NURS 535 COMPREHENSIVE EXAM UPDATED
QUESTIONS AND SOLUTIONS RATED A+
✔✔GERD - ✔✔Pathologic
Alterations in protective mechanisms
Bothersome S/S
Complications
✔✔Cause of GER - ✔✔weak or incompetent lower esophageal sphincter
✔✔S/S GERD - ✔✔Retrosternal burning, bitter taste, belching,dysphagia, excessive
salivation, occurs at night or in recumbent position, relieved by sitting up
✔✔Red flags of GERD - ✔✔Bilious or forceful vomiting
Hematemesis, Hematochezia
Dysphagia
Abdominal tenderness or distention
Failure to thrive
Fever, lethargy, hepatosplenomegaly
Macrocephaly, microcephaly, seizures
Persistent or recurrent symptoms
✔✔Diagnosis of GERD - ✔✔pH testing
✔✔Management of GER - ✔✔Positioning and thickened feeds
Pharmacotherapy
Nissed
✔✔Conservative therapy for GER - ✔✔For Infants
•Normalize feeding volume and frequency
•Consider thickened formula
•Consider non-prone positioning during sleep
•Consider trial of hypoallergenic formula for 1 month before starting meds
For Older Children
•Avoid large meals
•Do not lie down immediately after eating
•Lose weight, if obese
•Avoid caffeine, chocolate, and spicy foods that provoke symptoms
•Eliminate exposure to tobacco smoke
✔✔Antacids - ✔✔counteract or neutralize acidity, usually in the stomach
H2 receptor antagonist
PPI
,Prokinetics
Surface agents
✔✔H2 Antagonists - ✔✔Cimetidine
Ranitidine
Famotidine
Nizatidine
Blocks acid production
✔✔PPI - ✔✔Blocks the production of stomach acid by shutting down the proton pump
-Prazole
✔✔Prokinetic medications - ✔✔Used to treat GERD. increases the motility of the
esophagus and stomach./increases gastric emptying
✔✔Black box warning of prokinetics - ✔✔Risks of long-term and high-dose use,
irreversible tardive dyskinesia, most common cause of the drug
✔✔Surface mucosal protector - ✔✔Sucralfate - A coating agent that adheres selectively
to damaged mucosa
Slows back diffusion of acid, pepsin, and bile salt
✔✔When to refer to a GI specialist - ✔✔GERD, Relapses off therapy, FTT, stricture,
Barretts esophagus, adenocarcinoma, extra-esophageal presentations
✔✔Number one symptom of GER - ✔✔Effortless vomiting
✔✔Pyloric stenosis - ✔✔Narrowing of the opening of the stomach to the duodenum
✔✔Pyloric stenosis manifestations - ✔✔Projectile vomiting and loss of gastric contents,
dehydration, FTT, Left to right peristalsis
✔✔Pyloric stenosis diagnosis - ✔✔XRay
Ultrasound
Barium swallow
✔✔Meckel's diverticulum - ✔✔outpouching of distal ileum
Most common cause of GI bleeding in kids
Dg: Hemoccult positive, CBC, plain films not helpful, CT scan
,Treatment: Stabilization, surgical referral, administration of broad-spectrum abxs prior to
surgery and perioperativel
✔✔Meckel's diverticulum rule of 2's - ✔✔2% of the population have a Meckel's
diverticulum. 2% of those are symptomatic, and they occur within ~~2 feet of the
ileocecal valve
✔✔Meckel's diverticulum complications - ✔✔Inflammation, obstruction, painless
hematochezia, stools can be dark maroon, occasional infarction
✔✔Intussusception - ✔✔telescoping of a segment of the intestine
✔✔Intussusception characteristic manifestations - ✔✔Acute abdominal pain with
intervals of no pain, vomiting, abdominal mass, later-currant jelly stools, abdominal
distention
✔✔Intussusception diagnosis/treatment - ✔✔Diagnosis: Barium enema or water soluble
contrast enema
Treatment: NG tube for decompression
operation to pull intestine out of itself; if necrotic, they have to cut that section out
✔✔Diarrhea - ✔✔Result of abnormality of digestion, absorption, and/or secretion
Acute - infections
Chronic - Malabsorptions, food allergies, lactose intolerance, parasites, celiacs, CF,
Crohn's
✔✔Viral causes of diarrhea - ✔✔Rotavirus
Norovirus
Norwalk virus (shellfish and water)
✔✔Norovirus - ✔✔The leading viral cause of diarrhea in the United States. Poor
hygiene causes Norovirus to be easily passed from person to person and from infected
individuals to food items.
