Omphalacele & Gastroschisis Study Guide

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Sample questions from Omphalacele & Gastroschisis Study Guide

This material has 18 questions with answers and rationales. Here are the first 5.

1. 1.A nurse reviews prenatal imaging showing an abdominal wall defect at the umbilical ring. The herniated bowel and part of the liver are covered by a membrane, and the umbilical cord inserts into the membrane. Which interpretation and delivery plan are most appropriate?

   • A.The findings suggest gastroschisis; associated chromosomal conditions are common, so genetic evaluation is the main priority.
   • B.The findings suggest omphalocele; evaluate for associated anomalies and plan birth at a center with neonatal and pediatric surgical services.
   • C.The findings suggest omphalocele; cesarean birth is required for every affected fetus regardless of defect size.
   • D.The findings suggest gastroschisis; routine newborn care is appropriate until feeding intolerance develops.

   Rationale: A midline, membrane-covered defect with cord insertion into the sac suggests omphalocele, which involves abnormal return of abdominal organs during development. Associated cardiac and chromosomal conditions warrant evaluation, and coordinated specialty delivery planning is important. Gastroschisis is usually right of the umbilicus without a covering sac and has fewer chromosomal associations. Cesarean birth is not required for every omphalocele; delivery route is individualized. Neither condition is appropriate for routine care without prompt stabilization and surgical evaluation.

2. 2.A newborn with gastroschisis is breathing spontaneously. Exposed bowel appears pink, but the infant's temperature is falling. Which delivery-room action is most appropriate?

   • A.Push the bowel into the abdomen and secure the defect with a pressure dressing.
   • B.Leave the bowel uncovered under a radiant warmer so its color remains visible.
   • C.Protect and support the bowel in a sterile transparent bowel bag, provide warmth, and continue airway and breathing assessment.
   • D.Cover the bowel tightly with dry gauze and begin oral glucose solution to prevent hypoglycemia.

   Rationale: A sterile transparent bowel bag limits evaporative heat and fluid losses while allowing assessment. Supporting the bowel helps prevent traction or twisting, and airway and breathing remain priorities. Forceful bedside reduction can injure bowel and compromise ventilation or perfusion. A radiant warmer alone does not adequately protect exposed bowel from fluid and heat loss. Dry gauze may adhere to bowel, tight dressings can impair circulation, and oral fluids are contraindicated before evaluation and repair.

3. 3.A newborn with gastroschisis is awaiting surgery. The infant is NPO with an orogastric tube for decompression and is receiving prescribed IV fluids, antibiotics, and an opioid analgesic. Urine output decreases and heart rate rises. What should the nurse do first?

   • A.Assess perfusion, fluid intake and losses, tube output, and respiratory status; promptly notify the neonatal team.
   • B.Give an oral feeding to replace gastrointestinal losses while continuing the IV infusion.
   • C.Remove the orogastric tube because decompression is the most likely cause of dehydration.
   • D.Stop all fluids and analgesia until the infant produces a larger amount of urine.

   Rationale: Tachycardia and declining urine output may indicate inadequate circulating volume or another deterioration. These infants can have substantial fluid losses, so perfusion assessment, accurate intake and output, and prompt team notification guide prescribed treatment. Respiratory assessment is also essential during opioid therapy. Oral feeding violates NPO status and increases aspiration risk. Removing decompression can worsen distention and vomiting. Stopping needed fluids may worsen hypoperfusion, and analgesia should be adjusted based on assessment and orders rather than automatically withheld.

4. 4.A newborn with gastroschisis is undergoing staged silo reduction because immediate primary closure would place excessive pressure on the abdominal contents. After a reduction, the infant develops a tense abdomen, increasing oxygen needs, cool legs, and decreased urine output. Which response is most appropriate?

   • A.Document the findings as expected effects of reduction and reassess at the next scheduled care time.
   • B.Increase enteral feeding to stimulate bowel movement and reduce abdominal pressure.
   • C.Administer an additional sedative dose before assessing circulation because agitation usually causes these changes.
   • D.Immediately notify the surgical and neonatal teams while supporting breathing and assessing perfusion for excessive intra-abdominal pressure.

   Answer and rationale are in the full material.

5. 5.After repair of an abdominal wall defect, an infant receives parenteral nutrition while intestinal function recovers and later progresses to enteral feeding. Which parent statement best demonstrates appropriate understanding of discharge teaching?

   • A.Once the incision heals, green vomiting is a normal part of recovery and can wait until the next visit.
   • B.We will follow the feeding plan and seek urgent evaluation for green vomiting or increasing abdominal swelling.
   • C.If feeding causes discomfort, we will stop all feeds for several days without contacting the care team.
   • D.Because the defect has been repaired, growth monitoring and surgical follow-up are no longer needed.

   Answer and rationale are in the full material.