NSG5442/ NSG 5442 Exam 3 Study Guide Summer 2025 | Complete Answered Review Guide.

NSG 5442 Exam 3 Study GuideFall1/Summer2 2025 Week 7  Intimate Partner Violence (what is it? Do you have to report it? Process? What kind of things would suggest IPV? Issues for the child associated with IPV?) 1) The primary care pediatric nurse practitioner suspects that the parent of a child who is doing poorly in school is being abused by a partner. What is a priority response by the nurse practitioner? a) Notifying the child’s school counselor about this problem. b) Referring the child and family to a social worker. c) Reporting this according to any mandated reporting laws. d) Suggesting that the parent avoid the abusive situation. 2) A 9-year-old child exhibits school refusal and a reluctance to attend sleepovers with classmates. The parent is concerned because the child has recently begun sleeping in the parents’ bed. Which initial action by the primary care pediatric nurse practitioner is appropriate? a) Assess for environmental stress, parental dysfunction, and maternal depression. b) Ask about recent traumatic events that may have precipitated this behavior. c) Consider a possible pediatric autoimmune neuropsychiatric disorder cause. d) Recommend firm insistence on school and activity attendance.  Sexual abuse (Process for doing forensic exams and specimens, Reporting, history) 1) The primary care pediatric nurse practitioner is evaluating a 12-year-old girl who reports penile penetration of her vagina by her mother’s boyfriend the day before yesterday. The PNP reports this to the local child abuse hotline. What is the PNP’s next action? a) Attaining a history of the abuse from the child. b) Obtaining urethral specimens for STI testing. c) Performing a colposcopic examination to evaluate for trauma. d) Referring the child to the ED for forensic specimen collection. Injury prevention and first aid/preparation for parents 1) The primary care pediatric nurse practitioner is counseling the parents of a toddler about appropriate discipline. The parents report that the child is very active and curious, and they are worried about the potential for injury. What will the pediatric nurse practitioner recommend? a) Allow the child to explore and experiment while providing appropriate limits. b) Be present while the child plays to continually teach the child what is appropriate. c) Let the child experiment at will and to make mistakes in order to learn. d) Say “no” whenever the child does something that is not acceptable. 2) A child is brought to the clinic after falling from a swing and scraping both knees and hands. An examination reveals abraded skin with oozing serous fluid and blood, along with dirt and grime from the playground surface. What will the primary care pediatric nurse practitioner do to minimize the risk of infection? a) Apply povidone-iodine to all areas b) Irrigate gently with normal saline c) Rinse with hydrogen peroxide d) Scrub the abraded areas with alcohol 3) A school-age child steps on a nail while wearing tennis shoes and develops cellulitis in that foot. The child's immunizations are up to date. What antibiotic will the pediatric nurse practitioner empirically prescribe? a) Amoxicillin-clavulanate b) Ciprofloxacin c) Clindamycin d) Trimethoprim-sulfamethoxazole 4) A child has a 1cm laceration on the forehead proximal to the hairline after running into a pole while playing sports. To minimize the risk of infection, the primary care pediatric nurse practitioner will irrigate the wound and a) Allow the wound to heal by secondary intention b) Delay closure of the wound for several days c) Refer the child to a plastic surgeon for wound closure d) Suture the wound within 6 hours 5) The primary care pediatric nurse practitioner is preparing to close a laceration on a child's forehead using topical skin adhesive. What is the correct way to apply this product?a) Apply the adhesive between the wound margins and then hold the edges together. b) Apply the adhesive to the wound and then secure the edges with surgical tape c) Have the child remain still for 15 to 20 minutes after the adhesive is applied d) Hold the wound edges together and apply the adhesive on top of the skin 6) A toddler is brought to the clinic after grabbing the hot end of his mother's curling iron. An examination reveals a pale, yellow burned area to the palm of one hand. What is true about this burn? a) It may take up to 3 weeks to heal with scarring likely b) Scarring is unlikely, with healing expected in 3 to 7 days c) Surgical intervention and skin grafting are usually required d) This type of burn usually heals without scarring in 7 to 14 days 7) A school-age child sustained a contusion on the front of one thigh while playing football and reports some difficulty flexing his foot on the affected side. What will the primary care pediatric nurse practitioner do to treat this injury? a) Place the child on crutches and limit weight-bearing until symptoms subside. b) Prescribe acetaminophen with hydrocodone along with NSAIDs c) Recommend rest, ice packs, compression, and evaluation of the extremity d) Refer the child to an orthopedic specialist for immediate evaluation and treatment 8)  Child abuse (what we might see) 9) The social-interactional system perspective of child abuse and neglect says that the legitimization of violence in the family is due to which of the following factors? a) Family pathology of a genetic nature. b) Increased availability of pornography. c) Emphasis on hiding sexuality and not being open. d) Society’s attitudes, beliefs, and values. 10) Which of the following statements best defines the term child maltreatment? a) Intentional injury of a child. b) Not giving a child what he or she wants. c) Failure to provide what a child needs.d) Accidental harm to a child by someone. 11) During a well child examination on an infant who has colic, the primary care pediatric nurse practitioner learns that the infant’s mother is 17 years old and that the father, who is in the military, was deployed to wartime duty shortly after the baby was born. To determine the immediate risk of child maltreatment for this infant, the nurse practitioner will ask about: a) Childrearing and parenting styles. b) Role responsibilities of the parents. c) Spiritual beliefs and religious practices. d) The location of extended family members. 12) The primary care pediatric nurse is performing a well child examination on an adolescent who was adopted as a toddler. The parent reports that the child had been removed from an abusive home at age 3 years. What will the nurse practitioner evaluate in light of possible longterm effects of this early situation? a) Cognitive and psychosocial development. b) Mental health and suicide risk. c) Moral development and conscience formation. d) Spirituality, faith, and religious affiliation. 