Deck 43: The Child with a Gastrointestinal Alteration

Question 1

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

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

Answer 1

Hypocalcemia

Question 2

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

Answer 2

Oatmeal

Question 3

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

Answer 3

Decreasing symptoms

Question 4

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 5

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 6

After an infant is born the nurse notices that the child has herniation of abdominal viscera into the base of the umbilical cord.What will the nurse document about this condition?

A) Diaphragmatic hernia
B) Umbilical hernia
C) Gastroschisis
D) Omphalocele

Question 7

The nurse is caring for a neonate with a suspected tracheoesophageal fistula (TEF).Nursing care should include which of the following?

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 8

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 9

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 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 in a quiet spot to avoid stress.
D) Do not give antacids 1 hour before or after antiulcer medications.

Question 11

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 caffeine in the child's diet to promote bowel elimination.
C) Use a Fleet enema daily.
D) Give the child a choice of beverage to mix with a laxative.

Question 12

A child has irritable bowel syndrome.The nurse is teaching the parents about the pathophysiology associated with the symptoms their child is experiencing.Which response indicates to the nurse that 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."

Question 13

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 14

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) "Does anyone in your family have a cleft lip or palate?"
C) "This defect is associated with intrauterine infection during the second trimester."
D) "The prevalent of cleft lip is higher in Caucasians."

Question 15

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 16

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 17

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 18

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 19

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 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) "Your baby can't have anything to eat or drink until bowel function returns."
D) "Add cereal to the baby's formula to help him pass the barium."

Question 21

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 and 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/week.

Question 22

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 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) Remaining compliant with a high-protein diet

Question 24

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 25

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

A) clear liquids.
B) IV solutions while the child is NPO.
C) oral rehydration solution (ORS).
D) antidiarrheal medications.

Question 26

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 27

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 cramping, diarrhea, and weight loss.
C) Edema usually accompanies this disease.
D) Symptoms of Crohn disease usually disappear by late adolescence.

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

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.
B) Assess stools after surgery.
C) Keep the child NPO until bowel sounds return.
D) Maintain IV fluids at ordered rate.

Question 30

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 31

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 due to extreme absenteeism

Question 32

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.

Question 33

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 34

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 35

A baby is scheduled for abdominal surgery for hypertrophic pyloric stenosis and has an NG tube to intermittent suction.When the family asks why the child has the tube,what response by the nurse is best?

A) "The nasogastric tube decompresses the abdomen and decreases vomiting."
B) "We can keep a more accurate measure of intake and output with the tube."
C) "The tube is used to decrease postoperative diarrhea."
D) "The nasogastric tube makes the baby more comfortable after surgery."

Question 36

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 37

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 38

Which parasite causes acute diarrhea?

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

Question 39

Which viral pathogen frequently causes acute diarrhea in young children?

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

Question 40

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 41

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 42

The earliest clinical manifestation of biliary atresia is

A) jaundice.
B) vomiting.
C) hepatomegaly.
D) absence of stooling.

Question 43

The nurse has educated the parents of a child with celiac disease on diet modifications.Which food choices by the child's parents 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 44

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 45

A nurse is teaching a student nurse in the pediatric clinic about vomiting in children.The nurse states that getting parents to estimate the amount a child has vomited is quite difficult.What is the best explanation for this problem?

A) Parents are too upset by the vomiting to pay close attention.
B) Parents don't know how to accurately estimate the amount.
C) Descriptions about vomitus are vague and non-specific.
D) Infants and small children often swallow the vomitus.

Question 46

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 47

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 48

The nurse cares for many children with different types of hepatitis.What information about this disease is correct? (Select all that apply.)

A) Hepatitis A can be contracted from contaminated water.
B) Only a small percentage of children infected with hepatitis B fully recover.
C) People infected with chronic hepatitis C are usually asymptomatic.
D) Hepatitis D is the most likely to cause a fulminating illness.
E) Hepatitis E is the most common type in children in the United States.

Question 49

Bismuth subsalicylate,clarithromycin,and metronidazole are prescribed for a child with a peptic ulcer for what purpose?

A) Eradicate Helicobacter pylori
B) Coat gastric mucosa
C) Treat epigastric pain
D) Reduce gastric acid production

Question 50

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 the Trendelenburg position after eating.
B) Thicken formula with rice cereal.
C) Give continuous nasogastric tube feedings.
D) Give larger, less frequent feedings.

Question 51

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

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

Question 52

Which treatment provides the best chance of survival for a child with cirrhosis?

A) Liver transplantation
B) Treatment with corticosteroids
C) Treatment with immune globulin
D) Provision of nutritional support

Question 53

A histamine-receptor antagonist such as cimetidine (Tagamet)or ranitidine (Zantac)is ordered for an infant with GER.What is the purpose of these drugs?

A) Prevent reflux
B) Prevent hematemesis
C) Reduce gastric acid production
D) Increase gastric acid production

Question 54

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 vitamin K
D) Inspect skin for pallor and cyanosis
E) Monitor serum liver panels

Question 55

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.