Question 1

The nurse is discussing home care with a mother whose 6-year-old child has hepatitis A.What information should the nurse include?

Accepted Answer

Hand washing is the single most effective measure in preventing and controlling hepatitis.Hepatitis A can be transmitted through the fecal-oral route.Family members must be taught preventive measures.Rest and quiet activities are essential and adjusted to the child's condition,but bed rest is not necessary.The child is not infectious 1 week after the onset of jaundice and may return to school as activity level allows.

Question 2

An infant is born with a gastroschisis.Care preoperatively should include which priority intervention?

Accepted Answer

Initial management of a gastroschisis involves covering the exposed bowel with a transparent plastic bowel bag or loose,moist dressings.The infant cannot be placed prone,and feedings will be withheld until surgery is performed.Electrolyte laboratory values will be monitored but not before covering the defect with a sterile bowel bag.

Question 3

Melena,the passage of black,tarry stools,suggests bleeding from which source?

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 4

What term describes invagination of one segment of bowel within another?

Accepted Answer

Intussusception occurs when a proximal section of the bowel telescopes into a more distal segment,pulling the mesentery with it.The mesentery is compressed and angled,resulting in lymphatic and venous obstruction.Atresia is the absence or closure of a natural opening in the body.Stenosis is a narrowing or constriction of the diameter of a bodily passage or orifice.Herniation is the protrusion of an organ or part through connective tissue or through a wall of the cavity in which it is normally enclosed.

Question 5

A school-age child with celiac disease asks for guidance about snacks that will not exacerbate the disease.What snack should the nurse suggest?

Accepted Answer

Celiac disease symptoms result from ingestion of gluten.Corn and rice do not contain gluten.Popcorn or corn chips will not exacerbate the intestinal symptoms.Pizza and pretzels are usually made from wheat flour that contains gluten.Also,in the early stages of celiac disease,the child may be lactose intolerant.Oatmeal contains gluten.

Question 6

A child who has just had definitive repair of a high rectal malformation is to be discharged.What should the nurse address in the discharge preparation of this family?

Accepted Answer

The parents are taught to notify the practitioner if any signs of an anal stricture or other complications develop.Constipation is avoided because a firm stool will place strain on the suture line.Daily enemas are contraindicated after surgical repair of a rectal malformation.Fiber and stool softeners are often given to keep stools soft and avoid tension on the suture line.The child needs to recover from the surgical procedure.Then bowel training may begin,depending on the child's developmental and physiologic readiness.

Question 7

The parents of a newborn with an umbilical hernia ask about treatment options.The nurse's response should be based on which knowledge?

Accepted Answer

The umbilical hernia usually resolves by ages 3 to 5 years of age without intervention.Umbilical hernias rarely become problematic.Incarceration,where the hernia is constricted and cannot be reduced manually,is rare.Umbilical hernias are not associated with a high mortality rate.Taping the abdomen flat does not help heal the hernia; it can cause skin irritation.

Question 8

What immunization is recommended for all newborns?

Accepted Answer

Universal vaccination for hepatitis B is recommended for all newborns.Hepatitis A vaccine is recommended for infants starting at 12 months.No vaccine is currently available for hepatitis C.

Question 9

A 3-day-old infant presents with abdominal distention,is vomiting,and has not passed any meconium stools.What disease should the nurse suspect?

Accepted Answer

The clinical manifestations of Hirschsprung disease in a 3-day-old infant include abdominal distention,vomiting,and failure to pass meconium stools.Pyloric stenosis would present with vomiting but not distention or failure to pass meconium stools.Intussusception presents with abdominal cramping and celiac disease presents with malabsorption.

Question 10

The nurse observes that a newborn is having problems after birth.What should indicate a tracheoesophageal fistula?

Accepted Answer

Excessive frothy saliva is indicative of a tracheoesophageal fistula.The child is unable to swallow the secretions,so there are excessive amounts of saliva in the mouth.Jitteriness is associated with several disorders,including electrolyte imbalances.Meconium ileus is associated with cystic fibrosis.Increased need for sleep is not associated with a tracheoesophageal fistula.

Question 11

A 6-month-old infant with Hirschsprung disease is scheduled for a temporary colostomy.What should postoperative teaching to the parents include?

Accepted Answer

In the postoperative period,the nurse involves the parents in the care of the child with a temporary colostomy,allowing them to help with feedings and observe for signs of wound infection or irregular passage of stool (constipation or true incontinence).Some children will require daily anal dilatations in the postoperative period to avoid anastomotic strictures but not stoma dilatations.Physical activities should be encouraged.There is not a risk of prolapse of the rectum in Hirschsprung disease,just strictures.

