NR 602 FINAL REVIEW EXAM QUESTIONS
WITH VERIFIED SOLUTIONS
What is colic?
"rule of threes”: an infant with colic
“cries for more than 3 hours a day,
for more than 3 days a week,
and more than 3 weeks”
Colic can persist up to age 5 months. Due to the amount of crying, regurgitation and vomiting
may occur after feedings
What medication(s) have shown to be effective in treating Colic (if any?)
Dicyclomine (Bentylol®, Merbentyl®) & Hyoscyamine (Levsin
Drops®, Donnalix Infant Drops
Are alternative medications such as probiotics effective in the treatment of Colic?
There is no clear evidence that probiotics are more
effective
Appendicitis
RLQ pain, typically increases when walking, jumping or coughing, and usually worsens as time
goes on
Foreign Bodies
objects swallowed by a toddler/child:
more common in infants after 6 months with coordination of hand-mouth movements.
Coins are the most common culprit. Most objects pass without problem; 10% to 20% require
surgical management.
Signs and symptoms include dysphagia, odynophagia, drooling, regurgitation, abdominal pain,
and difficulty breathing.
Intussusception
Intestinal obstruction that causes intermittent abdominal pain, sometimes with vomiting and
bloody stool.
The sliding of one part of the intestine into another. The pressure created by the walls of the
intestine pressing together causes:
,decreased blood
flow, irritation, and swelling.
If a hole occurs:
infection, shock, and dehydration can occur rapidly.
Most common between 6 and 36 months but may present in younger infants. Vomiting is bilious
once obstruction occurs
CH 40 Gi Disorders Questions
The parent of a colicky infant asks about using a probiotic medication. What will you tell
them?
There is no conclusive evidence about using probiotics to treat colic.
A toddler who was born prematurely refuses most solid foods and has poor weight gain. A
barium swallow study reveals a normal esophagus.
What will the primary care pediatric nurse practitioner consider next to manage this
child's nutritional needs?
Video fluoroscopy swallowing study (FTT + Weight loss)
A toddler is seen in the clinic after a 2-day history of intermittent vomiting and diarrhea.
An assessment reveals an irritable child with dry mucous membranes, 3 3-second capillary
refill, 2-second recoil of skin, mild tachycardia and tachypnea, and cool hands and feet.
The child has had two wet diapers in the past 24 hours.
What will the primary care pediatric nurse practitioner recommend?
Oral rehydration solution with follow-up in 24 hours. (FTT + Weight loss)
A 9-year-old girl has a history of frequent vomiting, and her mother has frequent migraine
headaches. The child has recently begun having more frequent and prolonged episodes
accompanied by headaches. An exam reveals abnormal eye movements and mild ataxia.
What is the correct action?
Refer to a pediatric gastroenterologist for further workup. (FTT + Weight loss)
The parent of a 3-month-old reports that the infant arches and gags while feeding and spits
up undigested formula frequently. The infant's weight gain has dropped to the 5th
percentile from the 12th percentile.
What is the best course of treatment for this infant?
Begin a trial of extensively hydrolyzed protein formula for 2-4 weeks. (FTT + Weight loss)
A school-age child has a 3-month history of dull, aching epigastric pain that worsens with
eating and awakens the child from sleep. A complete blood count shows a hemoglobin of 8
mg/dL.
What is the next step in management?
,Refer for EGD. (FTT + Weight loss)
A 2-month-old infant cries up to 4 hours each day and, according to the parents, is
inconsolable during crying episodes with fists and legs noted to be tense and stiff. The
infant is breastfeeding frequently but is often fussy during feedings. The physical exam is
normal, and the infant is gaining weight normally.
What will the primary care pediatric nurse practitioner recommend?
Eliminating certain foods from the mother's diet. (FTT + Weight loss)
A child is in the clinic after swallowing a metal bead. A radiograph of the GI tract shows a
6 mm cylindrical object in the child's stomach. The child is able to swallow without
difficulty and is not experiencing pain.
What is the correct course of treatment?
Have the parents watch for the object in the child's stool. (Foreign body)
A 10-year-old child has had abdominal pain for 2 days, which began in the periumbilical
area and then localized to the right lower quadrant. The child vomited once today and then
experienced relief from pain followed by an increased fever.
What is the likely diagnosis?
Appendicitis with perforation
An 18-month-old child has a 1 day history of intermittent, cramping abdominal pain with
nonbilious vomiting. The child is observed to scream and draw up his legs during pain
episodes and becomes lethargic in between. The primary care pediatric nurse practitioner
notes a small amount of bloody, mucous stool in the diaper.
