Chapter 26: The Child with Gastrointestinal Dysfunction

MULTIPLE CHOICE
1. What test is used to screen for carbohydrate malabsorption?

a. Stool pH
b. Urine ketones
c. C urea breath test
d. ELISA stool assay
ANS: A
The anticipated pH of a stool specimen is 7.0. A stool pH of less than 5.0 is
indicative of carbohydrate malabsorption. The bacterial fermentation of
carbohydrates in the colon produces short-chain fatty acids, which lower the
stool pH. Urine ketones detect the presence of ketones in the urine, which
indicates the use of alternative sources of energy to glucose. The C urea breath
test measures the amount of carbon dioxide exhaled. It is used to determine the
presence of Helicobacter pylori. ELISA (enzyme-linked immunosorbent assay)
detects the presence of antigens and antibodies. It is not useful for disorders of
metabolism.
DIF: Cognitive Level: Understanding REF: p. 1055
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
2. A toddlers mother calls the nurse because she thinks her son has swallowed a
button type of battery. He has no signs of respiratory distress. The nurses
response should be based on which premise?

a. An emergency laparotomy is very likely.

b. The location needs to be confirmed by radiographic examination.
Surgery will be necessary if the battery has not passed in the stool
c. in 48 hours.
Careful observation is essential because an ingested battery
d. cannot be accurately detected.
ANS: B
Button batteries can cause severe damage if lodged in the esophagus. If both
poles of the battery come in contact with the wall of the esophagus, acid burns,
necrosis, and perforation can occur. If the battery is in the stomach, it will most
likely be passed without incident. Surgery is not indicated. The battery is metallic
and is readily seen on radiologic examination.
DIF: Cognitive Level: Applying REF: p. 1068 TOP: Nursing Process: Planning
MSC: Client Needs: Physiological Integrity
3. The mother of a child with cognitive impairment calls the nurse because her
son has been gagging and drooling all morning. The nurse suspects foreign body
ingestion. What physiologic occurrence is most likely responsible for the
presenting signs?

a. Gastrointestinal perforation may have occurred.

b. The object may have been aspirated.
c. The object may be lodged in the esophagus.
d. The object may be embedded in stomach wall.
ANS: C
Gagging and drooling may be signs of esophageal obstruction. The child is unable
to swallow saliva, which contributes to the drooling. Signs of gastrointestinal (GI)
perforation include chest or abdominal pain and evidence of bleeding in the GI
tract. If the object was aspirated, the child would most likely have coughing,
choking, inability to speak, or difficulty breathing. If the object was embedded in
the stomach wall, it would not result in symptoms of gagging and drooling.
DIF: Cognitive Level: Applying REF: p. 1071
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
4. What is a high-fiber food that the nurse should recommend for a child with
chronic constipation?

a. White rice
b. Popcorn
c. Fruit juice
d. Ripe bananas
ANS: B
Popcorn is a high-fiber food. Refined rice is not a significant source of fiber.
Unrefined brown rice is a fiber source. Fruit juices are not a significant source of
fiber. Raw fruits, especially those with skins and seeds, other than ripe bananas,
have high fiber.
DIF: Cognitive Level: Applying REF: p. 1074 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
5. A 2-year-old child has a chronic history of constipation and is brought to the
clinic for evaluation. What should the therapeutic plan initially include?

a. Bowel cleansing
b. Dietary modification
c. Structured toilet training
d. Behavior modification
ANS: A
The first step in the treatment of chronic constipation is to empty the bowel and
allow the distended rectum to return to normal size. Dietary modification is an
important part of the treatment. Increased fiber and fluids should be gradually
added to the childs diet. A 2-year-old child is too young for structured toilet
training. For an older child, a regular schedule for toileting should be established.
Behavior modification is part of the overall treatment plan. The child practices
releasing the anal sphincter and recognizing cues for defecation.
DIF: Cognitive Level: Understanding REF: p. 1072
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
6. What statement best describes Hirschsprung disease?

a. The colon has an aganglionic segment.

b. It results in frequent evacuation of solids, liquid, and gas.
c. The neonate passes excessive amounts of meconium.
It results in excessive peristaltic movements within the
d. gastrointestinal tract.
ANS: A
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.
DIF: Cognitive Level: Understanding REF: p. 1074
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
7. What procedure is most appropriate for assessment of an abdominal
circumference related to a bowel obstruction?

