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Chapter 18: Elimination Garzon Maaks: Burns' Pediatric Primary Care, 7th Edition

The document contains 6 multiple choice questions about elimination and toilet training for infants and children. Each question provides a scenario about a well-child exam and asks how the pediatric nurse practitioner should respond. The correct answers focus on assessing for issues like stool consistency, toilet training readiness, and behavioral or medical factors that could explain changes in elimination habits. The practitioner's role is to evaluate potential causes, reassure parents when normal, and recommend association exercises or changes to bathroom routines rather than premature training or unnecessary referrals.

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Helen Ugochukwu
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146 views

Chapter 18: Elimination Garzon Maaks: Burns' Pediatric Primary Care, 7th Edition

The document contains 6 multiple choice questions about elimination and toilet training for infants and children. Each question provides a scenario about a well-child exam and asks how the pediatric nurse practitioner should respond. The correct answers focus on assessing for issues like stool consistency, toilet training readiness, and behavioral or medical factors that could explain changes in elimination habits. The practitioner's role is to evaluate potential causes, reassure parents when normal, and recommend association exercises or changes to bathroom routines rather than premature training or unnecessary referrals.

Uploaded by

Helen Ugochukwu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as RTF, PDF, TXT or read online on Scribd
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Chapter 18: Elimination

Garzon Maaks: Burns’ Pediatric Primary Care, 7th Edition

MULTIPLE CHOICE

1. The primary care pediatric nurse practitioner is performing a well child exam on a 4-month-
old infant who is nursing exclusively. The mother reports that the infant has had a marked
decrease in the number of stools each day, from 3 to 5 stools each day to only one stool every
other day. How will the nurse practitioner respond?
a. Ask the mother to describe the color and consistency of the stools.
b. Explain to the mother that breastfed infants should have daily stools.
c. Recommend using a glycerin suppository as needed.
d. Suggest to the mother that she increase her intake of fluids.
ANS: A
It is common for older breastfed infants to stool less frequently. The PNP should assess the
color and consistency of the stools to make sure that they are normal. As long as infants are
happy, thriving, and free from clinical signs of GI distress, parents can be reassured that this is
normal. It is not necessary to use a glycerin suppository or ask the mother to increase fluids in
the absence of clinical pathology.

2. The primary care pediatric nurse practitioner is performing a well child exam on a 12-month-
old infant. The parent tells the nurse practitioner that the infant has predictable bowel and
bladder habits and asks about toilet training. What will the nurse practitioner tell this parent?
a. It is too early to begin introducing the child to the toilet, and the parent should wait
until the child is at least 2 years old.
b. Placing the child on a “potty” chair helps the child associate elimination cues with
the toilet.
c. Predictability of elimination patterns indicates readiness for toilet training, and the
parent can begin this process.
d. The parent should wait until other signs of toilet training readiness occur before
introducing the child to the toilet.
ANS: B
Once elimination patterns are predictable, the parent may place the child on a potty chair to
help the child associate elimination with the toilet, as long as the parent understands that this
is not actual potty training. It is not too early to begin this association exercise. Predictability
of elimination patterns does not indicate cognitive readiness for toilet training.

3. The primary care pediatric nurse practitioner is performing a well child exam on a 24-month-
old child. The parent tells the nurse practitioner that the child is being toilet trained and
expresses frustration that on some days the child uses the toilet every time and on other days
not at all. What will the nurse practitioner do?
a. Advise the parent to make the child get clean clothes after an accident.
b. Ask the parent about the child’s toilet habits and understanding of toilet training.
c. Recommend using an awards system to encourage toilet use.
d. Suggest that the parent place the child on the toilet at predictable intervals.
ANS: B
Children often will not toilet train easily if the process is started too early. The PNP should
assess toilet training readiness to see if the child is ready. If the child is not ready, toilet
training can be very stressful to both the child and the parent(s), so the PNP should not make
recommendations that add to this stress.

4. The primary care pediatric nurse practitioner is discussing toileting issues with the parent of a
3-year-old toddler who reports that the child has been toilet trained for several months but has
recently been refusing to have bowel movements and is becoming constipated. What will the
nurse practitioner do?
a. Ask the parent about bathroom facilities in the child’s day care.
b. Refer the child to a gastroenterologist for evaluation of pathology.
c. Suggest putting the child in diapers and resuming toilet training in a few weeks.
d. Tell the parent that this represents a developmental delay.
ANS: A
The child has bowel dysfunction that may be related to restricted access to bathroom facilities,
causing the child to actively try to prevent bowel movements. The fact that the child
previously had control indicates a behavioral cause. It is not necessary to refer to a specialist.
Putting the child in diapers and resuming toilet training later is useful for the child who is
unable to toilet train. Without further evaluation, the PNP cannot determine that there is a
developmental delay.

5. The primary care pediatric nurse practitioner is evaluating a 5-year-old child who has frequent
soiling of stool associated with stomach aches and decreased appetite for the past 2 months.
The parent states that the child has two or fewer formed bowel movements each week and has
been toilet trained for about 2 years. Which initial assessment will the nurse practitioner
make?
a. History of neurogenic conditions
b. Recent adjustments in the family
c. Recent illnesses, fluid intake, changes in diet
d. Toilet training history
ANS: C
The child has been toilet trained and has recently developed chronic constipation. The first
step is to evaluate recent illnesses or dietary changes that could cause constipation and painful
stools that resulted in stool withholding. The other options represent more underlying
physiologic or psychological pathology and should be explored if simple physiologic causes
are not present.

6. The parent of a 5-year-old child tells the primary care pediatric nurse practitioner that the
child has been using the toilet to urinate for since age 3 but continues to defecate in “pull-
ups.” The nurse practitioner learns that the child has predictable bowel movements and a
physical examination is normal. What will the nurse practitioner recommend?
a. Providing a reward system to offer incentives when the child uses the toilet
b. Put the child back in diapers and resume toilet training in a few months
c. Putting the child on the toilet for 5 to 10 minutes at the usual time of defecation
d. Use of polyethylene glycol until the child is able to use the toilet regularly
ANS: C
Since this child has predictable bowel patterns, the parent can put the child on the toilet for 5
to 10 minutes at these times to encourage toilet use. Rewards may be used at some point, but
it is not recommended since the child is learning to do what is to be expected. Younger
children may be put back in diapers and retrained in a few months. The child is not
constipated and does not need medication.

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