Name
Purdue University Globle
NU580 FNP II – Primary Care of Children and Adolescents’ Health
Prof. Name
Date
A pharmaceutical company develops a new medication that has been tested only in adults. The FDA determines that the medication may benefit children with certain illnesses. Under the Pediatric Research Equity Act (PREA), what may the pharmaceutical company be required to do?
A. Conduct pediatric drug studies to determine whether the medication is safe and effective in children.
B. Market the medication for pediatric use without additional studies.
C. Delay marketing the medication until additional adult studies are completed.
D. Require pediatric providers to determine appropriate pediatric dosing.
Answer: A. Conduct pediatric drug studies to determine whether the medication is safe and effective in children.
PREA can require manufacturers to evaluate certain medications in pediatric populations when the FDA determines that pediatric studies are needed.
A primary care pediatric nurse practitioner prescribes a new medication for a child who subsequently develops a previously unknown adverse reaction. Where should the adverse reaction be reported?
A. Institute for Safe Medication Practices (ISMP)
B. Drug Enforcement Administration (DEA)
C. FDA MedWatch website
D. Centers for Disease Control and Prevention (CDC)
Answer: C. FDA MedWatch website.
The FDA MedWatch program collects reports of serious problems associated with medical products, including unexpected adverse drug reactions.
A pediatric nurse practitioner is considering prescribing a relatively new medication for a 15-month-old child. The medication is metabolized by the liver. The practitioner should consult a pharmacologist about giving the medication:
A. Less often or at a lower dose.
B. More often to maintain therapeutic levels.
C. At the same dose as an older child.
D. Only by intravenous route.
Answer: A. Less often or at a lower dose.
Medication metabolism can differ substantially in young children. Pharmacokinetic differences may require adjustments to the medication dose or dosing interval.
A pediatric nurse practitioner wants to prescribe a medication for an off-label use in a child. The medication has been reviewed using pharmacology resources and FDA information, and no major contraindications have been identified. What else should the practitioner do?
A. Discuss the recommendation with the parents and document their consent.
B. Avoid prescribing the medication.
C. Obtain approval from the FDA.
D. Consult the pharmacy board before prescribing.
Answer: A. Discuss the recommendation with the parents and document their consent.
Off-label prescribing may be appropriate when clinically justified. The practitioner should discuss the treatment, including its intended use and potential risks and benefits, with the child’s parents or guardians and document the discussion.
An adolescent with asthma frequently forgets to use twice-daily inhaled corticosteroids scheduled at 8 AM and 8 PM. Which strategy may improve medication adherence?
A. Ask the adolescent to identify two times each day that may work better.
B. Tell the adolescent to continue the same schedule.
C. Switch immediately to oral corticosteroids.
D. Ask the parents to administer every dose.
Answer: A. Ask the adolescent to identify two times each day that may work better.
Involving adolescents in medication scheduling can improve adherence. A schedule that fits naturally into the adolescent’s daily routine may be easier to maintain.
A toddler has a lower respiratory tract illness with a low-grade fever. The child is eating well, drinking fluids, and has normal oxygen saturation. The nurse practitioner suspects viral pneumonia. What should be done?
A. Begin high-dose antibiotics immediately.
B. Admit the child for IV antibiotics.
C. Teach the parents about symptomatic care and order appropriate laboratory testing to assist with the diagnosis.
D. Prescribe oral corticosteroids.
Answer: C. Teach the parents about symptomatic care and order appropriate laboratory testing to assist with the diagnosis.
When a child is clinically stable and a viral illness is suspected, management generally focuses on supportive care and appropriate diagnostic evaluation rather than automatically prescribing antibiotics.
A single mother of a 4-year-old child reports difficulty administering twice-daily amoxicillin for 10 days during a previous ear infection because of her busy work schedule. The child currently has another ear infection. What should the nurse practitioner do?
A. Prescribe the same amoxicillin regimen.
B. Delay treatment until adherence improves.
C. Prescribe azithromycin once daily for 5 days.
D. Refer the child to an infectious disease specialist.
Answer: C. Prescribe azithromycin once daily for 5 days.
A medication regimen that is simpler to administer may improve adherence when treatment history indicates difficulty following a more frequent or prolonged regimen.
