Deck 23: Gastrointestinal Alterations

Question 1

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

A) 2
B) 4
C) 6
D) 8

Answer 1

6

Question 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

Answer 2

a 10- to 20-milliliter stomach capacity at birth

Question 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

Answer 3

common because the lower esophageal sphincter tone is decreased

Question 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

Question 5

A mother wants to know why she can't give her 1-month-old child cereal as the child seems hungry all the time. Which of the following is the nurse's 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.

Question 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

Question 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

Question 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

Question 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 infant's mouth periodically during the feeding
D) unusually loud burping sounds

Question 10

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

A) epigastric tenderness over several days
B) crying without producing any tears
C) failure to gain weight
D) olive-shaped mass in the epigastrium

Question 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

Question 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

Question 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

Question 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
B) 5 days
C) 1 week
D) 1 month

Question 15

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

A) Caucasians
B) Afro-Americans
C) American Indians
D) Asians

Question 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

Question 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
B) 3 months of age or 12 pounds
C) 1 year old or 20 pounds
D) 18 months old or 20 pounds

Question 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
B) 6 months
C) 1 year
D) 1-1/2 years

Question 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

Question 20

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

A) pity
B) love
C) shock
D) anger

Question 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 baby's 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.

Question 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 child's 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.

Question 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 nurse's 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 baby's 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) "Let's 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."

Question 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 nurse's 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."

Question 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.
B) Place ice packs on the breast.
C) Pump part of the milk from the breast.
D) Give a little water from a bottle first.

Question 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
B) a regular nipple and bottle
C) a special nipple designed for clefts
D) a special bottle

Question 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
B) engage, start, swallow, and restart
C) enter, stimulate, swallow, and retry
D) enlarge, stimulate, swallow, and rest

Question 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

Question 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
B) "sippy" cup
C) Asepto syringe with a rubber tip
D) special straw for drawing fluid up

Question 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 child's appearance?"
B) "How does the mother feel about this baby?"
C) "Is the father going to help with this baby's care?"
D) "How bad are the cleft lip and the cleft palate?"

Question 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.

Question 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

Question 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

Question 34

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

A) male
B) female
C) lower-than-average birth weight
D) of American Indian heritage

Question 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.

Question 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
B) cleft palate
C) esophageal atresia
D) intussusception

Question 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

Question 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
B) family education regarding care
C) preventing aspiration pneumonia
D) discharge planning

Question 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
B) elevated
C) even with the bed
D) lowered

Question 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

Question 41

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

A) cancer
B) Hirschsprung's disease
C) benign tumors
D) intussusception

Question 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
B) polyps
C) viruses
D) drug use in pregnancy

Question 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

Question 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
B) currant-jelly-like stools
C) frothy stools that float
D) black tar-colored stools

Question 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

Question 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
B) vitamin and mineral deficiencies
C) adjustment to being at home
D) abnormal vital signs

Question 47

Hirschsprung's 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

Question 48

In Hirschsprung's disease the normal portion of the bowel:

A) becomes atrophied and shrinks
B) loses function
C) becomes hypertrophied and dilated
D) functions normally

Question 49

The nurse assessing newborn babies and infants after birth will notice which of the following symptoms as a primary manifestation of Hirschsprung's 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

Question 50

Which of the following is the major cause of death in Hirschsprung's disease?

A) widespread infection in the body
B) failure to take in enough nourishment
C) bacterial endocarditis and heart failure
D) enterocolitis, sepsis, or bowel perforation

Question 51

When is Hirschsprung's 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

Question 52

The nurse assessing an older infant or child will suspect Hirschsprung's disease then the child has a history of which of the following symptoms?

A) chronic constipation
B) blood in the stools
C) chronic vomiting
D) clay-colored stools

Question 53

Which of the following is the most current treatment for Hirschsprung's 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

Question 54

The nurse caring for the child who is going to have surgery related to Hirschsprung's disease knows that assessment of the infant's 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 child's 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.

Question 55

Which of the following anorectal malformations do not require surgery?

A) imperforate anus
B) anal stenosis
C) rectal atresia
D) anal agenesis

Question 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

Question 57

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

A) meticulous skin care
B) pushing fluids
C) keeping the anal area covered
D) high-fiber diet

Question 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
B) require help from an expert
C) be no different than for other toddlers
D) be easier

Question 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 can't 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.

Question 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
B) esophageal stricture
C) gastroesophageal reflux (GER)
D) intestinal malrotation

Question 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 infant's 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.

Question 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 nurse's 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."

Question 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 nurse's 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."

Question 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 infant's chart or computer record
B) weigh the infant
C) assess respiratory status
D) check the medication administration record and set up medications

Question 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?"

Question 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."

Question 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

Question 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."

Question 69

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
B) right lower quadrant
C) left lower quadrant
D) periumbilical area

Question 70

A child is expected to require prolonged corticosteroid therapy for inflammatory bowel disease. The nurse is providing discharge instructions to the child's 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 child's 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 child's mood regularly."