Test 2 Practice Questions

If a child with thalassemia major is not treated, death will most likely occur by which of the following ages?

5-6

The primary care pediatric nurse practitioner is prescribing contraception for an adolescent who has not used birth control previously. The adolescent has a normal exam and has no family history of cardiovascular and peripheral vascular disease or diabetes. Which preparation is used initially?

A combination oral contraceptive pills (OCP) with 30 to 35 mcg of estrogen and low progestin.

A nurse has admitted a child to the hospital with a diagnosis of rule out peptic ulcer disease. Which test will the nurse expect to be ordered to confirm the diagnosis of a peptic ulcer?

A fiberoptic upper endoscopy Endoscopy provides direct visualization of the stomach lining and confirms the diagnosis of peptic ulcer.

A nurse is planning care for a child admitted with nephrotic syndrome. Which interventions should be included in the plan of care? Select all that apply. A. Administration of antihypertensive medications B. Daily weights C. Salt-restricted diet D. Frequent position changes E. Teaching parents to expect tea-colored urine

B, C, D

A 9-month-old infant has developed two teeth since the 6-month checkup. The local water supply contains fluoride. What will the primary care pediatric nurse practitioner do to promote healthy dentition at this visit?

Apply sodium fluoride varnish to the infant's teeth. The U.S. Preventive Task Force has issued two recommendations for preventing caries in children, including: 1) primary providers apply sodium fluoride varnish to the primary teeth of all infants and children beginning at the onset of the first tooth, and 2) establishment of a dental home by age 12 months, or 6 months after the eruption of the first primary tooth. Oral fluoride supplementation is only given when local water supplies are fluoride deficient.

The parent of a 4 month old infant is concerned that the infant cannot hear. Which test will the primary care pediatric nurse practitioner order to evaluate potential hearing loss in this infant?

Auditory brainstem response (ABR)

A child who has been taking antibiotics is brought to the clinic with a rash. The parent reports that the child had a fever associated with what looked like sunburn and now has "blisters" all over. A physical examination shows coalescent target lesions and widespread bullae and areas of peeled skin revealing moist, red surfaces. What will the primary care pediatric nurse practitioner do?

Consult with a pediatric intensivist for admission to a pediatric intensive care unit. The child's symptoms, including a fever, a rash that resembles a sunburn, blisters, coalescent target lesions, widespread bullae, and areas of peeled skin revealing moist, red surfaces, are indicative of a severe skin reaction known as toxic epidermal necrolysis (TEN). TEN is a potentially life-threatening dermatological condition that is often caused by a reaction to medications, such as antibiotics. It involves the detachment of the top layer of skin (the epidermis) from the lower layers of the skin (the dermis) all over the body. Immediate medical attention is required to manage the condition and prevent complications, which can include infections and organ damage.

A parent asks about ways to promote dental health in school age children while on a family vacation that are convenient while camping and picnicking. What will the pediatric nurse practitioner recommend?

Offering gum containing xylitol after meals Xylitol keeps the bacteria from adhering to teeth which decreases plaque.

A toddler is seen in the clinic after a 2 day history of intermittent vomiting and diarrhea. An assessment reveals an irritable child with dry mucous membranes, 3 second capillary refill, 2 second recoil of skin, mild tachycardia and tachypnea, and cool hands and feet. The child has had two wet diapers in the past 24 hours. What will the primary care pediatric nurse practitioner recommend?

Oral rehydration solution with followup in 24 hours This child has mild to moderate dehydration, according to vital signs and symptoms, and may be managed with oral rehydration solution with good follow-up. Anti-diarrheal medications are generally not useful, but antiemetics may be used. It is not necessary to administer IV fluids or to hospitalize unless more severe dehydration occurs.

A previously healthy school-age child develops herpes zoster on the lower back. What will the primary care pediatric nurse practitioner do to manage this condition? A. Order Burow solution and warm soothing baths as comfort measures. B. Prescribe oral acyclovir 30 mg/kg/day in 4 doses/day for 5 days. C. Recommend topical antihistamines to control itching. D. Stress the need to remain home from school until the lesions are gone.

Order Burow solution and warm soothing baths as comfort measures Burow solution is a liquid made of aluminum acetate and water that can be used to treat a variety of skin conditions, including herpes zoster (shingles). Best if applied three times a day as compresses. NOTE: Acyclovir can slow the growth and spread of the virus, but the recommended dose is (20mg/kg) 4 times a day for 5 days, NOT 30mg/kg. Also, it must be started in the first 3 days.

A 16 year old female reports breast tenderness and a "lump." The primary care pediatric nurse practitioner palpates a small fluid filled mass in her right breast. A pregnancy test is negative. Which action is correct?

Order an ultrasound of the mass.

A 3 year old child with pressure equalizing tubes (PET) in both ears has otalgia in .one ear. The primary care pediatric nurse practitioner is able to visualize the tube and does not see exudate in the ear canal and obtains a type A tympanogram. What will the nurse practitioner do?

Order ototopical antibiotic/corticosteroid drops. Ototopical antibiotic/corticosteroid drops are often the first line of treatment in such cases. These drops can help to reduce inflammation and treat any potential infection directly at the site, providing relief from symptoms.

What will the primary care pediatric nurse practitioner teach the parents of a child who has new pressure equalizing tubes (PET) in both ears?

Parents should notice improved hearing in their child.

A toddler exhibits exotropia of the right eye during a cover-uncover screen. The primary care pediatric nurse practitioner will refer to a pediatric ophthalmologist to initiate which treatment?

Patching of the unaffected eye for 2 hours each day Exotropia is a form of strabismus where the eyes are deviated outward. In this case, the toddler's right eye is deviating. One common treatment for this condition is patching the unaffected eye. This forces the child to use the affected eye, which helps to strengthen the eye muscles and improve eye coordination. The patch is typically worn for a few hours each day.