a. Measuring the abdomen after feedings

b. Marking the point of measurement with a pen
c. Measuring the circumference at the symphysis pubis
Using a new tape measure with each assessment to ensure
d. accuracy
ANS: B
Pen marks on either side of the tape measure allow the nurse to measure the
same spot on the childs abdomen at each assessment. The child most likely will
be kept NPO (nothing by mouth) if a bowel obstruction is present. If the child is
being fed, the assessment should be done before feedings. The symphysis pubis
is too low. Usually the largest part of the abdomen is at the umbilicus. Leaving
the tape measure in place reduces the trauma to the child.
DIF: Cognitive Level: Applying REF: p. 1067
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
8. 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 childs age.

b. It is essential because it will be an adjustment.
c. Preparation is not needed because the colostomy is temporary.
Preparation is important because the child needs to deal with
d. negative body image.
ANS: B
The childs 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.
DIF: Cognitive Level: Applying REF: p. 1075
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Psychosocial Integrity
9. 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. Monitor electrolyte balance.
c. Prevent abdominal distention.
d. Maintain accurate record of output.
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.
DIF: Cognitive Level: Applying REF: p. 1077
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
10. A parent of an infant with gastroesophageal reflux asks how to decrease the
number and total volume of emesis. What recommendation should the nurse
include in teaching this parent?

a. Surgical therapy is indicated.

b. Place in prone position for sleep after feeding.
c. Thicken feedings and enlarge the nipple hole.
Reduce the frequency of feeding by encouraging larger volumes of
d. formula.
ANS: C
Thickened feedings decrease the childs crying and increase the caloric density of
the feeding. Although it does not decrease the pH, the number and volume of
emesis are reduced. Surgical therapy is reserved for children who have failed to
respond to medical therapy or who have an anatomic abnormality. The prone
position is not recommended because of the risk of sudden infant death
syndrome. Smaller, more frequent feedings are more effective than less frequent,
larger volumes of formula.
DIF: Cognitive Level: Applying REF: p. 1093
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Physiological Integrity
11. After surgery yesterday for gastroesophageal reflux, the nurse finds that the
infant has somehow removed the nasogastric (NG) tube. What nursing action is
most appropriate to perform at this time?

a. Notify the practitioner.

b. Insert the NG tube so feedings can be given.
c. Replace the NG tube to maintain gastric decompression.
Leave the NG tube out because it has probably been in long
d. enough.
ANS: A
When surgery is performed on the upper gastrointestinal tract, usually the
surgical team replaces the NG tube because of potential injury to the operative
site. The decision to replace the tube or leave it out is made by the surgical team.
Replacing the tube is also usually done by the practitioner because of the surgical
site.
DIF: Cognitive Level: Applying REF: p. 1077
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
12. An adolescent with irritable bowel syndrome comes to see the school nurse.
What information should the nurse share with the adolescent?

a. A low-fiber diet is required.

b. Stress management may be helpful.
c. Milk products are a contributing factor.
d. Pantoprazole (a proton pump inhibitor) is effective in treatment.
ANS: B
Irritable bowel syndrome is believed to involve motor, autonomic, and
psychologic factors. Stress management, environmental modification, and
psychosocial intervention may reduce stress and gastrointestinal symptoms. A
high-fiber diet with psyllium supplement is often beneficial. Milk products can
exacerbate bowel problems caused by lactose intolerance. Antispasmodic drugs,
antidiarrheal drugs, and simethicone are beneficial for some individuals. Proton
pump inhibitors have no effect.
DIF: Cognitive Level: Applying REF: p. 1078
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Physiological Integrity
13. What clinical manifestation should 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. Colicky, cramping, abdominal pain around the umbilicus
ANS: D
Pain is the cardinal feature. It is initially generalized, usually periumbilical. The
pain becomes constant and may shift to the right lower quadrant. Rebound
tenderness is not a reliable sign and is extremely painful to the child. Bright or
dark red rectal bleeding and abdominal pain that is relieved by eating are not
signs of acute appendicitis.
DIF: Cognitive Level: Understanding REF: p. 1079
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
14. When caring for a child with probable appendicitis, the nurse should be alert
to recognize which sign or symptom as a manifestation of perforation?

a. Anorexia
b. Bradycardia
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. Anorexia is already a clinical manifestation of appendicitis.
Tachycardia, not bradycardia, is a manifestation of peritonitis. Abdominal
distention usually increases in addition to an increase in pain (usually diffuse
and accompanied by rigid guarding of the abdomen).
DIF: Cognitive Level: Applying REF: p. 1079
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
15. The nurse is caring for a child admitted with acute abdominal pain and
possible appendicitis. What intervention is appropriate to relieve the abdominal
discomfort during the evaluation?

