Exam 2 Flashcards
A 9monthold infant has developed two teeth since the 6month checkup. The local water supply contains fluoride. What will the primary care pediatric
nurse practitioner do to promote healthy dentition at this visit?
Q. Apply sodium fluoride varnish to the infant’s teeth.
R. Encourage the parents to make an initial dental appointment.
S. Prescribe oral fluoride supplementation.
T. Teach the parents how to brush the infant’s teeth with fluoride
toothpaste.
Q. Apply sodium fluoride varnish to the infant’s teeth.
What will the primary care pediatric nurse practitioner recommend to the parent of an infant who is teething who asks about comfort measures?
A. Administer oral ibuprofen or apply topical salicylates.
B. Apply a topical anesthetic such a benzocaine to the gums.
C. Give the infant a cold teething ring or wet washcloth to chew.
D. Try Baby Orajel on the infant’s gums several times daily.
C. Give the infant a cold teething ring or wet washcloth to chew.
An 18monthold child has horizontal, bright white lines along the upper gum line
of the teeth. What is the most important question the primary care pediatric nurse practitioner will
ask the child’s parents?
A. If the child is still drinking milk from a bottle
B. If the child or the parents are brushing the teeth
C. If they are brushing the child’s teeth twice daily
D. If they have taken the child to a dentist
A. If the child is still drinking milk from a bottle
A 4yearold child who has had extensive dental surgery to treat dental caries has white spot lesions on the primary teeth. How often should this child receive fluoride varnish
applications?
A. Annually
B. Twice yearly
C. Every 3 to 6 months
D. Every month
C. Every 3 to 6 months
The parents of a formula fed newborn report that they get their drinking water from a well. What will the primary care pediatric nurse practitioner recommend to provide adequate fluoride for this infant?
A. Giving the infant a fluoride supplement
B. Testing the fluoride level of their water source
C. Using bottled water to prepare the infant’s formula
D. Using powdered formula with added fluoride
B. Testing the fluoride level of their water source
What will the primary care pediatric nurse practitioner teach the parent of an infant about cleaning the child’s teeth?
A. To allow the child to control the amount of toothpaste used
B. To choose a toothpaste with a mint flavor
C. To use a smear of toothpaste and not to rinse the mouth
D. To use a toothpaste containing whitening agents
To use a smear of toothpaste and not to rinse the mouth
A parent asks about ways to promote dental health in schoolage children while on a family vacation that are convenient while camping and picnicking. What will the pediatric nurse practitioner recommend?
A. Getting fluoride varnish treatments prior to vacations
B. Giving the children fluoridated water after meals
C. Having the children use a chlorhexidine gluconate oral rinse
D. Offering gum containing xylitol after meals
Offering gum containing xylitol after meals
An adolescent has localized bleeding of the gums when brushing the teeth. An
exam of the mouth reveals the presence of plaque and calculus on the teeth, which are not loose.
What will the primary care pediatric nurse practitioner recommend?
A. Consistently brushing and flossing the teeth twice daily
B. Referral to an oral surgeon for treatment
C. Rinsing the mouth daily with chlorhexidine gluconate
D. Using a xylitol containing gum after meals
A. Consistently brushing and flossing the teeth twice daily
A school age child has had herpes stomatitis for a week and continues to
complain of pain. What will the primary care pediatric nurse practitioner recommend?
A. Administration of a topical antiviral medication
B. Taking oral acyclovir for 5 to 7 days
C. Topical application of diphenhydramine and Maalox
D. Using a chlorhexidine gluconate rinse
C. Topical application of diphenhydramine and Maalox
A child has several shallow mucosal lesions on the buccal mucosa and tongue that are surrounded with an erythematous halo and covered by yellow plaques. What will the primary care pediatric nurse practitioner recommend?
A. Chlorhexidine gluconate
B. Diphenhydramine and Maalox
C. Oral acyclovir
D. Topical antiviral medication
A. Chlorhexidine gluconate
During a well child exam, the primary care pediatric nurse practitioner notes
yellowish-white serpentine bordered lesions on the anterior portion of a child’s tongue. What will
the nurse practitioner do?
A. Order chlorhexidine gluconate rinses to treat the lesions.
B. Prescribe oral acyclovir to shorten the course of the disease.
C. Reassure the parent that these are benign lesions.
D. Refer the child to a pediatric dentist for evaluation.
Reassure the parent that these are benign lesions.
4yearold child who has asthma has teeth with smooth, cupped out teeth on the chewing surfaces. Which is the most likely explanation for this finding?
A. Bruxism
B. Bulimia
C. Decreased saliva
D. Gastroesophageal reflux
D. Gastroesophageal reflux
An adolescent female reports facial pain and frequent popping of her jaw. An exam reveals unilateral tender facial muscles and a deviation of the mandible to the affected side with opening of the mouth. What will the primary care pediatric nurse practitioner do?
