Module 2A (Ch 30, 32, 29, 12, 37, 31, 35) Flashcards
The parent of a 4monthold infant is concerned that the infant cannot hear. Which test will the primary care pediatric nurse practitioner order to evaluate potential hearing loss in this infant?
Auditory brainstem response (ABR
The primary care pediatric nurse practitioner obtains a tympanogram on a child that reveals a sharp peak of 180 mm H2O. What does this value indicate
Negative ear pressure
An 18monthold child with no previous history of otitis media awoke during the
night with right ear pain. The primary care pediatric nurse practitioner notes an axillary temperature of 100.5°F and an erythematous, bulging tympanic membrane. A tympanogram reveals of peak of +150 mm H2O. What is the recommended treatment for this child?
An analgesic medication and watchful waiting
A 7monthold infant has had two prior acute ear infections and is currently on the
10th day of therapy with amoxicillinclavulanate after a failed course of amoxicillin. The primary care pediatric nurse practitioner notes marked middle ear effusion and erythema of the TM. The child is irritable and has a temperature of 99.8°F. What is the next step in management of this child’s ear infection
Refer the child to an otolaryngologist
. A 3yearold child with pressureequalizing tubes (PET) in both ears has otalgia in
one ear. The primary care pediatric nurse practitioner is able to visualize the tube and does not see exudate in the ear canal and obtains a type A tympanogram. What will the nurse practitioner do
Order ototopical antibiotic/corticosteroid drops
What will the primary care pediatric nurse practitioner teach the parents of a child who has new pressureequalizing tubes (PET) in both ears?
Parents should notice improved hearing in their child.
A child with a history of otitis externa asks about ways to prevent this condition. What will the primary care pediatric nurse practitioner recommend
Drying the ear canal with a hair dryer
A child complains of itching in both ears and is having trouble hearing. The
primary care pediatric nurse practitioner notes periauricular edema and marked swelling of the external auditory canal and elicits severe pain when manipulating the external ear structures. Which is an appropriate intervention?
Order ototopical antibiotic/corticosteroid drops.
A child who has otitis externa has severe swelling of the external auditory canal
that persists after 2 days of therapy with ototopical antibiotic/corticosteroid drops. What is the next step in treatment for this child
Insert a wick into the external auditory canal.
The primary care pediatric nurse practitioner notes a small, round object in a
child’s external auditory canal, near the tympanic membrane. The child’s parent thinks it is
probably a dried pea. What will the nurse practitioner do to remove this object?
Refer the child to an otolaryngologist for removal
A 3yearold child has had one episode of acute otitis media 3 weeks prior with a normal tympanogram just after treatment with amoxicillin. In the clinic today, the child has a type B tympanogram, a temperature of 102.5°F, and a bulging tympanic membrane. What will the primary care pediatric nurse practitioner order
Amoxicillinclavulanate twice daily
The primary care pediatric nurse practitioner diagnoses acute otitis media in a 2 yearold child who has a history of three ear infections in the first 6 months of life. The child’s tympanic membrane is intact and the child has a temperature of 101.5°F. What will the nurse practitioner prescribe for this child
id treat but An analgesic medication and watchful waiting
A child who was treated with amoxicillin and then amoxicillinclavulanate for acute
otitis media is seen for followup. The primary care pediatric nurse practitioner notes dullgray tympanic membranes with a visible airfluid level. The child is afebrile and without pain. What is the next course of action
Monitoring ear fluid levels for 3 months
A schoolage child has a history of chronic otitis media and is seen in the clinic
with vertigo. The primary care pediatric nurse practitioner notes profuse purulent otorrhea from both pressureequalizing tubes and a pearlywhite lesion on one tympanic membrane. Which condition is most likely
Cholesteatoma
In a respiratory disorder causing a checkvalve obstruction, which symptoms will be present
Air entry on inspiration with expiratory occlusion
A child has an acute infection causing lower airway obstruction. Which initial symptom is expected in this child
Wheezing
A 4yearold child with an upper respiratory tract infection has cloudy nasal
discharge and moderate nasal congestion interfering with sleep. The parent asks what product to use to help with symptoms. What will the primary care pediatric nurse practitioner recommend
Saline rinses
A 5yearold child has enlarged tonsils and a history of four throat infections in the
previous year with fever, cervical lymphadenopathy, and positive Group AStreptococcus pyogenes (GABHS) cultures. The parent reports that the child snores at night and expresses concerns about the child’s quality of sleep. The next step in managing this child’s condition is to
refer to a pulmonologist for polysomnography evaluation
A schoolage child has an abrupt onset of sore throat, nausea, headache, and a
temperature of 102.3°F. An examination reveals petechiae on the soft palate, beefyred tonsils with yellow exudate, and a scarlatiniform rash. A Rapid Antigen Detection Test (RADT) is negative. What is the next step in management for this child?
