NURS 535 EXAM 1 SET QUESTIONS AND
ANSWERS SET A+
✔✔Juvenile arthritis - ✔✔A chronic and painful muscular condition seen in children
✔✔Systemic arthritis - ✔✔Primary manifestations are High Fever,
polyarthritis (5 or more joints), and Rheumatoid rash
Affects internal organs and joints
✔✔Polyarthritis - ✔✔Inflammation of many joints
✔✔Oligoarthritis - ✔✔Affects four or fewer joints
Primarily affects the knees, ankles, and elbows.
More common in females
15%-20% of patients have uveitis (eye inflammation)
50%-60% of JIA
✔✔Enthesitis-related arthritis - ✔✔The category of enthesitis-related arthritis is applied
to children with arthritis and enthesitis or arthritis and two or more of the following:
Sacroiliac joint tenderness
Inflammatory spinal pain
Human leukocyte antigen (HLA)-B27
Positive family history of anterior uveitis with pain, a spondyloarthropathy, or
inflammatory bowel disease
,Anterior uveitis associated with pain, redness, or photophobia
The descriptors for this group include:
Age at onset
Pattern of large or small joint involvement
Presence of axial involvement, symmetry, and progression to polyarthritis
✔✔Psoriatic arthritis - ✔✔DIP joint involvement, rash w/ silvery scale on elbows and
knees, pitting nails and swollen fingers.
✔✔Cleft lip and palate complications - ✔✔feeding problems:
-unable to suck successfully
-excess air intake results in GI distress
Otologic:
-high risk for otitis media related to cleft allowing bacteria to enter eustachian tube
-hearing loss can result
Dental/orthodontic:
-may have delay in eruption of primary teeth and when come in may be abnormal,
small, missing etc
-higher risk for tooth decay
speech development:
-palate, faulty dentition and hearing problems can lead to speech problems
✔✔Tracheoesophageal fistula (TEF) - ✔✔Congenital defect resulting in a connection
between the esophagus and trachea
✔✔TEF Physical exam - ✔✔Spitting and vomiting, aspiration of feedings, aspiration
pneumonia
✔✔GER - ✔✔Normal
During transient relaxation of LES
Multiple times/day
Doesn't produce any troublesome symptoms and without complications
✔✔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
ANSWERS SET A+
✔✔Juvenile arthritis - ✔✔A chronic and painful muscular condition seen in children
✔✔Systemic arthritis - ✔✔Primary manifestations are High Fever,
polyarthritis (5 or more joints), and Rheumatoid rash
Affects internal organs and joints
✔✔Polyarthritis - ✔✔Inflammation of many joints
✔✔Oligoarthritis - ✔✔Affects four or fewer joints
Primarily affects the knees, ankles, and elbows.
More common in females
15%-20% of patients have uveitis (eye inflammation)
50%-60% of JIA
✔✔Enthesitis-related arthritis - ✔✔The category of enthesitis-related arthritis is applied
to children with arthritis and enthesitis or arthritis and two or more of the following:
Sacroiliac joint tenderness
Inflammatory spinal pain
Human leukocyte antigen (HLA)-B27
Positive family history of anterior uveitis with pain, a spondyloarthropathy, or
inflammatory bowel disease
,Anterior uveitis associated with pain, redness, or photophobia
The descriptors for this group include:
Age at onset
Pattern of large or small joint involvement
Presence of axial involvement, symmetry, and progression to polyarthritis
✔✔Psoriatic arthritis - ✔✔DIP joint involvement, rash w/ silvery scale on elbows and
knees, pitting nails and swollen fingers.
✔✔Cleft lip and palate complications - ✔✔feeding problems:
-unable to suck successfully
-excess air intake results in GI distress
Otologic:
-high risk for otitis media related to cleft allowing bacteria to enter eustachian tube
-hearing loss can result
Dental/orthodontic:
-may have delay in eruption of primary teeth and when come in may be abnormal,
small, missing etc
-higher risk for tooth decay
speech development:
-palate, faulty dentition and hearing problems can lead to speech problems
✔✔Tracheoesophageal fistula (TEF) - ✔✔Congenital defect resulting in a connection
between the esophagus and trachea
✔✔TEF Physical exam - ✔✔Spitting and vomiting, aspiration of feedings, aspiration
pneumonia
✔✔GER - ✔✔Normal
During transient relaxation of LES
Multiple times/day
Doesn't produce any troublesome symptoms and without complications
✔✔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
