Exam 2 Flashcards
(218 cards)
1
Q
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.
A
Q. Apply sodium fluoride varnish to the infant’s teeth.
2
Q
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.
A
C. Give the infant a cold teething ring or wet washcloth to chew.
3
Q
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
A. If the child is still drinking milk from a bottle
4
Q
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
A
C. Every 3 to 6 months
5
Q
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
A
B. Testing the fluoride level of their water source
6
Q
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
A
To use a smear of toothpaste and not to rinse the mouth
7
Q
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
A
Offering gum containing xylitol after meals
8
Q
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
A. Consistently brushing and flossing the teeth twice daily
9
Q
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
A
C. Topical application of diphenhydramine and Maalox
10
Q
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
A. Chlorhexidine gluconate
11
Q
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.
A
Reassure the parent that these are benign lesions.
12
Q
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
A
D. Gastroesophageal reflux
13
Q
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
A. Recommend ice packs, NSAIDs, and a soft diet.
14
Q
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.
A
C. Refer the child to a dentist immediately for further examination.
15
Q
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
A
B. Daily chlorhexidine gluconate rinses
16
Q
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.”
A
b. “I let my baby cry a while to learn to be patient.”
17
Q
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.
A
d. It is important for the parent to learn to manage criticism and power struggles.
18
Q
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.
A
c. Take time to actively listen to the parent’s and child’s perceptions of the problem.
19
Q
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
A
d. Observation of the child with caretakers in structured and unstructured situations.
20
Q
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.
A
b. Refer the child to a mental health specialist for evaluation and treatment.
21
Q
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
a. Ask the parent if the child is slow to warm up to other new situations.
22
Q
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.
A
d. The significance of this loss must be reworked at each developmental level.
23
Q
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
a. “Fear of imaginary creatures does not usually occur at this age.”
24
Q
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
A
d. Play therapy
25
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.
26
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)
27
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
28
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
29
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.
30
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
31
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
32
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.
33
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.
34
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
35
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.
36
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.
37
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.
38
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
39
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.
40
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.
41
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
42
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
43
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.
44
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
45
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
46
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
47
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.
48
. 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
49
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
50
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
51
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
52
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
53
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
54
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
55
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
56
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
57
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.
58
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.
59
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
60
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
61
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
62
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.
63
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.
64
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.
65
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.
66
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.
67
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.
68
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
69
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
70
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
71
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.
72
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.
73
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
74
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
75
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.
76
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.
77
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.
78
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.
79
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
80
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
81
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
82
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
83
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.
84
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.
85
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.
86
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
87
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.
88
A 3yearold child with pressure equalizing tubes (PET) in both ears has otalgia in one ear. The primary care pediatric nurse practitioner is able to visualize the tube and does not see exudate in the ear canal and obtains a type A tympanogram. What will the nurse practitioner do?
a. Order ototopical antibiotic/corticosteroid drops.
b. Prescribe a prophylactic antibiotic medication.
c. Reassure the parent that this is a normal exam.
d. Refer the child to an otolaryngologist for followup
a. Order ototopical antibiotic/corticosteroid drops.
89
A 7monthold infant has had two prior acute ear infections and is currently on the 10th day of therapy with amoxicillin clavulanate after a failed course of amoxicillin. The primary care pediatric nurse practitioner notes marked middle ear effusion and erythema of the TM. The child is irritable and has a temperature of 99.8°F. What is the next step in management of this child's ear infection?
a. Order a second course of amoxicillin clavulanate.
b. Perform tympanocentesis for culture.
c. Prescribe clindamycin twice daily.
d. Refer the child to an otolaryngologist
d. Refer the child to an otolaryngologist
90
An 18monthold child with no previous history of otitis media awoke during the night with right ear pain. The primary care pediatric nurse practitioner notes an axillary temperature of 100.5°F and an erythematous, bulging tympanic membrane. A tympanogram reveals of peak of +150 mm H2O. What is the recommended treatment for this child?
a. Amoxicillin 80 to 90 mg/kg/day in two divided doses
b. An analgesic medication and watchful waiting
c. Ceftriaxone 50 to 75 mg/kg/dose IM given once
d. Ototopical antibiotic drops twice daily for 5 days
b. An analgesic medication and watchful waiting
91
The primary care pediatric nurse practitioner obtains a tympanogram on a child that reveals a sharp peak of 180 mm H2O. What does this value indicate?
a. A normal tympanic membrane
b. Middle ear effusion
c. Negative ear pressure
d. Tympanic membrane perforation
c. Negative ear pressure
92
The parent of a 4monthold infant is concerned that the infant cannot hear. Which test will the primary care pediatric nurse practitioner order to evaluate potential hearing loss in this infant?
a. Acoustic reflectometry
b. Audiometry
c. Auditory brainstem response (ABR)
d. Evoked otoacoustic emission (EOAE) testing
c. Auditory brainstem response (ABR)
93
In a respiratory disorder causing a check valve obstruction, which symptoms will be present?
a. Air entry on inspiration with expiratory occlusion
b. Complete obstruction on inspiration and expiration
c. Narrowing of the lumen with increased air flow resistance
d. Obstruction of air entry with unimpeded expiratory air flow
a. Air entry on inspiration with expiratory occlusion
94
A child has an acute infection causing lower airway obstruction. Which initial symptom is expected in this child?
a. Atelectasis
b. Barrel chest
c. Over-inflation
d. Wheezing
d. Wheezing
95
A 4yearold child with an upper respiratory tract infection has cloudy nasal discharge and moderate nasal congestion interfering with sleep. The parent asks what product to use to help with symptoms. What will the primary care pediatric nurse practitioner recommend?
a. Antihistamines
b. Decongestant sprays
c. Saline rinses
d. Zinc supplements
c. Saline rinses
96
A 5yearold child has enlarged tonsils and a history of four throat infections in the previous year with fever, cervical lymphadenopathy, and positive Group AStreptococcus pyogenes (GABHS) cultures. The parent reports that the child snores at night and expresses concerns about the child's quality of sleep. The next step in managing this child's condition is to
a. continue to observe the child for two or more GABHS infections.
b. prescribe prophylactic antibiotics to prevent recurrent infection.
c. refer to a pulmonologist for polysomnography evaluation.
d. refer to an otolaryngologist for possible tonsillectomy.
c. refer to a pulmonologist for polysomnography evaluation.
97
A schoolage child has an abrupt onset of sore throat, nausea, headache, and a temperature of 102.3°F. An examination reveals petechiae on the soft palate, beefyred tonsils with yellow exudate, and a scarlatiniform rash. A Rapid Antigen Detection Test (RADT) is negative. What is the next step in management for this child?
a. Consider a sexual abuse diagnosis.
b. Obtain an antistreptococcal antibody titer.
c. Perform a follow-up throat culture.
d. Prescribe amoxicillin for 10 days.
c. Perform a follow-up throat culture.
98
An adolescent has suspected infectious mononucleosis after exposure to the virus in the past week. The primary care pediatric nurse practitioner examines the adolescent and notes exudate on the tonsils, soft palate petechiae, and diffuse adenopathy. Which test will the primary care pediatric nurse practitioner perform to confirm the diagnosis?
a. Complete blood count
b. EBV-specific antibody testing
c. Heterophile antibody testing
d. Throat culture
b. EBV-specific antibody testing
99
A school age child has had nasal discharge and daytime cough but no fever for 12 days without improvement in symptoms. The child has not had antibiotics recently and there is no significant antibiotic resistance in the local community. What is the appropriate treatment for this child?
a. Amoxicillin 45 mg/kg/day
b. Amoxicillin 8090 mg/kg/day
c. Amoxicillin clavulanate 8090 mg/kg/day
d. Saline irrigation for symptomatic relief
a. Amoxicillin 45 mg/kg/day
100
After 14 days of treatment with amoxicillin 45 mg/kg/day for acute rhinosinusitis, a child continues to have mucopurulent nasal discharge along with induration, swelling, and erythema of both eyelids. What is the next course of treatment?
