Chapter 43 The Child with a Gastrointestinal Alteration

Chapter 43  The Child with a Gastrointestinal Alteration

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. What is the best response by the nurse to a mother asking about the cause of her infant’s

bilateral cleft lip?
a. “Did you use alcohol during your pregnancy?”
b. “Does anyone in your family have a cleft lip or palate?”
c. “This defect is associated with intrauterine infection during the second trimester.”
d. “The prevalent of cleft lip is higher in Caucasians.”

ANS: B
Cleft lip and palate result from embryonic failure resulting from multiple genetic and
environmental factors. A genetic pattern or familial risk seems to exist. Tobacco during
pregnancy (not drinking) has been associated with bilateral cleft lip. The defect occurred at
approximately 6 to 8 weeks of gestation. Second-trimester intrauterine infection is not a
known cause of bilateral cleft lip. The prevalence of cleft lip and palate is higher in Asian and
Native American populations.

PTS: 1 DIF: Cognitive Level: Application/Application
REF: p. 960 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity

2. The postoperative care plan for an infant with surgical repair of a cleft lip includes

a. a clear liquid diet for 72 hours.
b. nasogastric feedings until the sutures are removed.
c. elbow restraints to keep the infant’s fingers away from the mouth.
d. rinsing the mouth after every feeding.

ANS: C
Keeping the infant’s hands away from the incision reduces potential complications at the
surgical site. The infant’s diet is advanced from clear liquid to soft foods within 48 hours of
surgery. After surgery, the infant can resume preoperative feeding techniques. Rinsing the
mouth after feeding is an inappropriate intervention. Feeding a small amount of water after
feedings will help keep the mouth clean. A cleft lip repair site should be cleansed with a wet
sterile cotton swab after feedings.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 962 | Patient-Centered Teaching Box OBJ: Nursing Process: Planning
MSC: Client Needs: Physiologic Integrity

3. The nurse is caring for a neonate with a suspected tracheoesophageal fistula (TEF). Nursing

care should include which of the following?
a. Elevating the head but give nothing by mouth
b. Elevating the head for feedings
c. Feeding glucose water only
d. Avoiding suction unless infant is cyanotic

ANS: A

When a newborn is suspected of having TEF, the most desirable position is supine with the
head elevated on an incline plane of at least 30 degrees. It is imperative that any source of
aspiration be removed at once; oral feedings are withheld. Feedings should not be given to
infants suspected of having TEF. The oral pharynx should be kept clear of secretion by oral
suctioning. This is to avoid cyanosis that is usually the result of laryngospasm caused by
overflow of saliva into the larynx.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 966
OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

4. A nurse is teaching a group of parents about TEF. Which statement made by the nurse is

accurate about TEF?
a. This defect results from an embryonal failure of the foregut to differentiate into the

trachea and esophagus.
b. It is a fistula between the esophagus and stomach that results in the oral intake

being refluxed and aspirated.
c. An extra connection between the esophagus and trachea develops because of

genetic abnormalities.
d. The defect occurs in the second trimester of pregnancy.

ANS: A
When the foregut does not differentiate into the trachea and esophagus during the fourth to
fifth week of gestation, a TEF occurs. A TEF is an abnormal connection between the
esophagus and trachea. There is no connection between the trachea and esophagus in normal
fetal development. This defect occurs early in pregnancy during the fourth to fifth week of
gestation.

PTS: 1 DIF: Cognitive Level: Comprehension/Understanding
REF: p. 965 | Pathophysiology Box OBJ: Integrated Process: Teaching-Learning
MSC: Client Needs: Physiologic Integrity

5. What maternal assessment is related to an infant’s diagnosis of TEF?

a. Maternal age more than 40 years
b. First term pregnancy for the mother
c. Maternal history of polyhydramnios
d. Complicated pregnancy

ANS: C
A maternal history of polyhydramnios is associated with TEF. Advanced maternal age, first
term pregnancy, or complicated pregnancy are not related.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 962 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity