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Chapter 23: The Child with

Gastrointestinal Dysfunction

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Terms in this set (44)

What statement best describes ANS: A

Hirschsprung disease?
a.
The colon has an aganglionic
segment.
b.
It results in frequent evacuation
of solids, liquid, and gas.
Mechanical obstruction in the colon results from a
lack of innervation. In most cases, the aganglionic
segment includes the rectum and some portion of
the distal colon. There is decreased evacuation of
the large intestine secondary to the aganglionic
segment. Liquid stool may ooze around the
blockage. The obstruction does not affect
meconium production. The infant may not be able
to pass the meconium stool. There is decreased
movement in the colon.

c.

The neonate passes excessive

amounts of meconium.

d.

It results in excessive peristaltic

movements within the
gastrointestinal tract.
Chapter 23: The Child with Gastrointestinal Dysfunction
A 3-year-old child with
Hirschsprung disease is
hospitalized for surgery. A
temporary colostomy will be
necessary. How should the
nurse prepare this child?
a.
It is unnecessary because of
child's age.
ANS: B
The child's age dictates the type and extent of
psychologic preparation. When a colostomy is
performed, it is necessary to prepare the child who
is at least preschool age by telling him or her about
the procedure and what to expect in concrete
terms, with the use of visual aids. The preschooler is
not yet concerned with body image.

b.

It is essential because it will be

an adjustment.

c.

Preparation is not needed

because the colostomy is
temporary.

d.

Preparation is important
because the child needs to
deal with negative body image.

Chapter 23: The Child with Gastrointestinal Dysfunction

A child has a nasogastric (NG)
tube after surgery for
Hirschsprung disease. What is
the purpose of the NG tube?
a.
Prevent spread of infection.
b.
ANS: C
The NG tube is placed to suction out
gastrointestinal secretions and prevent abdominal
distention. The NG tube would not affect infection.
Electrolyte content of the NG drainage can be
monitored. Without the NG tube, there would be no
drainage. After the NG tube is placed, it is important
to maintain an accurate record of intake and output.
This is not the reason for placement of the tube.

Monitor electrolyte balance.

c.

Prevent abdominal distention.

d.

Maintain accurate record of

output.

Chapter 23: The Child with Gastrointestinal Dysfunction

What term describes ANS: D
invagination of one segment of
bowel within another? Intussusception occurs when a proximal section of
the bowel telescopes into a more distal segment,
a. pulling the mesentery with it. The mesentery is
compressed and angled, resulting in lymphatic and
Atresia venous obstruction. Atresia is the absence or
closure of a natural opening in the body. Stenosis is
b. a narrowing or constriction of the diameter of a
bodily passage or orifice. Herniation is the
Stenosis protrusion of an organ or part through connective
tissue or through a wall of the cavity in which it is
c. normally enclosed.

Herniation

d.

Intussusception

Chapter 23: The Child with Gastrointestinal Dysfunction

DELETEA child with acute
gastrointestinal bleeding is
admitted to the hospital. The
nurse observes which sign or
symptom as an early
manifestation of shock?
ANS: A
Restlessness is an indication of impending shock in a
child. Capillary refill is slowed in shock. The child will
feel cool. The blood pressure initially remains within
the normal range and then declines.

a.

Restlessness

b.

Rapid capillary refill

c.

Increased temperature

d.

Increased blood pressure

Chapter 23: The Child with Gastrointestinal Dysfunction

DELETEWhat immunization is
recommended for all
newborns?
a.
Hepatitis A vaccine
ANS: B
Universal vaccination for hepatitis B is
recommended for all newborns. Hepatitis A vaccine
is recommended for infants starting at 12 months.
No vaccine is currently available for hepatitis C.

b.

Hepatitis B vaccine

c.

Hepatitis C vaccine

d.

Hepatitis A, B, and C vaccines

Chapter 23: The Child with Gastrointestinal Dysfunction

The nurse observes that a
newborn is having problems
after birth. What should
indicate a tracheoesophageal
fistula?
a.
Jitteriness
b.
ANS: C
Excessive frothy saliva is indicative of a
tracheoesophageal fistula. The child is unable to
swallow the secretions, so there are excessive
amounts of saliva in the mouth. Jitteriness is
associated with several disorders, including
electrolyte imbalances. Meconium ileus is
associated with cystic fibrosis. Increased need for
sleep is not associated with a tracheoesophageal
fistula.

Meconium ileus

c.

Excessive frothy saliva

d.

Increased need for sleep

Chapter 23: The Child with Gastrointestinal Dysfunction

The nurse is caring for a
neonate with a suspected
tracheoesophageal fistula.
What should nursing care
include?
a.
Feed glucose water only.
b.
Elevate the patient's head for
feedings.
ANS: C
When 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. The oral pharynx should
be kept clear of secretions by oral suctioning. This is
to prevent the cyanosis that is usually the result of
laryngospasm caused by overflow of saliva into the
larynx.

c.

Raise the patient's head and

give nothing by mouth.

d.

Avoid suctioning unless the

infant is cyanotic.

Chapter 23: The Child with Gastrointestinal Dysfunction

The nurse is caring for an infant
who had surgical repair of a
tracheoesophageal fistula 24
hours ago. Gastrostomy
feedings have not been
started. What do nursing
actions related to the
gastrostomy tube include?
a.
Keep the tube clamped.
b.
ANS: C
In the immediate postoperative period, the
gastrostomy tube is open to gravity drainage. This
usually is continued until the infant is able to
tolerate feedings. The tube is unclamped in the
postoperative period to allow for the drainage of
secretions and air. Gastrostomy tubes are not
suctioned on an as-needed basis. They may be
connected to low suction to facilitate drainage of
secretions. Lowering the tube to a point below the
level of the stomach would create too much
pressure.

Suction the tube as needed.

c.

Leave the tube open to gravity

drainage.

d.

Lower the tube to a point

below the level of the stomach.

Chapter 23: The Child with Gastrointestinal Dysfunction

A 3-day-old infant presents
with abdominal distention, is
vomiting, and has not passed
any meconium stools. What
disease should the nurse
suspect?
a.
Pyloric stenosis
ANS: C
The clinical manifestations of Hirschsprung disease
in a 3-day-old infant include abdominal distention,
vomiting, and failure to pass meconium stools.
Pyloric stenosis would present with vomiting but not
distention or failure to pass meconium stools.
Intussusception presents with abdominal cramping
and celiac disease presents with malabsorption.

b.

Intussusception

c.

Hirschsprung disease

d.

Celiac disease

Chapter 23: The Child with Gastrointestinal Dysfunction

A 6-month-old infant with
Hirschsprung disease is
scheduled for a temporary
colostomy. What should
postoperative teaching to the
parents include?
a.
Dilating the stoma
b.
Assessing bowel function
c.
Limitation of physical activities
d.
Measures to prevent prolapse
of the rectum
Chapter 23: The Child with Gastrointestinal Dysfunction
ANS: B
In the postoperative period, the nurse involves the
parents in the care of the child with a temporary
colostomy, allowing them to help with feedings and
observe for signs of wound infection or irregular
passage of stool (constipation or true incontinence).
Some children will require daily anal dilatations in
the postoperative period to avoid anastomotic
strictures but not stoma dilatations. Physical
activities should be encouraged. There is not a risk
of prolapse of the rectum in Hirschsprung disease,
just strictures.
The nurse is preparing to admit
a 3-year-old child with
intussusception. What clinical
manifestations should the
nurse expect to observe?
(Select all that apply.)
a.
Absent bowel sounds
b.
Passage of red, currant jelly-
like stools
ANS: B, D, F
Intussusception occurs when a proximal segment of
the bowel telescopes into a more distal segment,
pulling the mesentery with it and leading to
obstruction. Clinical manifestations of
intussusception include the passage of red, currant
jelly-like stools; a tender, distended abdomen; and
sudden acute abdominal pain. Absent bowel
sounds, anorexia, and hematemesis are clinical
manifestations observed in other types of
gastrointestinal dysfunction.

c.
Anorexia

d.
Tender, distended abdomen

e.
Hematemesis

f.
Sudden acute abdominal pain

Chapter 23: The Child with Gastrointestinal Dysfunction

The nurse is caring for a
neonate with a suspected
tracheoesophageal fistula
(TEF).
Nursing care should include
a. Elevating the head but give
nothing by mouth
b. Elevating the head for
feedings
c. Feeding glucose water only
d. Avoiding suction unless
infant is cyanotic
ANS: A
Feedback
A When a newborn is suspected of having TEF, the
most desirable position is supine with the head
elevated on an incline plane of at least 30 degrees.
It is imperative that any source of aspiration be
removed at once; oral feedings are withheld.
Feedings should not be given to infants suspected
of having TEF.

A nurse is teaching a group of ANS: A

parents about TEF. Which
statement made by the nurse is
accurate about TEF? Feedback When the foregut does not differentiate
into the trachea and esophagus during
the fourth to fifth week of gestation, a TEF occurs.
a. This defect results from an TEF is an abnormal connection between the
embryonal failure of the esophagus and trachea. There is no connection
foregut to differentiate into between the trachea and esophagus in normal fetal
the trachea and esophagus. development. This defect occurs early in pregnancy
b. It is a fistula between the during the fourth to fifth week of gestation.
esophagus and stomach that
results in the oral intake
being refluxed and aspirated.
c. An extra connection
between the esophagus and
trachea develops because of
genetic abnormalities.
d. The defect occurs in the
second trimester of pregnancy.

Chapter 23: The Child with Gastrointestinal Dysfunction

What maternal assessment is ANS: C
related to an infant's diagnosis
of TEF?
a. Maternal age more than 40 Feedback
years A maternal history of polyhydramnios is associated
b. First term pregnancy for the with TEF. Complicated pregnancy is not a risk factor
mother for TEF.
c. Maternal history of
polyhydramnios
d. Complicated pregnancy

Which assessment finding ANS: B

should the nurse expect in an
infant with Hirschsprung
disease? Feedback

a. "Currant jelly" stools Constipation results from absence of ganglion cells

b. Constipation with passage of
foul-smelling, ribbon-like
stools
c. Foul-smelling, fatty stools
d. Diarrhea
in the rectum and colon, and is present since the
neonatal period with passage of frequent foul-
smelling, ribbon-like, or pellet-like stools.

Chapter 23: The Child with Gastrointestinal Dysfunction

What is an appropriate
statement for the nurse to
make to parents of a child who
has had a barium enema to
correct an intussusception?
a. "I will call the physician when
the baby passes his first stool."
b. "I am going to dilate the anal
sphincter with a gloved finger
to help the baby pass
the barium."
c. "I would like you to save all
the soiled diapers so I can
inspect them."
d. "Add cereal to the baby's
formula to help him pass the
barium."
Which description of a stool is
characteristic of
intussusception?
a. Ribbon-like stools
b. Hard stools positive for
guaiac
c. "Currant jelly" stools
d. Loose, foul-smelling stools
Chapter 23: The Child with Gastrointestinal Dysfunction
ANS: C
Feedback
A The physician does not need to be notified when
the infant passes the first stool.
B Dilating the anal sphincter is not appropriate for
the child after a barium enema.
C The nurse needs to inspect diapers after a barium
enema because it is important
to document the passage of barium and note the
characteristics of the stool.
D After reduction, the infant is given clear liquids
and the diet is gradually
increased.
ANS: C
Feedback
A Ribbon-like stools are characteristic of
Hirschsprung disease.
B With intussusception, passage of bloody mucus
stools occurs. Stools will not be
hard.
C Pressure on the bowel from obstruction leads to
passage of "currant jelly" stools.
D Loose, foul-smelling stools may indicate
infectious gastroenteritis
Which order should the nurse
question when caring for a 5-
year-old child after surgery for
Hirschsprung disease?
a. Monitor rectal temperature
every 4 hours and report an
elevation greater than
38.5° C.
b. Assess stools after surgery.
c. Keep the child NPO until
bowel sounds return.
d. Maintain IV fluids at ordered
rate.
Therapeutic management of
most children with
Hirschsprung disease is
primarily
a. Daily enemas
b. Low-fiber diet
c. Permanent colostomy
d. Surgical removal of the
affected section of the bowel
Chapter 23: The Child with internal
Gastrointestinal
ANS: A
Feedback
A Rectal temperatures should not be taken after this
surgery. Rectal temperatures
are generally not the route of choice for children
because of the route's traumatic
nature.
ANS: D
Feedback
A Preoperative management may include enemas
and a low-fiber, high-calorie,
high-protein diet, until the child is physically ready
for surgery.
B Preoperative management may include enemas
and low-fiber, high-calorie,
high-protein diet, until the child is physically ready
for surgery.
C The colostomy that is created in Hirschsprung
disease is usually temporary.
D Most 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
anal sphincter. Dysfunction
A newborn infant is diagnosed B
with tracheoesophageal fistula
(TEF). The nurse assesses the
infant, knowing that a typical
finding in this disorder is:
A. Slowed reflexes
B. Cyanosis, coughing, and
choking
C. Diaphragmatic breathing
D. Passage of large amounts of
frothy stool

A nurse is preparing a child for D

a barium enema. For which of
the following conditions would
this plan of care be
appropriate?
A. Gastroschisis
B. Pyloric stenosis
C. Appendicitis
D. Intussusception

Which question would be most C

helpful in obtaining a nursing
history from the mother of an
infant with suspected
intussusception?
A. Is your child eating
normally?
B. How often has your child
been vomiting?
C. What do your child's stools
look like?
D. When did your child last
urinate?
Chapter 23: The Child with Gastrointestinal Dysfunction
A newborn's failure to pass D
meconium within the first 24 to
48 hours after birth may
indicate all of the following
conditions EXCEPT:
A. Cystic fibrosis
B. Hirschspring's disease
C. Imperforate anus
D. Intussusception

Which assessment finding D

would be most likely found on
an infant diagnosed with
Hirschsprung's disease?
A. Scaphoid abdomen (sunken,
concave abdomen)
B. Cyanosis of distal extremities
C. Hyperactive reflexes
D. Weight less than normal for
height and age

Chapter 23: The Child with Gastrointestinal Dysfunction

DELETEMatch the following 1-C
structural defects with the 2-A
correct assessment data. Each 3-B
item is used only once. 4-D
5-E
1. Failure to pass meconium in
newborns
2. Stool of red currant jelly
consistency
3. Olive-shaped mass in the
right upper quadrant
4. Excess spitting up or forceful
vomiting
5. Painless swelling extending
toward the scrotum

A. Intussusception
B. Hypertrophic pyloric
stenosis
C. Hirschsprung's disease
D. GERD
E. Inguinal hernia

Chapter 23: The Child with Gastrointestinal Dysfunction

Which intervention should the C
nurse include in care of an
infant following surgical repair
of a cleft lip?

A. Position the infant in the

prone position for feedings, to
avoid aspiration.
B. Use a special feeding device
with shorter nipples.
C. Administer pain medications
as ordered.
D. Let the infant touch the
suture lines as a means of self-
comfort.

When assessing a newborn A

with cleft lip, the nurse should
be alert that which of the
following will most likely be
compromised?

A. Sucking ability
B. Respiratory status
C. Locomotion
D. GI function

Chapter 23: The Child with Gastrointestinal Dysfunction

A nurse caring for Paulo, an B
infant born with a cleft palate,
notices that the parents rarely
interact with their child. The
nurse overhears the mother
telling her husband that she
"feels like crying" every time
she looks at their son. What
would be the best response
from the nurse?

a) "Many infants are born with

this condition. Your son's palate
is not nearly as bad as some
cases."
b) "I sense you could use more
information on caring for a
cleft palate. Would you be
interested in meeting with
other parents who have dealt
with this?"
c) "Your son needs you right
now. You should put your
negative feelings about his
condition aside for his sake."
d) "Keep in mind that your son's
condition is not life-threatening
and can be corrected
eventually."

Chapter 23: The Child with Gastrointestinal Dysfunction

The nurse is reviewing the d) Mother age 42 with pregnancy
medical record of a child with a
cleft lip and palate. When
reviewing the child's history,
what would the nurse identify
as a risk factor for this
condition?

a) History of hypoxia at birth

b) Preterm birth
c) Maternal use of
acetaminophen in third
trimester
d) Mother age 42 with
pregnancy

Chapter 23: The Child with Gastrointestinal Dysfunction

The nurse observes the b) Ask the parents if they have any questions
interactions of parents with regarding the care of their child.
their infant who was born with
a cleft lip. The mother is
attempting to feed the baby,
but does not make eye
contact. The father is watching
television with his back turned
to the mother and baby. What
psychosocial nursing
intervention would be most
helpful to this family?

a) Explain to the parents that

surgical intervention will fix the
defect in the baby's lip.
b) Ask the parents if they have
any questions regarding the
care of their child.
c) Teach the mother the
appropriate technique for
breast-feeding an infant with
cleft lip.
d) Refer the family to a social
worker or mental health
practitioner.

Chapter 23: The Child with Gastrointestinal Dysfunction

The nurse is positioning an a) Right side lying
infant who has just had his left- c) Supine
sided cleft lip repaired. What
positions are acceptable for
this infant? Select all that apply.

a) Right side lying

b) Left side lying
c) Supine
d) Prone
e) High fowlers

A nurse is caring for a 6-year-
old girl recently diagnosed
with celiac disease and is
discussing dietary restrictions
with the girl's mother. Which
response indicates a need for
further teaching?
d) "My daughter can eat any kind of fruit."
While most fruits and fruit juices are allowed, the
nurse needs to make sure the mother knows that
some fruit pie fillings and dried fruit may contain
gluten.

a) "There is gluten hidden in

unexpected foods."
b) "My daughter is eating more
vegetables."
c) "There are many types of
flour besides wheat."
d) "My daughter can eat any
kind of fruit."

Chapter 23: The Child with Gastrointestinal Dysfunction

The nurse is reinforcing dietary B. Bananas
teaching with the caregiver of a C. Skim milk
child diagnosed with celiac F. Applesauce
syndrome. Which foods would
be permitted in the diet of the
child with celiac syndrome?
Select all that apply.

A. Corn flakes
B. Bananas
C. Skim milk
D. Rye bread
E. Wheat bread
F. Applesauce

The nurse is reinforcing dietary B "She loves hot dogs, and we always cut hers up
teaching with the caregiver of a into small pieces."
child diagnosed with celiac
syndrome. The caregivers make
the following statements. Commercially canned creamed soups, cold cuts,
Which statement indicates a frankfurters, and pudding mixes generally contain
need for further teaching wheat products and should not be included in the
regarding the dietary diet of the child with celiac syndrome. This caregiver
restrictions for the child with needs further teaching regarding giving her child
celiac syndrome? hot dogs, even if they are cut into small pieces. The
other choices show an understanding of the dietary
A."The soup we eat at our restrictions.
house is all made from scratch."
B."She loves hot dogs, and we
always cut hers up into small
pieces."
C."I have learned to make my
own bread with no gluten."
D. "Even though milk and
pudding are good for her, we
Chapter
don't give her23: The
those Child with Gastrointestinal Dysfunction
foods."
What does the nurse expect C) Bulky,frothy
the appearance of the stools
of a child with celiac disease to Celiac disease causes malabsorption. Stools that
be? are large, bulky, and frothy may indicate
malabsorption.
A) Ribbon like
B) Hard,constipated
C) Bulky,frothy
D) Loose,foul-smelling

The nurse provides home care 1. rice

instructions to the parents of a
child with celiac disease. The
nurse should teach the parents
to include which food item in
the child's diet?

1.Rice
2.Oatmeal
3.Rye toast
4.Wheat bread

Chapter 23: The Child with Gastrointestinal Dysfunction

The mother of a newborn with
a cleft lip reports she is having
a hard time looking her baby.
What is the best action by the
nurse?
A. Explain that surgery will
make this better in the future.
B. Encourage the mother to
provide care for her infant.
C. Encourage the child's
mother to hold her infant
against her shoulder to provide
closeness while avoiding
visualizing the defect.
D. Tell the mother that while
this is difficult it will get easier.
A mother who intended to
breastfeed has given birth to
an infant with a cleft palate.
Nursing interventions should
include:
a. giving medication to
suppress lactation.
b. encouraging and helping
mother to breastfeed.
c. teaching mother to feed
breast milk by gavage.
d. recommending use of a
breast pump to maintain
lactation until infant can suck.
Chapter 23: The Child with Gastrointestinal Dysfunction
B. Encourage the mother to provide care for her
infant.
Providing care to the infant is the best means for the
mother to begin bonding with her baby. Activities
such as feeding, diapering and bathing will be
helpful. Encouraging the mother to avoid looking at
the cleft lip will not assist her in the process of
accepting it. While surgery will be performed it will
not take place for a few months making it vital that
she begin bonding with her infant. Telling the parent
she will get used to it minimizes her concerns and is
not the most therapeutic response by the nurse.
b. encouraging and helping mother to breastfeed.
The 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 infant's
oral cavity so that the tongue action facilitates milk
expression. Because breastfeeding is an option, if
the mother wishes to breastfeed, medications
should not be given to suppress lactation. Because
breastfeeding can usually be accomplished, gavage
feedings are not indicated. The suction required to
stimulate milk, absent initially, may be useful before
nursing to stimulate the let-down reflex.
The nurse is caring for an infant b. cleansing the suture line, supine and side-lying
whose cleft lip was repaired. positions, arm restraints.
Important aspects of this
infant's postoperative care The suture line should be cleansed gently after
include: feeding. The child should be positioned on the
back, on the side, or in an infant seat. Elbows are
a. arm restraints, postural restrained to prevent the child from accessing the
drainage, mouth irrigations. operative site.
b. cleansing the suture line,
supine and side-lying positions,
arm restraints.
c. mouth irrigations, prone
position, cleansing suture line.
d. supine and side-lying
positions, postural drainage,
arm restraints.

A preschooler with a history of 3."Is the child unresponsive when given directions?"
cleft palate repair comes to the
clinic for a routine well-child Unresponsiveness may be an indication of hearing
checkup. To determine if this loss. A child who has a history of cleft palate should
child is experiencing a long- be routinely checked for hearing loss.
term effect of cleft palate,
which question should the
nurse ask?

1."Was the child recently

treated for pneumonia?"
2."Does the child play with an
imaginary friend?"
3."Is the child unresponsive
when given directions?"
4."Has the child had any
difficulty swallowing food?"

Chapter 23: The Child with Gastrointestinal Dysfunction

The nurse is conducting a d) A sausage-shaped mass in the upper
physical examination of an 18- midabdomen
month-old with suspected
intussusception. Which finding
would the nurse identify as the
hallmark of this condition?

a) Skin tenting
b) Perianal skin tags
c) Abdominal pain and
guarding
d) A sausage-shaped mass in
the upper midabdomen

A. Intussusception
A 9-month-old girl is brought
to the emergency room with
Intussusception, the invagination of one portion of
what appears to be bouts of
the intestine into another, usually occurs in the
intense abdominal pain 15
second half of the first year of life. Children with this
minutes apart in which she
disorder suddenly draw up their legs and cry as if
draws up her legs and cries,
they are in severe pain; they may vomit. After the
often accompanied by
peristaltic wave that caused the discomfort passes,
vomiting. In between the
they are symptom-free and play happily. In
bouts, the child recovers and
approximately 15 minutes, however, the same
appears to be without
phenomenon of intense abdominal pain strikes
symptoms. Blood is found in
again. After approximately 12 hours, blood appears
the stool. What condition
in the stool and possibly in vomitus, described as a
should the nurse suspect in this
"currant jelly" appearance. Volvulus with malrotation
case?
and necrotizing enterocolitis typically occur in the
first 6 months of life and do not match the
A.Intussusception
symptoms described above. Short-bowel/short-gut
B.Celiac disease
syndrome typically occurs when a large portion of
C.Enterocolitis
the intestine has been removed due to a previous
D. Gastroentercolitis
disease or trauma.

Chapter 23: The Child with Gastrointestinal Dysfunction

A child is diagnosed with
intussusception. The nurse
anticipates that what action
would be attempted first to
reduce this condition?
A.Barium enema
B. Surgery
C. Upper endoscopy
D. Endoscopic retrograde
cholangiopancreatography
A. Barium enema
A barium enema is successful in reducing a large
percentage of intussusception cases. Other cases
are reduced surgically. Upper endoscopy is used to
visualize the upper gastrointestinal tract from the
mouth to the upper jejunum. Endoscopic retrograde
cholangiopancreatography is used to view the
hepatobiliary system.