members is not specific to this medical condition.

C

Simple dietary modifications are effective in management of lactose intolerance. Symptoms of lactose intolerance are usually relieved after instituting a lactose-free diet.

D

Diarrhea is a manifestation of lactose intolerance. Enemas are contraindicated for this alteration in bowel elimination.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1103

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

12. The child with lactose intolerance is most at risk for which electrolyte imbalance?

a.

Hyperkalemia

b.

Hypoglycemia

c.

Hyperglycemia

d.

Hypocalcemia

ANS: D

Feedback

A

The child with lactose intolerance is not at risk for hyperkalemia.

B

Lactose intolerance does not affect glucose metabolism.

C

Hyperglycemia does not result from ingestion of a lactose-free diet.

D

The child between 1 and 10 years requires a minimum of 800 mg of calcium daily. Because high-calcium dairy products containing lactose are restricted from the childs diet, alternative sources such as egg yolk, green leafy vegetables, dried beans, and cauliflower must be provided to prevent hypocalcemia.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1103

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

13. What food choice by the parent of a 2-year-old child with celiac disease indicates a need for further teaching?

a.

Oatmeal

b.

Rice cake

c.

Corn muffin

d.

Meat patty

ANS: A

Feedback

A

The child with celiac disease is unable to fully digest gluten, the protein found in wheat, barley, rye, and oats. Oatmeal contains gluten and is not an appropriate food selection.

B

Rice is an appropriate choice because it does not contain gluten.

C

Corn is digestible because it does not contain gluten.

D

Meats do not contain gluten and can be included in the diet of a child with celiac disease.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1105

OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

14. Which assessment finding should the nurse expect in an infant with Hirschsprung disease?

a.

Currant jelly stools

b.

Constipation with passage of foul-smelling, ribbon-like stools

c.

Foul-smelling, fatty stools

d.

Diarrhea

ANS: B

Feedback

A

Currant jelly stools are associated with intussusception.

B

Constipation results from absence of ganglion cells in the rectum and colon, and is present since the neonatal period with passage of frequent foul-smelling, ribbon-like, or pellet-like stools.

C

Foul-smelling, fatty stools are associated with cystic fibrosis and celiac disease.

D

Diarrhea is not typically associated with Hirschsprung disease but may result from impaction.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1099

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

15. What is an expected outcome for the parents of a child with encopresis?

a.

The parents will give the child an enema daily for 3 to 4 months.

b.

The family will develop a plan to achieve control over incontinence.

c.

The parents will have the child launder soiled clothes.

d.

The parents will supply the child with a low-fiber diet.

ANS: B

Feedback

A

Stool softeners or laxatives, along with dietary changes, are typically used to treat encopresis. Enemas are indicated when a fecal impaction is present.

B

Parents of the child with encopresis often feel guilty and believe that encopresis is willful on the part of the child. The family functions effectively by openly discussing problems and developing a plan to achieve control over incontinence.

C

This action is a punishment and will increase the childs shame and embarrassment. The child should not be punished for an action that is not willful.

D

Increasing fiber in the diet and fluid intake results in greater bulk in the stool, making it easier to pass.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1082

OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

16. Which intervention should be included in the nurses plan of care for a 7-year-old child with encopresis who has cleared the initial impaction?

a.

Have the child sit on the toilet for 30 minutes when he gets up in the morning and at bedtime.

b.

Increase sugar in the childs diet to promote bowel elimination.

c.

Use a Fleets enema daily.

d.

Give the child a choice of beverage to mix with a laxative.

ANS: D

Feedback

A

To facilitate bowel elimination, the child should sit on the toilet for 5 to 10 minutes after breakfast and dinner.

B

Decreasing the amount of sugar in the diet will help keep stools soft.

C

Daily Fleets enemas can result in hypernatremia and hyperphosphatemia, and are used only during periods of fecal impaction.

