Comprehensive Clinical Case Study of an 18-Month-
Old Presenting with Vomiting and Diarrhea:
Samantha Graves | Updated for 2026/2027
What test is used to screen for carbohydrate malabsorption?
a. Stool pH
b. Urine ketones
c. C urea breath test
d. ELISA stool assay - answer-ANS: A
The anticipated pH of a stool specimen is 7.0. A stool pH of less than 5.0 is indicative of
carbohydrate malabsorption. The bacterial fermentation of carbohydrates in the colon
produces short-chain fatty acids, which lower the stool pH. Urine ketones detect the presence
of ketones in the urine, which indicates the use of alternative sources of energy to glucose. The
C urea breath test measures the amount of carbon dioxide exhaled. It is used to determine the
presence of Helicobacter pylori. ELISA (enzyme-linked immunosorbent assay) detects the
presence of antigens and antibodies. It is not useful for disorders of metabolism.
A toddler's mother calls the nurse because she thinks her son has swallowed a button type of
battery. He has no signs of respiratory distress. The nurse's response should be based on which
premise?
a. An emergency laparotomy is very likely.
b. The location needs to be confirmed by radiographic examination.
c. Surgery will be necessary if the battery has not passed in the stool in 48 hours.
d. Careful observation is essential because an ingested battery cannot be accurately detected. -
answer-ANS: B
Button batteries can cause severe damage if lodged in the esophagus. If both poles of the
battery come in contact with the wall of the esophagus, acid burns, necrosis, and perforation
1
,can occur. If the battery is in the stomach, it will most likely be passed without incident. Surgery
is not indicated. The battery is metallic and is readily seen on radiologic examination.
The mother of a child with cognitive impairment calls the nurse because her son has been
gagging and drooling all morning. The nurse suspects foreign body ingestion. What physiologic
occurrence is most likely responsible for the presenting signs?
a.Gastrointestinal perforation may have occurred.
b.The object may have been aspirated.
c.The object may be lodged in the esophagus.
d.The object may be embedded in stomach wall. - answer-ANS: C
Gagging and drooling may be signs of esophageal obstruction. The child is unable to swallow
saliva, which contributes to the drooling. Signs of gastrointestinal (GI) perforation include chest
or abdominal pain and evidence of bleeding in the GI tract. If the object was aspirated, the child
would most likely have coughing, choking, inability to speak, or difficulty breathing. If the object
was embedded in the stomach wall, it would not result in symptoms of gagging and drooling.
What is a high-fiber food that the nurse should recommend for a child with chronic
constipation?
a.White rice
b.Popcorn
c.Fruit juice
d.Ripe bananas - answer-ANS: B
Popcorn is a high-fiber food. Refined rice is not a significant source of fiber. Unrefined brown
rice is a fiber source. Fruit juices are not a significant source of fiber. Raw fruits, especially those
with skins and seeds, other than ripe bananas, have high fiber.
2
,A 2-year-old child has a chronic history of constipation and is brought to the clinic for
evaluation. What should the therapeutic plan initially include?
a.Bowel cleansing
b.Dietary modification
c.Structured toilet training
d.Behavior modification - answer-ANS: A
The first step in the treatment of chronic constipation is to empty the bowel and allow the
distended rectum to return to normal size. Dietary modification is an important part of the
treatment. Increased fiber and fluids should be gradually added to the child's diet. A 2-year-old
child is too young for structured toilet training. For an older child, a regular schedule for
toileting should be established. Behavior modification is part of the overall treatment plan. The
child practices releasing the anal sphincter and recognizing cues for defecation.
What statement best describes Hirschsprung disease?
a.The colon has an aganglionic segment.
b.It results in frequent evacuation of solids, liquid, and gas.
c.The neonate passes excessive amounts of meconium.
d.It results in excessive peristaltic movements within the gastrointestinal tract. - answer-ANS: A
Mechanical obstruction in the colon results from a lack of innervation. In most cases, the
aganglionic segment includes the rectum and some portion of the distal colon. There is
decreased evacuation of the large intestine secondary to the aganglionic segment. Liquid stool
may ooze around the blockage. The obstruction does not affect meconium production. The
infant may not be able to pass the meconium stool. There is decreased movement in the colon.
3
, What procedure is most appropriate for assessment of an abdominal circumference related to a
bowel obstruction?
a.
Measuring the abdomen after feedings
b.
Marking the point of measurement with a pen
c.
Measuring the circumference at the symphysis pubis
d.
Using a new tape measure with each assessment to ensure accuracy - answer-ANS: B
Pen marks on either side of the tape measure allow the nurse to measure the same spot on the
child's abdomen at each assessment. The child most likely will be kept NPO (nothing by mouth)
if a bowel obstruction is present. If the child is being fed, the assessment should be done before
feedings. The symphysis pubis is too low. Usually the largest part of the abdomen is at the
umbilicus. Leaving the tape measure in place reduces the trauma to the child.
