Maternity Nursing (OB Maternal &
Newborn) NCLEX Practice Quiz #4 | 75
Questions
1. 1. Question
Discharge teaching for a child with celiac disease would include
instructions about avoiding which of the following?
o A. Rice
o B. Milk
o C. Wheat
o D. Chicken
Incorrect
Correct Answer: C. Wheat
Children with celiac disease cannot tolerate or digest gluten.
Therefore, because of its gluten content, wheat and wheat-containing
products must be avoided.
Option A: Rice is one of the most popular gluten-free grains for
people with celiac disease. Many gluten-free packaged goods are
made with rice instead of wheat.
Option B: It’s also important to note that while milk is gluten-
free, for those newly diagnosed with celiac disease, secondary
lactose intolerance is common due to the loss of lactase, an
enzyme that digests milk sugar along the lining of the small
intestine.
Option D: There are many naturally gluten-free foods to enjoy
on the celiac disease diet, including: Animal proteins: Beef,
chicken, dairy products, eggs, game meat, lamb, pork, seafood,
and turkey.
2. 2. Question
Which of the following would the nurse expect to assess in a child with
celiac disease having a celiac crisis secondary to an upper respiratory
infection?
, A. Respiratory distress
B. Lethargy
C. Watery diarrhea
D. Weight gain
Incorrect
Correct Answer: C. Watery diarrhea
Episodes of celiac crises are precipitated by infections, ingestion of
gluten, prolonged fasting, or exposure to anticholinergic drugs. Celiac
crisis is typically characterized by severe watery diarrhea. Celiac crisis
is a rare initial presentation of CD characterized by severe diarrhea,
dehydration, weight loss, hypoproteinemia, and metabolic and
electrolyte disturbances. Although rare, it should be considered in
patients with apparently unexplained chronic diarrhea.
Option A: Respiratory distress is unlikely in a routine upper
respiratory infection. Mainly present in children, celiac crisis
causes profuse intractable diarrhea with severe metabolic
disturbances (such as acidosis and hypokalemia), hypotension,
neuromuscular weakness, cardiac arrhythmias, and respiratory
failure.
Option B: Irritability, rather than lethargy, is more likely. Due to
the wide variety of symptoms that may present themselves, it
can sometimes be difficult to diagnose celiac disease. One person
might have diarrhea and abdominal pain, while another person
has irritability or depression.
Option D: Because of the fluid loss associated with severe
watery diarrhea, the child’s weight is more likely to be decreased.
3. 3. Question
Which of the following should the nurse do first after noting that a
child with Hirschsprung disease has a fever and watery explosive
diarrhea?
A. Notify the physician immediately.
B. Administer antidiarrheal medications.
C. Monitor child every 30 minutes.
, D. Nothing, this is characteristic of Hirschsprung disease.
Incorrect
Correct Answer: A. Notify the physician immediately.
For the child with Hirschsprung disease, fever and explosive diarrhea
indicate enterocolitis, a life-threatening situation. Therefore, the
physician should be notified immediately.
Option B: Generally, because of the intestinal obstruction and
inadequate propulsive intestinal movement, antidiarrheals are
not used to treat Hirschsprung disease.
Option C: The child is acutely ill and requires intervention, with
monitoring more frequently than every 30 minutes.
Option D: Hirschsprung disease typically presents with chronic
constipation. Hirschsprung’s disease (congenital megacolon) is
caused by the failed migration of colonic ganglion cells during
gestation. Varying lengths of the distal colon are unable to relax,
causing functional colonic obstruction.
4. 4. Question
A newborn’s failure to pass meconium within the first 24 hours after
birth may indicate which of the following?
A. Hirschsprung disease
B. Celiac disease
C. Intussusception
D. Abdominal wall defect
Incorrect
Correct Answer: A. Hirschsprung disease
Failure to pass meconium within the first 24 hours after birth may be
an indication of Hirschsprung disease, a congenital anomaly resulting
in mechanical obstruction due to inadequate motility in an intestinal
segment.
Option B: Celiac disease is a serious autoimmune disease that
occurs in genetically predisposed people where the ingestion of
gluten leads to damage in the small intestine. It is estimated to
affect 1 in 100 people worldwide. Two and one-half million
Americans are undiagnosed and are at risk for long-term health
complications.
, Option C: Intussusception is a process in which a segment of
intestine invaginates into the adjoining intestinal lumen, causing
bowel obstruction. With early diagnosis, appropriate fluid
resuscitation, and therapy, the mortality rate from
intussusception in children is less than 1%. If left untreated,
however, this condition is uniformly fatal in 2-5 days.
Option D: Types of abdominal wall defects may include
gastroschisis. Contents of the abdomen protrude out of the body
through an opening in the abdominal muscles near the umbilical
cord. Without a protective covering, the organs are exposed to
amniotic fluid and may swell or become damaged.
5. 5. Question
When assessing a child for possible intussusception, which of the
following would be least likely to provide valuable information?
A. Stool inspection
B. Pain pattern
C. Family history
D. Abdominal palpation
Incorrect
Correct Answer: C. Family history
Because intussusception is not believed to have a familial tendency,
obtaining a family history would provide the least amount of
information.
Option A: Later signs include rectal bleeding, often with “red
currant jelly” stool, and lethargy. Physical examination may
reveal a “sausage-shaped” mass.
Option B: Early symptoms include periodic abdominal pain,
nausea, vomiting (green from bile), pulling legs to the chest, and
cramping abdominal pain. Pain is intermittent because the bowel
segment transiently stops contracting.
Option D: A sausage-shaped mass may be palpated in the right
upper quadrant. Almost all intussusceptions occur with the
intussusceptum having been located proximally to the
intussuscipiens. This is because a peristaltic action of the
intestine pulls the proximal segment into the distal segment.
