Question 1

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:
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 2

Therapeutic management of the child with acute diarrhea and dehydration usually begins with:
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 antidiarrheals because they do not get rid of pathogens.

Question 3

A parasite that causes acute diarrhea is:
A)Shigella organisms.
B)Salmonella organisms.
C)Giardia lamblia.
D)Escherichia coli.

Accepted Answer

Giardiasis is a parasite that represents 15% of nondysenteric illness in the United States. Shigella,Salmonella,and E. coli are bacterial pathogens.

Question 4

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 causes diarrhea. Shigella is a bacterial pathogen that is uncommon in the United States.

Question 5

A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with gastroesophageal reflux. The purpose of this is to:
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. Preventing reflux and hematemesis,and increasing gastric acid production are not the modes of action of histamine-receptor antagonists.

Question 6

Nurses must be alert for increased fluid requirements when a child has:
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 7

Acute diarrhea is often caused by:
A)Celiac disease.
B)Antibiotic therapy.
C)Immunodeficiency.
D)Protein malnutrition.

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 8

The nurse is explaining to a parent how to care for a child with vomiting associated with a viral illness. The nurse should include:
A)Avoiding carbohydrate-containing liquids.
B)Giving nothing by mouth for 24 hours.
C)Brushing teeth or rinsing mouth after vomiting.
D)Giving plain water until vomiting ceases for at least 24 hours.

Accepted Answer

It is important to emphasize the need for the child to brush the teeth or rinse the mouth after vomiting to dilute the hydrochloric acid that comes in contact with the teeth. Administration of a glucose-electrolyte solution to an alert child will help restore water and electrolytes satisfactorily. It is important to include carbohydrates to spare body protein and avoid ketosis.

Question 9

When caring for a child with probable appendicitis,the nurse should be alert to recognize that a sign of perforation is:
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 10

A 3-year-old child with Hirschsprung's disease is hospitalized for surgery. A temporary colostomy will be necessary. The nurse should recognize that preparing this child psychologically is:
A)Not necessary because of child's age.
B)Not necessary because the colostomy is temporary.
C)Necessary because it will be an adjustment.
D)Necessary because the child must deal with a negative body image.

Accepted Answer

The child's age dictates the type and extent of psychologic preparation. When a colostomy is performed,the child who is at least preschool age is told about the procedure and what to expect in concrete terms with the use of visual aids. It is necessary to prepare this age child for procedures. The preschooler is not yet concerned with body image.

Question 11

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 12

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.

Question 13

A high-fiber food that the nurse could recommend for a child with chronic constipation is:
A)Popcorn.
B)Pancakes.
C)Muffins.
D)Ripe bananas.

Accepted Answer

Popcorn is a high-fiber food. Cake does not have significant fiber unless made with fruit or bran. Raw fruits,especially those with skins and seeds and other than ripe bananas and avocado,are high in fiber.

Question 14

A 4-month-old infant has gastroesophageal reflux disease (GERD) but 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

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 a 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 15

A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet with the family. Which statement by the parent would indicate a correct understanding of the teaching?
A)"I will keep my child on a clear liquid diet for the next 24 hours."
B)"I should encourage my child to drink carbonated drinks but avoid food for the next 24 hours."
C)"I will offer my child bananas,rice,applesauce,and toast for the next 48 hours."
D)"I should have my child eat a normal diet with easily digested foods for the next 48 hours."

Accepted Answer

Easily digested foods such as cereals,cooked vegetables,and meats should be provided for the child. Early reintroduction of nutrients is desirable. Continued feeding or reintroduction of a regular diet has no adverse effects and actually lessens the severity and duration of the illness. Clear liquids and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic. A diet of bananas,applesauce,and toast is contraindicated because it has little nutritional value (low in energy and protein),is high in carbohydrates,and is low in electrolytes.

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

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 is most intense at McBurney point are not signs of acute appendicitis.

Question 18

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 1% to 4% of the general population. The standard therapy is surgical removal of the diverticulum.

Question 19

An infant is brought to the emergency department with poor skin turgor,weight loss,lethargy,and tachycardia. This is suggestive of:
A)Overhydration.
B)Dehydration.
C)Sodium excess.
D)Potassium 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 20

Constipation has recently become a problem for a school-age girl. She is healthy except for seasonal allergies,which are now being successfully treated with antihistamines. The nurse should suspect that the constipation is most likely caused by:
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. With a change in bowel habits,the presence and role of any recently prescribed medications should be assessed.

Quiz 47: Gastrointestinal Dysfunction

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:

Therapeutic management of the child with acute diarrhea and dehydration usually begins with:

A parasite that causes acute diarrhea is:

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

A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with gastroesophageal reflux. The purpose of this is to:

Nurses must be alert for increased fluid requirements when a child has:

Acute diarrhea is often caused by:

The nurse is explaining to a parent how to care for a child with vomiting associated with a viral illness. The nurse should include:

When caring for a child with probable appendicitis,the nurse should be alert to recognize that a sign of perforation is:

A 3-year-old child with Hirschsprung's disease is hospitalized for surgery. A temporary colostomy will be necessary. The nurse should recognize that preparing this child psychologically is:

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

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

A high-fiber food that the nurse could recommend for a child with chronic constipation is:

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

A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet with the family. Which statement by the parent would indicate a correct understanding of the teaching?

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

Which clinical manifestation would most suggest acute appendicitis?

Which statement is most descriptive of Meckel's diverticulum?

An infant is brought to the emergency department with poor skin turgor,weight loss,lethargy,and tachycardia. This is suggestive of:

Constipation has recently become a problem for a school-age girl. She is healthy except for seasonal allergies,which are now being successfully treated with antihistamines. The nurse should suspect that the constipation is most likely caused by: