Test Bank - Introduction to Maternity and Pediatric Nursing 8e (by Leifer) 256
Chapter 28: The Child with a Gastrointestinal Condition
MULTIPLE CHOICE
1. Which finding in a newborn is suggestive of tracheoesophageal fistula?
a. Failure to pass meconium in 24 hours
b. Choking on the first feeding
c. Palpable mass in the sternal area
d. Visible peristalsis across abdomen
ANS: B
After birth, a newborn with tracheoesophageal fistula will vomit and choke when the first feeding is
introduced.
DIF: Cognitive Level: Comprehension REF: Page 660
TOP: Esophageal Atresia KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
2. A child is brought to the pediatric clinic because he has been vomiting for the past 2 days. What acid-base
imbalance would the nurse expect to occur from this persistent vomiting?
a. Hyperkalemia
b. Hypernatremia
c. Acidosis
d. Alkalosis
ANS: D
Hydrochloric acid and sodium chloride from the stomach are lost from persistent vomiting. This results in
alkalosis.
DIF: Cognitive Level: Comprehension REF: Page 666
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OBJ: 9 TOP: Acid-Base Balance
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
3. On the second day of hospitalization for a 3-month-old brought in for treatment for gastroenteritis, the nurse
makes all of the assessments listed below. Which assessment finding indicates ineffectiveness of treatment?
a. Weight loss of 4 ounces
b. Dry mucous membranes
c. Decreased skin turgor
d. Depressed fontanelle
ANS: A
Weight loss is the most significant indicator of dehydration because an infants weight comprises 77% water.
DIF: Cognitive Level: Application REF: Page 672
OBJ: 9 TOP: Dehydration KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
4. Why are rapid respirations a possible cause of dehydration?
a. They prevent the child from drinking.
b. They increase circulation, thus increasing urine production.
c. They cause evaporation of fluid on the mucous membranes.
d. They often lead to vomiting.
ANS: C
Rapid respirations cause increased insensible fluid loss.
DIF: Cognitive Level: Comprehension REF: Page 672
TOP: Dehydration KEY: Nursing Process Step: Data Collection
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, INTRODUCTION TO MATERNITY AND PEDIATRIC NURSING 8TH EDITION LEIFER TEST BANK
Test Bank - Introduction to Maternity and Pediatric Nursing 8e (by Leifer) 257
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
5. Which is the most appropriate intervention for a 3-month-old infant who has gastroesophageal reflux?
a. Position the infant in the crib on his or her abdomen, with the head elevated.
b. Administer medication as ordered to stimulate the pyloric sphincter.
c. Give thin rice cereal with formula before feeding solid foods.
d. Place the infant in an infant seat after feedings.
ANS: A
After feedings, the infant is placed in a prone position to avoid increased intraabdominal pressure.
DIF: Cognitive Level: Application REF: Page 667
TOP: Gastroesophageal Reflux KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
6. The nurse is interviewing parents of an infant with pyloric stenosis. What would the nurse expect the parents
to report?
a. Diarrhea
b. Projectile vomiting
c. Poor appetite
d. Constipation
ANS: B
Vomiting is the outstanding symptom of pyloric stenosis. Food is ejected with considerable force, which is
described as projectile vomiting.
DIF: Cognitive Level: Comprehension REF: Page 661
TOP: Pyloric Stenosis KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
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7. A mother reports that her child has been scratching the anal area and complaining of itching. What does the
nurse suspect based on this information?
a. Pinworms
b. Giardiasis
c. Ringworm
d. Roundworm
ANS: A
With pinworms, the nurse or parent may notice that the child scratches the anal area and complains of
itchiness. The other choices do not cause this reaction.
DIF: Cognitive Level: Application REF: Page 678
TOP: Worms KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
8. The nurse is teaching a parent about pyrvinium (Povan). What would be included in regard to potential side
effects?
a. Diarrhea
b. Skin rash
c. Red stool
d. Metallic taste
ANS: C
The nurse should advise parents that pyrvinium stains clothing and turns stools red.
DIF: Cognitive Level: Knowledge REF: Page 678
TOP: Worms KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
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