Question 1

Nurses must be alert for increased fluid requirements when a child presents with which possible concern?
A) Fever
B) Mechanical ventilation
C) Congestive heart failure
D) Increased intracranial pressure (ICP)

Accepted Answer

Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume.Respiratory rate influences insensible fluid loss and should be monitored in the mechanically ventilated child.Congestive heart failure is a case of fluid overload in children.ICP does not lead to increased fluid requirements in children.

Question 2

Therapeutic management of most children with Hirschsprung's disease is primarily:
A) daily enemas.
B) low-fiber diet.
C) permanent colostomy.
D) surgical removal of affected section of bowel.

Accepted Answer

Most children with Hirschsprung's disease require surgical rather than medical management.Surgery is done to remove the aganglionic portion of the bowel,relieve obstruction,and restore normal bowel motility and function of the internal anal sphincter.Preoperative management may include enemas and low-fiber,high-calorie,high-protein diet until the child is physically ready for surgery.The colostomy that is created in Hirschsprung's disease is usually temporary.

Question 3

The best chance of survival for a child with cirrhosis is:
A) liver transplantation.
B) treatment with corticosteroids.
C) treatment with immune globulin.
D) provision of nutritional support.

Accepted Answer

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 has revolutionized the approach to cirrhosis.Liver failure and cirrhosis are indications for transplantation.Liver transplantation reflects the failure of other medical and surgical measures,such as treatment with corticosteroids or immune globulin and nutritional support,to prevent or treat cirrhosis.

Question 4

What is used to treat moderate-to-severe inflammatory bowel disease?
A) Antacids
B) Antibiotics
C) Corticosteroids
D) Antidiarrheal medications

Accepted Answer

Corticosteroids such as prednisone and prednisolone are used in short bursts to suppress the inflammatory response in inflammatory bowel disease.Antacids and antidiarrheals are not drugs of choice to treat the inflammatory process of inflammatory bowel disease.Antibiotics may be used as adjunctive therapy to treat complications.

Question 5

What is the primary purpose of prescribing a histamine receptor antagonist for an infant diagnosed with gastroesophageal reflux?
A) Prevent reflux
B) Prevent hematemesis.
C) Reduce gastric acid production.
D) Increase gastric acid production.

Accepted Answer

The mechanism of action of histamine receptor antagonists is to reduce the amount of acid present in gastric contents and may prevent esophagitis.None of the remaining options are modes of action of histamine receptor antagonists but rather desired effects of medication therapy.

Question 6

When caring for a child with probable appendicitis,the nurse should be alert to recognize what sign of perforation?
A) Bradycardia
B) Anorexia
C) Sudden relief from pain
D) Decreased abdominal distention

Accepted Answer

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

Question 7

Therapeutic management of the child with acute diarrhea and dehydration usually begins with what intervention?
A) Clear liquids
B) Adsorbents such as kaolin and pectin
C) Oral rehydration solution (ORS)
D) Antidiarrheal medications such as paregoric

Accepted Answer

ORS is the first treatment for acute diarrhea.Clear liquids are not recommended because they contain too much sugar,which may contribute to diarrhea.Adsorbents are not recommended and neither are antidiarrheal because they do not get rid of pathogens.

Question 8

Which clinical manifestation would most suggest acute appendicitis?
A) Rebound tenderness
B) Bright red or dark red rectal bleeding
C) Abdominal pain that is relieved by eating
D) Abdominal pain that is most intense at McBurney point

Accepted Answer

Pain is the cardinal feature.It is initially generalized and usually periumbilical.The pain localizes to the right lower quadrant at McBurney point.Rebound tenderness is not a reliable sign and is extremely painful to the child.Abdominal pain that is relieved by eating and bright or dark red rectal bleeding are not signs of acute appendicitis.

