Chapter 024wong S Essentials of Pediatrics Test Bank

IHockenberry & Wilson: Wongs Essentials of Pediatric
Nursing,
8th Edition
Pub Review
Chapter 24: The Child with Gastrointestinal Dysfunction
MULTIPLE CHOICE
1.
Nurses must be alert for increased fluid requirements when a
child has which of the following?
a.
Fever
b.
Mechanical ventilation
c.
Congestive heart failure
d.
Increased intracranial pressure
(ICP)
ANS: A
Fever leads to great insensible fluid loss in young children because of
increased body surface area relative to fluid volume.
DIF: Cognitive Level: Comprehension
REF:
Page 814
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk
Potential
2.
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: C
Melena is denatured blood from the upper GI tract or bleeding from the
right colon.
REF:
Page 815
Potential
3.
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 dehydration
b.
Hypotonic dehydration
c.
Hypertonic dehydration
d.
All types of dehydration in infants
and small children
ANS: A
Isotonic dehydration is the correct term for this definition and is the
most frequent form of dehydration in children.
REF:
Page 816
Potential
4.
Which of the following types
loss in excess of electrolyte loss?
a.
b.
c.
d.
of dehydration results from water

Isotonic dehydration
Isosmotic dehydration
Hypotonic dehydration
Hypertonic dehydration
ANS: D
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.
REF:
Page 816
Potential
5.
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.
Overhydration
b.
Dehydration
c.
Sodium excess
d.
Potassium excess
ANS: B
These clinical manifestations indicate dehydration.
REF:
Page 816
MSC: Area of Client Needs: Physiologic Integrity: Physiologic

Adaptation
6.
a.
b.
c.
d.
Acute diarrhea is often caused by which of the following?

Celiac disease
Antibiotic therapy
Immunodeficiency
Protein malnutrition
ANS: B
Acute diarrhea is a sudden increase in frequency and change in
consistency of stools and may be associated with antibiotic therapy.
REF:
Page 817
Adaptation
7.
Which of the following is the viral pathogen that frequently
causes acute diarrhea in young children?
a.
Giardia organisms
b.
Shigella organisms
c.
Rotavirus
d.
Salmonella organisms
ANS: C
Rotavirus is the most frequent viral pathogen that causes diarrhea in
young children.
REF:
Page 818
Adaptation
8.
a.
b.
c.
d.
Which of the following is a parasite that causes acute diarrhea?

Shigella organisms
Salmonella organisms
Giardia lamblia
Escherichia coli
ANS: C
G. lamblia is a parasite that represents 10% of nondysenteric illness in
the United States.
REF:
Page 820

Adaptation
9.
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 intolerance
b.
Parasitic infection
c.
Fat malabsorption
d.
Bacterial gastroenteritis
ANS: D
Neutrophils and red blood cells in stool indicate bacterial
gastroenteritis.
REF:
Page 821
Potential
10.
Therapeutic management of the child with acute diarrhea and
dehydration usually begins with which of the following?
a.
Clear liquids
b.
Adsorbents, such as kaolin and
pectin
c.
Oral rehydration solution (ORS)
d.
Antidiarrheal medications such
as paregoric
ANS: C
ORS is the first treatment for acute diarrhea.
REF:
Page 821
Potential
11.
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
c.
d.
hours.
I will offer my child bananas,
rice, applesauce, and toast for
the next 48 hours.
I should have my child eat a
normal diet with easily digested
foods for the next 48 hours.
ANS: D
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.
DIF: Cognitive Level: Application REF: Page 821 | Page 822
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Basic Care and
Comfort
12.
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: A
In children with severe dehydration, IV fluids are initiated.
DIF: Cognitive Level: Application REF: Page 822
TOP: Integrated Process: Nursing Process: Implementation
Adaptation
13.
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
d.
diarrhea.
indicated because it decreases
fluid and electrolyte losses.
ANS: A
Antidiarrheal 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: Analysis
REF: Page 823
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
14.
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.
Diet
b.
Allergies
c.
Antihistamines
d.
Emotional factors
ANS: C
Constipation 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.
REF:
Page 823
15.
Which of the following is a high-fiber food that the nurse could
recommend for a child with chronic constipation?
a.
Popcorn
b.
Pancakes
c.
Muffins
d.
Ripe bananas
ANS: A
Popcorn is a high-fiber food.

REF:
Page 825
Comfort
16.
Therapeutic management of most children with Hirschsprung
disease is primarily which of the following?
a.
Daily enemas
b.
Low-fiber diet
c.
Permanent colostomy
d.
Surgical removal of affected
section of bowel
ANS: 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 internal anal sphincter.
REF:
Page 826
Adaptation
17.
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: B
Isotonic solutions should be used in children. Saline is the solution of
choice.
REF:
Page 826
Potential
18.
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
c.
d.
colostomy is temporary.
necessary because it will be an
adjustment.
necessary because child must
deal with a negative body image.
ANS: C
The 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.
MSC: Area of Client Needs: Psychosocial Integrity: Coping and
Adaptation
19.
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: C
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.
REF:
Page 827
Potential
20.
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
d.
feedings.
Give larger, less frequent
feedings.
ANS: B
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 to increase the caloric density of the formula.
This may benefit infants who are underweight as a result of GER
disease.
Potential
21.
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: C
The mechanism of action of histamine-receptor antagonists is to
reduce the amount of acid present in gastric contents and perhaps
prevent esophagitis.
REF:
Page 828
22.
Which of the following clinical manifestations would be the most
suggestive of 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
ANS: D
Pain is the cardinal feature. It is initially generalized, usually

periumbilical. The pain localizes to the right lower quadrant at
McBurney point.
REF:
Page 830
Adaptation
23.
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.
Bradycardia
b.
Anorexia
c.
Sudden relief from pain
d.
Decreased abdominal distention
ANS: C
Signs of peritonitis, in addition to fever, include sudden relief from pain
after perforation.
REF:
Page 830
Adaptation
24.
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: B
The child should be allowed to take a position of comfort, usually with
the legs flexed.
REF:
Page 831
Adaptation
25.
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: C
Bloody stools are often a presenting sign of Meckel diverticulum. It is
associated with mild to profuse intestinal bleeding.
REF:
Page 832
Adaptation
26.
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 disease
b.
Ulcerative colitis
c.
Meckel diverticulum
d.
Irritable bowel syndrome
ANS: A
The 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.
REF:
Page 834
Adaptation
27.
Which of the following is used to treat moderate to severe
inflammatory bowel disease?
a.
Antacids
b.
Antibiotics
c.
Corticosteroids
d.
Antidiarrheal medications
ANS: C
Corticosteroids, such as prednisone and prednisolone, are used in short
bursts to suppress the inflammatory response in inflammatory bowel
disease.
REF:
Page 834
28.
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: A
This combination of drug therapy is effective in the treatment of H.
pylori.
REF:
Page 837
29.
a.
b.
c.
d.
Which of the following statements best characterizes hepatitis A?

Incubation period is 6 weeks to 6
months.
Principal mode of transmission is
through the parenteral route.
Onset is usually rapid and acute.
There is a persistent carrier
state.
ANS: C
Hepatitis A is the most common form of acute hepatitis in most parts of
the world. It is characterized by a rapid and acute onset.
REF:
Page 839
Potential
30.
Which of the following is now
immunization of all newborns?
a.
b.
c.
recommended for the

Hepatitis A vaccine
Hepatitis B vaccine
Hepatitis C vaccine
d.
Hepatitis A, B, and C vaccines
ANS: B
Universal vaccination for hepatitis B is now recommended for all
newborns.
REF:
Page 839
MSC: Area of Client Needs: Health Promotion and Maintenance:
Immunizations
31.
a.
b.
c.
d.
The best chance of survival for a child with cirrhosis is:

liver transplantation.
treatment with corticosteroids.
treatment with immune globulin.
provision of nutritional support.
ANS: A
The 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.
REF:
Page 841
Adaptation
32.
Which of the following is the earliest clinical manifestation of
biliary atresia?
a.
Jaundice
b.
Vomiting
c.
Hepatomegaly
d.
Absence of stooling
ANS: A
Jaundice 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.
REF:
Page 842
Adaptation
33.
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: B
For 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.
REF: Page 845
MSC: Area of Client Needs: Psychosocial Integrity: Coping and
Adaptation
34.
Caring for the newborn with a cleft lip and palate before surgical
repair includes which of the following?
a.
Gastrostomy feedings
b.
Keeping infant in near-horizontal
position during feedings
c.
Allowing little or no sucking
d.
Providing satisfaction of sucking
needs
ANS: D
Using special or modified nipples for feeding techniques helps meet
the infants sucking needs.
Potential
35.
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.
b.
c.
d.
Give medication to suppress

lactation.
Encourage and help mother to
breastfeed.
Teach mother to feed breast milk
by gavage.
Recommend use of a breast
pump to maintain lactation until
infant can suck.
ANS: B
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 infants oral
cavity so that the tongue action facilitates milk expression.
REF:
Page 845
Potential
36.
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 irrigations
b.
Cleansing 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
ANS: B
The 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.
REF: Page 846
TOP: Integrated Process: Nursing Process: Planning
Potential
37.
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: C
Remove restraints periodically, while supervising the infant, to allow
him or her to exercise arms and to provide cuddling and tactile
stimulation.
REF:
Page 846
TOP: Integrated Process: Nursing Process: Planning
Potential
38.
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: A
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.
REF: Page 848
Potential
39.
Which type of hernia has an impaired blood supply to the
herniated organ?
a.
Hiatal hernia
b.
Incarcerated hernia
c.
d.
Omphalocele
Strangulated hernia
ANS: D
A strangulated hernia is one in which the blood supply to the herniated
organ is impaired.
REF:
Page 849
Potential
40.
a.
b.
c.
d.
Pyloric stenosis can best be described as which of the following?

Dilation of the pylorus
Hypertrophy of the pyloric
muscle
Hypotonicity of the pyloric
muscle
Reduction of tone in the pyloric
muscle
ANS: B
Hypertrophic pyloric stenosis occurs when the circumferential muscle
of the pyloric sphincter becomes thickened, resulting in elongation and
narrowing of the pyloric channel.
REF:
Page 849
Potential
41.
Which of the following observations made of the exposed
abdomen is most indicative of pyloric stenosis?
a.
Abdominal rigidity
b.
Substernal retraction
c.
Visible peristalsis
d.
Marked distention of lower
abdomen
ANS: C
Visible gastric peristaltic waves that move from left to right across the
epigastrium are observed in pyloric stenosis.
REF:
Page 851
Potential
42.
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
palpation
b.
Rounded abdomen and
hypoactive bowel sounds
c.
Visible peristalsis and weight loss
d.
Distention of lower abdomen and
constipation
ANS: C
Visible gastric peristaltic waves that move from left to right across the
epigastrium and weight loss are observed in pyloric stenosis.
Potential
43.
Excessive vomiting can result in which of the following in an
infant with pyloric stenosis?
a.
Hyperchloremia
b.
Hypernatremia
c.
Metabolic acidosis
d.
Metabolic alkalosis
ANS: D
Infants with excessive vomiting are prone to metabolic alkalosis from
the loss of hydrogen ions.
REF:
Page 852
Potential
44.
Invagination of one segment of bowel within another is called
which of the following?
a.
Atresia
b.
Stenosis
c.
Herniation
d.
Intussusception
ANS: D
Intussusception 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.
REF:
Page 852
Potential
45.
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: A
Passage 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.
REF: Page 853
Potential
46.
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: A
The 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.
REF:
Page 856
Comfort
47.
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: B
During 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.
REF:
Page 857
MULTIPLE RESPONSE
1.
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 care
b.
Necessity of firm stools to keep
suture line clean
c.
Bowel training beginning as soon
d.
e.
as child returns home

Changes in stooling patterns to
report to practitioner
Use of diet modification to
prevent constipation
ANS: A, D, E
Wound 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.
Potential
2.
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, F
The 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.
TOP: Integrated Process: Nursing Process: Problem Identification
Potential

Chapter 024wong S Essentials of Pediatrics Test Bank

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Chapter 024wong S Essentials of Pediatrics Test Bank

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IHockenberry & Wilson: Wongs Essentials of Pediatric

approximately balanced proportion?

of dehydration results from water

MSC: Area of Client Needs: Physiologic Integrity: Physiologic

Acute diarrhea is often caused by which of the following?

Which of the following is a parasite that causes acute diarrhea?

MSC: Area of Client Needs: Physiologic Integrity: Physiologic

DIF: Cognitive Level: Comprehension

Pain is the cardinal feature. It is initially generalized, usually

Which of the following statements best characterizes hepatitis A?

recommended for the

Hepatitis A, B, and C vaccines

The best chance of survival for a child with cirrhosis is:

Give medication to suppress

Pyloric stenosis can best be described as which of the following?

Intussusception occurs when a proximal section of the bowel

The main consideration is helping the child adhere to dietary

as child returns home

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