Gastrointestinal Disorders of the Child NCLEX

Gastrointestinal Disorders of the Child NCLEX

Which of the following would cause a child to be at risk for oral candidiasis?

• Corticosteroid use
• Antibiotic Use
• Cancer of the eye
• Reuse of pacifiers
• Family history - Answer: A and B. Anything that suppresses the child's immune system can place the

child at risk for development of oral thrush. Corticosteroid use and immunosuppressive medication medications/conditions can cause this. Antibiotics use kills bacteria in the oral area, which can give fungus an opportunity to invade. Cancer of the eye alone would not place the child at risk, the medications used to treat the cancer could.

The nurse is administer Mycostatin the child who has been diagnosed with having oral thrush. Which of the following should the nurse include in the plan of administration?

• Administer this medication with every meal
• Avoid using a cotton tipped applicator as this interferes with the medication mechanism of action
• Plan on administering the medication once a day
• The mother may need to be treated as well as the child - Answer: D. This is true for breastfeeding

children. The mother will also need to be treated as fungus can easily spread from the child's mouth to the nipple and surrounding area. This medication is administered after meals in order to give the longest amount of contact possible with the oral growths. A cotton tipped applicator may be used.Breastfeeding may continue as long as the thrush is being appropriately treated.

Which of the following assessment findings would the nurse most expect to find in the child who has been diagnosed with having hypertrophic pyloric stenosis?

• Currant jelly stools and a palpable, hard mass in the right upper quadrant
• Projectile vomiting and hunger soon afterwards

• Weight loss and bloody diarrhea
• Severe, crampy abdominal pain and lethargy - Answer: B. Pyloric stenosis is where the pylorus

becomes edematous and large blocking the entrance out of the stomach. Projectile (forceful vomiting) and hunger afterwards would be expected in pyloric stenosis, as all nutrition is being blocked from heading into the small intestine. Other symptoms include a palpable mass in the right upper quadrant, weight loss, dehydration, and lethargy. Currant jelly stools and diarrhea would not be expected with this disorder because of the blockage created.

A mother and 7 month old infant present to the pediatric clinic. The infant appears developmentally appropriate and healthy, but the mother tells you that she is exacerbated. She says yesterday her infant had been incessantly crying with vomiting and jelly-like stool. But now, the infant appears fine. Which of the following GI disorders does the nurse suspect?

• Hypertrophic pyloric stenosis
• Celiac's disease
• Intussusception
• Encopresis - Answer: C. Intussusception is when a proximal portion of the bowel "telescopes" into a

more distal portion. This produces sudden onset, crampy abdominal pain accompanied by currant jelly stools, vomiting, crying/knee drawing up, and lethargy. This disorder is episodic and often the bowel will suddenly reduce down temporarily eliminating symptoms.

A mother and 7 month old infant present to the pediatric clinic. The infant appears developmentally appropriate and healthy, but the mother tells you that she is exacerbated. She says yesterday her infant had been incessantly crying with vomiting and jelly-like stool. But now is fine. What is the nurse's first action?

• Determine prenatal status of the mother and child
• Prepare the child for immediate surgery
• Palpate the stomach for a mass
• Administer barium enema - Answer: C. Page 725. ADPIE. The nurse would further assess the child.

The nurse suspects this child to possibly have intussusception. A "sausage-like" mass in the upper mid- abdomen is a hallmark sign of intussusception. It may not be present at this time, but it would be important to assess for this finding. A barium enema is often used to treat this disorder. Surgery can also be used. The prenatal status of the mother/child would not be a priority assessment.

You are the awesome nursing teacher with a huge class of 80 students. Yikes. Anyway, in pediatric clinical, you ask the students to differentiate omphalocele and gastroschisis. Which statement, if made by a student, indicates that they were smart and knew the right answer?

• The contents of the omphacele contain organs such as the bladder and uterus while gastroschisis

contains pieces of the digestive tract

• With omphacele, the organs are covered with a protective sheath while with gastroschisis the organs

protruding from the abdomen are exposed completely.

• In gastroschisis, parts of the intestines protrude through in a sac from the umbilicus while in

omphacele, they can protrude from anywhere in the abdominal wall.

• Both disorders consist of portions of the digestive tract protruding out of a dysfunctional abdominal

wall, gastroschisis also contains portions of the biliary tract - Answer: B. See page 711.

When planning care for the infant diagnosed with cleft lip and palate, which action would the nurse take in relation to the priority nursing diagnosis for this child?

• Prevent the baby from vigorously crying
• Burp the baby well throughout feedings
• Temporarily refrain from having the baby breastfeed
• Encourage mother to use false palate covering when feeding baby - Answer: D. A false palate

covering will help prevent the baby from aspirating while breastfeeding by providing a covering for the cleft palate. Adaptive nipples can also be used for this purpose. Burping the baby would be important to include in the plan of care, but would not be for the priority nursing diagnosis of risk for aspiration. It would not be necessary to have the baby refrain from breastfeeding. Preventing the baby from vigorously crying would be important postoperatively to prevent sutures from ripping.

The nurse is caring for the child with cleft lip and palate. Which of the following does the nurse

understand as a complication of this disorder? Select all that apply:

• Heart malformation
• Otitis media
• Altered dentation
• Speech impediments

• Encopresis - Answer: B, C, and D. These are complications that can occur with cleft lip and palate.

Others include feeding difficulties, aspiration, and hearing loss (related to ear infections). Page 707.

You are taking care of an infant who has come back from having cleft lip and palate repair. The nurse

would include all of the following in the plan of care except:

• Use of pacifier to prevent vigorous crying
• Holding, cuddling and rocking of infant
• Arm restraints or mummy restraint
• Placing infant in the supine position - Answer: A. It would be important to protect the palate

operative site by avoiding putting items in the mouth that might disrupt the sutures such as suction catheters, spoons, straws, pacifiers, or plastic syringes. It would be important to keep the infant from rubbing the surgical sight. To prevent this the infant will be placed in the supine or side-lying position and arm restraints are often used. Holding, cuddling and rocking the infant can help soothe and comfort the infant after surgery.

The nurse understands that the young child is at a greater risk of developing fluid loss than an adult

because of which of the following? Select all that apply:

• Greater body surface area
• Thinner skin
• Renal immaturity
• Higher likelihood of febrile illness

E) Higher basic metabolic rate - Answer: A, C, D, and E. (pages 695-696)

A pediatric nurse is assessing a 2-month-old child who has been vomiting for the past 48 hours with accompanying fever of 100.7. The nurse recognizes that which of the following does not represent dehydration in an infant?1) 3-5 wet diapers a day for the past 2 days 2) Lack of tears when crying 3) Puffiness of the skin