Sources: Any food contaminated by someone who is infected with this virus.
✔✔Rotovirus - ✔✔Rotavirus is an example of a fecal-oral cycle pathogen that is a
common causative agent of viral diarrhea which can be severe, especially in infants.
Rotovirus infects and kills intestinal epithelial cells, causing fluids to leak into the
intestinal lumen. Diarrhea and symptoms of gastroenteritis usually last for 24 - 48 hours.
Rotovirus is in the Reovirus family, they have segmented double-stranded RNA
genomes surrounded by an icosahedral capsid with no envelope.
, ✔✔Rotavirus vaccine - ✔✔Only given to infants
2, 4, 6 months of age
✔✔Treatment of bacterial diarrhea - ✔✔Campylobacter: Erythromycin 40mg/kg/day
;TID dosing( 5-7 days)
Clostridium: Metronidazole 30mg/kg/day; QID dosing (7-10 days)
Salmonella: Antibiotics children < 1 year of age or immune-compromised
Trimethoprim-sulfamethoxazole (TMP-SMZ); 8mg/kg/day; BID dosing x 7-10days
Shigella: TMP-SMZ
E-coli: TMP-SMZ if diarrhea mod-severe
✔✔Parasitic Infections - Giardiasis - ✔✔Manifestations:
Infants & children at daycare centers
Spread in water
Cysts passed in feces, mature in hours --> days
Diarrhea,vomiting,anorexia,poorgrowth
Watery, greasy, foul smelling stools
5 years: cramps, intermittent loose stools & constipation
✔✔Giardiasis - Diagnosis and treatment - ✔✔Stool cultures over several weeks
Furazolidone 5-8 mg/kg/day; QID; (7-
10days)
Metronidazole 40mg/kg/day; TID; ( 7- 10 days)
✔✔Parasitic infections - Enterobiasis (Pinworms) - ✔✔Manifestations:
Anal itching, not diarrhea
Irritability, restlessness, bedwetting
Hand-mouth ingestion from environment
Scratching causes re- infestation
QUESTIONS AND SOLUTIONS RATED A+
✔✔GERD - ✔✔Pathologic
Alterations in protective mechanisms
Bothersome S/S
Complications
✔✔Cause of GER - ✔✔weak or incompetent lower esophageal sphincter
✔✔S/S GERD - ✔✔Retrosternal burning, bitter taste, belching,dysphagia, excessive
salivation, occurs at night or in recumbent position, relieved by sitting up
✔✔Red flags of GERD - ✔✔Bilious or forceful vomiting
Hematemesis, Hematochezia
Dysphagia
Abdominal tenderness or distention
Failure to thrive
Fever, lethargy, hepatosplenomegaly
Macrocephaly, microcephaly, seizures
Persistent or recurrent symptoms
✔✔Diagnosis of GERD - ✔✔pH testing
✔✔Management of GER - ✔✔Positioning and thickened feeds
Pharmacotherapy
Nissed
✔✔Conservative therapy for GER - ✔✔For Infants
•Normalize feeding volume and frequency
•Consider thickened formula
•Consider non-prone positioning during sleep
•Consider trial of hypoallergenic formula for 1 month before starting meds
For Older Children
•Avoid large meals
•Do not lie down immediately after eating
•Lose weight, if obese
•Avoid caffeine, chocolate, and spicy foods that provoke symptoms
•Eliminate exposure to tobacco smoke
✔✔Antacids - ✔✔counteract or neutralize acidity, usually in the stomach
H2 receptor antagonist
PPI
,Prokinetics
Surface agents
✔✔H2 Antagonists - ✔✔Cimetidine
Ranitidine
Famotidine
Nizatidine
Blocks acid production
✔✔PPI - ✔✔Blocks the production of stomach acid by shutting down the proton pump
-Prazole
✔✔Prokinetic medications - ✔✔Used to treat GERD. increases the motility of the
esophagus and stomach./increases gastric emptying
✔✔Black box warning of prokinetics - ✔✔Risks of long-term and high-dose use,
irreversible tardive dyskinesia, most common cause of the drug
✔✔Surface mucosal protector - ✔✔Sucralfate - A coating agent that adheres selectively
to damaged mucosa
Slows back diffusion of acid, pepsin, and bile salt
✔✔When to refer to a GI specialist - ✔✔GERD, Relapses off therapy, FTT, stricture,