13) The school nurse observes parents interacting with a school-aged child and notices that they do not show any affection toward the child, and there is no evidence of emotional support or supervision. Later the nurse learns from the child that he must take care of all his own hygiene tasks, has to find something to eat on his own, and his parents never say anything nice about him. The nurse at this point believes that the parents are engaging in? a) Physical abuse b) Psychological abuse c) Withholding of love d) Poor parenting 14) The majority of perpetrators of abuse to children reported to state Child Protective Service agencies as suspected victims of abuse and neglect are: a) neighbors within one block b) parents c) strangers d) relatives other than parents 15) The majority of child abuse victims fall into which of the following age ranges? a) over 10 years b) 6 to 8 years c) 8 to 10 years d) under 6 years 16) Which of the following is the most common type of mistreatment of children?a) physical abuse b) neglect c) sexual abuse d) emotional maltreatment 17) In the sociological model of family violence, family violence is viewed as: a) a pattern of behavior that is passed from generation to generation b) a pattern of harm within the nuclear family with no outside persons involved c) any harmful action(s) between related persons no matter how distant the relationship is d) harmful activities within a group designated as family no matter what the relationship 18) When family violence is passed from generation to generation, this type of abuse has which of the following characteristics? a) It continues without changing to another type. b) The form of abuse may change. c) It usually gets more violent. d) It is more detrimental to the child from generation to generation 19) Which of the following children is in a high-risk family for less nurturing and more hurtful behavior? a) a child being raised by grandparents b) a child who is forbidden from playing with other children c) a child being raised by two men d) a child in a nuclear family their both parents have full-time jobs 20) According to the social-interactional systemic perspective of child abuse and neglect, four factors place the family members at risk for abuse. These risk factors are the family itself,the caregiver, the child, and: a) chronic poverty b) genetics c) the presence of a family crisis d) the national emphasis on sex 21) When caregivers lack knowledge about parenting, lack parenting skills, and are emotionally immature, the child often assumes which of the following roles? a) Victim b) caregiver role toward the caregiver c) regressed child of regressed caregivers d) Scapegoat 22) When there is a depressed parent in the family, it is most likely that the depression will have which of the following effects? a) will not affect the person’s ability or performance in parenting b) will cause the parent who is depressed to try harder to be a good parentc) places the parent at risk for physically or emotionally abusing the children d) will be seen in the child during the growing-up years 23) The nurse working in the pediatric clinic notices that a newborn seems particularly fussy. The mother verifies that this is a very fussy baby and that it is impossible to soothe the baby. In thinking through what to further assess and what to teach the mother, the nurse will keep in mind that fussy babies are: a) often in some kind of pain b) somewhat neurologically unstable c) often victims of the mothers drug use d) at greater risk for abuse 24) Which of the following children are at greatest risk of abuse or neglect by the parents? a) post maturity babies b) 13-year-old children c) children with high intelligent quotient (IQ) d) premature infants 25) A child is brought to the pediatric clinic for immunizations for school. The parent wants the immunizations to be given in the arm. The nurse explains that at least one of the injections has to be given in the buttocks. When the nurse pulls the diaper down, the nurse sees bite marks around the genital and buttock area. Which of the following explanations is most likely? a) A neighborhood toddler is in a biting stage. b) This child is in a biting stage, and the parents bit him back to get him to stop biting. c) The child is a victim of sexual or physical abuse. d) This must have happened then the dog slept with the child 26) A parent brings a toddler to the pediatric clinic. The nurse observes anumber of bruises on the child in various stages of healing. The parent claims thetoddler bruises easily. The best action on the part of the pediatrician and the nurse would be to: a) believe the parents and schedule an appointment in 2 weeks b) report this to child and family services and order a screening battery of bleeding and clotting blood work c) check with the other parent or another caregiver to see what he or she might be able to add to this history d) tell the parent that it is clear that he or she is lying and to tell the truth 27) Common injuries to pediatric and adolescent female genital tract include straddle injuries. These injuries result from a fall on a: a) Bicycle. b) Wagon. c) Sidewalk.d) Step.  Shaken baby syndrome (signs/symptoms) 28) Which finding would lead the family nurse practitioner to consider shaken baby syndrome in an infant? a) Anisocoria. b) Subconjunctival hemorrhages. c) Visible head trauma. d) Retinal hemorrhages.  Be able to recognize defects based on description of assessment findings or symptoms. 29) The primary care pediatric nurse practitioner is examining a 2-weekold infant and auscultates a wide splitting of S2 during expiration. What condition may this finding represent? a) Atrial septal defect. i) A wide splitting of S2 without becoming a single sound on expiration may indicate increased pulmonary flow, typical of atrial septal defect. b) Coarctation of the aorta. c) Patent ductus arteriosus. d) Ventricular septal defect.  The second heart sound (S2) is caused by the closure of the aortic and pulmonary valves at the end of systole. A “split” second heart sound occurs when the aortic and pulmonary valves close at different times. The causes include:  Normal during inspiration  Atrial septal defect (fixed split)  Pulmonary valve stenosis (wide split)  During inspiration, the chest wall and diaphragm expand and create negative intrathoracic pressure, which pulls the lungs and heart open. Negative intrathoracic pressure causes increased filling of the right atrium and ventricle from the systemic venous circulation. It takes longer for the right ventricle to empty the greater volume of blood, causing a slight delay inthe pulmonary valve closing compared with the aortic valve. Therefore, there is a “split” second heart sound during inspiration.  An atrial septal defect allows blood to flow from the left atrium to the right atrium, increasing the volume of blood the right ventricle has to empty before the pulmonary valve can close. The atrial septal defect causes a “fixed split” second heart sound, which does not vary during inspiration and expiration.  Pulmonary valve stenosis can cause a “widely split” second heart sound, as it takes notably longer for the right ventricle to empty through the narrow pulmonary valve compared with the left ventricle. 30) The primary care pediatric nurse practitioner provides primary care for a 4-month-old infant who has ventricular septal defect. The infant has been breastfeeding well but in the past month has dropped from the 20th percentile to the 5th for weight. What will the nurse practitioner recommend? a) Adding solid foods to the infant’s diet to increase caloric intake. b) Fortifying breast milk to increase the number of calories per ounce. c) Stopping breastfeeding and giving 30 kcal/ounce formula. d) Supplementing breastfeeding with 24 kcal/ounce formula. 31) A 3-month-old infant who was previously healthy now has a persistent cough, bilateral lung crackles, and poor appetite. The primary care pediatric nurse practitioner auscultates a grade III/VI, low-pitched, holosystolic murmur over the left lower sternal border and palpates the liver at one centimeter below the ribs. What diagnosis is likely? a) Atrial septal defect. b) Coarctation of the aorta. c) Patent ductus arteriosus. d) Ventricular septal defect. 