A 17 year old sexually active female who began having periods at age 14 reports having moderate to severe dull lower abdominal pain associated predominantly with periods but that occurs at other times as well. The history reveals a recent onset of these symptoms. A pregnancy test is negative. Which course of action is most important?

Perform a full diagnostic workup to evaluate potential causes.

An African American child has recurrent tinea capitis (fungal infection of the scalp) and has just developed a new area of alopecia after successful treatment several months prior. When prescribing treatment with griseofulvin and selenium shampoo, what else will the primary care pediatric nurse practitioner do?

Perform fungal cultures on family members and pets.

The primary care pediatric nurse practitioner notes velvety, brown thickening .of skin in the axillae, groin, and neck folds of an adolescent Hispanic female who is overweight. What is the initial step in managing this condition?

Performing metabolic laboratory tests

An 8 year old child is diagnosed with systemic lupus erythematosus (SLE), and the child's parent asks if there is a cure. What will the primary care pediatric nurse practitioner tell the parent?

Periods of remission may occur but there is no permanent cure.

A 3 year old child has head lice. What will the initial treatment recommendation be to treat this child?

Permethrin

A 9 month old infant has vesiculo pustular lesions on the palms and soles, on the face and neck, and in skin folds of the extremities. The primary care pediatric nurse practitioner notes linear and S-shaped burrow lesions on the parent's hands and wrists. What is the treatment for this rash for this infant?

Permethrin 5% cream applied to face, neck, and body and rinsed off in 8 to 14 hours Scabies

A child has several circular, scaly lesions on the arms and abdomen, some of which have central clearing. The primary care pediatric nurse practitioner notes a smaller, scaly lesion on the child's scalp. How will the nurse practitioner treat this child?

Prescribe oral griseofulvin for 2 to 4 weeks. Griseofulvin is used to treat infections such as ringworm, athlete's foot, jock itch, and fungal infections of the scalp, fingernails, or toenails

A preschool age child who attends day care has a 2 day history of matted eyelids in the morning and burning and itching of the eyes. The primary care pediatric nurse practitioner notes yellow-green purulent discharge from both eyes, conjunctival erythema, and mild URI symptoms. Which action is correct?

Prescribe topical antibiotic drops.

An adolescent who recently spent time in a hot tub while on vacation has discrete, erythematous 1 to 2mm papules that are centered around hair follicles on the thighs, upper arms, and buttocks. How will the primary care pediatric nurse practitioner manage this condition?

Prescribe topical keratolytics and topical antibiotics. Hot-tub folliculitis. Warm compresses after washing with soap and water several times a day• Topical keratolytics, such as benzoyl peroxide 5% to 10% twice a day for 5 days, especially if chronic or recurrent• Topical antibiotic, such as erythromycin or clindamycin, in cream, gel, solution, or ointment twice a day for 10 to 14 days for superficial folliculitis

When changing an infants diaper, the nurse notices small bright red papules with satellite lesions on the perineum, anterior thigh, and lower abdomen. This rash is characteristic of

Primary candidiasis

A 16 year old female reports dull, achy cramping pain in her lower abdomen lasting 2 or 3 hours that occurs between her menstrual periods each month. The adolescent is not sexually active. What is the treatment for this condition?

Prostaglandin inhibitor analgesics (NSAIDs) and a heating pad. The treatment for mittelschmerz is typically symptomatic.

What needs to be included as essential teaching for adolescents with systemic lupus erythematosus (SLE)?

Protection from sun and fluorescent lights to minimize rash

A school-age child has a rash without fever or preceding symptoms. Physical examination reveals a 3cm ovoid, erythematous lesion on the trunk with a finely scaled elevated border, along with generalized macular, ovoid lesions appearing in a "Christmas tree" pattern on the child's back. What is the initial action?

Reassure the child's parents that the rash is benign and self-limited. Pityriasis Rosea. This condition often starts with a single, large pink patch found on the trunk of the body, known as a "herald patch". After a few days to weeks, more skin rashes will appear on the body, often in a "Christmas tree" pattern.

During a well child exam, the primary care pediatric nurse practitioner notes yellowish white serpentine bordered lesions on the anterior portion of a child's tongue. What will the nurse practitioner do?

Reassure the parent that these are benign lesions. "geographic tongue"

A child has small, firm, flesh colored papules in both axillae which are mildly pruritic. What is an acceptable initial approach to managing this condition?

Reassuring the parents that these are benign and may disappear spontaneously. Molluscum

A young adolescent reports chest pain associated with coughing and lifting. Physical examination reveals tenderness over several ribs, radiating to the back. Auscultation of the heart, lungs, and abdomen are normal. There is no history of injury. What will the primary care pediatric nurse practitioner do?

Recommend NSAIDs, stretching exercises, and ice packs to the area. costochondritis

An adolescent female reports facial pain and frequent popping of her jaw. An exam reveals unilateral tender facial muscles and a deviation of the mandible to the affected side with opening of the mouth. What will the primary care pediatric nurse practitioner do?

Recommend ice packs, NSAIDs, and a soft diet. TMJ is a biopsychosocial problem. Conservative treatment should always be the first course of treatment, so ice, NSAIDs, and dietary changes should be recommended to minimize discomfort. If conservative measures are not effective, children should be referred to a team of dentists and psychologists to manage the problem. Surgical intervention is not recommended. Botox injections are being studied but currently are not FDA approved.

A 9-month-old 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?

Refer immediately to a pediatric surgeon. A scrotal mass that is difficult to reduce or is painful is likely to be a hernia. Immediate referral is indicated to rule out incarceration, which is a medical emergency with potentially severe consequences if not promptly treated. The referral must be immediate, since surgery is required. A child with a non-tender, reducible hernia will require referral, but parents can be taught signs of incarceration until an appointment can be scheduled and the specialist seen.

An adolescent male comes to the clinic reporting unilateral scrotal pain, nausea, and vomiting that began that morning. The primary care pediatric nurse practitioner palpates a painful, swollen testis and elicits increased pain with slight elevation of the testis (a negative Phren's sign). What will the nurse practitioner do?

