Deck 30: Alterations in Gastrointestinal Function

Question 1

A woman pregnant at term arrives at the small rural hospital in active labor. She has received no prenatal care. At delivery, it is discovered that the newborn has a gastroschisis defect. Immediate transfer to a pediatric hospital is planned. Nursing care to prepare the infant for discharge would include:

A)Covering the exposed intestines with sterile moist gauze.
B)Wrapping the infant warmly in two or three blankets.
C)Providing a sterile water feeding to maintain hydration during transport.
D)Preventing the parents from seeing the infant prior to transfer to reduce their anxiety.

Answer 1

Covering the exposed intestines with sterile moist gauze.

Question 2

A nasogastric tube to suction is ordered for a child newly diagnosed with a diaphragmatic hernia. The nurse notes that the surgeon has not ordered fluid replacement for the NG drainage. What might occur if large amounts of gastric drainage are noted without replacement?

A)The infant may lose weight due to loss of nutrition.
B)The infant will develop metabolic alkalosis.
C)The infant will become dehydrated.
D)The infant will develop hyperbilirubinemia.

Answer 2

The infant will develop metabolic alkalosis.

Question 3

An infant has been born with an esophageal atresia and tracheoesophageal fistula. What is a priority preoperative nursing diagnosis?

A)Ineffective tissue perfusion: gastrointestinal, related to decreased circulation
B)Ineffective infant feeding pattern related to uncoordinated suck and swallow
C)Acute pain related to esophageal defect
D)Aspiration, risk for related to regurgitation

Answer 3

Aspiration, risk for related to regurgitation

Question 4

A nurse is preparing for the delivery of a newborn with a known diaphragmatic hernia defect. Which equipment should the nurse prepare for use?

A)Appropriate bag-valve-mask system
B)Sterile gauze and saline
C)Soft arm restraints
D)Equipment for intubation

Question 5

A child returns from exploratory abdominal surgery following a gunshot wound to the abdomen. Which nursing intervention would the nurse omit from the plan of care for this child?

A)NPO status until bowel sounds return
B)Frequent assessment of the surgical site
C)Avoiding narcotics to prevent depression of the respiratory system
D)Allow parents at the bedside as soon as possible.

Question 6

An adolescent complains of recurrent abdominal pain with diarrhea and bloody stools. The nurse should recognize these as symptoms of which inflammatory bowel disease?

A)Necrotizing enterocolitis
B)Ulcerative colitis
C)Crohn's disease
D)Appendicitis

Question 7

At delivery, it was discovered that the newborn had a bilateral cleft lip. The parents are distressed about the appearance of their infant. Nursing behaviors that can help the parents bond to the infant include: Standard Text: Select all that apply.

A)Calling the infant by name when referring to the infant.
B)Keeping the infant's lower face covered with the blanket.
C)Smiling at the infant and talking to the infant in the parents' presence.
D)Showing the parents before and after pictures of other children with cleft lips.
E)Discussing positive features of their baby.

Question 8

Following hospital discharge for treatment of gastroesophageal reflux, the home health nurse visits the family. Which finding made by the nurse during the visit requires the nurse to intervene?

A)The infant's formula has rice cereal added.
B)The mother hold the infant is a high Fowler's position while feeding.
C)After feeding, the infant is placed in an infant seat.
D)The mother draws up the ranitidine (Zantac) in a syringe for oral administration.

Question 9

The nurse who works in the newborn nursery must be alert for infants with congenital gastrointestinal defects. Defects that might be diagnosed in the newborn nursery would include: Standard Text: Select all that apply.

A)Pyloric stenosis.
B)Biliary atresia.
C)Hirschsprung's disease.
D)Umbilical hernia.
E)Diaphragmatic hernia.

Question 10

The nurse is preparing to ambulate an 11-year-old child who has had an appendectomy. In addition to pharmacological pain management, which of the following nonpharmacologic, independent nursing pain management strategies would be appropriate for this child?

A)A warm, moist pack
B)EMLA cream to the incision site
C)An ice pack
D)A splint pillow against the abdomen when moving or coughing

Question 11

Which statement indicates that parents have understood the nurse's teaching with regard to colostomy stoma care for their toddler?

A)"We will change the colostomy bag with each wet diaper."
B)"We will expect a moderate amount of bleeding after cleansing the area around the stoma."
C)"We will watch for skin irritation around the stoma."
D)"We will use adhesive enhancers when we change the bag."

Question 12

A three-year-old child is suspected of having Hirschsprung's disease. Which assessment factors would support such a medical diagnosis?

A)Clay-colored stools and dark urine
B)History of early passage of meconium in the newborn period
C)History of chronic, progressive constipation and failure to gain weight
D)Continual bouts of foul-smelling diarrhea

Question 13

The woman has a normal pregnancy except for polyhydramnios. The delivery goes well and the baby is born and receives APGAR scores of seven and nine. Upon admission to the newborn nursery, the nurse is unsuccessful in inserting a nasogastric tube. The infant is suspected of having an esophageal atresia/tracheoesophageal fistula. While waiting for the pediatrician to see the infant, the nurse should:

A)Position the infant in semi-Fowler position.
B)Allow the infant to be taken to the mother's room for bonding.
C)Offer the infant formula feeding instead of breastfeeding.
D)Wrap the infant in blankets and place in a crib by the viewing window.

Question 14

The nurse is measuring an abdominal girth on a child with abdominal distension. Identify the area on the child's abdomen where the tape measure should be placed for an accurate abdominal girth.

A)Below the umbilicus
B)Just below the sternum
C)Just above the pubic bone
D)Just above the umbilicus, around the largest circumference of the abdomen

Question 15

The nurse is planning postoperative care for an infant after a cleft lip repair. Which intervention should the nurse include in this infant's plan of care?

A)Suctioning with a tonsil tip (Yankauer) device
B)Using a pacifier to reduce straining the suture line with crying
C)Supine positioning
D)Frequent breast or bottle feeding

Question 16

A toddler is admitted to the surgical unit for planned closure of the temporary colostomy. The nurse completes the admission assessment and reviews the medical orders. Which order should the nurse question?

A)Clear liquids today.NPO tomorrow
B)Type and cross-match for one unit of packed red blood cells.
C)Rectal temperatures every four hours
D)Start an intravenous line with D5NS at 20 ml per hour.

Question 17

Following diagnosis of Crohn's disease, the nurse is explaining dietary modifications to the teenagers. The nurse would recommend: Standard Text: Select all that apply.

A)Increased fiber in the diet to promote solid stools.
B)Small, frequent feedings are preferred over three meals a day.
C)Identify foods that cause distress and eliminate them from the diet.
D)High-calorie dietary supplement shakes can help meet nutritional requirements.
E)Socialization is important at mealtime no matter the dynamics.

Question 18

An infant born with an omphalocele defect is being admitted to the intensive care nursery. Which of the following should the nurse in charge instruct the nursing technician to prepare?

A)Radiant warmer
B)Crib
C)Bilirubin light
D)Formula for feeding

Question 19

A child with inflammatory bowel disease is taking prednisone daily. The family should be taught to administer the prednisone at what time?

A)Between meals
B)At bedtime
C)One hour before meals
D)With meals