NR602 FINAL EXAM- Chamberlain
Spring 2024
The parent of an infant asks about using a probiotic medication. What will the primary care pediatric
nurse practitioner tell this parent? - VERIFIED ANS: There is no conclusive evidence about using
probiotics to treat colic.
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? - VERIFIED ANS: Video fluoroscopy swallowing
A toddler is seen in the clinic after a 2 day history of intermittent vomiting and diarrhea. An assessment
reveals an irritable child with dry mucous membranes, 3 second 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? - VERIFIED ANS: Oral
rehydration solution with follow-up in 24
A 9 year old 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? - VERIFIED ANS:
Refer to a pediatric gastroenterologist for further workup
The parent of a 3 month old reports that the infant arches and gags while feeding and spits up
undigested formula frequently. The infant's weight gain has dropped to the 5th percentile from the 12th
percentile. What is the best course of treatment for this infant? - VERIFIED ANS: Begin a trial of
extensively hydrolyzed protein formula for 2 to 4 weeks
A school age child has a 3 month 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 - VERIFIED ANS: Referral for esophagogastroduodenoscopy (EGD)
A 2 month old 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 - VERIFIED ANS: Eliminating certain
foods from the mother's diet
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? - VERIFIED ANS: Have the parents watch for
the object in the child's stool.
A 10 year old 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 - VERIFIED ANS: Appendicitis with
perforation
An 18 month old child has a 1 day 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? - VERIFIED ANS: Intussusception
A school age 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 workupfor this child? - VERIFIED
ANS: CBC, ESR, amylase, lipase, UA, and abdominal ultrasound
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? - VERIFIED ANS: Teaching about the brain gut interaction causing symptoms
A school age child has recurrent diarrhea with foul smelling stools, excessive flatus, abdominal
distension, and failure to thrive. A 2 week lactose free trial failed to reduce symptoms. What is the next
step in diagnosing this condition - VERIFIED ANS: Serologic testing for celiac disease
,A child is diagnosed with Crohn disease. What are likely complications for this child? - VERIFIED ANS:
Intestinal obstruction with scarring and strictures
A 12 month old infant exhibits poor weight gain after previously normal growth patterns. There is no
history of vomiting, diarrhea, or irregular bowel movements, and the physical exam is normal. What is
the next step in evaluating these findings? - VERIFIED ANS: Feeding and stooling history and 3day diet
history
A 2 year old child has an acute diarrheal illness. The child is afebrile and, with oral rehydration measures,
has remained well hydrated. The parent asks what can be done to help shorten the course of this illness.
What will the primary care pediatric nurse practitioner recommend? - VERIFIED ANS: Lactobacillus
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? - VERIFIED ANS: Send the urine to the lab for culture.
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? - VERIFIED ANS: Treat with antibiotics
for urinary tract infection.
A dipstick urinalysis is positive for leukocyte esterase and nitrites in a schoolage 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? - VERIFIED ANS: Prescribe trimethoprim
sulfamethoxazole (TMP) twice daily for 3 to 5 days.
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? - VERIFIED ANS: Order amoxicillin clavulanate
A 3 year old child has just completed a 7day course of amoxicillin for a second febrile urinary tract
infection and currently has a negative urine culture. What is the next course of action? - VERIFIED ANS:
Obtain a renal and bladder ultrasound.
, 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? - VERIFIED ANS: TMP-SMX; TMP 2 mg/kg as
a single daily dose
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? -
VERIFIED ANS: That surgery to correct the condition is possible
A healthy 14yearold female has a dipstick urinalysis that is positive for 56 RBCs per hpf but otherwise
normal. What is the first question the primary care pediatric nurse practitioner will ask this patient -
VERIFIED ANS: When was your last menstrual period (LMP
A child has gross hematuria, abdominal pain, and arthralgia as well as a rash. What diagnosis is most
likely? - VERIFIED ANS:
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? - VERIFIED ANS: Monitor for proteinuria at each annual
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? - VERIFIED
ANS: "Steroids will be used when relapses occur."
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? -
VERIFIED ANS: Continue with steroids and salt restrictions until the urine is negative for protein.
