Which should the nurse include in the plan of care to decrease symptoms of gastroesophageal reflux (GER) in a 2-month-old? (Select all that apply.)

Correct Answer: D

Rationale: In managing gastroesophageal reflux (GER) in a 2-month-old, the nurse should include holding the infant in an upright position for 30 minutes following a feeding (Option D) in the plan of care. This position helps prevent the reflux of stomach contents into the esophagus by utilizing gravity to aid digestion and reduce regurgitation. Option A is incorrect because placing the infant in an infant seat immediately after feedings can actually increase intra-abdominal pressure, worsening GER symptoms. Option B is also incorrect as placing the infant in the prone position after feeding increases the risk of aspiration. Option C is incorrect because while it is true that most infants outgrow GER by the first year of life, it is important to provide symptomatic relief and support to the infant and parents in the meantime. Educational context: Understanding the correct positioning after feeding is crucial in managing GER in infants and can significantly impact their comfort and reduce symptoms. Nurses play a key role in educating parents on appropriate interventions to alleviate GER symptoms and improve the overall well-being of the infant.

Correct Answer: D

Rationale: In pediatric gastrointestinal nursing, understanding congenital disorders associated with exocrine pancreatic insufficiency is crucial for providing effective care. The correct answer to the question is D) cystic fibrosis. Cystic fibrosis is the most common congenital disorder linked to exocrine pancreatic insufficiency. This genetic condition affects the production of a protein that results in thick, sticky mucus in various organs, including the pancreas, leading to pancreatic insufficiency. Option A) Shwachman Diamond syndrome is a rare genetic disorder that primarily affects the bone marrow and pancreas, leading to pancreatic insufficiency as well. However, it is not as common as cystic fibrosis in causing exocrine pancreatic insufficiency. Option B) Johanson-Blizzard syndrome is another rare genetic disorder characterized by pancreatic insufficiency, intellectual disability, and other physical abnormalities. While it can also present with pancreatic insufficiency, it is not as prevalent as cystic fibrosis. Option C) Pearson bone marrow syndrome is a mitochondrial disorder that primarily affects blood cell production and does not commonly present with exocrine pancreatic insufficiency. Educationally, knowing the most common congenital disorder associated with exocrine pancreatic insufficiency helps nurses prioritize care interventions, such as enzyme replacement therapy, nutritional support, and monitoring for complications like malabsorption. Understanding the differences between these congenital disorders aids in accurate assessment and tailored nursing interventions for pediatric patients with gastrointestinal conditions.

Correct Answer: A

Rationale: In the context of pediatric gastrointestinal nursing interventions, understanding the etiology of gastroenteritis outbreaks is crucial for effective management. Direct person-to-person contact outbreaks of gastroenteritis are commonly caused by Shigella. Shigella is highly contagious and can spread rapidly through poor hygiene practices, making person-to-person transmission a significant concern in pediatric settings. Shigella is known for causing severe watery diarrhea, fever, and abdominal cramps, particularly in young children. Its ability to survive in various environments and low infectious dose make it a key culprit in outbreaks involving direct contact. Salmonella, on the other hand, is typically associated with foodborne outbreaks rather than direct person-to-person transmission. Rotavirus is a leading cause of viral gastroenteritis in children but is primarily spread through fecal-oral route rather than direct contact. Clostridium difficile is more commonly linked to healthcare-associated infections rather than direct person-to-person outbreaks. Educationally, emphasizing the modes of transmission of different pathogens causing gastroenteritis helps nurses and healthcare providers implement appropriate infection control measures to prevent and manage outbreaks effectively. Understanding the specific characteristics of each pathogen aids in targeted interventions and reduces the risk of transmission in pediatric populations.

Correct Answer: D

Rationale: In pediatric gastrointestinal nursing, understanding the risks associated with severe dehydration is crucial for providing effective care. The correct answer, option D - depressed level of consciousness, is the most critical indicator necessitating intravenous resuscitation in severe dehydration cases. A depressed level of consciousness signifies severe fluid and electrolyte imbalances, requiring rapid intervention to prevent further complications like shock or organ failure. Option A, age < 9 months, is not the most crucial factor in determining the need for intravenous resuscitation. While infants are more vulnerable to dehydration, the severity of dehydration is better indicated by specific clinical signs like altered consciousness. Option B, postmaturity, is not directly linked to the immediate need for intravenous resuscitation in cases of severe dehydration. Postmaturity may have other implications but is not a primary factor in this scenario. Option C, fever >38°C, while indicating a possible infection or underlying cause of dehydration, is not as urgent an indicator for intravenous resuscitation as a depressed level of consciousness, which directly reflects the severity of dehydration. Educationally, understanding these clinical indicators is vital for nurses caring for pediatric patients with gastrointestinal issues. Recognizing the signs of severe dehydration and knowing when to initiate intravenous resuscitation can be life-saving in pediatric nursing practice. Nurses must be able to prioritize interventions based on the severity of the child's condition to provide optimal care and prevent complications.

Correct Answer: C

Rationale: In pediatric gastrointestinal nursing, the use of ondansetron is common for managing vomiting. The correct answer is C) orally. Ondansetron is typically administered orally in the form of tablets, oral dissolving tablets, or liquid solution in pediatric patients. Administering ondansetron orally is preferred in pediatric patients as it is convenient, non-invasive, and well-tolerated. It allows for easy dosing and administration, especially in children who may have difficulty with intravenous or intramuscular routes. Option A) intravenously and option B) intramuscularly are less preferred in pediatric patients due to the discomfort associated with these routes, especially in children. Intravenous administration may also carry a higher risk of complications such as infection or infiltration. Option D) sublingually is not a common route of administration for ondansetron in pediatric patients. While sublingual administration may offer rapid onset of action, it is not the standard route for this medication in the pediatric population. In an educational context, understanding the appropriate routes of administration for medications in pediatric patients is crucial for nurses to ensure safe and effective care. By knowing the preferred route for ondansetron administration, nurses can optimize treatment outcomes while considering the unique needs and preferences of pediatric patients.