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NURS 629 PED EXAM 4 SUM19

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NURS 629 PED
EXAM 4
SUM19
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 - Answers -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? - Answers -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? -
Answers -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? - Answers -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? - Answers -Refer to a pediatric
gastroenterologist for further workup.

,5. The parent of a 3monthold reports that the infant arches and gags while feeding -
Answers -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? - Answers -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? - Answers -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? -
Answers -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? - Answers -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? - Answers -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? - Answers -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? - Answers -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? - Answers -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? - Answers -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? - Answers -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? - Answers -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? - Answers -
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? - Answers -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? - Answers -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? - Answers -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
mild proteinuria. What will the primary care pediatric nurse practitioner do to manage
this condition? - Answers -Refer the child to a pediatric nephrologist for hospitalization.

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