NURS 629 PED EXAM 4 SUM19
QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS 100%
CORRECT RATED A+
1. Pediatric Hypertension Workup
Question: A 12-year-old child whose weight and BMI are in the 75th percentile
has a diastolic blood pressure that is persistently between the 95th and 99th
percentiles for age, sex, and height on three separate occasions. What initial
diagnostic testing is indicated?
Answer: ✔✔ Renal function and plasma renin tests.
Clinical Rationale: Stage 2 hypertension in a non-obese child on multiple occasions
strongly points toward secondary hypertension (an underlying medical cause rather
than primary/essential hypertension). Since renal parenchyma disease and
renovascular diseases are the most common secondary causes of hypertension in
pediatric patients, a thorough renal workup—including serum creatinine, blood urea
nitrogen (BUN), and plasma renin activity—is a mandatory initial step.
2. Probiotics and Infantile Colic
Question: A parent inquires about administering an over-the-counter probiotic
medication to treat their infant's colic symptoms. What evidence-based guidance
should the primary care pediatric nurse practitioner provide?
Answer: ✔✔ There is no conclusive evidence about using probiotics to treat
colic.
Clinical Rationale: While some small studies suggest certain strains (like
Lactobacillus reuteri) might reduce crying time in exclusively breastfed infants, the
global clinical data remains conflicting and inconclusive. Probiotics are not
universally recommended as a definitive cure or standard first-line therapy for
infantile colic.
,3. Pediatric Feeding and Swallowing Dysfunction
Question: A toddler with a history of prematurity presents with poor weight gain
and chronic refusal of most solid foods. A barium swallow study demonstrates a
structurally normal esophagus. What diagnostic evaluation should the primary care
pediatric nurse practitioner order next to properly manage this child’s nutritional
and safety needs?
Answer: ✔✔ Video fluoroscopy swallowing study (VFSS).
Clinical Rationale: A standard barium swallow rules out gross structural defects of
the esophagus (like strictures or webs), but it does not adequately evaluate the
complex mechanics of the oral and pharyngeal phases of swallowing. A video
fluoroscopy swallowing study (also known as a modified barium swallow) provides
a real-time, dynamic radiologic evaluation of the patient's swallowing physiology.
This is essential for detecting silent aspiration or subtle oropharyngeal dysphagia,
which are common underlying causes of food refusal and failure to thrive in
children born prematurely.
3. A toddler is seen in the clinic after a 2day history of intermittent vomiting and
diarrhea. An assessment reveals an irritable child with dry mucous membranes,
3second capillary refill, 2 second recoil of skin, mild tachycardia and tachypnea,
and cool hands and feet.
The child has had two wet diapers in the past 24 hours. What will the primary care
pediatric nurse practitioner recommend? -ANSWER ✔✔Oral rehydration solution
with followup in 24 hours
4. A 9yearold girl has a history of frequent vomiting and her mother has frequent
migraine headaches. The child has recently begun having more frequent and
prolonged episodes accompanied by headaches. An exam reveals abnormal eye
movements and mild ataxia. What is the correct action? -ANSWER ✔✔Refer to a
pediatric gastroenterologist for further workup.
,5. The parent of a 3monthold reports that the infant arches and gags while feeding -
ANSWER ✔✔Begin a trial of extensively hydrolyzed protein formula for 2 to 4
weeks.
A schoolage child has a 3month history of dull, aching epigastric pain that worsens
with eating and awakens the child from sleep. A complete blood count shows a
hemoglobin of 8 mg/dL. What is the next step in management? -ANSWER
✔✔Referral for esophagogastroduodenoscopy (EGD)
7. A 2monthold infant cries up to 4 hours each day and, according to the parents, is
inconsolable during crying episodes with fists and legs noted to be tense and stiff.
The infant is breastfeeding frequently but is often fussy during feedings. The
physical exam is normal and the infant is gaining weight normally. What will the
primary care pediatric nurse practitioner recommend? -ANSWER ✔✔Eliminating
certain foods from the mother's diet
8. A child is in the clinic after swallowing a metal bead. A radiograph of the GI
tract shows a 6 mm cylindrical object in the child's stomach. The child is able to
swallow without difficulty and is not experiencing pain. What is the correct course
of treatment? -ANSWER ✔✔Have the parents watch for the object in the child's
stool
9. A 10yearold child has had abdominal pain for 2 days, which began in the
periumbilical area and then localized to the right lower quadrant. The child vomited
once today and then experienced relief from pain followed by an increased fever.
What is the likely diagnosis? -ANSWER ✔✔Appendicitis with perforation
An 18monthold child has a 1day history of intermittent, cramping abdominal pain
with nonbilious vomiting. The child is observed to scream and draw up his legs
during pain episodes and becomes lethargic in between. The primary care pediatric
, nurse practitioner notes a small amount of bloody, mucous stool in the diaper. What
is the most likely diagnosis? -ANSWER ✔✔Intussusception
13. A schoolage child has recurrent diarrhea with foulsmelling stools, excessive
flatus, abdominal distension, and failuretothrive. A 2week lactosefree trial failed to
reduce symptoms. What is the next step in diagnosing this condition? -ANSWER
✔✔Serologic testing for celiac disease
12. An adolescent is diagnosed with functional abdominal pain (FAP). The child's
symptoms worsen during stressful events, especially with school anxiety. What will
be an important
part of treatment for this child? -ANSWER ✔✔Teaching about the braingut
interaction causing symptoms
11. A schoolage child has had abdominal pain for 3 months that occurs once or
twice weekly and is associated with a headache and occasional difficulty sleeping,
often causing the child to
stay home from school. The child does not have vomiting or diarrhea and is gaining
weight normally.
The physical exam is normal. According to Bishop, what is included in the initial
diagnostic workup for
this child? -ANSWER ✔✔CBC, ESR, amylase, lipase, UA, and abdominal
ultrasound
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? -ANSWER ✔✔Send the urine to the lab
for culture.
QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS 100%
CORRECT RATED A+
1. Pediatric Hypertension Workup
Question: A 12-year-old child whose weight and BMI are in the 75th percentile
has a diastolic blood pressure that is persistently between the 95th and 99th
percentiles for age, sex, and height on three separate occasions. What initial
diagnostic testing is indicated?
Answer: ✔✔ Renal function and plasma renin tests.
Clinical Rationale: Stage 2 hypertension in a non-obese child on multiple occasions
strongly points toward secondary hypertension (an underlying medical cause rather
than primary/essential hypertension). Since renal parenchyma disease and
renovascular diseases are the most common secondary causes of hypertension in
pediatric patients, a thorough renal workup—including serum creatinine, blood urea
nitrogen (BUN), and plasma renin activity—is a mandatory initial step.
2. Probiotics and Infantile Colic
Question: A parent inquires about administering an over-the-counter probiotic
medication to treat their infant's colic symptoms. What evidence-based guidance
should the primary care pediatric nurse practitioner provide?
Answer: ✔✔ There is no conclusive evidence about using probiotics to treat
colic.
Clinical Rationale: While some small studies suggest certain strains (like
Lactobacillus reuteri) might reduce crying time in exclusively breastfed infants, the
global clinical data remains conflicting and inconclusive. Probiotics are not
universally recommended as a definitive cure or standard first-line therapy for
infantile colic.
,3. Pediatric Feeding and Swallowing Dysfunction
Question: A toddler with a history of prematurity presents with poor weight gain
and chronic refusal of most solid foods. A barium swallow study demonstrates a
structurally normal esophagus. What diagnostic evaluation should the primary care
pediatric nurse practitioner order next to properly manage this child’s nutritional
and safety needs?
Answer: ✔✔ Video fluoroscopy swallowing study (VFSS).
Clinical Rationale: A standard barium swallow rules out gross structural defects of
the esophagus (like strictures or webs), but it does not adequately evaluate the
complex mechanics of the oral and pharyngeal phases of swallowing. A video
fluoroscopy swallowing study (also known as a modified barium swallow) provides
a real-time, dynamic radiologic evaluation of the patient's swallowing physiology.
This is essential for detecting silent aspiration or subtle oropharyngeal dysphagia,
which are common underlying causes of food refusal and failure to thrive in
children born prematurely.
3. A toddler is seen in the clinic after a 2day history of intermittent vomiting and
diarrhea. An assessment reveals an irritable child with dry mucous membranes,
3second capillary refill, 2 second recoil of skin, mild tachycardia and tachypnea,
and cool hands and feet.
The child has had two wet diapers in the past 24 hours. What will the primary care
pediatric nurse practitioner recommend? -ANSWER ✔✔Oral rehydration solution
with followup in 24 hours
4. A 9yearold girl has a history of frequent vomiting and her mother has frequent
migraine headaches. The child has recently begun having more frequent and
prolonged episodes accompanied by headaches. An exam reveals abnormal eye
movements and mild ataxia. What is the correct action? -ANSWER ✔✔Refer to a
pediatric gastroenterologist for further workup.
,5. The parent of a 3monthold reports that the infant arches and gags while feeding -
ANSWER ✔✔Begin a trial of extensively hydrolyzed protein formula for 2 to 4
weeks.
A schoolage child has a 3month history of dull, aching epigastric pain that worsens
with eating and awakens the child from sleep. A complete blood count shows a
hemoglobin of 8 mg/dL. What is the next step in management? -ANSWER
✔✔Referral for esophagogastroduodenoscopy (EGD)
7. A 2monthold infant cries up to 4 hours each day and, according to the parents, is
inconsolable during crying episodes with fists and legs noted to be tense and stiff.
The infant is breastfeeding frequently but is often fussy during feedings. The
physical exam is normal and the infant is gaining weight normally. What will the
primary care pediatric nurse practitioner recommend? -ANSWER ✔✔Eliminating
certain foods from the mother's diet
8. A child is in the clinic after swallowing a metal bead. A radiograph of the GI
tract shows a 6 mm cylindrical object in the child's stomach. The child is able to
swallow without difficulty and is not experiencing pain. What is the correct course
of treatment? -ANSWER ✔✔Have the parents watch for the object in the child's
stool
9. A 10yearold child has had abdominal pain for 2 days, which began in the
periumbilical area and then localized to the right lower quadrant. The child vomited
once today and then experienced relief from pain followed by an increased fever.
What is the likely diagnosis? -ANSWER ✔✔Appendicitis with perforation
An 18monthold child has a 1day history of intermittent, cramping abdominal pain
with nonbilious vomiting. The child is observed to scream and draw up his legs
during pain episodes and becomes lethargic in between. The primary care pediatric
, nurse practitioner notes a small amount of bloody, mucous stool in the diaper. What
is the most likely diagnosis? -ANSWER ✔✔Intussusception
13. A schoolage child has recurrent diarrhea with foulsmelling stools, excessive
flatus, abdominal distension, and failuretothrive. A 2week lactosefree trial failed to
reduce symptoms. What is the next step in diagnosing this condition? -ANSWER
✔✔Serologic testing for celiac disease
12. An adolescent is diagnosed with functional abdominal pain (FAP). The child's
symptoms worsen during stressful events, especially with school anxiety. What will
be an important
part of treatment for this child? -ANSWER ✔✔Teaching about the braingut
interaction causing symptoms
11. A schoolage child has had abdominal pain for 3 months that occurs once or
twice weekly and is associated with a headache and occasional difficulty sleeping,
often causing the child to
stay home from school. The child does not have vomiting or diarrhea and is gaining
weight normally.
The physical exam is normal. According to Bishop, what is included in the initial
diagnostic workup for
this child? -ANSWER ✔✔CBC, ESR, amylase, lipase, UA, and abdominal
ultrasound
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? -ANSWER ✔✔Send the urine to the lab
for culture.
