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1. What test is used to screen for carbohy- ANS: A
drate malabsorption? The anticipated pH of a stool specimen is
7.0. A stool pH of less than 5.0 is indicative of
a. Stool pH carbohydrate malabsorption. The bacterial
b. Urine ketones fermentation of carbohydrates in the colon
c. C urea breath test produces short-chain fatty acids, which low-
d. ELISA stool assay er 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 ex-
haled. It is used to determine the presence
of Helicobacter pylori. ELISA (enzyme-linked
immunosorbent assay) detects the pres-
ence of antigens and antibodies. It is not
useful for disorders of metabolism.
2. A toddler's mother calls the nurse because ANS: B
she thinks her son has swallowed a button Button batteries can cause severe damage
type of battery. He has no signs of respira- if lodged in the esophagus. If both poles
tory distress. The nurse's response should of the battery come in contact with the wall
be based on which premise? of the esophagus, acid burns, necrosis, and
a. An emergency laparotomy is very likely. perforation can occur. If the battery is in
b. The location needs to be confirmed by the stomach, it will most likely be passed
radiographic examination. without incident. Surgery is not indicated.
c. Surgery will be necessary if the battery The battery is metallic and is readily seen on
has not passed in the stool in 48 hours. radiologic examination.
d. Careful observation is essential because
an ingested battery cannot be accurately
detected.
3.
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The mother of a child with cognitive im- ANS: C
pairment calls the nurse because her son Gagging and drooling may be signs of
has been gagging and drooling all morn- esophageal obstruction. The child is unable
ing. The nurse suspects foreign body in- to swallow saliva, which contributes to the
gestion. What physiologic occurrence is drooling. Signs of gastrointestinal (GI) per-
most likely responsible for the presentingforation include chest or abdominal pain
signs? and evidence of bleeding in the GI tract. If
the object was aspirated, the child would
a.Gastrointestinal perforation may have most likely have coughing, choking, inability
occurred. to speak, or difficulty breathing. If the ob-
b.The object may have been aspirated. ject was embedded in the stomach wall, it
c.The object may be lodged in the esopha- would not result in symptoms of gagging
gus. and drooling.
d.The object may be embedded in stom-
ach wall.
4. What is a high-fiber food that the nurse ANS: B
should recommend for a child with chron-
ic constipation? Popcorn is a high-fiber food. Refined rice is
not a significant source of fiber. Unrefined
a.White rice brown rice is a fiber source. Fruit juices are
b.Popcorn not a significant source of fiber. Raw fruits,
c.Fruit juice especially those with skins and seeds, other
d.Ripe bananas than ripe bananas, have high fiber.
5. A 2-year-old child has a chronic history of ANS: A
constipation and is brought to the clinic
for evaluation. What should the therapeu- The first step in the treatment of chronic
tic plan initially include? constipation is to empty the bowel and al-
low the distended rectum to return to nor-
a.Bowel cleansing mal size. Dietary modification is an impor-
b.Dietary modification tant part of the treatment. Increased fiber
and fluids should be gradually added to
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c.Structured toilet training the child's diet. A 2-year-old child is too
d.Behavior modification young for structured toilet training. For an
older child, a regular schedule for toileting
should be established. Behavior modifica-
tion is part of the overall treatment plan. The
child practices releasing the anal sphincter
and recognizing cues for defecation.
6. What statement best describes ANS: A
Hirschsprung disease?
Mechanical obstruction in the colon results
a.The colon has an aganglionic segment. from a lack of innervation. In most cases,
b.It results in frequent evacuation of the aganglionic segment includes the rec-
solids, liquid, and gas. tum and some portion of the distal colon.
c.The neonate passes excessive amounts There is decreased evacuation of the large
of meconium. intestine secondary to the aganglionic seg-
d.It results in excessive peristaltic move- ment. Liquid stool may ooze around the
ments within the gastrointestinal tract. 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.
7. What procedure is most appropriate for ANS: B
assessment of an abdominal circumfer-
ence related to a bowel obstruction? Pen marks on either side of the tape mea-
sure allow the nurse to measure the same
a. spot on the child's abdomen at each assess-
ment. The child most likely will be kept NPO
Measuring the abdomen after feedings (nothing by mouth) if a bowel obstruction
is present. If the child is being fed, the as-
b.
sessment should be done before feedings.
The symphysis pubis is too low. Usually the
Marking the point of measurement with a
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pen largest part of the abdomen is at the um-
bilicus. Leaving the tape measure in place
c. reduces the trauma to the child.
Measuring the circumference at the sym-
physis pubis
d.
Using a new tape measure with each as-
sessment to ensure accuracy
8. A 3-year-old child with Hirschsprung dis- ANS: B
ease is hospitalized for surgery. A tem-
porary colostomy will be necessary. How The child's age dictates the type and extent
should the nurse prepare this child? of psychologic preparation. When a colosto-
my is performed, it is necessary to prepare
a. the child who is at least preschool age by
telling him or her about the procedure and
It is unnecessary because of child's age. what to expect in concrete terms, with the
use of visual aids. The preschooler is not yet
b.
concerned with body image.
It is essential because it will be an adjust-
ment.
c.
Preparation is not needed because the
colostomy is temporary.
d.