D

Offering realistic choices is helpful in meeting the school-age childs sense of control.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1083

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

17. The nurse is teaching the parents of a child who has been diagnosed with irritable bowel syndrome about the pathophysiology associated with the symptoms their child is experiencing. Which response indicates to the nurse that her teaching has been effective?

a.

My child has an absence of ganglion cells in the rectum causing alternating diarrhea and constipation.

b.

The cause of my childs diarrhea and constipation is disorganized intestinal contractility.

c.

My child has an intestinal obstruction; thats why he has abdominal pain.

d.

My child has an intolerance to gluten, and this causes him to have abdominal pain.

ANS: B

Feedback

A

The absence of ganglion cells in the rectum is associated with Hirschsprung disease.

B

Disorganized contractility and increased mucus production are precipitating factors of irritable bowel disease.

C

Intestinal obstruction is associated with pyloric stenosis.

D

Intolerance to gluten is the underlying cause of celiac disease.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1084

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

18. What is an expected outcome for the child with irritable bowel disease?

a.

Decreasing symptoms

b.

Adherence to a low-fiber diet

c.

Increasing milk products in the diet

d.

Adapting the lifestyle to the lifelong problems

ANS: A

Feedback

A

Management of irritable bowel disease is aimed at identifying and decreasing exposure to triggers and decreasing bowel spasms, which will decrease symptoms. Management includes maintenance of a healthy, well-balanced, moderate-fiber, lower fat diet.

B

A moderate amount of fiber in the diet is indicated for the child with irritable bowel disease.

C

No modification in dairy products is necessary unless the child is lactose intolerant.

D

Irritable bowel syndrome is typically self-limiting and resolves by age 20 years.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1084

OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

19. An infant is born and the nurse notices that the child has herniation of abdominal viscera into the base of the umbilical cord. What will the nurse document on her or his assessment of this condition?

a.

Diaphragmatic hernia

b.

Umbilical hernia

c.

Gastroschisis

d.

Omphalocele

ANS: D

Feedback

A

A diaphragmatic hernia is the protrusion of part of the abdominal organs through an opening in the diaphragm.

B

An umbilical hernia is a soft skin protrusion of abdominal stricture through the esophageal hiatus.

C

Gastroschisis is the protrusion of intraabdominal contents through a defect in the abdominal wall lateral to the umbilical ring. There is no peritoneal sac.

D

Omphalocele is the herniation of the abdominal viscera into the base of the umbilical cord.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1078 | Table 43-2

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

20. What is an appropriate statement for the nurse to make to parents of a child who has had a barium enema to correct an intussusception?

a.

I will call the physician when the baby passes his first stool.

b.

I am going to dilate the anal sphincter with a gloved finger to help the baby pass the barium.

c.

I would like you to save all the soiled diapers so I can inspect them.

d.

Add cereal to the babys formula to help him pass the barium.

ANS: C

Feedback

A

The physician does not need to be notified when the infant passes the first stool.

B

Dilating the anal sphincter is not appropriate for the child after a barium enema.

C

The nurse needs to inspect diapers after a barium enema because it is important to document the passage of barium and note the characteristics of the stool.

D

After reduction, the infant is given clear liquids and the diet is gradually increased.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1089

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

21. What is the best response to parents who ask why their infant has a nasogastric tube to intermittent suction before abdominal surgery for hypertrophic pyloric stenosis?

a.

The nasogastric tube decompresses the abdomen and decreases vomiting.

b.

We can keep a more accurate measure of intake and output with the nasogastric tube.

c.

The tube is used to decrease postoperative diarrhea.

d.

Believe it or not, the nasogastric tube makes the baby more comfortable after surgery.

ANS: A

Feedback

A

The nasogastric tube provides decompression and decreases vomiting.

B

A nursing responsibility when a patient has a nasogastric tube is measurement of accurate intake and output, but this is not why nasogastric tubes are inserted.

C

Nasogastric tube placement does not decrease diarrhea.

D

The presence of a nasogastric tube can be perceived as a discomfort by the patient.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1096

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

22. Which description of a stool is characteristic of intussusception?

a.

Ribbon-like stools

b.

Hard stools positive for guaiac

c.

Currant jelly stools

d.

Loose, foul-smelling stools

ANS: C

Feedback

A

Ribbon-like stools are characteristic of Hirschsprung disease.

B

With intussusception, passage of bloody mucus stools occurs. Stools will not be hard.

C

Pressure on the bowel from obstruction leads to passage of currant jelly stools.

D

Loose, foul-smelling stools may indicate infectious gastroenteritis.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1097

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

23. What is a priority concern for a 14-year-old child with inflammatory bowel disease?

a.

Compliance with antidiarrheal medication therapy

b.

Long-term complications

c.

Dealing with the embarrassment and stress of diarrhea

d.

Home schooling

ANS: C

Feedback

A

Antidiarrheal medications are not typically ordered for a child with inflammatory bowel disease.

B

Long-term complications are not a priority concern for the adolescent with inflammatory bowel disease.

C

Embarrassment and stress from chronic diarrhea are real concerns for the adolescent with inflammatory bowel disease.

D

Exacerbations may interfere with school attendance, but home schooling is not a usual consideration for the adolescent with inflammatory bowel disease.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 1092-1093

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

24. Which statement about Crohn disease is the most accurate?

a.

The signs and symptoms of Crohn disease are usually present at birth.

b.

Signs and symptoms of Crohn disease include abdominal pain, diarrhea, and often a palpable abdominal mass.

c.

Edema usually accompanies this disease.

d.

Symptoms of Crohn disease usually disappear by late adolescence.

ANS: B

Feedback

A

Signs and symptoms are not usually present at birth.

B

Crohn disease can occur anywhere in the GI tract from the mouth to the anus and is most common in the terminal ileum. Signs and symptoms include abdominal pain, diarrhea (nonbloody), fever, palpable abdominal mass, anorexia, severe weight loss, fistulas, obstructions, and perianal and anal lesions.

C

Diarrhea and malabsorption from Crohn disease cause weight loss, anorexia, dehydration, and growth failure. Edema does not accompany this disease.

D

Crohn disease is a long-term health problem. Symptoms do not typically disappear by adolescence.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1092 | Table 43-4

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

25. Therapeutic management of the child with acute diarrhea and dehydration usually begins with

a.

Clear liquids

b.

Adsorbents, such as kaolin and pectin

c.

Oral rehydration solution (ORS)

d.

Antidiarrheal medications such as paregoric

ANS: C

Feedback

A

Clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea.

B

Adsorbents are not recommended.

C

Orally administered rehydration solution is the first treatment for acute diarrhea.

D

Antidiarrheals are not recommended because they do not get rid of pathogens.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 1088-1089

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

26. What is the most important action to prevent the spread of gastroenteritis in a daycare setting?

a.

Administering prophylactic medications to children and staff

b.

Frequent handwashing

c.

Having parents bring food from home

d.

Directing the staff to wear gloves at all times

ANS: B

Feedback

A

Prophylactic medications are not helpful in preventing gastroenteritis.

B

Handwashing is the most the important measure to prevent the spread of infectious diarrhea.

C

Bringing food from home will not prevent the spread of infectious diarrhea.

D

Gloves should be worn when changing diapers, soiled clothing, or linens. They do not need to be worn for interactions that do not involve contact with secretions. Handwashing after contact is indicated.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1089

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

27. What is an expected outcome for a 1-month-old infant with biliary atresia?

a.

Correction of the defect with the Kasai procedure

b.

Adequate nutrition and age-appropriate growth and development

c.

Adherence to a salt-free diet with vitamin B12 supplementation

d.

Adequate protein intake

ANS: B

Feedback

A

The goal of the Kasai procedure is to allow for adequate growth until a transplant can be done. It is not a curative procedure.

