Gastrointestinal Disorders
Answer 2 can also be eliminated because a 4-year-old who is post appendectomy is
not at risk for blood clots.
25. 1. Intravenous morphine given as needed may cause the child to have periods of pain when the medication has worn off. The child may also be hesitant to ask for pain medication, fearing an invasive procedure.
3. The fundus is not wrapped around the middle portion of the stomach. There is no benefit to decreasing the stomach’s capacity.
4. The fundus of the stomach is not dilated.
TEST-TAKING HINT:The test taker needs to be familiar with surgical options for GER disease.
19. 1. If Reglan is administered immediately before a feeding, the medication will not have enough time to take effect.
2. This medication should be administered prior to a feeding to be effective.
3. Reglan increases gastric emptying and should be administered 30 minutes before a feeding.
4. This medication should be administered prior to a feeding to be effective.
TEST-TAKING HINT:The test taker needs to be familiar with the administration of Reglan.
20. 1. Although this is an accurate description of the mechanism of action, it does not tell the parents how the medication functions.
2. This accurate description gives the parents information that is clear and concise.
3. Prilosec does not increase the rate of gastric emptying.
4. Prilosec does not relax the pressure of the lower esophageal sphincter.
TEST-TAKING HINT:The test taker should eliminate answers 1 and 4 because they do not communicate information in a manner that will be clear to many parents.
21. 1. The ultrasound should not be canceled but obtained emergently because the child probably has a perforated appendix. The child should be NPO because surgery is imminent.
2. The ultrasound should not be canceled but obtained emergently because the child probably has a perforated appendix.
3. The child will not be discharged due to most likely having a perforated appendix.
4. The physician should be notified immediately, as a sudden change or loss of pain often indicates a perforated appendix.
TEST-TAKING HINT:The test taker should eliminate answers 1 and 2 because there is no reason to cancel the ultrasound. The physician should always be notified of any changes in a patient’s condition.
2. Liquid Tylenol with codeine may not offer sufficient pain control in the immediate postoperative period.
3. Morphine administered through a PCA pump offers the child control over managing pain. The PCA pump also has the benefit of offering a basal rate as well as an as-needed rate for optimal pain management.
4. The intramuscular route should be avoided if less invasive routes are available. A 5-year-old fears invasive procedures and may deny pain to avoid receiving an injection.
TEST-TAKING HINT:The test taker needs to recall that PCA analgesia is very effective, even in young children.
26. 1. Many 3-year-olds have difficulty understanding how to use an incentive spirometer.
2. Blowing bubbles is a developmentally appropriate way to help the preschooler take deep breaths and cough.
3. In the early postoperative period, a fever is likely a respiratory issue and not a result of infection of the incision.
4. Although acetaminophen may be adminis-tered, encouraging the child to breathe deeply and cough will help prevent the fever from returning.
TEST-TAKING HINT:The test taker should be aware that a fever in the first few days after surgery is generally due to pul-monary complications, so that answer 3 can be eliminated. Remembering the developmental needs of the child, the test taker should select answer 2.
27. 1. The child should wait a few days to return to school to avoid being easily fatigued at first.
2. The child should wait 6 weeks before returning to any strenuous activity.
3. Any signs of infection should be reported to the primary care provider.
4. The child should be encouraged to walk every day because it will help the bowels return to normal and help the child regain stamina.
TEST-TAKING HINT:The test taker should note that the question is asking which of the answers indicate that more education is needed. Answer 2 should be selected because 2 weeks is too early to return to strenuous contact sports.
28. 1. The early stages of acute hepatitis are referred to as the anicteric phase,
during which the child usually complains of nausea, vomiting, and generalized malaise.
2. A tender enlarged liver is noted in the right upper quadrant.
3. The child does not appear jaundiced until the icteric phase.
4. The child does not appear jaundiced until the icteric phase. The child usually does not feel well during the early stages of acute hepatitis.
TEST-TAKING HINT:The test taker needs to be familiar with the manifestations of acute hepatitis. Knowing that the early stage is referred to as the anicteric phase, answers 3 and 4 can be eliminated.
