Question 1

An infant with short bowel syndrome will be on total parenteral nutrition (TPN) for an extended period of time. What should the nurse monitor the infant for ?
A) Central venous catheter infection, electrolyte losses, and hyperglycemia
B) Hypoglycemia, catheter migration, and weight gain
C) Venous thrombosis, hyperlipidemia, and constipation
D) Catheter damage, red currant jelly stools, and hypoglycemia

Accepted Answer

Numerous complications are associated with short bowel syndrome and long-term TPN. Infectious, metabolic, and technical complications can occur. Sepsis can occur after improper care of the catheter. The gastrointestinal tract can also be a source of microbial seeding of the catheter. The nurse should monitor for catheter infection, electrolyte losses, and hyperglycemia. Hypoglycemia, weight gain, constipation, or red currant jelly stools are not characteristics of short bowel syndrome with extended TPN.

Question 2

The nurse is caring for a child with celiac disease. The nurse understands that what may precipitate a celiac crisis? (Select all that apply.)
A) Exercise
B) Infections
C) Fluid overload
D) Electrolyte depletion
E) Emotional disturbance

Accepted Answer

A celiac crisis can be precipitated by infections, electrolyte depletion, and emotional disturbance. Exercise or fluid overload does not precipitate a crisis.

Question 3

The nurse is teaching a parent of a 6-month-old infant with gastroesophageal reflux (GER) before discharge. What instructions should the nurse include? (Select all that apply.)
A) Elevate the head of the bed in the crib to a 90-degree angle while the infant is sleeping.
B) Hold the infant in the prone position after a feeding.
C) Discontinue breastfeeding so that a formula and rice cereal mixture can be used.
D) The infant will require the Nissen fundoplication after 1 year of age.
E) Prescribed cimetidine (Tagamet) should be given 30 minutes before feedings.

Accepted Answer

Discharge instructions for an infant with GER should include the prone position (up on the shoulder or across the lap) after a feeding. Use of the prone position while the infant is sleeping is still controversial. The American Academy of Pediatrics recommends the supine position to decrease the risk of sudden infant death syndrome even in infants with GER. Prescribed cimetidine or another proton pump inhibitor should be given 30 minutes before the morning and evening feeding so that peak plasma concentrations occur with mealtime. The head of the bed in the crib does not need to be elevated. The mother may continue to breastfeed or express breast milk to add rice cereal if recommended by the health care provider; thickening breast milk or formula with cereal is not recommended by all practitioners. The Nissen fundoplication is only done on infants with GER in severe cases with complications.

Question 4

A health care provider prescribes feedings of 1 to 2 oz Pedialyte every 3 hours and to advance to 1/2 strength Similac with iron as tolerated postoperatively for an infant who had a pyloromyotomy. The nurse should decide to advance the feeding if which occurs?
A) The infant's IV line has infiltrated.
B) The infant has not voided since surgery.
C) The infant's mother states the infant is tolerating the feeding okay.
D) The infant is taking the Pedialyte without vomiting or distention.

Accepted Answer

After a pyloromyotomy, feedings are usually instituted within 12 to 24 hours, beginning with clear liquids. They are offered in small quantities at frequent intervals. Supervision of feedings is an important part of postoperative care. The feedings are advanced only if the infant is taking the clear liquids without vomiting or distention. Feedings would not be advanced if the infant has not voided, the IV line becomes infiltrated, or the mother states the infant is tolerating the feedings.

Question 5

The nurse is preparing to admit a 3-year-old child with intussusception. What clinical manifestations should the nurse expect to observe? (Select all that apply.)
A) Absent bowel sounds
B) Passage of red, currant jelly-like stools
C) Anorexia
D) Tender, distended abdomen
E) Hematemesis
F) Sudden acute abdominal pain

Accepted Answer

Intussusception occurs when a proximal segment of the bowel telescopes into a more distal segment, pulling the mesentery with it and leading to obstruction. Clinical manifestations of intussusception include the passage of red, currant jelly-like stools; a tender, distended abdomen; and sudden acute abdominal pain. Absent bowel sounds, anorexia, and hematemesis are clinical manifestations observed in other types of gastrointestinal dysfunction.

