Question 1

The nurse,caring for an infant whose cleft lip was repaired,should include which interventions into the infant's postoperative plan of care? (Select all that apply.)

Accepted Answer

Apply petroleum jelly to the operative site for several days after surgery.Elbows are restrained to prevent the child from accessing the operative site for up to 7 to 10 days.The child should be positioned on back or side or in an infant seat.Postural drainage is not indicated.This would increase the pressure on the operative site when the child is placed in different positions.Mouth irrigations would not be indicated.

Question 2

What is the major focus of the therapeutic management for a child with lactose intolerance?

Accepted Answer

Simple dietary modifications are effective in the management of lactose intolerance.Symptoms of lactose intolerance are usually relieved after instituting a lactose-free diet.Medications are not typically ordered in the management of lactose intolerance.Providing emotional support to family members is not specific to this medical condition.Diarrhea is a manifestation of lactose intolerance.Enemas are contraindicated for this alteration in bowel elimination.

Question 3

What is the most appropriate nursing action when a child with a probable intussusception has a normal,brown stool?

Accepted Answer

Passage of a normal brown stool indicates that the intussusception has reduced itself.This is immediately reported to the practitioner,who may choose to alter the diagnostic/therapeutic plan of care.

Question 4

The nurse is caring for an infant with suspected pyloric stenosis.Which clinical manifestation would indicate pyloric stenosis?

Accepted Answer

Visible gastric peristaltic waves that move from left to right across the epigastrium are observed in pyloric stenosis,as is weight loss.Abdominal rigidity and pain on palpation,and rounded abdomen and hypoactive bowel sounds,are usually not present.The upper abdomen is distended,not the lower abdomen.

Question 5

The nurse,caring for a neonate with a suspected tracheoesophageal fistula,should include what intervention into the plan of care?

Accepted Answer

When a newborn is suspected of having tracheoesophageal fistula,the most desirable position is supine with the head elevated on an inclined plane of at least 30 degrees to maintain an airway and facilitate drainage of secretions.It is imperative that any source of aspiration be removed at once; oral feedings are withheld.Feeding of fluids should not be given to infants suspected of having tracheoesophageal fistulas.The oral pharynx should be kept clear of secretion by oral suctioning.This is to avoid the cyanosis that is usually the result of laryngospasm caused by overflow of saliva into the larynx.

Question 6

Careful hand washing before and after contact can prevent the spread of which condition in day care and school settings?

Accepted Answer

Hepatitis A is spread person to person,by the fecal-oral route,and through contaminated food or water.Good hand washing is critical in preventing its spread.The virus can survive on contaminated objects for weeks.Irritable bowel syndrome is the result of increased intestinal motility and is not contagious.Ulcerative colitis and cirrhosis are not infectious.

Question 7

Which description of a stool is characteristic of intussusception?

Accepted Answer

With intussusception,passage of bloody mucus-coated stools occurs.Pressure on the bowel from obstruction leads to passage of "currant jelly" stools.Ribbon-like stools are characteristic of Hirschsprung's disease.Stools will not be hard.Loose,foul-smelling stools may indicate infectious gastroenteritis.

Question 8

What should the nurse stress in a teaching plan for the mother of an 11-year-old diagnosed with ulcerative colitis?

Accepted Answer

Coping with the stress of chronic illness and the clinical manifestations associated with ulcerative colitis (diarrhea,pain)are important teaching foci.Avoidance of triggers can help minimize the impact of the disease and its effect on the child.Ulcerative colitis is not infectious.Although nutritional guidance is a priority teaching focus,diarrhea is a problem with ulcerative colitis,not constipation.Daily enemas are not part of the therapeutic plan of care.

Question 9

What food choice by the parent of a 2-year-old child with celiac disease indicates a need for further teaching?

Accepted Answer

The child with celiac disease is unable to fully digest gluten,the protein found in wheat,barley,rye,and oats.Oatmeal contains gluten and is not an appropriate food selection.Rice is an appropriate choice because it does not contain gluten.Corn is digestible because it does not contain gluten.Meats do not contain gluten and can be included in the diet of a child with celiac disease.

Question 10

Which statements regarding hepatitis B are correct? (Select all that apply.)

Accepted Answer

The vaccine elicits the formation of an antibody to the hepatitis B surface antigen,which is protective against hepatitis B.Hepatitis B can be transferred to an infant of a breastfeeding mother,especially if the mother's nipples are cracked.The onset of hepatitis B is insidious.Immunity develops after one exposure to hepatitis B.Hepatitis B can exist in a carrier state.

