The Child with Health Problems Involving Ingestion, Nutrition, or Diet 479

Question 1

The Client with Toxic Substance Ingestion

1. A toddler is brought to the emergency room after ingesting an undetermined amount of drain
   cleaner. The nurse should expect to assist with which of the following first?
2. Administering an emetic.
3. Performing a tracheostomy.
4. Performing gastric lavage.
5. Inserting an indwelling urinary (Foley) catheter.

Answer 1

The Client with Toxic Substance Ingestion
1. 2. Drain cleaner almost always contains lye, which can burn the mouth, pharynx, and esophagus
on ingestion. The nurse would be prepared to assist with a tracheostomy, which may be necessary
because of swelling around the area of the larynx. An emetic is contraindicated because, as the
substance burns on ingestion, so too would it burn when vomiting. Additionally, the mucosa becomes
necrotic and vomiting could lead to perforations. Gastric lavage is contraindicated because the
mucosa is burned from the ingestion of the caustic lye, causing necrosis. Gastric lavage also could
lead to perforation of the necrotic mucosa. Insertion of an indwelling urinary (Foley) catheter would
be indicated after the measures to remove the caustic substance have been started.
CN: Reduction of risk potential; CL: Apply

Question 2

2. After the acute stage following an ingestion of drain cleaner by a child, the nurse should be
   alert for the development of which of the following as a likely complication?
3. Tracheal stenosis.
4. Tracheal varices.
5. Esophageal strictures.
6. Esophageal diverticula.

Answer 2

2. 3. As the burn from the lye ingestion heals, scar tissue develops and can lead to esophageal
      strictures, a common complication of lye ingestion. Tracheal stenosis would occur if the child had
      vomited and aspirated. Tracheal varices do not commonly occur after the ingestion of lye or other
      substances. Although very rare, esophageal diverticula may occur. Diverticula are commonly found in
      the colon of adults.
      CN: Physiological adaptation; CL: Analyze

Question 3

3. The parents of a 3-year-old suspect that the child has recently ingested a large amount of
   acetaminophen. The child does not appear in immediate distress. The nurse should anticipate doing
   which of these interventions in order of priority, from first to last?
4. Draw acetaminophen serum levels.
5. Attempt to determine the exact time and amount of drug ingested.
6. Administer acetylcysteine (Acetadote) IV.
7. Administer activated charcoal.

Answer 3

3.
2. Attempt to determine the exact time and amount of drug ingested.
4. Administer activated charcoal.
1. Draw acetaminophen serum levels.
3. Administer acetylcysteine (Acetadote) IV.
The nurse should first attempt to determine exactly when and how much acetaminophen the parents
think the child has taken. Determining the time of ingestion helps establish the immediate care and
when lab values should be drawn. Gastric decontamination with activated charcoal is used within 4
hours of ingestion to bind the drug and help prevent toxic serum levels. Serum blood levels should bedone after the gastric decontamination, but preferably not too soon after ingestion since levels drawn
before 4 hours may not reflect maximum serum concentrations and will need to be repeated. The
decision to administer acetylcysteine and prevent liver damage is based on serum levels.
CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 4

4. When developing the plan of care for a toddler who has taken an acetaminophen overdose,
   which of the following should the nurse expect to include as part of the initial treatment?
5. Frequent blood level determinations.
6. Gastric lavage.
7. Tracheostomy.
8. Electrocardiogram.

Answer 4

4. 2. Initial management of a child who has ingested a large amount of acetaminophen would
      include inducing vomiting or performing gastric lavage with or without activated charcoal to aid in
      the removal of the substance. Frequent blood level determinations may be obtained during the follow-
      up phase, but they are not done as part of the initial treatment. Tracheostomy is not typically part of
      the initial treatment for acetaminophen overdose. However, it may be necessary later if respiratory
      distress develops. Acetaminophen primarily affects the liver, not the heart. Therefore, an
      electrocardiogram would not be considered part of the initial treatment plan.
      CN: Reduction of risk potential; CL: Apply

Question 5

5. While assessing a preschooler brought by her parents to the emergency department after
   ingestion of kerosene, the nurse should be alert for which of the following?
6. Uremia.
7. Hepatitis.
8. Carditis.
9. Pneumonitis

Answer 5

5. 4. Chemical pneumonitis is the most common complication of ingestion of hydrocarbons, such
      as in kerosene. The pneumonitis is caused by irritation from the hydrocarbons aspirated into the lungs.
      Uremia is the result of renal insufficiency, which causes nitrogenous waste products to build up in the
      blood rather than being excreted. Hepatitis is caused by a viral infection. Carditis in a preschooler
      may be the result of rheumatic fever.
      CN: Physiological adaptation; CL: Analyze

Question 6

The Client with Lead Poisoning
6. Which of the following statements by the mother of an 18-month-old child should indicate to
the nurse that the child needs laboratory testing for lead levels?
1. “My child does not always wash after playing outside.”
2. “My child drinks two cups of milk every day.”
3. “My child has more temper tantrums than other kids.”
4. “My child is smaller than other kids of the same age.”