B

Adequate nutrition, preventing skin breakdown, adequate growth and development, and family education and support are expected outcomes in an infant with biliary atresia.

C

Vitamin B12 supplementation is not indicated. A salt-restricted diet is appropriate.

D

Protein intake may need to be restricted to avoid hepatic encephalopathy.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 1110-1111

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

28. Which assessment finding is the most significant to report to the physician for a child with cirrhosis?

a.

Weight loss

b.

Change in level of consciousness

c.

Skin with pruritus

d.

Black, foul-smelling stools

ANS: B

Feedback

A

One complication of cirrhosis is ascites. The child needs to be assessed for increasing abdominal girth and edema. A child who is retaining fluid will not exhibit weight loss.

B

The child with cirrhosis must be assessed for encephalopathy, which is characterized by a change in level of consciousness. Encephalopathy can result from a buildup of ammonia in the blood from the incomplete breakdown of protein.

C

Biliary obstruction can lead to pruritus, which is a frequent finding. An alteration in the level of consciousness is of higher priority.

D

Black, tarry stools may indicate blood in the stool. This needs be reported to the physician. This is not a higher priority than a change in level of consciousness.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1112

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

29. Which nursing diagnosis has the highest priority for the toddler with celiac disease?

a.

Disturbed Body Image related to chronic constipation

b.

Risk for Disproportionate Growth related to obesity

c.

Excess Fluid Volume related to celiac crisis

d.

Imbalanced Nutrition: Less than Body Requirements related to malabsorption

ANS: D

Feedback

A

Body Image disturbances are not usually apparent in toddlers. This is more common in adolescents. It is not the priority nursing diagnosis.

B

Celiac disease causes disproportionate growth and development associated with malnutrition, not obesity.

C

Celiac crisis causes deficient fluid volume.

D

Imbalanced Nutrition: Less than Body Requirements is the highest priority nursing diagnosis because celiac disease causes gluten enteropathy, a malabsorption condition.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1105

OBJ: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

30. The nurse notes on assessment that a 1-year-old child is underweight, with abdominal distention, thin legs and arms, and foul-smelling stools. The nurse suspects failure to thrive is associated with

a.

Celiac disease

b.

Intussusception

c.

Irritable bowel syndrome

d.

Imperforate anus

ANS: A

Feedback

A

These are classic symptoms of celiac disease.

B

Intussusception is not associated with failure to thrive or underweight, thin legs and arms, and foul-smelling stools. Stools are like currant jelly.

C

Irritable bowel syndrome is characterized by diarrhea and pain, and the child does not typically have thin legs and arms.

D

Imperforate anus is the incomplete development or absence of the anus in its normal position in the perineum. Symptoms are evident in early infancy.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1103

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

31. The nurse caring for a child with suspected appendicitis should question which order from the physician?

a.

Keep patient NPO.

b.

Start IV of D5/0.45 normal saline at 60 mL/hr.

c.

Apply K-pad to abdomen prn for pain.

d.

Obtain CBC on admission to nursing unit.

ANS: C

Feedback

A

NPO status is appropriate for the potential appendectomy patient.

B

An IV is appropriate both as a preoperative intervention and to compensate for the short-term NPO status.

C

A K-pad (moist heat device) is contraindicated for suspected appendicitis because it may contribute to the rupture of the appendix.

D

Because appendicitis is frequently reflected in an elevated WBC, laboratory data are needed.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1090

OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

32. Which order should the nurse question when caring for a 5-year-old child after surgery for Hirschsprung disease?

a.

Monitor rectal temperature every 4 hours and report an elevation greater than 38.5 C.

b.

Assess stools after surgery.

c.

Keep the child NPO until bowel sounds return.

d.

Maintain IV fluids at ordered rate.

ANS: A

Feedback

A

Rectal temperatures should not be taken after this surgery. Rectal temperatures are generally not the route of choice for children because of the routes traumatic nature.

B

This is an appropriate intervention postoperatively. Stools should be soft and formed.

