IHockenberry & Wilson: Wongs Essentials of Pediatric Nursing, 8th EditionPub ReviewChapter 24: The Child with Gastrointestinal DysfunctionMULTIPLE CHOICE1.Nurses must be alert for increased fluid requirements when a child has which of the following?a.Feverb.Mechanical ventilationc.Congestive heart failured.Increased intracranial pressure (ICP)ANS:AFever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume.DIF:Cognitive Level: ComprehensionREF:Page 814TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential2.Melena, the passage of black, tarry stools, suggests bleeding from:a.perianal or rectal area.b.hemorrhoids or anal fissures.c.upper gastrointestinal (GI) tract.d.lower GI tract.ANS:CMelena is denatured blood from the upper GI tract or bleeding from the right colon.DIF:Cognitive Level: ComprehensionREF:Page 815TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential3.What type of dehydration is defined as dehydration that occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportion?a.Isotonic dehydrationb.Hypotonic dehydrationc.Hypertonic dehydrationd.All types of dehydration in infants and small childrenANS:AIsotonic dehydration is the correct term for this definition and is the most frequent form of dehydration in children.DIF:Cognitive Level: ComprehensionREF:Page 816TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential4.Which of the following types of dehydration results from water loss in excess of electrolyte loss?a.Isotonic dehydrationb.Isosmotic dehydrationc.Hypotonic dehydrationd.Hypertonic dehydrationANS:DHypertonic 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.DIF:Cognitive Level: ComprehensionREF:Page 816TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential5.An infant is brought to the emergency department with poor skin turgor, weight loss, lethargy, and tachycardia. This is suggestive of which of the following?a.Overhydrationb.Dehydrationc.Sodium excessd.Potassium excessANS:BThese clinical manifestations indicate dehydration.DIF:Cognitive Level: ComprehensionREF:Page 816TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Physiologic Adaptation6.Acute diarrhea is often caused by which of the following?a.Celiac diseaseb.Antibiotic therapyc.Immunodeficiencyd.Protein malnutritionANS:BAcute diarrhea is a sudden increase in frequency and change in consistency of stools and may be associated with antibiotic therapy.DIF:Cognitive Level: ComprehensionREF:Page 817TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Physiologic Adaptation7.Which of the following is the viral pathogen that frequently causes acute diarrhea in young children?a.Giardia organismsb.Shigella organismsc.Rotavirusd.Salmonella organismsANS:CRotavirus is the most frequent viral pathogen that causes diarrhea in young children.DIF:Cognitive Level: ComprehensionREF:Page 818TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Physiologic Adaptation8.Which of the following is a parasite that causes acute diarrhea?a.Shigella organismsb.Salmonella organismsc.Giardia lambliad.Escherichia coliANS:CG. lamblia is a parasite that represents 10% of nondysenteric illness in the United States.DIF:Cognitive Level: ComprehensionREF:Page 820TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Physiologic Adaptation9.A stool specimen from a child with diarrhea shows the presence of neutrophils and red blood cells. This is most suggestive of which of the following conditions?a.Protein intoleranceb.Parasitic infectionc.Fat malabsorptiond.Bacterial gastroenteritisANS:DNeutrophils and red blood cells in stool indicate bacterial gastroenteritis.DIF:Cognitive Level: ComprehensionREF:Page 821TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential10.Therapeutic management of the child with acute diarrhea and dehydration usually begins with which of the following?a.Clear liquidsb.Adsorbents, such as kaolin and pectinc.Oral rehydration solution (ORS)d.Antidiarrheal medications such as paregoricANS:CORS is the first treatment for acute diarrhea.DIF:Cognitive Level: ComprehensionREF:Page 821TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential11.A school-age child with diarrhea has been rehydrated. The nurse is discussing the childs diet with the family. Which of the following 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.ANS:DEasily 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.DIF:Cognitive Level: ApplicationREF:Page 821 | Page 822TOP:Integrated Process: Teaching/LearningMSC:Area of Client Needs: Physiologic Integrity: Basic Care and Comfort12.