a. Place in the Trendelenburg position.

b. Apply moist heat to the abdomen.
c. Allow the child to assume a position of comfort.
d. Administer a saline enema to cleanse the bowel.
ANS: C
The child should be allowed to take a position of comfort, usually with the legs
flexed. The Trendelenburg position will not help with the discomfort. If
appendicitis is a possibility, administering laxative or enemas or applying heat to
the area is dangerous. Such measures stimulate bowel motility and increase the
risk of perforation.
DIF: Cognitive Level: Applying REF: p. 1081
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
16. What statement is most descriptive of Meckel diverticulum?

a. It is acquired during childhood.

b. Intestinal bleeding may be mild or profuse.
c. It occurs more frequently in females than in males.
d. Medical interventions are usually sufficient to treat the problem.
ANS: B
Bloody stools are often a presenting sign of Meckel diverticulum. It is associated
with mild to profuse intestinal bleeding. Meckel diverticulum is the most
common congenital malformation of the gastrointestinal tract and is present in
1% to 4% of the general population. It is more common in males than in females.
The standard therapy is surgical removal of the diverticulum.
DIF: Cognitive Level: Understanding REF: p. 1083
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
17. One of the major differences in clinical presentation between Crohn disease
(CD) and ulcerative colitis (UC) is that UC is more likely to cause which clinical
manifestation?

a. Pain
b. Rectal bleeding
c. Perianal lesions
d. Growth retardation
ANS: B
Rectal bleeding is more common in UC than CD. Pain, perianal lesions, and
growth retardation are common manifestations of CD.
DIF: Cognitive Level: Understanding REF: p. 1084
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
18. Nutritional management of the child with Crohn disease includes a diet that
has which component?

a. High fiber
b. Increased protein
c. Reduced calories
d. Herbal supplements
ANS: B
The child with Crohn disease often has growth failure. Nutritional support is
planned to reduce ongoing losses and provide adequate energy and protein for
healing. Fiber is mechanically hard to digest. Foods containing seeds may
contribute to obstruction. A high-calorie diet is necessary to minimize growth
failure. Herbal supplements should not be used unless discussed with the
practitioner. Vitamin supplementation with folic acid, iron, and multivitamins is
recommended.
DIF: Cognitive Level: Understanding REF: p. 1086
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
19. What information should the nurse include when teaching an adolescent with
Crohn disease (CD)?

a. How to cope with stress and adjust to chronic illness

b. Preparation for surgical treatment and cure of CD
c. Nutritional guidance and prevention of constipation
Prevention of spread of illness to others and principles of high-
d. fiber diet
ANS: A
CD is a chronic illness with a variable course and many potential complications.
Guidance about living with chronic illness is essential for adolescents. Stress
management techniques can help with exacerbations and possible limitations
caused by the illness. At this time, there is no cure for CD. Surgical intervention
may be indicated for complications that cannot be controlled by medical and
nutritional therapy. Nutritional guidance is an essential part of management.
Constipation is not usually an issue with CD. CD is not infectious, so transmission
is not a concern. A low-fiber diet is indicated.
DIF: Cognitive Level: Understanding REF: p. 1086
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Physiological Integrity
20. A child with pyloric stenosis is having excessive vomiting. The nurse should
assess for what potential complication?

a. Hyperkalemia
b. Hyperchloremia
c. Metabolic acidosis
d. Metabolic alkalosis
ANS: D
Infants with excessive vomiting are prone to metabolic alkalosis from the loss of
hydrogen ions. Potassium and chloride ions are lost with vomiting. Metabolic
alkalosis, not acidosis, is likely.
DIF: Cognitive Level: Applying REF: p. 1091
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
21. What term describes invagination of one segment of bowel within another?

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. Atresia is the absence
or closure of a natural opening in the body. Stenosis is a narrowing or
constriction of the diameter of a bodily passage or orifice. Herniation is the
protrusion of an organ or part through connective tissue or through a wall of the
cavity in which it is normally enclosed.
DIF: Cognitive Level: Understanding REF: p. 1091
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
22. A school-age child with celiac disease asks for guidance about snacks that will
not exacerbate the disease. What snack should the nurse suggest?

