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Silvestri Chapter 33 Ed#55D

Silvestri Chapter 33 Ed#55D

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Published by Linda Kuglarz

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Published by: Linda Kuglarz on Oct 14, 2008
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Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 033 (edited file)—"Metabolic, Endocrine, and Gastrointestinal Disorders"10/14/08, Page 1 of 11, 5 Figure(s), 1 Table(s), 12 Box(es)
33: Metabolic, Endocrine, and Gastrointestinal Disorders
PRACTICE QUESTIONS
1. A nurse is caring for an 18-month-old child who has been vomiting. The appropriate positionin which to place the child during naps and sleep time is:1. Side-lying position2. Prone with the face turned to the side3. Supine4. Prone with the head elevatedAnswer: 1Rationale: The vomiting child should be placed in an upright or side-lying position to preventaspiration. Options 2, 3, and 4 will place the child at risk for aspiration if vomiting occurs.Test-Taking Strategy: Use the process of elimination. Eliminate options 2 and 4 first becausethey are similar. Additionally, these positions would place the child at risk for aspiration if vomiting occurred. Visualize the remaining two positions. Option 3 is also inappropriate andwould cause aspiration. Review appropriate positioning for the child who has been vomiting if you had difficulty with this question.Level of Cognitive Ability: ApplicationClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/ImplementationContent Area: Child HealthReference: Price, D., & Gwin, J. (2005).
Thompson’s pediatric nursing 
(9th ed.). Philadelphia:W.B. Saunders, pp. 156-157.2. A nurse is monitoring for signs of dehydration in a 1-year-old child who has been hospitalizedfor diarrhea and prepares to take the child’s temperature. Which method of temperaturemeasurement would be avoided?1. Tympanic2. Axillary3. Rectal4. ElectronicAnswer: 3Rationale: Rectal temperature measurements should be avoided if diarrhea is present. Use of arectal thermometer can stimulate peristalsis and cause more diarrhea. Axillary and tympanicmeasurements of temperature would be acceptable. Most measurements are done via electronicdevices.Test-Taking Strategy: Use the process of elimination and note the key word,
avoided 
. Eliminateoption 4 first because most methods of temperature measurement are done using an electronicdevice. Next, note the diagnosis stated in the question. This should direct you to option 3.Review interventions for the child with diarrhea if you had difficulty with this question.Level of Cognitive Ability: ApplicationClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/ImplementationContent Area: Child Health
 
Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 033 (edited file)—"Metabolic, Endocrine, and Gastrointestinal Disorders"10/14/08, Page 2 of 11, 5 Figure(s), 1 Table(s), 12 Box(es)
Reference: McKinney, E., James, S., Murray, S., & Ashwill, J. (2005).
Maternal-child nursing 
(2nd ed.). St. Louis: Elsevier, p. 1093.3. An infant returns to the nursing unit following a surgical repair of a cleft lip located on theright side of the lip. The best position to place this infant at this time is:1. On the right side2. On the left side3. Prone4. SupineAnswer: 2Rationale: Following cleft lip repair, the infant should be positioned on the side lateral to therepair to prevent contact of the suture lines with the bed linens. It is best to place the infant onthe left side rather than supine immediately after surgery to prevent the risk of aspiration if theinfant vomits.Test-Taking Strategy: Use the process of elimination. Consider the anatomical location of thesurgical site and the key words,
right side
. You should easily be directed to the correct optionusing these concepts. Review postoperative positioning techniques if you had difficulty with thisquestion.Level of Cognitive Ability: ApplicationClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/ImplementationContent Area: Child HealthReference: Leifer, G. (2003).
 Introduction to maternity and pediatric nursing 
(4th ed.).Philadelphia: W.B. Saunders, p. 658.4. A nurse reviews the record of an infant seen in the clinic. The nurse notes that a diagnosis of esophageal atresia with tracheoesophageal fistula (TEF) is suspected. The nurse expects to notewhich most likely clinical manifestation of this condition documented in the record?1. Severe projectile vomiting2. Coughing at nighttime3. Choking with feedings4. Incessant cryingAnswer: 3Rationale: Any child who exhibits the “3 Cs,”
c
oughing and
c
hoking during feedings, andunexplained
c
yanosis, should be suspected of TEF. Options 1, 2, and 4 are not specificallyassociated with TEF.Test-Taking Strategy: Use the process of elimination focusing on the diagnosis. Recalling the “3Cs” associated with this disorder will assist in directing you to the correct option. Review theclinical manifestations associated with this disorder if you had difficulty with this questionLevel of Cognitive Ability: ComprehensionClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/Data CollectionContent Area: Child HealthReference: Leifer, G. (2003).
 Introduction to maternity and pediatric nursing 
(4th ed.).Philadelphia: W.B. Saunders, p. 658.
 
Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 033 (edited file)—"Metabolic, Endocrine, and Gastrointestinal Disorders"10/14/08, Page 3 of 11, 5 Figure(s), 1 Table(s), 12 Box(es)
5. A nurse is reviewing the record of a child with a diagnosis of pyloric stenosis. Which datawould the nurse expect to note documented in the child’s record?1. Vomiting large amounts of bile2. Watery diarrhea3. Increased urine output4. Projectile vomitingAnswer: 4Rationale: Clinical manifestations of pyloric stenosis include projectile, nonbilious vomiting,irritability, hunger and crying, constipation, and signs of dehydration including a decrease inurine output.Test-Taking Strategy: Use the process of elimination. Considering the anatomical location of this disorder and its potential effects will assist in eliminating options 2 and 3. Recalling that amajor clinical manifestation is projectile, nonbilious vomiting will assist in directing you tooption 4. Review these clinical manifestations if you had difficulty with this question.Level of Cognitive Ability: ComprehensionClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/Data CollectionContent Area: Child HealthReference: Price, D., & Gwin, J. (2005).
Thompson’s pediatric nursing 
(9th ed.). Philadelphia:W.B. Saunders, pp. 152-153.6. A nurse reinforces instructions to the mother about dietary measures for a 5-year-old childwith lactose intolerance. The nurse tells the mother that which of the following supplements will be required due to the necessity of lactose avoidance in the diet?1. Zinc2. Protein3. Calcium4. FatsAnswer: 3Rationale: Lactose intolerance is the inability to tolerate lactose, the sugar found in dairy products. Removing milk from the diet can provide relief from symptoms. Additional dietarychanges may be required to provide adequate sources of calcium and, if the child is an infant, protein and calories.Test-Taking Strategy: Knowledge that lactose is the sugar found in dairy products will easilydirect you to option 3, because dairy products contain high sources of calcium. Review thedietary management for lactose intolerance if you had difficulty with this question.Level of Cognitive Ability: ApplicationClient Needs: Health Promotion and MaintenanceIntegrated Process: Nursing Process/ImplementationContent Area: Child HealthReference: Wong, D., & Hockenberry, M. (2003).
 Nursing care of infants and children
(7thed.). St. Louis: Mosby, p. 571.7. A nurse reinforces home care instructions to the parents of a child with celiac disease. Whichof the following food items would the nurse advise the parents to include in the child’s diet?1. Rice

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