risks
Risks:
An infant is born with esophageal atresia and tracheoesophageal fistula. Which risk factor is associated with this condition?
A) Maternal diabetes
B) Maternal folic acid deficiency
C) Exposure to teratogens like alcohol
D) All of the above
All
A newborn is diagnosed with a cleft lip during a routine prenatal visit. The nurse knows that which of the following best explains the pathophysiology of this condition?
A. A congenital defect caused by a chromosomal abnormality affecting brain development
B. A structural facial malformation resulting from genetic and environmental factors during embryonic development
C. A defect in neural tube closure occurring between weeks 4-6 of gestation
D. A respiratory anomaly resulting from incomplete formation of the nasal passages
Correct answer: B
Rationale: Cleft lip and palate are facial malformations caused by multiple genetic and environmental factors during embryonic development.
A nurse is assessing a child with suspected gastroenteritis. Which of the following findings is most concerning for dehydration?
A. Slight increase in appetite
B. Moist mucous membranes
C. Presence of tears while crying
D. High urine specific gravity and sunken fontanels
Correct answer: D
Rationale: High urine specific gravity and sunken fontanels are classic signs of dehydration in pediatric patients.
A nurse is caring for an infant post cleft palate repair. Which action by the nurse is contraindicated?
A. Positioning the infant on the abdomen
B. Administering clear liquids
C. Using a soft rubber-tipped suction catheter
D. Preventing use of hard foods
Correct answer: C
Rationale: Suctioning is contraindicated after cleft palate repair to avoid damaging the surgical site.
A nurse is teaching a parent of an infant with cleft palate about safe feeding practices. Which instruction is most appropriate?
A. “Feed your baby in a completely supine position.”
B. “Use a standard bottle and nipple.”
C. “Use the ESSR method: Enlarge the nipple, Stimulate sucking, Swallow, and allow Rest.”
D. “Limit feedings to no more than 60 minutes.”
Correct answer: C
Rationale: The ESSR method is specifically used for infants with cleft palate to promote effective and safe feeding.
Which clinical manifestation in an infant would most likely indicate progression from GER to GERD?
A. Painless emesis after meals
B. Weight loss and frequent respiratory infections
C. Spitting up that occurs only during feeding
D. Asymptomatic presentation after 3 months
Correct answer: B
Rationale: GERD involves pathologic symptoms such as failure to thrive, aspiration pneumonia, and frequent respiratory issues.
Which of the following best describes the pathology of esophageal atresia with tracheoesophageal fistula?
A) The esophagus ends in a blind pouch with no connection to the trachea
B) The upper esophagus connects normally to the stomach
C) A gap in the esophagus with an abnormal connection to the trachea
D) The esophagus is completely duplicated
Which of the following best describes the pathology of esophageal atresia with tracheoesophageal fistula?
C) A gap in the esophagus with an abnormal connection to the trachea
The provider orders a stool culture for a child with diarrhea. The nurse knows this test is helpful in:
A. Identifying electrolyte imbalances
B. Confirming viral causes of gastroenteritis
C. Detecting the presence of a specific pathogen
D. Assessing kidney function
Correct answer: C
Rationale: Stool cultures help detect specific bacterial or parasitic pathogens in cases of infectious diarrhea.
What is the nurse's priority action when caring for an infant hospitalized with acute infectious gastroenteritis?
A. Administer anti-diarrheal medication
B. Replace fluids and electrolytes to prevent dehydration
C. Start a high-protein diet
D. Provide toys to distract from discomfort
Correct answer: B
Rationale: The priority nursing intervention is to prevent or treat dehydration by replacing fluids and electrolytes.
Which of the following is the priority nursing diagnosis for an infant with an unrepaired cleft palate?
A. Risk for impaired skin integrity
B. Risk for aspiration
C. Risk for delayed growth and development
D. Risk for infection
Correct answer: B
Rationale: Due to the communication between the mouth and nasal cavity, the infant is at a high risk for aspiration during feeding.
Which of the following diagnostic tests is considered the gold standard for confirming GERD in infants?
A. Abdominal ultrasound
B. Upper GI series
C. 24-hour intraesophageal pH monitoring
D. Abdominal CT scan
Correct answer: C
Rationale: The 24-hour pH probe monitoring study is the gold standard for diagnosing GERD.
Which of the following statements best describes the transmission of infectious gastroenteritis in pediatric patients?
A. It is spread through airborne particles inhaled by the patient.
B. It is transmitted primarily through contact with infected blood.
C. It spreads via the fecal-oral route and can be caused by viral, bacterial, or parasitic organisms.
D. It is only spread through contaminated drinking water.
Correct answer: C
Rationale: Infectious gastroenteritis is commonly spread by the fecal-oral route and may involve various pathogens like viruses (e.g., rotavirus), bacteria, or parasites (e.g., Giardia).
Signs:
A newborn with this condition would most likely exhibit which sign?