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 (IV) fluids.b.ORS.c.clear liquids, 1 to 2 ounces at a time.d.administration of antidiarrheal medication.ANS:AIn children with severe dehydration, IV fluids are initiated.DIF:Cognitive Level: ApplicationREF:Page 822TOP:Integrated Process: Nursing Process: ImplementationMSC:Area of Client Needs: Physiologic Integrity: Physiologic Adaptation13.A mother calls the clinic nurse about her 4-year-old son who has acute diarrhea. She has been giving him the antidiarrheal drug loperamide (Imodium A-D). The nurses response should be based on knowledge that this drug is:a.not indicated.b.indicated because it slows intestinal motility.c.indicated because it decreases diarrhea.d.indicated because it decreases fluid and electrolyte losses.ANS:AAntidiarrheal medications are not recommended for the treatment of acute infectious diarrhea. These medications have adverse effects and toxicity, such as worsening of the diarrhea because of slowing of motility and ileus, or a decrease in diarrhea with continuing fluid losses and dehydration.DIF:Cognitive Level: AnalysisREF:Page 823TOP:Integrated Process: Teaching/LearningMSC:Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies14.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 which of the following?a.Dietb.Allergiesc.Antihistaminesd.Emotional factorsANS:CConstipation may be associated with drugs such as antihistamines, antacids, diuretics, opioids, antiepileptics, and iron. Because this is the only known change in her habits, the addition of antihistamines is most likely the cause of the diarrhea.DIF:Cognitive Level: ComprehensionREF:Page 823TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies15.Which of the following is a high-fiber food that the nurse could recommend for a child with chronic constipation?a.Popcornb.Pancakesc.Muffinsd.Ripe bananasANS:APopcorn is a high-fiber food.DIF:Cognitive Level: ComprehensionREF:Page 825TOP:Integrated Process: Teaching/LearningMSC:Area of Client Needs: Physiologic Integrity: Basic Care and Comfort16.Therapeutic management of most children with Hirschsprung disease is primarily which of the following?a.Daily enemasb.Low-fiber dietc.Permanent colostomyd.Surgical removal of affected section of bowelANS:DMost children with Hirschsprung 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.DIF:Cognitive Level: ComprehensionREF:Page 826TOP:Integrated Process: Nursing Process: ImplementationMSC:Area of Client Needs: Physiologic Integrity: Physiologic Adaptation17.Enemas are ordered to empty the bowel preoperatively for a child with Hirschsprung disease. The enema solution should be:a.tap water.b.normal saline.c.oil retention.d.phosphate preparation.ANS:BIsotonic solutions should be used in children. Saline is the solution of choice.DIF:Cognitive Level: ComprehensionREF:Page 826TOP:Integrated Process: Nursing Process: ImplementationMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential18.A 3-year-old child with Hirschsprung 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 childs age.b.not necessary because colostomy is temporary.c.necessary because it will be an adjustment.d.necessary because child must deal with a negative body image.ANS:CThe childs 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.DIF:Cognitive Level: ApplicationREF:Page 826TOP:Integrated Process: Teaching/LearningMSC:Area of Client Needs: Psychosocial Integrity: Coping and Adaptation19.The nurse is explaining to a parent how to care for a child with vomiting associated with a viral illness. Which of the following should the nurse include?a.Avoid carbohydrate-containing liquids.b.Give nothing by mouth for 24 hours.c.Brush teeth or rinse mouth after vomiting.d.Give plain water until vomiting ceases for at least 24 hours.ANS:CIt 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.DIF:Cognitive Level: ComprehensionREF:Page 827TOP:Integrated Process: Teaching/LearningMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential20.A 4-month-old infant has gastroesophageal reflux (GER) but is thriving without other complications. Which of the following 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.ANS:BSmall, 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 to increase the caloric density of the formula. This may benefit infants who are underweight as a result of GER disease.DIF:Cognitive Level: ApplicationREF:Page 827TOP:Integrated Process: Teaching/LearningMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential21.A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is ordered for an infant with GER. The purpose of this is to:a.prevent reflux.b.prevent hematemesis.c.reduce gastric acid production.d.increase gastric acid production.ANS:CThe mechanism of action of histamine-receptor antagonists is to reduce the amount of acid present in gastric contents and perhaps prevent esophagitis.DIF:Cognitive Level: ComprehensionREF:Page 828TOP:Integrated Process: Nursing Process: ImplementationMSC:Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies22.Which of the following clinical manifestations would be the most suggestive of acute appendicitis?a.Rebound tendernessb.Bright red or dark red rectal bleedingc.Abdominal pain that is relieved by eatingd.Abdominal pain that is most intense at McBurney pointANS:DPain is the cardinal feature. It is initially generalized, usually periumbilical. The pain localizes to the right lower quadrant at McBurney point.DIF:Cognitive Level: ComprehensionREF:Page 830TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Physiologic Adaptation23.When caring for a child with probable