C

This is an appropriate intervention postoperatively.

D

This is an appropriate postoperative order.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1101

OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

33. Which parasite causes acute diarrhea?

a.

Shigella organisms

b.

Salmonella organisms

c.

Giardia lamblia

d.

Escherichia coli

ANS: C

Feedback

A

Shigella is a bacterial pathogen.

B

Salmonella is a bacterial pathogen.

C

Giardiasis a parasite that represents 15% of nondysenteric illness in the United States.

D

E. coli is a bacterial pathogen.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1087 | Table 43-3

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

34. What goal has the highest priority for a child with malabsorption associated with lactose intolerance?

a.

The child will experience no abdominal spasms.

b.

The child will not experience constipation associated with malabsorption syndrome.

c.

The child will not experience diarrhea associated with malabsorption syndrome.

d.

The child will receive adequate nutrition as evidenced by a weight gain of 1 kg/day.

ANS: C

Feedback

A

A child usually has abdominal cramping pain and distention rather than spasms.

B

The child usually has diarrhea, not constipation.

C

This goal is correct for a child with malabsorption associated with lactose intolerance.

D

One kilogram a day is too much weight gain with no time parameters.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1103

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

35. What should the nurse stress in a teaching plan for the mother of an 11-year-old boy with ulcerative colitis?

a.

Preventing the spread of illness to others

b.

Nutritional guidance and preventing constipation

c.

Teaching daily use of enemas

d.

Coping with stress and avoiding triggers

ANS: D

Feedback

A

Ulcerative colitis is not infectious.

B

Although nutritional guidance is a priority teaching focus, diarrhea is a problem with ulcerative colitis, not constipation.

C

This is not part of the therapeutic plan of care.

D

Coping with the stress of chronic illness and the clinical manifestations associated with ulcerative colitis (diarrhea, pain) are important teaching foci. Avoidance of triggers can help minimize the impact of the disease and its effect on the child.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1094

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

36. An infant with imperforate anus has an anal plasty and temporary colostomy. Which statement by the infants mother indicates that she understands how to care for the infants colostomy at home?

a.

I will call the doctor right away if my baby starts vomiting.

b.

Ill call my home health nurse if the colostomy bag needs to be changed.

c.

Ill call the doctor if I notice that the colostomy stoma is pink.

d.

Ill have my mother help me with the care of the colostomy.

ANS: A

Feedback

A

Parents are taught signs of strangulation; vomiting, pain, and an irreducible mass in the abdomen. The physician should be contacted immediately if strangulation is suspected.

B

The mother should be taught the basics of colostomy care, including how to change the appliance.

C

The colostomy stoma should be pink in color, not pale or discolored.

D

There is no evidence that her mother knows how to care for a colostomy. This also does not indicate the mother has understanding of caring for the infants colostomy.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1078 | Table 43-2

OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

37. Careful handwashing before and after contact can prevent the spread of which condition in daycare and school settings?

a.

Irritable bowel syndrome

b.

Ulcerative colitis

c.

Hepatic cirrhosis

d.

Hepatitis A

ANS: D

Feedback

A

Irritable bowel syndrome is the result of increased intestinal motility and is not contagious.

B

Ulcerative colitis is not infectious.

C

Cirrhosis is not infectious.

D

Hepatitis A is spread person to person, by the fecal-oral route, and through contaminated food or water. Good handwashing is critical in preventing its spread. The virus can survive on contaminated objects for weeks.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1108

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

38. Which viral pathogen frequently causes acute diarrhea in young children?

a.

Giardia organisms

b.

Shigella organisms

c.

Rotavirus

d.

Salmonella organisms

ANS: C

Feedback

A

Giardia is a bacterial pathogen that causes diarrhea.

B

Shigella is a bacterial pathogen that is uncommon in the United States.

C

Rotavirus is the most frequent viral pathogen that causes diarrhea in young children.