Answer 6

The Client with Lead Poisoning
6. 1. Eating with dirty hands, especially after playing outside, can lead to lead poisoning because
lead is often present in soil surrounding homes. Also, children who eat lead-containing paint chips
commonly develop lead poisoning. Drinking two cups of milk per day is less than that which is
recommended for this age group, so more nutritional information would need to be obtained. Temper
tantrums are characteristic of 18-month-old children as they try to assert themselves. Determining
whether the child is smaller than other children the same age requires measuring height and weight
and plotting them on growth charts. In addition, inadequate growth could be a result of numerous
causes, such as genetics, chronic illness, or chronic drug use (eg, prednisone).
CN: Physiological adaptation; CL: Evaluate

Question 7

7. In an initial screening for lead poisoning, a 2-year-old child is found to have a lead level of 10
   mcg/dL (0.48 μmol/L). The nurse should:
8. Arrange a follow-up appointment in 6 months.
9. Obtain a consultation for chelation therapy.
10. Educate parents on ways to reduce lead in the environment.
11. Assure the parents this is a normal lead level.

Answer 7

7. 3. Treatment for children with minimally elevated lead levels should include family lead
      education, follow-up testing, and a social service consultation if needed. Waiting 6 months for a
      follow-up screening is too long because the effects of lead are irreversible. Oral chelation therapy is
      not begun until levels approach 45 mcg/dL (2.2 μmol/L). There is no such thing as a “normal” lead
      level because there is no beneficial action in the body.
      CN: Safety and infection control; CL: Synthesize

Question 8

8. When teaching the mother of a toddler diagnosed with lead poisoning, which of the following
   should the nurse include as the most serious complication if the condition goes untreated?
9. Cirrhosis of the liver.
10. Stunted growth rate.
11. Neurologic deficits.
12. Heart failure.

Answer 8

8. 3. The most serious and irreversible consequence of lead poisoning is mental retardation due to
      neurologic changes. It can be expected if lead poisoning is long-standing and goes untreated. Lead
      poisoning also affects the hematologic and renal systems. Cirrhosis is the end stage of several chronic
      liver diseases, such as biliary atresia and hepatitis. Lead poisoning is not associated with stunted
      growth. Chronic illnesses, such as cystic fibrosis, cause slowing of the growth velocity. Heart failure
      is associated with congenital heart disease and rheumatic fever.
      CN: Physiological adaptation; CL: Apply

Question 9

9. The nurse is teaching dietary interventions to the parents of a child with an elevated blood lead
   level (EBLL). Which nutrient is least important to include in the child’s diet?
10. Calcium.
11. Iron.
12. Vitamin A.
13. Vitamin C.

Answer 9

9. 3. Vitamin A is not known to play a significant role in preventing EBLL. Calcium intake inhibits
      lead absorption. Children with EBLL levels often are anemic. While this relationship is not well
      understood, iron supplementation has been shown to improve developmental outcomes. Vitamin C
      improves iron absorption.
      CN: Health promotion and maintenance; CL: Analyze

Question 10

The Client with Celiac Disease
10. Which of the following statements by a mother about her child would suggest to the nurse that
the child may have celiac disease and should be referred to a health care provider?
1. “His urine is so dark in color.”
2. “His stools are large and smelly.”
3. “His belly is so small.”
4. “He is so short.

Answer 10

The Client with Celiac Disease
10. 2. Celiac disease is a disorder involving intolerance to the protein gluten, which is found in
wheat, rye, oats, and barley. The stools of a child with celiac disease are characteristically
malodorous, pale, large (bulky), and soft (loose). Excessive flatus is common, and bouts of diarrhea
may occur. Dark urine is commonly associated with concentrated urine, such as when a child has
dehydration. The belly of a child with celiac disease, a malabsorption disorder, typically is
protuberant. A small belly may be associated with a child who is thin. Short stature is not associated
with this malabsorption disorder.
CN: Physiological adaptation; CL: Analyze

Question 11

11. During assessment of a child with celiac disease, the nurse should most likely note which of
the following physical findings?
1. Enlarged liver.
2. Protuberant abdomen.
3. Tender inguinal lymph nodes.
4. Periorbital edema

Answer 11

11. 2. The intestines of a child with celiac disease fill with accumulated undigested food and
       flatus, causing the characteristic protuberant abdomen. Celiac disease is not usually associated with
       any liver dysfunction, including poor liver functioning leading to liver enlargement. Tender inguinal
       lymph nodes are often associated with an infection. Periorbital edema, swelling around the eyes, is
       associated with nephritis.
       CN: Physiological adaptation; CL: Analyze

Question 12

12. After teaching the mother of a child with celiac disease about dietary management, which of
    the following statements by the mother indicates successful teaching?
13. “I will feed my child foods that contain wheat products.”
14. “I will be sure to give my child lots of milk.”
15. “I will plan to feed my child foods that contain rice.”
16. “I will be sure my child gets oatmeal every day.”

