Family Nurse Practitioner Exam

For an 8-year-old with type 1 diabetes and urinalysis showing leukocytes and ketones, what is the best initial test to order?

1. Urine for culture and sensitivity

2. 24-hour urine for protein and creatinine clearance

3. 24-hour urine for microalbumin

4. An intravenous pyelogram

The correct answer is: Urine for culture and sensitivity

The best initial test to order for an 8-year-old with type 1 diabetes presenting with a urinalysis showing leukocytes and ketones is a urine culture and sensitivity. In this scenario, the presence of leukocytes suggests a possible urinary tract infection (UTI), which is common in children with diabetes. The presence of ketones indicates that the child may be in a state of ketonuria, often seen in the context of poor glycemic control or diabetic ketoacidosis. Ordering a urine culture and sensitivity is fundamental in confirming the diagnosis of a UTI and identifying the specific bacteria responsible, as well as determining the most effective antibiotic treatment. Given the child’s diabetes and potential for complications, prompt identification and management of a UTI is crucial to prevent further health issues. The other tests, while valuable in different clinical contexts, do not serve as an immediate and appropriate step in this particular situation. A 24-hour urine for protein and creatinine clearance focuses on assessing kidney function over time and is more relevant for evaluating chronic kidney conditions rather than acute urinary issues. A 24-hour urine for microalbumin is primarily used to detect early diabetic nephropathy, which is not the immediate concern given the current symptoms. An intravenous pyel