What is the most likely diagnosis?
Intussusception
A school age child has had abdominal pain for 3 months that occurs once or twice weekly
and is associated with a headache and occasional difficulty sleeping, often causing the child
to stay home from school. The child does not have vomiting or diarrhea and is gaining
weight normally. The physical exam is normal.
According to Bishop, what is included in the initial diagnostic workup for this child?
CBC
ESR
Amylase
Lipase
UA
Abdominal ultrasound (GI Bleeding)
, An adolescent is diagnosed with functional abdominal pain (FAP). The child's symptoms
worsen during stressful events, especially with school anxiety.
What will be an important part of treatment for this child?
Teaching about the brain gut interaction causing symptoms. (GI Bleeding)
A school age child has recurrent diarrhea with foul smelling stools, excessiveflatus,
abdominal distension, and failure to thrive. A 2-week lactose free trial failed to reduce
symptoms.
What is the next step in diagnosing this condition?
Serologic testing for celiac disease. (GI Bleeding)
A child is diagnosed with Crohn's disease.
What are likely complications?
Intestinal obstruction with scarring and strictures.
A 12-month-old infant exhibits poor weight gain after previously normal growth patterns.
There is no history of vomiting, diarrhea, or irregular bowel movements, and the physical
exam is normal.
What is the next step in evaluating these findings?
Feeding hx
Stooling history
and a 3-day diet history
A 2-year-old child has an acute diarrheal illness. The child is afebrile and, with oral
rehydration measures, has remained well hydrated. The parent asks what can be done to
help shorten the course of this illness.
What will the primary care pediatric nurse practitioner recommend?
Lactobacillus
CH 41 GU/UTI
Urinary tract infections
Symptoms: dysuria, flank pain, frequent urination, and foul odorous urine
What labs/diagnostics are important in confirming a diagnosis of UTI and why?
Urinalysis: Presence of white blood cells, leukocyte esterase, and nitrites indicate UTI.
Urine culture: Gold standard for UTI diagnosis. E coli accounts for 70% to 90% of UTIs
How do you diagnose UTI in an patient between the ages of 2-24 months old?
Urinalysis
WITH VERIFIED SOLUTIONS
What is colic?
"rule of threes”: an infant with colic
“cries for more than 3 hours a day,
for more than 3 days a week,
and more than 3 weeks”
Colic can persist up to age 5 months. Due to the amount of crying, regurgitation and vomiting
may occur after feedings
What medication(s) have shown to be effective in treating Colic (if any?)
Dicyclomine (Bentylol®, Merbentyl®) & Hyoscyamine (Levsin
Drops®, Donnalix Infant Drops
Are alternative medications such as probiotics effective in the treatment of Colic?
There is no clear evidence that probiotics are more
effective
Appendicitis
RLQ pain, typically increases when walking, jumping or coughing, and usually worsens as time
goes on
Foreign Bodies
objects swallowed by a toddler/child:
more common in infants after 6 months with coordination of hand-mouth movements.
Coins are the most common culprit. Most objects pass without problem; 10% to 20% require
surgical management.
Signs and symptoms include dysphagia, odynophagia, drooling, regurgitation, abdominal pain,
and difficulty breathing.
Intussusception
Intestinal obstruction that causes intermittent abdominal pain, sometimes with vomiting and
bloody stool.
The sliding of one part of the intestine into another. The pressure created by the walls of the
intestine pressing together causes:
,decreased blood
flow, irritation, and swelling.
If a hole occurs:
infection, shock, and dehydration can occur rapidly.
Most common between 6 and 36 months but may present in younger infants. Vomiting is bilious
once obstruction occurs
CH 40 Gi Disorders Questions
The parent of a colicky infant asks about using a probiotic medication. What will you tell
them?
There is no conclusive evidence about using probiotics to treat colic.
A toddler who was born prematurely refuses most solid foods and has poor weight gain. A
barium swallow study reveals a normal esophagus.
What will the primary care pediatric nurse practitioner consider next to manage this
child's nutritional needs?
Video fluoroscopy swallowing study (FTT + Weight loss)
A toddler is seen in the clinic after a 2-day history of intermittent vomiting and diarrhea.
An assessment reveals an irritable child with dry mucous membranes, 3 3-second capillary
refill, 2-second recoil of skin, mild tachycardia and tachypnea, and cool hands and feet.