A. Recommend ice packs, NSAIDs, and a soft diet.
B. Refer to a pediatric mental health specialist.
C. Refer to an orthodontist for a surgical intervention.
Suggest obtaining Botox injection treatments
A. Recommend ice packs, NSAIDs, and a soft diet.
A 5yearold child is hit in the face with a baseball bat and is brought to the clinic
by a parent. An exam reveals three avulsed front teeth. Radiologic studies are negative for facial fractures. What is the recommended treatment?
A. Prescribe tetracycline 4.4 mg/kg twice daily for 7 to 10 days.
B. Refer the child to a dentist for reimplantation of the avulsed teeth.
C. Refer the child to a dentist immediately for further examination.
D. Remove the teeth, place them in saline, and refer the child to a dentist.
C. Refer the child to a dentist immediately for further examination.
A child with cerebral palsy receives all nutrition via gastrostomy tube. What will the
primary care pediatric nurse practitioner recommend to promote dental health in this child?
A. Applying topical iodine every month
B. Daily chlorhexidine gluconate rinses
C. Ordering medications to prevent drooling
D. Prescribing prophylactic antibiotics
B. Daily chlorhexidine gluconate rinses
During a well child examination on a 4monthold infant, the primary care pediatric nurse practitioner evaluates mental health issues. Which statement by the parent indicates a potential problem with the parent infant relationship?
a. “I can sense a difference in my baby’s cries.”
b. “I let my baby cry a while to learn to be patient.”
c. “My baby prefers to nurse in a darkened room.”
d. “My baby seems very sensitive to loud noises.”
b. “I let my baby cry a while to learn to be patient.”
A child has a difficult temperament. What will the primary care pediatric nurse practitioner tell the parent about managing this child’s behavior?
a. A difficult temperament is its own risk factor for maladjustment disorders.
b. Children with difficult temperaments need strict adherence to rules.
c. Having a difficult temperament limits intelligence and emotional maturity
d. It is important for the parent to learn to manage criticism and power struggles.
d. It is important for the parent to learn to manage criticism and power struggles.
During a well child assessment of a preschool age child, the parent voices concerns that, because the child has behavior problems at school, the child may have a mental health disorder. Which initial approach will provide the best information?
a. Ask the parent whether other caregivers have voiced similar concerns.
b. Interview the child separately from the parent to encourage sharing of feelings.
c. Take time to actively listen to the parent’s and child’s perceptions of the problem.
d. Use a validated screening tool to ensure that all aspects of behaviors are evaluated.
c. Take time to actively listen to the parent’s and child’s perceptions of the problem.
The primary care pediatric nurse practitioner attempts to learn more about the emotional health of an 18monthold child through which assessment strategy?
a. Asking the child to tell a story using dolls and other props
b. Asking the child to draw a picture of him or herself and other family members
c. Interviewing the child separately from caretakers and parents
d. Observation of the child with caretakers in structured and unstructured situations
d. Observation of the child with caretakers in structured and unstructured situations.
A middle school age child is skipping school frequently and getting poor grades since the child’s father was killed while deployed in the military. How will the primary care pediatric nurse practitioner manage this situation?
a. Prescribe short term antidepressants for this situational depression.
b. Refer the child to a mental health specialist for evaluation and treatment.
c. Schedule extended appointments for counseling and mental health intervention.
d. Suggest that the child have close follow-up by a school counselor.
b. Refer the child to a mental health specialist for evaluation and treatment.
The parent of a 4yearold child reports that the child seems to be having trouble adjusting to a new day care and reportedly is always engaging in solitary play when the parent arrives to pick up the child. What will the primary care pediatric nurse practitioner do?
a. Ask the parent if the child is slow to warm up to other new situations.
b. Reassure the parent that parallel play is common among preschool age children.
c. Recommend that the parent spend time encouraging the child to play with others.
d. Suggest that the day care center may be neglecting the child.
a. Ask the parent if the child is slow to warm up to other new situations.
The parent of a school age child is concerned because the child has started to express anger about a grandparent’s death even though this occurred when the child was a toddler. What will the primary care pediatric nurse practitioner tell the parent?
a. Anger is an abnormal reaction to bereavement and loss in this age child.
b. Counseling is needed since the child has had sufficient time to resolve this issue.
c. Grief and bereavement lasting longer than a year may require medication.
d. The significance of this loss must be reworked at each developmental level.
d. The significance of this loss must be reworked at each developmental level.
The parent of a school age child reports that the child doesn’t like being alone in rooms because of a fear of aliens hiding in closets. What will the primary care pediatric nurse practitioner tell the parent?
a. “Fear of imaginary creatures does not usually occur at this age.”
b. “I may need to refer your child to a pediatric mental health specialist.”
c. “Your child is expressing normal fears for a school age child.”
d. “Your child may be watching too much violence on television.”
a. “Fear of imaginary creatures does not usually occur at this age.”