a. Amoxicillin 80 mg/kg/day for 14 days
b. Amoxicillin clavulanate for 10 to 14 days
c. Antibiotic ophthalmic drops for 5 to 7 days
d. Referral to a pediatric otolaryngologist
d. Referral to a pediatric otolaryngologist
101
The parent of a toddler and a 4weekold infant tells the primary care pediatric nurse practitioner that the toddler has just been diagnosed with pertussis. What will the nurse practitioner do to prevent disease transmission to the infant?
a. Administer the initial diphtheria, pertussis, and tetanus vaccine.
b. Instruct the parent to limit contact between the toddler and the infant.
c. Order azithromycin 10 mg/kg/day in a single dose daily for 5 days.
d. Prescribe erythromycin 10 mg/kg/dose four times daily for 14 days.
c. Order azithromycin 10 mg/kg/day in a single dose daily for 5 days.
102
A schoolage child has frequent nosebleeds. Nasal visualization reveals fresh clots and excoriated nasal mucosa but no visible site of bleeding. Coagulation studies are normal. In spite of symptomatic measures, the child continues to have nosebleeds. What is the next course of action?
a. Cauterize the mucosa with silver nitrate sticks.
b. Order a topical vasoconstrictor medication.
c. Prescribe a barrier agent such as petrolatum jelly.
d. Refer to an otolaryngologist for further evaluation.
d. Refer to an otolaryngologist for further evaluation.
103
A child is in the clinic because of symptoms of purulent, foul smelling nasal discharge from the right nostril. Nasal visualization reveals something shiny in a mass of mucous in the nasal cavity. What will the primary care pediatric nurse practitioner do?
a. Attempt to remove the mass gently using alligator forceps.
b. Perform a saline nasal rinse using a water jet device.
c. Refer the child to a pediatric otolaryngologist.
d. Suction the mucoid mass using a bulb syringe.
a. Attempt to remove the mass gently using alligator forceps.
104
A 2yearold child is brought to the clinic after developing a hoarse, bark-like cough during the night with "trouble catching his breath" according to the parent. The history reveals a 2 day history of low-grade fever and upper respiratory symptoms. On exam, the child has a respiratory rate of 40 breaths per minute, occasional stridor when crying, and a temperature of 101.3°F. What is the next step in treatment for this child?
a. Administer intramuscular dexamethasone.
b. Admit the child for inpatient hospitalization.
c. Give the child a racemic epinephrine treatment in the office.
d. Prescribe oral dexamethasone for 2 days.
d. Prescribe oral dexamethasone for 2 days.
105
The primary care pediatric nurse practitioner evaluates a child who awoke with a sore throat and high fever after a nap. The child appears anxious and is sitting on the parent's lap with the neck hyperextended. The physical exam reveals stridor, drooling, nasal flaring, and retractions. What will the nurse practitioner do next?
a. Administer a broad-spectrum intravenous antibiotic.
b. Obtain blood and throat cultures and start antibiotic therapy.
c. Send the child to radiology for a lateral neck radiograph.
d. Transport the child to the hospital via emergency medical services.
d. Transport the child to the hospital via emergency medical services.
106
A 5monthold infant who has a 3day history of cough and rhinorrhea has developed symptoms of respiratory distress with audible expiratory wheezes and increased coughing. The infant's immunizations are uptodate. The physical exam reveals a respiratory rate of 50 breaths per minute, coarse expiratory wheezing, and prolonged expiration. An oxygen saturation is 96% on room air. What is the recommended treatment for this infant?
a. Administer a trial of bronchodilators.
b. Obtain a viral culture of nasal washings.
c. Order an oral corticosteroid medication.
d. Recommend increased fluids and close followup.
d. Recommend increased fluids and close follow-up.