Question 6

The nurse is preparing to admit a 10-year-old child with appendicitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.)
A) Fever
B) Vomiting
C) Tachycardia
D) Flushed face
E) Hyperactive bowel sounds

Accepted Answer

Clinical manifestations of appendicitis include fever, vomiting, and tachycardia. Pallor is seen, not a flushed face, and the bowel sounds are hypoactive or absent, not hyperactive.

Question 7

The nurse is evaluating the laboratory results of a stool sample. What is a normal finding?
A) The laboratory reports a stool pH of 5.0.
B) The laboratory reports a negative guaiac.
C) The laboratory reports low levels of enzymes.
D) The laboratory reports reducing substances present.

Accepted Answer

The normal stool finding is a negative guaiac. Stool pH should be 7.0 to 7.5. A stool pH <5.0 is suggestive of carbohydrate malabsorption; colonic bacterial fermentation produces short-chain fatty acids, which lower stool pH. There should be no enzymes or reducing substances present in a normal stool sample.

Question 8

An infant had a gastrostomy tube placed for feedings after a Nissen fundoplication and bolus feedings are initiated. Between feedings while the tube is clamped, the infant becomes irritable, and there is evidence of cramping. What action should the nurse implement?
A) Burp the infant.
B) Withhold the next feeding.
C) Vent the gastrostomy tube.
D) Notify the health care provider.

Accepted Answer

If bolus feedings are initiated through a gastrostomy after a Nissen fundoplication, the tube may need to remain vented for several days or longer to avoid gastric distention from swallowed air. Edema surrounding the surgical site and a tight gastric wrap may prohibit the infant from expelling air through the esophagus, so burping does not relieve the distention. Some infants benefit from clamping of the tube for increasingly longer intervals until they are able to tolerate continuous clamping between feedings. During this time, if the infant displays increasing irritability and evidence of cramping, some relief may be provided by venting the tube. The next feeding should not be withheld, and calling the health care provider is not necessary.

Question 9

What intervention is contraindicated in a suspected case of appendicitis?
A) Enemas
B) Palpating the abdomen
C) Administration of antibiotics
D) Administration of antipyretics for fever

Accepted Answer

In any instance in which severe abdominal pain is observed and appendicitis is suspected, the nurse must be aware of the danger of administering laxatives or enemas. Such measures stimulate bowel motility and increase the risk of perforation. The abdomen is palpated after other assessments are made. Antibiotics should be administered, and antipyretics are not contraindicated.

Question 10

What is the purpose in using cimetidine (Tagamet) for gastroesophageal reflux?
A) The medication reduces gastric acid secretion.
B) The medication neutralizes the acid in the stomach.
C) The medication increases the rate of gastric emptying time.
D) The medication coats the lining of the stomach and esophagus.

Accepted Answer

Pharmacologic therapy may be used to treat infants and children with gastroesophageal reflux disease. Both H2-receptor antagonists (cimetidine [Tagamet], ranitidine [Zantac], or famotidine [Pepcid]) and proton pump inhibitors (esomeprazole [Nexium], lansoprazole [Prevacid], omeprazole [Prilosec], pantoprazole [Protonix], and rabeprazole [Aciphex]) reduce gastric hydrochloric acid secretion.

Question 11

The nurse is teaching parents about high-fiber foods that can prevent constipation. What foods should the nurse include in the teaching? (Select all that apply.)
A) Oranges
B) Bananas
C) Lima beans
D) Baked beans
E) Raisin bran cereal

Accepted Answer

Lima beans have 13.2 g of fiber in 1 cup, baked beans have 10.4 g of fiber in 1 cup, and raisin bran cereal has 7.3 g of fiber in 1 cup. One orange has only 3.1 g of fiber, and 1 banana has only 3.1 g of fiber, so they are not recommended as high-fiber foods.