D

Salmonella is a bacterial pathogen that causes diarrhea.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1087 | Table 43-3

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

39. A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells. This is most suggestive of

a.

Protein intolerance

b.

Parasitic infection

c.

Fat malabsorption

d.

Bacterial gastroenteritis

ANS: D

Feedback

A

Protein intolerance is suspected in the presence of eosinophils.

B

Parasitic infection is indicated by eosinophils.

C

Fat malabsorption is indicated by foul-smelling, greasy, bulky stools.

D

Neutrophils and red blood cells in stool indicate bacterial gastroenteritis.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1088

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

40. A school-age child with diarrhea has been rehydrated. The nurse is discussing the childs diet with the family. Which statement by the parent indicates a correct understanding of the teaching?

a.

I will keep my child on a clear liquid diet for the next 24 hours.

b.

I should encourage my child to drink carbonated drinks but avoid food for the next 24 hours.

c.

I will offer my child bananas, rice, applesauce, and toast for the next 48 hours.

d.

I should have my child eat a normal diet with easily digested foods for the next 48 hours.

ANS: D

Feedback

A

Clear liquids and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic.

B

Clear liquids and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic.

C

In some children, lactose intolerance will develop with diarrhea, and cows milk should be avoided in the recovery stage.

D

Easily digested foods such as cereals, cooked vegetables, and meats should be provided for the child. Early reintroduction of nutrients is desirable. Continued feeding or reintroduction of a regular diet has no adverse effects and actually lessens the severity and duration of the illness.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1089

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

41. Therapeutic management of most children with Hirschsprung disease is primarily

a.

Daily enemas

b.

Low-fiber diet

c.

Permanent colostomy

d.

Surgical removal of the affected section of the bowel

ANS: D

Feedback

A

Preoperative management may include enemas and a low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery.

B

Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery.

C

The colostomy that is created in Hirschsprung disease is usually temporary.

D

Most children with Hirschsprung disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1100

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

42. A 4-month-old infant has gastroesophageal reflux (GER) but is thriving without other complications. What should the nurse suggest to minimize reflux?

a.

Place in Trendelenburg position after eating.

b.

Thicken formula with rice cereal.

c.

Give continuous nasogastric tube feedings.

d.

Give larger, less frequent feedings.

ANS: B

Feedback

A

Placing the child in a Trendelenburg position increases the reflux.

B

Small frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice cereal per ounce of formula has been recommended. Milk thickening agents have been shown to decrease the number of episodes of vomiting and to increase the caloric density of the formula. This may benefit infants who are underweight as a result of GERD.

C

Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive.

D

Smaller, more frequent feedings are recommended in reflux.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1080

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

43. A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with GER. The purpose of this is to

a.

Prevent reflux.

b.

Prevent hematemesis.

c.

Reduce gastric acid production.

d.

Increase gastric acid production.

ANS: C

Feedback

A

These are not the modes of action of histamine-receptor antagonists.

B

These are not the modes of action of histamine-receptor antagonists.

C

The mechanism of action of histamine-receptor antagonists is to reduce the amount of acid present in gastric contents and to prevent esophagitis.

D

These are not the modes of action of histamine-receptor antagonists.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1080

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

44. What is used to treat moderate to severe inflammatory bowel disease?

a.

Antacids

b.

Antibiotics

c.

Corticosteroids

d.

Antidiarrheal medications

ANS: C

Feedback

A

These are not drugs of choice to treat the inflammatory process of inflammatory bowel disease.

B

Antibiotics may be used as adjunctive therapy to treat complications.

C

Corticosteroids, such as prednisone and prednisolone, are used in short bursts to suppress the inflammatory response in inflammatory bowel disease.

D

These are not drugs of choice to treat the inflammatory process of inflammatory bowel disease.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1092

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

45. Bismuth subsalicylate, clarithromycin, and metronidazole are prescribed for a child with a peptic ulcer to

a.

Eradicate Helicobacter pylori.

b.