107
A previously healthy school age child develops a cough and a low-grade fever. The primary care pediatric nurse practitioner auscultates wheezes in all lung fields. Which diagnosis will the nurse practitioner suspect?
a. Atypical pneumonia
b. Bacterial pneumonia
c. Bronchiolitis
d. Bronchitis
a. Atypical pneumonia
108
A child is diagnosed with community acquired pneumonia and will be treated as an outpatient. Which antibiotic will the primary care pediatric nurse practitioner prescribe?
a. Amoxicillin
b. Azithromycin
c. Ceftriaxone
d. Oseltamivir
a. Amoxicillin
109
The primary care pediatric nurse practitioner manages care in conjunction with a pediatric pulmonologist for a child with cystic fibrosis. Which medication regimen is used to facilitate airway clearance for this child?
a. Ibuprofen and azithromycin
b. Inhaled dornase alfa
c. Ivacaftor
d. Prophylactic clindamycin
b. Inhaled dornase alfa
110
The primary care pediatric nurse practitioner is examining a 2weekold infant and auscultates a wide splitting of S2 during expiration. What condition may this finding represent?
a. Atrial septal defect
b. Coarctation of the aorta
c. Patent ductus arteriosis
d. Ventricular septal defect
a. Atrial septal defect
111
The primary care pediatric nurse practitioner auscultates a new grade II vibratory, midsystolic murmur at the mid sternal border in a 4yearold child that is louder when the child is supine. What type of murmur is most likely?
a. Pathologic murmur
b. Pulmonary flow murmur
c. Still's murmur
d. Venous hum
c. Still's murmur
112
During a well child assessment, the primary care pediatric nurse practitioner auscultates a harsh, blowing grade IV/VI murmur in a 6monthold infant. What will the nurse practitioner do next?
a. Get a complete blood count to rule out severe anemia.
b. Obtain an electrocardiogram to assess for arrhythmia.
c. Order a chest radiograph to evaluate for cardiomegaly.
d. Refer to a pediatric cardiologist for further evaluation.
d. Refer to a pediatric cardiologist for further evaluation.
113
The primary care pediatric nurse practitioner provides primary care for a 4monthold infant who has a ventricular septal defect. The infant has been breastfeeding well but in the past month has dropped from the 20th percentile to the 5th for weight. What will the nurse practitioner recommend?
a. Adding solid foods to the infant's diet to increase caloric intake
b. Fortifying breast milk to increase the number of calories per ounce
c. Stopping breastfeeding and giving 30 kcal/ounce formula
d. Supplementing breastfeeding with 24 kcal/ounce formula
b. Fortifying breast milk to increase the number of calories per ounce
114
A 12-month-old infant who had cardiopulmonary bypass with RBC and plaasma infusions during surgery at 8 months is seen for a well child examination. Which vaccine may be administered at this visit?
a. MMR
b. OPV
c. PCV13
d. Varivax
c. PCV13
115
The primary care pediatric nurse practitioner performs a well child examination on a 12monthold child who had repair of a congenital heart defect at 8 months of age. The child has a normal exam. The parent reports that the child is not taking any medications. The nurse practitioner will contact the child's cardiologist to discuss whether the child needs which medication?
a. Amoxicillin
b. Capoten
c. Digoxin
d. Furosemide
a. Amoxicillin
116
During a well baby examination of a 6weekold infant, the primary care pediatric nurse practitioner notes poor weight gain, acrocyanosis of the hands and feet, and a respiratory rate of 60 breaths per minute. Oxygen saturation on room air is 93%. The remainder of the exam is unremarkable. Which action is correct?
a. Follow-up in 1 week to assess the infant's weight.
b. Order a chest radiograph and an electrocardiogram.
c. Reassure the parents that the exam is within normal limits.
d. Refer the infant to a pediatric cardiologist.
d. Refer the infant to a pediatric cardiologist.
117
A 3monthold infant who was previously healthy now has a persistent cough, bilateral lung crackles, and poor appetite. The primary care pediatric nurse practitioner auscultates a grade III/VI, low pitched, holosystolic murmur over the left lower sternal border and palpates the liver at one centimeter below the ribs. What diagnosis is likely?
a. Atrial septal defect
b. Coarctation of the aorta
c. Patent ductus arteriosis
d. Ventricular septal defect
d. Ventricular septal defect
118
An infant with trisomy 21 has a complete AV canal defect. Which finding, associated with having both of these conditions, will the primary care pediatric nurse practitioner expect?
