Question 1

A child diagnosed with Group A beta-hemolytic streptococci (GABHS) 2 weeks prior is in the clinic with periorbital edema, dyspnea, and elevated blood pressure. A urinalysis reveals tea-colored urine with hematuria and mild proteinuria. What will the primary care pediatric nurse practitioner do to manage this condition?

A) Prescribe a 10- to 14-day course of high-dose amoxicillin.
B) Prescribe high-dose steroids in consultation with a nephrologist.
C) Reassure the parents that this condition will resolve spontaneously.
D) Refer the child to a pediatric nephrologist for hospitalization.

D

Accepted Answer

The child is showing symptoms of post-streptococcal glomerulonephritis, which is a rare but serious complication of GABHS infection. The child needs urgent referral to a pediatric nephrologist for hospitalization and management of the condition. Antibiotics and steroids are not indicated in this case. Reassurance is also not appropriate as the condition requires immediate intervention.

Question 2

A 9-month-old 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?

A) Obtain an abdominal radiograph.
B) Refer immediately to a pediatric surgeon.
C) Schedule an appointment with a pediatric urologist.
D) Teach the parents signs of incarceration.

B

Accepted Answer

Scrotal swelling in infants can be due to a variety of causes, including inguinal hernias or hydroceles. However, the presence of a tender and difficult-to-reduce mass suggests the possibility of an incarcerated hernia, which can lead to serious complications such as bowel obstruction and necrosis. Therefore, referral to a pediatric surgeon for prompt evaluation and treatment is the most appropriate action. Obtaining an abdominal radiograph or scheduling an appointment with a pediatric urologist may be considered as additional steps in the management of the condition, but the immediate priority is to address the potential surgical emergency. Teaching the parents signs of incarceration is also important but should not delay the referral to a specialist.

Question 3

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?&#10;A) Obtain a complete blood count and C-reactive protein.&#10;B) Perform sensitivity testing before treating with antibiotics.&#10;C) Repeat the culture if symptoms persist or worsen.&#10;D) Treat with antibiotics for urinary tract infection.

Accepted Answer

A colony count between 50,000 and 100,000 of E. coli in a clean catch urine specimen indicates a urinary tract infection. Treatment with antibiotics is necessary to clear the infection and prevent complications such as pyelonephritis. Sensitivity testing can be done to guide antibiotic choice, but treatment should not be delayed while waiting for results. Obtaining a complete blood count and C-reactive protein may provide additional information, but they are not necessary for the diagnosis and management of a urinary tract infection. Repeat culture may be considered if symptoms persist or worsen despite appropriate treatment, but it is not necessary for initial management.

Question 4

A 3-year-old child has just completed a 7-day course of amoxicillin for a second febrile urinary tract infection and currently has a negative urine culture. What is the next course of action?&#10;A) Obtain a renal and bladder ultrasound.&#10;B) Prescribe prophylactic antibiotics to prevent recurrence.&#10;C) Refer the child for a voiding cystourethrogram.&#10;D) Screen urine regularly for leukocyte esterase and nitrites.

Accepted Answer

A renal and bladder ultrasound is recommended after a second febrile UTI in young children to assess for any anatomical abnormalities that may predispose to recurrent infections.

Question 5

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?

A) "Future episodes are likely to have worse outcomes."
B) "Steroids will be used when relapses occur."
C) "This represents a cure from this disease."
D) "Your child will need to take steroids indefinitely."

Accepted Answer

Nephrotic syndrome is a relapsing condition, and steroids are the first-line treatment for a relapse. While a complete cure is not possible, most children with nephrotic syndrome have a good long-term outlook, with 80-90% achieving remission after steroid therapy. However, relapses are common, and steroid treatment will be needed each time a relapse occurs. It is not necessary to use steroids indefinitely. Future outcomes are highly variable but are not likely to be worse with adequate follow-up and management.

Question 6

During a well child examination of a 2-year-old 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?

A) Order a CT scan of the chest, abdomen, and pelvis.
B) Perform urinalysis, CBC, and renal function tests.
C) Reevaluate the mass in 1 to 2 weeks.
D) Refer the child to an oncologist immediately.

Accepted Answer

The presence of a unilateral, smooth, firm abdominal mass in a child that does not cross the midline is suggestive of a Wilms' tumor. Immediate referral to an oncologist is necessary for further evaluation and management.

Question 7

A healthy 14-year-old female has a dipstick urinalysis that is positive for 5-6 RBCs per hpf but otherwise normal. What is the first question the primary care pediatric nurse practitioner will ask this patient?

A) "Are you sexually active?"
B) "Are you taking any medications?"
C) "Have you had a recent fever?"
D) "When was your last menstrual period (LMP)?"

Accepted Answer

The presence of RBCs in the urine can be indicative of various conditions, including kidney stones, urinary tract infections, or menstrual bleeding. Given that this patient is a 14-year-old female, it is important to first ask about her menstrual history to determine if the presence of RBCs could be related to her menstrual cycle. The other questions may also be important to ask, but determining menstrual history is the priority in this case.

Question 8

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?

A) Administer IM ceftriaxone and prescribe doxycycline twice daily for 10 days.
B) Encourage bed rest, scrotal support, and ice packs to the scrotum as tolerated.
C) Prescribe NSAIDs, limited activities, and warm compresses to the scrotum.
D) Refer the adolescent immediately to a pediatric urologist or surgeon.