The parent of a preschool age child reports that the child often appears anxious and nervous and that this is associated occasionally with a rapid heart rate and tremors. What is the best type of referral that the primary care pediatric nurse practitioner could recommend?
a. Cognitive behavioral therapy
b. Family therapy
c. Medication therapy
d. Play therapy
d. Play therapy
A 9yearold child exhibits school refusal and a reluctance to attend sleepovers with classmates. The parent is concerned because the child has recently begun sleeping in the parents’ bed. Which initial action by the primary care pediatric nurse practitioner is appropriate?
a. Assess for environmental stress, parental dysfunction, and maternal depression.
b. Ask about recent traumatic events that may have precipitated this behavior.
c. Consider a possible pediatric autoimmune neuropsychiatric disorder cause.
d. Recommend firm insistence on school and activity attendance.
a. Assess for environmental stress, parental dysfunction, and maternal depression.
The parent of a schoolage child reports that the child becomes frustrated when unable to perform tasks well and often has temper tantrums and difficulty sleeping. Which disorder may be considered in this child?
a. Generalized anxiety disorder (GAD)
b. Obsessive compulsive disorder (OCD)
c. Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS)
d. Separation anxiety disorder (SAD)
a. Generalized anxiety disorder (GAD)
The parent of a school age girl reports that the child has difficulty getting ready for school and is often late because of a need to check and recheck whether her teeth are clean and her room light has been turned off. What will the primary care pediatric nurse practitioner recommend to this parent?
a. Cognitive behavioral therapy
b. Deferral of treatment until symptoms worsen
c. Medication management with an SSRI
d. Referral to a child psychiatrist
a. Cognitive behavioral therapy
The parents of a 4yearold boy are concerned because he has begun twisting and pulling out his hair, especially when he is tired or stressed. What will the primary care pediatric nurse practitioner recommend as part of an initial approach to treat this behavior?
a. Consultation with a pediatric behavioral specialist
b. Cutting his hair so that it is too short to pull
c. Long term antistreptococcal prophylaxis
d. Medication with Risperdal or clonidine
b. Cutting his hair so that it is too short to pull
A newly divorced mother of a toddler reports that the child began having difficulty sleeping and nightmares along with exhibiting angry outbursts and tantrums 2 months prior. The primary care pediatric nurse practitioner learns that the child refuses to play with usual playmates and often spends time sitting quietly. What will the nurse practitioner do initially?
a. Ask the mother about the child’s relationship with the father.
b. Consult with a child psychiatrist to prescribe medications.
c. Recommend cognitive behavioral or psychodynamic therapy.
d. Refer the family to a child behavioral specialist for counseling.
a. Ask the mother about the child’s relationship with the father.
An adolescent has recently begun doing poorly in school and has stopped participating in sports and other extracurricular activities. During the history interview, the adolescent reports feeling tired, having difficulty concentrating, and experiencing a loss of appetite for the past few weeks but cannot attribute these changes to any major life event. Which is an important next step in managing this patient?
a. Administering a diagnostic rating scale for depression
b. Considering a short term trial of an antidepressant medication
c. Determining suicidal ideation and risk of suicide
d. Referring the adolescent to a mental health specialist
c. Determining suicidal ideation and risk of suicide
An adolescent is diagnosed with major depression, and the mental health specialist has prescribed fluoxetine. What other treatment is important to protect against suicide risk?
a. Addition of risperidone therapy
b. Cognitive behavioral therapy
c. Family therapy
d. Hospitalization
b. Cognitive behavioral therapy
A 13yearold child has exhibited symptoms of mild depression for several weeks. The parent reports feeling relieved that the symptoms have passed but concerned that the child now seems to have boundless energy and an inability to sit still. What will the primary care pediatric nurse practitioner do?
A. Administer an ADHD diagnostic scale and consider an ADHD medication.
B. Consult with a child psychiatrist to prescribe an antidepressant medication.
C. Reassure the parent that this behavior is common after mild depressive symptoms
D. Refer the child to a child psychiatrist for evaluation of bipolar disorder.
D. Refer the child to a child psychiatrist for evaluation of bipolar disorder.
A toddler has begun hitting and biting other children at a day care center and is exhibiting temper tantrums and bad language at home. The parent reports that these behaviors began shortly after a sibling was born. What will the primary care pediatric nurse practitioner do?