a. Pizza
b. Pretzels
c. Popcorn
d. Oatmeal cookies
ANS: C
Celiac disease symptoms result from ingestion of gluten. Corn and rice do not
contain gluten. Popcorn or corn chips will not exacerbate the intestinal
symptoms. Pizza and pretzels are usually made from wheat flour that contains
gluten. Also, in the early stages of celiac disease, the child may be lactose
intolerant. Oatmeal contains gluten.
DIF: Cognitive Level: Applying REF: p. 1096
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Physiological Integrity
23. An infant with short bowel syndrome is receiving total parenteral nutrition
(TPN). The practitioner has added continuous enteral feedings through a
gastrostomy tube. The nurse recognizes this as important for which reason?

a. Wean the infant from TPN the next day

b. Stimulate adaptation of the small intestine
c. Give additional nutrients that cannot be included in the TPN
d. Provide parents with hope that the child is close to discharge
ANS: B
Long-term survival without TPN depends on the small intestines ability to
increase its absorptive capacity. Continuous enteral feedings facilitate the
adaptation. TPN is indicated until the child is able to receive all nutrition via the
enteral route. Before this is accomplished, the small intestine must adapt and
increase in cell number and cell mass per villus column. TPN is formulated to
meet the infants nutritional needs. Continuous enteral feedings through a
gastrostomy tube is a positive sign, but the infants ability to tolerate increasing
amounts of enteral nutrition is only one factor that determines readiness for
discharge.
DIF: Cognitive Level: Analyzing REF: p. 1097
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
24. Melena, the passage of black, tarry stools, suggests bleeding from which
source?

a. The perianal or rectal area

b. The upper gastrointestinal (GI) tract
c. The lower GI tract
d. Hemorrhoids or anal fissures
ANS: B
Melena is denatured blood from the upper GI tract or bleeding from the right
colon. Blood from the perianal or rectal area, hemorrhoids, or lower GI tract
would be bright red.
DIF: Cognitive Level: Understanding REF: p. 1098
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
25. A child with acute gastrointestinal bleeding is admitted to the hospital. The
nurse observes which sign or symptom as an early manifestation of shock?

a. Restlessness
b. Rapid capillary refill
c. Increased temperature
d. Increased blood pressure
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.
DIF: Cognitive Level: Analyzing REF: p. 1099
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
26. What signs or symptoms are most commonly associated with the prodromal
phase of acute viral hepatitis?

a. Bruising and lethargy

b. Anorexia and malaise
c. Fatigability and jaundice
d. Dark urine and pale stools
ANS: B
The signs and symptoms most common in the prodromal phase are anorexia,
malaise, lethargy, and easy fatigability. Bruising would not be an issue unless
liver damage has occurred. Jaundice is a late sign and often does not occur in
children. Dark urine and pale stools would occur during the onset of jaundice
(icteric phase) if it occurs.
DIF: Cognitive Level: Understanding REF: p. 1102
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
27. What immunization is recommended for all newborns?

a. Hepatitis A vaccine
b. Hepatitis B vaccine
c. Hepatitis C vaccine
 d. Hepatitis A, B, and C vaccines
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.
DIF: Cognitive Level: Understanding REF: p. 1103
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
28. The nurse is discussing home care with a mother whose 6-year-old child has
hepatitis A. What information should the nurse include?

a. Advise bed rest until 1 week after the icteric phase.

b. Teach infection control measures to family members.
Inform the mother that the child cannot return to school until 3
c. weeks after onset of jaundice.
Reassure the mother that hepatitis A cannot be transmitted to
d. other family members.
ANS: B
Hand washing is the single most effective measure in preventing and controlling
hepatitis. Hepatitis A can be transmitted through the fecaloral route. Family
members must be taught preventive measures. Rest and quiet activities are
essential and adjusted to the childs condition, but bed rest is not necessary. The
child is not infectious 1 week after the onset of jaundice and may return to school
as activity level allows.
DIF: Cognitive Level: Applying REF: p. 1104
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Physiological Integrity
29. What therapeutic intervention provides the best chance of survival for a child
with cirrhosis?

a. Nutritional support
b. Liver transplantation
c. Blood component therapy
d. Treatment with corticosteroids
ANS: B
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. Liver transplantation reflects the failure of other medical and surgical
measures to prevent or treat cirrhosis. Nutritional support is necessary for the
child with cirrhosis, but it does not stop the progression of the disease. Blood
components are indicated when the liver can no longer produce clotting factors.
It is supportive therapy, not curative. Corticosteroids are not used in end-stage
liver disease.
DIF: Cognitive Level: Understanding REF: p. 1105
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
30. The nurse observes that a newborn is having problems after birth. What
should indicate a tracheoesophageal fistula?