Perform a followup throat culture.
An adolescent has suspected infectious mononucleosis after exposure to the
virus in the past week. The primary care pediatric nurse practitioner examines the adolescent and notes exudate on the tonsils, soft palate petechiae, and diffuse adenopathy. Which test will the primary care pediatric nurse practitioner perform to confirm the diagnosis
EBVspecific antibody testing
A schoolage child has had nasal discharge and daytime cough but no fever for
12 days without improvement in symptoms. The child has not had antibiotics recently and there is no significant antibiotic resistance in the local community. What is the appropriate treatment for this child
Amoxicillin 45 mg/kg/day
After 14 days of treatment with amoxicillin 45 mg/kg/day for acute rhinosinusitis, a
child continues to have mucopurulent nasal discharge along with induration, swelling, and
erythema of both eyelids. What is the next course of treatment
Referral to a pediatric otolaryngologist
The parent of a toddler and a 4weekold infant tells the primary care pediatric
nurse practitioner that the toddler has just been diagnosed with pertussis. What will the nurse practitioner do to prevent disease transmission to the infant?
Order azithromycin 10 mg/kg/day in a single dose daily for 5 days.
A schoolage child has frequent nosebleeds. Nasal visualization reveals fresh
clots and excoriated nasal mucosa but no visible site of bleeding. Coagulation studies are normal. In spite of symptomatic measures, the child continues to have nosebleeds. What is the next course of action
Refer to an otolaryngologist for further evaluation
A child is in the clinic because of symptoms of purulent, foulsmelling nasal
discharge from the right nostril. Nasal visualization reveals something shiny in a mass of mucous in
the nasal cavity. What will the primary care pediatric nurse practitioner do
Attempt to remove the mass gently using alligator forceps
A 2yearold child is brought to the clinic after developing a hoarse, barklike
cough during the night with “trouble catching his breath” according to the parent. The history reveals a 2 day history of lowgrade fever and upper respiratory symptoms. On exam, the child has a respiratory rate of 40 breaths per minute, occasional stridor when crying, and a temperature of 101.3°F. What is the next step in treatment for this child
Prescribe oral dexamethasone for 2 days
The primary care pediatric nurse practitioner evaluates a child who awoke with a
sore throat and high fever after a nap. The child appears anxious and is sitting on the parent’s lap with the neck hyperextended. The physical exam reveals stridor, drooling, nasal flaring, and retractions. What will the nurse practitioner do next
Transport the child to the hospital via emergency medical services.
A 5monthold infant who has a 3day history of cough and rhinorrhea has
developed symptoms of respiratory distress with audible expiratory wheezes and increased coughing. The infant’s immunizations are uptodate. The physical exam reveals a respiratory rate of 50 breaths per minute, coarse expiratory wheezing, and prolonged expiration. An oxygen saturation is 96% on room air. What is the recommended treatment for this infant
Recommend increased fluids and close followup
A previously healthy schoolage child develops a cough and a lowgrade fever.
The primary care pediatric nurse practitioner auscultates wheezes in all lung fields. Which
diagnosis will the nurse practitioner suspect
Atypical pneumonia
A child is diagnosed with communityacquired pneumonia and will be treated as
an outpatient. Which antibiotic will the primary care pediatric nurse practitioner prescribe
Amoxicillin
The primary care pediatric nurse practitioner manages care in conjunction with a
pediatric pulmonologist for a child with cystic fibrosis. Which medication regimen is used to facilitate airway clearance for this child
Inhaled dornase alfa
The primary care pediatric nurse practitioner performs a vision screen on a 4
monthold infant and notes the presence of convergence and accommodation with mild esotropia
of the left eye. What will the nurse practitioner do
Refer the infant to a pediatric ophthalmologist.
During a well child exam on a 4yearold child, the primary care pediatric nurse
practitioner notes that the clinic nurse recorded “20/50” for the child’s vision and noted that the child had difficulty cooperating with the exam. What will the nurse practitioner recommend
Test the child’s vision in 1 month.
During a well child assessment of an AfricanAmerican infant, the primary care
pediatric nurse practitioner notes a dark redbrown light reflex in the left eye and a slightly brighter,
redorange light reflex in the right eye. The nurse practitioner will
refer the infant to an ophthalmologist.
The primary care pediatric nurse practitioner performs a Hirschberg test to evaluate
ocular alignment.
The primary care pediatric nurse practitioner applies fluorescein stain to a child’s
eye. When examining the eye with a cobalt blue filter light, the entire cornea appears cloudy. What does this indicate
There is too much stain on the cornea
A toddler exhibits exotropia of the right eye during a coveruncover screen. The
primary care pediatric nurse practitioner will refer to a pediatric ophthalmologist to initiate which
treatment
Patching of the unaffected eye for 2 hours each day
The primary care pediatric nurse practitioner performs a well child examination on
a 9monthold infant who has a history of prematurity at 28 weeks’ gestation. The infant was treated for retinopathy of prematurity (ROP) and all symptoms have resolved. When will the infant need an ophthalmologic exam
At 12 months of age
During a wellbaby assessment on a 1weekold infant who had a normal exam
when discharged from the newborn nursery 2 days prior, the primary care pediatric nurse practitioner notes moderate eyelid swelling, bulbar conjunctival injections, and moderate amounts
of thick, purulent discharge. What is the likely diagnosis
Chlamydia trachomatis conjunctivitis
The primary care pediatric nurse practitioner performs a well baby assessment of
a 5dayold infant and notes mild conjunctivitis, corneal opacity, and serosanguinous discharge in the right eye. Which course of action is correct
Admit the infant to the hospital immediately.
A preschoolage child who attends day care has a 2day history of matted eyelids
in the morning and burning and itching of the eyes. The primary care pediatric nurse practitioner notes yellowgreen purulent discharge from both eyes, conjunctival erythema, and mild URI symptoms. Which action is correct?
Prescribe topical antibiotic drops
A 14yearold child has a 2week history of severe itching and tearing of both
eyes. The primary care pediatric nurse practitioner notes redness and swelling of the eyelids along
with stringy, mucoid discharge. What will the nurse practitioner prescribe
Topical NSAID drops
The primary care pediatric nurse practitioner observes a tender, swollen red
furuncle on the upper lid margin of a child’s eye. What treatment will the nurse practitioner
recommend
Warm, moist compresses 3 to 4 times daily
The primary care pediatric nurse practitioner is treating an infant with lacrimal duct
obstruction who has developed bacterial conjunctivitis. After 2 weeks of treatment with topical antibiotics along with massage and frequent cleansing of secretions, the infant’s symptoms have not improved. Which action is correct
Refer to an ophthalmologist
- A preschoolage child is seen in the clinic after waking up a temperature of 102.2°F, swelling and erythema of the upper lid of one eye, and moderate pain when looking from side to side. Which course of treatment is correct
Admit to the hospital for intravenous antibiotics.
A schoolage child is seen in the clinic after a fragment from a glass bottle flew into the eye. What will the primary care pediatric nurse practitioner do?
Refer immediately to an ophthalmologist
A schoolage child is hit in the face with a baseball bat and reports pain in one eye. The primary care pediatric nurse practitioner is able to see a dark red fluid level between the cornea and iris on gross examination, but the child resists any exam with a light. Which action is correct?
