Exam 3 NSG 3600 - PEDIATRICS
Comprehensive Examination -
Gastrointestinal System 2026
1. A newborn is diagnosed with rectal atresia. What is the priority nursing intervention immediately
after diagnosis?
A. Begin breastfeeding to establish nutrition
B. Keep the infant NPO and start IV fluids
C. Administer a soap suds enema
D. Place the infant in a warm incubator
ANSWER: B
Rationale:
A is incorrect: The infant should not be fed orally as there is a complete obstruction of the rectal
passage. Feeding could lead to complications and delays necessary surgical intervention.
B is correct: The infant must be kept NPO (nothing by mouth) as soon as rectal atresia is diagnosed, and
IV fluids should be started immediately to prepare for surgery. This prevents aspiration and maintains
hydration while awaiting surgical intervention.
emedicine.medscape.com
C is incorrect: Enemas are contraindicated in rectal atresia as there is no anal opening, and attempting
an enema could cause injury.
D is incorrect: While maintaining temperature is important, it is not the priority over preparing for
surgical intervention with NPO status and IV fluids.
2. Which finding would the nurse expect to assess in an infant with rectal atresia?
A. Passage of meconium within 24 hours
B. Normal-appearing anus with complete obstruction
,C. Diarrhea with blood
D. Abdominal distension with visible peristalsis
ANSWER: B
Rationale:
A is incorrect: Infants with rectal atresia will NOT pass meconium because there is a closure of the rectal
passage causing complete obstruction.
B is correct: Initially, the anus may appear to be normal in appearance, but it is later determined to be
an abnormal situation with complete obstruction. This is why rectal atresia can be missed on initial
examination.
www.ncbi.nlm.nih.gov
C is incorrect: Diarrhea with blood is more characteristic of intussusception, not rectal atresia.
D is incorrect: Visible peristalsis is more characteristic of hypertrophic pyloric stenosis, not rectal atresia.
3. The parents of an infant diagnosed with rectal atresia ask why surgery cannot be delayed. What is the
nurse's best response?
A. "The hospital schedule is very busy and we need to do it now"
B. "Immediate surgical intervention is mandatory for rectal atresia"
C. "Your insurance will only cover surgery this week"
D. "The surgeon prefers to operate early in the week"
ANSWER: B
Rationale:
A is incorrect: This does not address the medical necessity and is not patient-centered care.
B is correct: Immediate surgical intervention is mandatory for rectal atresia because it represents a
complete obstruction that prevents passage of stool. Delaying surgery can lead to serious complications
including bowel perforation and sepsis.
academy.nursing.com
C is incorrect: Insurance considerations are not the primary reason for immediate surgery; the medical
necessity is the priority.
D is incorrect: Surgeon preference is not the reason; the medical urgency is what necessitates
immediate intervention.
4. What diagnostic test would the nurse anticipate being ordered to evaluate associated anomalies in a
patient with rectal atresia?
A. Complete blood count
,B. IV pyelogram
C. Electrocardiogram
D. Pulmonary function tests
ANSWER: B
Rationale:
A is incorrect: While a CBC may be done as part of preoperative workup, it does not specifically evaluate
for associated anomalies common with rectal atresia.
B is correct: An IV pyelogram is used to evaluate the urinary tract because there is a high incidence of
urinary tract anomalies associated with anorectal malformations. The urinary tract should be assessed
as part of the diagnostic workup.
emedicine.medscape.com
C is incorrect: An ECG evaluates cardiac function but is not specifically indicated for evaluating
anomalies associated with rectal atresia.
D is incorrect: Pulmonary function tests are not typically indicated in newborns and are not related to
evaluating anomalies associated with rectal atresia.
5. An infant with rectal atresia is scheduled for surgical correction in two stages. What occurs during the
first stage?
A. Closure of the colostomy
B. Resection and colostomy creation
C. Pull-through procedure
D. Anastomosis of blind pouch to anus
ANSWER: B
Rationale:
A is incorrect: Closure of the colostomy occurs in the second stage, not the first stage.