a. Jitteriness
b. Meconium ileus
c. Excessive frothy saliva
d. Increased need for sleep
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.
DIF: Cognitive Level: Understanding REF: p. 1107
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
31. 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 patients head for feedings.
c. Raise the patients head and give nothing by mouth.
d. Avoid suctioning unless the infant is cyanotic.
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.
DIF: Cognitive Level: Analyzing REF: p. 1109
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
32. 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. 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.
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.
DIF: Cognitive Level: Applying REF: p. 1110
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
33. What should preoperative care of a newborn with an anorectal malformation
include?

a. Frequent suctioning
b. Gastrointestinal decompression
c. Feedings with sterile water only
d. Supine position with head elevated
ANS: B
Gastrointestinal decompression is an essential part of nursing care for a newborn
with an anorectal malformation. This helps alleviate intraabdominal pressure
until surgical intervention. Suctioning is not necessary for an infant with this
type of anomaly. Feedings are not indicated until it is determined that the
gastrointestinal tract is intact. Supine position with head elevated is indicated for
infants with a tracheoesophageal fistula, not anorectal malformations.
DIF: Cognitive Level: Applying REF: p. 1118
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
34. A child who has just had definitive repair of a high rectal malformation is to
be discharged. What should the nurse address in the discharge preparation of
this family?

a. Safe administration of daily enemas

b. Necessity of firm stools to keep suture line clean
c. Bowel training beginning as soon as the child returns home
d. Changes in stooling patterns to report to the practitioner
ANS: D
The parents are taught to notify the practitioner if any signs of an anal stricture
or other complications develop. Constipation is avoided because a firm stool will
place strain on the suture line. Daily enemas are contraindicated after surgical
repair of a rectal malformation. Fiber and stool softeners are often given to keep
stools soft and avoid tension on the suture line. The child needs to recover from
the surgical procedure. Then bowel training may begin, depending on the childs
developmental and physiologic readiness.
DIF: Cognitive Level: Applying REF: p. 1118
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Physiological Integrity
35. The parents of a newborn with an umbilical hernia ask about treatment
options. The nurses response should be based on which knowledge?

a. Surgery is recommended as soon as possible.

b. The defect usually resolves spontaneously by 3 to 5 years of age.
 c. Aggressive treatment is necessary to reduce its high mortality.
Taping the abdomen to flatten the protrusion is sometimes
d. helpful.
ANS: B
The umbilical hernia usually resolves by ages 3 to 5 years of age without
intervention. Umbilical hernias rarely become problematic. Incarceration, where
the hernia is constricted and cannot be reduced manually, is rare. Umbilical
hernias are not associated with a high mortality rate. Taping the abdomen flat
does not help heal the hernia; it can cause skin irritation.
DIF: Cognitive Level: Applying REF: p. 1114
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Physiological Integrity
36. The nurse is preparing to care for a newborn with an omphalocele. The nurse
should understand that care of the infant should include what intervention?

Initiating breast- or bottle-feedings to stabilize the blood glucose

a. level
b. Maintaining pain management with an intravenous opioid
Covering the intact bowel with a nonadherent dressing to prevent
c. injury
d. Performing immediate surgery
ANS: C
Nursing care of an infant with an omphalocele includes covering the intact bowel
with a nonadherent dressing to prevent injury or placing a bowel bag or moist
dressings and a plastic drape if the abdominal contents are exposed. The infant is
not started on any type of feeding but has a nasogastric tube placed for gastric
decompression. Pain management is started after surgery, but surgery is not
done immediately after birth. The infant is medically stabilized before different
surgical options are considered.
DIF: Cognitive Level: Applying REF: p. 1113 TOP: Nursing Process: Planning
MSC: Client Needs: Physiological Integrity
37. What should the nurse consider when providing support to a family whose
infant has just been diagnosed with biliary atresia?
 a. The prognosis for full recovery is excellent.
b. Death usually occurs by 6 months of age.
c. Liver transplantation may be needed eventually.
d. Children with surgical correction live normal lives.
ANS: C
Untreated biliary atresia results in progressive cirrhosis and death usually by 2
years of age. Surgical intervention at 8 weeks of age is associated with somewhat
better outcomes. Liver transplantation is also improving outcomes for 10-year
survival. Even with surgical intervention, most children require supportive
therapy. With early intervention, 10-year survival rates range from 27% to 75%.
DIF: Cognitive Level: Applying REF: p. 1105
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Physiological Integrity
38. 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
b. Intussusception
c. Hirschsprung disease
d. Celiac disease
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.
DIF: Cognitive Level: Analyzing REF: p. 1074
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
39. 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
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.
DIF: Cognitive Level: Applying REF: p. 1075
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Physiological Integrity
40. An infant is born with a gastroschisis. Care preoperatively should include
which priority intervention?

