Question 1

An infant is brought to the emergency department with dehydration. Which physical assessment finding does the nurse expect?
A) Weight gain
B) Bradycardia
C) Poor skin turgor
D) Brisk capillary refill

Accepted Answer

Clinical manifestations of dehydration include poor skin turgor, weight loss, lethargy, and tachycardia. The infant would have prolonged capillary refill, not brisk.

Question 2

Parents call the clinic and report that their toddler has had acute diarrhea for 24 hours. The nurse should further ask the parents if the toddler has which associated factor that is causing the acute diarrhea?
A) Celiac disease
B) Antibiotic therapy
C) Immunodeficiency
D) Protein malnutrition

Accepted Answer

Acute diarrhea is a sudden increase in frequency and change in consistency of stools and may be associated with antibiotic therapy. Celiac disease is a problem with gluten intolerance and may cause chronic diarrhea if not identified and managed appropriately. Immunodeficiency would occur with chronic diarrhea. Protein malnutrition or kwashiorkor causes chronic diarrhea from lowered resistance to infection.

Question 3

A child is admitted with bacterial gastroenteritis. Which lab results of a stool specimen confirm this diagnosis?
A) Eosinophils
B) Occult blood
C) pH less than 6
D) Neutrophils and red blood cells

Accepted Answer

Neutrophils and red blood cells in stool indicate bacterial gastroenteritis. Protein intolerance and parasitic infections are suspected in the presence of eosinophils. Occult blood may indicate pathogens such as Shigella, Campylobacter, or hemorrhagic Escherichia coli strains. A pH of less than 6 may indicate carbohydrate malabsorption or secondary lactase insufficiency.

Question 4

Enemas are ordered to empty the bowel preoperatively for a child with Hirschsprung disease. What enema solution should be used?
A) Tap water
B) Normal saline
C) Oil retention
D) Phosphate preparation

Accepted Answer

Isotonic solutions should be used in children. Saline is the solution of choice. Plain water is not used. This is a hypotonic solution and can cause rapid fluid shift, resulting in fluid overload. Oil-retention enemas will not achieve the "until clear" result. Phosphate enemas are not advised for children because of the harsh action of the ingredients. The osmotic effects of the phosphate enema can result in diarrhea, which can lead to metabolic acidosis.

Question 5

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

Accepted Answer

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

Question 6

Which condition in a child should alert a nurse for increased fluid requirements?
A) Fever
B) Mechanical ventilation
C) Congestive heart failure
D) Increased intracranial pressure (ICP)

Accepted Answer

Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume. Respiratory rate influences insensible fluid loss and should be monitored in the mechanically ventilated child. Congestive heart failure is a case of fluid overload in children. Increased ICP does not lead to increased fluid requirements in children.

Question 7

Which therapeutic management treatment is implemented for children with Hirschsprung disease?
A) Daily enemas
B) Low-fiber diet
C) Permanent colostomy
D) Surgical removal of affected section of bowel

Accepted Answer

Most children with Hirschsprung 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 low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. The colostomy that is created in Hirschsprung disease is usually temporary.

Question 8

Constipation has recently become a problem for a school-age girl. She is healthy except for seasonal allergies that are being treated with antihistamines. What should the nurse suspect caused the 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 change in her habits, the addition of antihistamines is most likely the cause of the diarrhea. With a change in bowel habits, the role of any recently prescribed medications should be assessed.

Question 9

The nurse is explaining to a parent how to care for a school-age child with vomiting associated with a viral illness. Which action 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.

Accepted Answer

It is important to emphasize the need for the child to brush the teeth or rinse the mouth after vomiting to dilute the hydrochloric acid that comes in contact with the teeth. Ad libitum administration of glucose-electrolyte solution to an alert child will help restore water and electrolytes satisfactorily. It is important to include carbohydrate to spare body protein and avoid ketosis.

Question 10

Which therapeutic management should the nurse prepare to initiate first for a child with acute diarrhea and moderate 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 diarrhea. Adsorbents are not recommended. Antidiarrheals are not recommended because they do not get rid of pathogens.

