CPEN Gastrointestinal Emergencies 4

Question 1

A 16-year-old with a history of alcohol use presents with epigastric pain radiating to the back, nausea, and vomiting. Serum lipase is 800 U/L. What is the most important initial management priority?

Accepted Answer

Aggressive IV fluid resuscitation with lactated Ringer's solution

Answer

Aggressive IV fluid resuscitation is the cornerstone of acute pancreatitis management, with lactated Ringer's preferred to reduce systemic inflammation.

Question 2

A 2-year-old presents with painless, maroon-colored rectal bleeding. The child is hemodynamically stable. Which diagnostic study is most appropriate to identify the bleeding source?

Accepted Answer

Technetium-99m pertechnetate (Meckel) scan

Answer

Painless lower GI bleeding in a toddler is classic for a Meckel diverticulum containing ectopic gastric mucosa, and a Meckel scan is the preferred diagnostic test.

Question 3

A child with end-stage liver disease presents with massive hematemesis. Which medication should be given immediately while preparing for endoscopy?

Accepted Answer

Octreotide IV

Answer

Octreotide (a somatostatin analogue) reduces portal pressure by causing splanchnic vasoconstriction and is the preferred pharmacologic agent for acute variceal bleeding in children.

Question 4

A 9-year-old is brought in after ingesting an unknown quantity of acetaminophen 3 hours ago. Labs are pending. Which antidote should be administered?

Accepted Answer

N-acetylcysteine (NAC)

Answer

N-acetylcysteine is the antidote for acetaminophen toxicity and is most effective when started within 8 hours of ingestion, before hepatic injury occurs.

Question 5

An 8-year-old with sickle cell disease presents with acute right upper quadrant pain, fever, and jaundice. Ultrasound shows gallstones and a distended gallbladder. Which complication is most concerning?

Accepted Answer

Acute cholecystitis with possible perforation

Answer

Children with sickle cell disease are at high risk for pigment gallstones and acute cholecystitis, which can progress to perforation if not managed promptly.

CPEN - Certified Pediatric Emergency Nurse Practice Test

CPEN - Certified Pediatric Emergency Nurse Practice Test

CPEN Gastrointestinal Emergencies 4