Deck 33: Gastrointestinal Disorders

Question 1

A 2­year­old 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?
A. Clear liquids only
B. Lactobacillus
C. Loperamide
D. Peppermint oil

Answer 1

Lactobacillus

Question 2

A toddler is seen in the clinic after a 2­day history of intermittent vomiting and
diarrhea. An assessment reveals an irritable child with dry mucous membranes, 3­second 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?
A. Anti­diarrheal medication and clear fluids for 24 hours
B. Bolus of IV normal saline in the clinic until improvement
C. Hospital admission for IV rehydration and oral fluids
D. Oral rehydration solution with follow­up in 24 hours

Answer 2

Oral rehydration solution with follow­up in 24 hours

Question 3

A school­age child has recurrent diarrhea with foul­smelling stools, excessive
flatus, abdominal distension, and failure­to­thrive. A 2­week lactose­free trial failed to reduce symptoms. What is the next step in diagnosing this condition?
A. Lactose hydrogen breath test
B. Serologic testing for celiac disease
C. Stool for ova and parasites
D. Sweat chloride test for cystic fibrosis

Answer 3

Serologic testing for celiac disease

Question 4

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?
A. Consultation with a dietician
B. Fiberoptic endoscopy evaluation
C. Magnetic resonance imaging
D. Videofluoroscopy swallowing study

Question 5

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?
A. Administer ipecac to induce vomiting.
B. Have the parents watch for the object in the child's stool.
C. Insert a nasogastric tube to flush out the object.
D. Refer the child for endoscopic removal of the object.

Question 6

The parent of a 3­month­old 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?
A. Begin a trial of extensively hydrolyzed protein formula for 2 to 4 weeks.
B. Institute an empiric trial of acid suppression with a proton pump inhibitor (PPI).
C. Perform esophageal pH monitoring to determine the degree of reflux.
D. Reassure the parent that these symptoms will likely resolve by 12 to 24 months.

Question 7

A child is diagnosed with Crohn disease. What are likely complications for this child?
A. Cancer of the colon and possible colectomy
B. Intestinal obstruction with scarring and strictures
C. Intestinal perforation and hemorrhage
D. Liver disease and sepsis

Question 8

A 12­month­old 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?
A. Complete blood count and electrolytes
B. Feeding and stooling history and 3­day diet history
C. Stool cultures for ova and parasites
D. Swallow study with videofluoroscopy

Question 9

A school­age 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?
A. CBC, ESR, amylase, lipase, UA, and abdominal ultrasound
B. CBC, ESR, CRP, and fecal calprotectin
C. CBC, ESR, CRP, UA, stool for ova, parasites, and culture
D. Stool for H. pylori antigen and serum IgA, IgG, tTg

Question 10

The parent of an infant asks about using a probiotic medication. What will the primary care pediatric nurse practitioner tell this parent?
A. Probiotic medications have demonstrated efficacy in treating colic.
B. Probiotics are not safe to use to treat infants who have colic.
C. There are no studies showing usefulness of probiotics to manage colic.
D. There is no conclusive evidence about using probiotics to treat colic.

Question 11

A 2­month­old 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?
A. A complete work­up, including laboratory and radiologic tests
B. Eliminating certain foods from the mother's diet
C. Empiric treatment with a proton pump inhibitor medication
D. Stopping breastfeeding and beginning a hydrolyzed formula

Question 12

A school­age child has a 3­month 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?
A. Administration of H2RA or PPI medications
B. Empiric therapy for H. pylori (HP)
C. Ordering an upper GI series
D. Referral for esophagogastroduodenoscopy (EGD)

Question 13

An 18­month­old child has a 1­day 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?
A. Appendicitis
B. Gastroenteritis
C. Intussusception
D. Testicular torsion

Question 14

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?
A. Informing the parents that the pain is most likely not real
B. Instituting a lactose­free diet along with lactobacillus supplements
C. Teaching about the brain­gut interaction causing symptoms
D. Using histamine2­blockers to help alleviate symptoms

Question 15

A 10­year­old 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?
A. Appendicitis with perforation
B. Gastroenteritis
C. Pelvic inflammatory disease (PID)
D. Urinary tract infection (UTI)

Question 16

A 9­year­old 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?
A. Begin using an anti­migraine medication to prevent headaches.
B. Prescribe ondansetron and lorazepam to help manage symptoms.
C. Reassure the parent that this is expected with cyclic vomiting syndrome.
D. Refer to a pediatric gastroenterologist for further workup.