Answer 12

12. 3. Damage to intestinal mucosa in celiac disease is caused by gliadin, a part of the protein
       found in wheat, rye, barley, and oats. Foods containing these grains must be eliminated entirely from
       the diet of children with celiac disease. Foods containing rice and corn are a good substitute.
       Although an adequate intake of milk is important for any child, children with celiac disease do not
       need an increased milk intake.
       CN: Physiological adaptation; CL: Evaluate

Question 13

13. After teaching the parents of a child with celiac disease about diet, which of the following, if
    stated by the parents to be avoided, indicates effective teaching? Select all that apply.
14. Chocolate candy.
15. Hot dogs.
16. Bologna on rye sandwich.
17. Corn tortillas.
18. White rice.

Answer 13

13. 1, 2, 3. Children with celiac disease should avoid foods containing the protein gluten, which
    is found in wheat, oats, rye, and barley grains. Children are allowed to eat foods containing rice or
    corn. Labels need to be read carefully since these glutens are used as fillers in many food items
    including many types of chocolate candy and hot dogs.
    CN: Reduction of risk potential; CL: Evaluate

Question 14

14. Which of the following foods would be appropriate for a 12-month-old child with celiac
disease?
1. Oatmeal.
2. Pancakes.
3. Rice cereal.
4. Waffles.

Answer 14

14. 3. The child with celiac disease should not eat foods containing wheat, oats, rye, or barley.
       Pancakes and waffles are made from flour that typically is derived from wheat and therefore should
       be avoided. Foods containing rice, such as rice cereal, or corn are appropriate. Pancakes and waffles
       are made from flour that typically is derived from wheat and therefore should be avoided.
       CN: Physiological adaptation; CL: Synthesize

Question 15

15. The mother of a child with celiac disease asks, “How long must he stay on this diet?” Which
response by the nurse is best?
1. “Until the jejunal biopsy is normal.”
2. “Until his stools appear normal.”
3. “For the next 6 months.”
4. “For the rest of his life.”

Answer 15

15. 4. Most children with celiac disease have a lifelong sensitivity to gluten, which requires that
       they maintain some type of diet restriction for the rest of their lives.
       CN: Physiological adaptation; CL: Synthesize

Question 16

The Client with Phenylketonuria
16. When preparing to obtain a neonatal screening test for phenylketonuria (PKU), the neonate
must have received which of the following to ensure reliable results?
1. A feeding of an iron-rich formula.
2. Nothing by mouth for 4 hours before the test.
3. Initial formula or breast milk at least 24 hours before the test.
4. A feeding of glucose water.

Answer 16

The Client with Phenylketonuria
16. 3. PKU is an autosomal recessive disorder involving the absence of an enzyme needed to
metabolize the essential amino acid, phenylalanine, to tyrosine. To ensure reliable results, the neonate
must have ingested sufficient protein, such as breast milk or formula, for at least 24 hours. Testing the
infant before that time, excessive vomiting, or poor intake can yield false-negative results. The infant
does not need to fast 4 hours before the test. A loading dose of glucose water does not affect test
values.
CN: Reduction of risk potential; CL: Evaluate

Question 17

17. When developing the plan of care for a child diagnosed with phenylketonuria (PKU), the
    nurse should establish which of the following goals?
18. Meeting the child’s nutritional needs for optimal growth.
19. Ensuring that the special diet is started at age 3 weeks.
20. Maintaining serum phenylalanine level higher than 12 mg/100 mL (720 μmol/L).
21. Maintaining serum phenylalanine level lower than 2 mg/100 mL (120 μmol/L).

Answer 17

17. 1. The goal of care is to prevent mental retardation by adjusting the diet to meet the infant’s
       nutritional needs for optimal growth. The diet needs to be started upon diagnosed, ideally within a
       few days of birth. Serum phenylalanine level should be maintained between 3 and 7 mg/100 mL (180
       to 420 μmol/L). Significant brain damage usually occurs if the level exceeds 10 to 15 mg/100 mL
       (600 to 900 μmol/L). If the level drops below 2 mg/100 mL (120 μmol/L), the body begins to
       catabolize its protein stores, causing growth retardation.
       CN: Physiological adaptation; CL: Create

Question 18

18. When taking a diet history from the mother of a 7-year-old child with phenylketonuria, a
    report of an intake of which of the following foods should cause the nurse to gather additional
    information?
19. Cola.
20. Carrots.
21. Orange juice.
22. Bananas.

Answer 18

18. 1. Foods with low phenylalanine levels include vegetables, fruits, and juices. Foods high in
       phenylalanine include meats and dairy products, which must be restricted or eliminated. Colas
       contain more phenylalanine than the fruits listed.
       CN: Physiological adaptation; CL: Analyze

Question 19

19. Which foods would the nurse teach the parents of a child with phenylketonuria (PKU) to
avoid? Select all that apply.
1. Hamburger.
2. Hot dog.
3. Ice cream.
4. Juice.
5. Cereal.

Answer 19

19. 1, 2, 3. Children with PKU lack an enzyme to metabolize phenylalanine and convert it to
    tyrosine. Treatment is dietary management to control the amount of phenylalanine ingested. Foods
    with low phenylalanine levels include fruits, most vegetables, and cereals. High-protein foods have
    high levels of phenylalanine and include meats and dairy products.
    CN: Reduction of risk potential; CL: Create

Question 20

20. When teaching the mother of a child diagnosed with phenylketonuria (PKU) about its
    transmission, the nurse should use knowledge of which of the following as the basis for the
    discussion?
21. Chromosome translocation.
22. Chromosome deletion.
23. Autosomal recessive gene.
24. X-linked recessive gene.

Answer 20

20. 3. PKU is caused by an inborn error of metabolism. It is an autosomal recessive disorder that
       inhibits the conversion of phenylalanine to tyrosine. A form of Down syndrome, trisomy 21, is an
       example of a disorder caused by chromosomal translocation. Cri du chat is an example of a disorder
       caused by chromosomal deletion. Hemophilia A is an example of a disorder caused by an X-linked
       recessive gene.
       CN: Physiological adaptation; CL: Apply

Question 21

21. A newborn diagnosed with phenylketonuria (PKU) is placed on a milk substitute, Lofenalac.
    The mother asks the nurse how long her infant will be taking this. Which of the following responses
    would be most appropriate?
22. “Until the infant is taking solid foods well.”
23. “Until the child has stopped growing.”
24. “Until the phenylalanine level remains below normal for 6 months.”
25. “Probably for a long time, but it’s not definitely known.”

Answer 21

21. 4. Although it is not known how long diet therapy must continue for children with PKU, many
       experts suggest continuing it indefinitely because of academic difficulties and lower intelligence
       quotients in older children who have stopped the restrictive diet. For women, it is necessary to
       resume the diet before conception to lower the phenylalanine levels in the fetus and prevent
       complications.
       CN: Physiological adaptation; CL: Synthesize

Question 22

22. Even though several teaching sessions have been documented in the client’s health record, the
    mother asks the nurse again what caused her child’s phenylketonuria (PKU). Which of the following
    statements would best reflect the nurse’s interpretation of why the mother keeps asking for
    information that she has already received?
23. Because the child’s condition is chronic, parents commonly want very detailed explanations
    about the causes of and treatments for their child’s disease.
24. Parents of a chronically ill child commonly require a long time to work through the grieving
    process for their child’s disease.
25. Parents commonly test health workers’ knowledge about the causes of and treatments for their
    child’s disease.
26. Parents commonly deal with their guilt about possibly causing their child’s disease by asking
    challenging questions.

Answer 22

22. 2. PKU is considered a chronic illness. Parents typically grieve about the loss of health in
       their child afflicted with a chronic disease. Many times, they repeat questions, as though trying to
       deny what is really happening. This type of behavior represents an attempt to integrate the experience
       and their feelings with their self-image as they pass through the grieving process. Asking for detailedexplanations, testing the competence of health workers, and expressing impatience with health
       workers may explain the parents’ behavior, but viewing the behavior as a part of the grieving process
       is the most plausible explanation.
       CN: Psychosocial integrity; CL: Analyze

Question 23

The Client with Colic
23. When performing the nursing history, which of the following would be most important for the
nurse to obtain from the mother of an infant with suspected colic?
1. The type of formula the infant is taking.
2. The infant’s crying pattern.
3. The infant’s sleep position.
4. The position of the infant during burping.

Answer 23

The Client with Colic
23. 2. Information on the crying pattern of the infant is most helpful in confirming the diagnosis of
colic. Typically the colic attack begins abruptly, with the infant crying loudly and continuously,
possibly for hours. The attack may end when the child becomes exhausted. The child also may attain
some relief after passing stool or flatus. Often, in an attempt to alleviate the infant’s crying, parents try
to feed the infant, resulting in overfeeding leading to discomfort and distention. Asking about the type
of formula, sleep position, or position for burping will not provide sufficient information to confirm
the diagnosis of colic. However, the nurse can obtain additional information after determining the
nature of the crying pattern.
CN: Physiological adaptation; CL: Analyze

Question 24

24. The parents of a child with colic are asked to describe the infant’s bowel movements. Which
    of the following descriptions should the nurse expect?
25. Soft, yellow stools.
26. Frequent watery stools.
27. Ribbon-like stools.
28. Foul-smelling stools.