Question 12

What should the nurse consider when providing support to a family whose infant has just been diagnosed with biliary atresia?

Accepted Answer

Untreated biliary atresia results in progressive cirrhosis and death usually by 2 years of age.Surgical intervention at 8 weeks of age is associated with somewhat better outcomes.Liver transplantation is also improving outcomes for 10-year survival.Even with surgical intervention,most children require supportive therapy.With early intervention,10-year survival rates range from 27% to 75%.

Question 13

The nurse is preparing to care for a newborn with an omphalocele.The nurse should understand that care of the infant should include what intervention?

Accepted Answer

Nursing care of an infant with an omphalocele includes covering the intact bowel with a nonadherent dressing to prevent injury or placing a bowel bag or moist dressings and a plastic drape if the abdominal contents are exposed.The infant is not started on any type of feeding but has a nasogastric tube placed for gastric decompression.Pain management is started after surgery,but surgery is not done immediately after birth.The infant is medically stabilized before different surgical options are considered.

Question 14

What therapeutic intervention provides the best chance of survival for a child with cirrhosis?

Accepted Answer

The only successful treatment for end-stage liver disease and liver failure may be liver transplantation,which has improved the prognosis for many children with cirrhosis.Liver transplantation reflects the failure of other medical and surgical measures to prevent or treat cirrhosis.Nutritional support is necessary for the child with cirrhosis,but it does not stop the progression of the disease.Blood components are indicated when the liver can no longer produce clotting factors.It is supportive therapy,not curative.Corticosteroids are not used in end-stage liver disease.

Question 15

A child with acute gastrointestinal bleeding is admitted to the hospital.The nurse observes which sign or symptom as an early manifestation of shock?

Accepted Answer

Restlessness is an indication of impending shock in a child.Capillary refill is slowed in shock.The child will feel cool.The blood pressure initially remains within the normal range and then declines.

Question 16

The nurse is caring for a neonate with a suspected tracheoesophageal fistula.What should nursing care include?

Accepted Answer

When a newborn is suspected of having a tracheoesophageal fistula,the most desirable position is supine with the head elevated on an inclined plane of at least 30 degrees.It is imperative that any source of aspiration be removed at once; oral feedings are withheld.The oral pharynx should be kept clear of secretions by oral suctioning.This is to prevent the cyanosis that is usually the result of laryngospasm caused by overflow of saliva into the larynx.

Question 17

What signs or symptoms are most commonly associated with the prodromal phase of acute viral hepatitis?

Accepted Answer

The signs and symptoms most common in the prodromal phase are anorexia,malaise,lethargy,and easy fatigability.Bruising would not be an issue unless liver damage has occurred.Jaundice is a late sign and often does not occur in children.Dark urine and pale stools would occur during the onset of jaundice (icteric phase)if it occurs.

Question 18

What should preoperative care of a newborn with an anorectal malformation include?

Accepted Answer

Gastrointestinal decompression is an essential part of nursing care for a newborn with an anorectal malformation.This helps alleviate intraabdominal pressure until surgical intervention.Suctioning is not necessary for an infant with this type of anomaly.Feedings are not indicated until it is determined that the gastrointestinal tract is intact.Supine position with head elevated is indicated for infants with a tracheoesophageal fistula,not anorectal malformations.

Question 19

The nurse is caring for an infant who had surgical repair of a tracheoesophageal fistula 24 hours ago.Gastrostomy feedings have not been started.What do nursing actions related to the gastrostomy tube include?

Accepted Answer

In the immediate postoperative period,the gastrostomy tube is open to gravity drainage.This usually is continued until the infant is able to tolerate feedings.The tube is unclamped in the postoperative period to allow for the drainage of secretions and air.Gastrostomy tubes are not suctioned on an as-needed basis.They may be connected to low suction to facilitate drainage of secretions.Lowering the tube to a point below the level of the stomach would create too much pressure.

Question 20

An infant with short bowel syndrome is receiving total parenteral nutrition (TPN).The practitioner has added continuous enteral feedings through a gastrostomy tube.The nurse recognizes this as important for which reason?

Accepted Answer

Long-term survival without TPN depends on the small intestine's ability to increase its absorptive capacity.Continuous enteral feedings facilitate the adaptation.TPN is indicated until the child is able to receive all nutrition via the enteral route.Before this is accomplished,the small intestine must adapt and increase in cell number and cell mass per villus column.TPN is formulated to meet the infant's nutritional needs.Continuous enteral feedings through a gastrostomy tube is a positive sign,but the infant's ability to tolerate increasing amounts of enteral nutrition is only one factor that determines readiness for discharge.

Quiz 26: The Child With Gastrointestinal Dysfunction