GU. 1. A 30monthold girl who has been toilet trained for 6 months has daytime enuresis and dysuria and a low-grade fever. A dipstick urinalysis is negative for leukocyte esterase and nitrites. What is the next step? a. Begin empiric treatment with trimethoprim sulfamethoxazole. b. Discuss behavioral interventions for toilet training. c. Reassure the child’s parents that the child does not have a urinary tract infection. d. Send the urine to the lab for culture. Correct 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. Correct 3. A dipstick urinalysis is positive for leukocyte esterase and nitrites in a school aged 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. Correct 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 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.” Correct c. “This represents a cure from this disease.” d. “Your child will need to take steroids indefinitely. 5. A child who has nephrotic syndrome is on a steroid 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. MN580- Final In consultation with the child’s nephrologist, what is the correct course of treatment considering this finding? a. Begin a taper of the steroid medication while continuing salt restrictions. b. Continue with steroids and salt restrictions until the urine is negative for protein. Correct 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. 5. 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. Prescribe a 10to 14day course of high dose amoxicillin. b. Prescribe high dose steroids in consultation with a nephrologist. c. Reassure the parents that this condition will resolve spontaneously. d. Refer the child to a pediatric nephrologist for hospitalization. Correct 6. During a well child examination of a 2yearold child, the primary care pediatric nurse practitioner palpates a unilateral, smooth, firm abdominal mass which does not cross the midline. What is the next course of action that? a. Order a CT scan of the chest, abdomen, and pelvis. b. Perform urinalysis, CBC, and renal function tests. c. Reevaluate the mass in 1 to 2 weeks. d. Refer the child to an oncologist immediately. Correct 7. 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? a. Reassure the parent that the testis will most likely descend into place on its own. b. Refer the infant to a pediatric urologist or surgeon for possible orchiopexy. Correct c. Teach the parent to manipulate the testis into the scrotum during diaper changes. d. Tell the parent that hormonal therapy may be needed to correct the condition. 8. A 9monthold infant is brought to the clinic with scrotal swelling and fussiness. The primary care pediatric nurse practitioner notes a tender mass in the affected scrotum that is difficult to reduce. What is the correct action? a. Obtain an abdominal radiograph.