Accepted Answer

The presentation of unilateral scrotal pain, swelling, and tenderness with nausea and vomiting is strongly suggestive of testicular torsion, a urologic emergency that requires immediate surgical intervention to prevent testicular loss. A negative Phren's sign suggests the same diagnosis. Antibiotics, rest, and scrotal support are not appropriate management in this case. Referral to a pediatric urologist or surgeon is essential for prompt diagnosis and treatment.

Question 9

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?

A) Monitor for proteinuria at each annual well child examination.
B) Order a 24-hour timed urine collection for creatinine and protein excretion.
C) Reassure the parents that this is a benign condition with no follow-up needed.
D) Refer the child to a pediatric nephrologist for further evaluation.

Accepted Answer

A finding of 2+ proteinuria on a random dipstick urinalysis in an adolescent may be a benign finding. However, it is recommended to monitor for proteinuria at each annual well child examination. If the proteinuria persists or if there are any other concerning symptoms or findings, further evaluation by a pediatric nephrologist may be necessary. A 24-hour timed urine collection for creatinine and protein excretion may be ordered if the initial finding is persistent or if there are other concerning symptoms or findings, but is not necessary in this case. Reassuring the parents without further evaluation or monitoring is not recommended.

Question 10

The mother of a 12-month-old 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?

A) Attempt to retract the foreskin to visualize the penis.
B) Order corticosteroid cream 3 times daily for 4 weeks.
C) Refer the child to a pediatric urologist.
D) Teach the mother to gently stretch the foreskin with cleaning.

Accepted Answer

The infant may be experiencing symptoms of balanitis or balanoposthitis, inflammation of the penis or inflammation of the penis and foreskin, respectively. In infants, these conditions may be caused by poor hygiene, but can also indicate an underlying anatomical issue. Attempting to retract the foreskin in this case may cause further injury or pain to the infant, so this option should be avoided. Treatment with corticosteroid cream can be appropriate for some cases of balanitis or balanoposthitis, but referral to a pediatric urologist is indicated when there is significant or recurrent inflammation, especially if the infant is having difficulty urinating, as in this case. The pediatric urologist can assess for underlying anatomical abnormalities, provide guidance on whether and when to try retracting the foreskin, and discuss options for medical or surgical management.

Question 11

A 30-month-old girl who has been toilet trained for 6 months has daytime enuresis and dysuria and a low-grade fever. A dipstick urinalysis is negative for leukocyte esterase and nitrites. What is the next step?

A) Begin empiric treatment with trimethoprim-sulfamethoxazole.
B) Discuss behavioral interventions for toilet training.
C) Reassure the child's parents that the child does not have a urinary tract infection.
D) Send the urine to the lab for culture.

Accepted Answer

The answer of A 30-month-old girl who has been toilet...

Question 12

A preschool-age 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?

A) Hospitalize for intravenous antibiotics.
B) Order amoxicillin clavulanate.
C) Prescribe trimethoprim-sulfamethoxazole.
D) Refer for a voiding cystourethrogram.

Accepted Answer

The answer of A preschool-age child with no previous history...

Question 13

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?

A) That long-term antibiotic prophylaxis will prevent scarring
B) That surgery to correct the condition is possible
C) that the child will most likely require kidney transplant
D) that the condition will probably resolve spontaneously

Accepted Answer

The answer of The parent of a toddler diagnosed with...

Question 14

A 6-month-old infant has a retractile testis that was noted at the 2-month well baby exam. What will the primary care pediatric nurse practitioner do to manage this condition?&#10;A) Reassure the parent that the testis will most likely descend into place on its own.&#10;B) Refer the infant to a pediatric urologist or surgeon for possible orchiopexy.&#10;C) Teach the parent to manipulate the testis into the scrotum during diaper changes.&#10;D) Tell the parent that hormonal therapy may be needed to correct the condition.

Accepted Answer

The answer of A 6-month-old infant has a retractile testis...

Question 15

A child has gross hematuria, abdominal pain, and arthralgia as well as a rash. What diagnosis is most likely?&#10;A) Henoch-Sch&#246;nlein purpura&#10;B) Rhabdomyosarcoma&#10;C) Sickle cell disease&#10;D) Systemic lupus erythematosus

Accepted Answer

The answer of A child has gross hematuria, abdominal pain,...

Question 16

An adolescent has right-sided 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?

A) Extracorporeal shockwave lithotripsy (ESWL)
B) Increasing fluid intake up to 2 L daily
C) Percutaneous removal of renal calculi
D) Referral to a pediatric nephrologist

Accepted Answer

The answer of An adolescent has right-sided flank pain without...

Question 17

A dipstick urinalysis is positive for leukocyte esterase and nitrites in a school-age child with dysuria and foul-smelling 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?

A) Order ciprofloxacin ER once daily for 3 days if the culture is positive.
B) Prescribe trimethoprim-sulfamethoxazole (TMP) twice daily for 3 to 5 days.
C) Reassure the child's parents that this is likely an asymptomatic bacteriuria.
D) Wait for urine culture results to determine the correct course of treatment.

Accepted Answer

The answer of A dipstick urinalysis is positive for leukocyte...

Question 18

A child who has nephrotic syndrome is on a steroids and a salt-restricted 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?

A) Begin a taper of the steroid medication while continuing salt restrictions.
B) Continue with steroids and salt restrictions until the urine is negative for protein.
C) Discontinue the steroids and salt restrictions now that improvement has occurred.
D) Relax salt restrictions and continue administration of steroids until proteinuria is gone.

Accepted Answer

The answer of A child who has nephrotic syndrome is...

Deck 41: Genitourinary Disorders