4
Old Presenting with Vomiting and Diarrhea:
Samantha Graves | Updated for 2026/2027
What test is used to screen for carbohydrate malabsorption?
a. Stool pH
b. Urine ketones
c. C urea breath test
d. ELISA stool assay - answer-ANS: A
The anticipated pH of a stool specimen is 7.0. A stool pH of less than 5.0 is indicative of
carbohydrate malabsorption. The bacterial fermentation of carbohydrates in the colon
produces short-chain fatty acids, which lower the stool pH. Urine ketones detect the presence
of ketones in the urine, which indicates the use of alternative sources of energy to glucose. The
C urea breath test measures the amount of carbon dioxide exhaled. It is used to determine the
presence of Helicobacter pylori. ELISA (enzyme-linked immunosorbent assay) detects the
presence of antigens and antibodies. It is not useful for disorders of metabolism.
A toddler's mother calls the nurse because she thinks her son has swallowed a button type of
battery. He has no signs of respiratory distress. The nurse's response should be based on which
premise?
a. An emergency laparotomy is very likely.
b. The location needs to be confirmed by radiographic examination.
c. Surgery will be necessary if the battery has not passed in the stool in 48 hours.
d. Careful observation is essential because an ingested battery cannot be accurately detected. -
answer-ANS: B
Button batteries can cause severe damage if lodged in the esophagus. If both poles of the
battery come in contact with the wall of the esophagus, acid burns, necrosis, and perforation
1
,can occur. If the battery is in the stomach, it will most likely be passed without incident. Surgery
is not indicated. The battery is metallic and is readily seen on radiologic examination.
The mother of a child with cognitive impairment calls the nurse because her son has been
gagging and drooling all morning. The nurse suspects foreign body ingestion. What physiologic
occurrence is most likely responsible for the presenting signs?
a.Gastrointestinal perforation may have occurred.
b.The object may have been aspirated.
c.The object may be lodged in the esophagus.
d.The object may be embedded in stomach wall. - answer-ANS: C
Gagging and drooling may be signs of esophageal obstruction. The child is unable to swallow
saliva, which contributes to the drooling. Signs of gastrointestinal (GI) perforation include chest
or abdominal pain and evidence of bleeding in the GI tract. If the object was aspirated, the child
would most likely have coughing, choking, inability to speak, or difficulty breathing. If the object
was embedded in the stomach wall, it would not result in symptoms of gagging and drooling.
What is a high-fiber food that the nurse should recommend for a child with chronic
constipation?
a.White rice
b.Popcorn
c.Fruit juice
d.Ripe bananas - answer-ANS: B
Popcorn is a high-fiber food. Refined rice is not a significant source of fiber. Unrefined brown
rice is a fiber source. Fruit juices are not a significant source of fiber. Raw fruits, especially those
with skins and seeds, other than ripe bananas, have high fiber.
2
,A 2-year-old child has a chronic history of constipation and is brought to the clinic for
evaluation. What should the therapeutic plan initially include?
a.Bowel cleansing
b.Dietary modification
c.Structured toilet training
d.Behavior modification - answer-ANS: A
The first step in the treatment of chronic constipation is to empty the bowel and allow the
distended rectum to return to normal size. Dietary modification is an important part of the
treatment. Increased fiber and fluids should be gradually added to the child's diet. A 2-year-old
child is too young for structured toilet training. For an older child, a regular schedule for
toileting should be established. Behavior modification is part of the overall treatment plan. The
child practices releasing the anal sphincter and recognizing cues for defecation.
What statement best describes Hirschsprung disease?
a.The colon has an aganglionic segment.
b.It results in frequent evacuation of solids, liquid, and gas.
c.The neonate passes excessive amounts of meconium.
d.It results in excessive peristaltic movements within the gastrointestinal tract. - answer-ANS: A
Mechanical obstruction in the colon results from a lack of innervation. In most cases, the
aganglionic segment includes the rectum and some portion of the distal colon. There is
decreased evacuation of the large intestine secondary to the aganglionic segment. Liquid stool
may ooze around the blockage. The obstruction does not affect meconium production. The
infant may not be able to pass the meconium stool. There is decreased movement in the colon.
3
, What procedure is most appropriate for assessment of an abdominal circumference related to a
bowel obstruction?
a.
Measuring the abdomen after feedings
b.
Marking the point of measurement with a pen
c.
Measuring the circumference at the symphysis pubis
d.
Using a new tape measure with each assessment to ensure accuracy - answer-ANS: B
Pen marks on either side of the tape measure allow the nurse to measure the same spot on the
child's abdomen at each assessment. The child most likely will be kept NPO (nothing by mouth)
if a bowel obstruction is present. If the child is being fed, the assessment should be done before
feedings. The symphysis pubis is too low. Usually the largest part of the abdomen is at the
umbilicus. Leaving the tape measure in place reduces the trauma to the child.
4
