The Child with Gastrointestinal Dysfunction Flashcards
A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. What recommendation should the nurse include in teaching this parent?
a.
Surgical therapy is indicated.
b.
Place in prone position for sleep after feeding.
c.
Thicken feedings and enlarge the nipple hole.
d.
Reduce the frequency of feeding by encouraging larger volumes of formula.
ANS: C
Thickened feedings decrease the child’s crying and increase the caloric density of the feeding. Although it does not decrease the pH, the number and volume of emesis are reduced. Surgical therapy is reserved for children who have failed to respond to medical therapy or who have an anatomic abnormality. The prone position is not recommended because of the risk of sudden infant death syndrome. Smaller, more frequent feedings are more effective than less frequent, larger volumes of formula.
The nurse is caring for a neonate with a suspected tracheoesophageal fistula. What should nursing care include?
a.
Feed glucose water only.
b.
Elevate the patient’s head for feedings.
c.
Raise the patient’s head and give nothing by mouth.
d.
Avoid suctioning unless the infant is cyanotic.
ANS: C
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.
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
ANS: C
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.
A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. How should the nurse prepare this child?
a.
It is unnecessary because of child’s age.
b.
It is essential because it will be an adjustment.
c.
Preparation is not needed because the colostomy is temporary.
d.
Preparation is important because the child needs to deal with negative body image.
ANS: B
The child’s age dictates the type and extent of psychologic preparation. When a colostomy is performed, it is necessary to prepare the child who is at least preschool age by telling him or her about the procedure and what to expect in concrete terms, with the use of visual aids. The preschooler is not yet concerned with body image.
The nurse is preparing to admit a 7-year-old child with hepatitis B. What clinical features of hepatitis B should the nurse recognize? (Select all that apply.)
a.
The onset is rapid.
b.
Rash is common.
c.
Jaundice is present
d.
No carrier state exists.
e.
The mode of transmission is principally by the parenteral route.
ANS: B, C, E
Clinical features of hepatitis B include a rash, jaundice, and the mode of transmission principally by the parenteral route. The onset is insidious, not rapid, and a carrier state does exist.
A 3-day-old infant presents with abdominal distention, is vomiting, and has not passed any meconium stools. What disease should the nurse suspect?
a.
Pyloric stenosis
b.
Intussusception
c.
Hirschsprung disease
d.
Celiac disease
ANS: C
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.
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
ANS: B, D, F
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.
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
ANS: A, C, E
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.
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
ANS: A, B, C
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.
What procedure is most appropriate for assessment of an abdominal circumference related to a bowel obstruction?
a.
Measuring the abdomen after feedings
b.
Marking the point of measurement with a pen
c.
Measuring the circumference at the symphysis pubis
d.
Using a new tape measure with each assessment to ensure accuracy
ANS: B
Pen marks on either side of the tape measure allow the nurse to measure the same spot on the child’s abdomen at each assessment. The child most likely will be kept NPO (nothing by mouth) if a bowel obstruction is present. If the child is being fed, the assessment should be done before feedings. The symphysis pubis is too low. Usually the largest part of the abdomen is at the umbilicus. Leaving the tape measure in place reduces the trauma to the child.
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
ANS: A
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.
What therapeutic intervention provides the best chance of survival for a child with cirrhosis?
a.
Nutritional support
b.
Liver transplantation
c.
Blood component therapy
d.
Treatment with corticosteroids
ANS: B
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.
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.
ANS: C
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.
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?
a.
Keep the tube clamped.
b.
Suction the tube as needed.
c.
Leave the tube open to gravity drainage.
d.
Lower the tube to a point below the level of the stomach.
ANS: C
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.
What should preoperative care of a newborn with an anorectal malformation include?
a.
Frequent suctioning
b.
Gastrointestinal decompression
c.
Feedings with sterile water only
d.
Supine position with head elevated
ANS: B
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.
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.
ANS: A
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.
The nurse is preparing to admit a 6-month-old child with gastroesophageal reflux disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.)
a.
Spitting up
b.
Bilious vomiting
c.
Failure to thrive
d.
Excessive crying
e.
Respiratory problems
ANS: A, C, D, E
Clinical manifestations of gastroesophageal reflux disease include spitting up, failure to thrive, excessive crying, and respiratory problems. Hematemesis, not bilious vomiting, is a manifestation.