Refer the adolescent immediately to a pediatric urologist or surgeon. These symptoms are indicative of testicular torsion. Testicular torsion causes a sudden onset of unilateral pain and is distinguished from epididymitis when elevation of the scrotum causes an increase in pain (Phren's sign). It is a surgical emergency and should warrant immediate referral. -Epididymitis is caused by infection and requires antibiotics, bed rest, scrotal support, and ice packs. -Testicular appendix torsion is self-limited and can be managed with NSAIDs, bed rest or limited activities, and warm compresses.

A child diagnosed with Group A beta-hemolytic streptococci (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?

Refer the child to a pediatric nephrologist for hospitalization. This child has symptoms of glomerulonephritis and the symptoms indicate a need for hospitalization: elevated BP, edema, and dyspnea. The condition usually does self-resolve, but the child needs hospitalization for close monitoring and follow-up. Diuretics and antihypertensive are usually needed. Weight check and restriction of fluids needed.

The primary care pediatric nurse practitioner notes a small, round object in a child's external auditory canal, near the tympanic membrane. The child's parent thinks it is probably a dried pea. What will the nurse practitioner do to remove this object?

Refer the child to an otolaryngologist for removal.

The primary care pediatric nurse practitioner performs a vision screen on a 4-month-old infant and notes the presence of convergence and accommodation with mild esotropia of the left eye. What will the nurse practitioner do?

Refer the infant to a pediatric ophthalmologist. Untreated esotropia can lead to other complications, such as lazy eye (amblyopia).

A 6-month-old infant has a retractile testis that was noted at the 2-month well baby exam. What will the primary care pediatric nurse practitioner do to manage this condition?

Refer the infant to a pediatric urologist or surgeon for possible orchiopexy. A retractile testis that does not retain scrotal residence should be referred to a pediatricurologist or surgeon by 6 months of age for consideration of an orchiopexy (a surgery to move the testes into the scrotum)

A 9-year-old girl has a history of frequent vomiting and her mother has frequent migraine headaches. The child has recently begun having more frequent and prolonged episodes accompanied by headaches. An exam reveals abnormal eye movements and mild ataxia. What is the correct action?

Refer to a pediatric gastroenterologist for further workup. This child has an abnormal neurologic examination, which is a red flag warranting referral for further workup for children with cyclic vomiting syndrome. Anti-migraine medications are used in children over age 12 years and therefore should not be used for this patient. Ondansetron and lorazepam may be useful for unrelenting nausea and poor sleep, but this child needs to be referred to evaluate neurologic symptoms. These signs are not expected.

A parent is oncerned that a 12-month-old is bow-legged. A PE reveals internal tibial torsion bilaterally. A x-ray reveals asymmetric bowing of the legs with an angle > 15 degrees. What is the correct action for the PCP?

Refer to a pediatric orthopedic specialist for treatment.

The primary care pediatric nurse practitioner is treating an infant with lacrimal duct obstruction who has developed bacterial conjunctivitis. After 2 weeks of treatment with topical antibiotics along with massage and frequent cleansing of secretions, the infant's symptoms have not improved. Which action is correct?

Refer to an ophthalmologist.

A school-age child has a 3-month history of dull, aching epigastric pain that worsens with eating and awakens the child from sleep. A complete blood count shows a hemoglobin of 8 mg/dL. What is the next step in management?

Referral for esophagogastroduodenoscopy (EGD) EGD is the procedure of choice in children for detecting PUD because it allows direct visualization of mucosa, localization of the source of bleeding, and collection of tissue specimens. Empiric therapy for HP is not recommended due to increased antibiotic resistance, but once PUD is diagnosed, H2RA or PPI medications are first-line drugs.

The mother of an infant with multiple anomalies tells the nurse that she had a viral infection in the beginning of her pregnancy. Which viral infection is associated with fetal anomalies?

Rubella

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. Reassure the child's parents that the child does not have a urinary tract infection. d. Send the urine to the lab for culture.

Send the urine to the lab for culture. urine in the bladder less than 4 hours may be tested as negative for leukocyte esterase

A school-age child has recurrent diarrhea with foul-smelling stools, excessive flatus, abdominal distension, and failure-to-thrive. A 2-week lactose-free trial failed to reduce symptoms. What is the next step in diagnosing this condition?

Serologic testing for celiac disease This child has symptoms consistent with celiac disease, especially FTT and foul-smelling stools.

The PCP elicits positive ortolani and barlow signs in a 6-month-old infant not previously noted in the medical record. What is the correct treatment?

Surgical intervention

_________________________ is a chronic, multisystem, autoimmune disease characterized by inflammation of the connective tissue.

Systemic lupus erythematosus SLE varies in severity and is marked by remission and exacerbations. Although the etiology is unknown, genetic, hormonal, environmental, and immune response factors are likely to be responsible.

The nurse observes a red butterfly-shaped rash that spreads across the childs cheeks and nose. This assessment finding is characteristic of which condition?

Systemic lupus erythematosus (SLE)

An adolescent is diagnosed with functional abdominal pain (FAP). The child's symptoms worsen during stressful events, especially with school anxiety. What will be an important part of treatment for this child?

Teaching about the brain-gut interaction causing symptoms

The nurse is teaching the parents of a child who had surgery for cryptorchidism. At what age would the nurse recommend that the child begin to perform monthly testicular self-exams?

Teaching the parents of a child who had surgery for cryptorchidism, the nurse would recommend that the child begin to perform monthly testicular self-exams once he reaches puberty.

During a well child exam on a 4-year-old child, the primary care pediatric nurse practitioner notes that the clinic nurse recorded "20/50" for the child's vision and noted that the child had difficulty cooperating with the exam. What will the nurse practitioner recommend?

Test the child's vision in 1 month.

What should the nurse teach a school-age child and his parents about the management of ulcer disease?