29. 1. A diet that is high in protein and carbohydrates helps maintain caloric intake and protein stores while preventing muscle wasting. A low-fat diet prevents abdominal distention.
2. The child should be encouraged to consume a diet higher in protein.
3. The child should be encouraged to consume a low-fat diet.
4. The child should be encouraged to consume a low-fat diet.
TEST-TAKING HINT:The child with hepati-tis is usually placed on a diet that is high in both protein and carbohydrates but low in fat.
30. 1. The child with acute hepatitis usually does not feel well, and activities should be limited to quiet, restful ones.
2. The child with acute hepatitis usually does not feel well, and activities should be limited to quiet, restful ones.
3. Video games are not developmentally appropriate for a 3-year-old
4. Playing with puzzles is a developmen-tally appropriate activity for a 3-year-old on bedrest.
TEST-TAKING HINT:The test taker should incorporate developmentally appropriate activities for the child in the early stages of acute hepatitis. Answers 1 and 2 can be eliminated as they are not activities that can be done while resting. Answer 4 should be selected because it is a better activity for a 3-year-old.
31. 1. The infant with biliary atresia usually has an enlarged liver and spleen. The stools appear clay-colored due to the ab-sence of bile pigments. The urine is tea-colored due to the excretion of bile salts.
usually repaired until the child is 18 months old.
TEST-TAKING HINT:The test taker should consider the palate’s involvement in the development of speech and therefore eliminate answer 3. The palate is usually given at least a year to grow sufficiently.
35. 1. Encouraging parents to express their feel-ings is important, but it is more appropri-ate to give the parents information on breastfeeding.
2. Some mothers are able to breastfeed their infants who have a cleft lip and palate. The breast can help fill in the cleft and help the infant create suction.
3. Breastfeeding is sometimes an option.
4. Breastfeeding does not increase the risk of aspiration among infants with a cleft lip and palate.
TEST-TAKING HINT:The test taker should be led to select answer 2 because the breast can sometimes act to fill in the cleft.
36. 1. The infant may rub the face on the bedding if positioned on the side.
2. The infant may rub the face on the bedding if positioned on the side.
3. The supine position is preferred because there is decreased risk of the infant rubbing the suture line.
4. The infant may rub the face on the bedding if positioned on the abdomen.
TEST-TAKING HINT:The test taker should be led to answer 3 because it is the only option in which the suture line is not at increased risk for injury.
37. 1. The child should not be allowed to use anything that creates suction in the mouth, such as pacifiers or straws.
2. The child should not have anything hard in the mouth, such as crackers, cookies, or a spoon.
3. Pain medication should be adminis-tered regularly to avoid crying, which places stress on the suture line.
4. A Yankauer suction should not be used in the mouth because it creates suction and is a hard instrument that could irritate the suture line. The child should be posi-tioned to allow secretions to drain out of the child’s mouth. Suction should be used only in the event of an emergency.
TEST-TAKING HINT:The child who has had a cleft palate repair should have nothing in the mouth that could irritate the suture line. Answers 1, 2, and 4 can be eliminated.
2. The urine typically contains bile salts, not blood. There is usually no blood noted in the stool.
3. The skin is usually dry and itchy, not oily.
4. Manifestations of biliary atresia usually appear by 3 weeks of life.
TEST-TAKING HINT:The test taker needs to be familiar with the manifestations of biliary atresia and should be led to select answer 1.
32. 1. Although cholestyramine is used to lower cholesterol, its primary purpose in the child with biliary atresia is to relieve pruritus.
2. The primary reason cholestyramine is administered to the child with biliary atresia is to relieve pruritus.
3. Cholestyramine is not administered to help the child gain weight.
4. Cholestyramine does not assist with the absorption of feedings.
TEST-TAKING HINT:The test taker needs to consider the manifestations of the disease process when considering why medications are administered. The liver is unable to eliminate bile, which leads to intense pruritus.
33. 1. The Kasai procedure is a palliative pro-cedure in which a bile duct is attached to a loop of bowel to assist with bile drainage.
