Peds - GI, GU, Cardiac Practice Questions and 100% Correct Answers
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Therapeutic management of most children with Hirschsprung's disease is primarily: a.Daily enemas. b.Low-fiber diet. c.Permanent colostomy. d.Surgical removal of affected section of bowel ANS: D. Surgical removal of affected section of bowel Most children with Hirschsprung's disease require surgical...
therapeutic management of most children with hirsc
most children with hirschsprungs disease require
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Peds - GI, GU, Cardiac Practice
Questions and 100% Correct Answers
Therapeutic management of most children with Hirschsprung's disease is primarily:
a.Daily enemas.
b.Low-fiber diet.
c.Permanent colostomy.
d.Surgical removal of affected section of bowel ✅ANS: D. Surgical removal of affected
section of bowel
Most children with Hirschsprung's disease require surgical rather than medical
management. Surgery is done to remove the aganglionic portion of the bowel, relieve
obstruction, and restore normal bowel motility and function of the internal anal sphincter.
Preoperative management may include enemas and low-fiber, high-calorie, high-protein
diet until the child is physically ready for surgery. The colostomy that is created in
Hirschsprung's disease is usually temporary.
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?
1.Diarrhea
2.Projectile vomiting
3.Regurgitation of feedings
4.Foul-smelling ribbon-like stools ✅ANS: 4. Foul-smelling ribbon-like stools
Hirschsprung's disease is a congenital anomaly also known as congenital aganglionosis
or aganglionic megacolon. It occurs as the result of an absence of ganglion cells in the
rectum and other areas of the affected intestine. Chronic constipation beginning in the
first month of life and resulting in pellet-like or ribbon-like stools that are foul-smelling is
a clinical manifestation of this disorder. Delayed passage or absence of meconium stool
in the neonatal period is also a sign. Bowel obstruction, especially in the neonatal
period; abdominal pain and distention; and failure to thrive are also clinical
manifestations. Options 1, 2, and 3 are not associated specifically with this disorder.
A histamine-receptor antagonist such as cimetidine (Tagamet) or ranitidine (Zantac) is
ordered for an infant with gastroesophageal reflux. The purpose of this is to:
a.Prevent reflux.
b.Prevent hematemesis.
c.Reduce gastric acid production.
d.Increase gastric acid production. ✅ANS: C. Reduce gastric acid production.
The mechanism of action of histamine-receptor antagonists is to reduce the amount of
acid present in gastric contents and may prevent esophagitis. Preventing reflux and
hematemesis, and increasing gastric acid production are not the modes of action of
histamine-receptor antagonists.
,A 4-month-old infant has gastroesophageal reflux disease (GERD) but is thriving
without other complications. What should the nurse suggest to minimize reflux?
a.Place in Trendelenburg position after eating.
b.Thicken formula with rice cereal.
c.Give continuous nasogastric tube feedings.
d.Give larger, less frequent feedings. ✅ANS: B. Thicken formula with rice cereal.
Small frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice
cereal per ounce of formula has been recommended. Milk thickening agents have been
shown to decrease the number of episodes of vomiting and increase the caloric density
of the formula. This may benefit infants who are underweight as a result of GERD.
Placing the child in a Trendelenburg position would increase the reflux. Continuous
nasogastric feedings are reserved for infants with severe reflux and failure to thrive.
Smaller, more frequent feedings are recommended in reflux.
An infant is seen in the health care provider's office for complaints of frequent vomiting
and spitting up after feedings. Findings indicate that the infant is not gaining weight, and
gastroesophageal reflux is suspected. Which would the nurse anticipate being
prescribed initially in the care of this child?
1.Administer omeprazole before feeding.
2.Place in prone position after each feeding.
3.Instruct parents to keep a log of feedings and any reflux present.
4.Administer predigested formula and feed small, frequent feedings. ✅ANS: 4.
Administer predigested formula and feed small, frequent feedings
For infants with frequent vomiting and spitting up, the diagnosis of gastroesophageal
reflux should be considered. The initial action is to alter the formula to a predigested
formula and feed small, frequent feedings.After the formula is changed, the family will
be instructed to keep a log of feedings and any reflux with the new formula. Medication
is not started until after the formula is changed. A prone position increases the risk of
reflux and thus aspiration.
The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this
infant's postoperative care include:
a.Arm restraints, postural drainage, mouth irrigations.
b.Cleansing suture line, supine and side-lying positions, arm restraints.
c.Mouth irrigations, prone position, cleansing suture line.
d.Supine and side-lying positions, postural drainage, arm restraints. ✅ANS: B.
Cleansing suture line, supine and side-lying positions, arm restraints.
The suture line should be cleansed gently after feeding. The child should be positioned
on back or side or in infant seat. Elbows are restrained to prevent the child from
accessing the operative site. Postural drainage is not indicated. This would increase the
pressure on the operative site when the child is placed in different positions. Mouth
irrigations would not be indicated.
During the first few days after surgery for cleft lip, which intervention should the nurse
do?
a. Leave infant in crib at all times to prevent suture strain.
, b. Keep infant heavily sedated to prevent suture strain.
c. Remove restraints periodically to cuddle infant.
d. Alternate position from prone to side-lying to supine. ✅ANS: C. Remove restraints
periodically to cuddle infant
Remove restraints periodically, while supervising the infant, to allow him or her to
exercise arms and to provide cuddling and tactile stimulation. The infant should not be
left in the crib, but should be removed for appropriate holding and stimulation. Analgesia
and sedation are administered for pain. Heavy sedation is not indicated. The child
should not be placed in the prone position.
A nurse is caring for an infant who has a cleft palate. The parents ask the nurse how
long they should wait before the child can have corrective surgery. The nurse should
explain that the parents should wait no longer than 6 to 12 months for surgery to
prevent which of the following outcomes?
A. Repeated ear infections
B. Nutritional deficits
C. Immune system deficits
D. Difficulty with language acquisitions. ✅D. Difficulty with language acquisitions.
Rationale: Clients who have a cleft palate can have difficulty acquiring language
because they need to use the palate for vocalizing sounds. Because of the cleft in the
palate, these infants could develop poor speech habits.
The nurse is providing discharge instructions to the mother of a child who had a cleft
palate repair. Which statement should the nurse make to the mother?
1."You should use a plastic spoon to feed the child."
2."You need to use an orthodontic nipple on the child's bottle."
3."You can allow the child to use a pacifier but only for 30 minutes at a time."
4."You need to monitor the child's temperature for signs of infection using an oral
thermometer." ✅ANS: 2. "You need to use an orthodontic nipple on the child's bottle."
An orthodontic nipple should be placed on the child's bottle, and the mother should be
instructed to give the child baby food or baby food mixed with water. The mother should
be instructed that straws, pacifiers, spoons, or fingers must be kept away from the
child's mouth for 7 to 10 days after surgery. A pacifier should not be used for at least 2
weeks following the surgical repair. Additionally, the mother should be advised to avoid
taking oral temperatures.
The nurse is caring for a neonate with a suspected tracheoesophageal fistula. Nursing
care should include:
a.Elevating the head but giving nothing by mouth.
b.Elevating the head for feedings.
c.Feeding glucose water only.
d.Avoiding suctioning unless the infant is cyanotic. ✅ANS: A. Elevating the head but
giving nothing by mouth
When a newborn is suspected of having tracheoesophageal fistula, the most desirable
position is supine with the head elevated on an incline plane of at least 30 degrees. It is
imperative that any source of aspiration be removed at once; oral feedings are withheld.
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