A. Advise the parent that the child is exhibiting early symptoms of ADHD.
B. Engage the parent in positive parenting strategies to facilitate appropriate child coping.
C. Recommend evaluating the child for conduct or oppositional defiant disorder.
D. Suggest putting the child in another day care center to ameliorate the problems.
B. Engage the parent in positive parenting strategies to facilitate appropriate child coping.
A 14yearold female comes to the clinic with amenorrhea for 3 months. A pregnancy test is negative. The adolescent’s body weight is at 82% of expected for height and age. The mother reports that her daughter often throws up and refuses to eat most foods. Which condition does the primary care pediatric nurse practitioner suspect?
A. Anorexia nervosa
B. Bulimia nervosa
C. Depression
D. Substance abuse
A. Anorexia nervosa
The primary care pediatric nurse practitioner is teaching a parent of a child with dry skin about hydrating the skin with bathing. What will the nurse practitioner include in teaching?
A. Apply lubricating agents at least 1 hour after the bath.
B. Have the child soak in a lukewarm water bath.
C. Keep the child in the bath until the skin begins to “prune.”
D. Soaping should be done at the beginning of the bath.
B. Have the child soak in a lukewarm water bath.
A child will need an occlusive dressing to treat lichen simplex chronicus. What will the primary care pediatric nurse practitioner tell the parents about applying this treatment?
A. Apply ointment before the dressing.
B. Plastic wrap should not be used.
C. The dressing should be applied to dry skin.
D. Change the dressing twice daily.
A. Apply ointment before the dressing.
When prescribing topical glucocorticoids to treat inflammatory skin conditions, the primary care pediatric nurse practitioner will
A. initiate therapy with a high potency glucocorticoid.
B. order lotions when higher potency is necessary.
C. prescribe brand name preparations for consistent effects.
use fluorinated steroids to minimize adverse effects
C. prescribe brand name preparations for consistent effects.
A preschool age child has honey crusted lesions on erythematous, eroded skin around the nose and mouth, with satellite lesions on the arms and legs. The child’s parent has several similar lesions and reports that other children in the day care have a similar rash. How will this be treated?
A. Amoxicillin 40 to 5 mg/kg/day for 7 to 10 days
B. Amoxicillin clavulanate 90 mg/kg/day for 10 days
C. Bacitracin cream applied to lesions for 10 to 14 days
D. Mupirocin ointment applied to lesions until clear
B. Amoxicillin clavulanate 90 mg/kg/day for 10 days
A child is brought to clinic with several bright red lesions on the buttocks. The
primary care pediatric nurse practitioner examines the lesions and notes sharp margins and an “orange peel” look and feel. The child is afebrile and does not appear toxic. What is the course of treatment for these lesions?
A. Hospitalize the child for intravenous antibiotics and possible I&D of the lesions.
B. Initiate empiric antibiotic therapy and follow up in 24 hours to assess response.
C. Obtain blood cultures prior to beginning antibiotic treatment.
D. Perform gram stain and culture of the lesions before initiating antibiotics.
B. Initiate empiric antibiotic therapy and follow up in 24 hours to assess response.
An adolescent who recently spent time in a hot tub while on vacation has discrete, erythematous 1 to 2mm papules that are centered around hair follicles on the thighs, upper arms, and buttocks. How will the primary care pediatric nurse practitioner manage this condition?
A. Culture the lesions and treat with appropriate IM antibiotics.
B. Hospitalize for incision and drainage and intravenous antibiotics.
C. Order an anti-staphylococcal betalactamaseresistant antibiotic.
D. Prescribe topical keratolytics and topical antibiotics.
D. Prescribe topical keratolytics and topical antibiotics.
An infant is brought to clinic with bright erythema in the neck and flexural folds after recent treatment with antibiotics for otitis media. What is the treatment for this condition?
A. 1% hydrocortisone cream to affected areas for 1 to 2 days
B. Oral fluconazole 6 mg/kg on day 1, then 3 mg/kg/dose for 14 days
C. Topical keratolytics and topical antibiotics for 7 to 10 days
D. Topical nystatin cream applied several times daily
D. Topical nystatin cream applied several times daily
A school age child has several annular lesions on the abdomen characterized by central clearing with scaly, red borders. What is the first step in managing this condition?
A. Fluoresce the lesions with a Wood’s lamp.
B. Obtain fungal cultures of the lesions.
C. Perform KOH treated scrapings of the lesion borders.
D. Treat empirically with antifungal cream.
D. Treat empirically with antifungal cream
A child has several circular, scaly lesions on the arms and abdomen, some of
which have central clearing. The primary care pediatric nurse practitioner notes a smaller, scaly lesion on the child’s scalp. How will the nurse practitioner treat this child?
A. Obtain scrapings of the lesions for fungal cultures.
B. Order prescription strength antifungal creams.
C. Prescribe oral griseofulvin for 2 to 4 weeks.
D. Recommend OTC antifungal creams and shampoos.
C. Prescribe oral griseofulvin for 2 to 4 weeks.
A child is diagnosed with tinea versicolor. What is the correct management of this disorder?
