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Week 1 to 6 Quiz NR 602 Primary Care of the Childbearing & Childrearing Family
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Week 1 to 6 Quiz NR 602 Primary Care of the Childbearing & Childrearing Family
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Week 5 QuizNR 602
Primary Care of the Childbearing & Childrearing
Family
1. 1. A child who had 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. a. Prescribe a 10- to 14-day course of high-dose amoxicillin.
b. b. Prescribe high-dose steroids in consultation with a
nephrologist.
c. c. Reassure the parents that this condition will resolve
spontaneously.
d. d. Refer the child to a pediatric nephrologist for
hospitalization.
ANS: D
This child has symptoms of post-streptococcal glomerulonephritis and
signs indicating a need for hospitalization: elevated BP, edema, and
dyspnea. The PNP should refer the child to a nephrologist for hospital
admission and care. Amoxicillin is not indicated; this condition is an
immunologic response to GABHS and not an infection. Steroids are not
effective in treating this disease. Although the condition usually does
self-resolve, the child needs hospitalization for close monitoring and
follow-up.
1. 2. 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. a. Extracorporeal shockwave lithotripsy (ESWL)
b. b. Increasing fluid intake up to 2 L daily
c. c. Percutaneous removal of renal calculi
d. d. Referral to a pediatric nephrologist
ANS: B
The first line of therapy for all stone types is increasing fluids. ESWL may
be indicated if symptoms worsen and stones are not passed.
, Percutaneous removal of renal calculi and referral to nephrology may be
indicated with worsening symptoms.
1. 3. A 9-month-old infant with a history of three urinary tract
infections is diagnosed with grade II vesicoureteral reflux. Which
medication will be prescribed?
a. a. Amoxicillin 10 mg/kg as a single daily dose
b. b. Ceftriaxone IM 50 mg/kg as a single daily dose
c. c. Nitrofurantoin 1-2 mg/kg as a single daily dose
d. d. TMP-SMX; TMP 2 mg/kg as a single daily dose
ANS: D
TMP-SMX is a first-line medication for grade II VUR prophylaxis. TMPSMX:
TMP 2 mg/kg as a single daily dose or 5 mg/kg twice/wk (based on TMP
component) if older than 1 month.Amoxicillin is a first-line treatment in
infants younger than 2 months. It is not necessary to give IM
medications. Nitrofurantoin is expensive and poorly tolerated.
1. 4. 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. a. “Are you sexually active?”
b. b. “Are you taking any medications?”
c. c. “Have you had a recent fever?”
d. d. “When was your last menstrual period (LMP)?”
ANS: D
Menstrual blood may appear in urine and is a common cause of urine
with RBCs present, so this would be an appropriate first question of an
adolescent. Asking about sexual activity or recent fevers may be part of
the diagnostic reasoning if common causes are not present. Medications
may discolor the urine but do not cause RBCs to be present.
1. 5. 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. a. Order ciprofloxacin ER once daily for 3 days if the culture is
positive.
b. b. Prescribe trimethoprim-sulfamethoxazole (TMP) twice daily
for 3 to 5 days.
c. c. Reassure the child’s parents that this is likely an
asymptomatic bacteriuria.
d. d. Wait for urine culture results to determine the correct course
of treatment.
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