A nurse is assessing a 1-year-old toddler who notices a large abdominal mass and pink-tinged urine on the diaper. Which of the following disorders should the nurse suspect?

Choice A reason: Recurrent epigastric pain is not a complication of peptic ulcer disease, but rather a common symptom of it. Peptic ulcer disease is the erosion of the mucosal lining of the stomach or duodenum, which can cause pain, burning, or discomfort in the upper abdomen.

Choice B reason: Hyperactive bowel sounds are not a complication of peptic ulcer disease, but rather a normal finding in a child who has not eaten for a while. Hyperactive bowel sounds indicate increased peristalsis, which can be caused by hunger, stress, or infection.

Choice C reason: Yellowish-red emesis is a complication of peptic ulcer disease, as it indicates bleeding from the ulcer. Bleeding can occur when the ulcer erodes the blood vessels or the protective layer of the mucosa. Yellowish-red emesis means that the blood has been partially digested by the stomach acid, giving it a coffee-ground appearance.

Choice D reason: Melena stool is a complication of peptic ulcer disease, as it indicates bleeding from the ulcer. Melena stool is black and tarry, and it has a foul odor. It means that the blood has passed through the entire digestive tract, and has been altered by the intestinal bacteria and enzymes.

Choice A reason: Keeping the baby in an upright position after feedings is an effective strategy to prevent or reduce gastroesophageal reflux, as it allows gravity to help the stomach contents stay down. The parent should hold the baby upright for at least 20 to 30 minutes after each feeding, and avoid placing the baby in a car seat or swing, which can increase the abdominal pressure.

Choice B reason: Feeding the baby formula rather than breast milk is not necessary for gastroesophageal reflux, as breast milk is easier to digest and less likely to cause reflux than formula. The parent should continue to breastfeed the baby, unless there is a medical reason to switch to formula. The parent should also avoid overfeeding the baby, and burp the baby frequently during and after feedings.

Choice C reason: Positioning the baby lying on his stomach is not recommended for gastroesophageal reflux, as it can increase the risk of aspiration, suffocation, and sudden infant death syndrome (SIDS). The parent should place the baby on his back to sleep, and elevate the head of the crib or bassinet by 30 degrees to reduce the reflux.

Choice D reason: Thickening the baby's formula with honey is not advised for gastroesophageal reflux, as honey can cause botulism, a serious and potentially fatal illness, in infants under one year of age. The parent should not add any thickening agents to the formula, unless prescribed by the provider. Some studies suggest that thickening the formula with rice cereal may reduce the reflux, but the evidence is inconclusive and the practice may have adverse effects, such as increased caloric intake, constipation, or food allergies.