Primary Care of the childbearing and
childrearing family-final review
Chapter 40 - GI Disorders - ANS>>
The parent of a colicky infant asks about using a probiotic medication.
What will you tell them? - ANS>>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? - ANS>>Video fluoroscopy swallowing study
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 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? - ANS>>Oral
rehydration solution with follow-up in 24 hours.
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? - ANS>>Refer to a pediatric gastroenterologist for further
workup.
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 12 th percentile.
What is the best course of treatment for this infant? - ANS>>Begin a trial of extensively
hydrolyzed protein formula for 2-4 weeks.
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? - ANS>>Refer for EGD.
,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? - ANS>>Eliminating
certain foods from the mother's diet.
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? - ANS>>Have the parents watch for the object
in the child's stool.
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? - ANS>>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? - ANS>>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? -
ANS>>CBC
ESR
Amylase
Lipase
UA
Abdominal ultrasound
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? - ANS>>Teaching about the
brain gut interaction causing symptoms.
A school age child has recurrent diarrhea with foul smelling stools, excessive
flatus, 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? - ANS>>Serologic testing for celiac
disease.
A child is diagnosed with Crohn's disease.
What are likely complications? - ANS>>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? - ANS>>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? - ANS>>Lactobacillus
Chapter 41 - GU Disorders - ANS>>
A 30 month old girl who has been toilet trained for 6 months has daytime enuresis and
dysuria and a low-grade fever. A dipstick urinalysis is negative for leukocyte esterase
and nitrites.
What is the next step? - ANS>>Send the urine to the lab for culture.
The clean catch urine specimen of a child with dysuria, frequency, and fever has a
colony count between 50,000 and 100,000 of E. coli.
What is the treatment for this child? - ANS>>Treat with antibiotics for urinary tract
infection
A dipstick urinalysis is positive for leukocyte esterase and nitrites in a schoolage child
with dysuria and foul-smelling urine but no fever who has not had previous urinary tract
infections. A culture is pending.
childrearing family-final review
Chapter 40 - GI Disorders - ANS>>
The parent of a colicky infant asks about using a probiotic medication.
What will you tell them? - ANS>>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? - ANS>>Video fluoroscopy swallowing study
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 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? - ANS>>Oral
rehydration solution with follow-up in 24 hours.
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? - ANS>>Refer to a pediatric gastroenterologist for further
workup.
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 12 th percentile.
What is the best course of treatment for this infant? - ANS>>Begin a trial of extensively
hydrolyzed protein formula for 2-4 weeks.
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? - ANS>>Refer for EGD.
,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? - ANS>>Eliminating
certain foods from the mother's diet.
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? - ANS>>Have the parents watch for the object
in the child's stool.
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? - ANS>>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? - ANS>>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? -
ANS>>CBC
ESR
Amylase
Lipase
UA
Abdominal ultrasound
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? - ANS>>Teaching about the
brain gut interaction causing symptoms.
A school age child has recurrent diarrhea with foul smelling stools, excessive
flatus, 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? - ANS>>Serologic testing for celiac
disease.
A child is diagnosed with Crohn's disease.
What are likely complications? - ANS>>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? - ANS>>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? - ANS>>Lactobacillus
Chapter 41 - GU Disorders - ANS>>
A 30 month old girl who has been toilet trained for 6 months has daytime enuresis and
dysuria and a low-grade fever. A dipstick urinalysis is negative for leukocyte esterase
and nitrites.
What is the next step? - ANS>>Send the urine to the lab for culture.
The clean catch urine specimen of a child with dysuria, frequency, and fever has a
colony count between 50,000 and 100,000 of E. coli.
What is the treatment for this child? - ANS>>Treat with antibiotics for urinary tract
infection
A dipstick urinalysis is positive for leukocyte esterase and nitrites in a schoolage child
with dysuria and foul-smelling urine but no fever who has not had previous urinary tract
infections. A culture is pending.