A. Application of selenium sulfide 2.5% lotion twice weekly for 2 to 4 weeks
B. Oral antifungal treatment with fluconazole once weekly for 2 to 3 weeks
C. Sun exposure for up to an hour every day for 2 to 4 weeks
D. Using ketoconazole 2% shampoo on lesions twice daily for 2 to 4 weeks
A. Application of selenium sulfide 2.5% lotion twice weekly for 2 to 4 weeks
An adolescent female has grouped vesicles on her oral mucosa. To determine whether these are caused by HSV1 or HSV2, the primary care pediatric nurse practitioner will order which test?
A. Direct fluorescent antibody test
B. Enzyme linked immunosorbent assay
C. Tzanck smear
D. Viral culture
D. Viral culture
A 4yearold child has clusters of small, clear, tense vesicles with an erythematous base on one side of the mouth along the vermillion border, which are causing discomfort and difficulty eating. What will the primary care pediatric nurse practitioner recommend as treatment?
A. Mupirocin ointment applied to lesions 3 times daily
B. Oral acyclovir 20 to 40 mg/kg/dose for 7 to 10 days
C. Topical acyclovir applied to lesions 4 times daily
D. Topical diphenhydramine and magnesium hydroxide
D. Topical diphenhydramine and magnesium hydroxide
A previously healthy schoolage child develops herpes zoster on the lower
back. What will the primary care pediatric nurse practitioner do to manage this condition?
A. Order Burow solution and warm soothing baths as comfort measures.
B. Prescribe oral acyclovir 30 mg/kg/day in 4 doses/day for 5 days.
C. Recommend topical antihistamines to control itching.
D. Stress the need to remain home from school until the lesions are gone.
A. Order Burow solution and warm soothing baths as comfort measures.
. A child has small, firm, fleshcolored papules in both axillae which are mildly
pruritic. What is an acceptable initial approach to managing this condition?
A. Application of trichloroacetic acid 25% to 50% using a dropper
B. Applying liquid nitrogen for 2 to 3 seconds to each lesion
C. Reassuring the parents that these are benign and may disappear spontaneously
Referral to a dermatologist for manual removal of lesions with curettage
C. Reassuring the parents that these are benign and may disappear spontaneously
A schoolage child is brought to clinic after a pediculosis capitis infestation is reported at the child’s school. If this child is positive, what will the primary care pediatric nurse practitioner expect to find on physical examination, along with live lice near the scalp?
A. Excoriated macules along the child’s collar and underwear lines
B. Inflammation and pustules on the face and neck
C. Itching of the scalp, with skin excoriation on the back of the head
D. Linear or S shaped lesions in webs of fingers and sides of hands
C. Itching of the scalp, with skin excoriation on the back of the head
A 3yearold child has head lice. What will the initial treatment recommendation be to treat this child?
A. Lindane
B. Permethrin
C. Pyrethrin
D. Spinosad
B. Permethrin
A 9-month old infant has vesiculopustular lesions on the palms and soles, on the face and neck, and in skin folds of the extremities. The primary care pediatric nurse practitioner notes linear and S-shaped burrow lesions on the parent’s hands and wrists. What is the treatment for this rash for this infant?
A. Ivermectin 200 mcg/kg for 7 to 14 days, along with symptomatic treatment for itching
B. Permethrin 5% cream applied to face, neck, and body and rinsed off in 8 to 14 hours
C. Treatment of all family members except the infant with permethrin 5% cream and ivermectin
D. Treatment with permethrin 5% cream for 7 days in conjunction with ivermectin 200 mcg/kg
B. Permethrin 5% cream applied to face, neck, and body and rinsed off in 8 to 14 hours
An adolescent has acne with lesions on the cheeks and under the chin.
Which distribution is this?
A. Athletic
B. Frictional
C. Hormonal
D. Pomadal
C. Hormonal
An adolescent has acne characterized by papules and pustules mostly on the forehead and chin. What will the primary care pediatric nurse practitioner prescribe?
A. Azelaic acid applied daily at nighttime
B. Benzoyl peroxide applied twice daily
C. Topical erythromycin with benzoyl peroxide
D. Tretinoin applied nightly after washing the face
C. Topical erythromycin with benzoyl peroxide
A child has an area of inflammation on the neck that began after wearing a handknot woolen sweater. On examination, the skin appears chafed with mild erythematous patches. The lesions are not pruritic. What is an appropriate initial treatment?
A. Application of a lanolinbased emollient
B. Burow solution soaks and cool compresses
C. Oral antihistamines given 4 times daily
D. Topical corticosteroids applied 2 to 3 times daily
D. Topical corticosteroids applied 2 to 3 times daily
An adolescent who had cradle cap as an infant is in the clinic with thick crusts of yellow, greasy scales on the forehead and behind the ears. What will the primary care pediatric nurse practitioner recommend?