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
Spring 2024
The parent of an infant asks about using a probiotic medication. What will the primary care pediatric
nurse practitioner tell this parent? - VERIFIED ANS: There is no conclusive evidence about using
probiotics to treat colic.
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? - VERIFIED ANS: Video fluoroscopy swallowing
A toddler is seen in the clinic after a 2 day history of intermittent vomiting and diarrhea. An assessment
reveals an irritable child with dry mucous membranes, 3 second 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? - VERIFIED ANS: Oral
rehydration solution with follow-up in 24
A 9 year old 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? - VERIFIED ANS:
Refer to a pediatric gastroenterologist for further workup
The parent of a 3 month old reports that the infant arches and gags while feeding and spits up
undigested formula frequently. The infant's weight gain has dropped to the 5th percentile from the 12th
percentile. What is the best course of treatment for this infant? - VERIFIED ANS: Begin a trial of
extensively hydrolyzed protein formula for 2 to 4 weeks
A school age child has a 3 month 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 - VERIFIED ANS: Referral for esophagogastroduodenoscopy (EGD)
A 2 month old 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 - VERIFIED ANS: Eliminating certain
foods from the mother's diet
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? - VERIFIED ANS: Have the parents watch for
the object in the child's stool.
A 10 year old 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 - VERIFIED ANS: Appendicitis with
perforation
An 18 month old child has a 1 day 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? - VERIFIED ANS: Intussusception
A school age 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 workupfor this child? - VERIFIED
ANS: CBC, ESR, amylase, lipase, UA, and abdominal ultrasound
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? - VERIFIED ANS: Teaching about the brain gut interaction causing symptoms
A school age child has recurrent diarrhea with foul smelling stools, excessive flatus, abdominal
distension, and failure to thrive. A 2 week lactose free trial failed to reduce symptoms. What is the next
step in diagnosing this condition - VERIFIED ANS: Serologic testing for celiac disease
,A child is diagnosed with Crohn disease. What are likely complications for this child? - VERIFIED ANS:
Intestinal obstruction with scarring and strictures
A 12 month old infant exhibits poor weight gain after previously normal growth patterns. There is no
history of vomiting, diarrhea, or irregular bowel movements, and the physical exam is normal. What is
the next step in evaluating these findings? - VERIFIED ANS: Feeding and stooling history and 3day diet
history
A 2 year old child has an acute diarrheal illness. The child is afebrile and, with oral rehydration measures,
has remained well hydrated. The parent asks what can be done to help shorten the course of this illness.
What will the primary care pediatric nurse practitioner recommend? - VERIFIED ANS: Lactobacillus
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? - VERIFIED ANS: Send the urine to the lab for culture.
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? - VERIFIED ANS: Treat with antibiotics
for urinary tract infection.
A dipstick urinalysis is positive for leukocyte esterase and nitrites in a schoolage 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? - VERIFIED ANS: Prescribe trimethoprim
sulfamethoxazole (TMP) twice daily for 3 to 5 days.
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? - VERIFIED ANS: Order amoxicillin clavulanate
A 3 year old child has just completed a 7day course of amoxicillin for a second febrile urinary tract
infection and currently has a negative urine culture. What is the next course of action? - VERIFIED ANS:
Obtain a renal and bladder ultrasound.
, 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? - VERIFIED ANS: TMP-SMX; TMP 2 mg/kg as
a single daily dose
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? -
VERIFIED ANS: That surgery to correct the condition is possible
A healthy 14yearold female has a dipstick urinalysis that is positive for 56 RBCs per hpf but otherwise
normal. What is the first question the primary care pediatric nurse practitioner will ask this patient -
VERIFIED ANS: When was your last menstrual period (LMP
A child has gross hematuria, abdominal pain, and arthralgia as well as a rash. What diagnosis is most
likely? - VERIFIED ANS:
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? - VERIFIED ANS: Monitor for proteinuria at each annual
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? - VERIFIED
ANS: "Steroids will be used when relapses occur."
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? -
VERIFIED ANS: Continue with steroids and salt restrictions until the urine is negative for protein.
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