appendicitis, the nurse should be alert to recognize that which of the following is a sign of perforation?a.Bradycardiab.Anorexiac.Sudden relief from paind.Decreased abdominal distentionANS:CSigns of peritonitis, in addition to fever, include sudden relief from pain after perforation.DIF:Cognitive Level: ComprehensionREF:Page 830TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Physiologic Adaptation24.The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. Which of the following is appropriate to relieve the abdominal discomfort?a.Place in Trendelenburg position.b.Allow to assume position of comfort.c.Apply moist heat to the abdomen.d.Administer a saline enema to cleanse bowel.ANS:BThe child should be allowed to take a position of comfort, usually with the legs flexed.DIF:Cognitive Level: ComprehensionREF:Page 831TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Physiologic Adaptation25.Which of the following statements is most descriptive of Meckel 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.ANS:CBloody stools are often a presenting sign of Meckel diverticulum. It is associated with mild to profuse intestinal bleeding.DIF:Cognitive Level: ComprehensionREF:Page 832TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Physiologic Adaptation26.Which of the following is characterized by a chronic inflammatory process that may involve any part of the GI tract from mouth to anus?a.Crohn diseaseb.Ulcerative colitisc.Meckel diverticulumd.Irritable bowel syndromeANS:AThe chronic inflammatory process of Crohn disease involves any part of the GI tract from the mouth to the anus but most often affects the terminal ileum.DIF:Cognitive Level: ComprehensionREF:Page 834TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Physiologic Adaptation27.Which of the following is used to treat moderate to severe inflammatory bowel disease?a.Antacidsb.Antibioticsc.Corticosteroidsd.Antidiarrheal medicationsANS:CCorticosteroids, such as prednisone and prednisolone, are used in short bursts to suppress the inflammatory response in inflammatory bowel disease.DIF:Cognitive Level: ComprehensionREF:Page 834TOP:Integrated Process: Nursing Process: ImplementationMSC:Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies28.Bismuth subsalicylate, clarithromycin, and metronidazole are prescribed for a child with a peptic ulcer to:a.eradicate Helicobacter pylori.b.coat gastric mucosa.c.treat epigastric pain.d.reduce gastric acid production.ANS:AThis combination of drug therapy is effective in the treatment of H. pylori.DIF:Cognitive Level: ComprehensionREF:Page 837TOP:Integrated Process: Nursing Process: ImplementationMSC:Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies29.Which of the following statements best characterizes hepatitis A?a.Incubation period is 6 weeks to 6 months.b.Principal mode of transmission is through the parenteral route.c.Onset is usually rapid and acute.d.There is a persistent carrier state.ANS:CHepatitis A is the most common form of acute hepatitis in most parts of the world. It is characterized by a rapid and acute onset.DIF:Cognitive Level: ComprehensionREF:Page 839TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential30.Which of the following is now recommended for the immunization of all newborns?a.Hepatitis A vaccineb.Hepatitis B vaccinec.Hepatitis C vaccined.Hepatitis A, B, and C vaccinesANS:BUniversal vaccination for hepatitis B is now recommended for all newborns.DIF:Cognitive Level: ComprehensionREF:Page 839TOP:Integrated Process: Nursing Process: ImplementationMSC:Area of Client Needs: Health Promotion and Maintenance: Immunizations31.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.ANS:AThe 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.DIF:Cognitive Level: ComprehensionREF:Page 841TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Physiologic Adaptation32.Which of the following is the earliest clinical manifestation of biliary atresia?a.Jaundiceb.Vomitingc.Hepatomegalyd.Absence of stoolingANS:AJaundice is the earliest and most striking manifestation of biliary atresia. It is first observed in the sclera, may be present at birth, but is usually not apparent until age 2 to 3 weeks.DIF:Cognitive Level: ComprehensionREF:Page 842TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Physiologic Adaptation33.A newborn was admitted to the nursery with a complete bilateral cleft lip and palate. The physician explained the plan of therapy and its expected good results. However, the mother refuses to see or hold her baby. Initial therapeutic approach to the mother should be which of the following?a.Restate what the physician has told her about plastic surgery.b.Encourage her to express her feelings.c.Emphasize the normalcy of her baby and the babys need for mothering.d.Recognize that negative feelings toward the child continue throughout childhood.ANS:BFor parents, cleft lip and cleft palate deformities are particularly disturbing. The nurse must place emphasize not only the infants physical needs but also the parents emotional needs. The mother needs to be able to express her feelings before she can accept her child.DIF:Cognitive Level: AnalysisREF:Page 845TOP:Integrated Process: Nursing Process: ImplementationMSC:Area of Client Needs: Psychosocial Integrity: Coping and Adaptation34.Caring for the newborn with a cleft lip and palate before surgical repair includes which of the following?a.Gastrostomy feedingsb.Keeping infant in near-horizontal position during feedingsc.Allowing little or no suckingd.Providing satisfaction of sucking needsANS:DUsing special or modified nipples for feeding techniques helps meet the infants sucking needs.DIF:Cognitive Level: ApplicationREF:Page 845TOP:Integrated Process: Nursing Process: ImplementationMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential35.A mother who intended to breastfeed has given birth to an infant with a cleft palate. Nursing interventions should include which of the following?a.Give medication to suppress lactation.b.Encourage and help mother to breastfeed.c.Teach mother to feed breast milk by gavage.d.Recommend use of a breast pump to maintain lactation until infant can suck.ANS:BThe mother who wishes to breastfeed may need encouragement and support because the defect does present some logistical issues. The nipple must be positioned and stabilized well back in the infants oral cavity so that the tongue action facilitates milk expression.DIF:Cognitive Level: ComprehensionREF:Page 845TOP:Integrated Process: Nursing Process: ImplementationMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential36.The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infants postoperative care include which of the following?a.Arm restraints, postural drainage, mouth irrigationsb.Cleansing suture line, supine and side-lying positions, arm restraintsc.Mouth irrigations, prone position, cleansing suture lined.Supine and side-lying positions, postural drainage, arm restraintsANS:BThe suture line should be cleansed gently after feeding. The child should be positioned on the back, on the side, or in an infant seat. Elbows are restrained to prevent the child from accessing the operative site.DIF:Cognitive Level: AnalysisREF:Page 846TOP:Integrated Process: Nursing Process: PlanningMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential37.During the first few days after surgery for cleft lip, the nurse should do which of the following?a.Leave infant in crib at all times to prevent suture strain.b.Keep infant heavily sedated to prevent suture strain.c.Remove restraints periodically to cuddle infant.d.Alternate position from prone to side lying to supine.ANS:CRemove restraints periodically, while supervising the infant, to allow him or her to exercise arms and to provide cuddling and tactile stimulation.DIF:Cognitive Level: ComprehensionREF:Page 846TOP:Integrated Process: Nursing Process: PlanningMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential38.The nurse is caring for a neonate with a suspected tracheoesophageal fistula. Nursing care should include which of the following?a.Elevate head but give nothing by mouth.b.Elevate head for feedings.c.Feed glucose water only.d.Avoid suctioning unless infant is cyanotic.ANS:AWhen 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.DIF:Cognitive Level: AnalysisREF:Page 848TOP:Integrated Process: Nursing Process: ImplementationMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential39.Which type of hernia has an impaired blood supply to the herniated organ?a.Hiatal herniab.Incarcerated herniac.Omphaloceled.Strangulated herniaANS:DA strangulated hernia is one in which the blood supply to the herniated organ is impaired.DIF:Cognitive Level: ComprehensionREF:Page 849TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential40.Pyloric stenosis can best be described as which of the following?a.Dilation of the pylorusb.Hypertrophy of the pyloric musclec.Hypotonicity of the pyloric muscled.Reduction of tone in the pyloric muscleANS:BHypertrophic pyloric stenosis occurs when the circumferential muscle of the pyloric sphincter becomes thickened, resulting in elongation and narrowing of the pyloric channel.DIF:Cognitive Level: ComprehensionREF:Page 849TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential41.Which of the following observations made of the exposed abdomen is most indicative of pyloric stenosis?a.Abdominal rigidityb.Substernal retractionc.Visible peristalsisd.Marked distention of lower abdomenANS:CVisible gastric peristaltic waves that move from left to right across the epigastrium are observed in pyloric stenosis.DIF:Cognitive Level: ComprehensionREF:Page 851TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential42.The nurse is caring for an infant with suspected pyloric stenosis. Which of the following clinical manifestations would indicate pyloric stenosis?a.Abdominal rigidity and pain on palpationb.Rounded abdomen and hypoactive bowel soundsc.Visible peristalsis and weight lossd.Distention of lower abdomen and constipationANS:CVisible gastric peristaltic waves that move from left to right across the epigastrium and weight loss are