A school-age child with asthma develops severe wheezing after gym class and needs his inhaler immediately after returning home. What should the nurse practitioner do?
A. Prescribe nebulizer treatments only.
B. Increase the daily inhaled corticosteroid dose.
C. Recommend keeping one inhaler at home only.
D. Write the prescription for two metered-dose inhalers with spacers.
Answer: D. Write the prescription for two metered-dose inhalers with spacers.
Having access to a rescue inhaler in appropriate locations can help ensure that a child can promptly treat acute asthma symptoms.
A 30-month-old girl who has been toilet trained for 6 months presents with daytime enuresis, dysuria, and a low-grade fever. Urinalysis is negative for leukocyte esterase and nitrites. What is the next step?
A. Begin empiric TMP-SMX.
B. Reassure the parents.
C. Repeat the dipstick in 1 week.
D. Send the urine to the laboratory for culture.
Answer: D. Send the urine to the laboratory for culture.
A negative dipstick does not always exclude a urinary tract infection when clinical symptoms suggest infection. Urine culture can provide definitive microbiologic evaluation.
A child with dysuria, urinary frequency, and fever has a clean-catch urine culture showing 50,000–100,000 colonies of E. coli. What is the appropriate treatment?
A. Repeat the urine culture.
B. Observe without treatment.
C. Increase fluid intake only.
D. Treat with antibiotics for a urinary tract infection.
Answer: D. Treat with antibiotics for a urinary tract infection.
A significant growth of a urinary pathogen in a symptomatic child supports treatment for a UTI.
A school-age child has dysuria and foul-smelling urine. Urinalysis is positive for leukocyte esterase and nitrites, and a urine culture is pending. What treatment should be started?
A. Amoxicillin.
B. Trimethoprim-sulfamethoxazole (TMP-SMX) twice daily for 3–5 days.
C. Nitrofurantoin for 14 days.
D. Wait for culture results.
Answer: B. Trimethoprim-sulfamethoxazole (TMP-SMX) twice daily for 3–5 days.
When the clinical presentation and urinalysis are consistent with a UTI, empiric antibiotic treatment may be initiated while awaiting culture results.
A preschool child has mild flank pain and fever. Urinalysis is positive for leukocyte esterase and nitrites, and a urine culture is pending. What is the appropriate treatment?
A. Ciprofloxacin.
B. Amoxicillin-clavulanate.
C. Nitrofurantoin.
D. No antibiotics until the culture returns.
Answer: B. Amoxicillin-clavulanate.
A febrile UTI with flank discomfort raises concern for upper urinary tract involvement and requires an antibiotic appropriate for the suspected infection.
A 3-year-old child has completed a 7-day course of amoxicillin for a second febrile UTI and now has a negative urine culture. What is the next step?
A. Obtain a renal and bladder ultrasound.
B. Begin prophylactic antibiotics.
C. Repeat urine culture monthly.
D. No further evaluation.
Answer: A. Obtain a renal and bladder ultrasound.
Imaging may be indicated in children with recurrent febrile UTIs to evaluate the urinary tract for structural abnormalities.
A 9-month-old infant has had three UTIs and is diagnosed with grade II vesicoureteral reflux. Which medication is prescribed?
A. Amoxicillin.
B. Cephalexin.
C. Nitrofurantoin.
D. TMP-SMX (TMP 2 mg/kg once daily).
Answer: D. TMP-SMX (TMP 2 mg/kg once daily).
Low-dose antimicrobial prophylaxis may be used in selected children with vesicoureteral reflux to reduce the risk of recurrent UTIs.
A parent asks how grade V vesicoureteral reflux will be treated. What should the nurse practitioner explain?
A. Observation only.
B. Surgery to correct the condition is possible.
C. Long-term steroids.
D. Bed rest until the condition resolves.
Answer: B. Surgery to correct the condition is possible.
Severe vesicoureteral reflux may require evaluation for surgical correction, particularly when there are recurrent infections or renal complications.
A healthy 14-year-old female has 5–6 RBCs per high-power field on urinalysis but no other abnormalities. What should the nurse practitioner ask first?
A. Family history of kidney disease.
B. Fluid intake.
C. Exercise history.
D. “When was your last menstrual period (LMP)?”
Answer: D. “When was your last menstrual period (LMP)?”
Menstrual contamination can cause blood to appear in a urine specimen. Determining the timing of the menstrual cycle is therefore an important initial consideration.
A child presents with gross hematuria, abdominal pain, arthralgia, and a rash. What is the most likely diagnosis?
A. Henoch-Schönlein purpura (IgA vasculitis).
B. Minimal change disease.
C. Nephrolithiasis.
D. Urinary tract infection.
Answer: A. Henoch-Schönlein purpura (IgA vasculitis).
IgA vasculitis commonly presents with a characteristic purpuric rash along with abdominal pain, joint symptoms, and renal findings such as hematuria.
An adolescent has 2+ proteinuria on a random urinalysis, but the first-morning urine sample is negative. How should this be managed?
A. Monitor for proteinuria at each annual well-child examination.
B. Refer to nephrology immediately.
C. Begin ACE inhibitor therapy.
D. Order a renal biopsy.
Answer: A. Monitor for proteinuria at each annual well-child examination.
Proteinuria that occurs during the day but disappears in a first-morning urine specimen can be consistent with orthostatic proteinuria, which is generally monitored when no other concerning findings are present.
A child is diagnosed with nephrotic syndrome and responds well to steroid treatment. What should the pediatric nurse practitioner tell the parents about the disease?
A. Steroids are used only once.
B. Steroids will be used when relapses occur.
C. Lifelong antibiotics are required.
D. Surgery is usually necessary.
Answer: B. Steroids will be used when relapses occur.
Children with steroid-responsive nephrotic syndrome may experience relapses. Corticosteroids are commonly used again when clinically significant relapses occur.
A child with nephrotic syndrome is receiving steroids and following a salt-restricted diet during a relapse. Urine protein has decreased from 3+ to 1+. What is the correct management?
A. Stop steroids immediately.
B. Continue steroids and salt restriction until urine is negative for protein.
C. Begin IV albumin.
D. Remove salt restrictions.
Answer: B. Continue steroids and salt restriction until urine is negative for protein.
Treatment is continued while monitoring urinary protein and the child’s clinical response.
A child had a group A beta-hemolytic streptococcal infection 2 weeks ago and now presents with periorbital edema, dyspnea, hypertension, tea-colored urine, hematuria, and mild proteinuria. What should the nurse practitioner do?
A. Begin oral antibiotics.
B. Repeat urinalysis in 1 week.
C. Start corticosteroids.
D. Refer the child to a pediatric nephrologist for hospitalization.
Answer: D. Refer the child to a pediatric nephrologist for hospitalization.
The combination of edema, hypertension, hematuria, and respiratory symptoms after a recent streptococcal infection can indicate significant poststreptococcal glomerulonephritis requiring urgent evaluation and management.
An adolescent has right-sided flank pain without fever. Urinalysis shows gross hematuria without evidence of infection. The nurse practitioner suspects nephrolithiasis. What is the initial treatment?
A. Immediate surgery.
B. Increase fluid intake up to 2 L daily.
C. Begin antibiotics.
D. Restrict fluids.
Answer: B. Increase fluid intake up to 2 L daily.
Adequate hydration is an important component of initial conservative management for uncomplicated nephrolithiasis.
During a well-child examination of a 2-year-old child, the nurse practitioner palpates a unilateral, smooth, firm abdominal mass that does not cross the midline. What is the next step?
A. Repeat the examination in 1 month.
B. Order antibiotics.
C. Schedule a routine ultrasound.
D. Refer the child to an oncologist immediately.
Answer: D. Refer the child to an oncologist immediately.
A firm abdominal mass in a young child requires prompt evaluation for a possible renal or other abdominal tumor.
A 6-month-old infant has a retractile testis noted at a previous examination. What management is appropriate?
A. Observe until adolescence.
B. Refer to a pediatric urologist or surgeon for possible orchiopexy.
C. Begin antibiotics.
D. Perform manual reduction.
Answer: B. Refer to a pediatric urologist or surgeon for possible orchiopexy.
Persistent or non-descended testes require appropriate follow-up and evaluation by a pediatric urology specialist.
A 9-month-old infant presents with scrotal swelling and fussiness. The nurse practitioner finds a tender scrotal mass that is difficult to reduce. What should be done?
A. Apply ice packs.
B. Refer immediately to a pediatric surgeon.
C. Prescribe pain medication only.
D. Observe for 24 hours.
Answer: B. Refer immediately to a pediatric surgeon.
A tender, difficult-to-reduce mass may represent an incarcerated hernia and requires urgent surgical evaluation.
The mother of a 12-month-old uncircumcised male reports painful urination. Examination reveals a tight pinpoint foreskin opening with thickening and inflammation. What is the correct action?
A. Reassure the parents.
B. Prescribe antibiotics only.
C. Refer the child to a pediatric urologist.
D. Forcefully retract the foreskin.
Answer: C. Refer the child to a pediatric urologist.
A severely narrowed or symptomatic foreskin requires appropriate specialist evaluation. Forceful retraction should be avoided because it can cause injury.
An adolescent male presents with sudden unilateral scrotal pain, nausea, and vomiting. Examination reveals a swollen, painful testis and a negative Phren sign. What should the nurse practitioner do?
A. Prescribe NSAIDs.
B. Order a routine ultrasound.
C. Observe for improvement.
D. Refer immediately to a pediatric urologist or surgeon.
Answer: D. Refer immediately to a pediatric urologist or surgeon.
Testicular torsion is a surgical emergency. Prompt specialist evaluation is necessary because delays can result in testicular ischemia and loss.
A pediatric nurse practitioner needs to assess a possible hymenal tear in a prepubertal female who is anxious about the examination. Which approach should be used?
A. Lithotomy position.
B. Knee-chest position.
C. Standing examination.
D. Prone position.
Answer: B. Knee-chest position.
The knee-chest position can provide an appropriate view of the genital structures while helping facilitate examination of a prepubertal child.
A pediatric nurse practitioner is prescribing contraception for an adolescent who has never used birth control. The adolescent has a normal examination and no cardiovascular risk factors. Which preparation should be used initially?
A. Combination oral contraceptive pill with 30–35 mcg estrogen and low progestin.
B. Progestin-only pill.
C. Depot medroxyprogesterone.
D. Copper IUD.
Answer: A. Combination oral contraceptive pill with 30–35 mcg estrogen and low progestin.
For adolescents who have no contraindications to estrogen-containing contraception, a combined oral contraceptive may be considered.
An adolescent female reports unprotected intercourse 4 days ago and is concerned about pregnancy. What should the nurse practitioner prescribe?
A. Ulipristal acetate (Ella).
B. Levonorgestrel after 7 days.
C. Combined oral contraceptives.
D. No treatment.
Answer: A. Ulipristal acetate (Ella).
Ulipristal acetate is an emergency contraceptive option that can be used within 5 days of unprotected intercourse.
A 4-year-old girl has recurrent UTIs, persistent dysuria, and genital redness. Examination reveals a thin membrane extending from the posterior fourchette toward the clitoris. What treatment is indicated?
A. Oral antibiotics.
B. Sitz baths only.
C. Topical steroids.
D. Estrogen-containing cream.
Answer: D. Estrogen-containing cream.
Topical estrogen is commonly used for symptomatic labial adhesions in prepubertal girls.
A school-age female has had vulvovaginitis for 2 months. Cultures are negative, and symptoms persist despite antibiotics. What is the next treatment?
A. Estrogen cream at bedtime for 2–3 weeks.
B. Oral fluconazole.
C. Repeat antibiotics.
D. Surgical intervention.
Answer: A. Estrogen cream at bedtime for 2–3 weeks.
Persistent symptoms require reassessment of the underlying cause rather than automatically continuing antibiotic therapy.
A 16-year-old female reports dull, achy cramping pain in the lower abdomen lasting 2–3 hours between menstrual periods every month. She is not sexually active. What is the treatment?
A. Oral contraceptives.
B. Surgery.
C. Prostaglandin inhibitor analgesics and a heating pad.
D. Antibiotics.
Answer: C. Prostaglandin inhibitor analgesics and a heating pad.
Mild, predictable midcycle pelvic pain can often be managed conservatively with analgesics and local heat.
A 17-year-old sexually active female reports new-onset moderate to severe lower abdominal pain associated with menstruation and occurring at other times. Her pregnancy test is negative. What is the priority action?
A. Perform a full diagnostic workup.
B. Prescribe NSAIDs only.
C. Reassure the patient.
D. Start oral contraceptives immediately.
Answer: A. Perform a full diagnostic workup.
New or significant pelvic pain outside the expected menstrual pattern requires evaluation for gynecologic, infectious, urinary, gastrointestinal, and other possible causes.
A 15-year-old female has a positive pregnancy test and asks the nurse practitioner not to tell her parents. She is unsure about continuing the pregnancy. What should the nurse practitioner do first?
A. Determine the state-mandated reporting laws.
B. Notify the parents immediately.
C. Refer for adoption counseling.
D. Schedule prenatal care.
Answer: A. Determine the state-mandated reporting laws.
Confidentiality requirements and exceptions vary by jurisdiction. The practitioner should first determine the applicable state laws and requirements.
A 16-year-old female reports breast tenderness and a lump. Examination reveals a small fluid-filled mass. Her pregnancy test is negative. What action is appropriate?
A. Mammography.
B. Order an ultrasound of the mass.
C. Surgical excision.
D. Reassure and discharge.
Answer: B. Order an ultrasound of the mass.
Ultrasound is commonly used as the initial imaging modality for evaluating a palpable breast mass in an adolescent.
A 16-year-old female has not started menstruating but has normal sexual maturity development. She denies sexual activity. Which laboratory test should be ordered first?
A. Thyroid function tests.
B. FSH.
C. Pregnancy test.
D. Prolactin level.
Answer: C. Pregnancy test.
Pregnancy should be excluded when evaluating amenorrhea, even when the adolescent reports no sexual activity.
An adolescent female has menstrual periods every 30 days that are consistently heavy and last 5–8 days. What is the diagnosis?
A. Metrorrhagia.
B. Menorrhagia.
C. Dysmenorrhea.
D. Amenorrhea.
Answer: B. Menorrhagia.
Menorrhagia refers to abnormally heavy or prolonged menstrual bleeding occurring at regular intervals.
An adolescent female has heavy and irregular menstrual periods. Physical examination is normal, and a complete blood count shows a hemoglobin level of 8.9 g/dL. What test should the nurse practitioner order next?
A. Coagulation studies.
B. Pelvic ultrasound.
C. Pregnancy test.
D. Pap smear.
Answer: A. Coagulation studies.
Significant heavy menstrual bleeding in an adolescent should prompt consideration of an underlying bleeding disorder, particularly when anemia is present.
A 14-year-old female has menometrorrhagia with moderately increased menstrual flow and irregular periods. Her hemoglobin level is 13.1 g/dL. How should this condition be managed?
A. Iron supplementation and prostaglandin inhibitors.
B. Blood transfusion.
C. Hysterectomy.
D. Antibiotics.
Answer: A. Iron supplementation and prostaglandin inhibitors.
Conservative treatment can help reduce menstrual blood loss and manage symptoms when the adolescent is hemodynamically stable.
A sexually active adolescent female tests positive for Neisseria gonorrhoeae and Chlamydia trachomatis. She wants treatment immediately because she is moving away the next day. What should the nurse practitioner prescribe?
A. Doxycycline only.
B. Ceftriaxone 250 mg IM and azithromycin 1 g PO one time each.
C. Ceftriaxone only.
D. Metronidazole only.
Answer: B. Ceftriaxone 250 mg IM and azithromycin 1 g PO one time each.
The listed regimen reflects the treatment approach represented in this question. Current STI treatment recommendations should be checked against the latest CDC guidelines because recommended doses and preferred regimens can change over time.
A 16-year-old sexually active female presents with fever, bilateral lower abdominal pain, and malaise. Pelvic examination reveals adnexal tenderness. Urinalysis is normal, and cervical cultures are pending. What medications should the nurse practitioner prescribe?
A. Azithromycin only.
B. Ceftriaxone only.
C. Ceftriaxone, doxycycline, and metronidazole.
D. Metronidazole only.
Answer: C. Ceftriaxone, doxycycline, and metronidazole.
The clinical presentation is concerning for pelvic inflammatory disease (PID), for which empiric broad-spectrum treatment is generally initiated when clinical criteria are met rather than waiting for cervical culture results.