2. The procedure is palliative, not curative because most children require a liver transplant after a few years.
3. The Kasai procedure does not band a bile duct.
4. The Kasai procedure does not band a bile duct.
TEST-TAKING HINT:The test taker should eliminate answers 2 and 3 as the majority of cases of biliary atresia require a liver transplant. The Kasai procedure is per-formed to give the child a few years to grow before requiring a transplant.
34. 1. The palate is not repaired until the child is approximately 18 months old to allow for growth. Waiting beyond 18 months may interfere with speech.
2. The lip is usually repaired in the first few weeks of life, and the palate is usually repaired at approximately 18 months.
3. The palate is repaired earlier than 3 years so that speech development is not impaired.
4. The lip is repaired in the first few weeks of life, but the palate is not
38. 1. Maternal polyhydramnios is present because the infant cannot swallow and absorb the amniotic fluid in utero.
2. Many mothers of infants with esophageal atresia deliver early due to the pressure of the unabsorbed amniotic fluid.
3. Although good nutrition is essential in every pregnancy, there is not a direct relationship between diet and esophageal atresia.
4. Although alcohol should not be consumed in any pregnancy, there is not a direct link between diet and esophageal atresia.
TEST-TAKING HINT:The test taker should select answer 1 because esophageal atresia prevents the infant from ingesting much, leading to increased amniotic fluid in utero.
39. 1. The infant’s feeding should be stopped immediately and oxygen administered.
The nurse should call for help but should not leave the infant while in distress.
2. The mother should stop feeding the in-fant, but oxygen should be applied while the infant is cyanotic. The infant should be placed on a monitor, and vital signs should be obtained.
3. Although obtaining oxygen saturations is extremely important, the infant is visually cyanotic, so the nurse should administer oxygen as a priority.
4. The infant should be taken from the mother and placed in the crib where the nurse can assess the baby. Oxygen should be administered immediately, and vital signs should be obtained.
TEST-TAKING HINT:The test taker should be led to answer 4 because the baby is cyanotic and needs oxygen.
40. 1. The infant should be monitored, and vital signs should be obtained frequently, but the parents should be encouraged to hold their baby.
2. Intravenous fluids are administered to prevent dehydration because the infant is NPO. Intravenous antibiotics are ad-ministered to prevent pneumonia be-cause aspiration of secretions is likely.
3. The infant should receive only the amount of oxygen needed to keep satura-tions above 94%.
4. As soon as the diagnosis is made, the in-fant is made NPO immediately because the risk for aspiration is extremely high.
TEST-TAKING HINT:Infants with tracheoe-sophageal atresia are at great risk for
aspiration and subsequent pneumonia.
With this knowledge, the test taker should eliminate answer 4 and select answer 2.
41. 1. Medications can be placed in the GT also.
2. Two ounces of water is too much water for an infant and could cause electrolyte imbalances. The tube can be flushed with 3 to 5 mL to prevent clogging.
3. The area around the GT should be cleaned with soap and water to prevent an infection.
4. If redness develops, the parents should call the physician because an infection could be present.
TEST-TAKING HINT:The test taker should immediately eliminate answer 1 because medications and feedings can be placed in the GT. The test taker should recall that 2 ounces of water after each feeding is a large amount (recalling that infants are typically fed at least every 4 hours).
42. 1. Umbilical hernias occur more often in low-birth-weight infants.
2. Umbilical hernias occur more often in African-American infants than in white infants.
3. Umbilical hernias affect males and females equally.
4. Umbilical hernias occur more often in premature infants.
TEST-TAKING HINT:The test taker needs to be familiar with the occurrence of umbilical hernias.
43. 1. Most umbilical hernias resolve sponta-neously by age 2 to 3 years. Surgery is not usually recommended until the age of 3 be-cause the hernia may resolve before that.
2. If the hernia appears larger, swollen, or tender, the intestine may be trapped, which is a surgical emergency.
3. A pressure dressing should never be placed over the hernia because it can cause irritation and does not help the hernia resolve.
4. If the hernia is corrected surgically, the recurrence rate is low.
TEST-TAKING HINT:The test taker should be led to select answer 2 because a change in the hernia indicates an incar-cerated hernia, which is an emergency.
44. 1. This approach sounds like the nurse is avoiding the mother’s question. It would be better to offer the information and then ask about her concerns.
uncommon to see lethargy as a response to an allergy.
