Question 1

A woman pregnant at term arrives at the small rural hospital in active labor. She has received no prenatal care. At delivery, it is discovered that the newborn has a gastroschisis defect. Immediate transfer to a pediatric hospital is planned. Nursing care to prepare the infant for discharge would include:
A)Covering the exposed intestines with sterile moist gauze.
B)Wrapping the infant warmly in two or three blankets.
C)Providing a sterile water feeding to maintain hydration during transport.
D)Preventing the parents from seeing the infant prior to transfer to reduce their anxiety.

Accepted Answer

The exposed intestines should be covered with sterile moist gauze to prevent damage, drying out, or infection prior to transfer to the pediatric hospital. Blankets may be used for warmth, but are not the priority in this situation. A sterile water feeding would not be indicated, as the infant would require surgical repair of the gastroschisis before any feedings could be given. The parents should be encouraged to see their infant and be involved in their care, as appropriate.

Question 2

A nasogastric tube to suction is ordered for a child newly diagnosed with a diaphragmatic hernia. The nurse notes that the surgeon has not ordered fluid replacement for the NG drainage. What might occur if large amounts of gastric drainage are noted without replacement?
A)The infant may lose weight due to loss of nutrition.
B)The infant will develop metabolic alkalosis.
C)The infant will become dehydrated.
D)The infant will develop hyperbilirubinemia.

Accepted Answer

B

Question 3

An infant has been born with an esophageal atresia and tracheoesophageal fistula. What is a priority preoperative nursing diagnosis?
A)Ineffective tissue perfusion: gastrointestinal, related to decreased circulation
B)Ineffective infant feeding pattern related to uncoordinated suck and swallow
C)Acute pain related to esophageal defect
D)Aspiration, risk for related to regurgitation

Accepted Answer

Aspiration is a major risk for infants with esophageal atresia and tracheoesophageal fistula due to the connection between the esophagus and the trachea, which allows for the passage of gastric contents into the lungs.

Question 4

A nurse is preparing for the delivery of a newborn with a known diaphragmatic hernia defect. Which equipment should the nurse prepare for use?
A)Appropriate bag-valve-mask system
B)Sterile gauze and saline
C)Soft arm restraints
D)Equipment for intubation

Accepted Answer

The answer of A nurse is preparing for the delivery...

Question 5

A child returns from exploratory abdominal surgery following a gunshot wound to the abdomen. Which nursing intervention would the nurse omit from the plan of care for this child?
A)NPO status until bowel sounds return
B)Frequent assessment of the surgical site
C)Avoiding narcotics to prevent depression of the respiratory system
D)Allow parents at the bedside as soon as possible.

Accepted Answer

Narcotics may be necessary for pain management after surgery, even in children. The concern for respiratory depression is managed by careful monitoring and dosing, rather than avoiding narcotics altogether.

Question 6

An adolescent complains of recurrent abdominal pain with diarrhea and bloody stools. The nurse should recognize these as symptoms of which inflammatory bowel disease?
A)Necrotizing enterocolitis
B)Ulcerative colitis
C)Crohn's disease
D)Appendicitis

Accepted Answer

Recurrent abdominal pain with diarrhea and bloody stools are classic symptoms of ulcerative colitis, an inflammatory bowel disease that primarily affects the colon and rectum. The other options (A, C, and D) are not typically associated with bloody stools. Necrotizing enterocolitis is more commonly seen in premature infants and involves necrosis of intestinal tissue. Crohn's disease can cause abdominal pain and diarrhea, but it may also involve other parts of the gastrointestinal tract. Appendicitis is characterized by pain in the lower right abdomen, and typically does not involve bloody stools.

Question 7

At delivery, it was discovered that the newborn had a bilateral cleft lip. The parents are distressed about the appearance of their infant. Nursing behaviors that can help the parents bond to the infant include: Standard Text: Select all that apply.
A)Calling the infant by name when referring to the infant.
B)Keeping the infant's lower face covered with the blanket.
C)Smiling at the infant and talking to the infant in the parents' presence.
D)Showing the parents before and after pictures of other children with cleft lips.
E)Discussing positive features of their baby.

Accepted Answer

These options help promote bonding by personalizing the infant (A), demonstrating normal interactions and positive engagement (C), providing hope and a positive outlook for the future (D), and focusing on the positive aspects of the baby beyond the cleft lip (E). Covering the infant's lower face (B) would not promote bonding as it suggests hiding part of the baby, which could reinforce feelings of shame or discomfort.

Question 8

Following hospital discharge for treatment of gastroesophageal reflux, the home health nurse visits the family. Which finding made by the nurse during the visit requires the nurse to intervene?
A)The infant's formula has rice cereal added.
B)The mother hold the infant is a high Fowler's position while feeding.
C)After feeding, the infant is placed in an infant seat.
D)The mother draws up the ranitidine (Zantac) in a syringe for oral administration.

