NR602-Final Questions with Answers
1. Chapter 40 - GI Disorders:
2. 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.
3. 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 man- age this child's nutritional needs?:
Video fluoroscopy swallowing study
4. 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 mem- branes, 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.
5. 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 fre- quent 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.
6. 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?: Begin a trial of extensively hydrolyzed protein formula for 2-4
weeks.
7. 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.
8. 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?: Eliminat- ing certain foods from the mother's
diet.
9. 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.
10. 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
11. An 18-month-old child has a 1 day history of intermittent, cramping ab- dominal 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
12. 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
13. 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.
14. A school age child has recurrent diarrhea with foul smelling stools, exces- sive
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?: Serologic testing for celiac disease.
15. A child is diagnosed with Crohn's disease.
What are likely complications?: Intestinal obstruction with scarring and strictures.
16. 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.
1. Chapter 40 - GI Disorders:
2. 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.
3. 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 man- age this child's nutritional needs?:
Video fluoroscopy swallowing study
4. 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 mem- branes, 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.
5. 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 fre- quent 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.
6. 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?: Begin a trial of extensively hydrolyzed protein formula for 2-4
weeks.
7. 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.
8. 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?: Eliminat- ing certain foods from the mother's
diet.
9. 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.
10. 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
11. An 18-month-old child has a 1 day history of intermittent, cramping ab- dominal 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
12. 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
13. 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.
14. A school age child has recurrent diarrhea with foul smelling stools, exces- sive
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?: Serologic testing for celiac disease.
15. A child is diagnosed with Crohn's disease.
What are likely complications?: Intestinal obstruction with scarring and strictures.
16. 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.