Coat gastric mucosa.

c.

Treat epigastric pain.

d.

Reduce gastric acid production.

ANS: A

Feedback

A

This combination of drug therapy is effective in the treatment of H. pylori.

B

This drug combination is prescribed to eradicate the H. pylori.

C

This drug combination is prescribed to eradicate the H. pylori.

D

This drug combination is prescribed to eradicate the H. pylori.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1085

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

46. Which statement best characterizes hepatitis A?

a.

Incubation period is 6 weeks to 6 months.

b.

Principal mode of transmission is through the parenteral route.

c.

Onset is usually rapid and acute.

d.

There is a persistent carrier state.

ANS: C

Feedback

A

The incubation period is approximately 3 weeks for hepatitis A.

B

The principal mode of transmission for hepatitis A is the fecal-oral route.

C

Hepatitis A is the most common form of acute hepatitis in most parts of the world. It is characterized by a rapid acute onset.

D

Hepatitis A does not have a carrier state.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1107 | Table 43-5

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

47. The best chance of survival for a child with cirrhosis is

a.

Liver transplantation

b.

Treatment with corticosteroids

c.

Treatment with immune globulin

d.

Provision of nutritional support

ANS: A

Feedback

A

The only successful treatment for end-stage liver disease and liver failure may be liver transplantation, which has improved the prognosis for many children with cirrhosis.

B

Liver transplantation has revolutionized the approach to cirrhosis. Liver failure and cirrhosis are indications for transplantation. Liver transplantation reflects the failure of other medical and surgical measures to prevent or treat cirrhosis.

C

Liver transplantation has revolutionized the approach to cirrhosis. Liver failure and cirrhosis are indications for transplantation. Liver transplantation reflects the failure of other medical and surgical measures to prevent or treat cirrhosis.

D

Liver transplantation has revolutionized the approach to cirrhosis. Liver failure and cirrhosis are indications for transplantation. Liver transplantation reflects the failure of other medical and surgical measures to prevent or treat cirrhosis.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1112

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

48. The earliest clinical manifestation of biliary atresia is

a.

Jaundice

b.

Vomiting

c.

Hepatomegaly

d.

Absence of stooling

ANS: A

Feedback

A

Jaundice is the earliest and most striking manifestation of biliary atresia. It is first observed in the sclera, may be present at birth, but is usually not apparent until age 2 to 3 weeks.

B

Vomiting is not associated with biliary atresia.

C

Hepatomegaly and abdominal distention are common but occur later.

D

Stools are large and lighter in color than expected because of the lack of bile.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1110

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

49. Which type of hernia has an impaired blood supply to the herniated organ?

a.

Hiatal hernia

b.

Incarcerated hernia

c.

Omphalocele

d.

Strangulated hernia

ANS: D

Feedback

A

A hiatal hernia is the intrusion of an abdominal structure, usually the stomach, through the esophageal hiatus.

B

An incarcerated hernia is a hernia that cannot be reduced easily.

C

Omphalocele is the protrusion of intraabdominal viscera into the base of the umbilical cord. The sac is covered with peritoneum and not skin.

D

A strangulated hernia is one in which the blood supply to the herniated organ is impaired.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1076

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

50. An infant with short bowel syndrome will be discharged home on total parenteral nutrition (TPN) and gastrostomy feedings. Nursing care should include

a.

Preparing family for impending death

b.

Teaching family signs of central venous catheter infection

c.

Teaching family how to calculate caloric needs

d.

Securing TPN and gastrostomy tubing under the diaper to lessen risk of dislodgment

ANS: B

Feedback

A

The prognosis for patients with short bowel syndrome depends in part on the length of residual small intestine. It has improved with advances in TPN.

B

During TPN therapy, care must be taken to minimize the risk of complications related to the central venous access device, such as catheter infections, occlusions, or accidental removal. This is an important part of family teaching.

C

Although parents need to be taught about nutritional needs, the caloric needs and prescribed TPN and rate are the responsibility of the health care team.