Accepted Answer

Placing the infant in an infant seat after feeding can increase the risk of gastroesophageal reflux. The nurse should intervene and educate the family about alternative positions for the infant after feeding, such as holding the infant upright for 30 minutes or placing them on their stomach for a short period of time under supervision. The other options are appropriate practices for the treatment of gastroesophageal reflux.

Question 9

The nurse who works in the newborn nursery must be alert for infants with congenital gastrointestinal defects. Defects that might be diagnosed in the newborn nursery would include: Standard Text: Select all that apply.
A)Pyloric stenosis.
B)Biliary atresia.
C)Hirschsprung's disease.
D)Umbilical hernia.
E)Diaphragmatic hernia.

Accepted Answer

The answer of The nurse who works in the newborn...

Question 10

The nurse is preparing to ambulate an 11-year-old child who has had an appendectomy. In addition to pharmacological pain management, which of the following nonpharmacologic, independent nursing pain management strategies would be appropriate for this child?
A)A warm, moist pack
B)EMLA cream to the incision site
C)An ice pack
D)A splint pillow against the abdomen when moving or coughing

Accepted Answer

Using a splint pillow against the abdomen when moving or coughing can help to provide support and relieve pain to the incision site after an appendectomy. A warm, moist pack or ice pack may not be appropriate for this type of surgical incision, and EMLA cream is not typically used for pain management in postoperative patients.

Question 11

Which statement indicates that parents have understood the nurse's teaching with regard to colostomy stoma care for their toddler?
A)"We will change the colostomy bag with each wet diaper."
B)"We will expect a moderate amount of bleeding after cleansing the area around the stoma."
C)"We will watch for skin irritation around the stoma."
D)"We will use adhesive enhancers when we change the bag."

Accepted Answer

Watching for skin irritation around the stoma is a critical aspect of colostomy stoma care, and indicates that the parents have understood the nurse's teaching. Option A is incorrect as changing the colostomy bag with each wet diaper is unnecessary and may lead to wastage of resources. Option B is incorrect as moderate bleeding is not a normal occurrence after cleansing the area around the stoma, and may indicate an infection or other complication. Option D is incorrect as the use of adhesive enhancers may damage the skin around the stoma and also increase the risk of infection.

Question 12

A three-year-old child is suspected of having Hirschsprung's disease. Which assessment factors would support such a medical diagnosis?
A)Clay-colored stools and dark urine
B)History of early passage of meconium in the newborn period
C)History of chronic, progressive constipation and failure to gain weight
D)Continual bouts of foul-smelling diarrhea

Accepted Answer

Hirschsprung's disease is characterized by chronic constipation, failure to gain weight, and abdominal distension due to the absence of ganglion cells in the distal portion of the colon. Meconium is not normally passed until shortly after birth, so a history of early passage of meconium would not support a diagnosis of Hirschsprung's disease. Clay-colored stools and dark urine may be indicative of liver dysfunction, not Hirschsprung's disease. Foul-smelling diarrhea is not a typical symptom of Hirschsprung's disease.

Question 13

The woman has a normal pregnancy except for polyhydramnios. The delivery goes well and the baby is born and receives APGAR scores of seven and nine. Upon admission to the newborn nursery, the nurse is unsuccessful in inserting a nasogastric tube. The infant is suspected of having an esophageal atresia/tracheoesophageal fistula. While waiting for the pediatrician to see the infant, the nurse should:
A)Position the infant in semi-Fowler position.
B)Allow the infant to be taken to the mother's room for bonding.
C)Offer the infant formula feeding instead of breastfeeding.
D)Wrap the infant in blankets and place in a crib by the viewing window.

Accepted Answer

Positioning the infant in semi-Fowler position can help prevent aspiration and provide better air exchange, which is especially important if the infant has a tracheoesophageal fistula. The other options would not be appropriate until the infant's condition has been assessed and treated. The infant may need to be transferred to a neonatal intensive care unit for further management.

Question 14

The nurse is measuring an abdominal girth on a child with abdominal distension. Identify the area on the child's abdomen where the tape measure should be placed for an accurate abdominal girth.
A)Below the umbilicus
B)Just below the sternum
C)Just above the pubic bone
D)Just above the umbilicus, around the largest circumference of the abdomen

Accepted Answer

The tape measure should be placed just above the umbilicus, around the largest circumference of the abdomen to accurately measure the child's abdominal girth.

Question 15

The nurse is planning postoperative care for an infant after a cleft lip repair. Which intervention should the nurse include in this infant's plan of care?
A)Suctioning with a tonsil tip (Yankauer) device
B)Using a pacifier to reduce straining the suture line with crying
C)Supine positioning
D)Frequent breast or bottle feeding

Accepted Answer

Supine positioning is recommended to prevent the infant from rubbing the suture line on bedding, which could disrupt healing.

