Chapter 40 - GI Disorders - ANSWER
The parent of a colicky infant asks about using a probiotic medication.
What will you tell them? - ANSWERThere is no conclusive evidence about using probiotics to treat colic.
A toddler who was born prematurely refuses most solid foods and has poor weight ga...
The parent of a colicky infant asks about using a probiotic medication.
What will you tell them? - ANSWERThere 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? - ANSWERVideo 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? - ANSWEROral 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? - ANSWERRefer 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? - ANSWERBegin 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? - ANSWERRefer 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? - ANSWEREliminating 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? - ANSWERHave 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? - ANSWERAppendicitis 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? - ANSWERIntussusception
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? - ANSWERCBC
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? - ANSWERTeaching 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? - ANSWERSerologic testing for celiac disease.
A child is diagnosed with Crohn's disease.
What are likely complications? - ANSWERIntestinal 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? - ANSWERFeeding 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? -
ANSWERLactobacillus
Chapter 41 - GU Disorders - ANSWER
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? - ANSWERSend 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? - ANSWERTreat 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.
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