a. Crackles in both lungs
b. Hepatomegaly
c. Oxygen desaturation
d. Peripheral edema
c. Oxygen desaturation
119
A 9monthold infant has a grade III/VI, harsh, rumbling, continuous murmur in the left infraclavicular fossa and pulmonic area. A chest radiograph reveals cardiac enlargement. The primary care pediatric nurse practitioner will refer the infant to a pediatric cardiologist and prepare the parents for which intervention to repair this defect?
a. Cardiopulmonary bypass surgery
b. Coil insertion in the catheterization laboratory
c. Indomethacin administration
d. Observation for spontaneous closure
b. Coil insertion in the catheterization laboratory
120
A 5yearold child who had a repair for transposition of the great arteries shortly after birth is growing normally and has been asymptomatic since the surgery. The primary care nurse practitioner notes mild shortness of breath with exertion and, upon questioning, learns that the child has recently complained of dizziness. What will the nurse practitioner do?
a. Order an echocardiogram and chest radiograph.
b. Perform pulmonary function testing.
c. Reassure the parent that these symptoms are common.
d. Refer the child to the cardiologist immediately.
d. Refer the child to the cardiologist immediately.
121
The primary care pediatric nurse practitioner is performing a well child examination on a schoolage child who had complete repair of a tetralogy of Fallot defect in infancy. What is important in this child's health maintenance regime?
a. Cardiology clearance for sports participation
b. Restriction of physical activity to avoid pulmonary complications
c. Subacute bacterial endocarditis prophylaxis precautions
d. Teaching about management of hypercyanotic episodes
a. Cardiology clearance for sports participation
122
During a routine well child exam on a 5yearold child, the primary care pediatric nurse practitioner auscultates a grade II/VI, harsh, late systolic ejection murmur at the upper left sternal border that transmits to both lung fields. The child has normal growth and development. What will the nurse practitioner suspect?
a. Aortic stenosis
b. Patent ductus arteriosus
c. Pulmonic stenosis
d. Tricuspid atresia
c. Pulmonic stenosis
123
A 5yearold child has an elevated blood pressure during a well child exam. The primary care pediatric nurse practitioner notes mottling and pallor of the child's feet and lower legs and auscultates a systolic ejection murmur in the left infraclavicular region radiating to the child's back. The nurse practitioner will suspect which condition?
a. Aortic stenosis
b. Coarctation of the aorta
c. Patent ductus arteriosus
d. Pulmonic stenosis
b. Coarctation of the aorta
124
An adolescent female has a history of repaired tetralogy of Fallot. Which longterm complication is a concern for this patient?
a. Aortic stenosis
b. Chronic cyanosis
c. Mitral valve prolapse
d. Ventricular failure
c. Mitral valve prolapse
125
A 6yearold child has a systolic blood pressure between the 95th and 99th percentile for age, sex, and height and a diastolic blood pressure between the 90th and the 95th percentile on three separate clinic visits. This child's blood pressure is classified as
a. normotensive.
b. prehypertensive.
c. stage 1 hypertensive.
d. stage 2 hypertensive.
c. stage 1 hypertensive.
126
A 12yearold child whose weight and BMI are in the 75th percentile has a diastolic blood pressure that is between the 95th and 99th percentiles for age, sex, and height on three separate occasions. Initial tests for this child will include
a. complete blood count.
b. erythrocyte sedimentation rate.
c. renal function and plasma renin tests.
c. renal function and plasma renin tests.
127
The primary care pediatric nurse practitioner is performing a sports physical on an adolescent whose history reveals mild aortic stenosis. What will the nurse practitioner recommend?
a. Avoidance of all sports to prevent sudden death
b. Clearance for any sports since this is mild
c. Evaluation by a cardiologist prior to participation
d. Low intensity sports, such as golf or bowling
c. Evaluation by a cardiologist prior to participation
128
A 12yearold child whose BMI is greater than the 95th percentile has a blood pressure at the 98th percentile for age, sex, and height. After lifestyle changes that include diet and exercise, the child's BMI drops to the 90th percentile, but the blood pressure remains the same. What is the primary care pediatric nurse practitioner's next step in treating this child?