Refer the child immediately to an ophthalmologist
The primary care pediatric nurse practitioner is performing a well child exam
on a 4monthold infant who is nursing exclusively. The mother reports that the infant has had a marked decrease in the number of stools each day, from 3 to 5 stools each day to only one stool every other day. How will the nurse practitioner respond?
Ask the mother to describe the color and consistency of the stools.
The primary care pediatric nurse practitioner is performing a well child exam
on a 12monthold infant. The parent tells the nurse practitioner that the infant has predictable bowel and bladder habits and asks about toilet training. What will the nurse practitioner tell this parent
Placing the child on a “potty” chair helps the child associate elimination cues with the toilet.
The primary care pediatric nurse practitioner is performing a well child exam
on a 24monthold child. The parent tells the nurse practitioner that the child is being toilet trained and expresses frustration that on some days the child uses the toilet every time and on other days not at all. What will the nurse practitioner do
Ask the parent about the child’s toilet habits and understanding of toilet training.
The primary care pediatric nurse practitioner is discussing toileting issues
with the parent of a 3yearold toddler who reports that the child has been toilet trained for several months but has recently been refusing to have bowel movements and is becoming constipated. What will the nurse practitioner do?
Ask the parent about bathroom facilities in the child’s day care.
The primary care pediatric nurse practitioner is evaluating a 5yearold child
who has frequent soiling of stool associated with stomach aches and decreased appetite for the past 2 months. The parent states that the child has two or fewer formed bowel movements each week and has been toilet trained for about 2 years. Which initial assessment will the nurse practitioner make
Recent illnesses, fluid intake, changes in diet
The primary care pediatric nurse practitioner is managing a 6yearold child
who has chronic constipation and encopresis. The nurse practitioner has ruled out neurogenic etiology. The parents report that the child was difficult to toilet train as a toddler. What is key to managing this child’s condition
Encouraging use of maintenance medications for at least 2 months after resolution
of constipation
The parent of a 5yearold child tells the primary care pediatric nurse
practitioner that the child has been using the toilet to urinate for since age 3 but continues to defecate in “pullups.” The nurse practitioner learns that the child has predictable bowel movements and a physical examination is normal. What will the nurse practitioner recommend
Putting the child on the toilet for 5 to 10 minutes at the usual time of defecation
The primary care pediatric nurse practitioner evaluates a 4yearold girl whose parent reports frequent urination in the evenings on weekdays, incontinence after voiding. The parent reports that the child has soft formed stools 5 or 6 times weekly. Which assessment will the nurse practitioner make initially?
Examination for labial adhesions
The primary care pediatric nurse practitioner is concerned that a toddler may
have vesicoureteral reflux based on a history of dysfunctional voiding patterns and a series of
urinary tract infections. Which intervention is appropriate
Referral to a urologist for evaluation
The primary care pediatric nurse practitioner is evaluating a 4yearold
female child for enuresis. The parents reports that the child has never been dry at night and has recently begun having daytime incontinence, usually when at preschool. The nurse practitioner learns that the child does not appear to have an abnormal urine stream. What will the nurse practitioner do next
Examine the urethral meatus and labia and obtain a dipstick clean catch urinalysis
The primary care pediatric nurse practitioner is counseling the parent of an 8 yearold child who has primary nocturnal enuresis. The nurse practitioner recommends an enuresis alarm, but the parent wishes to use medication. What will the nurse practitioner tell the parent
The combination of alarm therapy and intermittent drug therapy is best.
The primary care pediatric nurse practitioner is teaching a parent of a child
with dry skin about hydrating the skin with bathing. What will the nurse practitioner include in
teaching
Have the child soak in a lukewarm water bath
A child will need an occlusive dressing to treat lichen simplex chronicus. What
will the primary care pediatric nurse practitioner tell the parents about applying this treatment
Apply ointment before the dressing.
When prescribing topical glucocorticoids to treat inflammatory skin conditions, the primary care pediatric nurse practitioner will
prescribe brandname preparations for consistent effects.