Question 9

What condition is characterized by a chronic inflammatory process that may involve any part of the gastrointestinal (GI)tract from mouth to anus?
A) Crohn's disease
B) Ulcerative colitis
C) Meckel's diverticulum
D) Irritable bowel syndrome

Accepted Answer

The chronic inflammatory process of Crohn's disease involves any part of the GI tract from the mouth to the anus but most often affects the terminal ileum.Ulcerative colitis,Meckel's diverticulum,and irritable bowel syndrome do not affect the entire GI tract.

Question 10

What is a common cause of acute diarrhea?
A) Hirschsprung's disease
B) Antibiotic therapy
C) Hypothyroidism
D) Meconium ileus

Accepted Answer

Acute diarrhea is a sudden increase in frequency and change in consistency of stools and may be associated with antibiotic therapy.Hirschsprung's disease,hypothyroidism,and meconium ileus are usually manifested with constipation rather than diarrhea.

Question 11

What is the earliest clinical manifestation of biliary atresia?
A) Jaundice
B) Vomiting
C) Hepatomegaly
D) Absence of stooling

Accepted Answer

Jaundice is the earliest and most striking manifestation of biliary atresia.It is first observed in the sclera and may be present at birth,but is usually not apparent until ages 2 to 3 weeks.Vomiting is not associated with biliary atresia.Hepatomegaly and abdominal distention are common but occur later.Stools are large and lighter in color than expected because of the lack of bile.

Question 12

A 4-month-old infant diagnosed with gastroesophageal reflux disease (GERD)is thriving without other complications.What should the nurse suggest to minimize reflux?
A) Place in Trendelenburg position after eating.
B) Thicken formula with rice cereal.
C) Give continuous nasogastric tube feedings.
D) Give larger, less frequent feedings.

Accepted Answer

Giving small frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice cereal per ounce of formula has been recommended.Milk thickening agents have been shown to decrease the number of episodes of vomiting and increase the caloric density of the formula.This may benefit infants who are underweight as a result of GERD.Placing the child in Trendelenburg position would increase the reflux.Continuous nasogastric feedings are reserved for infants with severe reflux and failure to thrive.Smaller,more frequent feedings are recommended in reflux.

Question 13

A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting.Therapeutic management of this child will begin with which intervention?
A) Intravenous fluids
B) Oral rehydration solution (ORS)
C) Clear liquids, 1 to 2 ounces at a time
D) Administration of antidiarrheal medication

Accepted Answer

Intravenous fluids are initiated in children with severe dehydration.ORS is acceptable therapy if the dehydration is not severe.Diarrhea is not managed by using clear liquids by mouth.These fluids have a high carbohydrate content,low electrolyte content,and high osmolality.Antidiarrheal medications are not recommended for the treatment of acute infectious diarrhea.

Question 14

An infant is brought to the emergency department with poor skin turgor,sunken fontanel,lethargy,and tachycardia.This is suggestive of which condition?
A) Overhydration
B) Dehydration
C) Sodium excess
D) Calcium excess

Accepted Answer

These clinical manifestations indicate dehydration.Symptoms of overhydration are edema and weight gain.Regardless of extracellular sodium levels,total body sodium is usually depleted in dehydration.Symptoms of hypocalcemia are a result of neuromuscular irritability and manifest as jitteriness,tetany,tremors,and muscle twitching.

Question 15

Bismuth subsalicylate may be prescribed for a child with a peptic ulcer to effect what result?
A) Eradicate Helicobacter pylori
B) Coat gastric mucosa
C) Treat epigastric pain
D) Reduce gastric acid production

Accepted Answer

This combination of drug therapy is effective in the treatment and eradication of H.pylori.It does not bring about any of the results.

Question 16

A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells.This is most suggestive of which condition?
A) Protein intolerance
B) Parasitic infection
C) Fat malabsorption
D) Bacterial gastroenteritis

Accepted Answer

Neutrophils and red blood cells in stool indicate bacterial gastroenteritis.Protein intolerance is suspected in the presence of eosinophils.Parasitic infection is indicated by eosinophils.Fat malabsorption is indicated by foul-smelling,greasy,bulky stools.