a. Prone position
b. Sterile water feedings
c. Monitoring serum laboratory electrolytes
d. Covering the defect with a sterile bowel bag
ANS: D
Initial management of a gastroschisis involves covering the exposed bowel with a
transparent plastic bowel bag or loose, moist dressings. The infant cannot be
placed prone, and feedings will be withheld until surgery is performed.
Electrolyte laboratory values will be monitored but not before covering the
defect with a sterile bowel bag.
DIF: Cognitive Level: Applying REF: p. 1113 TOP: Nursing Process: Planning
MSC: Client Needs: Physiological Integrity
41. What is the purpose in using cimetidine (Tagamet) for gastroesophageal
reflux?

a. The medication reduces gastric acid secretion.

b. The medication neutralizes the acid in the stomach.
 c. The medication increases the rate of gastric emptying time.
d. The medication coats the lining of the stomach and esophagus.
ANS: A
Pharmacologic therapy may be used to treat infants and children with
gastroesophageal reflux disease. Both H2-receptor antagonists (cimetidine
[Tagamet], ranitidine [Zantac], or famotidine [Pepcid]) and proton pump
inhibitors (esomeprazole [Nexium], lansoprazole [Prevacid], omeprazole
[Prilosec], pantoprazole [Protonix], and rabeprazole [Aciphex]) reduce gastric
hydrochloric acid secretion.
DIF: Cognitive Level: Analyzing REF: p. 1077 TOP: Nursing Process: Evaluation
MSC: Client Needs: Physiological Integrity
42. A health care provider prescribes feedings of 1 to 2 oz Pedialyte every 3 hours
and to advance to 1/2 strength Similac with iron as tolerated postoperatively for
an infant who had a pyloromyotomy. The nurse should decide to advance the
feeding if which occurs?

a. The infants IV line has infiltrated.

b. The infant has not voided since surgery.
c. The infants mother states the infant is tolerating the feeding okay.
d. The infant is taking the Pedialyte without vomiting or distention.
ANS: D
After a pyloromyotomy, feedings are usually instituted within 12 to 24 hours,
beginning with clear liquids. They are offered in small quantities at frequent
intervals. Supervision of feedings is an important part of postoperative care. The
feedings are advanced only if the infant is taking the clear liquids without
vomiting or distention. Feedings would not be advanced if the infant has not
voided, the IV line becomes infiltrated, or the mother states the infant is
tolerating the feedings.
DIF: Cognitive Level: Applying REF: p. 1063
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
43. The nurse is assisting a child with celiac disease to select foods from a menu.
What foods should the nurse suggest?
 a. Hamburger on a bun
b. Spaghetti with meat sauce
c. Corn on the cob with butter
d. Peanut butter and crackers
ANS: C
Treatment of celiac disease consists primarily of dietary management. Although
a gluten-free diet is prescribed, it is difficult to remove every source of this
protein. Some patients are able to tolerate restricted amounts of gluten. Because
gluten occurs mainly in the grains of wheat and rye but also in smaller quantities
in barley and oats, these foods are eliminated. Corn, rice, and millet are
substitute grain foods. Corn on the cob with butter would be gluten free.
DIF: Cognitive Level: Applying REF: p. 1096
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
44. An infant with short bowel syndrome will be on total parenteral nutrition
(TPN) for an extended period of time. What should the nurse monitor the infant
for ?

Central venous catheter infection, electrolyte losses, and

a. hyperglycemia
b. Hypoglycemia, catheter migration, and weight gain
c. Venous thrombosis, hyperlipidemia, and constipation
d. Catheter damage, red currant jelly stools, and hypoglycemia
ANS: A
Numerous complications are associated with short bowel syndrome and long-
term TPN. Infectious, metabolic, and technical complications can occur. Sepsis
can occur after improper care of the catheter. The gastrointestinal tract can also
be a source of microbial seeding of the catheter. The nurse should monitor for
catheter infection, electrolyte losses, and hyperglycemia. Hypoglycemia, weight
gain, constipation, or red currant jelly stools are not characteristics of short
bowel syndrome with extended TPN.
DIF: Cognitive Level: Applying REF: p. 1097
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
45. A child is being admitted to the hospital with acute gastroenteritis. The health
care provider prescribes an antiemetic. What antiemetic does the nurse
anticipate being prescribed?

