A 16yearold sexually active female has a fever, bilateral lower abdominal
pain,and malaise. A speculum and bimanual exam reveals adnexal tenderness.
The urinalysis is normal and cervical cultures are pending. What medications will the primary care pediatric nurse practitioner prescribe for this p...
A 16yearold sexually active female has a fever, bilateral lower abdominal
pain,and malaise. A speculum and bimanual exam reveals adnexal tenderness.
The urinalysis is normal and cervical cultures are pending. What medications will the primary care
pediatric nurse practitioner prescribe for this patient? - ANSWERPID- she is Sexually active+Adnexal
Tenderness and negative for UTI.
Ceftriaxone, doxycycline, and metronidazole
Rational- This is PID the treatment is Ceftriaxone 250 mg IM plus Doxyclicline 100 mg BID for 14 days
plus with or without Metronidazole 500 mg PO bid for 14 days.
4. A sexually active adolescent female tests positive for N. gonorrhea
and Chalmydia. She tells the primary care pediatric nurse practitioner that she
wants to be treated today since she is moving out of town the next day. What will the nurse
practitioner order?What is the treatment for her - ANSWERCeftriaxone 250 mg IM and azithromycin
1 g PO one time each
Rational- Remember the G in Gonorehea for or Ceftriaxone and Chlamydia you can give either
Doxycycline 100 mg for 7 days or Azithromycin 1 g PO x1 because she is moving she are giving this
combination.
A 14yearold female has menometrorrhagia with moderate increase in menstrual flow and irregular
periods. Her hemoglobin is 13.1 g/dL. How will this be managed? - ANSWERIron supplementation
and prostaglandin inhibitors
Rationale: Her hemoglobin level is at 13.1 and the normal range for this age group is 11.9-15. It is
better to give Iron because of the bleeding and for pain reliefe Prostoglandins such as Ibuprofen.
An adolescent female has heavy periods that are also irregular. The physical exam is normal. A
complete blood count reveals a hemoglobin of 8.9 g/dL. What test will the primary care pediatric
nurse practitioner order next? - ANSWERCoagulation studies
Rational-The normal Hemoglobin range is 11.9-13.1 and she is outside the range. We need to look
for reasons of this.
An adolescent female has periods every 30 days that are consistently
,heavy and last from 5 to 8 days. What is her diagnosis? - ANSWERMenorrhagia-
Rationale- The diagnosis for this is periods lasting longer than 7 days. Hers are lasting 8 days. She is
consistant with when her periods start so it won't be menometrorrhagia because that is irregular
periods.
A 16yearold female has not had a menstrual period yet and is concerned. She
denies sexual activity. An exam reveals an adult sexual maturity rating.
Which laboratory test will the primary care pediatric nurse practitioner order initially? -
ANSWERPregnancy Test
Rationale- All people lie and the number one reason for Ammenorrhea is pregnancy. After I rule out
that then I can look at other things such as nutrition, is she an athlete and is it Primary Amenorrhea
which is failure to have a period for 3 years or creast development or by age 15. or Secondary
Anemia which is no menstrual periods for 3 months or absent of period for 6 months for those on
irregular periods.
A 16yearold female reports breast tenderness and a "lump." The primary care pediatric nurse
practitioner palpates a small fluidfilled mass in her right breast. - ANSWEROrder an Ultra Sound of
Breast
Rationale- First thing you always do is order an ultra sound first to determine reason. Most girls this
age do not have breast cancer.
A 15yearold n female has a positive pregnancy test and asks the primary care
pediatric nurse practitioner not to tell her parents. She is tearful and says she isn't sure she wants to
keep the baby. What will the nurse practitioner do first? - ANSWERDetermine the state mandated
reporting laws.
Rationale- Each state has different laws on reporting to parents about STIs and Pregnancy.
A 17yearold sexually active female who began having periods at age 14 reports having moderate to
severe dull lower abdominal pain associated
predominantly with periods but that occurs at other times as well. The history reveals a recent onset
of these symptoms. A pregnancy test is negative. Which course of action is most important? -
ANSWERPerform a full diagnostic workup to evaluate potential causes.
Rationale- This is not normal and needs more workup to determine the reason for it. She is sexually
active so this raises more concerns for other things that might be going on such as PID or an STI
A 16yearold female reports dull, achy cramping pa in in her lower abdomen
lasting 2 or 3 hours that occurs between her menstrual periods each month.
, The adolescent is not sexually active. What is the treatment for this condition? -
ANSWERProstaglandin inhibitor analgesics and a heating pad
Rationale -This is signs of normal period and the 1st line treatment is Prostoglandin and heating pad.
A schoolage female has had vulvovaginitis for 2 months. All cultures and tests .are negative, but the
symptoms persist after treatment with both topical antibiotics and oral amoxicillin. What is the next
course of action to treat this condition? - ANSWEREstrogen cream at bedtime for 2 to 3 weeks
A 4yearold female who has had two urinary tract infections has persistent dysuria and genital
redness. The physical exam reveals a thin, flat membrane from the posterior fourchette almost to the
clitoris. Which treatment is indicated? - ANSWERUse of estrogencontaining cream
An adolescent female tells the primary care pediatric nurse practitioner
that shehad unprotected sexual intercourse 4 days prior and is worried she might become pregnant.
What will the nurse practitioner do? - ANSWERPrescribe ulipristal acetate (Ella).
Rationale- ella emergency contraception prevents pregnancy up to 5 days after unprotected sex.
The primary care pediatric nurse practitioner is prescribing contraception
for an adolescent who has not used birth control previously. The adolescent has a normal exam and
has no family history of cardiovascular and peripheral
vascular disease or diabetes. Which preparation is used initially? - ANSWERA combination oral
contraceptive pills (OCP) with 30 to 35
mcg of estrogen and low progestin
Rationale- Pt does not have history of cardiovascular, thrombosis, stroke of diabetes use this method
first. Remember to start low then increase.
The primary care pediatric nurse practitioner needs to assess a potential
hymenal tear in a prepubertal female who is apprehensive about the exam. Which approach will the
nurse practitioner use? - ANSWERPlace the child in the kneechest position on the exam table.
The mother of a 12monthold 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? - ANSWERRefer to urologist
A 6monthold infant has a retractile testis that was noted at the 2month
well baby exam. What will the primary care pediatric nurse practitioner do to
manage this condition? - ANSWERRefer the infant to a pediatric urologist or surgeon for possible
orchiopexy.
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