Newborn) NCLEX Practice Quiz #4 | 75
Questions
1. 1. Question
Discharge teaching for a child with celiac disease would include
instructions about avoiding which of the following?
o A. Rice
o B. Milk
o C. Wheat
o D. Chicken
Incorrect
Correct Answer: C. Wheat
Children with celiac disease cannot tolerate or digest gluten.
Therefore, because of its gluten content, wheat and wheat-containing
products must be avoided.
Option A: Rice is one of the most popular gluten-free grains for
people with celiac disease. Many gluten-free packaged goods are
made with rice instead of wheat.
Option B: It’s also important to note that while milk is gluten-
free, for those newly diagnosed with celiac disease, secondary
lactose intolerance is common due to the loss of lactase, an
enzyme that digests milk sugar along the lining of the small
intestine.
Option D: There are many naturally gluten-free foods to enjoy
on the celiac disease diet, including: Animal proteins: Beef,
chicken, dairy products, eggs, game meat, lamb, pork, seafood,
and turkey.
2. 2. Question
Which of the following would the nurse expect to assess in a child with
celiac disease having a celiac crisis secondary to an upper respiratory
infection?
, A. Respiratory distress
B. Lethargy
C. Watery diarrhea
D. Weight gain
Incorrect
Correct Answer: C. Watery diarrhea
Episodes of celiac crises are precipitated by infections, ingestion of
gluten, prolonged fasting, or exposure to anticholinergic drugs. Celiac
crisis is typically characterized by severe watery diarrhea. Celiac crisis
is a rare initial presentation of CD characterized by severe diarrhea,
dehydration, weight loss, hypoproteinemia, and metabolic and
electrolyte disturbances. Although rare, it should be considered in
patients with apparently unexplained chronic diarrhea.
Option A: Respiratory distress is unlikely in a routine upper
respiratory infection. Mainly present in children, celiac crisis
causes profuse intractable diarrhea with severe metabolic
disturbances (such as acidosis and hypokalemia), hypotension,
neuromuscular weakness, cardiac arrhythmias, and respiratory
failure.
Option B: Irritability, rather than lethargy, is more likely. Due to
the wide variety of symptoms that may present themselves, it
can sometimes be difficult to diagnose celiac disease. One person
might have diarrhea and abdominal pain, while another person
has irritability or depression.
Option D: Because of the fluid loss associated with severe
watery diarrhea, the child’s weight is more likely to be decreased.
3. 3. Question
Which of the following should the nurse do first after noting that a
child with Hirschsprung disease has a fever and watery explosive
diarrhea?
A. Notify the physician immediately.
B. Administer antidiarrheal medications.
C. Monitor child every 30 minutes.
, D. Nothing, this is characteristic of Hirschsprung disease.
Incorrect
Correct Answer: A. Notify the physician immediately.
For the child with Hirschsprung disease, fever and explosive diarrhea
indicate enterocolitis, a life-threatening situation. Therefore, the
physician should be notified immediately.
Option B: Generally, because of the intestinal obstruction and
inadequate propulsive intestinal movement, antidiarrheals are
not used to treat Hirschsprung disease.
Option C: The child is acutely ill and requires intervention, with
monitoring more frequently than every 30 minutes.
Option D: Hirschsprung disease typically presents with chronic
constipation. Hirschsprung’s disease (congenital megacolon) is
caused by the failed migration of colonic ganglion cells during
gestation. Varying lengths of the distal colon are unable to relax,
causing functional colonic obstruction.
4. 4. Question
A newborn’s failure to pass meconium within the first 24 hours after
birth may indicate which of the following?
A. Hirschsprung disease
B. Celiac disease
C. Intussusception
D. Abdominal wall defect
Incorrect
Correct Answer: A. Hirschsprung disease
Failure to pass meconium within the first 24 hours after birth may be
an indication of Hirschsprung disease, a congenital anomaly resulting
in mechanical obstruction due to inadequate motility in an intestinal
segment.
Option B: Celiac disease is a serious autoimmune disease that
occurs in genetically predisposed people where the ingestion of
gluten leads to damage in the small intestine. It is estimated to
affect 1 in 100 people worldwide. Two and one-half million
Americans are undiagnosed and are at risk for long-term health
complications.
, Option C: Intussusception is a process in which a segment of
intestine invaginates into the adjoining intestinal lumen, causing
bowel obstruction. With early diagnosis, appropriate fluid
resuscitation, and therapy, the mortality rate from
intussusception in children is less than 1%. If left untreated,
however, this condition is uniformly fatal in 2-5 days.
Option D: Types of abdominal wall defects may include
gastroschisis. Contents of the abdomen protrude out of the body
through an opening in the abdominal muscles near the umbilical
cord. Without a protective covering, the organs are exposed to
amniotic fluid and may swell or become damaged.
5. 5. Question
When assessing a child for possible intussusception, which of the
following would be least likely to provide valuable information?
A. Stool inspection
B. Pain pattern
C. Family history
D. Abdominal palpation
Incorrect
Correct Answer: C. Family history
Because intussusception is not believed to have a familial tendency,
obtaining a family history would provide the least amount of
information.
Option A: Later signs include rectal bleeding, often with “red
currant jelly” stool, and lethargy. Physical examination may
reveal a “sausage-shaped” mass.
Option B: Early symptoms include periodic abdominal pain,
nausea, vomiting (green from bile), pulling legs to the chest, and
cramping abdominal pain. Pain is intermittent because the bowel
segment transiently stops contracting.
Option D: A sausage-shaped mass may be palpated in the right
upper quadrant. Almost all intussusceptions occur with the
intussusceptum having been located proximally to the
intussuscipiens. This is because a peristaltic action of the
intestine pulls the proximal segment into the distal segment.