Answer 24

24. 1. Infants with colic usually pass normal stools, typically soft and yellowish. Frequent watery
       stools might indicate diarrhea. Ribbon-like stools are suggestive of a narrowing of the colon or the
       rectum. Foul-smelling stools by themselves are related to diet. When other symptoms such as large
       size and protuberant abdomen are present, malabsorption may be possible.
       CN: Physiological adaptation; CL: Analyze

Question 25

25. The mother tells the nurse that the diagnosis of colic upsets her because she knows her infant
    will continue to have colicky pain. Which of the following responses by the nurse would be most
    appropriate?
26. “I know that your baby’s crying upsets you, but she needs your undivided attention for the next
    few months.”
27. “It can be difficult to listen to your baby cry so loud and so long, so try to make sure that you
    get some free time.”
28. “It must be distressing to see your baby in pain, but at least she doesn’t have an intestinal
    obstruction.”
29. “The next 3 months will be a difficult time for you, but your baby will outgrow the colic by
    this time.”

Answer 25

25. 2. The nurse needs to provide the parents with support because of the infant’s crying. The
       parents are stressed and need to be encouraged to get out of the house and arrange for some free time.
       Although infants need lots of attention and care for the first few months, they do not need the mother’s
       undivided attention. Comparing colic with other problems is inappropriate. Parents have the right to
       be upset. Although colic usually disappears spontaneously by age 3 months, the nurse should not make
       any guarantees.
       CN: Psychosocial integrity; CL: Synthesize

Question 26

26. The nurse judges that the mother has understood the teaching about care of an infant with
    colic when the nurse observes the mother doing which of the following?
27. Holding the infant prone while feeding.
28. Holding the infant in her lap to burp.
29. Placing the infant prone after the feeding.
30. Burping the infant during and after the feeding.

Answer 26

26. 4. Infants with colic should be burped frequently during and after the feeding. Much of the
       discomfort of colic appears to be associated with the presence of air in the stomach and the intestines.
       Frequent burping helps to relieve the air. Infants with colic should be held fairly upright while being
       fed, to help air rise. The preferred position for burping the infant with colic is to hold the infant at the
       mother’s shoulder so that the infant’s abdomen lies on the shoulder. This position causes more
       pressure to be exerted on the infant’s abdomen, leading to a more forceful burp. The child should be
       placed in an infant seat after feedings.
       CN: Physiological adaptation; CL: Evaluate

Question 27

The Client with Obesity
27. An 8-year-old has a body mass index (BMI) for age at the 90th percentile, but has no other
risk factors. The nurse should:
1. Refer the family to a dietician.
2. Recommend the child be reweighed in 1 year.
3. Refer the child to a health care provider specializing in pediatric weight loss.
4. Recommend the child participate in a commercial diet program.

Answer 27

The Client with Obesity
27. 1. Children aged 2 to 20 years with a BMI-for-age at the 90th percentile are considered
overweight. If no other risk factors are present, the family should receive dietary counseling to slow
the child’s weight gain until an appropriate height for weight is attained. Without intervention, the
child may become obese. A health care provider who specializes in pediatric weight loss should be
considered when the child is obese and has complicating factors. Commercial diet programs alone donot include the necessary monitoring for children, thus are rarely appropriate.
CN: Management of care; CL: Synthesize

Question 28

28. A mother brings her 7-month-old infant to the well-baby clinic for a check-up. She is
    concerned that the infant is overweight. She feeds the infant formula whenever the infant is hungry.
    The nurse should instruct the mother to:
29. Give the infant 2% milk formula and add vitamins.
30. Use skim milk because it is high in protein and lower in calories.
31. Decrease the amount of formula feedings to 16 oz (473 mL) daily, and supplement with juice
    and water.
32. Bring a 3-day record of the infant’s intake back for further evaluation.

Answer 28

28. 4. A 3-day diet history is the best way to accurately assess the child’s intake. Children under
       age 1 year should not drink cow’s milk because of the risk of allergy. Children over age 1 year should
       drink whole milk because skim milk and 2% milk do not contain all the essential fatty acids needed
       by young children. It is unknown at this time how much formula the child is actually taking, but an
       infant should not have more than 6 oz (177.4 mL) of juice per day and additional water is usually not
       necessary. If an infant is taking no more than 32 oz (946 mL) of formula per day and is eating some
       baby food and cereal, additional fluids and frequent feeding should not be necessary.
       CN: Health promotion and maintenance; CL: Synthesize

Question 29

29. Which of the following methods should the nurse use to provide the most accurate assessment
    of an adolescent’s status regarding obesity?
30. A food intake diary for 1 week.
31. Body mass index (BMI)-for-age.
32. A 4-hour dietary history.
33. Skinfold thickness measurements.