B is correct: The first stage of surgical correction for rectal atresia involves resection of the atretic
segment and creation of a colostomy. This allows for bowel decompression and protects the surgical
site.
www.ncbi.nlm.nih.gov
C is incorrect: The pull-through procedure is part of the second stage of correction.
D is incorrect: Anastomosis of the blind pouch to the anus occurs in the second stage when the
colostomy is closed.
, 6. Post-operatively, which complication should the nurse monitor for in an infant who had surgical repair
of rectal atresia?
A. Fistulas and strictures
B. Projectile vomiting
C. Currant-jelly stools
D. Olive-shaped mass
ANSWER: A
Rationale:
A is correct: Fistulas and strictures are potential complications that can occur after surgery for rectal
atresia. The nurse must monitor for these complications as they can affect bowel function and may
require additional interventions.
www.sciencedirect.com
B is incorrect: Projectile vomiting is characteristic of hypertrophic pyloric stenosis, not a complication of
rectal atresia surgery.
C is incorrect: Currant-jelly stools are characteristic of intussusception, not a complication of rectal
atresia surgery.
D is incorrect: An olive-shaped mass is characteristic of hypertrophic pyloric stenosis, not a complication
of rectal atresia surgery.
7. Which nursing intervention is appropriate for preoperative care of an infant with rectal atresia?
A. Encourage oral feeding to maintain strength
B. Maintain NPO status and IV fluid administration
C. Administer oral laxatives
D. Apply warm compresses to the abdomen
ANSWER: B
Rationale:
A is incorrect: Oral feeding is contraindicated preoperatively in rectal atresia due to the complete
obstruction.
B is correct: The infant must be maintained NPO (nothing by mouth) with IV fluids to prevent aspiration,
maintain hydration, and prepare for surgery. This is standard preoperative care for rectal atresia.
emedicine.medscape.com
C is incorrect: Oral laxatives are contraindicated as there is a complete obstruction and the infant is
NPO.
Comprehensive Examination -
Gastrointestinal System 2026
1. A newborn is diagnosed with rectal atresia. What is the priority nursing intervention immediately
after diagnosis?
A. Begin breastfeeding to establish nutrition
B. Keep the infant NPO and start IV fluids
C. Administer a soap suds enema
D. Place the infant in a warm incubator
ANSWER: B
Rationale:
A is incorrect: The infant should not be fed orally as there is a complete obstruction of the rectal
passage. Feeding could lead to complications and delays necessary surgical intervention.
B is correct: The infant must be kept NPO (nothing by mouth) as soon as rectal atresia is diagnosed, and
IV fluids should be started immediately to prepare for surgery. This prevents aspiration and maintains
hydration while awaiting surgical intervention.
emedicine.medscape.com
C is incorrect: Enemas are contraindicated in rectal atresia as there is no anal opening, and attempting
an enema could cause injury.
D is incorrect: While maintaining temperature is important, it is not the priority over preparing for
surgical intervention with NPO status and IV fluids.
2. Which finding would the nurse expect to assess in an infant with rectal atresia?
A. Passage of meconium within 24 hours
B. Normal-appearing anus with complete obstruction
,C. Diarrhea with blood
D. Abdominal distension with visible peristalsis
ANSWER: B
Rationale:
A is incorrect: Infants with rectal atresia will NOT pass meconium because there is a closure of the rectal
passage causing complete obstruction.
B is correct: Initially, the anus may appear to be normal in appearance, but it is later determined to be
an abnormal situation with complete obstruction. This is why rectal atresia can be missed on initial
examination.
www.ncbi.nlm.nih.gov
C is incorrect: Diarrhea with blood is more characteristic of intussusception, not rectal atresia.
D is incorrect: Visible peristalsis is more characteristic of hypertrophic pyloric stenosis, not rectal atresia.
3. The parents of an infant diagnosed with rectal atresia ask why surgery cannot be delayed. What is the
nurse's best response?
