MN580-FinalGU.1.A 30monthold girl who has beentoilet trained for 6 months has daytime enuresis and dysuriaand a low-grade fever. A dipstick urinalysis isnegative for leukocyte esterase and nitrites. Whatisthenextstep?a.Beginempirictreatmentwithtrimethoprimsulfamethoxazole.b.Discussbehavioralinterventionsfortoilettraining.c.Reassurethechild’sparentsthatthechilddoesnothaveaurinarytractinfection.d.Sendtheurinetothelabforculture.Correct2.Thecleancatchurinespecimenofachildwithdysuria,frequency,andfeverhasacolonycount between 50,000 and100,000 ofE.coli.What is thetreatmentforthischild?a.ObtainacompletebloodcountandCreactiveprotein.b.Performsensitivitytestingbeforetreatingwithantibiotics.c.Repeatthecultureif symptomspersistorworsen.d.Treatwithantibioticsforurinarytractinfection.Correct3.A dipstick urinalysis is positive forleukocyte esterase and nitrites in a school aged child withdysuriaandfoul-smellingurinebutnofever whohasnothadpreviousurinary tractinfections.Acultureispending.What willthe pediatricnurse practitioner do totreatthischild?a.OrderciprofloxacinER oncedaily for3daysifthe cultureispositive.b.Prescribetrimethoprimsulfamethoxazole(TMP)twicedailyfor3to5days.Correctc.Reassurethechild’sparentsthatthisislikelyanasymptomaticbacteriuria.d.Waitforurinecultureresultstodeterminethecorrectcourseoftreatment.4.A child is diagnosed with nephroticsyndrome, and the pediatric nursepractitioner providesprimary care in consultation with a pediatric nephrologist. The child was treated with steroidsand responded well to this treatment. What will the nurse practitioner tell the child’s parentsabout this disease?a.“Futureepisodesarelikelytohaveworseoutcomes.”b.“Steroidswillbeusedwhenrelapsesoccur.”Correctc.“Thisrepresents acurefromthisdisease.”d.“Yourchildwillneedtotakesteroidsindefinitely.5.A child who has nephrotic syndrome is on a steroid and a salt restricteddiet for a relapse ofsymptoms.Adipstick urinalysisshows1+protein,downfrom3+atthe beginning oftheepisode.
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