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Chapter 24: The Child with Gastrointestinal
Dysfunction
Chapter 24: The Child with Gastrointestinal Dysfunction
MULTIPLE CHOICE
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
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
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
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
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
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
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
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
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
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.
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.
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
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.
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.
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
TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
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
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
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.”
b. “I should encourage my child to drink carbonated drinks but avoid food for the next 24
hours.”
c. “I will offer my child bananas, rice, applesauce, and toast for the next 48 hours.”
d. “I should have my child eat a normal diet with easily digested foods for the next 48 hours.”
ANS: D
Easily digested foods such as cereals, cooked vegetables, and meats should be provided for
the child. Early reintroduction of nutrients is desirable. Continued feeding or reintroduction of
a regular diet has no adverse effects and actually lessens the severity and duration of the
illness. Clear liquids and carbonated drinks have high carbohydrate content and few
electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic.
The BRAT diet has little nutritional value and is high in carbohydrates.
PTS: 1 DIF: Cognitive Level: Apply REF: 775-776
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Basic Care and Comfort
12. A young child is brought to the emergency department with severe dehydration
secondary to acute diarrhea and vomiting. Therapeutic management of this child should
begin with:
a. intravenous (IV) fluids.
b. ORS.
c. clear liquids, 1 to 2 ounces at a time.
d. administration of antidiarrheal medication.
ANS: A
In children with severe dehydration, IV fluids are initiated. ORS is acceptable therapy if the
dehydration is not severe. Diarrhea is not managed by using clear liquids by mouth. These
fluids have a high carbohydrate content, low electrolyte content, and high osmolality.
Antidiarrheal medications are not recommended for the treatment of acute infectious
diarrhea.
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