EXAM_4_SAUNDERS_GASTROINTESTINAL_DYSFUNCTION.docx
1. The clinic nurse reviews the record of an infant and notes that the health care provider
has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the
assessment findings documented in the record, knowing that which sign most likely led
the mother to seek health care for the infant?
Foul-smelling ribbon-like stools
2. An infant has just returned to the nursing unit after surgical repair of a cleft lip on the
right side. The nurse should place the infant in which best position at this time?
Left lateral position
3. The nurse reviews the record of a newborn infant and notes that a
diagnosis of esophageal atresia with tracheoesophageal fistula is
suspected. The nurse expects to note which most likely sign of this
condition documented in the record?
Choking with feedings
4. The nurse provides feeding instructions to a parent of an infant diagnosed
with gastroesophageal reflux disease. Which instruction should the nurse
give to the parent to assist in reducing the episodes of emesis?
Thicken the feedings by adding rice cereal to the formula.
5. A child is hospitalized because of persistent vomiting. The nurse should
monitor the child closely for which problem?
Metabolic alkalosis
6. The nurse is caring for a newborn with a suspected diagnosis of
imperforate anus. The nurse monitors the infant, knowing that which is a
clinical manifestation associated with this disorder?
Failure to pass meconium stool in the first 24 hours after birth
7. The nurse admits a child to the hospital with a diagnosis of pyloric
stenosis. On assessment, which data would the nurse expect to obtain
when asking the parent about the child's symptoms?
Projectile vomiting
8. The nurse is preparing to care for a child with a diagnosis of
intussusception. The nurse reviews the child's record and expects to note
which sign of this disorder documented?
Bright red blood and mucus in the stools
9. Which interventions should the nurse include when creating a care plan
for a child with hepatitis? Select all that apply.
Providing a low-fat, well-balanced diet
1
, EXAM_4_SAUNDERS_GASTROINTESTINAL_DYSFUNCTION.docx
Instructing the parents to avoid administering medications unless prescribed
Teaching the child effective hand-washing techniques
10. An infant born with an imperforate anus returns from surgery after
requiring a colostomy. The nurse assesses the stoma and notes that it is
red and edematous. Based on this finding, which action should the nurse
take?
Document the findings.
11. The clinic nurse is assessing jaundice in a child with hepatitis. Which
anatomical area would provide the best data regarding the presence of
jaundice?
The nail beds
12. The parents of a newborn with a cleft lip are concerned and ask the nurse
when the lip will be repaired. With which statement should the nurse
respond?
Cleft-lip repair is usually performed during the first weeks of life.
13. A 1-year-old child is diagnosed with intussusception, and the mother of
the child asks the student nurse to describe the disorder. Which statement
by the student nurse indicates correct understanding of this disorder?
"It is a condition in which a proximal segment of the bowel prolapses into a
distal segment of the bowel."
14. A 3-year-old child is seen in the health care clinic, and a diagnosis of
encopresis is made. The nurse expects to provide teaching about which
client problem?
Odor
Rationale:
Encopresis is the repeated voluntary or involuntary passage of feces of normal or
near-normal consistency in places not appropriate for that purpose according to
the individual's own sociocultural setting. Signs include evidence of soiled
clothing, scratching or rubbing the anal area because of irritation, fecal odor
without apparent awareness by the child, and social withdrawal.
15. The nurse has been assigned to care for a neonate just delivered who has gastroschisis.
Which concern should the nurse address in the client's plan of care?
Infection
16. The nurse is assigned to care for a child who is scheduled for an appendectomy. Select
the prescriptions that the nurse anticipates will be prescribed. Select all that apply.
Initiate an IV line.
Maintain an NPO status.
2
1. The clinic nurse reviews the record of an infant and notes that the health care provider
has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the
assessment findings documented in the record, knowing that which sign most likely led
the mother to seek health care for the infant?
Foul-smelling ribbon-like stools
2. An infant has just returned to the nursing unit after surgical repair of a cleft lip on the
right side. The nurse should place the infant in which best position at this time?
Left lateral position
3. The nurse reviews the record of a newborn infant and notes that a
diagnosis of esophageal atresia with tracheoesophageal fistula is
suspected. The nurse expects to note which most likely sign of this
condition documented in the record?
Choking with feedings
4. The nurse provides feeding instructions to a parent of an infant diagnosed
with gastroesophageal reflux disease. Which instruction should the nurse
give to the parent to assist in reducing the episodes of emesis?
Thicken the feedings by adding rice cereal to the formula.
5. A child is hospitalized because of persistent vomiting. The nurse should
monitor the child closely for which problem?
Metabolic alkalosis
6. The nurse is caring for a newborn with a suspected diagnosis of
imperforate anus. The nurse monitors the infant, knowing that which is a
clinical manifestation associated with this disorder?
Failure to pass meconium stool in the first 24 hours after birth
7. The nurse admits a child to the hospital with a diagnosis of pyloric
stenosis. On assessment, which data would the nurse expect to obtain
when asking the parent about the child's symptoms?
Projectile vomiting
8. The nurse is preparing to care for a child with a diagnosis of
intussusception. The nurse reviews the child's record and expects to note
which sign of this disorder documented?
Bright red blood and mucus in the stools
9. Which interventions should the nurse include when creating a care plan
for a child with hepatitis? Select all that apply.
Providing a low-fat, well-balanced diet
1
, EXAM_4_SAUNDERS_GASTROINTESTINAL_DYSFUNCTION.docx
Instructing the parents to avoid administering medications unless prescribed
Teaching the child effective hand-washing techniques
10. An infant born with an imperforate anus returns from surgery after
requiring a colostomy. The nurse assesses the stoma and notes that it is
red and edematous. Based on this finding, which action should the nurse
take?
Document the findings.
11. The clinic nurse is assessing jaundice in a child with hepatitis. Which
anatomical area would provide the best data regarding the presence of
jaundice?
The nail beds
12. The parents of a newborn with a cleft lip are concerned and ask the nurse
when the lip will be repaired. With which statement should the nurse
respond?
Cleft-lip repair is usually performed during the first weeks of life.
13. A 1-year-old child is diagnosed with intussusception, and the mother of
the child asks the student nurse to describe the disorder. Which statement
by the student nurse indicates correct understanding of this disorder?
"It is a condition in which a proximal segment of the bowel prolapses into a
distal segment of the bowel."
14. A 3-year-old child is seen in the health care clinic, and a diagnosis of
encopresis is made. The nurse expects to provide teaching about which
client problem?
Odor
Rationale:
Encopresis is the repeated voluntary or involuntary passage of feces of normal or
near-normal consistency in places not appropriate for that purpose according to
the individual's own sociocultural setting. Signs include evidence of soiled
clothing, scratching or rubbing the anal area because of irritation, fecal odor
without apparent awareness by the child, and social withdrawal.
15. The nurse has been assigned to care for a neonate just delivered who has gastroschisis.
Which concern should the nurse address in the client's plan of care?
Infection
16. The nurse is assigned to care for a child who is scheduled for an appendectomy. Select
the prescriptions that the nurse anticipates will be prescribed. Select all that apply.
Initiate an IV line.
Maintain an NPO status.
2
