Chapter 25: GI

Question 1

1. What test is used to screen for carbohydrate malabsorption?
   a. Stool pH
   b. Urine ketones
   c. C urea breath test
   d. ELISA stool assay

Answer 1

ANS: A Stool pH

The anticipated pH of a stool specimen is 7.0. A stool pH of less than 5.0 is indicative of carbohydrate
malabsorption. The bacterial fermentation of carbohydrates in the colon produces short-chain fatty acids, which lower the stool pH. Urine ketones detect the presence of ketones in the urine, which indicates the use of
alternative sources of energy to glucose. The C urea breath test measures the amount of carbon dioxide
exhaled. It is used to determine the presence of Helicobacter pylori. ELISA (enzyme-linked immunosorbent
assay) detects the presence of antigens and antibodies. It is not useful for disorders of metabolism.

Question 2

2. A toddlers mother calls the nurse because she thinks her son has swallowed a button type of battery. He has
   no signs of respiratory distress. The nurses 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.

Answer 2

ANS: B. The location needs to be confirmed by radiographic examination.

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

Question 3

3. The mother of a child with cognitive impairment calls the nurse because her son has been gagging and
   drooling all morning. The nurse suspects foreign body ingestion. What physiologic occurrence is most likely
   responsible for the presenting signs?

a. Gastrointestinal perforation may have occurred.
b. The object may have been aspirated.
c. The object may be lodged in the esophagus.
d. The object may be embedded in stomach wall

Answer 3

ANS: C. The object may be lodged in the esophagus.

Gagging and drooling may be signs of esophageal obstruction. The child is unable to swallow saliva, which
contributes to the drooling. Signs of gastrointestinal (GI) perforation include chest or abdominal pain and
evidence of bleeding in the GI tract. If the object was aspirated, the child would most likely have coughing, choking, inability to speak, or difficulty breathing. If the object was embedded in the stomach wall, it would
not result in symptoms of gagging and drooling.

Question 4

4. What is a high-fiber food that the nurse should recommend for a child with chronic constipation?
   a. White rice
   b. Popcorn
   c. Fruit juice
   d. Ripe bananas

Answer 4

ANS: B. Popcorn

Popcorn is a high-fiber food. Refined rice is not a significant source of fiber. Unrefined brown rice is a fiber
source. Fruit juices are not a significant source of fiber. Raw fruits, especially those with skins and seeds, other
than ripe bananas, have high fiber.

Question 5

5. A 2-year-old child has a chronic history of constipation and is brought to the clinic for evaluation. What
   should the therapeutic plan initially include?

a. Bowel cleansing
b. Dietary modification
c. Structured toilet training
d. Behavior modification

Answer 5

ANS: A. Bowel cleansing

The first step in the treatment of chronic constipation is to empty the bowel and allow the distended rectum to
return to normal size. Dietary modification is an important part of the treatment. Increased fiber and fluids
should be gradually added to the childs diet. A 2-year-old child is too young for structured toilet training. For
an older child, a regular schedule for toileting should be established. Behavior modification is part of the
overall treatment plan. The child practices releasing the anal sphincter and recognizing cues for defecation.

Question 6

6. What statement best describes Hirschsprung disease?
   a. The colon has an aganglionic segment.
   b. It results in frequent evacuation of solids, liquid, and gas.
   c. The neonate passes excessive amounts of meconium.
   d. It results in excessive peristaltic movements within the gastrointestinal tract.

Answer 6

ANS: A. The colon has an aganglionic segment

Mechanical obstruction in the colon results from a lack of innervation. In most cases, the aganglionic segment
includes the rectum and some portion of the distal colon. There is decreased evacuation of the large intestine
secondary to the aganglionic segment. Liquid stool may ooze around the blockage. The obstruction does not
affect meconium production. The infant may not be able to pass the meconium stool. There is decreased
movement in the colon

Question 7

7. 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

Answer 7

ANS: B. Marking the point of measurement with a pen

Pen marks on either side of the tape measure allow the nurse to measure the same spot on the childs 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.

Question 8

8. 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 childs 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.

Answer 8

ANS: B. It is essential because it will be an adjustment.

The childs 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.

Question 9

9. A child has a nasogastric (NG) tube after surgery for Hirschsprung disease. What is the purpose of the NG
   tube?

a. Prevent spread of infection.
b. Monitor electrolyte balance.
c. Prevent abdominal distention.
d. Maintain accurate record of output

Answer 9

ANS: C. Prevent abdominal distention.

The NG tube is placed to suction out gastrointestinal secretions and prevent abdominal distention. The NG tube
would not affect infection. Electrolyte content of the NG drainage can be monitored. Without the NG tube,
there would be no drainage. After the NG tube is placed, it is important to maintain an accurate record of
intake and output. This is not the reason for placement of the tube.

Question 10

10. 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.

Answer 10

ANS: C. Thicken feedings and enlarge the nipple hole.

Thickened feedings decrease the childs 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.

Question 11

11. 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.

Answer 11

ANS: A. Notify the practitioner.

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.

Question 12

12. An adolescent with irritable bowel syndrome comes to see the school nurse. What information should the
    nurse share with the adolescent?

a. A low-fiber diet is required
b. Stress management may be helpful.
c. Milk products are a contributing factor.
d. Pantoprazole (a proton pump inhibitor) is effective in treatment.

Answer 12

ANS: B. Stress management may be helpful.

Irritable bowel syndrome is believed to involve motor, autonomic, and psychologic factors. Stress
management, environmental modification, and psychosocial intervention may reduce stress and gastrointestinal
symptoms. A high-fiber diet with psyllium supplement is often beneficial. Milk products can exacerbate bowel
problems caused by lactose intolerance. Antispasmodic drugs, antidiarrheal drugs, and simethicone are
beneficial for some individuals. Proton pump inhibitors have no effect.

Question 13

13. What clinical manifestation should be the most suggestive of acute appendicitis?
    a. Rebound tenderness
    b. Bright red or dark red rectal bleeding
    c. Abdominal pain that is relieved by eating
    d. Colicky, cramping, abdominal pain around the umbilicus

Answer 13

ANS: D. Colicky, cramping, abdominal pain around the umbilicus

Pain is the cardinal feature. It is initially generalized, usually periumbilical. The pain becomes constant and
may shift to the right lower quadrant. Rebound tenderness is not a reliable sign and is extremely painful to the
child. Bright or dark red rectal bleeding and abdominal pain that is relieved by eating are not signs of acute
appendicitis.

Question 14

14. When caring for a child with probable appendicitis, the nurse should be alert to recognize which sign or
    symptom as a manifestation of perforation?

a. Anorexia
b. Bradycardia
c. Sudden relief from pain
d. Decreased abdominal distention

Answer 14

ANS: C. Sudden relief from pain

Signs of peritonitis, in addition to fever, include sudden relief from pain after perforation. Anorexia is already
a clinical manifestation of appendicitis. Tachycardia, not bradycardia, is a manifestation of peritonitis. Abdominal distention usually increases in addition to an increase in pain (usually diffuse and accompanied by
rigid guarding of the abdomen).

Question 15

15. 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.

Answer 15

ANS: C. Allow the child to assume a position
of comfort.

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

Question 16

16. What statement is most descriptive of Meckel diverticulum?
    a. It is acquired during childhood.
    b. Intestinal bleeding may be mild or profuse.
    c. It occurs more frequently in females than in males.
    d. Medical interventions are usually sufficient to treat the problem.

Answer 16

ANS: B. Intestinal bleeding may be mild or profuse.

Bloody stools are often a presenting sign of Meckel diverticulum. It is associated with mild to profuse
intestinal bleeding. Meckel diverticulum is the most common congenital malformation of the gastrointestinal
tract and is present in 1% to 4% of the general population. It is more common in males than in females. The
standard therapy is surgical removal of the diverticulum.

Question 17

17. One of the major differences in clinical presentation between Crohn disease (CD) and ulcerative colitis
    (UC) is that UC is more likely to cause which clinical manifestation?

a. Pain
b. Rectal bleeding
c. Perianal lesions
d. Growth retardation

Answer 17

ANS: B. Rectal bleeding

Rectal bleeding is more common in UC than CD. Pain, perianal lesions, and growth retardation are common
manifestations of CD

Question 18

18. 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

Answer 18

ANS: B. Increased protein

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.

Question 19

19. 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

Answer 19

ANS: A. How to cope with stress and adjust to chronic illness

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.

Question 20

20. A child with pyloric stenosis is having excessive vomiting. The nurse should assess for what potential
    complication?

a. Hyperkalemia
b. Hyperchloremia
c. Metabolic acidosis
d. Metabolic alkalosis

Answer 20

ANS: D. Metabolic alkalosis

Infants with excessive vomiting are prone to metabolic alkalosis from the loss of hydrogen ions. Potassium and
chloride ions are lost with vomiting. Metabolic alkalosis, not acidosis, is likely.

Question 21

21. What term describes invagination of one segment of bowel within another?
    a. Atresia
    b. Stenosis
    c. Herniation
    d. Intussusception

Answer 21

ANS: D. Intussusception

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 22

22. A school-age child with celiac disease asks for guidance about snacks that will not exacerbate the disease. What snack should the nurse suggest?
    a. Pizza
    b. Pretzels
    c. Popcorn
    d. Oatmeal cookies

Answer 22

ANS: C. Popcorn

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 23

23. 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?

a. Wean the infant from TPN the next day
b. Stimulate adaptation of the small intestine
c. Give additional nutrients that cannot be included in the TPN
d. Provide parents with hope that the child is close to discharge

Answer 23

ANS: B. Stimulate adaptation of the small intestine

Long-term survival without TPN depends on the small intestines 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 infants nutritional needs. Continuous
enteral feedings through a gastrostomy tube is a positive sign, but the infants ability to tolerate increasing
amounts of enteral nutrition is only one factor that determines readiness for discharge.

Question 24

24. Melena, the passage of black, tarry stools, suggests bleeding from which source?
    a. The perianal or rectal area
    b. The upper gastrointestinal (GI) tract
    c. The lower GI tract
    d. Hemorrhoids or anal fissures

Answer 24

ANS: B. The upper gastrointestinal (GI) tract

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 25

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

a. Restlessness
b. Rapid capillary refill
c. Increased temperature
d. Increased blood pressure

Answer 25

ANS: A. Restlessness

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 26

26. What signs or symptoms are most commonly associated with the prodromal phase of acute viral hepatitis?
    a. Bruising and lethargy
    b. Anorexia and malaise
    c. Fatigability and jaundice
    d. Dark urine and pale stools

Answer 26

ANS: B. Anorexia and malaise

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 27

27. What immunization is recommended for all newborns?
    a. Hepatitis A vaccine
    b. Hepatitis B vaccine
    c. Hepatitis C vaccine
    d. Hepatitis A, B, and C vaccines

Answer 27

ANS: B. Hepatitis B vaccine

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 28

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

a. Advise bed rest until 1 week after the icteric phase.
b. Teach infection control measures to family members.
c. Inform the mother that the child cannot return to school until 3 weeks after onset of jaundice.
d. Reassure the mother that hepatitis A cannot be transmitted to other family members.

Answer 28

ANS: B. Teach infection control measures to family members.

Hand washing is the single most effective measure in preventing and controlling hepatitis. Hepatitis A can be transmitted through the fecaloral route. Family members must be taught preventive measures. Rest and quiet
activities are essential and adjusted to the childs 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 29

29. 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

Answer 29

ANS: B. Liver transplantation

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 30

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

a. Jitteriness
b. Meconium ileus
c. Excessive frothy saliva
d. Increased need for sleep

Answer 30

ANS: C. Excessive frothy saliva

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 31

31. 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 patients head for feedings.
c. Raise the patients head and give nothing by mouth.
d. Avoid suctioning unless the infant is cyanotic.

Answer 31

ANS: C. Raise the patients head and give nothing by mouth.

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 32

32. 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

Answer 32

ANS: C. Leave the tube open to gravity drainage.

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 33

33. 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

Answer 33

ANS: B. Gastrointestinal decompression

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 34

34. 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?

a. Safe administration of daily enemas
b. Necessity of firm stools to keep suture line clean
c. Bowel training beginning as soon as the child returns home
d. Changes in stooling patterns to report to the practitioner

Answer 34

ANS: D. Changes in stooling patterns to report to the practitioner

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 childs developmental and physiologic readiness.

Question 35

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

a. Surgery is recommended as soon as possible.
b. The defect usually resolves spontaneously by 3 to 5 years of age.
c. Aggressive treatment is necessary to reduce its high mortality.
d. Taping the abdomen to flatten the protrusion is sometimes helpful.

Answer 35

ANS: B. The defect usually resolves spontaneously by 3 to 5 years of age.

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 36

36. 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?

a. Initiating breast- or bottle-feedings to stabilize the blood glucose level
b. Maintaining pain management with an intravenous opioid
c. Covering the intact bowel with a nonadherent dressing to prevent injury
d. Performing immediate surgery

Answer 36

ANS: C. Covering the intact bowel with a nonadherent dressing to prevent injury

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 37

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

a. The prognosis for full recovery is excellent.
b. Death usually occurs by 6 months of age.
c. Liver transplantation may be needed eventually.
d. Children with surgical correction live normal lives

Answer 37

ANS: C. Liver transplantation may be needed eventually.

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 38

38. 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

Answer 38

ANS: C. Hirschsprung disease

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 39

39. 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

Answer 39

ANS: B. Assessing bowel function

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 40

40. An infant is born with a gastroschisis. Care preoperatively should include which priority intervention?
    a. Prone position
    b. Sterile water feedings
    c. Monitoring serum laboratory electrolytes
    d. Covering the defect with a sterile bowel bag

Answer 40

ANS: D. Covering the defect with a sterile bowel bag

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 41

41. 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

Answer 41

ANS: A. The medication reduces gastric acid secretion.

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 42

42. 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 infants IV line has infiltrated.
b. The infant has not voided since surgery.
c. The infants mother states the infant is tolerating the feeding okay.
d. The infant is taking the Pedialyte without vomiting or distention.

Answer 42

ANS: D. The infant is taking the Pedialyte without vomiting or distention.

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 43

43. 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

Answer 43

ANS: C. Corn on the cob with butter

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 44

44. 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

Answer 44

ANS: A. Central venous catheter infection, electrolyte losses, and hyperglycemia

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 45

45. 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)

Answer 45

ANS: A. Ondansetron (Zofran)

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 46

46. 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

Answer 46

ANS: D. 30 minutes before breakfast

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 47

47. 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.

Answer 47

ANS: C. Vent the gastrostomy tube.

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 48

48. 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

Answer 48

ANS : A. Enemas

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 49

49. 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 jellylike
d. Loose stools with undigested food

Answer 49

ANS: C. Currant jellylike

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

Question 50

50. 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

Answer 50

ANS: B. The laboratory reports a negative guaiac

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.