Deck 24: The Child With Gastrointestinal Dysfunction

Question 1

Enemas are ordered to empty the bowel preoperatively for a child with Hirschsprung disease. The enema solution should be:

A)Tap water
B)Normal saline
C)Oil retention
D)Phosphate preparation

Answer 1

Normal saline

Question 2

Constipation has recently become a problem for a school-age girl. She is healthy except for seasonal allergies, which are now being successfully treated with antihistamines. The nurse should suspect that the constipation is most likely caused by which of the following?

A)Diet
B)Allergies
C)Antihistamines
D)Emotional factors

Answer 2

Antihistamines

Question 3

Acute diarrhea is often caused by which of the following?

A)Celiac disease
B)Antibiotic therapy
C)Immune deficiency
D)Protein malnutrition

Answer 3

Antibiotic therapy

Question 4

An infant is brought to the emergency department with the following clinical manifestations: poor skin turgor, weight loss, lethargy, and tachycardia. This is suggestive of which of the following?

A)Overhydration
B)Dehydration
C)Sodium excess
D)Potassium excess

Question 5

A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. The nurse should recognize that preparing this child is:

A)Not necessary because of child's age.
B)Not necessary, because colostomy is temporary.
C)Necessary, because it will be an adjustment.
D)Necessary, because child must deal with negative body image.

Question 6

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

A)Clear liquids
B)Adsorbents, such as kaolin and pectin
C)Orally administered rehydration solutions (ORS)
D)Antidiarrheal medications such as paregoric

Question 7

Melena, the passage of black, tarry stools, suggests bleeding from:

A)Perianal or rectal area.
B)Hemorrhoids or anal fissures.
C)Upper gastrointestinal (GI) tract.
D)Lower GI tract.

Question 8

Therapeutic management of most children with Hirschsprung disease is primarily which of the following?

A)Daily enemas
B)Low-fiber diet
C)Permanent colostomy
D)Surgical removal of affected section of bowel

Question 9

Which of the following is a parasite that causes acute diarrhea?

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

Question 10

Which of the following is the viral pathogen that frequently causes acute diarrhea in young children?

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

Question 11

What type of dehydration is defined as "dehydration that occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportion"?

A)Isotonic dehydration
B)Hypotonic dehydration
C)Hypertonic dehydration
D)All types of dehydration in infants and small children

Question 12

A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting. Therapeutic management of this child will begin with:

A)Intravenous fluids.
B)ORS.
C)Clear liquids, 1 to 2 oz.at a time.
D)Administration of antidiarrheal medication.

Question 13

Nurses must be alert for increased fluid requirements when a child has which of the following?

A)Fever
B)Mechanical ventilation
C)Congestive heart failure
D)Increased intracranial pressure

Question 14

Which of the following is a high-fiber food that the nurse could recommend for a child with chronic constipation?

A)Popcorn
B)Pancakes
C)Muffins
D)Ripe bananas

Question 15

A mother calls the clinic nurse about her 4-year-old son who has acute diarrhea. She has been giving him the antidiarrheal drug loperamide (Imodium A-D). The nurse's response should be based on knowledge that this drug is:

A)Not indicated.
B)Indicated, because it slows intestinal motility.
C)Indicated, because it decreases diarrhea.
D)Indicated, because it decreases fluid and electrolyte losses.

Question 16

The nurse is explaining to a parent how to care for a child with vomiting associated with a viral illness. Which of the following should the nurse include?

A)Avoid carbohydrate-containing liquids.
B)Give nothing by mouth for 24 hours.
C)Brush teeth or rinse mouth after vomiting.
D)Give plain water until vomiting ceases for at least 24 hours.

Question 17

A 7-year-old child with acute diarrhea has been rehydrated with (ORSs). The nurse should recommend that the child's diet be advanced to include which of the following?

A)Regular diet
B)Clear liquids
C)High-carbohydrate diet
D)BRAT diet (bananas, rice, apples, and toast or tea)

Question 18

A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet with the family. Which of the following may be tolerated the best?

A)Clear liquids
B)Carbonated drinks
C)Applesauce and milk
D)Easily digested foods

Question 19

Which of the following types of dehydration results from water loss in excess of electrolyte loss?

A)Isotonic dehydration
B)Isosmotic dehydration
C)Hypotonic dehydration
D)Hypertonic dehydration

Question 20

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

A)Protein intolerance
B)Parasitic infection
C)Fat malabsorption
D)Bacterial gastroenteritis

Question 21

Which of the following statements is most descriptive of Meckel diverticulum?

A)It is more common in females than in males.
B)It is acquired during childhood.
C)Intestinal bleeding may be mild or profuse.
D)Medical interventions are usually sufficient to treat the problem.

Question 22

A 4-month-old infant has gastroesophageal reflux (GER) but is thriving without other complications. Which of the following 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 23

Which of the following is true concerning hepatitis B?

A)It cannot exist in carrier state.
B)It can be prevented by HBV vaccine.
C)Principle mode of transmission is fecal-oral route.
D)Immunity to all types of hepatitis develops after one attack.

Question 24

Which of the following is characterized by a chronic inflammatory process that may involve any part of the GI from mouth to anus?

A)Crohn disease
B)Ulcerative colitis
C)Meckel diverticulum
D)Irritable bowel syndrome

Question 25

The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's postoperative care include which of the following?

A)Arm restraints, postural drainage, mouth irrigations
B)Cleansing suture line, supine and side-lying positions, arm restraints
C)Mouth irrigations, prone position, cleansing suture line
D)Supine and side-lying positions, postural drainage, arm restraints

Question 26

Which of the following is now recommended for the immunization of all newborns?