The diet should be a regular diet that is low in caffeine, and the child should eat a meal or snack every 2 to 3 hours, and do not give antacids 1 hour before or after antiulcer medications, as they can interfere with the meds.

What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux?

The importance of taking prophylactic antibiotics

Which statement is true regarding how infants acquire immunity?

The infant acquires humoral and cell-mediated immunity in response to infections and immunizations.

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?

There is a metaphyseal fragment on the compression side of fracture. - types I and II rarely show growth disturbances - Type V have a compression or crushing injury to the physis

The primary care pediatric nurse practitioner applies fluorescein stain to a child's eye. When examining the eye with a cobalt blue filter light, the entire cornea appears cloudy. What does this indicate?

There is too much stain on the cornea.

Parents ask the nurse to explain what it means then the pediatrician says that their childs vesicoureteral reflux is a grade I. Which of the following is the nurses best response to explain the significance of the grade?

This grade of reflux is most likely to resolve spontaneously.

How should the nurse respond when asked by the mother of a child with beta-thalassemia why the child is receiving deferoxamine?

To eliminate excessive iron being stored in the organs. Multiple transfusions result in hemosiderosis. Deferoxamine is given to chelate iron and prevent organ damage.

What will the primary care pediatric nurse practitioner teach the parent of an infant about cleaning the child's teeth?

To use a smear of toothpaste and not to rinse the mouth

A school age child has had herpes stomatitis for a week and continues to complain of pain. What will the primary care pediatric nurse practitioner recommend?

Topical application of diphenhydramine and Maalox

A child has an area of inflammation on the neck that began after wearing a hand knot woolen sweater. On examination, the skin appears chafed with mild erythematous patches. The lesions are not pruritic. What is an appropriate initial treatment?

Topical corticosteroids applied 2 to 3 times daily Contact Dermatitis

A 4 year old child has clusters of small, clear, tense vesicles with an erythematous base on one side of the mouth along the vermillion border, which are causing discomfort and difficulty eating. What will the primary care pediatric nurse practitioner recommend as treatment?

Topical diphenhydramine and magnesium hydroxide (Mag hydroxide is the same as maalox, just a different type of antacid) Used to treat Aphthous Ulcer, stomatitis, etc. Magic Mouthwash

An adolescent has acne characterized by papules and pustules mostly on the forehead and chin. What will the primary care pediatric nurse practitioner prescribe?

Topical erythromycin with benzoyl peroxide

An infant is brought to clinic with bright erythema in the neck and flexural folds after recent treatment with antibiotics for otitis media. What is the treatment for this condition?

Topical nystatin cream (antifungal) applied several times daily

A school age child has several annular lesions on the abdomen characterized by central clearing with scaly, red borders. What is the first step in managing this condition?

Treat empirically with antifungal cream. tinea corporis (ringworm)

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?

Treat with antibiotics for urinary tract infection. If children are symptomatic and have more than 10,000 colonies of a single pathogen, they are considered to have a UTI and are treated. NOTE: Anything under 10,000 is considered normal. Anything over 10,000 should be considered uti when symptomatic!!!

The primary care pediatric nurse practitioner is reviewing the rheumatology planof care for a child who is diagnosed with SLE. Besides reinforcing information about prescribed medications, what will the nurse practitioner teach the family tohelp minimize flaring of episodes?

Use UVA and UVB sunscreen daily.

4 year old female who has had two urinary tract infections has persistent dysuria and genital redness. The physical exam reveals a thin, flat membrane from the posterior fourchette almost to the clitoris. Which treatment is indicated?

Use of estrogen-containing cream The symptoms and physical exam findings suggest labial adhesions or labial fusion. This condition is common in prepubertal girls and can lead to symptoms such as urinary tract infections, dysuria (painful urination), and genital redness.

A toddler who was born prematurely refuses most solid foods and has poor weight gain. A barium swallow study reveals a normal esophagus. What will the primary care pediatric nurse practitioner consider next to manage this child's nutritional needs?

Videofluoroscopy swallowing study A videofluoroscopy is also known as a modified barium swallow and is a swallowing study that evaluates other possible structural defects that may interfere with swallowing.

An adolescent female has grouped vesicles on her oral mucosa. To determine whether these are caused by HSV1or HSV2, the primary care pediatric nurse practitioner will order which test?

Viral Culture

The primary care pediatric nurse practitioner observes a tender, swollen red furuncle on the upper lid margin of a child's eye. What treatment will the nurse practitioner recommend?

Warm, moist compresses 3 to 4 times daily (STYE)

A healthy 14-year-old female has a dipstick urinalysis that is positive for 5-6 RBCs per hpf but otherwise normal. What is the first question the primary care pediatric nurse practitioner will ask this patient?

When was your last menstrual period (LMP)?"

A child has gross hematuria, abdominal pain, and arthralgia as well as a rash. What diagnosis is most likely? a. Henoch-Schönlein purpura b. Rhabdomyosarcoma c. Sickle cell disease d. Systemic lupus erythematosus

a. Henoch-Schönlein purpura HSP may presents with gross hematuria in the presence of abdominal pain with or without bloody stools, arthralgias, and a purpuric rash. Rhabdomyosarcoma is characterized by gross hematuria and voiding dysfunction. Sickle cell disease can cause gross hematuria but not always.

An 18-month-old child has horizontal, bright white lines along the upper gum line of the teeth. What is the most important question the primary care pediatric nurse practitioner will ask the child's parents?

a. If the child is still drinking milk from a bottle Horizontal, bright white lines along the gum line are commonly seen in children still drinking from bottles and are early caries lesions.

An adolescent has 2+ proteinuria in a random dipstick urinalysis. A subsequent first-morning voided specimen is negative. What will the primary care pediatric nurse practitioner do to manage this condition? a. Monitor for proteinuria at each annual well child examination. b. Order a 24-hour timed urine collection for creatinine and protein excretion. c. Reassure the parents that this is a benign condition with no follow-up needed. d. Refer the child to a pediatric nephrologist for further evaluation.

a. Monitor for proteinuria at each annual well child examination. Orthostatic proteinuria is common in adolescents and is demonstrated by proteinuria of greater than 1+ with activity and low-protein to normal urine on a first-morning void. A 24-hour urine collection is not indicated unless the first-morning void is elevated. Although the orthostatic proteinuria is mostly benign, annual monitoring is recommended.

