CPEN Genitourinary and Obstetrical Emergencies

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?

Accepted Answer

Prepare the patient for emergent surgical consultation

Answer

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?

Accepted Answer

Escherichia coli

Answer

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?

Accepted Answer

Ectopic pregnancy

Answer

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?

Accepted Answer

Wilms tumor (nephroblastoma)

Answer

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?

Accepted Answer

Nephrotic syndrome

Answer

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.

CPEN - Certified Pediatric Emergency Nurse Practice Test

CPEN - Certified Pediatric Emergency Nurse Practice Test

CPEN Genitourinary and Obstetrical Emergencies