Comprehensive

Question 1

Otitis media treatment

• first and second line
• complications

Answer 1

1. Amoxicillin
2. Cefdinir (PCN allergy)

Mastoiditis is direct complication

Question 2

Scoliosis evaluation and associated problems

Answer 2

Highly associated with abnormalities of cardiac, pulmonary and neurologic function (eval with the forward bend test – every well child and sports physical)

Question 3

Tooth avulsion

Answer 3

If reimplanted within 30 min, 90% are viable

Question 4

Retinoblastoma, findings

Answer 4

Ophthalmoscopic exam may show a WHITE REFLEX in affected eye and RED REFLEX in unaffected eye

Question 5

Sports physical, exclusion from contact play

Answer 5

Contact sports should not be played by those with single kidney, single eye, hemophilia, or unexplained syncope

Question 6

Aphthous Stomatitis

Answer 6

• Topical steroids are first line for minor cases
• Other agents to consider are honey, amlexnox, coating or occlusive agents (2-octyl-cyanoacrylate, sulcralfate, bismuth subsalicylate)

Question 7

Legg-Calve-Perthes

Answer 7

Disease of disrupted blood supply to the femoral head

Typical age of onset is about 4-8 yrs

Most common cause of limp in this age group
- 5x more common in males
- Associated with down syndrome, congenital GU abnormalities, inguinal hernia

Question 8

What are some signs of cellulitis. What does orange peel mean? How would you treat suspected cellulitis?

Answer 8

• Cellulitis is most common complication of cat bite

Treatment:

Question 9

Bites, animal vs. human; presentation and management

Answer 9

• Human bites must be properly irrigated and debrided
• Cat scratch: doxy and rifampin
• Cat Scratch: bartonella henselae

Question 10

Asthma Guidelines / Stepwise Therapy

Question 11

When conducting a physical examination on a 5-day-old neonate, which of the following findings suggests coarctation of the aorta?

Answer 11

Higher blood pressure in the right arm than in the right leg

Question 12

During the physical examination of a 1 year old child, the examiner notes a thrill in the left lower sternal border. The most likely etiology of this finding is

Answer 12

Ventricular septal defec

Question 13

Laryngotracheobronchitis is typically manifested by

Answer 13

Hoarse voice and barking cough

Question 14

Stridor is associated with which of the following respiratory conditions in children?

Answer 14

Laryngotracheobronchitis

Question 15

You are treating a child for community acquired pneumonia. Knowing the most common pathogens that cause CAP in pediatrics, what will you treat your patient with as first line?

Answer 15

Amoxicillin

Statpearl: Cef and Vanc

Question 16

A distinguishing feature of viral influenza is:

Answer 16

abrupt-onset, profound malaise.

Question 17

Which of the following can be seen with “irritable bowel syndrome”

Answer 17

Recurrent diarrhea

Question 18

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?

Answer 18

Feeding and stooling history and 3-day diet history

Question 19

13-month-old infant presents with vomiting; abdominal pain; and pale, bulky, greasy, and foul-smelling stools. A possible diagnosis the clinician would document on the chart might be

Answer 19

Gluten sensitive enteropathy

Question 20

Occurrence of gastroesophageal reflux is highest in which pediatric population

Answer 20

Premature infants

Question 21

A toddler’s mother calls the nurse because she thinks her son has swallowed a button type of battery. He has no signs of respiratory distress. The nurse practitioner’s response should be based on which of the following

Answer 21

The location needs to be confirmed by x-ray

Question 22

When caring for a child with probable appendicitis, the nurse practitioner should be alert to recognize which of the following as a sign of perforation

Answer 22

Sudden relief of pain

Question 23

Tooth decalcification, erosion, and decay in an underweight adolescent girl raises suspicion for:

Answer 23

Bulimia nervosa

Question 24

During a well child examination of a 2-year-old child, the primary care pediatric nurse practitioner palpates a unilateral, smooth, firm abdominal mass which does not cross the midline. What is the next course of action that?

Answer 24

Refer the child to an oncologist immediately.

Question 25

Which of the following clusters of symptoms would make a clinician suspect a child has developed glomerulonephritis?

Answer 25

Gross hematuria, flank pain, and hypertension

Question 26

A 17-year-old female presents to your clinic for complaints of urinary frequency. She states she occasionally has burning with urination, but frequency is her worst symptom. She has some “tactile” fevers. She also reports suprapubic tenderness. She states her periods are “normal”. She denies sexual activity, but is guarded in her discussion with you. She states she has had urinary tract infections before. How do you proceed?

