Nonpharmacologic measures have been ineffective in a 7-year-old diagnosed with enuresis. When planning treatment, the nurse practitioner would consider which medication as third-line treatment?
oxybutynin (Ditropan XL).
desmopressin acetate (DDAVP).
tolterodine (Detrol).
imipramine (Tofranil).
The Correct Answer is D
Rationale:
A. Oxybutynin (Ditropan XL) is used primarily for bladder overactivity and may be considered earlier than third-line therapy depending on the patient’s symptoms.
B. Desmopressin acetate (DDAVP) is usually first-line pharmacologic therapy for primary nocturnal enuresis, particularly when fluid restriction and behavioral strategies have failed.
C. Tolterodine (Detrol) is another anticholinergic used for overactive bladder but is generally not considered third-line for uncomplicated enuresis.
D. Imipramine (Tofranil), a tricyclic antidepressant, is considered third-line therapy for enuresis due to its potential for significant side effects, including cardiac toxicity in overdose. It is reserved for patients who do not respond to behavioral strategies and first-line medications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Rationale:
A. Amoxicillin (Amoxil) is sometimes used for prophylaxis in young children, but its efficacy against common urinary pathogens and resistance patterns is lower compared with trimethoprim-sulfamethoxazole.
B. Ciprofloxacin (Cipro) is not typically recommended for routine prophylaxis in children due to potential adverse effects on developing cartilage.
C. Sulfamethoxazole and trimethoprim (Bactrim) is the preferred first-line antibiotic for prophylaxis in children with vesicoureteral reflux. It is effective against E. coli and other common urinary pathogens, has a favorable safety profile, and is widely used in this age group for long-term low-dose prophylaxis.
D. Cephalexin (Keflex) can be used in some cases but is generally considered second-line compared with Bactrim for continuous prophylaxis.
Correct Answer is D
Explanation
Rationale:
A. A heart rate of 90–110 beats per minute is below the normal range for a newborn and would be considered bradycardia.
B. 115–140 beats per minute falls within the normal resting range for infants, especially when asleep.
C. 150–170 beats per minute can be normal during activity or crying in a newborn.
D. Tachycardia in infants younger than 1 month is defined as a heart rate greater than 180 beats per minute at rest. Persistent tachycardia may indicate underlying conditions such as infection, dehydration, anemia, or cardiac disorders and warrants further evaluation.
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