32) An infant with trisomy 21 has a complete AV canal defect. Which finding, associated with having both of these conditions, will the primary care pediatric nurse practitioner expect? a) Crackles in both lungs. b) Hepatomegaly. c) Oxygen desaturation. d) Peripheral edema. 33) A 9-month-old infant has a grade III/VI, harsh, rumbling, continuous murmur in the left infraclavicular fossa and pulmonic area. A chest radiograph reveals cardiac enlargement. The primary care pediatric nurse practitioner will refer the infant to a pediatric cardiologist and prepare the parents for which intervention to repair this defect? a) Cardiopulmonary bypass surgery. b) Coil insertion in the catheterization laboratory. c) Indomethacin administration. d) Observation for spontaneous closure.34) A 5-year-old child who had a repair for transposition of the great arteries shortly after birth is growing normally and has been asymptomatic since the surgery. The primary care nurse practitioner notes mild shortness of breath with exertion and, upon questioning, learns that the child has recently complained of dizziness. What will the nurse practitioner do? a) Order an echocardiogram and chest radiograph. b) Perform pulmonary function testing. c) Reassure the parent that these symptoms are common. d) Refer the child to the cardiologist immediately. 35) The primary care pediatric nurse practitioner is performing a well child examination on a school-age child who had complete repair of a tetralogy of Fallot defect in infancy. What is important in this child’s health maintenance regime? a) Cardiology clearance for sports participation. b) Restriction of physical activity to avoid pulmonary complications. c) Sub-acute bacterial endocarditis prophylaxis precautions. d) Teaching about management of hypercyanotic episodes. 36) The primary care pediatric nurse practitioner is performing a sports physical on an adolescent whose history reveals mild aortic stenosis. What will the nurse practitioner recommend? a) Avoidance of all sports to prevent sudden death. b) Clearance for any sports since this is mild. c) Evaluation by a cardiologist prior to participation. d) Low-intensity sports, such as golf or bowling. 37) During a routine well child exam on a 5-year-old child, the primary care pediatric nurse practitioner auscultates a grade II/VI, harsh, late systolic ejection murmur at the upper left sternal border that transmits to both lung fields. The child has normal growth and development. What will the nurse practitioner suspect? a) Aortic stenosis. b) Patent ductus arteriosus. c) Pulmonic stenosis. d) Tricuspid atresia. 38) A 5-year-old child has an elevated blood pressure during a well child exam. The primary care pediatric nurse practitioner notes mottling and pallor of the child’s feet and lower legs and auscultates a systolic ejection murmur in the left infraclavicular region radiating to the child’s back. The nurse practitioner will suspect which condition? a) Aortic stenosis. b) Coarctation of the aorta. c) Patent ductus arteriosus. d) Pulmonic stenosis. 39) An adolescent female has a history of repaired tetralogy of Fallot. Which long-term complication is a concern for this patient? a) Aortic stenosis.b) Chronic cyanosis. c) Mitral valve prolapse. d) Ventricular failure. 40) The primary care pediatric nurse practitioner is examining a 2-weekold infant and auscultates a wide splitting of S2 during expiration. What condition may this finding represent? a) Atrial septal defect. b) Coarctation of the aorta. c) Patent ductus arteriosus. d) Ventricular septal defect. 41)  Murmurs (What kind are heard where, and what do they indicate?) 1) The primary care pediatric nurse practitioner is evaluating a heart murmur during a pre-participation examination of a high school athlete. Which finding would be a concern requiring referral to a cardiologist? a) A murmur that is louder when squatting and softer when standing. b) A murmur that is quieter when squatting and louder with a Valsalva maneuver. c) A murmur with narrow and variable splitting of S2. d) A systolic murmur that is grade 1 or 2. ***^ Hypertrophic cardiomyopathy or mitral valve prolapse must be ruled out 1) During a well child assessment, the primary care pediatric nurse practitioner auscultates a harsh, blowing grade IV/VI murmur in a 6- month-old infant. What will the nurse practitioner do next? a) Get a complete blood count to rule out severe anemia. b) Obtain an electrocardiogram to assess for arrhythmia. c) Order a chest radiograph to evaluate for cardiomegaly. d) Refer to a pediatric cardiologist for further evaluation. 2) Immunizations for cardiac patients (understand what immunization alternatives must occur) 1) Patients with health problems involving heart, lung, kidney, or metabolic disease (diabetes), asthma, blood disorder, no spleen, complement component deficiency, cochlear implant, or cerebrospinal fluid leak, or long-term aspirin therapy a) These are contraindications or precautions to live attenuated injectable vaccines (LAIV). b) Age-appropriate inactivated or recombinant influenza vaccine (RIV) is preferred 2) Pneumococcal vaccine a) PCV 13 first, then PPSV23 8 weeks later 3) A 12-month-old infant who had cardiopulmonary bypass with RBC and plasma infusions during surgery at 8 months is seen for a well child examination. Which vaccine may be administered at this visit? a) MMR. b) OPV. c) PCV-13. d) Varivax.  Hypertension (stages and management) 1) The primary care pediatric nurse practitioner is discussing lifestyle changes with an adolescent who has hypertension. What will the nurse practitioner recommend about exercise for this client? a) Regular to vigorous activity initially with a combination of resistance and aerobic exercise to maintain lower blood pressure. b) Moderate daily exercise such as walking for 20 minutes daily with increasing intensity as blood pressure drops. c) Vigorous aerobic exercise combined with maximal strength training to lower blood pressure. d) Vigorous aerobic exercise only to reduce blood pressure and then to maintain lowered blood pressure. 2) A 6-year-old child has a systolic blood pressure between the 95th and 99th percentile for age, sex, and height and a diastolic blood pressurebetween the 90th and the 95th percentile on three separate clinic visits. This child’s blood pressure is classified as: a) Normotensive. b) Pre-hypertensive. c) Stage 1 hypertensive. d) Stage 2 hypertensive. 3) A 12-year-old 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: a) Complete blood count. b) Erythrocyte sedimentation rate. c) Renal function and plasma renin tests. d) Urinalysis and electrolytes. 4) A 12-year-old child whose BMI is greater than the 95th percentile has a blood pressure at the 98th percentile for age, sex, and height. After lifestyle changes that include diet and exercise, the child’s BMI drops to the 90th percentile, but the blood pressure remains the same. What is the primary care pediatric nurse practitioner’s next step in treating this child? a) Continued close monitoring of blood pressure. b) Ordering an echocardiogram or MRI. c) Prescribing an ACE inhibitor medication. d) Referral to a nephrologist or cardiologist. 5)  Pacemakers (education) 1) Sinus bradycardia is the most common cause of bradycardia in children and can be due to hypoxia, acidosis, increased intracranial pressure, abdominal distention, hypothermia, hypoglycemia, eating disorders, or athletic conditioning. Bradycardia can also be caused by drugs such as beta blockers or digoxin. 2) Complete AV block can either be congenital or acquired after cardiac surgery. Ninety percent of congenital cases are secondary to maternal connective tissue disorders or complex CHF (levo- or L-looped transposition of the great arteries [L-TGA]) heterotaxy. a) Treat the underlying cause. Symptomatic children and those with high-grade AV block may require temporary or permanent pacing. A permanent pacemaker may be indicated if bradycardia persists after the underlying cause is treated or if there is a high-grade AV block.1) Iron deficiency anemia (s/s, risk factors, treatments, tests) 1) A complete blood count on a 12-month-old infant reveals microcytic, hypochromic anemia with a hemoglobin of 9.5 g/dL. The infant has mild pallor with no hepatosplenomegaly. The primary care pediatric nurse practitioner suspects: a) Hereditary spherocytosis. b) Iron-deficiency anemia. c) Lead intoxication. d) Sickle-cell anemia. 2) The primary care pediatric nurse practitioner evaluates a 5-year-old child who presents with pallor and obtains labs revealing a hemoglobin of 8.5 g/dL and a hematocrit of 31%. How will the nurse practitioner manage this patient? a) Prescribe elemental iron and recheck labs in 1 month. b) Reassure the parent that this represents mild anemia. c) Recommend a diet high in iron-rich foods. d) Refer to a hematologist for further evaluation. 3) The primary care pediatric nurse practitioner is managing care for a child diagnosed with iron-deficiency anemia who had an initial hemoglobin of 8.8 g/dL and hematocrit of 32% who has been receiving ferrous sulfate as 3 mg/kg/day of elemental iron for 4 weeks. The child’s current lab work reveals elevations in Hgb/Hct and reticulocytes with a hemoglobin of 10.5 g/dL and a hematocrit of 36%. What is the next step in management of this patient? a) Continue the current dose of ferrous sulfate and recheck labs in 1 to 2 months. b) Discontinue the supplemental iron and encourage an iron-enriched diet. c) Increase the ferrous sulfate dose to 4 to 6 mg/kg/day of elemental iron. d) Refer the child to a pediatric hematologist to further evaluate the anemia. 4) The primary care pediatric nurse practitioner performs a well baby examination on a 4-month-old infant who is exclusively breastfed and whose mother plans to introduce only small amounts of fruits and vegetables in addition to breastfeeding. To ensure that the infant gets adequate amounts of iron, what will the nurse practitioner recommend? a) Elemental iron supplementation of 1 mg/kg/day until cereals are added. b) Elemental iron supplementation of 3 mg/kg/day for the duration of breastfeeding.c) Monitoring the infant’s hemoglobin and hematocrit at every well-baby checkup. d) Offering iron-fortified formula to ensure adequate iron intake. 5) The primary care pediatric nurse practitioner reviews hematology reports on a child with beta-thalassemia minor and notes an Hgb level of 8 g/dL. What will the nurse practitioner do? a) Evaluate serum ferritin. b) Order Hgb electrophoresis. c) Prescribe supplemental iron. d) Refer for RBC transfusions. 6) The primary care pediatric nurse practitioner sees a 12-month-old infant who is being fed goat’s milk and a vegetarian diet. The child is pale and has a beefy-red, sore tongue and oral mucus membranes. Which tests will the nurse practitioner order to evaluate this child’s condition? a) Hemoglobin electrophoresis. b) RBC, folate, iron, and B12 levels. c) Reticulocyte levels. d) Serum lead levels. 7) A toddler who presents with anemia and reticulocytopenia has a history of a gradual decrease in energy and increase in pallor beginning after a recent viral infection. How will the primary care pediatric nurse practitioner treat this child? a) Closely observe the child’s symptoms and lab values. b) Consult with a pediatric hematologist. c) Prescribe supplemental iron for 4 to 6 months. d) Refer for transfusions to correct the anemia. 8) Because of their inability to ambulate, children with cerebral palsy should be evaluated for which nutrients? a) Calcium and vitamin D. b) Fat-soluble vitamins. c) Iron and zinc. d) Sodium and potassium. 9) A 14-year-old female has menometrorrhagia with moderate increase in menstrual flow and irregular periods. Her hemoglobin is 13.1 g/dL. How will this be managed? a) Iron supplementation and prostaglandin inhibitors. b) One OCP twice daily for 3 to 4 days and then daily. c) Progestin every day for 10 to 14 days. d) Referral to a pediatric gynecologist for treatment. 10) The primary care pediatric nurse practitioner is performing a well child examination on a 15-year-old girl who consumes a vegan diet. Based on this assessment, which nutrients may this adolescent need to supplement? a) Calcium, vitamin C, and vitamin A. b) Iron, folic acid, and B12. c) Magnesium, vitamin E, and zinc.d) Vitamin D, vitamin C, and phosphorus. 2) Left shift 1) The primary care pediatric nurse practitioner reviews a child’s complete blood count with differential white blood cell values and recognizes a “left shift” because of: a) A decreased eosinophil count. b) A decreased lymphocyte count. c) An elevated monocyte count. d) An elevated neutrophil count. 2)  Deficiencies associated with vegetarian diet 1) The primary care pediatric nurse practitioner sees a 12-month-old infant who is being fed goat’s milk and a vegetarian diet. The child is pale and has a beefy-red, sore tongue and oral mucus membranes. Which tests will the nurse practitioner order to evaluate this child’s condition? a) Hemoglobin electrophoresis. b) RBC, folate, iron, and B12 levels. c) Reticulocyte levels. d) Serum lead levels.3) The parent of a 14-year-old child tells the primary care pediatric nurse practitioner that the adolescent has expressed a desire to be a vegetarian, is refusing all meat served at home, and wants the family to eat vegetarian meals. What will the nurse practitioner tell the parent? a) Do not allow a vegetarian diet in order to maintain appropriate limits for the adolescent. b) Provide vegetarian options for the adolescent that preserve adequate nutrition and protein intake. c) Suggest that the adolescent prepare appropriate vegetarian dishes to complement family meals. d) Tell the adolescent that a vegetarian diet may be considered in adulthood but not while living at home. 4) The primary care pediatric nurse practitioner is performing a well child examination on a 15-year-old girl who consumes a vegan diet. Based on this assessment, which nutrients may this adolescent need to supplement? a) Calcium, vitamin C, and vitamin A. b) Iron, folic acid, and B12. c) Magnesium, vitamin E, and zinc. d) Vitamin D, vitamin C, and phosphorus. 5) The parent of a toddler tells the primary care pediatric nurse practitioner that the family has adopted a plant-based diet and the child is receiving rice and almond milk instead of cow’s milk. The nurse practitioner will counsel the parents about: a) Calcium deficiency. b) Excess caloric intake. c) Excess fat intake. d) Protein deficiency.  Transient erythroblastopenia 1)  Sickle Cell 2) The pediatric nurse practitioner provides primary care for a 30-monthold child who has sickle cell anemia who has had one dose of 23-valent pneumococcal vaccine. Which is an appropriate action for health maintenance in this child? a) Administer an initial meningococcal vaccine.b) Begin folic acid dietary supplementation. c) Decrease the dose of penicillin V prophylaxis. d) Give a second dose of 23-valent pneumococcal vaccine. 3) The parent of a 12-year-old child who has sickle cell trait (SCT) asks the primary care pediatric nurse practitioner whether the child may play football. What will the nurse practitioner tell this parent? a) Children with SCT should not play any contact sports. b) Children with SCT may not play for NCAA schools in college. c) Children with SCT should follow heat acclimatization guidelines. d) Children with SCT should not participate in organized sports. 4) A 2-year-old child who has SCA comes to the clinic with a cough and fever of 101.5 C. The child currently takes penicillin V prophylaxis 125 mg orally twice daily. What will the primary care pediatric nurse practitioner do? a) Admit the child to the hospital to evaluate for sepsis. b) Give intravenous fluids and antibiotics in clinic. c) Increase the penicillin V dose to 250 mg. d) Order a chest radiograph to rule out pneumonia.  Thalassemia 1) The primary care pediatric nurse practitioner reviews hematology reports on a child with beta-thalassemia minor and notes an Hgb level of 8 g/dL. What will the nurse practitioner do? a) Evaluate serum ferritin. b) Order Hgb electrophoresis. c) Prescribe supplemental iron. d) Refer for RBC transfusions. Week 8  Types of fractures specifically Salter Harris 1) A school-age child has a fractured wrist with a Salter-Harris Type II fracture, according to the radiologist. What is true about this type of fracture?a) Growth disturbance of the long bones of the arm is likely. b) There is metaphyseal fragment on the compression side of fracture. c) There is usually a compression or crushing injury to the physis. d) This will require anatomic reduction using an open approach. 2) A child is admitted to the rural clinic after a car accident in which she sustained a closed head injury and fractured femur. The child is lethargic and follows commands slowly, and her pupils are equal and reactive. The child is to be transferred to a hospital by air ambulance. In assessing the child, what would the family nurse practitioner consider as a significant change in her condition? a) She is able to move her lower extremities to command. b) Vital signs are blood pressure of 130/50 mm Hg and pulse of 70 beats/min. c) Urine output is less than 500 mL in 24 hours. d) She complains of a headache in the frontal area.  Developmental Dysplasia of Hip (diagnosis) 1) What will the primary care pediatric nurse practitioner elicit when obtaining a positive Barlow maneuver when screening for developmental dysplasia of the hip? a) Dislocation of an unstable hip. b) Dropping of the iliac crest with a raised leg. c) Reduction of a dislocated hip. d) Unequal knee heights in a supine child. 2) The primary care pediatric nurse practitioner elicits positive Ortolani and Barlow signs in a 6-month-old infant not previously noted in the medical record. What is the correct treatment? a) Pavlik harness b) Spica cast c) Surgical intervention i) Barlow and Ortolani positive only in the first few months of life d) Triple diapering 3) A 14-year-old boy who is overweight develops a unilateral limp with pain in the hip and knee on the affected side. An exam reveals external rotation of the hip when flexed and pain associated with attempts to internally rotate the hip. What is most important initially when managing this child's condition?a) Place the child on crutches or in a wheelchair to prevent weightbearing. b) Provide information about weight loss to minimize further injury. c) Recommend seeing an orthopedic specialist as soon as possible. d) Refer the child to physical therapy to improve range of motion. 4) What is the normal degree of adduction of the hips bilaterally at age 6- 18mo: a) 70-80 degrees 5) Which sign if positive is indicative of Developmental Dysplasia of the Hip (DDH)? a) Galeazzi sign  Scoliosis (diagnosis) 1) A young adolescent female is observed to have mild unequal scapula prominences on gross examination while standing. In the Adams forward bending position, this inequality disappears. What will the primary care pediatric nurse practitioner do? a) Discuss posture and exercise and ask about backpacks and books. b) Obtain radiographic studies of the entire spine and neck. c) Reassure the child’s parent that functional scoliosis will self-resolve. d) Refer to an orthopedic specialist for evaluation and possible bracing. 2)  Growing pains 1) Extremity pain, often referred to as growing pains by the layperson, is a frequent clinical presentation. The pain is usually nonarticular; in two-thirds of pediatric patients, it is described as being located in the shins, calves, thighs, or popliteal fossa. It is almost always bilateral. The pain appears late in the day or is nocturnal, often waking the child. The pain lasts from minutes to hours. By morning, the child is almost always pain-free. Because it occurs late in the day and is often reported on days of increased activity, it may represent a localoveruse syndrome; it may also be associated with low vitamin D levels and decreased bone strength. Leg aches of childhood are generally not associated with serious organic disease, have a peak incidence between 3 and 12 years of age, and usually resolve by late childhood; with the prevalence of 2.6% to 49.6% of school-age children who experience intermittent leg aches. However, it is important to differentiate these pains from more serious pathologic conditions. Restless legs syndrome, also known as periodic limb movement disorder, is a more recently recognized common source of nocturnal leg pains in pediatrics. a) Clinical findings: pain or leg aches typically described as: i) Occurring characteristically in the evening or late in the day; may wake the child up from sleep. ii) Pain gone in the morning with no limitation of activity. iii)Poorly localized and bilateral. iv) Occurring commonly in the front of the thighs, in the calves, and behind the knees. v) No limp vi) Without fevers or swelling vii) Without report of recent or remote trauma b) Evaluate: i) Have child stand on tiptoes and heels ii) Measure leg length iii)Evaluate range of motion iv) Observe for limping c) Differential diagnosis: restless leg syndrome, neoplastic lesions, leukemia, sickle cell anemia, juvenile arthritis, and subacute osteomyelitis apophysitis. d) Treatment: massage, heat, and analgesia. e) Refer if pain is localized to one region, is associated with swelling or other constitutional symptoms, is increasing in severity, or alters gait.  Osgood Schlatter’s disease  Osgood-Schlatter disease is a common cause of knee pain in adolescents. It is caused by microtrauma in the deep fibers of the patellar tendon at its insertion on the tibial tuberosity. The diagnosis is usually based on history and physical examination. The quadriceps femoris muscle inserts on arelatively small area of the tibial tuberosity and naturally high tension exists at the insertion site. In pediatric patients, additional stress is placed on the cartilaginous site with vigorous physical activity (overuse), leading to traumatic changes at insertion. Osgood-Schlatter disease is often seen in the adolescent years after the patient has undergone a rapid growth spurt the previous year. It occurs more frequently in males than in females, typically between 13 and 14 years in males and 11 years in females. 2) A child who plays soccer is in the clinic reporting pain and swelling in both knees. A physical examination reveals swelling and focal tenderness at the tibial tuberosities, with pain worsening when asked to extend the knees against resistance. What is the treatment for this condition? a) Apply ice packs to both knees and avoid activities that cause pain. b) Began quadriceps-stretching exercises now to prevent further injury. c) Obtain radiographic studies to rule out fractures or ligament tears. d) Refer to a pediatric orthopedic specialist to evaluate the need for surgery.  