a. Ondansetron (Zofran)
b. Promethazine (Phenergan)
c. Metoclopramide (Reglan)
d. Dimenhydrinate (Dramamine)
ANS: A
Ondansetron reduces the duration of vomiting in children with acute
gastroenteritis. This would be the expected prescribed antiemetic. Adverse
effects with earlier generation antiemetics (e.g., promethazine and
metoclopramide) include somnolence, nervousness, irritability, and dystonic
reactions and should not be routinely administered to children. For children who
are prone to motion sickness, it is often helpful to administer an appropriate
dose of dimenhydrinate (Dramamine) before a trip, but it would not be ordered
as an antiemetic.
DIF: Cognitive Level: Analyzing REF: p. 1069 TOP: Nursing Process: Planning
MSC: Client Needs: Physiological Integrity
46. The nurse should instruct parents to administer a daily proton pump
inhibitor to their child with gastroesophageal reflux at which time?

a. Bedtime
b. With a meal
c. Midmorning
d. 30 minutes before breakfast
ANS: D
Proton pump inhibitors are most effective when administered 30 minutes before
breakfast so that the peak plasma concentrations occur with mealtime. If they
are given twice a day, the second best time for administration is 30 minutes
before the evening meal.
DIF: Cognitive Level: Applying REF: p. 1078
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Physiological Integrity
47. An infant had a gastrostomy tube placed for feedings after a Nissen
fundoplication and bolus feedings are initiated. Between feedings while the tube
is clamped, the infant becomes irritable, and there is evidence of cramping. What
action should the nurse implement?

a. Burp the infant.

b. Withhold the next feeding.
c. Vent the gastrostomy tube.
d. Notify the health care provider.
ANS: C
If bolus feedings are initiated through a gastrostomy after a Nissen
fundoplication, the tube may need to remain vented for several days or longer to
avoid gastric distention from swallowed air. Edema surrounding the surgical site
and a tight gastric wrap may prohibit the infant from expelling air through the
esophagus, so burping does not relieve the distention. Some infants benefit from
clamping of the tube for increasingly longer intervals until they are able to
tolerate continuous clamping between feedings. During this time, if the infant
displays increasing irritability and evidence of cramping, some relief may be
provided by venting the tube. The next feeding should not be withheld, and
calling the health care provider is not necessary.
DIF: Cognitive Level: Applying REF: p. 1078
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
48. What intervention is contraindicated in a suspected case of appendicitis?

a. Enemas
b. Palpating the abdomen
c. Administration of antibiotics
d. Administration of antipyretics for fever
ANS: A
In any instance in which severe abdominal pain is observed and appendicitis is
suspected, the nurse must be aware of the danger of administering laxatives or
enemas. Such measures stimulate bowel motility and increase the risk of
perforation. The abdomen is palpated after other assessments are made.
Antibiotics should be administered, and antipyretics are not contraindicated.
DIF: Cognitive Level: Analyzing REF: p. 1080 TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment
49. The nurse is caring for a child with Meckel diverticulum. What type of stool
does the nurse expect to observe?

a. Steatorrhea
b. Clay colored
c. Currant jellylike
d. Loose stools with undigested food
ANS: C
In Meckel diverticulum the bleeding is usually painless and may be dramatic and
occur as bright red or currant jellylike stools, or it may occur intermittently and
appear as tarry stools. The stools are not clay colored, steatorrhea, or loose with
undigested food.
DIF: Cognitive Level: Understanding REF: p. 1083
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
50. The nurse is evaluating the laboratory results of a stool sample. What is a
normal finding?

a. The laboratory reports a stool pH of 5.0.

b. The laboratory reports a negative guaiac.
c. The laboratory reports low levels of enzymes.
d. The laboratory reports reducing substances present.
ANS: B
The normal stool finding is a negative guaiac. Stool pH should be 7.0 to 7.5. A
stool pH <5.0 is suggestive of carbohydrate malabsorption; colonic bacterial
fermentation produces short-chain fatty acids, which lower stool pH. There
should be no enzymes or reducing substances present in a normal stool sample.
DIF: Cognitive Level: Analyzing REF: p. 1056 TOP: Nursing Process: Evaluation
MSC: Client Needs: Physiological Integrity
MULTIPLE RESPONSE
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.)

