Deck 43: The Child With a Gastrointestinal Alteration

Question 1

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 child's diarrhea and constipation is disorganized intestinal contractility."
C) "My child has an intestinal obstruction; that's why he has abdominal pain."
D) "My child has an intolerance to gluten, and this causes him to have abdominal pain."

Answer 1

"The cause of my child's diarrhea and constipation is disorganized intestinal contractility."

Question 2

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.

Answer 2

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

Question 3

What is the best response by the nurse to a mother asking about the cause of her infant's bilateral cleft lip?

A) "Did you use alcohol during your pregnancy?"
B) "Do you know of anyone in your family or the baby's father's 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"

Answer 3

"Do you know of anyone in your family or the baby's father's family who was born with cleft lip or palate problems?"

Question 4

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

Question 5

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 infant's fingers away from the mouth
D) Rinsing the mouth after every feeding

Question 6

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.

Question 7

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 baby's formula to help him pass the barium."

Question 8

What maternal assessment is related to an infant's 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

Question 9

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.

Question 10

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 infant's 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.

Question 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.

Question 12

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

Question 13

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

A) Hyperkalemia
B) Hypoglycemia
C) Hyperglycemia
D) Hypocalcemia

Question 14

Which intervention should be included in the nurse's 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 child's diet to promote bowel elimination.
C) Use a Fleets enema daily.
D) Give the child a choice of beverage to mix with a laxative.

Question 15

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

Question 16

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.

Question 17

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

Question 18

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.

Question 19

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

Question 20

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

Question 21

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.

Question 22

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."

Question 23

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

Question 24

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

Question 25

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

A) "I will call the doctor right away if my baby starts vomiting."
B) "I'll call my home health nurse if the colostomy bag needs to be changed."
C) "I'll call the doctor if I notice that the colostomy stoma is pink."
D) "I'll have my mother help me with the care of the colostomy."

Question 26

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

Question 27

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

Question 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

Question 29

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

Question 30

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.

Question 31

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

Question 32

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.

Question 33

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

Question 34

Which viral pathogen frequently causes acute diarrhea in young children?

A) Giardia organisms
B) Shigella organisms
C) Rotavirus
D) Salmonella organisms

Question 35

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

Question 36

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

Question 37

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.

Question 38

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

Question 39

Which parasite causes acute diarrhea?

A) Shigella organisms
B) Salmonella organisms
C) Giardia lamblia
D) Escherichia coli

Question 40

A school-age child with diarrhea has been rehydrated.The nurse is discussing the child's 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."

Question 41

You are the nurse caring for a child with celiac disease.Which food choices by the child's 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

Question 42

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

A) Hiatal hernia
B) Incarcerated hernia
C) Omphalocele
D) Strangulated hernia

Question 43

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.

Question 44

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.

Question 45

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

A) Antacids
B) Antibiotics
C) Corticosteroids
D) Antidiarrheal medications

Question 46

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.

Question 47

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.

Question 48

The earliest clinical manifestation of biliary atresia is

A) Jaundice
B) Vomiting
C) Hepatomegaly
D) Absence of stooling

Question 49

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

Question 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

Question 51

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.

Question 52

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

Question 53

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.

Question 54

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.

Question 55

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