THE CHILD WITH GASTROINSTESTINAL DYSFUNCTION
1
(Important Chapters 22,24, 25, 26, 27, 30 Wong, 30,31, 32 Foundations)
Chapter 24 The Child with Gastrointestinal Dysfunction
1. Which condition in a child should alert a nurse for increased fluid requirements?
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. Respiratory rate influences insensible fluid loss and
should be monitored in the mechanically ventilated child. Congestive heart failure is a
case of fluid overload in children. Increased ICP does not lead to increased fluid
requirements in children.
PTS: 1 DIF: Cognitive Level: Understand REF: 763
2. A nurse is conducting an in-service on gastrointestinal disorders. The nurse includes that
melena, the passage of black, tarry stools, suggests bleeding from which area?
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.
Blood from the perianal or rectal area, hemorrhoids, or lower GI tract would be bright
red.
PTS: 1 DIF: Cognitive Level: Apply REF: 792
3. Which 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. Hypotonic dehydration occurs when the electrolyte deficit
exceeds the water deficit, leaving the serum hypotonic. Hypertonic dehydration results
from water loss in excess of electrolyte loss and is usually caused by a proportionately
larger loss of water or a larger intake of electrolytes. This definition is specific to isotonic
dehydration.
PTS: 1 DIF: Cognitive Level: Understand REF: 767
4. A nurse is admitting an infant with dehydration caused from water loss in excess of electrolyte
loss. Which type of dehydration is this infant experiencing?
a. Isotonic
, 2
(Important Chapters 22,24, 25, 26, 27, 30 Wong, 30,31, 32 Foundations)
b. Isosmotic
c. Hypotonic
d. Hypertonic -
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. Isotonic dehydration occurs in conditions in which electrolyte and
water deficits are present in balanced proportion and is another term for isotonic
dehydration. Hypotonic dehydration occurs when the electrolyte deficit exceeds the water
deficit, leaving the serum hypotonic.
PTS: 1 DIF: Cognitive Level: Understand REF: 767
5. An infant is brought to the emergency department with dehydration. Which physical
assessment finding does the nurse expect?
a. Weight gain
b. Bradycardia
c. Poor skin turgor
d. Brisk capillary refill -
ANS: C
Clinical manifestations of dehydration include poor skin turgor, weight loss, lethargy, and
tachycardia. The infant would have prolonged capillary refill, not brisk.
PTS: 1 DIF: Cognitive Level: Understand REF: 767
6. Parents call the clinic and report that their toddler has had acute diarrhea for 24 hours. The
nurse should further ask the parents if the toddler has which associated factor that is causing the
acute diarrhea?
a. Celiac disease
b. Antibiotic therapy
c. Immunodeficiency
d. 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. Celiac disease is a problem with gluten
intolerance and may cause chronic diarrhea if not identified and managed appropriately.
Immunodeficiency would occur with chronic diarrhea. Protein malnutrition or
kwashiorkor causes chronic diarrhea from lowered resistance to infection.
PTS: 1 DIF: Cognitive Level: Apply REF: 772
7. Which pathogen 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
, 3
(Important Chapters 22,24, 25, 26, 27, 30 Wong, 30,31, 32 Foundations)
Rotavirus is the most frequent viral pathogen that causes diarrhea in young children.
Giardia (parasite) and Salmonella are bacterial pathogens that cause diarrhea. Shigella is
a bacterial pathogen that is uncommon in the United States.
PTS: 1 DIF: Cognitive Level: Understand REF: 772
8. Which is a parasite that causes acute diarrhea?
a. Shigella organisms
b. Salmonella organisms
c. Giardia lamblia
d. Escherichia coli -
ANS: C
G. lamblia is a parasite that represents 10% of non-dysenteric illness in the United States.
Shigella, Salmonella, and E. coli are bacterial pathogens.
PTS: 1 DIF: Cognitive Level: Understand REF: 775
9. A child is admitted with bacterial gastroenteritis. Which lab results of a stool specimen
confirm this diagnosis?
a. Eosinophils
b. Occult blood
c. pH less than 6
d. Neutrophils and red blood cells -
ANS: D
Neutrophils and red blood cells in stool indicate bacterial gastroenteritis. Protein
intolerance and parasitic infections are suspected in the presence of eosinophils. Occult
blood may indicate pathogens such as Shigella, Campylobacter, or hemorrhagic
Escherichia coli strains. A pH of less than 6 may indicate carbohydrate malabsorption or
secondary lactase insufficiency.
PTS: 1 DIF: Cognitive Level: Understand REF: 775
10. Which therapeutic management should the nurse prepare to initiate first for a child with acute
diarrhea and moderate dehydration?
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. Clear liquids are not recommended because
they contain too much sugar, which may contribute to diarrhea. Adsorbents are not
recommended. Antidiarrheals are not recommended because they do not get rid of
pathogens.
PTS: 1 DIF: Cognitive Level: Apply REF: 775
11. A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet
with the family. Which 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."