Answer 29

29. 2. The most accurate way to determine whether an adolescent has a problem with obesity is to
       calculate the BMI-for-age. The BMI indicates a relationship between height and weight. Numbers
       obtained through calculation are then applied to a BMI-for–age growth chart for interpretation. A
       food diary will provide information on what the adolescent is eating but does not provide information
       about obesity. A 4-hour diet history will not provide sufficient information about the client’s typical
       eating patterns over time. Measuring skinfold thickness with skinfold calipers is a common method
       used to assess obesity. The skinfold thickness test, which determines the amount of subcutaneous fat,
       determines obesity more accurately than does a height and weight chart. However, it is not the most
       accurate method and is not routinely performed by nurses.
       CN: Health promotion and maintenance; CL: Analyze

Question 30

30. When counseling an obese adolescent, the nurse should advise the client that which
complication is the most common?
1. Lifelong obesity.
2. Gastrointestinal problems.
3. Orthopedic problems.
4. Psychosocial problems.

Answer 30

30. 1. The most common complication of adolescent obesity is its persistence into adulthood. The
       incidence of gastrointestinal and orthopedic problems, such as Legg-Calvé-Perthes disease and genu
       valgum (knock knees), is greater for obese adolescents; however, they are not the most common
       complication. Although psychosocial problems do occur, they are not the most common complication.
       CN: Reduction of risk potential; CL: Apply

Question 31

31. Weight loss has been recommended for an overweight adolescent at a rate of approximately .
    The nurse explains this can be done by increasing activity and reducing empty calories by how many
    calories per day? ___________________ cal/day.

Answer 31

31. 250 cal/day. To lose 1 lb of weight, a client needs to burn approximately 3,500 cal. 0.5 lb ×
    3,500 cal/lb ÷ 7 days = 250 cal/day.
    CN: Basic care and comfort CL: Apply

Question 32

32. When developing a teaching plan for the mother of an infant about introducing solid foods
    into the diet, which of the following measures should the nurse expect to include in the plan to help
    prevent obesity?
33. Decreasing the amount of formula or breast milk intake as solid food intake increases.
34. Introducing the infant to the taste of vegetables by mixing them with formula or breast milk.
35. Mixing cereal and fruit in a bottle when offering solid food for the first few times.
36. Using a large-bowled spoon for feeding solid foods during the first several months.

Answer 32

32. 1. Decreasing the amount of formula given as the infant begins to take solids helps prevent
       excess caloric intake. Because the infant is receiving calories from the solid foods, the formula no
       longer needs to provide the infant’s total caloric requirements. Mixing vegetables with formula or
       breast milk does not allow the child to become accustomed to new textures or tastes. Solid foods
       should be given with a spoon, not in a bottle. Using a bottle with food allows the infant to ingest more
       food than is needed. Also, the infant needs to learn to eat from a spoon. A small-bowled spoon is
       recommended for infants because infants have a tendency to push food out with the tongue. The small-
       bowled spoon helps in placing the food at the back of the infant’s tongue when feeding.
       CN: Basic care and comfort; CL: Create

Question 33

33. A pregnant mother who has brought her toddler to the clinic for a check-up asks the nurse
    how she can keep her next baby from becoming obese. The mother plans to bottle-feed her next child.
    Which information should the nurse include in the teaching plan to help the mother avoid
    overnourishing her infant?
34. Recognizing clues indicating that a baby is full.
35. Establishing a regular feeding schedule.
36. Supplementing feedings with sterile water.
37. Adding more water than directed when preparing formula.

Answer 33

33. 1. Infants generally do not overeat unless they are urged to do so. Parents should watch for
       clues indicating that the infant is full—for example, stopping sucking and pushing the nipple out of the
       mouth. Bottle-feeding instead of breast-feeding is more likely to lead to excessive caloric intake. A
       demand schedule, rather than a regulated schedule, allows the infant to regulate intake according toindividual needs. Normally, giving an infant a regular supplementation of water is unnecessary; the
       infant’s sucking needs can be met by providing a pacifier. Adding more water to the formula than as
       directed decreases the caloric intake and also places the infant at risk for hyponatremia due to
       decreased sodium and increased water intake.
       CN: Basic care and comfort; CL: Synthesize

Question 34

The Client with Food Sensitivity
34. During a school party a child with a known food allergy has an itchy throat, wheezing, and
not feeling “quite right.” The nurse should do the following in what order from first to last?
1. Administer the child’s epinephrine (Epipen).
2. Assess vital signs.
3. Position to facilitate breathing.
4. Send someone to activate the Emergency Management Systems (EMS)
5. Notify the parents.