A. Daily application of ketoconazole 2% topical cream
B. Highpotency topical corticosteroids applied daily
C. Mineral oil and shampoo on the affected areas
D. Selenium sulfide shampoo twice weekly to the face
A. Daily application of ketoconazole 2% topical cream
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?
A. Aqueous epinephrine 1:1000 subcutaneously
B. Cetirizine once in clinic and then once daily for 2 weeks
C. Diphenhydramine 0.5 to 1 mg/kg/dose every 4 to 6 hours
D. Prednisone 1 to 2 mg/kg/day for 1 week with rapid taper
C. Diphenhydramine 0.5 to 1 mg/kg/dose every 4 to 6 hours
A child who has been taking antibiotics is brought to the clinic with a rash. The parent reports that the child had a fever associated with what looked like sunburn and now has “blisters” all over. A physical examination shows coalescent target lesions and widespread bullae and areas of peeled skin revealing moist, red surfaces. What will the primary care pediatric nurse practitioner do?
A. Consult with a pediatric intensivist for admission to a pediatric intensive care unit.
B. Order oral acyclovir 20 mg/kg/day in two doses for 6 to 12 months.
C. Prescribe systemic antihistamines and antimicrobial medications as prophylaxis.
D. Recommend analgesics, cool compresses, and oral antihistamines for comfort.
A. Consult with a pediatric intensivist for admission to a pediatric intensive care unit.
A schoolage child has a rash without fever or preceding symptoms. Physical examination reveals a 3cm ovoid, erythematous lesion on the trunk with a finely scaled elevated border, along with generalized macular, ovoid lesions appearing in a “Christmas tree” pattern on the child’s back. What is the initial action?
A. Obtain a KOH preparation of a skin scraping to verify the diagnosis.
B. Prescribe topical steroid creams to shorten the course of the disease.
C. Reassure the child’s parents that the rash is benign and self limited.
D. Recommend topical antihistamines and emollients to control the spread.
C. Reassure the child’s parents that the rash is benign and self limited.
A child who has psoriasis, who has been using a moderatepotency topical steroid on thick plaques on the extremities and a highpotency topical steroid on more severe plaques on the elbows and knees, continues to have worsening of plaques. In consultation with a dermatologist, which treatment will be added?
A. Anthralin ointment in high strength applied for 10 to 30 minutes daily
B. Calcipotriol cream applied liberally each day to the entire body
C. Oral steroids and methotrexate therapy until plaques resolve
D. Wideband ultraviolet therapy for 15 minutes twice daily
A. Anthralin ointment in high strength applied for 10 to 30 minutes daily
or
C. Oral steroids and methotrexate therapy until plaques resolve
LOOK UP
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?
A. Endocrine disorders
B. Malignancy
C. Neurofibromatosis
D. Sturge Weber syndrome
C. Neurofibromatosis
The 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?
A. Consultation with a pediatric dermatologist
B. Performing metabolic laboratory tests
C. Prescribing topical retinoic acid cream
D. Referral to a pediatric endocrinologist
B. Performing metabolic laboratory tests
An African American child has recurrent tinea capitis and has just developed a new area of alopecia after successful treatment several months prior. When prescribing treatment with griseofulvin and selenium shampoo, what else will the primary care pediatric nurse practitioner do?
A. Monitor CBC, LFT, and renal function during therapy.
B. Order oral prednisone daily for 5 to 14 days.
C. Perform fungal cultures on family members and pets.
D. Prescribe oral itraconazole or terbinafine.
C. Perform fungal cultures on family members and pets.
The primary care pediatric nurse practitioner performs a vision screen on a 4monthold infant and notes the presence of convergence and accommodation with mild esotropia of the left eye. What will the nurse practitioner do?
a. Patch the right eye to improve coordination of the left eye.
b. Reassure the parents that the infant will outgrow this.
c. Recheck the infant’s eyes in 2 to 4 weeks.
d. Refer the infant to a pediatric ophthalmologist.
d. Refer the infant to a pediatric ophthalmologist.
During a well child exam on a 4yearold child, the primary care pediatric nurse practitioner notes that the clinic nurse recorded “20/50” for the child’s vision and noted that the child had difficulty cooperating with the exam. What will the nurse practitioner recommend?
a. Follow up with a visual acuity screen in 6 months.
b. Refer to a pediatric ophthalmologist.
c. Retest the child in 1 year.
d. Test the child’s vision in 1 month.
d. Test the child’s vision in 1 month.