A 3-year-old child 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. Children with recurrent UTI should have a renal and bladder US to assess for hydronephrosis,scarring, or other atypical findings. If the US is concerning, VCUG and/or DMSA screen maybe performed.

A child who plays soccer is in the clinic reporting pain and swelling in both knees. A PE 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 - Osgood-Schlatter disease

During a well baby exam of a newborn, the PCP notes adduction of the right forefoot, with normal position of the mid-and hind-foot along with a convex-shaped lateral border of the foot. What will the PCP do to evaluate this deformity?

a. grasp the heel with one hand and abduct the forefoot with the other hand - metatarsus adductus - rigid requires ortho treatment - If the forefoot can be brought past the midline with the heel held in place, it is not considered to be a rigid deformity

A 14-year-old overweight boy 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 the child's condition?

a. place the child on crutches or in a wheelchair to prevent weight bearing slipped capital femoral epiphysis

The primary care pediatric nurse practitioner performs a Hirschberg test to evaluate

ocular alignment The Hirschberg test, also known as the corneal light reflex test, is a screening method used in the field of optometry and ophthalmology to check for strabismus, or misalignment of the eyes.

The narrowing of preputial opening of foreskin is called

phimosis

When prescribing topical glucocorticoids to treat inflammatory skin conditions, the primary care pediatric nurse practitioner will

prescribe brandname preparations for consistent effects.

Which diagnostic finding is present when a child has primary nephrotic syndrome?

proteinuria

During a well child assessment of an African-American infant, the primary care pediatric nurse practitioner notes a dark red-brown light reflex in the left eye and a slightly brighter, red-orange light reflex in the right eye. The nurse practitioner will

refer the infant to an ophthalmologist.

The parents ask the nurse if there is anything that can be done to reduce or eliminate the need for transfusions every 2 to 3 weeks for their child who has thalassemia. Which one of the following treatments will the nurse report as one that will decrease the childs need for frequent transfusions?

splenectomy or bone marrow transplantation The goals of both of these interventions is to introduce healthy stem cells into the marrow so normal RBCs and hemoglobin production will occur.

The nurse assessing a child with acute poststreptococcal glomerulonephritis should be alert for which finding?

tea colored urine

The parents of a formula fed newborn reports that they get their drinking water from a well. What will the primary care pediatric nurse practitioner recommend to provide adequate fluoride for this infant?

testing the fluoride level of their water source

What should the nurse expect to observe in the prodromal phase of rubeola?

Koplik spots They appear approximately 2 days before the appearance of a rash.

A 2-year-old child has an acute diarrheal illness. The child is afebrile and, with oral rehydration measures, has remained well hydrated. The parent asks what can be done to help shorten the course of this illness. What will the primary care pediatric nurse practitioner recommend?

Lactobacillus (Probiotic) Lactobacillus, given early in a viral diarrheal illness, can decrease the duration of diarrhea by about 25 hours and is safe to use in children. Parents should begin refeeding early to stimulate enterocyte growth and help facilitate mucosal repair. Loperamide may be given to children over the age of 3 years. Peppermint oil may help reduce cramping, but its efficacy is not certain.

An adolescent female has periods every 30 days that are consistently heavy and last from 5 to 8 days. What is her diagnosis?

Menorrhagia

A child who was treated with amoxicillin and then amoxicillin clavulanate for acute otitis media is seen for a follow-up. The primary care pediatric nurse practitioner notes dull gray tympanic membranes with a visible air-fluid level. The child is afebrile and without pain. What is the next course of action?

Monitoring ear fluid levels for 3 months

The primary care pediatric nurse practitioner obtains a tympanogram on a child that reveals a sharp peak of 180mm H2O. What does this value indicate?

Negative ear pressure A tympanogram is a graphical representation of the compliance of the middle ear as a function of air pressure. In a normal ear, the tympanic membrane (eardrum) should move easily when the air pressure in the ear canal is changed. This would be represented by a peak in the positive range.

Impetigo ordinarily results in

No scarring Impetigo tends to heal without scarring unless a secondary infection occurs.

A school age female has had vulvovaginitis for 2 months. All cultures and tests are negative, but the symptoms persist after treatment with both topical antibiotics and oral amoxicillin. What is the next course of action to treat this condition?

A. Estrogen cream at bedtime for 2 to 3 weeks. Vulvovaginitis is inflammation of the vulva and vagina. It's the most common gynecologic problem in prepubertal girls and can be caused by a variety of factors, including poor hygiene, irritants, foreign bodies, and in rare cases, sexual abuse. In this case, the girl has been treated with both topical antibiotics and oral amoxicillin, but her symptoms persist and all cultures and tests are negative. This suggests that the vulvovaginitis may not be due to a bacterial infection, but rather to estrogen deficiency. Applying a topical estrogen cream can help to thicken the mucosa and alleviate the symptoms of vulvovaginitis. The cream is typically applied at bedtime for 2 to 3 weeks. If the symptoms persist after this treatment, further evaluation may be needed.

An adolescent female tells the primary care pediatric nurse practitioner that she had unprotected sexual intercourse 4 days prior and is worried she might become pregnant. What will the nurse practitioner do?

A. Prescribe ulipristal acetate (Ella). this can be taken within 120 hrs (5 days of unprotected sex) best results ASAP

The primary care pediatric nurse practitioner performs a well baby assessment of a 5 day old infant and notes mild conjunctivitis, corneal opacity, and serosanguinous discharge in the right eye. Which course of action is correct?

Admit the infant to the hospital immediately. could indicate a severe infection or other eye condition that requires immediate medical attention

A preschool-age child who woke up with a temperature of 102.2°F, swelling, erythema of one upper lid, and moderate pain when looking from side to side is seen in the clinic. Which course of treatment is correct?