Answer 26

Order a urinalysis, urine pregnancy, and urine culture, treating the patient with Macrobid pending urine culture.

Question 27

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

Answer 27

Topical corticosteroids applied 2 to 3 times daily

Question 28

A child is brought to the clinic with a generalized, annular rash characterized by raised wheals 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?

Answer 28

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

Question 29

During a well child examination of an infant, the primary care pediatric nurse practitioner notes 10 café au lait spots on the infant’s trunk. What is the potential concern associated with this finding?

Answer 29

Neurofibromatosis

Question 30

he 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?

Answer 30

Performing metabolic laboratory tests

Question 31

An antalgic gait indicates:

Answer 31

Pain

Question 32

Genu varum is normal until age

Answer 32

2-3yo

Question 33

A positive Galeazzi sign would indicate what?

Answer 33

Developmental dysplasia of the hip

Question 34

During a well child visit, a mother expresses concern that her three-year-old child has recently started to stutter when excited. The pediatric primary care nurse practitioner informs the mother that stuttering in a preschool-aged child:

Answer 34

is a normal characteristic of language development

Question 35

A five-year-old child requires daily use of a short-acting beta2-agonist for wheezing and the child's symptoms exacerbate at least twice a week during physical exercise. The parent reports that the child has a dry cough at night, which occurs several times a week. This child's asthma is classified as:

Answer 35

moderate intermittent.

Question 36

The pediatric primary care nurse practitioner treats a two-year-old patient who has acute otitis media (AOM). The parents report a concern for speech delay. Review of the medical record reveals two additional AOM diagnoses in the past six months. The patient's plan of care includes:

Answer 36

an ear, nose, and throat consultation for recurrent otitis media.

Question 37

Which of the following patients should be referred for further developmental evaluation?

Answer 37

Term 6-month-old infant with poor head control

Question 38

A 15 yo female comes to the clinic for a health maintenance visit. The patient reports no complaints. She does well in school, has many friends, and gets along well with her parents and two siblings. She has recently become sexually active with her boyfriend of 6mo. The physical exam is normal for her age. What screening, lab tests, and/or immunizations should the NP order?

Answer 38

Vision, hearing, urinalysis, STD screen, and immunizations as needed

Question 39

A 13yo female is at the clinic for a routine check up. What presenting symptoms might alert the NP to the presence of a possible genetic disorder?

Answer 39

<10% on growth chart, Tanner I, and learning difficulties

Question 40

The NP is following a 15-year-old male adolescent with consistent blood pressure readings of 132 to 138/84 to 86 mm Hg, which is classified as significant hypertension. After performing a workup, the NP determines that the adolescent has primary hypertension. The most judicious recommendation for therapy is:

Answer 40

Diet and exercise counseling and referral to a specialist

Question 41

A 5-year-old child has sudden onset of nonblanching purpuric lesions scattered over the body and petechiae scattered over the neck and shoulders. The mother reports that the child has been healthy, except for a cold a few weeks ago. The child is not taking any medications. Physical examination reveals a healthy, afebrile child with no other significant findings. The laboratory data show a hemoglobin level of 12.5 g/dL, white blood cell count of 6500/mm3, and platelet count of 20,000/mm3. Based on this information, what should the NP do next?

Answer 41

Reassure the parents that these findings are consistent with acute idiopathic thrombocytopenia purpura (ITP), and advise a hematology consultation for confirmation

Question 42

A 10-year-old child is examined because of recurrent UTIs. A urologic workup is performed. No abnormalities are found. To help prevent future UTIs, you should suggest which of the following interventions

Answer 42

Practicing good perineal hygiene

Question 43

When discussing the cause of impetigo with the parents of a child just diagnosed, the NP tells them it is caused by:

Answer 43

Staphylococcus aureus or GABHS

Question 44

A 17-year-old adolescent comes to the office to ask about a self-medication regimen for monthly menstrual cramps. The adolescent reports routinely taking 1200 mg of ibuprofen every 4 to 6 hours for the first 3 days of menses each month to relieve cramps. The NP tells her:

Answer 44

The dose should be decreased because of the risk of gastrointestinal ulceration.