Answer 34

The Client with Food Sensitivity
34.
4. Send someone to activate the EMS
1. Administer the child’s epinephrine (Epipen).
3. Position to facilitate breathing.
2. Assess vital signs.
5. Notify the parents.
The child is exhibiting signs of anaphylaxis. The principles of emergency management involve
activating EMS when an emergency is first realized. The nurse then follows the priorities of
Circulation, Airway, Breathing (C, A, B). The epinephrine should then be given to reduce airway
constriction and prevent cardiovascular collapse. The child should be assisted into the most
comfortable position to facilitate breathing, usually with the head elevated. Then the nurse can take
the child’s vital signs to assess the effectiveness of the treatment. Lastly, the nurse should notify the
family.
CN: Physiological adaptation; CL: Synthesize

Question 35

35. After teaching the parents of a child with lactose intolerance about the disorder, the nurse
    determines that the teaching was effective when the mother describe the condition?
36. “The lack of an enzyme to break down lactose.”
37. “An allergy to lactose found in milk.”
38. “Inability to digest proteins completely.”
39. “Inability to digest fats completely.”

Answer 35

35. 1. Lactose intolerance is not an allergy. Rather, it is caused by the lack of the digestive enzyme
       lactase. This enzyme, found in the intestines, is necessary for the digestion of lactose, the primary
       carbohydrate in cow’s milk. Protein and fat digestion are not affected.
       CN: Physiological adaptation; CL: Evaluate

Question 36

36. After teaching the mother of a 2-year-old child with lactose intolerance about which dairy
    products to include in the child’s diet, which of the following if stated by the mother indicates
    effective teaching?
37. Ice cream.
38. Creamed soups.
39. Pudding.
40. Cheese.

Answer 36

36. 4. People who are lactose-intolerant usually are able to tolerate dairy products in which
       lactose has been fermented, such as yogurt, cheese, and buttermilk. Pudding, ice cream, and creamed
       soups contain lactose that has not been fermented.
       CN: Physiological adaptation; CL: Evaluate

Question 37

37. The breast-feeding mother of a 1-month-old diagnosed with cow’s milk sensitivity asks the
    nurse what she should do about feeding her infant. Which of the following recommendations would be
    most appropriate?
38. Continue to breast-feed but eliminate all milk products from your own diet.
39. Discontinue breast-feeding and start using a predigested formula.3. Limit breast-feeding to once per day and begin feeding an iron-fortified formula.
40. Change to a soy-based formula exclusively and begin solid foods.

Answer 37

37. 1. Mothers of infants with a cow’s milk allergy can continue to breast-feed if they eliminate
       cow’s milk from their diet. It is important to encourage mothers to continue to breast-feed because
       breast milk is usually the least allergenic and most easily digested food for an infant. In addition, the
       infant is able to obtain protein through the mother’s milk. If the mother stops breast-feeding, then apredigested protein hydrolysate formula would be the first choice. An iron-fortified formula is a
       cow’s milk-based formula. A soy-based formula is not used because approximately 20% of infants
       with cow’s milk sensitivity are also sensitive to soy. Solid foods are not introduced until the infant is
       4 to 6 months of age.
       CN: Basic care and comfort; CL: Synthesize

Question 38

38. The nurse teaches the parents of a preschool child diagnosed with lactose intolerance how to
    incorporate dairy products into their child’s diet. Which statement by the parent reflects the need for
    more teaching?
39. “My child should limit milk consumption to one small glass at a time.”
40. “It is best to drink milk alone, not with meals.”
41. “Eating hard cheese, cottage cheese, or yogurt may cause fewer symptoms than drinking milk.”
42. “Using lactase enzymes or milk products containing lactase may help decrease gas.”

Answer 38

38. 2. Children with lactose intolerance often tolerate small amounts of dairy products better
       when they are consumed at meal time with other foods. Most people with lactose intolerance can
       consume 2 to 4 oz (59 to 118 mL) of milk at a time without symptoms. Larger quantities are more
       likely to cause gas and bloating. Cheeses contain less lactose than milk and may be better tolerated.
       Yogurt also contains enzymes that are activated in the duodenum that substitute for natural lactase.
       Taking supplemental enzymes or drinking lactase-treated milk may also substitute for natural lactase.
       CN: Basic care and comfort; CL: Synthesize

Question 39

The Client with Failure to Thrive
39. The nurse is inserting a nasogastric tube in an infant to administer feedings. In the figure
below, indicate the location for the correct placement of the distal end of the tube.

