PEDIATRIC NURSING REVIEW QUESTIONS
BAD BELLIES I Authors: Scott DeBoer, MSN, RN, CPEN, CEN, CCRN, CFRN, EMT-P, and Michael Seaver, BA, RN, Dyer, IN, Grayslake, IL Section Editors: Scott DeBoer, MSN, RN, CPEN, CEN, CCRN, CFRN, EMT-P, and Michael Seaver, BA, RN
These online review questions offer emergency nurses an opportunity to test their knowledge about their practice.
QUESTIONS
5. Pain at McBurney’s point is a sign of: A. Meckel’s diverticulum B. Appendicitis C. Hirschsprung disease D. Necrotizing enterocolitis
1. When assessing an infant’s abdomen, each of the following statements is true except: A. The abdomen of an infant is naturally protuberant and may appear somewhat distended. B. It is not necessary to examine the rectum of an infant. C. Crying can result in significant abdominal distention. D. It may be necessary to evaluate the abdomen more than once for an accurate assessment. 2. In the emergency department, which is the correct sequence for assessing a child’s abdomen? A. Auscultation, percussion, inspection, and palpation B. Auscultation, inspection, percussion, and palpation C. Inspection, auscultation, percussion, and palpation D. Inspection, auscultation, palpation, and percussion 3. Cullen’s sign is characterized by: A. Bruising over the flanks B. Bruising around the umbilicus C. Bruising around the perineum D. Bruising around the xiphoid process 4. Grey-Turner’s sign is characterized by: A. Bruising over the flanks B. Bruising around the umbilicus C. Bruising around the perineum D. Bruising around the xiphoid process Scott DeBoer is Critical Care Transport Nurse, MedEx Chicago, Chicago, IL, and Founder, Pedi-Ed-Trics Emergency Medical Solutions, Dyer, IN. Michael Seaver is Senior Healthcare Informatics Consultant, Grayslake, IL. Review questions and answers on topics about which nurses should be knowledgeable. For correspondence, write: Scott DeBoer, MSN, RN, CPEN, CEN, CCRN, CFRN, EMT-P; E-mail: [email protected]. J Emerg Nurs 2017;43:e1-2. 0099-1767 Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jen.2017.03.006
September 2017
VOLUME 43 • ISSUE 5
ANSWERS 1. Correct answer: B
The physical examination of a child with an abdominal complaint can be challenging because the assessment isn’t necessarily limited to the belly. An examination of the rectum should be performed for all children suspected of having an intra-abdominal or pelvic disorder or those presenting with pooping problems or rectal bleeding. The abdomen on small children is naturally protuberant, and infants and young children who are stressed and crying will swallow large amounts of air (aerophagia), leading to further appearances of distention typically unrelated to the actual cause of the complaint. Often, tenseness of the abdominal wall will disappear with decompression by a nasogastric or orogastric tube. Multiple assessments are frequently needed to truly evaluate the nature of the complaint. Last, but not least, the examiner should always approach the child with a calm demeanor and warm hands. Emergency Nurses Association, 1 76-77; DeBoer, 2 45. 2. Correct answer: C
Look at the abdomen before you mess with it. Then listen to the abdomen before you mess with it. Why? You don’t want to create “false bowel sounds” by percussion and/or palpation. Percuss next, before deeply messing with the abdomen and altering the findings, and finally, do the painful part of the examination—palpate. Look, listen, tap, and touch. Emergency Nurses Association, 1 76-77; DeBoer, 2 478. 3. Correct answer: B
Cullen’s sign is characterized by bruising around the umbilicus and can be a late sign of intra-abdominal or retroperitoneal hemorrhage (12 to 24 hours after the injury). One way to remember it is that the first two letters in Cullen’s sign are
WWW.JENONLINE.ORG
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PEDIATRIC NURSING REVIEW QUESTIONS/DeBoer and Seaver
“CU.” If you “C” bruising around the “U”mbilicus, that is Cullen’s sign. More important than remembering the name of the sign is remembering that if you see it in a child, bad things are happening in the child’s abdomen. Emergency Nurses Association, 1 281-282; DeBoer, 2 479. 4. Correct answer: A
Grey-Turner’s sign is characterized by bruising on the flank and can also be a sign of intra-abdominal or retroperitoneal hemorrhage. You might think about “Turn(er’s) over on your flank” (Turners = Flank) as a way to remember this one. Again, more important than remembering the name of the sign is remembering that if you see this in a child, bad things are happening in the child’s abdomen. Emergency Nurses Association, 1 281-282; DeBoer, 2 480.
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5. Correct answer: B
Right lower quadrant pain, specifically at McBurney’s point, is one of the hallmark signs of appendicitis. Symptoms of Meckel’s diverticulum include rectal bleeding and vomiting, and if an obstruction occurs, abdominal distention and pain may be present. Hirschsprung disease, also known as congenital megacolon, is characterized by constipation, vomiting, and abdominal distention in newborns. Bloating and bloody diarrhea in premature infants are the most common symptoms of necrotizing enterocolitis. Emergency Nurses Association, 1 154-155; DeBoer, 2 488. REFERENCES 1. Emergency Nurses Association. Emergency Nursing Pediatric Course. 4th ed., Des Plaines, IL: Emergency Nurses Association; 2013:76-7. 154-155, 281-282. 2. DeBoer S. Certified Pediatric Emergency Nurse Review: Putting It All Together. 3rd ed., Dyer, IN: Pedi-Ed-Trics Emergency Medical Solutions; 2013:478-80. 488.
