A 5-year-old has a history of chronic recurrent abdominal pain and emesis. A diagnosis of cyclic vomiting was made at 3 years of age. Therapy with antimigraine medications was unsuccessful. During each episode, the serum ammonia, pH, glucose, and bicarbonate were normal. He now manifests bile-stained emesis, a tender distended abdomen, and bright-red blood per rectum. The most likely diagnosis is

Correct Answer: D

Rationale: The most likely diagnosis in this case is D) superior mesenteric artery syndrome (SMAS). SMAS occurs when the duodenum becomes compressed between the superior mesenteric artery and the aorta, leading to symptoms such as bile-stained emesis, abdominal distention, and bright-red blood per rectum. In this scenario, the history of chronic recurrent abdominal pain and emesis, along with the new symptoms, point towards SMAS as the most likely diagnosis. Option A) stress ulcers do not fit the clinical presentation as stress ulcers typically do not present with bile-stained emesis or bright-red blood per rectum. Option B) intussusception is less likely given the chronic nature of the symptoms and the absence of classic signs such as a palpable mass. Option C) malrotation typically presents earlier in infancy and would not explain the symptoms described in the scenario. Understanding pediatric gastrointestinal conditions is crucial for pediatric nurses as these conditions can have serious consequences if not promptly recognized and managed. By knowing the distinguishing features of conditions like SMAS, nurses can advocate for appropriate diagnostic tests and interventions to provide optimal care for pediatric patients with gastrointestinal issues.

Correct Answer: B

Rationale: In pediatric gastrointestinal nursing, understanding the causes of secretory diarrhea is crucial for effective intervention. The correct answer is option B) lactase deficiency. Secretory diarrhea occurs when there is an increase in the secretion of electrolytes and water into the intestinal lumen, leading to watery stools. Lactase deficiency, which is the inability to digest lactose, does not directly cause an increase in intestinal secretion. Option A) laxative abuse can lead to secretory diarrhea by irritating the intestinal lining and causing excessive secretion. Option C) irritable bowel syndrome can cause diarrhea as a symptom, but it is typically not classified as secretory diarrhea. Option D) thyrotoxicosis, a condition of excessive thyroid hormone production, can also lead to diarrhea but through a different mechanism unrelated to secretory diarrhea. Educationally, nurses need to differentiate between various causes of diarrhea to provide appropriate care. Understanding the pathophysiology behind secretory diarrhea and its distinct causes helps nurses tailor interventions such as fluid management and electrolyte replacement effectively. This knowledge also aids in patient education regarding dietary modifications and medication management to alleviate symptoms associated with secretory diarrhea.

Correct Answer: B

Rationale: Stickler syndrome is a genetic disorder characterized by a group of features that can affect multiple parts of the body. The correct answer, B) autosomal recessive inheritance, is the exception among the given options. Stickler syndrome is actually inherited in an autosomal dominant pattern, meaning that only one copy of the mutated gene is needed for the individual to develop the syndrome. Option A) prominent joints is a common feature of Stickler syndrome, where individuals may have joint hypermobility or joint issues. Option C) hypotonia, or low muscle tone, can also be present in individuals with Stickler syndrome due to the connective tissue abnormalities associated with the condition. Option D) retinal detachment is another feature of Stickler syndrome, as individuals with this condition are at risk for eye problems, including retinal issues. In an educational context, understanding the genetic inheritance pattern of Stickler syndrome is crucial for healthcare professionals working with pediatric patients. Recognizing the features of the syndrome can aid in early diagnosis and appropriate management of the condition. By knowing the correct inheritance pattern and typical clinical manifestations, nurses can provide comprehensive care and support for children and families affected by Stickler syndrome.

Correct Answer: D

Rationale: The correct answer is D) congenital chloride malabsorption. Osmotic diarrhea occurs when unabsorbed solutes in the intestinal lumen draw water into the intestine, leading to increased water content in the stool. Congenital chloride malabsorption is a condition where there is impaired absorption of chloride in the intestines, resulting in an osmotic effect leading to diarrhea. Option A) Escherichia coli is a common cause of infectious diarrhea but does not directly cause osmotic diarrhea. Carcinoid (Option B) and neuroblastoma (Option C) are not typically associated with causing osmotic diarrhea as they are related to tumors and not known for their direct impact on chloride absorption in the intestines. In the context of pediatric gastrointestinal nursing interventions, understanding the underlying causes of diarrhea, such as congenital chloride malabsorption, is crucial for providing appropriate care. Nurses need to be able to identify the etiology of diarrhea to implement targeted interventions, such as specific dietary modifications or medication management, to effectively manage the condition and prevent complications. This knowledge is essential for promoting optimal outcomes and quality of life for pediatric patients with gastrointestinal issues.

Correct Answer: D

Rationale: Rationale: The correct answer is option D) usually diagnosed before school age. Achalasia is a rare motility disorder of the esophagus characterized by the inability of the lower esophageal sphincter to relax, resulting in difficulty swallowing (dysphagia), regurgitation of undigested food, chest pain, and weight loss. While achalasia can occur at any age, it is more commonly diagnosed in adults rather than in children. Option A) dysphagia for solids and liquids is a feature of achalasia as the impaired esophageal motility affects the passage of both solids and liquids through the esophagus. Option B) may be accompanied by undernutrition is true as untreated achalasia can lead to weight loss and malnutrition due to difficulty in swallowing and inadequate intake of nutrients. Option C) may be misdiagnosed as asthma is also a common occurrence as the symptoms of achalasia such as chest pain and difficulty breathing can mimic asthma, leading to a misdiagnosis. In an educational context, understanding the clinical features of achalasia is crucial for pediatric nurses to provide early identification, intervention, and support for children with this condition. By differentiating achalasia from other gastrointestinal and respiratory disorders, nurses can collaborate with healthcare providers to ensure timely diagnosis and appropriate management to improve the quality of life for pediatric patients with achalasia.