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1. A 7-week-old infant is brought to the primary care clinic because of recurrent
crying. The parents report that the infant cries for approximately 3–4 hours each
evening on most days, but feeds well, gains weight appropriately, and has a
normal physical examination. Which finding most strongly supports a diagnosis
of infantile colic?
A. Crying that occurs primarily after feeding and is accompanied by projectile
vomiting
B. Crying associated with poor weight gain and persistent diarrhea
C. Crying accompanied by fever and abdominal distention
D. Crying exceeding 3 hours daily, occurring more than 3 days weekly for at
least 3 weeks
Answer: D
Rationale: Infantile colic is classically described by the “rule of threes”: crying
for more than 3 hours per day, more than 3 days per week, for at least 3 weeks
in an otherwise healthy infant.
2. A 9-year-old child develops abdominal pain that initially began around the
umbilicus and has progressively localized to the right lower quadrant. The child
,has anorexia, nausea, and a low-grade fever. Which physical examination
finding would further increase the clinician’s concern for appendicitis?
A. Left upper-quadrant tenderness
B. McBurney point tenderness
C. Costovertebral angle tenderness
D. Suprapubic tenderness
Answer: B
Rationale: McBurney point tenderness, located in the right lower quadrant, is a
classic finding associated with acute appendicitis. Migration of pain from the
periumbilical region to the RLQ further supports the diagnosis.
3. A 14-month-old suddenly develops episodes of severe abdominal pain.
During each episode, the child draws the knees toward the chest and cries
intensely. Between episodes, the child appears relatively comfortable. Several
hours later, the parent notices a blood-tinged, mucus-like stool. Which condition
should the nurse practitioner suspect?
A. Gastroesophageal reflux
B. Intussusception
C. Functional constipation
D. Viral gastroenteritis
Answer: B
Rationale: Intussusception commonly causes intermittent, severe colicky
abdominal pain followed by vomiting and, later, bloody mucus or “currant
jelly” stools. A sausage-shaped abdominal mass may also be palpable.
,4. A previously healthy 18-month-old with suspected intussusception is
hemodynamically stable. Imaging supports the diagnosis, and there is no
evidence of perforation or peritonitis. Which intervention is commonly used for
both diagnosis and treatment?
A. Air contrast enema
B. Immediate appendectomy
C. Oral polyethylene glycol
D. Upper gastrointestinal endoscopy
Answer: A
Rationale: An air or contrast enema can demonstrate the characteristic bowel
telescoping and may reduce the intussusception. Surgical consultation is
required when reduction is unsuccessful or complications such as perforation or
peritonitis are present.
5. A 2-year-old has had vomiting and diarrhea for 24 hours. The child is alert,
has moist mucous membranes, normal capillary refill, and is able to drink.
Which management is most appropriate?
A. Restrict oral fluids for 12 hours
B. Administer an antidiarrheal medication
C. Initiate immediate intravenous fluid resuscitation
D. Begin an oral rehydration solution
Answer: D
, Rationale: A child with mild dehydration who is alert and able to drink should
generally receive an appropriate oral rehydration solution. ORS replaces water
and electrolytes in physiologic proportions and is preferred over plain water or
sugary beverages.
6. A 10-month-old infant weighs 8 kg before an episode of gastroenteritis and
now weighs 7.2 kg. The clinician calculates the percentage of weight loss to
assess dehydration. Approximately what percentage of body weight has been
lost?
A. 5%
B. 8%
C. 10%
D. 12%
Answer: C
Rationale: Weight loss is calculated as:
(8 kg − 7.2 kg) ÷ 8 kg × 100 = 10%
Percentage of acute weight loss provides an important estimate of dehydration
severity in children.
7. During assessment of a child with gastroenteritis, which finding would be
most concerning for progression to severe dehydration?
A. Hypotension with lethargy
B. Increased thirst