CPEN Gastrointestinal Emergencies 3

Question 1

A neonate presents with failure to pass meconium in the first 48 hours of life, abdominal distension, and bilious vomiting. Rectal exam results in explosive release of gas and stool. Which diagnosis is most likely?

Accepted Answer

Hirschsprung disease

Answer

Hirschsprung disease classically presents with failure to pass meconium, abdominal distension, and explosive decompression upon rectal examination due to the absence of ganglion cells in the rectosigmoid.

Question 2

A premature neonate at 28 weeks gestation in the NICU develops abdominal distension, bloody stools, and pneumatosis intestinalis on X-ray. What is the most critical immediate intervention?

Accepted Answer

Make the infant NPO and start broad-spectrum antibiotics

Answer

Necrotizing enterocolitis requires immediate bowel rest (NPO), nasogastric decompression, and broad-spectrum antibiotics as initial management.

Question 3

A 14-year-old presents with rectal bleeding, urgency, and mucus in the stool for 6 weeks. Colonoscopy reveals continuous mucosal inflammation from the rectum. Which condition is most consistent with these findings?

Accepted Answer

Ulcerative colitis

Answer

Continuous mucosal inflammation starting at the rectum and extending proximally is the hallmark of ulcerative colitis, distinguishing it from the skip lesions of Crohn disease.

Question 4

A child with known hemophilia A presents with acute abdominal pain and is found to have a retroperitoneal hematoma on imaging. What is the most appropriate initial treatment?

Accepted Answer

Administer factor VIII concentrate

Answer

In a child with hemophilia A, the priority is to restore factor VIII activity to stop the bleeding before any surgical consideration.

Question 5

A 6-year-old ingests a button battery. X-ray confirms it is lodged in the esophagus. What is the most appropriate next step?

Accepted Answer

Immediate endoscopic removal

Answer

Button batteries lodged in the esophagus require immediate endoscopic removal due to the risk of liquefactive necrosis, perforation, and aortoesophageal fistula within hours.

CPEN - Certified Pediatric Emergency Nurse Practice Test

CPEN - Certified Pediatric Emergency Nurse Practice Test

CPEN Gastrointestinal Emergencies 3