D

The tubes should not be placed under the diaper due to risk of infection.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1075

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

MULTIPLE RESPONSE

1. You are the nurse caring for a child with celiac disease. Which food choices by the childs parent indicate understanding of teaching? Select all that apply.

a.

Oatmeal

b.

Steamed rice

c.

Corn on the cob

d.

Baked chicken

e.

Peanut butter and jelly sandwich on wheat bread

ANS: B, C, D

Feedback

Correct

Rice is an appropriate choice because it does not contain gluten. Corn is digestible because it does not contain gluten. Meats do not contain gluten and can be included in the diet of a child with celiac disease.

Incorrect

The child with celiac disease is unable to fully digest gluten, the protein found in wheat, barley, rye, and oats. Oatmeal contains gluten and is not an appropriate food selection. Wheat bread is not appropriate.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1105

OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

2. Which nursing interventions are significant for a child with cirrhosis who is at risk for bleeding? Select all that apply.

a.

Guaiac all stools

b.

Provide a safe environment

c.

Administer multivitamins with vitamins A, D, E, and K

d.

Inspect skin for pallor and cyanosis

e.

Monitor serum liver panels

ANS: A, B, C

Feedback

Correct

Identification of bleeding includes stool guaiac testing, which can detect if blood is present in the stool; protecting the child from injury by providing a safe environment; administering vitamin K to prevent bleeding episodes; and avoiding injections.

Incorrect

A skin assessment would likely reveal jaundice. Pallor and cyanosis are associated with a cardiac problem. These may be late signs of a significant bleeding episode, but not significant in the prevention stage of the nursing process. Monitoring serum liver panels is important but would not provide information on coagulation status or risk factors associated with bleeding.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 1112-1113

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

3. Which interventions should a nurse implement when caring for a child with hepatitis? Select all that apply.

a.

Provide a well-balanced low-fat diet.

b.

Schedule playtime in the playroom with other children.

c.

Teach parents not to administer any over-the-counter medications.

d.

Arrange for home schooling because the child will not be able to return to school.

e.

Instruct parents on the importance of good handwashing.

ANS: A, C, E

Feedback

Correct

The child with hepatitis should be placed on a well-balanced low-fat diet. Parents should be taught to not give over-the-counter medications because of impaired liver function. Hand hygiene is the most important preventive measure for the spread of hepatitis.

Incorrect

The child will be in contact isolation in the hospital so playtime with other hospitalized children is not scheduled. The child will be on contact isolation for a minimum of 1 week after the onset of jaundice. After that period, the child will be allowed to return to school.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1109

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

4. The nurse is providing home care instructions to the parents of an infant being discharged after repair of a bilateral cleft lip. Which instructions should the nurse include? Select all that apply.

a.

Acetaminophen (Tylenol) should not be given to your infant.

b.

Feed your infant in an upright position.

c.

Place your infant prone for a period of time each day.

d.

Burp your child frequently during feedings.

e.

Apply antibiotic ointment to the lip as prescribed.

ANS: B, D, E

Feedback

Correct

After cleft lip surgery the parents are taught to feed the infant in an upright position to decrease the chance of choking. The parents are taught to burp the infant frequently during feedings because excess air is often swallowed. Parents are taught to cleanse the suture line area with a cotton swab using a rolling motion and apply antibiotic ointment with the same technique.

Incorrect

Tylenol is used for pain and the child should never be placed prone as this position can you damage the suture line.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1107

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

COMPLETION

1. A girl with possible malabsorption syndrome is undergoing diagnostic testing for the condition. She is instructed to wear a facemask in order for expelled air to be collected. This test is known as the ________ breath test.

ANS:

hydrogen

A carbohydrate solution is given by mouth and exhaled. Inadequately digested carbohydrate produces hydrogen when acted on by the gastrointestinal flora. The hydrogen breath test will help confirm the diagnosis of malabsorption syndrome.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1102

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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