The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. What intervention is appropriate to relieve the abdominal discomfort during the evaluation?
a.
Place in the Trendelenburg position.
b.
Apply moist heat to the abdomen.
c.
Allow the child to assume a position of comfort.
d.
Administer a saline enema to cleanse the bowel.
ANS: C
The child should be allowed to take a position of comfort, usually with the legs flexed. The Trendelenburg position will not help with the discomfort. If appendicitis is a possibility, administering laxative or enemas or applying heat to the area is dangerous. Such measures stimulate bowel motility and increase the risk of perforation.
A toddler’s mother calls the nurse because she thinks her son has swallowed a button type of battery. He has no signs of respiratory distress. The nurse’s response should be based on which premise?
a.
An emergency laparotomy is very likely.
b.
The location needs to be confirmed by radiographic examination.
c.
Surgery will be necessary if the battery has not passed in the stool in 48 hours.
d.
Careful observation is essential because an ingested battery cannot be accurately detected.
ANS: B
Button batteries can cause severe damage if lodged in the esophagus. If both poles of the battery come in contact with the wall of the esophagus, acid burns, necrosis, and perforation can occur. If the battery is in the stomach, it will most likely be passed without incident. Surgery is not indicated. The battery is metallic and is readily seen on radiologic examination.
A 6-month-old infant with Hirschsprung disease is scheduled for a temporary colostomy. What should postoperative teaching to the parents include?
a.
Dilating the stoma
b.
Assessing bowel function
c.
Limitation of physical activities
d.
Measures to prevent prolapse of the rectum
ANS: B
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.
Nutritional management of the child with Crohn disease includes a diet that has which component?
a.
High fiber
b.
Increased protein
c.
Reduced calories
d.
Herbal supplements
ANS: B
The child with Crohn disease often has growth failure. Nutritional support is planned to reduce ongoing losses and provide adequate energy and protein for healing. Fiber is mechanically hard to digest. Foods containing seeds may contribute to obstruction. A high-calorie diet is necessary to minimize growth failure. Herbal supplements should not be used unless discussed with the practitioner. Vitamin supplementation with folic acid, iron, and multivitamins is recommended.
After surgery yesterday for gastroesophageal reflux, the nurse finds that the infant has somehow removed the nasogastric (NG) tube. What nursing action is most appropriate to perform at this time?
a.
Notify the practitioner.
b.
Insert the NG tube so feedings can be given.
c.
Replace the NG tube to maintain gastric decompression.
d.
Leave the NG tube out because it has probably been in long enough.
ANS: A
When surgery is performed on the upper gastrointestinal tract, usually the surgical team replaces the NG tube because of potential injury to the operative site. The decision to replace the tube or leave it out is made by the surgical team. Replacing the tube is also usually done by the practitioner because of the surgical site.
What information should the nurse include when teaching an adolescent with Crohn disease (CD)?
a.
How to cope with stress and adjust to chronic illness
b.
Preparation for surgical treatment and cure of CD
c.
Nutritional guidance and prevention of constipation
d.
Prevention of spread of illness to others and principles of high-fiber diet
ANS: A
CD is a chronic illness with a variable course and many potential complications. Guidance about living with chronic illness is essential for adolescents. Stress management techniques can help with exacerbations and possible limitations caused by the illness. At this time, there is no cure for CD. Surgical intervention may be indicated for complications that cannot be controlled by medical and nutritional therapy. Nutritional guidance is an essential part of management. Constipation is not usually an issue with CD. CD is not infectious, so transmission is not a concern. A low-fiber diet is indicated.
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
ANS: C, D, E
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.
The nurse is preparing to admit a 5-year-old child with hepatitis A. What clinical features of hepatitis A should the nurse recognize? (Select all that apply.)
a.
The onset is rapid.
b.
Fever occurs early.
c.
There is usually a pruritic rash.
d.
Nausea and vomiting are common.
e.
The mode of transmission is primarily by the parenteral route.
ANS: A, B, D
Clinical features of hepatitis A include a rapid onset, fever occurring early, and nausea and vomiting. A rash is rare, and the mode of transmission is by the fecal–oral route, rarely by the parenteral route.
