Question 1

A histamine-receptor antagonist such as cimetidine (Tagamet)or ranitidine (Zantac)is ordered for an infant with gastroesophageal reflux disease.What is the purpose of this drug?
A) It prevents reflux.
B) It prevents hematemesis.
C) It reduces gastric acid production.
D) It increases gastric acid production.

Accepted Answer

The mechanism of action of histamine-receptor antagonists is to reduce the amount of acid present in gastric contents and may prevent esophagitis.Preventing reflux and hematemesis and increasing gastric acid production are not the modes of action for histamine-receptor antagonists.

Question 2

A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting.What is the first step in therapeutic management for this child?
A) Intravenous fluids
B) Oral rehydration solution (ORS)
C) Clear liquids,1 to 2 ounces at a time
D) Administration of antidiarrheal medication

Accepted Answer

Intravenous fluids are initiated in children with severe dehydration.ORS is an acceptable therapy if the dehydration is not severe.Diarrhea is not managed by using clear liquids by mouth because they have a high carbohydrate content,low electrolyte content,and high osmolality.Antidiarrheal medications are not recommended for the treatment of acute,infectious diarrhea.

Question 3

An infant is brought to the emergency department with poor skin turgor,weight loss,lethargy,and tachycardia.What are these signs suggestive of?
A) Overhydration
B) Dehydration
C) Sodium excess
D) Potassium excess

Accepted Answer

These clinical manifestations indicate dehydration.Symptoms of overhydration are edema and weight gain.Regardless of extracellular sodium levels,total body sodium is usually depleted in dehydration.Symptoms of hypocalcemia are a result of neuromuscular irritability and manifest as jitteriness,tetany,tremors,and muscle twitching.These symptoms do not indicate hyperkalemia.

Question 4

What is the viral pathogen that frequently causes acute diarrhea in young children?
A) Giardia organisms
B) Shigella organisms
C) Rotavirus
D) Salmonella organisms

Accepted Answer

Rotavirus is the most common viral pathogen that causes diarrhea in young children.Giardia and Salmonella are bacterial pathogens that also cause diarrhea.Shigella is a bacterial pathogen that is uncommon in Canada.

Question 5

What is the first treatment a nurse provides in the therapeutic management of a child with acute diarrhea and dehydration?
A) Clear liquids
B) Adsorbents such as kaolin and pectin
C) Oral rehydration solution (ORS)
D) Antidiarrheal medications such as paregoric

Accepted Answer

ORS is the first treatment for acute diarrhea.Clear liquids are not recommended because they contain too much sugar,which may contribute to the diarrhea.Adsorbents are not recommended and neither are antidiarrheal medications because they do not get rid of pathogens.

Question 6

When a child has which symptom would the nurse be alert for increased fluid requirements?
A) Fever
B) Mechanical ventilation
C) Heart failure
D) Increased intracranial pressure (ICP)

Accepted Answer

Fever may cause dehydration to develop quickly.The respiratory rate influences insensible fluid loss and should be monitored in a mechanically ventilated child.Heart failure is a case of fluid overload in children.ICP does not lead to increased fluid requirements in children.

Question 7

The nurse is explaining to a parent how to care for a child with vomiting associated with a viral illness.What should the nurse include in her discussion?
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.

Accepted Answer

It is important to emphasize that the child needs to brush his teeth or rinse his mouth after vomiting to dilute the hydrochloric acid that comes in contact with the teeth.Administration of a glucose-electrolyte solution to an alert child will help restore water and electrolytes satisfactorily.It is important to include carbohydrates to spare body protein and avoid ketosis.

Question 8

A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells.These results are most suggestive of what condition?
A) Protein intolerance
B) Parasitic infection
C) Fat malabsorption
D) Bacterial gastroenteritis

Accepted Answer

Neutrophils and red blood cells in stool indicate bacterial gastroenteritis.Protein intolerance is suspected in the presence of eosinophils,as is parasitic infection.Fat malabsorption is indicated by foul-smelling,greasy,bulky stools.

Question 9

Which statement best describes Meckel's 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.

Accepted Answer

Blood in stools is often a presenting sign of Meckel's diverticulum,because it is associated with mild-to-profuse intestinal bleeding.It is twice as common in males as in females,and complications are more frequent in males.Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract and is present in 1 to 4% of the general population.The standard therapy is surgical removal of the diverticulum.

Question 10

What is often the cause of acute diarrhea?
A) Irritable bowel syndrome
B) Antibiotic therapy
C) Hypothyroidism
D) Hirschsprung's disease

Accepted Answer

Acute diarrhea is a sudden increase in frequency and change in consistency of stools and may be associated with antibiotic therapy,upper respiratory or urinary infections,or laxative use.Hirschsprung's disease and hypothyroidism are usually manifested with constipation rather than diarrhea.Irritable bowel disease is the cause of chronic diarrhea rather than acute diarrhea.

Question 11

Which is a parasite that causes acute diarrhea?
A) Shigella organisms
B) Salmonella organisms
C) Giardia lamblia
D) Escherichia coli

Accepted Answer

In Canada,the incidence of intestinal parasitic disease,especially giardiasis,has increased among young children and causes acute diarrhea.Shigella,Salmonella,and E.coli are bacterial pathogens,not parasites.

Question 12

What type of dehydration results from water loss in excess of electrolyte loss?
A) Isotonic dehydration
B) Isosmotic dehydration
C) Hypotonic dehydration
D) Hypertonic dehydration

Accepted Answer

Hypertonic dehydration results from water loss in excess of electrolyte loss.This is the most dangerous type of dehydration,caused by feeding children fluids with high amounts of solute.Isotonic dehydration occurs when electrolyte and water deficits are balanced in proportion.Isosmotic dehydration is another term for isotonic dehydration.Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit,leaving the serum hypotonic.

