Chapter 25: Select all

Question 1

1. The nurse is teaching a parent of a 6-month-old infant with gastroesophageal reflux (GER) before discharge. What instructions should the nurse include? (Select all that apply.)
   a. Elevate the head of the bed in the crib to a 90-degree angle while the infant is sleeping.
   b. Hold the infant in the prone position after a feeding.
   c. Discontinue breastfeeding so that a formula and rice cereal mixture can be used.
   d. The infant will require the Nissen fundoplication after 1 year of age.
   e. Prescribed cimetidine (Tagamet) should be given 30 minutes before feedings.

Answer 1

ANS: B, E

Discharge instructions for an infant with GER should include the prone position (up on the shoulder or across
the lap) after a feeding. Use of the prone position while the infant is sleeping is still controversial. The
American Academy of Pediatrics recommends the supine position to decrease the risk of sudden infant death
syndrome even in infants with GER. Prescribed cimetidine or another proton pump inhibitor should be given
30 minutes before the morning and evening feeding so that peak plasma concentrations occur with mealtime. The head of the bed in the crib does not need to be elevated. The mother may continue to breastfeed or express
breast milk to add rice cereal if recommended by the health care provider; thickening breast milk or formula
with cereal is not recommended by all practitioners. The Nissen fundoplication is only done on infants with
GER in severe cases with complications.

Question 2

2. 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 jellylike stools
c. Anorexia
d. Tender, distended abdomen
e. Hematemesis
f. Sudden acute abdominal pain

Answer 2

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 jellylike 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

Question 3

3. The school nurse is teaching a group of adolescents about avoiding contaminated water during a mission
   trip. What should the nurse include in the teaching? (Select all that apply.)

a. Ice
b. Meats
c. Raw vegetables
d. Unpeeled fruits
e. Carbonated beverage

Answer 3

ANS: A, B, C, D

The best measure during travel to areas where water may be contaminated is to allow children to drink only
bottled water and carbonated beverages (from the container through a straw supplied from home). Children
should also avoid tap water, ice, unpasteurized dairy products, raw vegetables, unpeeled fruits, meats, and
seafood

Question 4

4. The nurse is teaching parents about high-fiber foods that can prevent constipation. What foods should the
   nurse include in the teaching? (Select all that apply.)

a. Oranges
b. Bananas
c. Lima beans
d. Baked beans
e. Raisin bran cerea

Answer 4

ANS: C, D, E

Lima beans have 13.2 g of fiber in 1 cup, baked beans have 10.4 g of fiber in 1 cup, and raisin bran cereal has 7.3 g of fiber in 1 cup. One orange has only 3.1 g of fiber, and 1 banana has only 3.1 g of fiber, so they are not
recommended as high-fiber foods.

Question 5

5. The nurse is teaching parents of a child with gastroesophageal reflux (GER) disease foods that can
   exacerbate acid reflux. What foods should be included in the teaching session? (Select all that apply.)

a. Citrus
b. Bananas
c. Spicy foods
d. Peppermint
e. Whole wheat bread

Answer 5

ANS: A, C, D

Avoidance of certain foods that exacerbate acid reflux (e.g., caffeine, citrus, tomatoes, alcohol, peppermint, spicy or fried foods) can improve mild GER symptoms. Bananas and whole wheat bread will not exacerbate
acid reflux.

Question 6

6. The nurse is preparing to admit a 6-year-old child with irritable bowel syndrome (IBS). What clinical
   manifestations should the nurse expect to observe? (Select all that apply.)

a. Flatulence
b. Constipation
c. No urge to defecate
d. Absence of abdominal pain
e. Feeling of incomplete evacuation of the bowel

Answer 6

ANS: A, B, E

Children with IBS often have alternating diarrhea and constipation, flatulence, bloating or a feeling of
abdominal distention, lower abdominal pain, a feeling of urgency when needing to defecate, and a feeling of
incomplete evacuation of the bowel.

Question 7

7. The nurse is caring for a child with celiac disease. The nurse understands that what may precipitate a celiac
   crisis? (Select all that apply.)

a. Exercise
b. Infections
c. Fluid overload
d. Electrolyte depletion
e. Emotional disturbance

Answer 7

ANS: B, D, E

A celiac crisis can be precipitated by infections, electrolyte depletion, and emotional disturbance. Exercise or
fluid overload does not precipitate a crisis.

Question 8

8. The nurse is preparing to admit a 6-year-old child with celiac disease. What clinical manifestations should
   the nurse expect to observe? (Select all that apply.)

a. Steatorrhea
b. Polycythemia
c. Malnutrition
d. Melena stools
e. Foul-smelling stools

Answer 8

ANS: A, C, E

Clinical manifestations of celiac disease include impaired fat absorption (steatorrhea and foul-smelling stools)
and impaired nutrient absorption (malnutrition). Anemia, not polycythemia, is a manifestation, and melena
stools do not occu

Question 9

9. The nurse is preparing to admit a 10-year-old child with appendicitis. What clinical manifestations should
   the nurse expect to observe? (Select all that apply.)

a. Fever
b. Vomiting
c. Tachycardia
d. Flushed face
e. Hyperactive bowel sounds

Answer 9

ANS: A, B, C

Clinical manifestations of appendicitis include fever, vomiting, and tachycardia. Pallor is seen, not a flushed
face, and the bowel sounds are hypoactive or absent, not hyperactive.

Question 10

10. The nurse is preparing to admit a 2-month-old child with hypertrophic pyloric stenosis. What clinical
    manifestations should the nurse expect to observe? (Select all that apply.)

a. Weight loss
b. Bilious vomiting
c. Abdominal pain
d. Projectile vomiting
e. The infant is hungry after vomiting

Answer 10

ANS: A, D, E

Clinical manifestations of hypertrophic pyloric stenosis include weight loss, projectile vomiting, and hunger
after vomiting. The vomitus is nonbilious, and there is no evidence of pain or discomfort, just chronic hunger.

Question 11

11. The nurse is preparing to admit a 6-month-old child with gastroesophageal reflux disease. What clinical
    manifestations should the nurse expect to observe? (Select all that apply.)

a. Spitting up
b. Bilious vomiting
c. Failure to thrive
d. Excessive crying
e. Respiratory problems

Answer 11

ANS: A, C, D, E

Clinical manifestations of gastroesophageal reflux disease include spitting up, failure to thrive, excessive
crying, and respiratory problems. Hematemesis, not bilious vomiting, is a manifestation.

Question 12

12. The nurse is preparing to admit a 5-year-old child with hepatitis A. What clinical features of hepatitis A
    should the nurse recognize? (Select all that apply.)

a. The onset is rapid.
b. Fever occurs early.
c. There is usually a pruritic rash.
d. Nausea and vomiting are common.
e. The mode of transmission is primarily by the parenteral route.

Answer 12

ANS: A, B, D

Clinical features of hepatitis A include a rapid onset, fever occurring early, and nausea and vomiting. A rash is
rare, and the mode of transmission is by the fecaloral route, rarely by the parenteral route

Question 13

13. The nurse is preparing to admit a 7-year-old child with hepatitis B. What clinical features of hepatitis B
    should the nurse recognize? (Select all that apply.)

a. The onset is rapid.
b. Rash is common.
c. Jaundice is present
d. No carrier state exists
e. The mode of transmission is principally by the parenteral route.

Answer 13

ANS: B, C, E

Clinical features of hepatitis B include a rash, jaundice, and the mode of transmission principally by the
parenteral route. The onset is insidious, not rapid, and a carrier state does exist

Question 14

14. The nurse is preparing to admit a 7-year-old child with Crohn disease. What clinical manifestations should
    the nurse expect to observe? (Select all that apply.)

a. Pain is common.
b. Weight loss is severe.
c. Rectal bleeding is common.
d. Diarrhea is moderate to severe.
e. Anal and perianal lesions are rare

Answer 14

ANS: A, B, D

Clinical manifestations of Crohn disease include pain, severe weight loss, and moderate to severe diarrhea. Rectal bleeding is rare, but anal and perianal lesions are common.