Barretts esophagus, adenocarcinoma, extra-esophageal presentations
✔✔Number one symptom of GER - ✔✔Effortless vomiting
✔✔Pyloric stenosis - ✔✔Narrowing of the opening of the stomach to the duodenum
✔✔Pyloric stenosis manifestations - ✔✔Projectile vomiting and loss of gastric contents,
dehydration, FTT, Left to right peristalsis
✔✔Pyloric stenosis diagnosis - ✔✔XRay
Ultrasound
Barium swallow
✔✔Meckel's diverticulum - ✔✔outpouching of distal ileum
Most common cause of GI bleeding in kids
Dg: Hemoccult positive, CBC, plain films not helpful, CT scan
,Treatment: Stabilization, surgical referral, administration of broad-spectrum abxs prior to
surgery and perioperativel
✔✔Meckel's diverticulum rule of 2's - ✔✔2% of the population have a Meckel's
diverticulum. 2% of those are symptomatic, and they occur within ~~2 feet of the
ileocecal valve
✔✔Meckel's diverticulum complications - ✔✔Inflammation, obstruction, painless
hematochezia, stools can be dark maroon, occasional infarction
✔✔Intussusception - ✔✔telescoping of a segment of the intestine
✔✔Intussusception characteristic manifestations - ✔✔Acute abdominal pain with
intervals of no pain, vomiting, abdominal mass, later-currant jelly stools, abdominal
distention
✔✔Intussusception diagnosis/treatment - ✔✔Diagnosis: Barium enema or water soluble
contrast enema
Treatment: NG tube for decompression
operation to pull intestine out of itself; if necrotic, they have to cut that section out
✔✔Diarrhea - ✔✔Result of abnormality of digestion, absorption, and/or secretion
Acute - infections
Chronic - Malabsorptions, food allergies, lactose intolerance, parasites, celiacs, CF,
Crohn's
✔✔Viral causes of diarrhea - ✔✔Rotavirus
Norovirus
Norwalk virus (shellfish and water)
✔✔Norovirus - ✔✔The leading viral cause of diarrhea in the United States. Poor
hygiene causes Norovirus to be easily passed from person to person and from infected
individuals to food items.
Sources: Any food contaminated by someone who is infected with this virus.
✔✔Rotovirus - ✔✔Rotavirus is an example of a fecal-oral cycle pathogen that is a
common causative agent of viral diarrhea which can be severe, especially in infants.
Rotovirus infects and kills intestinal epithelial cells, causing fluids to leak into the
intestinal lumen. Diarrhea and symptoms of gastroenteritis usually last for 24 - 48 hours.
Rotovirus is in the Reovirus family, they have segmented double-stranded RNA
genomes surrounded by an icosahedral capsid with no envelope.
, ✔✔Rotavirus vaccine - ✔✔Only given to infants
2, 4, 6 months of age
✔✔Treatment of bacterial diarrhea - ✔✔Campylobacter: Erythromycin 40mg/kg/day
;TID dosing( 5-7 days)
Clostridium: Metronidazole 30mg/kg/day; QID dosing (7-10 days)
Salmonella: Antibiotics children < 1 year of age or immune-compromised
Trimethoprim-sulfamethoxazole (TMP-SMZ); 8mg/kg/day; BID dosing x 7-10days
Shigella: TMP-SMZ
E-coli: TMP-SMZ if diarrhea mod-severe
✔✔Parasitic Infections - Giardiasis - ✔✔Manifestations:
Infants & children at daycare centers
Spread in water
Cysts passed in feces, mature in hours --> days
Diarrhea,vomiting,anorexia,poorgrowth
Watery, greasy, foul smelling stools
5 years: cramps, intermittent loose stools & constipation
✔✔Giardiasis - Diagnosis and treatment - ✔✔Stool cultures over several weeks
Furazolidone 5-8 mg/kg/day; QID; (7-
10days)
Metronidazole 40mg/kg/day; TID; ( 7- 10 days)
✔✔Parasitic infections - Enterobiasis (Pinworms) - ✔✔Manifestations:
Anal itching, not diarrhea
Irritability, restlessness, bedwetting
Hand-mouth ingestion from environment
Scratching causes re- infestation