Crutch walking 1) A 14-year-old boy who is overweight develops a unilateral limp with pain in the hip and knee on the affected side. An exam reveals external rotation of the hip when flexed and pain associated with attempts to internally rotate the hip. What is most important initially when managing this child’s condition? a) Place the child on crutches or in a wheelchair to prevent weightbearing. b) Provide information about weight loss to minimize further injury. c) Recommend seeing an orthopedic specialist as soon as possible. d) Refer the child to physical therapy to improve range of motion. 2) Proper fit a) 2-3 finger width between axillae and rest pad (1-1.5”) – prevents nerve damage b) Hand grips should be even with top of hip line (elbows flexed 30 degrees) 3) Gaits a) Swing-to-gait/swing-through-gait i) Gait belt and tripod position before starting b) Two-point: move right crutch and left foot together i) Left crutch and right foot together c) Four-point: move right crutch, then left foot, then left crutch, then right footd) Three-point: move both crutches and injured leg together then move non-injured leg e)  Juvenile Rheumatoid Arthritis (complications) *at risk for uveitis 1) The primary care pediatric nurse practitioner examines a child who has had stiffness and warmth in the right knee and left ankle for 7 to 8 months but no back pain. The nurse practitioner will refer the child to a rheumatology specialist to evaluate for: a) Enthesitis-related JIA. b) Oligoarticular JIA. c) Polyarticular JIA. d) Systemic JIA. 2) The primary care pediatric nurse practitioner is prescribing ibuprofen for a 25 kg child with JIA who has oligoarthritis. If the child will take 4 doses per day, what is the maximum amount the child will receive per dose? a) 200 mg. b) 250 mg. c) 400 mg. d) 450 mg. 3) The parent of a school-age child who is diagnosed with oligoarticular JIA asks the primary care pediatric nurse practitioner what exercises the child may do to help reduce symptoms. What will the nurse practitioner recommend? a) Running. b) Swimming. c) Weights. d) Yoga. 4) The primary care pediatric nurse practitioner is managing care for a child who has JIA who has a positive ANA. Which specialty referral is critical for this child? a) Cardiology. b) Ophthalmology. c) Orthopedics. d) Pain management. McMurray’s Test 1) Patient lies supine a) Initial flexion: provider bends the patient’s knee to 90 degrees or to the point of maximal flexion. b) For medial meniscus tear: i) Provider rotates the tibia externally and applies valgus stress (bending knee inward) ii) The knee is then extended while maintaining this rotation and stress c) For lateral meniscus tear: i) Provider rotates the tibia internally and applies varus stress (bending knee outward) ii) The knee is then extended while maintaining this rotation and stress d) Throughout the movement, the provider places their hand on the side of the knee joint to feel for clicking, snapping, or other popping sounds. e) Tear indication: a positive result suggests a potential tear in medial or lateral meniscus, which is a C-shaped piece of cartilage in the knee.  Avascular necrosis of femoral head (Legg-Calve-Perthes Disease)  LCPD is a childhood hip disorder that results in infarction of the bony epiphysis of the femoral head presenting as avascular necrosis of the femoral head. The basic underlying cause is insufficient blood supply to the femoral head. There is an initial ischemic episode of unknown etiology that interrupts vascular circulation to the capital femoral epiphysis. The articular cartilage hypertrophies, and the epiphyseal marrow becomes necrotic. The area revascularizes, and the necrotic bone is replaced by new bone. This process can take 18 to 24 months. There is a critical point in these dual processes when the subchondral area becomes weak enough that fracture of the epiphysis occurs. At this time, the child becomes symptomatic. Withfracturing, further reabsorption and replacement by fibrous bone occurs, and the shape of the femoral head is altered. Articulation of the head in the hip joint is interrupted. The bone reossifies with or without treatment; without treatment, the femoral head flattens and enlarges, causing joint deformity. Lateral subluxation of the femoral head is associated with poor outcomes.  Etiology is unclear, but certain risk factors have been identified in pediatric patients. These include sex, socioeconomic group, and the presence of an inguinal hernia and genitourinary tract anomalies. Males are affected three to five times more often than females; incidence increases in lower socioeconomic groups and in pediatric patients with low birth weights. The disease is bilateral in 10% to 20% of pediatrics. It affects children 3 to 12 years of age with the peak incidence occurring between 5 and 8 years of age. 1) 1) Seizures (medication and side effects) 2) The parent of a child newly diagnosed with epilepsy asks the primary care pediatric nurse practitioner if the child will ever be able to participate in gym or sports. What will the nurse practitioner recommend? a) Bicycle riding is not safe for children with seizures. b) Contact sports should be avoided. c) Direct supervision of some activities is necessary. d) Underwater sports are not recommended. 3) A parent is concerned about adverse reactions. Based on an Institute of Medicine report, what will the primary care pediatric nurse practitioner tell the parent? a) Administering multiple vaccines may trigger the development of type 1 diabetes. b) The MMR may be linked to febrile seizures in immunocompromised children. c) There is some risk of CNS disorders associated with the hepatitis B vaccine. d) Vaccines containing thimerosol are linked to pervasive developmental disorders. 4) The parent of an infant asks why some vaccines, such as MMR, are not given along with other series of immunizations at 2, 4, and 6 months ofage. What will the primary care pediatric nurse practitioner tell this parent? a) Febrile seizures are more likely in younger infants with some vaccines. b) Maternal antibodies neutralize some vaccines and are delayed until 12 months. c) The risk of adverse effects is lower for some vaccines after the first year. d) Too many vaccines at once can overwhelm the infant’s immune system. 5) A child who has had a single non-febrile seizure has a normal neurologic exam. Which diagnostic test is indicated? a) Computerized tomography (CT). b) Electroencephalogram (EEG). c) Magnetic resonance imaging (MRI). d) Polysomnography. 6) The parents of an 18-month-old child bring the child to the clinic after observing a brief seizure of less than 2 minutes in their child. In the clinic, the child has a temperature of 103.1 F, and the primary care pediatric nurse practitioner notes a left otitis media. The child is alert and responding normally. What will the nurse practitioner do? a) Order a lumbar puncture, complete blood count, and urinalysis. b) Prescribe an antibiotic for the ear infection and reassure the parents. c) Refer to a pediatric neurologist for anticonvulsant and antipyretic prophylaxis. d) Send the child to the emergency department for EEG and possible MRI. 7) A quality of a partial seizure is: a) Status epilepticus. b) Tonic movements. c) Fluttering eyelids. d) Clonic movements. 8) A mother is asking the nurse why her daughter continues to have temporal lobe seizures even though she is on medication. The nurse knows that this is occurring because: a) The medication may not be in the therapeutic range. b) Temporal lobe seizures do not respond well to medications. c) The daughter may be missing doses of her medication. d) The food her daughter eats may have a negative reaction with the medication, causing more seizures. 9) Which of the following types of epilepsy are photosensitive? a) Juvenile myoclonic epilepsy. b) Temporal lobe epilepsy. c) Febrile seizures. d) Childhood absence seizures.10) A child who had a seizure one hour ago is exhibiting signs of paralysis on the left side of the body. The nurse understands that the child is exhibiting signs of: a) Lethargy due to previous seizure activity. b) Postictal paralysis. c) Permanent paralysis of the left side of the body. d) Major brain damage that is going to have long-term side effects. 11) A child with a known history of Benign Rolandic Epilepsy is having a seizure during lunch at the middle school. The school nurse is called to the cafeteria. What is the school nurse’s priority at this time? a) Prevent a possible choking incident by checking the student’s mouth for food. b) Lay the child down on the floor and make sure the area is safe. c) Call EMT for help. d) Notify the parents that their daughter is having a seizure. 12) An 18-month-old is having a seizure when the nurse is assessing him. The nurse notes that the child is fluttering his eyes and smacking his lips. The nurse should document this seizure as: a) An absence seizure. b) A tonic-clonic seizure. c) A myoclonic seizure. d) A febrile seizure. 13) A 9-month-old is admitted to the pediatric unit for seizures of unknown origin. The child has an EEG performed for several hours. The EEG notes several seizures occurring at different intervals. The nurse knows this child: a) Will develop at the same rate as his peers. b) May have several mental and physical challenges due to the frequent seizure activity. c) May exhibit a slight cognitive delay as he grows. d) Will grow out of having seizures. 14) A child has been in status epilepticus for the last 20 minutes. The child has Depakote, valproic acid, and diazepam gel ordered. The nurse should prepare which medication for administration at this time? a) Depakote. b) Valproic acid. c) Diazepam. d) None of the medications. The child will stop on his own. 15) Care for a child during status epilepticus should include all of the following except: a) Turn the patient to the right side. b) Loosen tight clothes. c) Move toys out of the area to prevent injury. d) Stay with the patient until the seizure has stopped. 16) In infants, especially preterm infants, seizures can present as: a) Awake apnea.b) Coughing spells. c) Regurgitation. d) Poor feeding. 17) A mother brings her 5-year-old son to the clinic with complaints that he is “acting funny.” She states there are brief periods when he does not respond to her, and then he suddenly responds and acts as if nothing has happened. The nurse would initially evaluate the child further for the presence of: a) Horner’s syndrome. b) Attention deficit disorder. c) Petit mal or absence seizures. d) Avoidance disorder of childhood. 18) 19) Are there different concerns about a new complaint of headache in a 3- year-old versus a 13-year-old? What are the similarities and differences in obtaining history, physical assessment, and differential diagnosis? 20) A 5-year-old has a tonic-clonic seizure and a temperature of 104°F (40°C). How would your management vary if this child were 3 months old? 8 years old? 21) A 10-year-old has a chief complaint of weakness. What are the key physical assessment points? What are the differential diagnoses? 22) A 17-year-old football player received a severe head injury when in a motor vehicle accident in early May. He required hospitalization and was unconscious for 30 hours. He had one seizure the week following his injury. You see him 1 month after his discharge. What sort of examination (including all the elements) are you going to do? What do you tell him about his returning to play on the varsity football team in late August? What sort of prediction can you make about his recovery? What sort of follow-up do you recommend?  Types (specifically absence) 1) An 18-month-old is having a seizure when the nurse is assessing him. The nurse notes that the child is fluttering his eyes and smacking his lips. The nurse should document this seizure as: a) An absence seizure. b) A tonic-clonic seizure. c) A myoclonic seizure. d) A febrile seizure. Febrile seizures 1) A parent is concerned about adverse reactions. Based on an Institute of Medicine report, what will the primary care pediatric nurse practitioner tell the parent? a) Administering multiple vaccines may trigger the development of type 1 diabetes. b) The MMR may be linked to febrile seizures in immunocompromised children. c) There is some risk of CNS disorders associated with the hepatitis B vaccine. d) Vaccines containing thimerosol are linked to pervasive developmental disorders.  Meningitis 2) The pediatric nurse practitioner provides primary care for a 30-monthold child who has sickle cell anemia who has had one dose of 23-valent pneumococcal vaccine. Which is an appropriate action for health maintenance in this child? a) Administer an initial meningococcal vaccine. b) Begin folic acid dietary supplementation. c) Decrease the dose of penicillin V prophylaxis. d) Give a second dose of 23-valent pneumococcal vaccine. 3) When performing a neurologic exam to assess for meningeal signs in an infant, the primary care pediatric nurse practitioner will attempt to elicit the Kernig sign by: a) Bending the infant at the waist to touch fingers to toes. b) Extending the leg at the knee with the infant supine. c) Flexing the infant’s neck to touch chin to chest. d) Turning the infant’s head from side to side. 4) Results from cerebrospinal fluid that was tested for meningitis have been received by the nurse. The results indicate bacterial meningitis. The nurse knows this because the results show: a) A low protein count and a low glucose count.b) A low red blood cell count. c) An elevated protein count and a low glucose level. d) A normal protein count and a high glucose count. 5) A child presents with a history of a purpuric rash with centrifugal distribution and a fever. After the family nurse practitioner examines this child, what would be the most important condition to rule out at this time? a) Lyme disease. b) Roseola. c) Meningococcemia. d) Rubella. 6) A 3-week-old infant has been diagnosed with bacterial meningitis. The family nurse practitioner is aware that the most common causative organism is: a) Escherichia coli. b) Neisseria meningitidis. c) Group B streptococcus. d) Streptococcus pneumoniae. 7) The family nurse practitioner is seeing a 3-year-old child with a history of hospitalization at 18 months for bacterial meningitis and treatment with ampicillin and gentamicin. Which test should the family nurse practitioner make sure to include in the exam? a) Vision testing. b) Hearing testing. c) Electrocardiogram (ECG). d) Lumbar puncture. 8)  Basic First Aid 1) Allergic reactions requiring epi pen --- when and how to use, follow-up care 1) A child is brought to the clinic with a generalized, annular rash characterized by raised wheals with pale centers. On physical examination, the child’s lungs are clear and there is no peripheral edema. A history reveals ingestion of strawberries earlier in the day. What is the initial treatment? a) Aqueous epinephrine 1:1000 subcutaneously. b) Cetirizine once in clinic and then once daily for 2 weeks. c) Diphenhydramine 0.5 to 1 mg/kg/dose every 4 to 6 hours. d) Prednisone 1 to 2 mg/kg/day for 1 week with rapid taper. 2) A child is brought to the clinic immediately after being stung by a wasp while playing in the yard. The physical examination reveals localized redness and edema at the site, along with abdominal tenderness, watery eyes, and generalized hives. What is the initial treatment? a) Administer intramuscular epinephrine. b) Apply a topical glucocorticoid cream. c) Give oral diphenhydramine. d) Order a bronchodilator treatment.  If the child has a food allergy, he/she should do these measures to prevent anaphylaxis?  Wear a medical alert bracelet.  Carry 2 doses of epinephrine.  Snake bites, dog bites, etc. 1) A child is bitten on one arm by a neighbor’s dog. The dog is immunized against rabies and the child’s last tetanus immunization was 4 years prior. The wound edges are gaping and avulsed. What is an important initial intervention when treating this injury? a) Administration of rabies prophylaxis and a tetanus booster. b) Debriding and suturing the wound the wound to prevent infection. c) Irrigation of the wounds with high-pressure normal saline.d) Reporting the animal bite to the local animal control authority. 2) A child is bitten by a snake near a swimming pool in an area where copperhead snakes are known to inhabit, although the parents cannot describe the snake. An examination of the bite reveals a severe local reaction at the site with edema and intense pain. What will the primary care pediatric nurse practitioner do first? a) Administer narcotic analgesics to provide comfort. b) Begin treatment with oral amoxicillin-clavulanate for 5 days. c) Clean the wound and administer tetanus prophylaxis. d) Transport the child by ambulance to a medical center. 3) A child is brought to the clinic with fever, headache, malaise, and a red, annular macule surrounded by an area of clearing and a larger, erythematous annular ring. The child complains of itching at the site. What will the primary care pediatric nurse practitioner do to determine the diagnosis? a) Ask about recent tick bites. b) Obtain a skin culture. c) Order blood cultures. d) Perform serologic testing. 4) A child whose family has been camping in a region with endemic Lyme disease suffered several tick bites. The parents report removing the ticks but are not able to verify the type or the length of time the ticks were attached. The child is asymptomatic. What is the action? a) Administer a prophylactic single dose of doxycycline. b) Perform serologic testing for IgG or IgM antibodies. c) Prescribe amoxicillin three times daily for 14 to 21 days. d) Teach the parents which signs and symptoms to report. 5) A child is bitten on one arm by a neighbor's dog. The dog is immunized against rabies and the child's last tetanus immunization was 4 years prior. The wound edges are gaping and avulsed. What is an important initial intervention when treating this injury? a) Administration of rabies prophylaxis and a tetanus booster b) Debriding and suturing the wound to prevent infection c) Irrigation of the wounds with high-pressure normal saline d) Reporting the animal bite to the local animal control authority 6) A child is brought to the clinic immediately after being stung by a wasp while playing in the yard. The physical examination reveals localized redness and edema at the site, along with abdominal tenderness, watery eyes, and generalized hives. What is the initial treatment? a) Administer intramuscular epinephrine b) Apply a topical glucocorticoid cream c) Give oral diphenhydramine d) Order a bronchodilator treatment 7)Week 9  UTI (symptoms) 1) 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) 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? a) Obtain a complete blood count and C-reactive protein. b) Perform sensitivity testing before treating with antibiotics. c) Repeat the culture if symptoms persist or worsen. d) Treat with antibiotics for urinary tract infection. 3) 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. 4) 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.5) A 3-year-old 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? a) Obtain a renal and bladder ultrasound. b) Prescribe prophylactic antibiotics to prevent recurrence. c) Refer the child for a voiding cystourethrogram. d) Screen urine regularly for leukocyte esterase and nitrites. 6) 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) Amoxicillin 10mg/kg as a single daily dose. b) Ceftriaxone IM 50 mg/kg as a single daily dose. c) Nitrofurantoin 1-2 mg/kg as a single daily dose. d) TMP-SMX; TMP 2 mg/kg as a single daily dose. 7) 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. 8) The primary care pediatric nurse practitioner is concerned that a toddler may have vesicoureteral reflux based on a history of dysfunctional voiding patterns and a series of urinary tract infections. Which intervention is appropriate? a) Initiating a bladder retraining program. b) Ordering a voiding cystourethrogram. c) Referral to a urologist for evaluation. d) Treatment with prophylactic antibiotics. 9) Henoch-Schönlein purpura 1) A child has gross hematuria, abdominal pain, and arthralgia as well as a rash. What diagnosis is most likely? a) Henoch-Schonlen purpura. b) Rhabdomyosarcoma. c) Sickle cell disease. d) Systemic lupus erythematosus. 2) Consider Henoch-Schönlein purpura (HSP) when there is gross hematuria in the presence of abdominal pain, with or without bloody stools, arthralgias, and purpuric rash (see Chapter 38). Nephrotic syndrome (treatment) 1) 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.” 2) 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 course of treatment considering this finding? a) Begin a taper of the steroid medication while continuing salt restrictions. b) Continue with steroids and salt restriction 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.  Wilms tumor (page 925) 1) Most common malignancy of GU tract, typically found as a firm, smooth mass in the abdomen or flank. Most occur in children between ages 2 and 5 years old. Peak incidence and median age at diagnosis is 3.5 years. a) Autosomal dominant b) Typically associated with congenital anomalies such as renal abnormalities, cryptorchidism, hypospadias, duplication of the collecting system, ambiguous genitalia, hemihypertrophy, aniridia, cardiac abnormalities, and Beckwith-Wiedemann, Denys-Drash, and Perlman syndromes. c) Occurs equally in both sexes d) More frequently found in African Americans and lower in Asians 2) Stage 1: the tumor is limited to the kidney and can be completed excised with the capsular surface intact.3) Stage II: the tumor extends beyond the kidney but can still be completely excised. 4) Stage III: there is postsurgical residual nonhematogenous extension confined to the abdomen. 5) Stage IV: there is hematogenous metastasis, most frequently to the lung. 6) Stage V: there is bilateral kidney involvement. History and Clinical Findings: o Most frequent finding is increasing abdominal size or actual palpable mass. o Pain reported if mass has undergone rapid growth or hemorrhage. o Fever, dyspnea, diarrhea, vomiting, weight loss, or malaise may be reported. Physical exam: o A firm, smooth abdominal, or flank mass that does not cross the midline may be noted. o BP is elevated if renal ischemia is present (rare). Diagnostics: o Chest and abdominal radiography to differentiate neuroblastoma, which is usually calcified o Abdominal ultrasound to differentiate a solid from a cystic mass or hydronephrosis and multicystic kidney. o UA demonstrates hematuria in 25% to 33% of children. 1) During a well child examination of a 2-year-old child