Question 12

The nurse is caring for a child with Meckel diverticulum. What type of stool does the nurse expect to observe?
A) Steatorrhea
B) Clay colored
C) Currant jelly-like
D) Loose stools with undigested food

Accepted Answer

In Meckel diverticulum the bleeding is usually painless and may be dramatic and occur as bright red or currant jelly-like stools, or it may occur intermittently and appear as tarry stools. The stools are not clay colored, steatorrhea, or loose with undigested food.

Question 13

The nurse is assisting a child with celiac disease to select foods from a menu. What foods should the nurse suggest?
A) Hamburger on a bun
B) Spaghetti with meat sauce
C) Corn on the cob with butter
D) Peanut butter and crackers

Accepted Answer

Treatment of celiac disease consists primarily of dietary management. Although a gluten-free diet is prescribed, it is difficult to remove every source of this protein. Some patients are able to tolerate restricted amounts of gluten. Because gluten occurs mainly in the grains of wheat and rye but also in smaller quantities in barley and oats, these foods are eliminated. Corn, rice, and millet are substitute grain foods. Corn on the cob with butter would be gluten free.

Question 14

The nurse should instruct parents to administer a daily proton pump inhibitor to their child with gastroesophageal reflux at which time?
A) Bedtime
B) With a meal
C) Midmorning
D) 30 minutes before breakfast

Accepted Answer

Proton pump inhibitors are most effective when administered 30 minutes before breakfast so that the peak plasma concentrations occur with mealtime. If they are given twice a day, the second best time for administration is 30 minutes before the evening meal.

Question 15

The nurse is preparing to admit a 2-month-old child with hypertrophic pyloric stenosis. What clinical manifestations should the nurse expect to observe? (Select all that apply.)
A) Weight loss
B) Bilious vomiting
C) Abdominal pain
D) Projectile vomiting
E) The infant is hungry after vomiting

Accepted Answer

Clinical manifestations of hypertrophic pyloric stenosis include weight loss, projectile vomiting, and hunger after vomiting. The vomitus is nonbilious, and there is no evidence of pain or discomfort, just chronic hunger.

Question 16

A child is being admitted to the hospital with acute gastroenteritis. The health care provider prescribes an antiemetic. What antiemetic does the nurse anticipate being prescribed?
A) Ondansetron (Zofran)
B) Promethazine (Phenergan)
C) Metoclopramide (Reglan)
D) Dimenhydrinate (Dramamine)

Accepted Answer

Ondansetron reduces the duration of vomiting in children with acute gastroenteritis. This would be the expected prescribed antiemetic. Adverse effects with earlier generation antiemetics (e.g., promethazine and metoclopramide) include somnolence, nervousness, irritability, and dystonic reactions and should not be routinely administered to children. For children who are prone to motion sickness, it is often helpful to administer an appropriate dose of dimenhydrinate (Dramamine) before a trip, but it would not be ordered as an antiemetic.

Question 17

The nurse is preparing to admit a 6-year-old child with celiac disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.)
A) Steatorrhea
B) Polycythemia
C) Malnutrition
D) Melena stools
E) Foul-smelling stools

Accepted Answer

Clinical manifestations of celiac disease include impaired fat absorption (steatorrhea and foul-smelling stools) and impaired nutrient absorption (malnutrition). Anemia, not polycythemia, is a manifestation, and melena stools do not occur.

Question 18

The nurse is teaching parents of a child with gastroesophageal reflux (GER) disease foods that can exacerbate acid reflux. What foods should be included in the teaching session? (Select all that apply.)
A) Citrus
B) Bananas
C) Spicy foods
D) Peppermint
E) Whole wheat bread

Accepted Answer

Avoidance of certain foods that exacerbate acid reflux (e.g., caffeine, citrus, tomatoes, alcohol, peppermint, spicy or fried foods) can improve mild GER symptoms. Bananas and whole wheat bread will not exacerbate acid reflux.