During a well child assessment of an African American infant, the primary care pediatric nurse practitioner notes a dark red-brown light reflex in the left eye and a slightly brighter, red-orange light reflex in the right eye. The nurse practitioner will
a. dilate the pupils and reassess the red reflex.
b. order autorefractor screening of the eyes.
c. recheck the red reflex in 1 month.
d. refer the infant to an ophthalmologist.
d. refer the infant to an ophthalmologist.
The primary care pediatric nurse practitioner performs a Hirschberg test to evaluate
a. color vision.
b. ocular alignment.
c. peripheral vision.
d. visual acuity.
b. ocular alignment.
The primary care pediatric nurse practitioner applies fluorescein stain to a child’s eye. When examining the eye with a cobalt blue filter light, the entire cornea appears cloudy. What does this indicate?
a. The cornea has not been damaged.
b. There is too little stain on the cornea.
c. There is damage to the cornea.
d. There is too much stain on the cornea.
d. There is too much stain on the cornea.
A toddler exhibits exotropia of the right eye during a cover/uncover screen. The primary care pediatric nurse practitioner will refer to a pediatric ophthalmologist to initiate which treatment?
a. Botulinum toxin injection
b. Corrective lenses
c. Occluding the affected eye for 6 hours per day
d. Patching of the unaffected eye for 2 hours each day
d. Patching of the unaffected eye for 2 hours each day
The primary care pediatric nurse practitioner performs a well child examination on a 9monthold infant who has a history of prematurity at 28 weeks’ gestation. The infant was treated for retinopathy of prematurity (ROP) and all symptoms have resolved. When will the infant need an ophthalmologic exam?
a. At 12 months of age
b. At 24 months of age
c. At 48 months of age
d. At 60 months of age
a. At 12 months of age
During a wellbaby assessment on a 1weekold infant who had a normal exam when discharged from the newborn nursery 2 days prior, the primary care pediatric nurse practitioner notes moderate eyelid swelling, bulbar conjunctival injections, and moderate amounts of thick, purulent discharge. What is the likely diagnosis?
a. Chemical induced conjunctivitis
b. Chlamydia trachomatis conjunctivitis
c. Herpes simplex virus (HSV) conjunctivitis
d. Neisseria gonorrhea conjunctivitis
b. Chlamydia trachomatis conjunctivitis
The primary care pediatric nurse practitioner performs a well baby assessment of a 5dayold infant and notes mild conjunctivitis, corneal opacity, and serosanguinous discharge in the right eye. Which course of action is correct?
a. Administer intramuscular ceftriaxone 50 mg/kg.
b. Admit the infant to the hospital immediately.
c. Give oral erythromycin 30 to 50 mg/kg/day for 2 weeks.
d. Teach the parent how to perform tear duct massage.
b. Admit the infant to the hospital immediately.
A preschoolage child who attends day care has a 2day history of matted eyelids in the morning and burning and itching of the eyes. The primary care pediatric nurse practitioner notes yellowgreen purulent discharge from both eyes, conjunctival erythema, and mild URI symptoms. Which action is correct?
a. Culture the conjunctival discharge.
b. Observe the child for several days.
c. Order an oral antibiotic medication.
d. Prescribe topical antibiotic drops.
d. Prescribe topical antibiotic drops.
A 14yearold child has a 2week history of severe itching and tearing of both eyes. The primary care pediatric nurse practitioner notes redness and swelling of the eyelids along with stringy, mucoid discharge. What will the nurse practitioner prescribe?
a. Saline solution or artificial tears
b. Topical mast cell stabilizer
c. Topical NSAID drops
d. Topical vasoconstrictor drops
c. Topical NSAID drops
The primary care pediatric nurse practitioner observes a tender, swollen red furuncle on the upper lid margin of a child’s eye. What treatment will the nurse practitioner recommend?
a. Culture of the lesion to determine causative organism
b. Referral to ophthalmology for incision and drainage
c. Topical steroid medication
d. Warm, moist compresses 3 to 4 times daily
d. Warm, moist compresses 3 to 4 times daily
The primary care pediatric nurse practitioner is treating an infant with lacrimal duct obstruction who has developed bacterial conjunctivitis. After 2 weeks of treatment with topical antibiotics along with massage and frequent cleansing of secretions, the infant’s symptoms have not improved. Which action is correct?
a. Perform massage more frequently.
b. Prescribe an oral antibiotic.
c. Recommend hot
compresses.
d. Refer to an ophthalmologist.
d. Refer to an ophthalmologist.
A preschool-age child is seen in the clinic after waking up a temperature of 102.2°F, swelling and erythema of the upper lid of one eye, and moderate pain when looking from side to side. Which course of treatment is correct?
a. Admit to the hospital for intravenous antibiotics.
b. Obtain a lumbar puncture and blood culture.
c. Order warm compresses 4 times daily for 5 days.
d. Prescribe a 10 to 14day course of oral antibiotics.
a. Admit to the hospital for intravenous antibiotics.