Question 13

When caring for a child with probable appendicitis,which should the nurse watch for as a sign of perforation?
A) Bradycardia
B) Anorexia
C) Sudden relief from pain
D) Decreased abdominal distension

Accepted Answer

Signs of peritonitis,in addition to fever,include sudden relief from pain after perforation.Tachycardia,not bradycardia,is a manifestation of peritonitis.Anorexia is already a clinical manifestation of appendicitis.Abdominal distension usually increases in addition to an increase in pain (usually diffuse and accompanied by rigid guarding of the abdomen).

Question 14

Which clinical manifestation indicates 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 the McBurney point

Accepted Answer

Pain is the cardinal feature.It is initially generalized and usually periumbilical.The pain localizes to the right lower quadrant at the McBurney point.Rebound tenderness is not a reliable sign and is extremely painful to the child.Abdominal pain that is relieved by eating and bright or dark red rectal bleeding are not signs of acute appendicitis.

Question 15

Which high-fibre food can the nurse recommend for a 10-year-old child with chronic constipation?
A) Popcorn
B) Pancakes
C) Muffins
D) Ripe bananas

Accepted Answer

Popcorn is a high-fibre food.Pancakes and muffins do not have significant fibre unless made with fruit or bran.Raw fruits,especially those with skins and seeds (other than ripe bananas and avocado),are high in fibre.

Question 16

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

Accepted Answer

Small,frequent feedings of formula combined with 5 to 15 mL of rice cereal per 30 mL of formula has been recommended.Milk thickening agents have been shown to decrease the number of episodes of vomiting and increase the caloric density of the formula.This may benefit infants who are underweight as a result of GER.Placing the child in a Trendelenburg position increases the reflux.Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive.

Question 17

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 would indicate 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."

Accepted Answer

Easily digested foods such as cereals,cooked vegetables,and meats should be provided to the child.Early reintroduction of nutrients is desirable.Continued feeding or reintroduction of a regular diet has no adverse effects and actually lessens the severity and duration of the illness.Clear liquids and carbonated drinks have high carbohydrate contents and few electrolytes.Caffeinated beverages should be avoided because caffeine is a mild diuretic.A diet of bananas,applesauce,and toast is contraindicated because it has little nutritional value (low in energy and protein),is high in carbohydrates,and is low in electrolytes.

Question 18

A 3-year-old child with Hirschsprung's disease is hospitalized for surgery.A temporary colostomy will be necessary.What should the nurse recognize about preparing this child psychologically for surgery?
A) It is not necessary because of child's age.
B) It is not necessary because the colostomy is temporary.
C) It is necessary because it will require the child's adjustment.
D) It is necessary because the child must deal with a negative body image.

Accepted Answer

The child's age dictates the type and extent of psychological preparation.Before a colostomy is performed,a child who is at least preschool age must be told about the procedure and what to expect in concrete terms with the use of visual aids.It is necessary to prepare a child this age for procedures.The preschooler is not yet concerned with body image.

Question 19

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.What is the most likely cause of her constipation?
A) Diet
B) Allergies
C) Antihistamines
D) Emotional factors

Accepted Answer

Constipation may be associated with drugs such as antihistamines,antacids,diuretics,opioids,antiepileptics,and iron.Because this is the only known recent change in her habits,the addition of antihistamines is most likely the etiology of the diarrhea.With a change in bowel habits,the presence and role of any recently prescribed medications should be assessed.

Question 20

What is the primary therapeutic management for most children with Hirschsprung's disease?
A) Daily enemas
B) Low-fibre diet
C) Permanent colostomy
D) Surgical removal of affected section of bowel

Accepted Answer

Most children with Hirschsprung's disease require surgical rather than medical management.Surgery is done to remove the aganglionic portion of the bowel,relieve obstruction,and restore normal bowel motility and function of the internal anal sphincter.Preoperative management may include enemas and a low-fibre,high-calorie,high-protein diet until the child is physically ready for surgery.The colostomy that is created in Hirschsprung's disease is usually temporary.

Quiz 46: Gastrointestinal Dysfunction

A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with gastroesophageal reflux disease.What is the purpose of this drug?

A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting.What is the first step in therapeutic management for this child?

An infant is brought to the emergency department with poor skin turgor,weight loss,lethargy,and tachycardia.What are these signs suggestive of?

What is the viral pathogen that frequently causes acute diarrhea in young children?

What is the first treatment a nurse provides in the therapeutic management of a child with acute diarrhea and dehydration?

When a child has which symptom would the nurse be alert for increased fluid requirements?

The nurse is explaining to a parent how to care for a child with vomiting associated with a viral illness.What should the nurse include in her discussion?

A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells.These results are most suggestive of what condition?

Which statement best describes Meckel's diverticulum?

What is often the cause of acute diarrhea?

Which is a parasite that causes acute diarrhea?

What type of dehydration results from water loss in excess of electrolyte loss?

When caring for a child with probable appendicitis,which should the nurse watch for as a sign of perforation?

Which clinical manifestation indicates acute appendicitis?

Which high-fibre food can the nurse recommend for a 10-year-old child with chronic constipation?

A 4-month-old infant has gastroesophageal reflux (GER) but is thriving without other complications.What should the nurse suggest to minimize reflux?

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 would indicate a correct understanding of the teaching?

A 3-year-old child with Hirschsprung's disease is hospitalized for surgery.A temporary colostomy will be necessary.What should the nurse recognize about preparing this child psychologically for surgery?

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.What is the most likely cause of her constipation?

What is the primary therapeutic management for most children with Hirschsprung's disease?