Elevate the head of the bed in the crib to a 90-degree angle while
a. the infant is sleeping.
b. Hold the infant in the prone position after a feeding.
Discontinue breastfeeding so that a formula and rice cereal
c. mixture can be used.
The infant will require the Nissen fundoplication after 1 year of
d. age.
Prescribed cimetidine (Tagamet) should be given 30 minutes
e. before feedings.
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.
DIF: Cognitive Level: Applying REF: p. 1078
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Physiological Integrity
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
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.
DIF: Cognitive Level: Applying REF: p. 1093
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
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 beverages
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.
DIF: Cognitive Level: Applying REF: p. 1102
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
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 cereal
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.
DIF: Cognitive Level: Applying REF: p. 1073
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
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
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.
DIF: Cognitive Level: Applying REF: p. 1076
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Health Promotion and Maintenance
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
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.
DIF: Cognitive Level: Applying REF: p. 1078
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
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
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.
DIF: Cognitive Level: Understanding REF: p. 1096
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
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
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 occur.
DIF: Cognitive Level: Applying REF: p. 1096
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
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
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.
DIF: Cognitive Level: Applying REF: p. 1079
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
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
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.
DIF: Cognitive Level: Applying REF: p. 1092
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
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
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.
DIF: Cognitive Level: Applying REF: p. 1076
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
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.
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.
DIF: Cognitive Level: Understanding REF: p. 1101
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
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.
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.
DIF: Cognitive Level: Understanding REF: p. 1101
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
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.
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.
DIF: Cognitive Level: Applying REF: p. 1085
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
COMPLETION
1. The health care provider has prescribed ondansetron (Zofran) 0.1 mg/kg as
needed for nausea for a child admitted for vomiting. The child weighs 55 lb.
Calculate the correct dose of Zofran in milligrams. Record your answer using one
decimal place.
_________________
ANS:
2.5
The correct calculation is:
55 lb/2.2 kg = 25 kg
Dose of Zofran is 0.1 mg/kg
0.1 mg 25 = 2.5 mg
DIF: Cognitive Level: Applying REF: p. 1069
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
2. The health care provider has prescribed metronidazole (Flagyl) 30 mg/kg a
day divided q 6 hours for a child with peptic ulcer disease. The child weighs 110
lb. The nurse is preparing to administer the 1200 dose. Calculate the dose the
nurse should administer in mg. Record your answer in a whole number.
______________
ANS:
375
The correct calculation is:
110 lb/2.2 kg = 50 kg
Dose of Flagyl: 30 mg/kg a day
30 mg 50 = 1500 mg a day
1500 mg/4 = 375 mg for one dose.
DIF: Cognitive Level: Applying REF: p. 1086
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
3. The health care provider has prescribed clarithromycin (Biaxin) 20 mg/kg/day
divided bid for a child with peptic ulcer disease. The child weighs 77 lb. The
nurse is preparing to administer the 0900 dose. Calculate the dose the nurse
should administer in milligrams. Record your answer in a whole number.
_______________
ANS:
350
The correct calculation is:
77 lb/2.2 kg = 35 kg
Dose of Biaxin is 20 mg/kg/day divided bid
20 mg 35 = 700 mg
700 mg/2 = 350 mg for one dose
DIF: Cognitive Level: Applying REF: p. 1090
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
4. The health care provider has prescribed famotidine (Pepcid) 1 mg/kg/day
divided bid for a child with gastroesophageal reflux disease. The child weighs 33
lb. The nurse is preparing to administer the 0900 dose. Calculate the dose the
nurse should administer in milligrams. Record your answer using one decimal
place.
_______________
ANS:
7.5
The correct calculation is:
33 lb/2.2 kg = 15 kg
Dose of Pepcid is 1 mg/kg/day divided bid
1 mg 15 = 15 mg
15 mg/2 = 7.5 mg
DIF: Cognitive Level: Applying REF: p. 1090
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
MATCHING
Diagnosis of hepatitis B is confirmed by the detection of various hepatitis virus
antigens, and the antibodies that are produced in response to the infection. Match
the antibody or antigen to its definition.

a. HBsAg
b. Anti-HBs
c. HBcAg
d. HBeAg
1. Indicates active infection
2. Detected only in the liver
3. Indicates resolving or past infection
4. Indicates ongoing infection or carrier state
1. ANS: D DIF: Cognitive Level: Understanding REF: p. 1102
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
2. ANS: C DIF: Cognitive Level: Understanding REF: p. 1103
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
3. ANS: B DIF: Cognitive Level: Understanding REF: p. 1103
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
4. ANS: A DIF: Cognitive Level: Understanding REF: p. 1103
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance