Question 1

The woman has a normal pregnancy except for polyhydramnios. The delivery goes well and the baby is born and receives APGAR scores of seven and nine. Upon admission to the newborn nursery, the nurse is unsuccessful in inserting a nasogastric tube. The infant is suspected of having an esophageal atresia/tracheoesophageal fistula. While waiting for the pediatrician to see the infant, the nurse should:

Accepted Answer

A) Position the infant in semi-Fowler position. 
B) Allow the infant to be taken to the mother's room for bonding. 
C) Offer the infant formula feeding instead of breastfeeding. 
D) Wrap the infant in blankets and place in a crib by the viewing window. A

Question 2

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

Accepted Answer

A) Ineffective infant feeding pattern related to uncoordinated suck and swallow 
B) Risk for aspiration related to regurgitation 
C) Acute pain related to esophageal defect 
D) Ineffective tissue perfusion: gastrointestinal related to decreased circulation B

Question 3

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

Accepted Answer

A) Clay-colored stools and dark urine 
B) History of early passage of meconium in the newborn period 
C) History of chronic, progressive constipation and failure to gain weight 
D) Continual bouts of foul-smelling diarrhea C

Question 4

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

Accepted Answer

A) A warm, moist pack 
B) EMLA cream to the incision site 
C) An ice pack 
D) A splint pillow against the abdomen when moving or coughing

Question 5

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

Accepted Answer

A) "We will change the colostomy bag with each wet diaper." 
B) "We will expect a moderate amount of bleeding after cleansing the area around the stoma." 
C) "We will watch for skin irritation around the stoma." 
D) "We will use adhesive enhancers when we change the bag."

Question 6

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

Accepted Answer

A) The infant may lose weight due to loss of nutrition. 
B) The infant will develop metabolic alkalosis. 
C) The infant will become dehydrated. 
D) The infant will develop hyperbilirubinemia.

Question 7

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

Accepted Answer

A) Between meals 
B) At bedtime 
C) One hour before meals 
D) With meals

Question 8

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

Accepted Answer

A) Below the umbilicus 
B) Just below the sternum 
C) Just above the pubic bone 
D) Just above the umbilicus, around the largest circumference of the abdomen

Question 9

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

Accepted Answer

A) Calling the infant by name when referring to the infant. 
B) Keeping the infant's lower face covered with the blanket. 
C) Smiling at the infant and talking to the infant in the parents' presence. 
D) Showing the parents before and after pictures of other children with cleft lips. 
E) Discussing positive features of their baby.

Question 10

The parents demonstrate that they have understood the nurse's teaching with regard to colostomy stoma care for their infant if they state:

Accepted Answer

A) "We will use adhesive enhancers when we change the bag." 
B) "We will expect a small amount of bleeding after cleansing the area around the stoma." 
C) "We will watch for skin irritation around the stoma." 
D) "We will change the colostomy bag with each wet diaper."

Question 11

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

Accepted Answer

A) Radiant warmer 
B) Crib 
C) Bilirubin light 
D) Formula for feeding

Question 12

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

Accepted Answer

A) Pyloric stenosis. 
B) Biliary atresia. 
C) Hirschsprung's disease. 
D) Umbilical hernia. 
E) Diaphragmatic hernia.

Question 13

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

Accepted Answer

A) Appropriate bag-valve-mask system 
B) Sterile gauze and saline 
C) Soft arm restraints 
D) Equipment for intubation

Question 14

Following diagnosis of Crohn's disease, the nurse is explaining dietary modifications to the teenagers. The nurse would recommend:

Accepted Answer

A) Increased fiber in the diet to promote solid stools. 
B) Small, frequent feedings are preferred over three meals a day. 
C) Identify foods that cause distress and eliminate them from the diet. 
D) High-calorie dietary supplement shakes can help meet nutritional requirements. 
E) Socialization is important at mealtime no matter the dynamics.

Question 15

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

Accepted Answer

A) Ineffective tissue perfusion: gastrointestinal, related to decreased circulation 
B) Ineffective infant feeding pattern related to uncoordinated suck and swallow 
C) Acute pain related to esophageal defect 
D) Aspiration, risk for related to regurgitation

Question 16

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

Accepted Answer

A) Clear liquids today.NPO tomorrow 
B) Type and cross-match for one unit of packed red blood cells. 
C) Rectal temperatures every four hours 
D) Start an intravenous line with D5NS at 20 ml per hour.

Question 17

A woman pregnant at term arrives at the small rural hospital in active labor. She has received no prenatal care. At delivery, it is discovered that the newborn has a gastroschisis defect. Immediate transfer to a pediatric hospital is planned. Nursing care to prepare the infant for discharge would include:

Accepted Answer

A) Covering the exposed intestines with sterile moist gauze. 
B) Wrapping the infant warmly in two or three blankets. 
C) Providing a sterile water feeding to maintain hydration during transport. 
D) Preventing the parents from seeing the infant prior to transfer to reduce their anxiety.

Question 18

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

Accepted Answer

A) NPO status until bowel sounds return 
B) Frequent assessment of the surgical site 
C) Avoiding narcotics to prevent depression of the respiratory system 
D) Allow parents at the bedside as soon as possible.

Question 19

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

Accepted Answer

A) The infant's formula has rice cereal added. 
B) The mother hold the infant is a high Fowler's position while feeding. 
C) After feeding, the infant is placed in an infant seat. 
D) The mother draws up the ranitidine (Zantac) in a syringe for oral administration.

Question 20

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

Accepted Answer

A) Necrotizing enterocolitis 
B) Ulcerative colitis 
C) Crohn's disease 
D) Appendicitis

Exam 52: The Child With Alterations in Gastrointestinal Function