Download NU665A (Primary Care of Child II) EXAM 3 2025-2026|115Qs&As|ALREADY GRADED A+ and more Exams Pediatrics in PDF only on Docsity!
NU665A (Primary Care of Child II) EXAM 3 2025 -
2026|115Qs&As|ALREADY GRADED A+
Your next patient is a 6-year-old male here with his mother. Mom brings the child in today because the child continues to wet the bed at least twice a week. A urinalysis was completed today and is normal. What is the best next step in the evaluation of this child? Ask the child and mother about his voiding and bowel patterns. You receive the results of newborn screening from a healthy, term neonate and find that the TSH done on the newborn screen is 82 mIU/L (elevated). What is your next step? Start thyroid supplementation and refer to pediatric endocrinology urgently. The father of a 7-year-old boy expresses concern that his son has grown 2 inches in the past six months. Upon examination, the PNP noted the presence of pubic hair. What would the PNP's next steps be in the care of this child? Refer the child to a pediatric endocrinologist for further work-up. A school-aged child is brought to the clinic with her father for increased urinary frequency, dysuria, and discomfort for the past two days. Today, she has a fever and some abdominal pain. The child was able to produce a clean catch urine sample and the urinalysis results include positive nitrites and leukocyte esterase. As the PNP, what would you do next? Since the child is symptomatic, send the urine for culture and sensitivity and start oral antibiotics.
A 7-month-old infant has an undescended testis that was noted at the end of his previous well-baby exam. What will the primary care pediatric nurse practitioner do to manage this condition? Refer the child to a pediatric urologist for further evaluation. A 15-year-old adolescent male presents today for his annual exam. He states he had a good day at school today and has soccer practice after his appointment. His routine urine dipstick indicates 2+ protein. He asks if this is normal. As the PNP, what would you tell him? This warrants some further investigation. I will order a first-morning urine sample and check the level of protein in your urine. A 15-year-old adolescent female whose BMI is at the 90th percentile reports irregular periods. Menarche was at 12 years of age. Through the assessment, it is noted that the child has widespread acne on her face and back. The child also states that she has noticed hair on her breasts and wants to know what she can do about this. The nurse practitioner will evaluate her further based on a suspicion of which diagnosis? Polycystic Ovary Syndrome A 10-year-old male is being seen today with concerns of change in school performance, some tremors, and complaints of heart palpitations for the past few weeks. Mom states there have been no changes in social history and family history is positive for thyroid disease. He had routine labs done one month ago and his T3 was elevated. What are the next steps in the care of this child? Refer the child to a pediatric endocrinologist for further workup
Can you give me an example of the foods and drinks your child consumes over a few days? Your next patient is a 2-month-old infant here with his mother. The infant is exclusively breastfed, and the mother asks why he needs to take Vitamin D supplements. As the PNP, how would you answer this? Breastmilk is the best for your child but in order to prevent bone growth issues, one daily dose of Vitamin D is recommended Your next patient is a 5-year-old male who presents with a 1cm laceration of the right forearm. The injury occurred three days ago while playing outside. His father is concerned because the wound keeps opening. There are no signs of infection. What is the most appropriate action? Clean the wound thoroughly and instruct the child and father regarding wound care and healing by secondary intention. Your next patient is a 10-day-old term newborn coming in for a weight check. She has regained her birth weight. As you are examining the infant, you note a small pink raised area inside the umbilicus. Mom states that her cord fell off about 3 days ago and there has been no discharge. What would you do next? Use topical 75% silver nitrate to the lesion, making sure not to touch healthy skin.