4. All bloody stools should be evaluated.
TEST-TAKING HINT:The child is described as lethargic and is having diarrhea and vomiting. This child needs to be seen to rule out an intussusception. At the very least, the mother should be told to bring the child to the emergency room because the described signs could also be seen in severe dehydration. The test taker should be led to select answer 1.
48. 1. The enema is used for confirmation of di-agnosis and reduction. In most cases of in-tussusception in young children, an enema is successful in reducing the intussusception.
2. In most cases of intussusception in young children, an enema is successful in reducing the intussusception.
3. In most cases of intussusception in young children, an enema is successful in reducing the intussusception.
4. There is not a high likelihood that the intussusception will recur.
TEST-TAKING HINT:The test taker needs to be aware that intussusceptions in young children respond well to reduction by enema.
49. 1. The child has already been diagnosed and appears to have developed peritonitis, which is a surgical emergency.
2. Although reducing enemas have a high success rate among infants with intussus-ception, they are contraindicated in the presence of peritonitis.
3. Although a second intravenous line may be needed, the nurse’s first priority is getting the child to the operating room.
4. Intussusception with peritonitis is a surgical emergency, so preparing the infant for surgery is the nurse’s top priority.
TEST-TAKING HINT:The child has already been diagnosed and is displaying signs of shock and peritonitis. The nurse must act quickly and get the child the surgical attention needed to avoid disastrous consequences.
50. 1. Although a rectal thermometer should never be used in a child with an anorectal malformation, an oral thermometer should not be used in an infant or young child.
2. A change in stool form is important to report because it could indicate stenosis of the rectum.
2. It is not at all uncommon for a family to have multiple children with pyloric stenosis.
3. Pyloric stenosis can run in families, and it is more common in males.
4. Although pyloric stenosis occurs more often in males, it can occur in females, especially in siblings of a child with pyloric stenosis.
TEST-TAKING HINT:The test taker needs to be familiar with pyloric stenosis.
45. 1. Infants with pyloric stenosis tend to be perpetually hungry because most of their feedings do not get absorbed.
2. Infants with pyloric stenosis vomit imme-diately after a feeding, especially as the pylorus becomes more hypertrophied.
3. Infants with pyloric stenosis are always hungry and often appear malnourished.
4. Most infants with pyloric stenosis are irri-table because they are hungry. Parents do not usually describe the vomiting episodes as “spitting up” because infants tend to have projectile vomiting.
TEST-TAKING HINT:Recall the dynamics of pyloric stenosis. Because feedings are not absorbed, the infant is irritable and hun-gry. The test taker can eliminate answers 1 and 4 and select answer 3.
46. 1. In addition to giving fluids intravenously and keeping the infant NPO, an NGT is placed to decompress the stomach.
2. In addition to giving fluids intra-venously and keeping the infant NPO, an NGT is placed to decompress the stomach.
3. The pylorus is distal to the stomach, so an NGT is placed above the obstruction.
4. The infant is made NPO as soon as diag-nosis is confirmed. Allowing the infant to feed perpetuates the vomiting and contin-ued hypertrophy of the pylorus.
TEST-TAKING HINT:The test taker should consider the pathophysiology of pyloric stenosis and eliminate answers 1, 3, and 4.
47. 1. The infant is displaying signs of intus-susception. This is an emergency that needs to be evaluated to prevent ischemia and perforation.
2. The mother should be told not to give the infant anything by mouth and bring the infant immediately to the emergency room.
3. Although similar symptoms may be seen among infants with allergies, a more serious illness must first be ruled out. It is
3. The child with a low anorectal malforma-tion should be capable of achieving bowel continence.
4. Any stool in the urine should be reported because it indicates a fistula is present.
TEST-TAKING HINT:The test taker should eliminate answer 3 as it contains the word
“never.” There are very few circumstances in health care in which “never” is the case.
51. 1. The child who has stool in the urine has a fistula connecting the rectum to the uri-nary tract, and the anorectal malformation cannot be low.
2. The presence of stool in the urine in-dicates that the anorectal malformation
2. The presence of stool in the urine in-dicates that the anorectal malformation