Question 17

Constipation has recently become a problem for a school-age child who is being treated for seasonal allergies.The nurse should focus the assessment on what possibly related factor?
A) Diet
B) Allergies
C) Antihistamines
D) Emotional factors

Accepted Answer

Constipation may be associated with drugs such as antihistamines,antacids,diuretics,opioids,antiepileptics,and iron.Because this is the only known recent change in her habits,the addition of antihistamines is most likely the etiology of the diarrhea,rather than diet,allergies,or emotional factors.With a change in bowel habits,the presence and role of any recently prescribed medications should be assessed.

Question 18

The viral pathogen that frequently causes acute diarrhea in young children is:
A) Giardia organisms.
B) Shigella organisms.
C) Rotavirus.
D) Salmonella organisms.

Accepted Answer

Rotavirus is the most frequent viral pathogen that causes diarrhea in young children.Giardia and Salmonella are bacterial pathogens that cause diarrhea.Shigella is a bacterial pathogen that is uncommon in the United States.

Question 19

Which statement is most descriptive of Meckel's diverticulum?
A) It is more common in females than in males.
B) It is acquired during childhood.
C) Intestinal bleeding may be mild or profuse.
D) Medical interventions are usually sufficient to treat the problem.

Accepted Answer

Blood stools are often a presenting sign of Meckel's diverticulum.It is associated with mild-to-profuse intestinal bleeding.It is twice as common in males as in females,and complications are more frequent in males.Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract and is present in 2% of the general population.The standard therapy is surgical removal of the diverticulum.

Question 20

Which type of dehydration results from water loss in excess of electrolyte loss?
A) Isotonic dehydration
B) Isosmotic dehydration
C) Hypotonic dehydration
D) Hypertonic dehydration

Accepted Answer

Hypertonic dehydration results from water loss in excess of electrolyte loss.This is the most dangerous type of dehydration.It is caused by feeding children fluids with high amounts of solute.Isotonic dehydration occurs in conditions in which electrolyte and water deficits are present in balanced proportion.Isosmotic dehydration is another term for isotonic dehydration.Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit,leaving the serum hypotonic.

Quiz 41: The Child With Gastrointestinal Dysfunction

Nurses must be alert for increased fluid requirements when a child presents with which possible concern?

Therapeutic management of most children with Hirschsprung's disease is primarily:

The best chance of survival for a child with cirrhosis is:

What is used to treat moderate-to-severe inflammatory bowel disease?

What is the primary purpose of prescribing a histamine receptor antagonist for an infant diagnosed with gastroesophageal reflux?

When caring for a child with probable appendicitis,the nurse should be alert to recognize what sign of perforation?

Therapeutic management of the child with acute diarrhea and dehydration usually begins with what intervention?

Which clinical manifestation would most suggest acute appendicitis?

What condition is characterized by a chronic inflammatory process that may involve any part of the gastrointestinal (GI) tract from mouth to anus?

What is a common cause of acute diarrhea?

What is the earliest clinical manifestation of biliary atresia?

A 4-month-old infant diagnosed with gastroesophageal reflux disease (GERD) is thriving without other complications.What should the nurse suggest to minimize reflux?

A young child is brought to the emergency department with severe dehydration secondary to acute diarrhea and vomiting.Therapeutic management of this child will begin with which intervention?

An infant is brought to the emergency department with poor skin turgor,sunken fontanel,lethargy,and tachycardia.This is suggestive of which condition?

Bismuth subsalicylate may be prescribed for a child with a peptic ulcer to effect what result?

A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells.This is most suggestive of which condition?

Constipation has recently become a problem for a school-age child who is being treated for seasonal allergies.The nurse should focus the assessment on what possibly related factor?

The viral pathogen that frequently causes acute diarrhea in young children is:

Which statement is most descriptive of Meckel's diverticulum?

Which type of dehydration results from water loss in excess of electrolyte loss?