Your next patient is a 4-year-old girl here with her mother for a follow-up from the pediatric urgent care center due to laceration to her scalp. She was jumping on the couch, fell, and hit the corner of the coffee table. She has six staples placed. Mom asks what is next for her child. What would you share? After reviewing safety, you inform the mother that she may make an appointment in 10 days to have the staples removed by any of the NPs or MDs in the office. Most Common Food Allergies in the United States milk, eggs, peanuts, tree nuts, fish, shellfish, soy, wheat Most Common Food Intolerances in the United States dairy, grains/gluten, beans, cabbage Irritable Bowel Syndrome Functional GI disorder A common condition of unknown cause with symptoms that can include intermittent cramping, abdominal pain, bloating, mixed constipation, and/or diarrhea symptoms happen w/out damaging the GI tract endoscopy/radiology tests do not show inflammation
You see a 20-month-old toddler with normal growth and development, in your office for diarrhea. His mother tells you that he is passing up to three loose stools a day and he drinks 20 ounces of apple juice a day. What could be his cause? Nonspecific "toddler" diarrhea In evaluating a child with bloody diarrhea, which of the following would not be appropriate first action? Upper GI A family eats at fast-food restaurants four to five times each week. If you suspect the diarrhea in infectious in nature, what is a likely causative organism? E. coli What condition would most likely occur in a 4-year-old boy? Giardia infection Steatorrhea is not consistent with which type of condition? C.difficile infections
Which of the following foods would be appropriate for a child with celiac disease? §Oatmeal for breakfast §Boiled rice with butter §Commercially baked bread §Cream of wheat Boiled rice with butter celiac disease malabsorption syndrome caused by an immune reaction to gluten; villi damaged/flattened in small intestine Baby Sally as in your office last week for her 6-month checkup. Her weight was 7kg. Today she presents with diarrhea and vomiting for 4 days. Today her weight is 6.5 kg. What is her percentage of dehydration? 7 % % dehydration formula (Normal weight - actual weight) / normal weight x 100 How much water is the body made up of?
Your patient has inflammatory bowel disease. Which finding is consistent with ulcerative colitis? §Occult blood §Perirectal abscess §Aphthous ulcers §Left-sided abdominal pain Left-sided abdominal pain A child has developed her second perirectal abscess in 6 months. She should be evaluated for which condition? Crohn's Disease Your next patient is a six-year-old male here with his mother. Mom brings the child in today because the child is the shortest in his class and mom is concerned there is a problem. Mom states that there are others in the family who are short. The child had some issues in his first years of life growing, but since 3 years of age, has consistently been at the 5th percentile of growth in height. What would be the PNP's next step in the care of this child? Explain that there are different reasons for the child being smaller than others and order a bone age.
The father of a 7-year-old boy expresses concern that his son has grown 2 inches in the past 6 months. Upon examination, the PNP noted the presence of pubic hair. What would the PNP's next steps be in the care of this child? Refer the child to a pediatric endocrinologist for further workup A 10-year-old male is being seen today with concerns of change in school performance, some tremors and complaints of heart palpitations for the past few weeks. Mom states there have been no changes in social history and family history is positive for thyroid disease. He had routine labs done 1 month ago and his T3 was elevated, What are the next steps in the care of this child? Refer the child to a pediatric endocrinologist for further work up Signs of hyperthyroidism include may include heart palpitations, tremors, increased appetite with weight loss, fatigue, poor sleep and concentration, decreased school performance as well as increased T3 levels, goiter, infertility §2-day old infant presents for first visit. Mother states that baby has difficulty latching onto the breast, but when taking breastmilk from a bottle, there is no issue. §PMH: NVD Born at 39.5 weeks APGAR 10/ §G1P §Received Hep B in the hospital §Breastfeeding only
Nurse maid elbow radial head dislocation toddler comes in and will not move arm Holds arm flexed and supinated to their side Treatment for nurse maid elbow Reduction, Supernation, or Hyperpronation fluorescein staining applying eye drops to cornea to look for corneal abrasions Suture placement 0.5cm spacing Knot on the same side (inferiorly placed) 0.5cm depth Evert the edges of the wound by inserting needle at 90-degree angle (ensures that wound edges are well approximated). Use needle holder to hold needle. Use forceps to grab wound edges. Usually, simple sutures are used on skin lacerations. Each suture is individually tied, then cut (simple interrupted sutures).
When cutting suture thread, do not cut too short. Leave a short tail (easier to remove). Nonabsorbable synthetic sutures are preferred for lacerations/wounds of the skin. If suturing scalp of a person with black hair, blue-colored suture thread is easier to visualize (for removal). Dermabond skin glue; tissue adhesive; used with small superficial lacerations; not useful over joints; for straight, non-jagged edges §The mother of a female infant is concerned that her daughter is developing breasts. The PNP notes mild breast development but no pubic or axillary hair. What is the likely diagnosis? Premature thelarche that will resolve over time A 16 yo adolescent female whose BMI is at the 90th percentile reports irregular periods. The PNP notes widespread acne on her face and back and an abnormal distribution of facial hair. The NP will evaluate her further based on a suspicion of which diagnosis? Polycystic ovary syndrome polycystic ovary syndrome symptoms of irregular menses, acne, and hirsutism and is associated with obesity
A school-age child has recurrent diarrhea with foul-smelling stools, excessive flatus, abdominal distension, and failure to thrive. He has not eliminated anything from his diet yet. What is the next step in diagnosing this condition? A two-week lactose free trial failed to reduce symptoms celiac disease symptoms
- Malabsorptive diarrhea
- Flatulence
- Steatorrhea (greasy, bulky stool), foul smelling
- Weight loss (FTT)
- Abd distention
- Weakness and growth retardation
- Iron deficiency
- Bone pain or Bone weakness
- Amenorrhea
- Fertility problems
- Dermatitis herpetiformis (blisters on extensor surface) The parent of a school-age child reports that the child is on a gluten-free diet. When questioned about the reason for this diet, the parent states that the child has fewer stomach aches since beginning the diet but has never been diagnosed with celiac disease. The parent reports using gluten-free grain products for all family members. The nurse practitioner will tell this parent that gluten-free diets:
May be deficient in essential nutrients Gluten-free grain products Highly processed and not enriched with iron or folate Many are very low in protein They often have sugar and fat added to them to improve taste An eight-year-old child is present with his mother with a report of "something in my left eye." The child reports that he was playing baseball as the catcher, and someone slid into home plate. After this, he felt something in his eye. The coach rinsed the eye out, but he still feels like something is in there. There is no report of change in vision or photophobia. The nurse practitioner decides that a fluorescein examination is appropriate. What should the NP do next? Pull down the lower lid, and with a moistened fluorescein strip, allow drops into the affected eye. A three-year-old child is presented with her mother with complaint of purulent rhinorrhea from left nostril with a strong odor. The mother reports that the child states she put a piece of corn in her nose and remembers the last time they had corn was two weeks ago. What would be the best intervention the nurse practitioner would do next? After examination and identification that there is a kernel of corn in the left nares, the nurse practitioner will use an alligator forceps and remove the foreign body.
Henoch-Schoenlein purpura (HSP) Henoch-Schoenlein Purpura (HSP) may present with gross hematuria in the presence of abdominal pain with or without bloody stools, arthralgias, and a purpuric rash A Mother brings her 3yo in for his well-child check. When discussing his diet, the mother states that she thinks the child is allergic to strawberries. She states that, when he at one about 12m ago, he had a few hives around his mouth and hands. She gave him diphenhydramine and has avoided strawberries since then. She asks if he will outgrow the allergy. How would you as the PNP advise her? Discuss that, because children can outgrow food intolerance and allergies, challenge the child with the food he/she is allergic to under close supervision about every one to two years The parents a 10-y.o recently diagnosed with Crohn's disease ask about some of the common symptoms with this condition. What should the PNP respond? Perirectal abscess Children with acute nephrotic syndrome may present with all but the following symptom weight loss
Symptoms of acute nephrotic syndrome periorbital edema, hypertension, and weight gain due to fluid retention. A 3yo presents with a history of low-grade fever, URI symptoms for two days, and now with swelling around the left eye. There is equal ocular movements bilaterally and no discomfort to the eye. What should the PNP do for this child? Prescribe clindamycin orally and follow up in the office in 24 hours. A 6yo child presents with fever and sore throat. A rapid strep test is negative. What would the NP do next? Send a throat culture and treat accordingly Treatment for pharyngitis (Group A streptococcus) amoxicillin is the first choice, but azithromycin and some cephalosporins may be prescribed The PNP is performing a well-child exam on a 14 yo child who was diagnosed with type 1 diabetes at age 9. The child had a lipid screen at age 11 with an LDL cholesterol <100mg/dL and is scheduled for an eye exam. What will the NP recommend as part of ongoing management for this child?
