Question 1

The parents demonstrate that they have understood the nurse's teaching with regard to colostomy stoma care for their infant if they state:

Accepted Answer

Option A is incorrect because adhesive enhancers are not recommended for infants as they may cause skin irritation or allergic reactions. Option B is incorrect because bleeding is not expected after cleansing the area around the stoma. Option D is incorrect because colostomy bags do not need to be changed with every wet diaper, only when they become full or when the seal is compromised. Option C is the correct answer because it is important to watch for skin irritation around the stoma, which can occur due to leakage or irritation from the adhesive of the colostomy bag.

Question 2

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

Accepted Answer

Hirschsprung's disease is a condition in which nerve cells are absent in a portion of the intestine, causing chronic constipation and failure to gain weight. Clay-colored stools and dark urine, as well as continual bouts of foul-smelling diarrhea, are not typical symptoms of this condition. A history of early passage of meconium in the newborn period may actually be a normal finding and not specific to Hirschsprung's disease.

Question 3

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

Accepted Answer

Recurrent abdominal pain, diarrhea, and bloody stools are symptoms commonly associated with ulcerative colitis, an inflammatory bowel disease affecting the large intestine (colon) and rectum. Necrotizing enterocolitis usually occurs in premature infants, while Crohn's disease can affect any part of the digestive tract from the mouth to the anus. Appendicitis typically presents with pain in the lower right abdomen, nausea, and vomiting.

Question 4

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:

Accepted Answer

A) Calling the infant by name helps personalize and humanize the baby, fostering a bond between the parents and the infant.C) Smiling and talking to the infant in the parents' presence models positive interactions and helps the parents see their baby as responsive and engaging.D) Showing before and after pictures of other children who had cleft lips can provide hope and reassurance about the possibilities of corrective surgery and the future appearance of their child.E) Discussing the positive features of their baby helps the parents focus on the baby's strengths and unique qualities, fostering a positive bond.

Question 5

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

Accepted Answer

Risk for aspiration is a priority because the connection between the esophagus and trachea (tracheoesophageal fistula) allows gastric contents to enter the airways, leading to a high risk of aspiration.

Question 6

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

Accepted Answer

A diaphragmatic hernia can cause respiratory distress in a newborn due to lung compression. Intubation is necessary to secure the airway and provide adequate ventilation, as bag-valve-mask ventilation can worsen the condition by inflating the stomach.

Question 7

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

Accepted Answer

Prednisone should be administered with meals or immediately after meals to decrease the risk of gastric upset and bleeding.

Question 8

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.

Accepted Answer

The tape measure should be placed just above the umbilicus, around the largest circumference of the abdomen, to measure an accurate abdominal girth.

Question 9

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:

Accepted Answer

Positioning the infant in semi-Fowler position will help prevent aspiration if there is an esophageal atresia/tracheoesophageal fistula. This position helps prevent reflux of gastric contents into the trachea and lungs. Allowing the infant to be taken to the mother's room for bonding or offering formula feeding is not appropriate until the infant's suspected condition is ruled out by the pediatrician. Placing the infant in a crib by a viewing window and wrapping in blankets does not address the suspected condition and may even increase the risk of aspiration.

Question 10

Following diagnosis of Crohn's disease, the nurse is explaining dietary modifications to the teenagers. The nurse would recommend:

Accepted Answer

Small, frequent meals can help manage symptoms. Identifying and eliminating distress-causing foods can prevent flare-ups. High-calorie supplements can help meet nutritional needs due to malabsorption issues in Crohn's disease.

Question 11

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

Accepted Answer

Watching for skin irritation around the stoma is a key aspect of colostomy stoma care. The other choices are incorrect: changing the bag with each wet diaper is not necessary, there should not be moderate bleeding after cleansing the stoma area, and adhesive enhancers are not always needed.

Question 12

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:

Accepted Answer

Gastroschisis is a congenital birth defect where the intestines are found outside of the abdominal cavity. The exposed intestines must be kept moist and free of bacterial contamination until surgical repair. Therefore, covering the exposed intestines with sterile moist gauze is the appropriate nursing care for this newborn. Wrapping the infant warmly in blankets or providing sterile water feeding are not priority nursing interventions for this condition. It is important for the parents to see and establish a bond with their infant, so preventing them from seeing the infant prior to transfer would not be appropriate.

Question 13

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

Accepted Answer

Aspiration is a major risk for infants with esophageal atresia and tracheoesophageal fistula due to the connection between the esophagus and the trachea, which can allow food or saliva to enter the lungs, leading to aspiration pneumonia.

Question 14

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:

Accepted Answer

The answer of The nurse who works in the newborn...

Question 15

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?

Accepted Answer

A splint pillow can help support the incision site and decrease pain during movement or coughing, making it an appropriate nonpharmacologic pain management strategy for this child who has had an appendectomy. A warm, moist pack, EMLA cream, and an ice pack may be appropriate for pain management in other situations, but not specifically for this child's post-operative pain.

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?

Accepted Answer

Rectal temperatures should be questioned in a patient with a colostomy closure or any rectal surgery to avoid disrupting the surgical site and to prevent potential harm or infection. Other methods of temperature measurement should be used.

Question 17

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?

Accepted Answer

Large amounts of gastric drainage can lead to a loss of stomach acid, which can result in metabolic alkalosis due to the loss of hydrogen ions.

Question 18

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?

Accepted Answer

Pain management is essential after surgery, and administering appropriate analgesics (which may include narcotics) is essential in promoting pediatric recovery. Avoiding appropriate pain management can cause the child to experience increased anxiety, which can lead to suboptimal healing. Therefore, the nurse should not omit administering appropriate pain management to the child.

Question 19

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?

Accepted Answer

Placing an infant in an infant seat after feeding can increase the risk of gastroesophageal reflux (GER) due to the infant's position. The nurse should intervene by educating the family on appropriate positioning for the infant after feeding. The other choices are appropriate and do not require intervention. Adding rice cereal to the infant's formula can help thicken the formula, reducing GER symptoms. Holding the infant in a high Fowler's position while feeding can also help reduce GER symptoms. Drawing up ranitidine in a syringe for oral administration is an appropriate way to administer the medication.

Question 20

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?

Accepted Answer

An omphalocele is a congenital defect where the intestines and sometimes other organs are outside of the abdominal cavity in a sac. The infant needs to be kept warm and the radiant warmer provides a stable temperature for the infant. The infant also needs to be placed in a sterile environment, so a crib would not be appropriate. Bilirubin light and formula for feeding are not immediately necessary for the infant's care.

Quiz 52: The Child With Alterations in Gastrointestinal Function