A)Hepatitis A vaccine
B)Hepatitis B vaccine
C)Hepatitis C vaccine
D)Hepatitis A, B, and C vaccines

Question 27

A newborn was admitted to the nursery with a complete bilateral cleft lip and palate. The physician explained the plan of therapy and its expected good results. However, the mother refuses to see or hold her baby. Initial therapeutic approach to the mother should be which of the following?

A)Restate what the physician has told her about plastic surgery.
B)Encourage her to express her feelings.
C)Emphasize the normalcy of her baby and the baby's need for mothering.
D)Recognize that negative feelings toward the child continue throughout childhood.

Question 28

During the first few days after surgery for cleft lip, the nurse should do which of the following?

A)Leave infant in crib at all times to prevent suture strain.
B)Keep infant heavily sedated to prevent suture strain.
C)Remove restraints periodically to cuddle infant.
D)Alternate position from prone to side lying to supine.

Question 29

Which of the following clinical manifestations would be the most suggestive of acute appendicitis?

A)Rebound tenderness
B)Bright red or dark red rectal bleeding
C)Abdominal pain that is relieved by eating
D)Abdominal pain that is most intense at McBurney point

Question 30

Caring for the newborn with a cleft lip and palate before surgical repair includes which of the following?

A)Gastrostomy feedings
B)Keeping infant in near-horizontal position during feedings
C)Allowing little or no sucking
D)Providing satisfaction of sucking needs

Question 31

Which of the following statements 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 32

A mother who intended to breast-feed has given birth to an infant with a cleft palate. Nursing interventions should include which of the following?

A)Give medication to suppress lactation.
B)Encourage and assist mother to breast-feed.
C)Teach mother to feed breast milk by gavage.
D)Recommend use of a breast pump to maintain lactation until infant can suck.

Question 33

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 34

Which of the following is the earliest clinical manifestation of biliary atresia?

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

Question 35

The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. Which of the following is appropriate to relieve the abdominal discomfort?

A)Place in Trendelenburg position.
B)Allow to assume position of comfort.
C)Apply moist heat to the abdomen.
D)Administer a saline enema to cleanse bowel.

Question 36

The best chance of survival for a child with cirrhosis is:

A)Liver transplantation.
B)Treatment with corticosteroids.
C)Treatment with immune globulin.
D)Providing nutritional support.

Question 37

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 38

Which of the following is used to treat moderate to severe inflammatory bowel disease?

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

Question 39

When caring for a child with probable appendicitis, the nurse should be alert to recognize that which of the following is a sign of perforation?

A)Bradycardia
B)Anorexia
C)Sudden relief from pain
D)Decreased abdominal distention

Question 40

The association of cleft palate with otitis media is primarily due to which of the following?

A)Plugging of the eustachian tube with food particles
B)Lowered resistance because of poor nutritional status
C)Inefficient function of eustachian tubes and improper middle ear drainage
D)Coexisting defects of middle ear and eustachian tube

Question 41

The nurse is caring for a boy with probable intussusception. He had diarrhea before admission but, while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool. Which of the following is the most appropriate nursing action?

A)Notify practitioner.
B)Measure abdominal girth.
C)Auscultate for bowel sounds.
D)Take vital signs, including blood pressure.

Question 42

Excessive vomiting can result in which of the following in an infant with pyloric stenosis?

A)Hyperchloremia
B)Hypernatremia
C)Metabolic acidosis
D)Metabolic alkalosis

Question 43

Which of the following observations made of the exposed abdomen is most indicative of pyloric stenosis?

A)Abdominal rigidity
B)Substernal retraction
C)Visible peristalsis
D)Marked distention of lower abdomen

Question 44

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

A)Elevate head but give nothing by mouth.
B)Elevate head for feedings.
C)Feed glucose water only.
D)Avoid suctioning unless infant is cyanotic.

Question 45

Invagination of one segment of bowel within another is called which of the following?

A)Atresia
B)Stenosis
C)Herniation
D)Intussusception

Question 46

Which of the following best describes the incidence of pyloric stenosis?

A)Females are affected more often than males.
B)African American infants are affected more often than Caucasian infants.
C)Premature infants are affected more often than full-term infants.
D)Firstborn infants are affected more than later born infants.

Question 47

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

A)Prepare family for impending death.
B)Teach family signs of central venous catheter infection.
C)Teach family how to calculate caloric needs.
D)Secure TPN and gastrostomy tubing under diaper to lessen risk of dislodgement.

Question 48

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 49

Pyloric stenosis can best be described as which of the following?

A)Dilation of the pylorus
B)Hypertrophy of the pyloric muscle
C)Hypotonicity of the pyloric muscle
D)Reduction of tone in the pyloric muscle

Question 50

A nursing responsibility when caring for an infant with suspected pyloric stenosis would be which of the following?

A)Observe for projectile vomiting.
B)Monitor for signs of metabolic acidosis.
C)Administer large, infrequent feedings to allow for rest.
D)Place infant in supine position after feedings.

Question 51

A child who has just had definitive repair of a high rectal malformation is to be discharged. Which of the following should the nurse address in the discharge preparation of this family? (Select all that apply.)

A)Perineal/wound care
B)Necessity of firm stools to keep suture line clean
C)Bowel training beginning as soon as child returns home
D)Changes in stooling patterns to report to practitioner
E)Use of diet modification to prevent constipation

Question 52

Which of the following is an important nursing consideration in the care of a child with celiac disease?

A)Refer to a nutritionist for detailed dietary instructions and education.
B)Help child and family understand that diet restrictions are usually only temporary.
C)Teach proper handwashing and standard precautions to prevent disease transmission.
D)Suggest ways to cope more effectively with stress to minimize symptoms.