Admit to the hospital for intravenous antibiotics. The child's symptoms of high fever, swelling and erythema of the upper lid of one eye, and moderate pain when looking from side to side suggest a severe infection that could potentially be orbital cellulitis, a serious infection of the tissues around the eye. This condition requires immediate medical attention and is typically treated with intravenous antibiotics in a hospital setting.

A preschool age child has honey crusted lesions on erythematous, eroded skin around the nose and mouth, with satellite lesions on the arms and legs. The child's parent has several similar lesions and reports that other children in the day care have a similar rash. How will this be treated?

Amoxicillin clavulanate 90 mg/kg/day for 10 days Amoxicillin-clavulanate can be used for severe cases or widespread impetigo. Mupiricin would be the first line therapy for un-complicated and non-widespread impetigo.

A 3 year old child has had one episode of acute otitis media 3 weeks prior with a normal tympanogram just after treatment with amoxicillin. In the clinic today, the child has a type B tympanogram, a temperature of 102.5°F, and a bulging tympanic membrane. What will the primary care pediatric nurse practitioner order?

Amoxicillin clavulanate twice daily

An 18 month old child with no previous history of otitis media awoke during the night with right ear pain. The primary care pediatric nurse practitioner notes an axillary temperature of 100.5°F and an erythematous, bulging tympanic membrane. A tympanogram reveals of peak of +150 mm H2O. What is the recommended treatment for this child?

An analgesic medication and watchful waiting The child's symptoms - ear pain, fever, and an erythematous, bulging tympanic membrane - are indicative of an acute otitis media (AOM), which is an infection of the middle ear. The tympanogram peak of +150 mm H2O suggests that there is no negative pressure in the middle ear, which is consistent with the presence of a middle ear infection. The current recommendation is watchful waiting before prescribing abx's.

Which statement best describes beta-thalassemia major (Cooley anemia)?

An overproduction of red cells occurs. Although numerous, the red cells are relatively unstable. Individuals who live near the Mediterranean Sea and their descendants have the highest incidence of thalassemia.

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?

Answer: Iron supplementation and prostaglandin inhibitors (NSAIDs). Note: while her hemoglobin is normal today, she should be treated with iron due to the irregular and excessive bleeding that accompanies this disorder. Description: menometrorrhagia is abnormal uterine bleeding, that causes irregular and excessive uterine bleeding. It's a combination of two other menstrual disorders: menorrhagia, which is heavy bleeding during a period, and metrorrhagia, which is when a period lasts longer than seven days or there's spotting between periods.

A 10-year-old child has had abdominal pain for 2 days, which began in the periumbilical area and then localized to the right lower quadrant. The child vomited once today and then experienced relief from pain followed by an increased fever. What is the likely diagnosis?

Appendicitis with perforation

A child is diagnosed with tinea versicolor. What is the correct management of this disorder?

Application of selenium sulfide 2.5% lotion twice weekly for 2 to 4 weeks. Selenium sulfide 2.5% lotion or 1% shampoo (over the counter) applied in a thin layer several hand-widths beyond lesions for 30 minutes twice a week for 2 to 4 weeks followed by monthly applications for 3 months to help prevent recurrences.Older adolescents can use ketoconazole 2% shampoo

A child will need an occlusive dressing to treat lichen simplex chronicus. What will the primary care pediatric nurse practitioner tell the parents about applying this treatment?

Apply ointment before the dressing. (LSC) is a localized, well-circumscribed area of thickened skin (lichenification) resulting from repeated rubbing, itching, and scratching of the skin

An adolescent has localized bleeding of the gums when brushing the teeth. An exam of the mouth reveals the presence of plaque and calculus on the teeth, which are not loose. What will the primary care pediatric nurse practitioner recommend?

Consistently brushing and flossing the teeth twice daily

Which assessment finding should the nurse expect in an infant with Hirschsprung disease?

Constipation with passage of foul-smelling, ribbon-like stools

A school-age child has a history of chronic otitis media and is seen in the clinic with vertigo. The primary care pediatric nurse practitioner notes profuse purulent otorrhea from both pressure equalizing tubes and a pearly white lesion on one tympanic membrane. Which condition is most likely?

Cholesteatoma A cholesteatoma is a skin growth that occurs in an abnormal location, the middle ear behind the eardrum. It is usually caused by repeated infection that causes an ingrowth of the skin of the eardrum. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear, leading to hearing loss.

An 8yearoldboy has a recent history of an upper respiratory infection andcomes to the clinic with a maculopapular rash on his lower extremities and swelling and tenderness inboth ankles. The pediatric nurse practitioner performs a UA, which shows proteinuriaand hematuria and diagnoses HSP. What ongoing evaluation will the nurse practitioner performduring the course of this disease?

BP management

The management of a child who has just been stung by a bee or wasp should include the application of

Bee or wasp stings are initially treated by carefully removing the stinger, cleansing with soap and water, application of cool compresses, and the use of common household agents such as lemon juice or a paste made with aspirin and baking soda.

The parent of a 3-month-old reports that the infant arches and gags while feeding and spits up undigested formula frequently. The infant's weight gain has dropped to the 5th percentile from the 12th percentile. What is the best course of treatment for this infant?

Begin a trial of extensively hydrolyzed protein formula for 2 to 4 weeks for tx of GERD. Formula-fed infants may be given a trial of a hydrolyzed protein formula to see ifimprovement occurs. An empiric trial of a PPI may be used in children and adolescents but is not recommended in infants. Esophageal pH monitoring may be performed in consultation with a specialist but not as first-line evaluation. The infant has warning signs of GERD that require further investigation and not just reassurance.

At what age is sexual development in boys and girls considered to be precocious?

Boys, 9 years; girls, 8 years

An adolescent female has heavy periods that are also irregular. The physical exam is normal. A complete blood count reveals a hemoglobin of 8.9 g/dL. What test will the primary care pediatric nurse practitioner order next?

Coagulation studies (blood clotting tests)

A 16 year old sexually active female has a fever, bilateral lower abdominal pain, and malaise. A speculum and bimanual exam reveals adnexal tenderness. The urinalysis is normal and cervical cultures are pending. What medications will the primary care pediatric nurse practitioner prescribe for this patient?

C. Ceftriaxone, doxycycline, and metronidazole The symptoms described in the question suggest that the patient may have pelvic inflammatory disease (PID), a condition often caused by sexually transmitted infections. The recommended treatment for PID includes a combination of antibiotics to cover the most common causative organisms, which are Chlamydia trachomatis and Neisseria gonorrhoeae. Ceftriaxone is effective against Neisseria gonorrhoeae, while doxycycline covers Chlamydia trachomatis. Metronidazole is added to the regimen to cover anaerobic bacteria that can be associated with PID.

A school-age child has had abdominal pain for 3 months that occurs once or twice weekly and is associated with a headache and occasional difficulty sleeping, often causing the child to stay home from school. The child does not have vomiting or diarrhea and is gaining weight normally. The physical exam is normal. According to Bishop, what is included in the initial diagnostic work-up for this child?

CBC, ESR, amylase, lipase, UA, and abdominal ultrasound Bishop suggests these labs as an initial approach in children suspected of having functional abdominal pain, along with a 3-day trial of a lactose-free diet.

A sexually active adolescent female tests positive for N. gonorrhoeae and C. trachomatis. She tells the primary care pediatric nurse practitioner that she wants to be treated today since she is moving out of town the next day. What will the nurse practitioner order?

Ceftriaxone 250 mg IM and azithromycin 1 g PO one time each

During a well-baby assessment on a 1-week-old infant who had a normal exam when discharged from the newborn nursery 2 days prior, the primary care pediatric nurse practitioner notes moderate eyelid swelling, bulbar conjunctival injections, and moderate amounts of thick, purulent discharge. What is the likely diagnosis?

Chlamydia trachomatis

A child has several shallow mucosal lesions on the buccal mucosa and tongue that are surrounded by an erythematous halo and covered by yellow plaques. What will the primary care pediatric nurse practitioner recommend?

Chlorhexidine gluconate Chlorhexidine gluconate (antimicrobial) rinses are useful to treat aphthous ulcers (canker sores). They are an antiseptic and disinfectant. They can help with mouth infections, mouth ulcers, and gum disease.

An 18-month-old child has a 1-day history of intermittent, cramping abdominal pain with non-bilious vomiting. The child is observed to scream and draw up his legs during pain episodes and becomes lethargic in between. The primary care pediatric nurse practitioner notes a small amount of bloody, mucous stool in the diaper. What is the most likely diagnosis?

Intussusception Intussusception is characterized by intermittent pain associated with drawing up the legs, "currant jelly" stools, and lethargy in between episodes.

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 10 mg/kg as a single daily dose B. Ceftriaxone IM 50 mg/kg as a single daily dose C. Nitrofurantoin 12mg/kg as a single daily dose D. TMP 2 mg/kg as a single daily dose

D. TMP 2 mg/kg as a single daily dose

An adolescent who had cradle cap as an infant is in the clinic with thick crusts of yellow, greasy scales on the forehead and behind the ears. What will the primary care pediatric nurse practitioner recommend?

Daily application of ketoconazole 2% topical cream Seborrheic dermatitis

A child with cerebral palsy receives all nutrition via gastrostomy tube. What will the primary care pediatric nurse practitioner recommend to promote dental health in this child?

Daily chlorhexidine gluconate rinses Daily chlorhexidine gluconate rinses are recommended for children with special health care needs to promote adequate oral hygiene and prevent caries. They are an antiseptic and disinfectant.

A 15 year old female has a positive pregnancy test and asks the primary care pediatric nurse practitioner not to tell her parents. She is tearful and says she isn't sure she wants to keep the baby. What will the nurse practitioner do first?

Determine the state mandated reporting laws.

A child is brought to the clinic with a generalized, annular rash (ring-like shape that spreads out from the center) characterized by raised wheels (welts) 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?

Diphenhydramine 0.5 to 1 mg/kg/dose every 4 to 6 hours Hives/Urticaria

A child with a history of otitis externa asks about ways to prevent this condition. What will the primary care pediatric nurse practitioner recommend?

Drying the ear canal with a hair dryer

A child is brought to clinic with several bright red lesions on the buttocks. The primary care pediatric nurse practitioner examines the lesions and notes sharp margins and an "orange peel" look and feel. The child is afebrile and does not appear toxic. What is the course of treatment for these lesions?

Initiate empiric antibiotic therapy and follow up in 24 hours to assess response. The child has clinical signs of erysipelas, which is a superficial variant of cellulitis and also a bacterial skin infection caused by strep. Because the child is afebrile and doesn't appear toxic, outpatient antibiotics with 24-hour follow-up can be initiated. If the child does not respond or becomes toxic, hospitalization and IV antibiotics are indicated.

A child who has otitis externa has severe swelling of the external auditory canal that persists after 2 days of therapy with ototopical antibiotic/corticosteroid drops. What is the next step in treatment for this child?

Insert a wick into the external auditory canal.

A 2-month-old infant cries up to 4 hours each day and, according to the parents, is inconsolable during crying episodes with fists and legs noted to be tense and stiff. The infant is breastfeeding frequently but is often fussy during feedings. The physical exam is normal and the infant is gaining weight normally. What will the primary care pediatric nurse practitioner recommend?

Eliminating certain foods from the mother's diet A first step in a breastfeeding infant with symptoms of colic should be to try eliminating certain foods such as cow's milk products, nuts, eggs, and fish from the mother's diet to see if improvement occurs.

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?

Evaluate serum ferritin

A 4 year old child who has had extensive dental surgery to treat dental caries has white spot lesions on the primary teeth. How often should this child receive fluoride varnish applications?

Every 3 to 6 months

What is the most appropriate intervention for the parents of a 6-year-old child with precocious puberty?

Explain the importance of having the child foster relationships with same-age peers.

A 12-month-old infant exhibits poor weight gain after previously normal growth patterns. There is no history of vomiting, diarrhea, or irregular bowel movements, and the physical exam is normal. What is the next step in evaluating these findings?

Feeding and stooling history and 3-day diet history A careful history and physical examination and limited laboratory evaluation are the first steps unless there is reason to think that an organic cause is present

A 4 year old child who has asthma has teeth with smooth, cupped out teeth on the chewing surfaces. Which is the most likely explanation for this finding?

Gastroesophageal reflux Children with asthma have higher rates of GERD, so this is the most likely cause of dental erosion. See picture of "tooth cupping"

What will the primary care pediatric nurse practitioner recommend to the parent of an infant who is teething who asks about comfort measures?

Give the infant a cold teething ring or wet washcloth to chew.

A child is in the clinic after swallowing a metal bead. A radiograph of the GI tract shows a 6 mm cylindrical object in the child's stomach. The child is able to swallow without difficulty and is not experiencing pain. What is the correct course of treatment?

Have the parents watch for the object in the child's stool. not concerning since it is in the stomach and she is without pain and dysphagia

An adolescent has acne with lesions on the cheeks and under the chin. Which distribution is this?

Hormonal

An adolescent has right-sided flank pain without fever. A dipstick urinalysis reveals gross hematuria without signs of infection or bacteriuria, and the primary care pediatric nurse practitioner diagnoses possible nephrolithiasis. What is the initial treatment for this condition?

Increasing fluid intake up to 2 L daily -Nephrolithiasis (bladder stones) -The first line of therapy for all stone types is increasing fluids. . ESWL may be indicated if symptoms worsen and stones are not passed.

A school age child is brought to clinic after a pediculosis capitis infestation (lice) is reported at the child's school. If this child is positive, what will the primary care pediatric nurse practitioner expect to find on physical examination, along with live lice near the scalp?

Itching of the scalp, with skin excoriation on the back of the head

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?

b. "Steroids will be used when relapses occur." Nephrotic syndrome is a kidney disorder characterized by massive loss of protein (albumin) in the urine from damaged glomeruli. Causes edema (periorbital, ascites, and peripherally), weight gain, fatigue, and decreased output. Urine will appear frothy (neFROTHY syndrome) and will show 2+ protein. Low levels of albumin in the blood (bc its being lost in the urine) and high cholesterol. Dx with ultrasound or kidney biopsy. Steroids decrease inflammation, increase urine output, and, reduce amount of protein loss. Diuretics, statins, and 25% albumin also occasionally needed. Fluid and Na restrictions, weight checks, abdominal girth checks, and skin care (very poor skin during these relapses) and protect from infection. The fact that a child is a "steroid responder" indicates that future episodes of treatment will be successful and have positive outcomes. This disease is chronic and not curable. Steroids are not given continuously and are not seen as prophylactic.

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 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. c. Discontinue the steroids and salt restrictions now that improvement has occurred. d. Relax salt restrictions and continue administration of steroids until proteinuria isgone.

b. Continue with steroids and salt restrictions until the urine is negative for protein.

A child is diagnosed with Crohn disease. What are likely complications for this child? a. Cancer of the colon and possible colectomy b. Intestinal obstruction with scarring and strictures c. Intestinal perforation and hemorrhage d. Liver disease and sepsis

b. Intestinal obstruction with scarring and strictures The other answers describe complications of ulcerative colitis. Think: Crohns is similarly spelled as Crowns, which are pointy and would scratch you (scarring)

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.

b. Order amoxicillin clavulanate. These symptoms suggest this young child may have pyelonephritis. Amoxicillin clavulanate may be given to young children with uncomplicated pyelonephritis who are well hydrated with no abdominal pain or vomiting.

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.

b. Prescribe trimethoprim-sulfamethoxazole (TMP) twice daily for 3 to 5 days. Short-term antibiotics of 3 to 5 days may be as effective for treating UTI in non-febrile bladder infections and TMP (Bactrim) is generally a first-line drug in children without history of UTI.

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

b. That surgery to correct the condition is possible Children with grade V VUR generally do not experience spontaneous resolution and will likely have to have surgery to correct the condition.

The mother of a 12-month-old uncircumcised male infant reports that the child seems to have pain associated with voiding. A physical examination reveals a tight, pinpoint opening of the foreskin, which is thickened and inflamed. What will the primary care pediatric nurse practitioner do? a. Attempt to retract the foreskin to visualize the penis. b. Order corticosteroid cream 3 times daily for 4 weeks. c. Refer the child to a pediatric urologist. d. Teach the mother to gently stretch the foreskin with cleaning.

c. Refer the child to a pediatric urologist. The child has symptoms consistent with pathologic phimosis and should be referred for possible circumcision. The foreskin should never be forcefully retracted.

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?

discuss posture and exercise and ask about backpacks and books

What will the PCP elicit when obtaining a positive Barlow maneuver when screening for developmental dysplasia of the hip?

dislocation of an unstable hip

Which of the following best describes the problem of cryptorchidism?

failure of one or both of the testes to descend through the inguinal canal into the scrotum

A 3 year-old child is brought to the clinic by a parent who reports that the child refuses to use the right arm after being swung by both arms while playing. The child is sitting with the right arm held slightly flexed and close to the body. There is no swelling or ecchymosis present. What will the PCP do?

gently attempt a supination and flexion technique - most likely annular ligament displacement injury (nursemaid's elbow)

A school-age child falls off a swing and suffers a closed fracture of the right clavicle. How will this be managed?

immobilization with a sling to support the affected extremity

What food choice by the parent of a 2-year-old child with celiac disease indicates a need for further teaching? Oatmeal Rice cake Corn muffin Meat patty

oatmeal