NR 602 Final Review
What is colic? - ANS "rule of threes": an infant with colic
"cries for more than 3 hours a day,
for more than 3 days a week,
and more than 3 weeks"
Colic can persist up to age 5 months. Due to the amount of crying, regurgitation and vomiting may occur
after feedings
What medication(s) have shown to be effective in treating Colic (if any?) - ANS Dicyclomine (Bentylol®,
Merbentyl®) & Hyoscyamine (Levsin
Drops®, Donnalix Infant Drops
Are alternative medications such as probiotics effective in the treatment of Colic? - ANS There is no
clear evidence that probiotics are more
effective
Appendicitis - ANS RLQ pain, typically increases when walking, jumping or coughing, and usually
worsens as time goes on
Foreign Bodies - ANS objects swallowed by a toddler/child:
more common in infants after 6 months with coordination of hand-mouth movements.
Coins are the most common culprit. Most objects pass without problem; 10% to 20% require surgical
management.
Signs and symptoms include dysphagia, odynophagia, drooling, regurgitation, abdominal pain, and
difficulty breathing.
,Intussusception - ANS Intestinal obstruction that causes intermittent abdominal pain, sometimes with
vomiting and bloody stool.
The sliding of one part of the intestine into another. The pressure created by the walls of the intestine
pressing together causes:
decreased blood
flow, irritation, and swelling.
If a hole occurs:
infection, shock, and dehydration can occur rapidly.
Most common between 6 and 36 months but may present in younger infants. Vomiting is bilious once
obstruction occurs
CH 40 Gi Disorders Questions - 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 (FTT + Weight loss)
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 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. (FTT + Weight loss)
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. (FTT +
Weight loss)
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 12th
percentile.
What is the best course of treatment for this infant? - ANS Begin a trial of extensively hydrolyzed
protein formula for 2-4 weeks. (FTT + Weight loss)
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. (FTT + Weight loss)
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. (FTT + Weight loss)
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. (Foreign body)
, 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 (GI Bleeding)
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. (GI Bleeding)
A school age child has recurrent diarrhea with foul smelling stools, excessiveflatus, abdominal
distension, and failure to thrive. A 2-week lactose free trial failed to reduce symptoms.
What is colic? - ANS "rule of threes": an infant with colic
"cries for more than 3 hours a day,
for more than 3 days a week,
and more than 3 weeks"
Colic can persist up to age 5 months. Due to the amount of crying, regurgitation and vomiting may occur
after feedings
What medication(s) have shown to be effective in treating Colic (if any?) - ANS Dicyclomine (Bentylol®,
Merbentyl®) & Hyoscyamine (Levsin
Drops®, Donnalix Infant Drops
Are alternative medications such as probiotics effective in the treatment of Colic? - ANS There is no
clear evidence that probiotics are more
effective
Appendicitis - ANS RLQ pain, typically increases when walking, jumping or coughing, and usually
worsens as time goes on
Foreign Bodies - ANS objects swallowed by a toddler/child:
more common in infants after 6 months with coordination of hand-mouth movements.
Coins are the most common culprit. Most objects pass without problem; 10% to 20% require surgical
management.
Signs and symptoms include dysphagia, odynophagia, drooling, regurgitation, abdominal pain, and
difficulty breathing.
,Intussusception - ANS Intestinal obstruction that causes intermittent abdominal pain, sometimes with
vomiting and bloody stool.
The sliding of one part of the intestine into another. The pressure created by the walls of the intestine
pressing together causes:
decreased blood
flow, irritation, and swelling.
If a hole occurs:
infection, shock, and dehydration can occur rapidly.
Most common between 6 and 36 months but may present in younger infants. Vomiting is bilious once
obstruction occurs
CH 40 Gi Disorders Questions - 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 (FTT + Weight loss)
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 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. (FTT + Weight loss)
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. (FTT +
Weight loss)
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 12th
percentile.
What is the best course of treatment for this infant? - ANS Begin a trial of extensively hydrolyzed
protein formula for 2-4 weeks. (FTT + Weight loss)
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. (FTT + Weight loss)
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. (FTT + Weight loss)
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. (Foreign body)
, 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 (GI Bleeding)
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. (GI Bleeding)
A school age child has recurrent diarrhea with foul smelling stools, excessiveflatus, abdominal
distension, and failure to thrive. A 2-week lactose free trial failed to reduce symptoms.