The child has had two wet diapers in the past 24 hours.
What will the primary care pediatric nurse practitioner recommend?
Oral rehydration solution with follow-up in 24 hours. (FTT + Weight loss)
A 9-year-old girl has a history of frequent vomiting, and her mother has frequent migraine
headaches. The child has recently begun having more frequent and prolonged episodes
accompanied by headaches. An exam reveals abnormal eye movements and mild ataxia.
What is the correct action?
Refer to a pediatric gastroenterologist for further workup. (FTT + Weight loss)
The parent of a 3-month-old reports that the infant arches and gags while feeding and spits
up undigested formula frequently. The infant's weight gain has dropped to the 5th
percentile from the 12th percentile.
What is the best course of treatment for this infant?
Begin a trial of extensively hydrolyzed protein formula for 2-4 weeks. (FTT + Weight loss)
A school-age child has a 3-month history of dull, aching epigastric pain that worsens with
eating and awakens the child from sleep. A complete blood count shows a hemoglobin of 8
mg/dL.
What is the next step in management?
,Refer for EGD. (FTT + Weight loss)
A 2-month-old infant cries up to 4 hours each day and, according to the parents, is
inconsolable during crying episodes with fists and legs noted to be tense and stiff. The
infant is breastfeeding frequently but is often fussy during feedings. The physical exam is
normal, and the infant is gaining weight normally.
What will the primary care pediatric nurse practitioner recommend?
Eliminating certain foods from the mother's diet. (FTT + Weight loss)
A child is in the clinic after swallowing a metal bead. A radiograph of the GI tract shows a
6 mm cylindrical object in the child's stomach. The child is able to swallow without
difficulty and is not experiencing pain.
What is the correct course of treatment?
Have the parents watch for the object in the child's stool. (Foreign body)
A 10-year-old child has had abdominal pain for 2 days, which began in the periumbilical
area and then localized to the right lower quadrant. The child vomited once today and then
experienced relief from pain followed by an increased fever.
What is the likely diagnosis?
Appendicitis with perforation
An 18-month-old child has a 1 day history of intermittent, cramping abdominal pain with
nonbilious vomiting. The child is observed to scream and draw up his legs during pain
episodes and becomes lethargic in between. The primary care pediatric nurse practitioner
notes a small amount of bloody, mucous stool in the diaper.
What is the most likely diagnosis?
Intussusception
A school age child has had abdominal pain for 3 months that occurs once or twice weekly
and is associated with a headache and occasional difficulty sleeping, often causing the child
to stay home from school. The child does not have vomiting or diarrhea and is gaining
weight normally. The physical exam is normal.
According to Bishop, what is included in the initial diagnostic workup for this child?
CBC
ESR
Amylase
Lipase
UA
Abdominal ultrasound (GI Bleeding)
, An adolescent is diagnosed with functional abdominal pain (FAP). The child's symptoms
worsen during stressful events, especially with school anxiety.
What will be an important part of treatment for this child?
Teaching about the brain gut interaction causing symptoms. (GI Bleeding)
A school age child has recurrent diarrhea with foul smelling stools, excessiveflatus,
abdominal distension, and failure to thrive. A 2-week lactose free trial failed to reduce
symptoms.
What is the next step in diagnosing this condition?
Serologic testing for celiac disease. (GI Bleeding)
A child is diagnosed with Crohn's disease.
What are likely complications?
Intestinal obstruction with scarring and strictures.
A 12-month-old infant exhibits poor weight gain after previously normal growth patterns.
There is no history of vomiting, diarrhea, or irregular bowel movements, and the physical
exam is normal.
What is the next step in evaluating these findings?
Feeding hx
Stooling history
and a 3-day diet history
A 2-year-old child has an acute diarrheal illness. The child is afebrile and, with oral
rehydration measures, has remained well hydrated. The parent asks what can be done to
help shorten the course of this illness.
What will the primary care pediatric nurse practitioner recommend?
Lactobacillus
CH 41 GU/UTI
Urinary tract infections
Symptoms: dysuria, flank pain, frequent urination, and foul odorous urine
What labs/diagnostics are important in confirming a diagnosis of UTI and why?
Urinalysis: Presence of white blood cells, leukocyte esterase, and nitrites indicate UTI.
Urine culture: Gold standard for UTI diagnosis. E coli accounts for 70% to 90% of UTIs
How do you diagnose UTI in an patient between the ages of 2-24 months old?
Urinalysis