Question 11

Which interventions should a nurse implement when caring for a child with hepatitis? (Select all that apply.)

Accepted Answer

The child with hepatitis should be placed on a well-balanced,low-fat diet.Parents should be taught to not give over-the-counter medications because of impaired liver function.Hand hygiene is the most important preventive measure for the spread of hepatitis.The child will be in contact isolation in the hospital,so playtime with other hospitalized children is not scheduled.The child will be on contact isolation for a minimum of 1 week after the onset of jaundice.After that period,the child will be allowed to return to school.

Question 12

A nurse is conducting dietary teaching on high-fiber foods for parents of a child with constipation.Which foods should the nurse include as being high in fiber? (Select all that apply.)

Accepted Answer

High-fiber foods include whole grain breads,bran pancakes,and raw carrots.Unrefined (brown)rice is high in fiber but white rice is not.Raw fruits,especially those with skins or seeds,other than ripe banana or avocados are high in fiber.

Question 13

Which type of hernia has an impaired blood supply to the herniated organ?

Accepted Answer

A strangulated hernia is one in which the blood supply to the herniated organ is impaired.A hiatal hernia is the intrusion of an abdominal structure,usually the stomach,through the esophageal hiatus.An incarcerated hernia is a hernia that cannot be reduced easily.Omphalocele is the protrusion of intraabdominal viscera into the base of the umbilical cord.The sac is covered with peritoneum and not skin.

Question 14

An important nursing consideration in the care of a child with celiac disease is to facilitate which intervention?

Accepted Answer

The main consideration is helping the child adhere to dietary management.Considerable time is spent in explaining to the child and parents the disease process,the specific role of gluten in aggravating the condition,and those foods that must be restricted.Referral to a nutritionist would help in this process.The most severe symptoms usually occur in early childhood and adult life.Dietary avoidance of gluten should be lifelong.Celiac disease is not transmissible or stress related.

Question 15

A mother shares with the clinic nurse that she has been giving her 4 year old the antidiarrheal drug loperamide.What conclusion should the nurse arrive at based on knowledge of this classification of drugs?

Accepted Answer

Antimotility medications are not recommended for the treatment of acute infectious diarrhea.These medications have adverse effects and toxicity,such as worsening of the diarrhea because of slowing of motility and ileus,or a decrease in diarrhea with continuing fluid losses and dehydration.Antidiarrheal medications are not recommended in infants and small children.

Question 16

The nurse is preparing to care for an infant returning from pyloromyotomy surgery.Which prescribed orders should the nurse anticipate implementing? (Select all that apply.)

Accepted Answer

Feedings are usually instituted soon after a pyloromyotomy surgery,beginning with clear liquids and advancing to formula or breast milk as tolerated.IV fluids are administered until the infant is taking and retaining adequate amounts by mouth.Appropriate analgesics should be given round the clock because pain is continuous.Ice should not be applied to the incisional area as it vasoconstricts and would reduce circulation to the incisional area and impair healing.

Question 17

An infant diagnosed with pyloric stenosis experiences excessive vomiting that can result in which condition?

Accepted Answer

Infants with excessive vomiting are prone to metabolic alkalosis from the loss of hydrogen ions.Chloride ions and sodium are lost with vomiting.Metabolic alkalosis,not acidosis,is likely.

Question 18

A mother who intended to breastfeed has given birth to an infant with a cleft palate.Which nursing interventions should be included in the plan of care? (Select all that apply.)

Accepted Answer

The mother who wishes to breastfeed may need encouragement and support because the defect does present some logistical issues.The nipple must be positioned and stabilized well back in the infant's oral cavity so that the tongue action facilitates milk expression.The suction required to stimulate milk,absent initially,may be useful before nursing to stimulate the let-down reflex.Because breastfeeding is an option,if the mother wishes to breastfeed,medications should not be given to suppress lactation.Because breastfeeding can usually be accomplished,gavage feedings are not indicated.

Question 19

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

Accepted Answer

Universal vaccination for hepatitis B is now recommended for all newborns.A vaccine is available for hepatitis A,but it is not yet universally recommended.No vaccine is currently available for hepatitis C.Only hepatitis B vaccine is recommended for newborns.

Quiz 41: The Child With Gastrointestinal Dysfunction