Question 16

A toddler is admitted to the surgical unit for planned closure of the temporary colostomy. The nurse completes the admission assessment and reviews the medical orders. Which order should the nurse question?
A)Clear liquids today.NPO tomorrow
B)Type and cross-match for one unit of packed red blood cells.
C)Rectal temperatures every four hours
D)Start an intravenous line with D5NS at 20 ml per hour.

Accepted Answer

Rectal temperatures should be questioned in a patient with a colostomy closure because it can disturb the surgical site and increase the risk of infection or damage. Other methods of temperature measurement should be used.

Question 17

Following diagnosis of Crohn's disease, the nurse is explaining dietary modifications to the teenagers. The nurse would recommend: Standard Text: Select all that apply.
A)Increased fiber in the diet to promote solid stools.
B)Small, frequent feedings are preferred over three meals a day.
C)Identify foods that cause distress and eliminate them from the diet.
D)High-calorie dietary supplement shakes can help meet nutritional requirements.
E)Socialization is important at mealtime no matter the dynamics.

Accepted Answer

The answer of Following diagnosis of Crohn's disease, the nurse...

Question 18

An infant born with an omphalocele defect is being admitted to the intensive care nursery. Which of the following should the nurse in charge instruct the nursing technician to prepare?
A)Radiant warmer
B)Crib
C)Bilirubin light
D)Formula for feeding

Accepted Answer

An infant born with an omphalocele defect requires immediate stabilization and monitoring, and often benefits from placement on a radiant warmer to maintain body temperature. A crib, bilirubin light, or formula feeding may be needed later, but are not the priority at the time of admission.

Question 19

A child with inflammatory bowel disease is taking prednisone daily. The family should be taught to administer the prednisone at what time?
A)Between meals
B)At bedtime
C)One hour before meals
D)With meals

Accepted Answer

Prednisone should be taken with meals to minimize gastrointestinal upset and to ensure that the medication is absorbed properly.

Quiz 30: Alterations in Gastrointestinal Function

A nasogastric tube to suction is ordered for a child newly diagnosed with a diaphragmatic hernia. The nurse notes that the surgeon has not ordered fluid replacement for the NG drainage. What might occur if large amounts of gastric drainage are noted without replacement?

An infant has been born with an esophageal atresia and tracheoesophageal fistula. What is a priority preoperative nursing diagnosis?

A nurse is preparing for the delivery of a newborn with a known diaphragmatic hernia defect. Which equipment should the nurse prepare for use?

A child returns from exploratory abdominal surgery following a gunshot wound to the abdomen. Which nursing intervention would the nurse omit from the plan of care for this child?

An adolescent complains of recurrent abdominal pain with diarrhea and bloody stools. The nurse should recognize these as symptoms of which inflammatory bowel disease?

At delivery, it was discovered that the newborn had a bilateral cleft lip. The parents are distressed about the appearance of their infant. Nursing behaviors that can help the parents bond to the infant include: Standard Text: Select all that apply.

Following hospital discharge for treatment of gastroesophageal reflux, the home health nurse visits the family. Which finding made by the nurse during the visit requires the nurse to intervene?

The nurse who works in the newborn nursery must be alert for infants with congenital gastrointestinal defects. Defects that might be diagnosed in the newborn nursery would include: Standard Text: Select all that apply.

The nurse is preparing to ambulate an 11-year-old child who has had an appendectomy. In addition to pharmacological pain management, which of the following nonpharmacologic, independent nursing pain management strategies would be appropriate for this child?

Which statement indicates that parents have understood the nurse's teaching with regard to colostomy stoma care for their toddler?

A three-year-old child is suspected of having Hirschsprung's disease. Which assessment factors would support such a medical diagnosis?

The nurse is measuring an abdominal girth on a child with abdominal distension. Identify the area on the child's abdomen where the tape measure should be placed for an accurate abdominal girth.

The nurse is planning postoperative care for an infant after a cleft lip repair. Which intervention should the nurse include in this infant's plan of care?

A toddler is admitted to the surgical unit for planned closure of the temporary colostomy. The nurse completes the admission assessment and reviews the medical orders. Which order should the nurse question?

Following diagnosis of Crohn's disease, the nurse is explaining dietary modifications to the teenagers. The nurse would recommend: Standard Text: Select all that apply.

An infant born with an omphalocele defect is being admitted to the intensive care nursery. Which of the following should the nurse in charge instruct the nursing technician to prepare?

A child with inflammatory bowel disease is taking prednisone daily. The family should be taught to administer the prednisone at what time?