VOLUME 43 • ISSUE 5
September 2017
BAD BELLIES I Authors: Scott DeBoer, MSN, RN, CPEN, CEN, CCRN, CFRN, EMT-P, and Michael Seaver, BA, RN, Dyer, IN, Grayslake, IL Section Editors: Scott DeBoer, MSN, RN, CPEN, CEN, CCRN, CFRN, EMT-P, and Michael Seaver, BA, RN
These online review questions offer emergency nurses an opportunity to test their knowledge about their practice.
QUESTIONS
5. Pain at McBurney’s point is a sign of: A. Meckel’s diverticulum B. Appendicitis C. Hirschsprung disease D. Necrotizing enterocolitis
1. When assessing an infant’s abdomen, each of the following statements is true except: A. The abdomen of an infant is naturally protuberant and may appear somewhat distended. B. It is not necessary to examine the rectum of an infant. C. Crying can result in significant abdominal distention. D. It may be necessary to evaluate the abdomen more than once for an accurate assessment. 2. In the emergency department, which is the correct sequence for assessing a child’s abdomen? A. Auscultation, percussion, inspection, and palpation B. Auscultation, inspection, percussion, and palpation C. Inspection, auscultation, percussion, and palpation D. Inspection, auscultation, palpation, and percussion 3. Cullen’s sign is characterized by: A. Bruising over the flanks B. Bruising around the umbilicus C. Bruising around the perineum D. Bruising around the xiphoid process 4. Grey-Turner’s sign is characterized by: A. Bruising over the flanks B. Bruising around the umbilicus C. Bruising around the perineum D. Bruising around the xiphoid process Scott DeBoer is Critical Care Transport Nurse, MedEx Chicago, Chicago, IL, and Founder, Pedi-Ed-Trics Emergency Medical Solutions, Dyer, IN. Michael Seaver is Senior Healthcare Informatics Consultant, Grayslake, IL. Review questions and answers on topics about which nurses should be knowledgeable. For correspondence, write: Scott DeBoer, MSN, RN, CPEN, CEN, CCRN, CFRN, EMT-P; E-mail: [email protected]. J Emerg Nurs 2017;43:e1-2. 0099-1767 Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jen.2017.03.006
September 2017
VOLUME 43 • ISSUE 5
ANSWERS 1. Correct answer: B
The physical examination of a child with an abdominal complaint can be challenging because the assessment isn’t necessarily limited to the belly. An examination of the rectum should be performed for all children suspected of having an intra-abdominal or pelvic disorder or those presenting with pooping problems or rectal bleeding. The abdomen on small children is naturally protuberant, and infants and young children who are stressed and crying will swallow large amounts of air (aerophagia), leading to further appearances of distention typically unrelated to the actual cause of the complaint. Often, tenseness of the abdominal wall will disappear with decompression by a nasogastric or orogastric tube. Multiple assessments are frequently needed to truly evaluate the nature of the complaint. Last, but not least, the examiner should always approach the child with a calm demeanor and warm hands. Emergency Nurses Association, 1 76-77; DeBoer, 2 45. 2. Correct answer: C
Look at the abdomen before you mess with it. Then listen to the abdomen before you mess with it. Why? You don’t want to create “false bowel sounds” by percussion and/or palpation. Percuss next, before deeply messing with the abdomen and altering the findings, and finally, do the painful part of the examination—palpate. Look, listen, tap, and touch. Emergency Nurses Association, 1 76-77; DeBoer, 2 478. 3. Correct answer: B
Cullen’s sign is characterized by bruising around the umbilicus and can be a late sign of intra-abdominal or retroperitoneal hemorrhage (12 to 24 hours after the injury). One way to remember it is that the first two letters in Cullen’s sign are
WWW.JENONLINE.ORG
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PEDIATRIC NURSING REVIEW QUESTIONS/DeBoer and Seaver
“CU.” If you “C” bruising around the “U”mbilicus, that is Cullen’s sign. More important than remembering the name of the sign is remembering that if you see it in a child, bad things are happening in the child’s abdomen. Emergency Nurses Association, 1 281-282; DeBoer, 2 479. 4. Correct answer: A
Grey-Turner’s sign is characterized by bruising on the flank and can also be a sign of intra-abdominal or retroperitoneal hemorrhage. You might think about “Turn(er’s) over on your flank” (Turners = Flank) as a way to remember this one. Again, more important than remembering the name of the sign is remembering that if you see this in a child, bad things are happening in the child’s abdomen. Emergency Nurses Association, 1 281-282; DeBoer, 2 480.
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5. Correct answer: B
Right lower quadrant pain, specifically at McBurney’s point, is one of the hallmark signs of appendicitis. Symptoms of Meckel’s diverticulum include rectal bleeding and vomiting, and if an obstruction occurs, abdominal distention and pain may be present. Hirschsprung disease, also known as congenital megacolon, is characterized by constipation, vomiting, and abdominal distention in newborns. Bloating and bloody diarrhea in premature infants are the most common symptoms of necrotizing enterocolitis. Emergency Nurses Association, 1 154-155; DeBoer, 2 488. REFERENCES 1. Emergency Nurses Association. Emergency Nursing Pediatric Course. 4th ed., Des Plaines, IL: Emergency Nurses Association; 2013:76-7. 154-155, 281-282. 2. DeBoer S. Certified Pediatric Emergency Nurse Review: Putting It All Together. 3rd ed., Dyer, IN: Pedi-Ed-Trics Emergency Medical Solutions; 2013:478-80. 488.
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September 2017