A. "The hospital schedule is very busy and we need to do it now"
B. "Immediate surgical intervention is mandatory for rectal atresia"
C. "Your insurance will only cover surgery this week"
D. "The surgeon prefers to operate early in the week"
ANSWER: B
Rationale:
A is incorrect: This does not address the medical necessity and is not patient-centered care.
B is correct: Immediate surgical intervention is mandatory for rectal atresia because it represents a
complete obstruction that prevents passage of stool. Delaying surgery can lead to serious complications
including bowel perforation and sepsis.
academy.nursing.com
C is incorrect: Insurance considerations are not the primary reason for immediate surgery; the medical
necessity is the priority.
D is incorrect: Surgeon preference is not the reason; the medical urgency is what necessitates
immediate intervention.
4. What diagnostic test would the nurse anticipate being ordered to evaluate associated anomalies in a
patient with rectal atresia?
A. Complete blood count
,B. IV pyelogram
C. Electrocardiogram
D. Pulmonary function tests
ANSWER: B
Rationale:
A is incorrect: While a CBC may be done as part of preoperative workup, it does not specifically evaluate
for associated anomalies common with rectal atresia.
B is correct: An IV pyelogram is used to evaluate the urinary tract because there is a high incidence of
urinary tract anomalies associated with anorectal malformations. The urinary tract should be assessed
as part of the diagnostic workup.
emedicine.medscape.com
C is incorrect: An ECG evaluates cardiac function but is not specifically indicated for evaluating
anomalies associated with rectal atresia.
D is incorrect: Pulmonary function tests are not typically indicated in newborns and are not related to
evaluating anomalies associated with rectal atresia.
5. An infant with rectal atresia is scheduled for surgical correction in two stages. What occurs during the
first stage?
A. Closure of the colostomy
B. Resection and colostomy creation
C. Pull-through procedure
D. Anastomosis of blind pouch to anus
ANSWER: B
Rationale:
A is incorrect: Closure of the colostomy occurs in the second stage, not the first stage.
B is correct: The first stage of surgical correction for rectal atresia involves resection of the atretic
segment and creation of a colostomy. This allows for bowel decompression and protects the surgical
site.
www.ncbi.nlm.nih.gov
C is incorrect: The pull-through procedure is part of the second stage of correction.
D is incorrect: Anastomosis of the blind pouch to the anus occurs in the second stage when the
colostomy is closed.
, 6. Post-operatively, which complication should the nurse monitor for in an infant who had surgical repair
of rectal atresia?
A. Fistulas and strictures
B. Projectile vomiting
C. Currant-jelly stools
D. Olive-shaped mass
ANSWER: A
Rationale:
A is correct: Fistulas and strictures are potential complications that can occur after surgery for rectal
atresia. The nurse must monitor for these complications as they can affect bowel function and may
require additional interventions.
www.sciencedirect.com
B is incorrect: Projectile vomiting is characteristic of hypertrophic pyloric stenosis, not a complication of
rectal atresia surgery.
C is incorrect: Currant-jelly stools are characteristic of intussusception, not a complication of rectal
atresia surgery.
D is incorrect: An olive-shaped mass is characteristic of hypertrophic pyloric stenosis, not a complication
of rectal atresia surgery.
7. Which nursing intervention is appropriate for preoperative care of an infant with rectal atresia?
A. Encourage oral feeding to maintain strength
B. Maintain NPO status and IV fluid administration
C. Administer oral laxatives
D. Apply warm compresses to the abdomen
ANSWER: B
Rationale:
A is incorrect: Oral feeding is contraindicated preoperatively in rectal atresia due to the complete
obstruction.
B is correct: The infant must be maintained NPO (nothing by mouth) with IV fluids to prevent aspiration,
maintain hydration, and prepare for surgery. This is standard preoperative care for rectal atresia.
emedicine.medscape.com
C is incorrect: Oral laxatives are contraindicated as there is a complete obstruction and the infant is
NPO.