Question 45

A 14-month-old is brought to the clinic with a cough and yellow-green nasal discharge for the past 7 days. The father has been giving the child over-the-counter cold medications every 6 hours. The child has no fever. Appetite, activity, and elimination are unchanged. The father states he had the same symptoms and was put on an antibiotic for a sinus infection. He is concerned that the child has the same infection. The most appropriate action by the NP is to

Answer 45

Reassure the father that the child probably has a viral infection and suggest supportive care; if symptoms don't improve in 7 days, return for evaluation

Question 46

A NP has been asked by the emergency room physician to evaluate a child for costochondritis. The NP would expect to find

Answer 46

Tenderness of the midsternal area

Question 47

A 12-year-old child is seen in the school-based clinic because of a red, swollen, tender area on the upper eyelid. The NP prescribes

Answer 47

Warm compresses to be applied two to three times a day and a topical antibiotic

Question 48

4-year-old child is brought to the clinic with ulcers on the tongue and oral mucosa. There are vesicles on the palms, soles, and interdigital areas. The NP diagnoses:

Answer 48

Hand-foot-and-mouth disease

Question 49

In evaluating a 7-year-old child for ADHD, the NP questions the parents about reported behavior at school. Of the following symptoms, which would be most descriptive of ADHD?

Answer 49

The child will not listen to direction or when spoken to, submits messy papers with careless mistakes, runs about or climbs excessively, has difficulty sustaining attention, and exhibits intrusive behavior

Question 50

A 6-year-old child with asthma is brought to the clinic because the parents have noticed daily wheezing for the past week, especially during the night. The NP recognizes that this may indicate the child has:

Answer 50

Moderate persistent asthma

Question 51

The mother of a 5-year-old child questions the NP about precocious puberty. The NP relates to the mother that complete or central precocious puberty:

Answer 51

Is usually idiopathic in girls

Question 52

A 10-year-old diabetic has blurred vision, fruity breath odor, and a rapid pulse. The blood glucose level is 380 mg/dL, and the urine glucose level is 2%. A test strip was positive for ketones. The child complains of cough and a sore throat. The NP reminds the child that ketoacidosis is a serious complication of diabetes and that ketone testing should be done:

Answer 52

During any illness, even a cold

Question 53

Hypothyroidism has just been diagnosed in a 5-year-old child, and thyroid replacement therapy has been initiated. Anticipatory guidance for the child and family should include:

Answer 53

Emphasizing the importance of compliance and periodic monitoring of the child's response to therapy

Question 54

The mother of a 2-year-old child is concerned about the child's thumb sucking during the day when not playing and at night while sleeping. The NP suggests that:

Answer 54

The parents should ignore the behavior because it is not harmful at this age

Question 55

A 2-year-old child is screened for lead poisoning. The blood level is 16 mg/dL. The NP discusses nutritional needs, including a diet high in:

Answer 55

Calcium and iron

Question 56

The 19-year-old mother of an infant in the NP's care has just found out that she is expecting her second child. The mother's first prenatal visit is scheduled soon. The mother smokes two packs of cigarettes a day. What action should the NP take?

Answer 56

Inform the mother about the risks to herself and to her children from secondhand smoke

Question 57

The NP has prescribed salmeterol (Serevent) by inhalation for an asthmatic. The family should be warned about which of the following side effects that occur with this medication?

Answer 57

tachycardia and headache

Question 58

A 7-year-old child is brought to the clinic for a rash that has been present for 24 hours. The child was "a little droopy about 3 days ago" but had no fever or other symptoms. The immunizations are up-to-date. The child now has a "slapped cheek" appearance, with a lacy, erythematous rash on the torso and upper arms. The rash blanches. The NP discusses with the mother the diagnosis of:

Answer 58

Human parvovirus B19, or fifth disease, for which there is no treatment

Question 59

5-year-old child is at the clinic for a routine well-child visit before beginning kindergarten. The mother reports the child's list of chores as follows: clean own room, make own bed, wash and dry own clothing, take out the trash, and help wash the dishes. If the chores are not completed, the child is grounded from other activities, such as playing with friends or watching television. The mother states that the child frequently must be grounded. How should the NP respond?

Answer 59

Perform a complete physical assessment of the child, as well as a parenting assessment

Question 60

The patient has an abnormally low neutrophil count. Neutropenia is most commonly caused by:

Answer 60

drug reactions