Question 11

Which pathogen 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 frequent viral pathogen that causes diarrhea in young children. Giardia (parasite) and Salmonella are bacterial pathogens that cause diarrhea. Shigella is a bacterial pathogen that is uncommon in the United States.

Question 12

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 psychologically 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 the child must deal with a negative body image.

Accepted Answer

The child's age dictates the type and extent of psychological preparation. When a colostomy is performed, the child who is at least preschool age is told about the procedure and what to expect in concrete terms, with the use of visual aids. It is necessary to prepare a 3-year-old child for procedures. The preschooler is not yet concerned with body image.

Question 13

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 what knowledge about this drug?
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

Accepted Answer

Antidiarrheal 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 14

A nurse is conducting an in-service on gastrointestinal disorders. The nurse includes that melena, the passage of black, tarry stools, suggests bleeding from which area?
A) Perianal or rectal area
B) Hemorrhoids or anal fissures
C) Upper gastrointestinal (GI) tract
D) Lower GI tract

Accepted Answer

Melena is denatured blood from the upper GI tract or bleeding from the right colon. Blood from the perianal or rectal area, hemorrhoids, or lower GI tract would be bright red.

Question 15

Which is a high-fiber food that the nurse should recommend for a child with chronic constipation?
A) Raisins
B) Pancakes
C) Muffins
D) Ripe bananas

Accepted Answer

Raisins are a high-fiber food. Pancakes and muffins do not have significant fiber unless made with fruit or bran. Raw fruits, especially those with skins and seeds, other than ripe bananas, have high fiber.

Question 16

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

Accepted Answer

Small, frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice cereal per ounce of formula have been recommended. Milk-thickening agents have been shown to decrease the number of episodes of vomiting and to increase the caloric density of the formula. This may benefit infants who are underweight as a result of GER disease. Placing the child in a Trendelenburg position would increase the reflux. Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive.

Question 17

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

Accepted Answer

G. lamblia is a parasite that represents 10% of non-dysenteric illness in the United States. Shigella, Salmonella, and E. coli are bacterial pathogens.

Question 18

A nurse is admitting an infant with dehydration caused from water loss in excess of electrolyte loss. Which type of dehydration is this infant experiencing?
A) Isotonic
B) Isosmotic
C) Hypotonic
D) Hypertonic

Accepted Answer

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

Question 19

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 for 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 content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic. The BRAT diet has little nutritional value and is high in carbohydrates.

Question 20

Which 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

Accepted Answer

Isotonic dehydration is the correct term for this definition and is the most frequent form of dehydration in children. Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic. Hypertonic dehydration results from water loss in excess of electrolyte loss and is usually caused by a proportionately larger loss of water or a larger intake of electrolytes. This definition is specific to isotonic dehydration.

Quiz 22: The Child with Gastrointestinal Dysfunction

An infant is brought to the emergency department with dehydration. Which physical assessment finding does the nurse expect?

Parents call the clinic and report that their toddler has had acute diarrhea for 24 hours. The nurse should further ask the parents if the toddler has which associated factor that is causing the acute diarrhea?

A child is admitted with bacterial gastroenteritis. Which lab results of a stool specimen confirm this diagnosis?

Enemas are ordered to empty the bowel preoperatively for a child with Hirschsprung disease. What enema solution should be used?

A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting. What should therapeutic management of this child begin with?

Which condition in a child should alert a nurse for increased fluid requirements?

Which therapeutic management treatment is implemented for children with Hirschsprung disease?

Constipation has recently become a problem for a school-age girl. She is healthy except for seasonal allergies that are being treated with antihistamines. What should the nurse suspect caused the constipation?

The nurse is explaining to a parent how to care for a school-age child with vomiting associated with a viral illness. Which action should the nurse include?

Which therapeutic management should the nurse prepare to initiate first for a child with acute diarrhea and moderate dehydration?

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

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 psychologically is:

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 what knowledge about this drug?

A nurse is conducting an in-service on gastrointestinal disorders. The nurse includes that melena, the passage of black, tarry stools, suggests bleeding from which area?

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

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

Which is a parasite that causes acute diarrhea?

A nurse is admitting an infant with dehydration caused from water loss in excess of electrolyte loss. Which type of dehydration is this infant experiencing?

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?

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