A preschool age child has honeycrusted lesions on erythematous, eroded
skin around the nose and mouth, with satellite lesions on the arms and legs. The child’s parent has several similar lesions and reports that other children in the day care have a similar rash. How will this be treated
Amoxicillinclavulanate 90 mg/kg/day for 10 days
A child is brought to clinic with several bright red lesions on the buttocks. The
primary care pediatric nurse practitioner examines the lesions and notes sharp margins and an “orange peel” look and feel. The child is afebrile and does not appear toxic. What is the
course of treatment for these lesions
Initiate empiric antibiotic therapy and follow up in 24 hours to assess response.
An adolescent who recently spent time in a hot tub while on vacation has
discrete, erythematous 1 to 2mm papules that are centered around hair follicles on the thighs, upper arms, and buttocks. How will the primary care pediatric nurse practitioner manage this condition
Prescribe topical keratolytics and topical antibiotics.
An infant is brought to clinic with bright erythema in the neck and flexural
folds after recent treatment with antibiotics for otitis media. What is the treatment for this
condition
Topical nystatin cream applied several times daily
A schoolage child has several annular lesions on the abdomen
characterized by central clearing with scaly, red borders. What is the first step in managing this
condition
Treat empirically with antifungal cream.
A child has several circular, scaly lesions on the arms and abdomen, some of
which have central clearing. The primary care pediatric nurse practitioner notes a smaller, scaly lesion on the child’s scalp. How will the nurse practitioner treat this child?
Prescribe oral griseofulvin for 2 to 4 weeks.
A child is diagnosed with tinea versicolor. What is the correct management of ID: 13348425718 this disorder?
Application of selenium sulfide 2.5% lotion twice weekly for 2 to 4 weeks
An adolescent female has grouped vesicles on her oral mucosa. To
determine whether these are caused by HSV1 or HSV2, the primary care pediatric nurse
practitioner will order which test
Viral culture
A 4yearold child has clusters of small, clear, tense vesicles with an
erythematous base on one side of the mouth along the vermillion border, which are causing discomfort and difficulty eating. What will the primary care pediatric nurse practitioner recommend as treatment
Topical diphenhydramine and magnesium hydroxide
A previously healthy schoolage child develops herpes zoster on the lower
back. What will the primary care pediatric nurse practitioner do to manage this condition?
Order Burow solution and warm soothing baths as comfort measures.
A child has small, firm, fleshcolored papules in both axillae which are mildly
pruritic. What is an acceptable initial approach to managing this condition?
Reassuring the parents that these are benign and may disappear spontaneously
A schoolage child is brought to clinic after a pediculosis capitis infestation is
reported at the child’s school. If this child is positive, what will the primary care pediatric nurse practitioner expect to find on physical examination, along with live lice near the scalp?
Itching of the scalp, with skin excoriation on the back of the head
A 3yearold child has head lice. What will the initial treatment recommendation be to treat this child
Permethrin
A 9monthold infant has vesiculopustular lesions on the palms and soles, on
the face and neck, and in skin folds of the extremities. The primary care pediatric nurse practitioner notes linear and Sshaped burrow lesions on the parent’s hands and wrists. What is the treatment for this rash for this infant?
Permethrin 5% cream applied to face, neck, and body and rinsed off in 8 to 14 hours
An adolescent has acne with lesions on the cheeks and under the chin.
Which distribution is this?
Topical erythromycin with benzoyl peroxide Correct
A child has an area of inflammation on the neck that began after wearing a
handknot woolen sweater. On examination, the skin appears chafed with mild erythematous
patches. The lesions are not pruritic. What is an appropriate initial treatment?
Topical corticosteroids applied 2 to 3 times daily
An adolescent who had cradle cap as an infant is in the clinic with thick crusts
of yellow, greasy scales on the forehead and behind the ears. What will the primary care
pediatric nurse practitioner recommend
Daily application of ketoconazole 2% topical cream
A child is brought to the clinic with a generalized, annular rash characterized
by raised wheals with pale centers. On physical examination, the child’s lungs are clear and there is no peripheral edema. A history reveals ingestion of strawberries earlier in the day. What is the initial treatment
Diphenhydramine 0.5 to 1 mg/kg/dose every 4 to 6 hours
A child who has been taking antibiotics is brought to the clinic with a rash.
The parent reports that the child had a fever associated with what looked like sunburn and now has “blisters” all over. A physical examination shows coalescent target lesions and widespread bullae and areas of peeled skin revealing moist, red surfaces. What will the primary care pediatric nurse practitioner do
Consult with a pediatric intensivist for admission to a pediatric intensive care unit
A schoolage child has a rash without fever or preceding symptoms. Physical
examination reveals a 3cm ovoid, erythematous lesion on the trunk with a finely scaled elevated border, along with generalized macular, ovoid lesions appearing in a “Christmas tree” pattern on the child’s back. What is the initial action
Reassure the child’s parents that the rash is benign and selflimited
A child who has psoriasis, who has been using a moderatepotency topical
steroid on thick plaques on the extremities and a highpotency topical steroid on more severe plaques on the elbows and knees, continues to have worsening of plaques. In consultation with a dermatologist, which treatment will be added
Anthralin ointment in high strength applied for 10 to 30 minutes daily
During a well child examination of an infant, the primary care pediatric nurse
practitioner notes 10 café au lait spots on the infant’s trunk. What is the potential concern associated with this finding
Neurofibromatosis
The primary care pediatric nurse practitioner notes velvety, brown thickening
of skin in the axillae, groin, and neck folds of an adolescent Hispanic female who is
overweight. What is the initial step in managing this condition?
Performing metabolic laboratory tests
An AfricanAmerican child has recurrent tinea capitis and has just developed
a new area of alopecia after successful treatment several months prior. When prescribing treatment with griseofulvin and selenium shampoo, what else will the primary care pediatric nurse practitioner do
Perform fungal cultures on family members and pets.
The primary care pediatric nurse practitioner is examining a 2weekold infant and
auscultates a wide splitting of S2 during expiration. What condition may this finding represent?
Atrial septal defect
The primary care pediatric nurse practitioner auscultates a new grade II vibratory,
midsystolic murmur at the mid sternal border in a 4yearold child that is louder when the child is
supine. What type of murmur is most likely
Still’s murmur
During a well child assessment, the primary care pediatric nurse practitioner
auscultates a harsh, blowing grade IV/VI murmur in a 6monthold infant. What will the nurse
practitioner do next
Refer to a pediatric cardiologist for further evaluation.
The primary care pediatric nurse practitioner provides primary care for a 4month
old infant who has a ventricular septal defect. The infant has been breastfeeding well but in the past month has dropped from the 20th percentile to the 5th for weight. What will the nurse practitioner recommend
Fortifying breast milk to increase the number of calories per ounce
A 12monthold infant who had cardiopulmonary bypass with RBC and plasma
infusions during surgery at 8 months is seen for a well child examination. Which vaccine may be administered at this visit
PCV13
The primary care pediatric nurse practitioner performs a well child examination on
a 12monthold child who had repair of a congenital heart defect at 8 months of age. The child has a normal exam. The parent reports that the child is not taking any medications. The nurse practitioner will contact the child’s cardiologist to discuss whether the child needs which medication
Amoxicillin
During a well baby examination of a 6weekold infant, the primary care pediatric
nurse practitioner notes poor weight gain, acrocyanosis of the hands and feet, and a respiratory rate of 60 breaths per minute. Oxygen saturation on room air is 93%. The remainder of the exam is unremarkable. Which action is correct
Refer the infant to a pediatric cardiologist.
A 3monthold infant who was previously healthy now has a persistent cough,
bilateral lung crackles, and poor appetite. The primary care pediatric nurse practitioner auscultates a grade III/VI, lowpitched, holosystolic murmur over the left lower sternal border and palpates the liver at one centimeter below the ribs. What diagnosis is likely?
Ventricular septal defect
An infant with trisomy 21 has a complete AV canal defect. Which finding,
associated with having both of these conditions, will the primary care pediatric nurse practitioner expect?
Oxygen desaturation
A 9monthold infant has a grade III/VI, harsh, rumbling, continuous murmur in the
left infraclavicular fossa and pulmonic area. A chest radiograph reveals cardiac enlargement. The primary care pediatric nurse practitioner will refer the infant to a pediatric cardiologist and prepare the parents for which intervention to repair this defect?
Coil insertion in the catheterization laboratory
A 5yearold child who had a repair for transposition of the great arteries shortly
after birth is growing normally and has been asymptomatic since the surgery. The primary care nurse practitioner notes mild shortness of breath with exertion and, upon questioning, learns that the child has recently complained of dizziness. What will the nurse practitioner do
Refer the child to the cardiologist immediately.
The primary care pediatric nurse practitioner is performing a well child
examination on a schoolage child who had complete repair of a tetralogy of Fallot defect in
infancy. What is important in this child’s health maintenance regime?
Cardiology clearance for sports participation
The primary care pediatric nurse practitioner is performing a sports physical on an
adolescent whose history reveals mild aortic stenosis. What will the nurse practitioner recommend
Evaluation by a cardiologist prior to participation
During a routine well child exam on a 5yearold child, the primary care pediatric
nurse practitioner auscultates a grade II/VI, harsh, late systolic ejection murmur at the upper left sternal border that transmits to both lung fields. The child has normal growth and development. What will the nurse practitioner suspect?
Pulmonic stenosis
A 5yearold child has an elevated blood pressure during a well child exam. The
primary care pediatric nurse practitioner notes mottling and pallor of the child’s feet and lower legs and auscultates a systolic ejection murmur in the left infraclavicular region radiating to the child’s back. The nurse practitioner will suspect which condition
Coarctation of the aorta
An adolescent female has a history of repaired tetralogy of Fallot. Which long term complication is a concern for this patient
Mitral valve prolapse
A 6yearold child has a systolic blood pressure between the 95th and 99th
percentile for age, sex, and height and a diastolic blood pressure between the 90th and the 95th
percentile on three separate clinic visits. This child’s blood pressure is classified as
stage 1 hypertensive
A 12yearold child whose weight and BMI are in the 75th percentile has a
diastolic blood pressure that is between the 95th and 99th percentiles for age, sex, and height on three separate occasions. Initial tests for this child will include
renal function and plasma renin tests
A 12yearold child whose BMI is greater than the 95th percentile has a blood
pressure at the 98th percentile for age, sex, and height. After lifestyle changes that include diet and exercise, the child’s BMI drops to the 90th percentile, but the blood pressure remains the same. What is the primary care pediatric nurse practitioner’s next step in treating this child
Referral to a nephrologist or cardiologist
A 7yearold child who has a history of a repaired congenital heart defect has
many dental caries along with gingival erythema and irritation and a temperature of 102.5°F. What
will the primary care pediatric nurse practitioner do next
Admit to the hospital with a pediatric cardiology consult
A 15yearold female reports fainting at school in class on two occasions. The
adolescent’s orthostatic blood pressures are normal. The primary care pediatric nurse practitioner suspects a cardiac cause for these episodes and will order which tests before referring her to a pediatric cardiologist
12lead electrocardiogram
A 30monthold girl who has been toilet trained for 6 months has daytime enuresis
and dysuria and a lowgrade fever. A dipstick urinalysis is negative for leukocyte esterase and nitrites. What is the next step?
Send the urine to the lab for culture.
The clean catch urine specimen of a child with dysuria, frequency, and fever has
a colony count between 50,000 and 100,000 of E. coli. What is the treatment for this child?
Treat with antibiotics for urinary tract infection.
A dipstick urinalysis is positive for leukocyte esterase and nitrites in a schoolage
child with dysuria and foulsmelling urine but no fever who has not had previous urinary tract infections. A culture is pending. What will the pediatric nurse practitioner do to treat this child
Prescribe trimethoprimsulfamethoxazole (TMP) twice daily for 3 to 5 days.
A preschoolage child with no previous history has mild flank pain and fever but
no abdominal pain or vomiting. A urinalysis is positive for leukocyte esterase and nitrites. A culture
is pending. Which is the correct course of treatment for this child
Order amoxicillin clavulanate
A 3yearold child has just completed a 7day course of amoxicillin for a second
febrile urinary tract infection and currently has a negative urine culture. What is the next course of action?
Obtain a renal and bladder ultrasound.
A 9monthold infant with a history of three urinary tract infections is diagnosed with grade II vesicoureteral reflux. Which medication will be prescribed
TMPSMX; TMP 2 mg/kg as a single daily dose
The parent of a toddler diagnosed with grade V vesicoureteral reflux asks the
primary care pediatric nurse practitioner how the disease will be treated. What will the nurse
practitioner tell this parent
That surgery to correct the condition is possible
A healthy 14yearold female has a dipstick urinalysis that is positive for 56 RBCs
per hpf but otherwise normal. What is the first question the primary care pediatric nurse practitioner will ask this patient
“When was your last menstrual period (LMP)?”
A child has gross hematuria, abdominal pain, and arthralgia as well as a rash.
What diagnosis is most likely?
HenochSchönlein purpura
- An adolescent has 2+ proteinuria in a random dipstick urinalysis. A subsequent first morning voided specimen is negative. What will the primary care pediatric nurse practitioner do to manage this condition
Monitor for proteinuria at each annual well child examination.
A child is diagnosed with nephrotic syndrome, and the pediatric nurse practitioner
provides primary care in consultation with a pediatric nephrologist. The child was treated with steroids and responded well to this treatment. What will the nurse practitioner tell the child’s parents about this disease?
“Steroids will be used when relapses occur.”
A child who has nephrotic syndrome is on a steroids and a saltrestricted diet for
a relapse of symptoms. A dipstick urinalysis shows 1+ protein, down from 3+ at the beginning of the episode. In consultation with the child’s nephrologist, what is the correct course of treatment considering this finding?
Continue with steroids and salt restrictions until the urine is negative for protein
A child who had GABHS 2 weeks prior is in the clinic with periorbital edema,
dyspnea, and elevated blood pressure. A urinalysis reveals teacolored urine with hematuria and mild proteinuria. What will the primary care pediatric nurse practitioner do to manage this condition
Refer the child to a pediatric nephrologist for hospitalization.
An adolescent has rightsided flank pain without fever. A dipstick urinalysis reveals
gross hematuria without signs of infection or bacteriuria, and the primary care pediatric nurse practitioner diagnoses possible nephrolithiasis. What is the initial treatment for this condition
Increasing fluid intake up to 2 L daily
During a well child examination of a 2yearold child, the primary care pediatric
nurse practitioner palpates a unilateral, smooth, firm abdominal mass which does not cross the
midline. What is the next course of action that
Refer the child to an oncologist immediately.
A 6monthold infant has a retractile testis that was noted at the 2month well
baby exam. What will the primary care pediatric nurse practitioner do to manage this condition?
Refer the infant to a pediatric urologist or surgeon for possible orchiopexy
A 9monthold infant is brought to the clinic with scrotal swelling and fussiness.
The primary care pediatric nurse practitioner notes a tender mass in the affected scrotum that is
difficult to reduce. What is the correct action
Refer immediately to a pediatric surgeon.
The mother of a 12monthold uncircumcised male infant reports that the child
seems to have pain associated with voiding. A physical examination reveals a tight, pinpoint opening of the foreskin, which thickened and inflamed. What will the primary care pediatric nurse practitioner do
Refer the child to a pediatric urologist.
An adolescent male comes to the clinic reporting unilateral scrotal pain, nausea,
and vomiting that began that morning. The primary care pediatric nurse practitioner palpates a painful, swollen testis and elicits increased pain with slight elevation of the testis (a negative Phren’s sign). What will the nurse practitioner do
Refer the adolescent immediately to a pediatric urologist or surgeon.