Question 19

The school nurse is teaching a group of adolescents about avoiding contaminated water during a mission trip. What should the nurse include in the teaching? (Select all that apply.)
A) Ice
B) Meats
C) Raw vegetables
D) Unpeeled fruits
E) Carbonated beverages

Accepted Answer

The best measure during travel to areas where water may be contaminated is to allow children to drink only bottled water and carbonated beverages (from the container through a straw supplied from home). Children should also avoid tap water, ice, unpasteurized dairy products, raw vegetables, unpeeled fruits, meats, and seafood.

Question 20

The nurse is preparing to admit a 6-year-old child with irritable bowel syndrome (IBS). What clinical manifestations should the nurse expect to observe? (Select all that apply.)
A) Flatulence
B) Constipation
C) No urge to defecate
D) Absence of abdominal pain
E) Feeling of incomplete evacuation of the bowel

Accepted Answer

Children with IBS often have alternating diarrhea and constipation, flatulence, bloating or a feeling of abdominal distention, lower abdominal pain, a feeling of urgency when needing to defecate, and a feeling of incomplete evacuation of the bowel.

Quiz 26: The Child with Gastrointestinal Dysfunction

An infant with short bowel syndrome will be on total parenteral nutrition (TPN) for an extended period of time. What should the nurse monitor the infant for ?

The nurse is caring for a child with celiac disease. The nurse understands that what may precipitate a celiac crisis? (Select all that apply.)

The nurse is teaching a parent of a 6-month-old infant with gastroesophageal reflux (GER) before discharge. What instructions should the nurse include? (Select all that apply.)

A health care provider prescribes feedings of 1 to 2 oz Pedialyte every 3 hours and to advance to 1/2 strength Similac with iron as tolerated postoperatively for an infant who had a pyloromyotomy. The nurse should decide to advance the feeding if which occurs?

The nurse is preparing to admit a 3-year-old child with intussusception. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

The nurse is preparing to admit a 10-year-old child with appendicitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

The nurse is evaluating the laboratory results of a stool sample. What is a normal finding?

An infant had a gastrostomy tube placed for feedings after a Nissen fundoplication and bolus feedings are initiated. Between feedings while the tube is clamped, the infant becomes irritable, and there is evidence of cramping. What action should the nurse implement?

What intervention is contraindicated in a suspected case of appendicitis?

What is the purpose in using cimetidine (Tagamet) for gastroesophageal reflux?

The nurse is teaching parents about high-fiber foods that can prevent constipation. What foods should the nurse include in the teaching? (Select all that apply.)

The nurse is caring for a child with Meckel diverticulum. What type of stool does the nurse expect to observe?

The nurse is assisting a child with celiac disease to select foods from a menu. What foods should the nurse suggest?

The nurse should instruct parents to administer a daily proton pump inhibitor to their child with gastroesophageal reflux at which time?

The nurse is preparing to admit a 2-month-old child with hypertrophic pyloric stenosis. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

A child is being admitted to the hospital with acute gastroenteritis. The health care provider prescribes an antiemetic. What antiemetic does the nurse anticipate being prescribed?

The nurse is preparing to admit a 6-year-old child with celiac disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

The nurse is teaching parents of a child with gastroesophageal reflux (GER) disease foods that can exacerbate acid reflux. What foods should be included in the teaching session? (Select all that apply.)

The school nurse is teaching a group of adolescents about avoiding contaminated water during a mission trip. What should the nurse include in the teaching? (Select all that apply.)

The nurse is preparing to admit a 6-year-old child with irritable bowel syndrome (IBS) . What clinical manifestations should the nurse expect to observe? (Select all that apply.)