A) Failure to pass meconium
B) Inability to swallow and excessive drooling
C) Respiratory distress
D) All of the above
Signs:
A newborn with this condition would most likely exhibit which sign?
D) All of the above
Which nursing intervention is a priority for an infant hospitalized with severe GERD and experiencing episodes of apnea?
A. Administer oral feedings every 2 hours
B. Place infant in a prone position after feeds
C. Monitor cardiorespiratory status continuously
D. Encourage pacifier use only during feedings
Correct answer: C
Rationale: Apnea is a potentially life-threatening complication; monitoring for respiratory distress and apnea is essential.
What infection control measure should the nurse implement for a child admitted with rotavirus?
A. Standard precautions only
B. Airborne precautions
C. Contact precautions
D. Droplet precautions
Correct answer: C
Rationale: Contact precautions are necessary because rotavirus spreads via the fecal-oral route and can survive on surfaces for extended periods.
A 6-month-old infant with GERD is prescribed famotidine. The nurse understands this medication is classified as:
A. A proton pump inhibitor
B. An antacid
C. A prokinetic agent
D. An H2 receptor antagonist
Correct answer: D
Rationale: Famotidine is an H2 receptor antagonist that reduces stomach acid production.
Which of the following best explains the pathophysiology of GERD in infants?
A. Overproduction of gastric acid causing ulceration of the esophagus
B. Delayed gastric emptying due to pyloric stenosis
C. Inappropriate relaxation of the lower esophageal sphincter allowing gastric contents to flow backward
D. Hyperactive intestinal peristalsis pushing contents upward
Correct answer: C
Rationale: GERD is caused by transient, inappropriate relaxation of the LES, which allows gastric contents to reflux into the esophagus.
During assessment, a nurse notes that formula is coming out of the infant's nose while feeding. The nurse should suspect:
A. Tracheoesophageal fistula
B. Gastroesophageal reflux
C. Cleft palate
D. Pyloric stenosis
Correct answer: C
Rationale: One of the hallmark signs of a cleft palate is formula or milk escaping through the nose due to the opening between the oral and nasal cavities.
Interventions:
An appropriate nursing intervention for this infant after surgical repair would be:
A) Keeping the infant NPO until discharge
B) Initiating oral feedings immediately
C) Placing in a prone position
D) Monitoring respiratory status and providing gavage feedings initially
Interventions:
An appropriate nursing intervention for this infant after surgical repair would be:
D) Monitoring respiratory status and providing gavage feedings initially
Which statement by a parent indicates understanding of how to prevent the spread of infectious gastroenteritis at home?
A. “I will give my child orange juice and sports drinks to keep them hydrated.”
B. “I will give the rotavirus vaccine as scheduled to prevent future infections.”
C. “I’ll stop oral fluids once the diarrhea slows down.”
D. “I will allow my child to return to daycare once they have one soft stool.”
Correct answer: B
Rationale: The rotavirus vaccine is a preventive measure. Sports drinks are not recommended due to high sugar content, and fluids should be continued until full recovery.
Which finding would indicate effective treatment of GERD in an infant?
A. Retaining feedings with regurgitation of less than 10 mL
B. Spitting up more frequently but gaining weight
C. Audible wheezing and mild retractions after feeding
D. Poor urine output and sunken fontanel
Correct answer: A
Rationale: Minimal regurgitation, adequate weight gain, and balanced IOs are signs of effective management.
An infant with GERD presents with hematemesis and anemia. What complication does this most likely indicate?
A. Delayed gastric emptying
B. Aspiration pneumonia
C. Esophageal ulceration or GI bleeding
D. Failure to thrive
Correct answer: C
Rationale: Hematemesis and anemia may indicate esophageal tissue damage or GI bleeding.
A nurse is monitoring the lab results of a child with gastroenteritis. Which of the following findings requires immediate attention?
A. Sodium level of 138 mEq/L
B. Potassium level of 3.0 mEq/L
C. Potassium level of 4.1 mEq/L
D. Sodium level of 142 mEq/L
Correct answer: B
Rationale: A potassium level of 3.0 mEq/L is low (normal is approximately 3.5–5.0 mEq/L) and can lead to serious complications like cardiac arrhythmias.
Which parent statement indicates correct understanding of home care for an infant with GERD?
A. “I’ll feed him lying flat so he stays calm.”
B. “I’ll give him small, frequent feedings with thickened formula as advised.”
C. “He doesn’t need to be burped if he’s had rice cereal.”
D. “I will stop his medication once he stops vomiting.”
Correct answer: B
Rationale: Small, frequent feedings with thickened formula and upright positioning are key strategies to manage GERD.
Education:
The parents should be educated about which potential complication?
A) Gastroesophageal reflux disease
B) Persistent cyanosis
C) Failure to thrive
D) All of the above
Education:
The parents should be educated about which potential complication?
D) All of the above