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Exam 2 NURS 629- Questions and Answers
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Exam 2 NURS 629- Questions and Answers
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Exam 2 NURS 629- Questions and AnswersWhat is GER? Correct Ans-Refers to the passage of gastric contents into the esophagus
from the stomach through the LES; normal physiological process in healthy individuals
What is GERD? Correct Ans-present when the reflux causes troublesome symptoms and/or
complications; most common esophageal disorder in children
GERD etiology Correct Ans-Inappropriate relaxation of LES w/ failure to prevent gastric
acid reflux into the esophagus, prolonged esophageal clearance of the gastric refluxate, and
impaired esophageal mucosal barrier function
1. Infants have increased intraabdominal pressure because of their inability to sit upright;
regurgitation is highest in the first month of life and decreases by 50% by the 5th month of life
GER symptoms Correct Ans-1. Infancy = regurgitation; signs of esophagitis (irritability,
arching, choking, gagging, feeding aversion); usually resolves 12-24 months of age
2. Child and adolescent = regurgitation during preschool years, complains of abdominal or
chest pain, neck contortions (arching, turning of head), asthma, sinusitis, laryngitis
3. Symptoms in all children = regurgitation w/ or w/o vomiting; ruminative behavior;
heartburn or chest pain; hematemesis; dysphagia; respiratory disorders (wheezing, stridor,
cough, hoarseness, persistent throat clearing or cough); halitosis
4. Signs in all children = esophagitis, esophageal stricture, barrett esophagus,
laryngeal/pharyngeal inflammation, recurrent pneumonia, anemia, dental erosion, apnea
spells, apparent life-threatening events, weight loss or poor weight gain
, Exam 2 NURS 629- Questions and Answers
GERD diagnosis Correct Ans-By history and physical exam; sometimes an empiric trial of
acid suppression w/a PPI x 4 weeks may be used as a diagnostic test in older children and
adolescents, but not recommended in infants and young children
1. Labs = obtain CBC w/ diff to r/o anemia and infection; UA and urine culture; stool for occult
blood; testing for H. pylori
2. Gold standard to diagnose reflux - esophageal pH monitoring
GERD management Correct Ans-1. H2RA and buffering agents - rapid onset of action,
useful in on-demand treatment; result in tolerance
----H2RA examples: cimetidine, famotidine, nizatidine, ranitidine
2. PPI - superior to H2RAs in relieving symptoms and promoting mucosal healing and do not
result in tolerance as do H2RA
----PPI examples: lansoprazole (prevacid), omeprazole (Prilosec), rabeprazole (aciphex),
pantoprazole (protonix), esomeprazole (nexium)
3. Cytoprotective agent - sucralfate (Carafate)
GERD: nutrition Correct Ans-thickening agents for formula in 1 tablespoon rice
cereal/ounce formula reduce regurgitation but not significantly; no evidence to support
dietary restrictions to decrease symptoms; avoid eating <2 hours before bedtime
GERD lifestyle Correct Ans-With GER, position infant in flat prone position after feeding if
awake and being observed
Position in flat supine position if sleeping
, Exam 2 NURS 629- Questions and Answers
Semi-sitting position applies abdominal pressure and causes more reflux; positioning infants
upright may worsen reflux;
Burp frequently during feeding
Left-side positioning for older children during sleep or elevation of the head of the bed
3 kinds of UTI Correct Ans-1) Asymptomatic bacteriuria
2) Cystitis
3) Pyelonephritis
Asymptomatic bacteriuria: Correct Ans-bacteria in the urine w/o other symptoms
Cystitis Correct Ans-Infection of the bladder that produces lower tract symptoms but does
not cause fever or renal injury
Pyelonephritis Correct Ans-Severe UTI involving the renal parenchyma or kidneys;
potential for irreversible renal damage
S/S - fever, irritability, vomiting in an infant, and urinary symptoms associated w/ a fever,
bacteriuria, vomiting and renal tenderness in older children
Main cause of UTI Correct Ans-E coli (70% of cases)
UTI diagnosis Correct Ans-1. Urine culture to confirm (>100,000 colonies in a clean catch
urine; or 10,000 colonies in a single pathogen and the child is symptomatic) = UTI
, Exam 2 NURS 629- Questions and Answers
2. UA - foul odor, cloudiness, nitrities, leukocytes, alkaline pH, proteinuria, hematuria, pyuria,
bacteriuria
3. CBC, ESR, CRP, BUN, and creatinine for children <1, appears ill or if pyelo is suspected
UTI Prevention Correct Ans-wipe front to back, bathe in clean water, then wash child, and
get out; increase water; void after intercourse; frequent and complete voiding; avoid bubble
baths and perfumed soaps; wear cotton underwear; treat perineal inflammation to prevent
UTI; treat constipation; decrease caffeine, carbonated beverages, chocolate, and citrus,
aspartame, alcohol and spicy foods
UTI Treatment in uncomplicated cystitis Correct Ans-Uncomplicated cystitis: children 2-24
months old and febrile children treated for 7-14 days
a. Trimethoprim-sulfamethoxazole (if >2 mo old) 8-12 mg/kg in 2 doses; adolescents - 160mg
BID
b. Amoxicillin
c. Amoxicillin clavulanate
d. Cephalexin
e. Cefixime (if >6 mo old)
f. Cefpodoxime proxetil (if >2 mo old)
g. Ciprofloxacin (if >18 years) 500 mg once daily x3 days
h. Nitrofurantoin (if >1 mo)
UTI Treatment in Pyelonephritis Correct Ans-a. Hospitalization if dehydrated, vomiting, or
not drinking
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