1
(Important Chapters 22,24, 25, 26, 27, 30 Wong, 30,31, 32 Foundations)
Chapter 24 The Child with Gastrointestinal Dysfunction
1. Which condition in a child should alert a nurse for increased fluid requirements?
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. Respiratory rate influences insensible fluid loss and
should be monitored in the mechanically ventilated child. Congestive heart failure is a
case of fluid overload in children. Increased ICP does not lead to increased fluid
requirements in children.
PTS: 1 DIF: Cognitive Level: Understand REF: 763
2. A nurse is conducting an in-service on gastrointestinal disorders. The nurse includes that
melena, the passage of black, tarry stools, suggests bleeding from which area?
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.
Blood from the perianal or rectal area, hemorrhoids, or lower GI tract would be bright
red.
PTS: 1 DIF: Cognitive Level: Apply REF: 792
3. Which 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. Hypotonic dehydration occurs when the electrolyte deficit
exceeds the water deficit, leaving the serum hypotonic. Hypertonic dehydration results
from water loss in excess of electrolyte loss and is usually caused by a proportionately
larger loss of water or a larger intake of electrolytes. This definition is specific to isotonic
dehydration.
PTS: 1 DIF: Cognitive Level: Understand REF: 767
4. A nurse is admitting an infant with dehydration caused from water loss in excess of electrolyte
loss. Which type of dehydration is this infant experiencing?
a. Isotonic
, 2
(Important Chapters 22,24, 25, 26, 27, 30 Wong, 30,31, 32 Foundations)
b. Isosmotic
c. Hypotonic
d. Hypertonic -
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. Isotonic dehydration occurs in conditions in which electrolyte and
water deficits are present in balanced proportion and is another term for isotonic
dehydration. Hypotonic dehydration occurs when the electrolyte deficit exceeds the water
deficit, leaving the serum hypotonic.
PTS: 1 DIF: Cognitive Level: Understand REF: 767
5. An infant is brought to the emergency department with dehydration. Which physical
assessment finding does the nurse expect?
a. Weight gain
b. Bradycardia
c. Poor skin turgor
d. Brisk capillary refill -
ANS: C
Clinical manifestations of dehydration include poor skin turgor, weight loss, lethargy, and
tachycardia. The infant would have prolonged capillary refill, not brisk.
PTS: 1 DIF: Cognitive Level: Understand REF: 767
6. Parents call the clinic and report that their toddler has had acute diarrhea for 24 hours. The
nurse should further ask the parents if the toddler has which associated factor that is causing the
acute diarrhea?
a. Celiac disease
b. Antibiotic therapy
c. Immunodeficiency
d. 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. Celiac disease is a problem with gluten
intolerance and may cause chronic diarrhea if not identified and managed appropriately.
Immunodeficiency would occur with chronic diarrhea. Protein malnutrition or
kwashiorkor causes chronic diarrhea from lowered resistance to infection.
PTS: 1 DIF: Cognitive Level: Apply REF: 772
7. Which pathogen 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
, 3
(Important Chapters 22,24, 25, 26, 27, 30 Wong, 30,31, 32 Foundations)
Rotavirus is the most frequent viral pathogen that causes diarrhea in young children.
Giardia (parasite) and Salmonella are bacterial pathogens that cause diarrhea. Shigella is
a bacterial pathogen that is uncommon in the United States.
PTS: 1 DIF: Cognitive Level: Understand REF: 772
8. Which is a parasite that causes acute diarrhea?
a. Shigella organisms
b. Salmonella organisms
c. Giardia lamblia
d. Escherichia coli -
ANS: C
G. lamblia is a parasite that represents 10% of non-dysenteric illness in the United States.
Shigella, Salmonella, and E. coli are bacterial pathogens.
PTS: 1 DIF: Cognitive Level: Understand REF: 775
9. A child is admitted with bacterial gastroenteritis. Which lab results of a stool specimen
confirm this diagnosis?
a. Eosinophils
b. Occult blood
c. pH less than 6
d. Neutrophils and red blood cells -
ANS: D
Neutrophils and red blood cells in stool indicate bacterial gastroenteritis. Protein
intolerance and parasitic infections are suspected in the presence of eosinophils. Occult
blood may indicate pathogens such as Shigella, Campylobacter, or hemorrhagic
Escherichia coli strains. A pH of less than 6 may indicate carbohydrate malabsorption or
secondary lactase insufficiency.
PTS: 1 DIF: Cognitive Level: Understand REF: 775
10. Which therapeutic management should the nurse prepare to initiate first for a child with acute
diarrhea and moderate dehydration?
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. Clear liquids are not recommended because
they contain too much sugar, which may contribute to diarrhea. Adsorbents are not
recommended. Antidiarrheals are not recommended because they do not get rid of
pathogens.
PTS: 1 DIF: Cognitive Level: Apply REF: 775
11. A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet
with the family. Which 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."