A schoolage child is seen in the clinic after a fragment from a glass bottle flew into the eye. What will the primary care pediatric nurse practitioner do?
a. Refer immediately to an ophthalmologist.
b. Attempt to visualize the glass fragment.
c. Irrigate the eye with sterile saline.
d. Instill a topical anesthetic.
a. Refer immediately to an ophthalmologist.
A schoolage child is hit in the face with a baseball bat and reports pain in one eye. The primary care pediatric nurse practitioner is able to see a dark red fluid level between the cornea and iris on gross examination, but the child resists any exam with a light. Which action is correct?
a. Administer an oral analgesic medication.
b. Apply a Fox shield and reevaluate the eye in 24 hours.
c. Instill anesthetic eyedrops into the affected eye.
d. Refer the child immediately to an ophthalmologist.
d. Refer the child immediately to an ophthalmologist.
A schoolage child has a history of chronic otitis media and is seen in the clinic with vertigo. The primary care pediatric nurse practitioner notes profuse purulent otorrhea from both pressure equalizing tubes and a pearly white lesion on one tympanic membrane. Which condition is most likely?
a. Cholesteatoma
b. Mastoiditis
c. Otitis externa
d. Otitis media with effusion
a. Cholesteatoma
A child who was treated with amoxicillin and then amoxicillin clavulanate for acute otitis media is seen for follow up. The primary care pediatric nurse practitioner notes dull gray tympanic membranes with a visible air fluid level. The child is afebrile and without pain. What is the next course of action?
a. Administering ceftriaxone IM
b. Giving clindamycin orally
c. Monitoring ear fluid levels for 3 months
d. Watchful waiting for 48 to 72 hours
c. Monitoring ear fluid levels for 3 months
The primary care pediatric nurse practitioner diagnoses acute otitis media in a 2yearold child who has a history of three ear infections in the first 6 months of life. The child’s tympanic membrane is intact and the child has a temperature of 101.5°F. What will the nurse practitioner prescribe for this child?
a. Amoxicillin twice daily for 10 days
b. An analgesic medication and watchful waiting
c. Antibiotic ear drops and ibuprofen
d. Ceftriaxone given once intramuscularly
b. An analgesic medication and watchful waiting
A 3yearold child has had one episode of acute otitis media 3 weeks prior with a normal tympanogram just after treatment with amoxicillin. In the clinic today, the child has a type B tympanogram, a temperature of 102.5°F, and a bulging tympanic membrane. What will the primary care pediatric nurse practitioner order?
a. A referral for tympanocentesis
b. Amoxicillin twice daily
c. Amoxicillin clavulanate twice daily
d. Intramuscular ceftriaxone
c. Amoxicillin clavulanate twice daily
The primary care pediatric nurse practitioner notes a small, round object in a child’s external auditory canal, near the tympanic membrane. The child’s parent thinks it is probably a dried pea. What will the nurse practitioner do to remove this object?
a. Irrigate the external auditory canal to flush out the object.
b. Refer the child to an otolaryngologist for removal.
c. Remove the object with a wire loop curette.
d. Use a bayonet forceps to grasp and remove the object.
b. Refer the child to an otolaryngologist for removal.
A child who has otitis externa has severe swelling of the external auditory canal that persists after 2 days of therapy with ototopical antibiotic/corticosteroid drops. What is the next step in treatment for this child?
a. Insert a wick into the external auditory canal.
b. Irrigate the external auditory canal with saline.
c. Order systemic corticosteroids.
d. Prescribe an oral antibiotic medication
a. Insert a wick into the external auditory canal.
A child complains of itching in both ears and is having trouble hearing. The primary care pediatric nurse practitioner notes periauricular edema and marked swelling of the external auditory canal and elicits severe pain when manipulating the external ear structures. Which is an appropriate intervention?
a. Obtain a culture of the external auditory canal.
b. Order ototopical antibiotic/corticosteroid drops.
c. Prescribe oral amoxicillin clavulanate.
d. Refer the child to an otolaryngologist.
b. Order ototopical antibiotic/corticosteroid drops.
A child with a history of otitis externa asks about ways to prevent this condition. What will the primary care pediatric nurse practitioner recommend?
a. Cleaning ear canals well after swimming
b. Drying the ear canal with a hair dryer
c. Swimming only in chlorinated pools
d. Using cerumenolytic agents daily
b. Drying the ear canal with a hair dryer
What will the primary care pediatric nurse practitioner teach the parents of a child who has new pressure equalizing tubes (PET) in both ears?
a. Parents should notice improved hearing in their child.
b. PET will help by reducing the number of ear infections the child has.
c. The child should use earplugs when showering or bathing.
d. The tubes will most likely remain in place for 3 to 4 years.
a. Parents should notice improved hearing in their child.