CPEN Gastrointestinal Emergencies 5

Question 1

A 5-year-old presents with abdominal pain, vomiting, and bloody diarrhea 3 days after eating undercooked hamburger at a cookout. Labs show thrombocytopenia, anemia, and elevated creatinine. Which complication is developing?

Accepted Answer

Hemolytic uremic syndrome

Answer

The triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury following E. coli O157:H7 infection is diagnostic of hemolytic uremic syndrome (HUS).

Question 2

A 7-year-old with celiac disease presents with severe abdominal pain, distension, and obstipation after being exposed to gluten. Which complication specific to celiac disease is most concerning?

Accepted Answer

Celiac crisis with refractory diarrhea and electrolyte imbalance

Answer

Celiac crisis is a rare but life-threatening complication triggered by gluten exposure, characterized by severe diarrhea, dehydration, metabolic disturbances, and malnutrition.

Question 3

During assessment of a 4-year-old with abdominal pain, the nurse notes that pain worsens when the right thigh is extended while the patient is lying on the left side. This finding is most consistent with which diagnosis?

Accepted Answer

Appendicitis (psoas sign)

Answer

The psoas sign—pain on right hip extension—indicates inflammation adjacent to the iliopsoas muscle, classically seen with a retrocecal appendix in appendicitis.

Question 4

A 13-year-old girl presents with acute severe periumbilical pain that has localized to the right lower quadrant. Pregnancy test is positive. Which condition must be immediately excluded before attributing pain to appendicitis?

Accepted Answer

Ectopic pregnancy

Answer

A positive pregnancy test with acute abdominal pain mandates immediate exclusion of ectopic pregnancy, which is life-threatening and can mimic appendicitis.

Question 5

A 6-year-old presents with sudden onset of severe abdominal pain, vomiting, and a distended, tympanitic abdomen. X-ray shows free air under the diaphragm. What is the most critical next step?

Accepted Answer

Perform nasogastric decompression and arrange emergent surgical consultation

Answer

Free air under the diaphragm indicates intestinal perforation requiring immediate NG decompression, IV antibiotics, and emergent surgical consultation.

CPEN - Certified Pediatric Emergency Nurse Practice Test

CPEN - Certified Pediatric Emergency Nurse Practice Test

CPEN Gastrointestinal Emergencies 5