observed in pyloric stenosis.DIF:Cognitive Level: ApplicationREF:Page 851TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential43.Excessive vomiting can result in which of the following in an infant with pyloric stenosis?a.Hyperchloremiab.Hypernatremiac.Metabolic acidosisd.Metabolic alkalosisANS:DInfants with excessive vomiting are prone to metabolic alkalosis from the loss of hydrogen ions.DIF:Cognitive Level: ComprehensionREF:Page 852TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential44.Invagination of one segment of bowel within another is called which of the following?a.Atresiab.Stenosisc.Herniationd.IntussusceptionANS:DIntussusception 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.DIF:Cognitive Level: ComprehensionREF:Page 852TOP:Integrated Process: Nursing Process: AssessmentMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential45.The nurse is caring for a boy with probable intussusception. He had diarrhea before admission but, while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool. Which of the following is the most appropriate nursing action?a.Notify practitioner.b.Measure abdominal girth.c.Auscultate for bowel sounds.d.Take vital signs, including blood pressure.ANS:APassage of a normal brown stool indicates that the intussusception has reduced itself. This is immediately reported to the practitioner, who may choose to alter the diagnostic-therapeutic care plan.DIF:Cognitive Level: AnalysisREF:Page 853TOP:Integrated Process: Nursing Process: ImplementationMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential46.Which of the following is an important nursing consideration in the care of a child with celiac disease?a.Refer to a nutritionist for detailed dietary instructions and education.b.Help child and family understand that diet restrictions are usually only temporary.c.Teach proper hand washing and standard precautions to prevent disease transmission.d.Suggest ways to cope more effectively with stress to minimize symptoms.ANS:AThe main consideration is helping the child adhere to dietary management. Considerable time is spent explaining to the child and parents about the disease process, the specific role of gluten in aggravating the condition, and foods that must be restricted. Referral to a nutritionist would help in this process.DIF:Cognitive Level: ComprehensionREF:Page 856TOP:Integrated Process: Teaching/LearningMSC:Area of Client Needs: Physiologic Integrity: Basic Care and Comfort47.An infant with short bowel syndrome will be discharged home on total parenteral nutrition (TPN) and gastrostomy feedings. Nursing care should include which of the following?a.Prepare family for impending death.b.Teach family signs of central venous catheter infection.c.Teach family how to calculate caloric needs.d.Secure TPN and gastrostomy tubing under diaper to lessen risk of dislodgment.ANS:BDuring TPN therapy care must be taken to minimize the risk of complications related to the central venous access device, such as catheter infections, occlusions, or accidental removal. This is an important part of family teaching.DIF:Cognitive Level: ComprehensionREF:Page 857TOP:Integrated Process: Teaching/LearningMSC:Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral TherapiesMULTIPLE RESPONSE1.A child who has just had definitive repair of a high rectal malformation is to be discharged. Which of the following should the nurse address in the discharge preparation of this family? (Select all that apply.)a.Perineal and wound careb.Necessity of firm stools to keep suture line cleanc.Bowel training beginning as soon as child returns homed.Changes in stooling patterns to report to practitionere.Use of diet modification to prevent constipationANS:A, D, EWound care instruction is necessary in a child who is being discharge after surgery. The parents are taught to notify the practitioner if any signs of an anal stricture or other complications develop. Constipation is avoided, since a firm stool will place strain on the suture line.DIF:Cognitive Level: ApplicationREF:Page 855TOP:Integrated Process: Teaching/LearningMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential2.Which of the following is true concerning hepatitis B? (Select all that apply.)a.Hepatitis B cannot exist in carrier state.b.Hepatitis B can be prevented by HBV vaccine.c.Hepatitis B can be transferred to an infant of a breastfeeding mother.d.Onset of hepatitis B is insidious.e.Principal mode of transmission for hepatitis B is fecal-oral route.f.Immunity to hepatitis B occurs after one attack.ANS:B, C, D, FThe vaccine elicits the formation of an antibody to the hepatitis B surface antigen, which is protective against hepatitis B. Hepatitis B can be transferred to an infant of a breastfeeding mother, especially if the mothers nipples are cracked. The onset of hepatitis B is insidious. Immunity develops after one exposure to hepatitis B.DIF:Cognitive Level: ApplicationREF:Page 839TOP:Integrated Process: Nursing Process: Problem IdentificationMSC:Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential