NURS 629 Ped Exam 4 EXAM
QUESTIONS AND WELL VERIFIED
ANSWERS
1. 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 -
ANSWER>>renal function and plasma renin tests
The parent of an infant asks about using a probiotic medication. What will the
primary care pediatric nurse practitioner tell this parent? - ANSWER>>there is no
conclusive evidence about using probiotics to treat colic.
2. A toddler who was born prematurely refuses most solid foods and has poor
weight gain. A barium swallow study reveals a normal esophagus. What will the
primary care pediatric nurse practitioner consider next to manage this child's
nutritional needs? - ANSWER>>Video fluoroscopy swallowing study
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.
2. 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? - ANSWER>>Treat with antibiotics for urinary tract infection
3. 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? - ANSWER>>Prescribe trimethoprimsulfamethoxazole (TMP)
twice daily for 3 to 5 days
4. 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? - ANSWER>>Order amoxicillin clavulanate
5. A 3yearold child has just completed a 7day course of amoxicillin for a
secondfebrile urinary tract infection and currently has a negative urine culture.
What is the next course of action? - ANSWER>>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? -
ANSWER>>TMPSMX; TMP 2 mg/kg as a single daily dose
12. 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? -
ANSWER>>Continue with steroids and salt restrictions until the urine is negative
for
protein
13. 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
QUESTIONS AND WELL VERIFIED
ANSWERS
1. 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 -
ANSWER>>renal function and plasma renin tests
The parent of an infant asks about using a probiotic medication. What will the
primary care pediatric nurse practitioner tell this parent? - ANSWER>>there is no
conclusive evidence about using probiotics to treat colic.
2. A toddler who was born prematurely refuses most solid foods and has poor
weight gain. A barium swallow study reveals a normal esophagus. What will the
primary care pediatric nurse practitioner consider next to manage this child's
nutritional needs? - ANSWER>>Video fluoroscopy swallowing study
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.
2. 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? - ANSWER>>Treat with antibiotics for urinary tract infection
3. 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? - ANSWER>>Prescribe trimethoprimsulfamethoxazole (TMP)
twice daily for 3 to 5 days
4. 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? - ANSWER>>Order amoxicillin clavulanate
5. A 3yearold child has just completed a 7day course of amoxicillin for a
secondfebrile urinary tract infection and currently has a negative urine culture.
What is the next course of action? - ANSWER>>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? -
ANSWER>>TMPSMX; TMP 2 mg/kg as a single daily dose
12. 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? -
ANSWER>>Continue with steroids and salt restrictions until the urine is negative
for
protein
13. 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