Answer 39

The Client with Failure to Thrive
39. The nasogastric tube should reside in the stomach. The site placement can be verified by
inserting 3 to 5 mL of air in the tube and auscultating the infant’s abdomen for the sound of air. The
nurse should then aspirate the injected air and a small amount of stomach contents and then test the
contents for acidity

CN: Safety and infection control; CL: Apply

Question 40

40. The nurse formulates the nursing diagnosis Imbalanced Nutrition: Less than body
    requirements related to negative feeding patterns for a 5-month-old infant diagnosed with failure to
    thrive. To meet the short-term outcomes of the infant’s plan of care, the nurse should expect to do
    which of the following?
41. Instruct the parents in proper feeding techniques.
42. Give the infant high-calorie formula.
43. Provide consistent staff to care for the infant.
44. Allow the infant to sit in a high chair during feedings.

Answer 40

40. 3. In the short-term care of this infant, it is important that the same person feed the infant at
       each meal and that this person be able to assess for negative feeding patterns and replace them with
       positive patterns. Once the infant is gaining weight and shows progress in the feeding patterns, the
       parents can be instructed in proper feeding techniques. This is a long-term outcome of nursing care.
       Because there is no organic reason for the failure to thrive, it should not be necessary to increase the
       formula calorie content. A 5-month-old infant is too young to be expected to sit in a high chair for
       feedings and should still be bottle-fed.
       CN: Physiological adaptation; CL: Synthesize

Question 41

41. The health care team determines that the family of an infant with failure to thrive who is to be
    discharged will need follow-up care. Which of the following would be the most effective method of
    follow-up?
42. Daily phone calls from the hospital nurse.
43. Enrollment in community parenting classes.
44. Twice-weekly clinic appointments.
45. Weekly visits by a community health nurse.

Answer 41

41. 4. The most effective follow-up care would occur in the home environment. The community
       health nurse can be supportive of the parents and will be able to observe parent-infant interactions in
       a natural environment. The community health nurse can evaluate the infant’s progress in gainingweight, offer suggestions to the parents, and help the family solve problems as they arise.
       CN: Physiological adaptation; CL: Synthesize

Question 42

Managing Care Quality and Safety
42. When providing intermittent nasogastric feedings to an infant with failure to thrive, which
method is preferred to confirm tube placement before each feeding?
1. Obtain a chest x-ray.
2. Verify that the gastric PH is less than 5.5.
3. Auscultate the stomach while instilling an air bolus.
4. Compare the tube insertion length to a standardized chart.

Answer 42

Managing Care Quality and Safety
42. 2. For children receiving intermittent gavage feedings, the best method to verify the tube
placement before each feeding is to aspirate a small amount of gastric contents to verify that the pH is
acidic. A pH of 5.5 or less should indicate correct placement in most babies. Depending on the type
of feeding tube used, an x-ray may be used to confirm the original tube placement, but use before
every feeding would expose the child to unnecessary radiation. Air boluses are misleading because
placement in the esophagus or respiratory tract may make the same sound in small infants. Charts
might be helpful in determining initial tube insertion length, but do not substitute for nursing
assessments.
CN: Reduction of risk potential; CL: Apply

Question 43

43. When teaching a mother about measures to prevent lead poisoning in her children, which of
    the following preventive measures should the nurse include as the most effective?
44. Condemning old housing developments.
45. Educating the public on common sources of lead.
46. Educating the public on the importance of good nutrition.
47. Keeping pregnant women out of old homes that are being remodeled.

Answer 43

43. 2. Public education about the sources of lead that could cause poisoning has been found to be
       the most effective measure to prevent lead poisoning. This includes recent efforts to alert the public to
       lead in certain types of window blinds. Condemning old housing developments has been ineffective
       because lead paint still exists in many other dwellings. Providing education about good nutrition,
       although important, is not an effective preventive measure. Pregnant women and children should not
       remain in an older home that is being remodeled because they may breathe in lead in the dust, but this
       is not the most effective preventive measure.
       CN: Safety and infection control; CL: Synthesize

Question 44

44. A child with a nut allergy is admitted with a severe reaction for the third time in 3 months.
    The parent says, “I am having trouble with the food labels.” The nurse should first:
45. Assess the parent’s ability to read.
46. Refer the client to the dietician.
47. Notify the primary care provider.
48. Obtain a social service consult.

Answer 44

44. 1. Three severe reactions in 3 months indicate a serious problem with adhering to the
       prevention plan. The nurse should first determine if the parent can actually read the label. The
       underlying problem may be that the parent is visually impaired or unable to read. The parent’s reading
       level determines what additional support is needed. Referrals to social service or dietary may be
       indicated, but the nurse does not yet have enough information about the problem. The nurse would
       communicate with the primary care provider after assessing the situation to recommend referrals.
       CN: Management of care; CL: Synthesize