CPEN Genitourinary and Obstetrical Emergencies — Questions and Answers
Question 1: A 3-year-old boy presents with sudden onset of severe scrotal pain and vomiting. Physical examination reveals an absent cremasteric reflex. What is the priority nursing action?
- Apply warm compresses to reduce pain and swelling
- Obtain a urinalysis and urine culture
- Prepare the patient for emergent surgical consultation (Correct answer)
- Administer oral antibiotics and discharge with follow-up
Correct answer: Prepare the patient for emergent surgical consultation
Absent cremasteric reflex combined with sudden severe scrotal pain is a classic presentation of testicular torsion, a urological emergency. Testicular viability depends on restoring blood flow within 4–6 hours; emergent surgical detorsion is required. Warm compresses and antibiotics are inappropriate and cause dangerous delays.
Question 2: A 6-year-old girl presents with fever, dysuria, and urinary frequency. Urinalysis shows positive leukocyte esterase and nitrites. Which organism is the most common cause of urinary tract infections in pediatric patients?
- Staphylococcus aureus
- Klebsiella pneumoniae
- Escherichia coli (Correct answer)
- Pseudomonas aeruginosa
Correct answer: Escherichia coli
E. coli accounts for approximately 80% of UTIs in children, particularly girls. Its fimbriae allow it to adhere to uroepithelial cells, making it the predominant pathogen. This knowledge guides empiric antibiotic selection while culture results are pending.
Question 3: A 14-year-old sexually active female presents with lower abdominal pain and vaginal discharge. Before pursuing any other diagnosis, the nurse should prioritize ruling out which condition?
- Ovarian cyst
- Pelvic inflammatory disease
- Appendicitis
- Ectopic pregnancy (Correct answer)
Correct answer: Ectopic pregnancy
In any sexually active female of reproductive age with abdominal pain, ectopic pregnancy must be ruled out first because rupture is immediately life-threatening. A urine or serum hCG should be obtained without delay. PID and appendicitis are also in the differential but are not acutely fatal in the same timeframe.
Question 4: An infant presents with a smooth, non-tender flank mass and hematuria. Which condition should the nurse suspect?
- Pyloric stenosis
- Intussusception
- Wilms tumor (nephroblastoma) (Correct answer)
- Neuroblastoma
Correct answer: Wilms tumor (nephroblastoma)
Wilms tumor is the most common renal malignancy in children, typically presenting between ages 3–4 with a smooth, non-tender abdominal mass and hematuria. Neuroblastoma also presents with an abdominal mass but typically crosses the midline and has adrenergic symptoms. Pyloric stenosis and intussusception do not cause flank masses or hematuria.
Question 5: A child presents with massive periorbital and peripheral edema, heavy froth in the urine, and laboratory results showing severe hypoalbuminemia and hyperlipidemia. Which condition does this constellation represent?
- Acute glomerulonephritis
- Nephrotic syndrome (Correct answer)
- Hemolytic uremic syndrome
- Renal tubular acidosis
Correct answer: Nephrotic syndrome
Nephrotic syndrome is defined by the classic tetrad of massive proteinuria (>3.5 g/day), hypoalbuminemia, edema, and hyperlipidemia. Loss of albumin through damaged glomerular filtration lowers oncotic pressure, causing fluid to shift into tissues. Acute glomerulonephritis is characterized by hematuria and hypertension rather than massive proteinuria.
Question 6: A 2-year-old boy presents with a swollen, painful glans. The caregiver states the foreskin was retracted and now cannot be returned to its normal position. What is this urologic emergency called?
- Phimosis
- Paraphimosis (Correct answer)
- Balanitis
- Priapism
Correct answer: Paraphimosis
Paraphimosis occurs when a retracted foreskin becomes trapped behind the corona and cannot be reduced, causing venous obstruction, progressive swelling, and potential arterial compromise. This is a urological emergency requiring prompt manual reduction. Phimosis is the inability to retract the foreskin, which is physiologically normal in young children and non-emergent.
CPEN Genitourinary and Obstetrical Emergencies
A 3-year-old boy presents with sudden onset of severe scrotal pain and vomiting.
Physical examination reveals an absent cremasteric reflex.
What is the priority nursing action?