a. Continued close
monitoring of blood pressure
b. Ordering an echocardiogram or MRI
c. Prescribing an ACE inhibitor medication
d. Referral to a nephrologist or cardiologist
d. Referral to a nephrologist or cardiologist
129
A 7yearold child who has a history of a repaired congenital heart defect has many dental caries along with gingival erythema and irritation and a temperature of 102.5°F. What will the primary care pediatric nurse practitioner do next?
a. Admit to the hospital with a pediatric cardiology consult.
b. Obtain blood cultures and a CBC and consult a pediatric cardiologist.
c. Refer the child to a pediatric dental surgeon immediately.
d. Start prophylactic antibiotics such as penicillin twice daily for 2 weeks.
a. Admit to the hospital with a pediatric cardiology consult.
130
A 15yearold female reports fainting at school in class on two occasions. The adolescent's orthostatic blood pressures are normal. The primary care pediatric nurse practitioner suspects a cardiac cause for these episodes and will order which tests before referring her to a pediatric cardiologist?
a. 12lead electrocardiogram
b. Echocardiogram
c. Tilt table testing
d. Treadmill exercise testing
a. 12lead electrocardiogram
131
The primary care pediatric nurse practitioner reviews a child's complete blood count with differential white blood cell values and recognizes a "left shift" because of
a. a decreased eosinophil count.
b. a decreased lymphocyte count.
c. an elevated monocyte count.
d. an elevated neutrophil count.
d. an elevated neutrophil count.
132
A complete blood count on a 12monthold infant reveals microcytic, hypochromic anemia with a hemoglobin of 9.5 g/dL. The infant has mild pallor with no hepatosplenomegaly. The primary care pediatric nurse practitioner suspects
a. hereditary spherocytosis.
b. iron deficiency anemia.
c. lead intoxication.
d. sickle cell anemia.
b. iron deficiency anemia.
133
The primary care pediatric nurse practitioner evaluates a 5yearold child who presents with pallor and obtains labs revealing a hemoglobin of 8.5 g/dL and a hematocrit of 31%. How will the nurse practitioner manage this patient?
a. Prescribe elemental iron and recheck labs in 1 month.
b. Reassure the parent that this represents mild anemia.
c. Recommend a diet high in iron rich foods.
d. Refer to a hematologist for further evaluation.
a. Prescribe elemental iron and recheck labs in 1 month.
134
The primary care pediatric nurse practitioner is managing care for a child diagnosed with iron deficiency anemia who had an initial hemoglobin of 8.8 g/dL and hematocrit of 32% who has been receiving ferrous sulfate as 3 mg/kg/day of elemental iron for 4 weeks. The child's current lab work reveals elevations in Hgb/Hct and reticulocytes with a hemoglobin of 10.5 g/dL and a hematocrit of 36%. What is the next step in management of this patient?
a. Continue the current dose of ferrous sulfate and recheck labs in 1 to 2 months.
b. Discontinue the supplemental iron and encourage an iron enriched diet.
c. Increase the ferrous sulfate dose to 4 to 6 mg/kg/day of elemental iron.
d. Refer the child to a pediatric hematologist to further evaluate the anemia.
a. Continue the current dose of ferrous sulfate and recheck labs in 1 to 2 months.
135
The primary care pediatric nurse practitioner performs a well baby examination on a 4monthold infant who is exclusively breastfed and whose mother plans to introduce only small amounts of fruits and vegetables in addition to breastfeeding. To ensure that the infant gets adequate amounts of iron, what will the nurse practitioner recommend?
a. Elemental iron supplementation of 1 mg/kg/day until cereals are added
b. Elemental iron supplementation of 3 mg/kg/day for the duration of breastfeeding
c. Monitoring the infant's hemoglobin and hematocrit at every well baby checkup
d. Offering iron fortified formula to ensure adequate iron intake
a. Elemental iron supplementation of 1 mg/kg/day until cereals are added
136
The primary care pediatric nurse practitioner reviews hematology reports on a child with beta thalassemia minor and notes an Hgb level of 8 g/dL. What will the nurse practitioner do?
a. Evaluate serum ferritin.
b. Order Hgb electrophoresis.
c. Prescribe supplemental iron.
d. Refer for RBC transfusions.
a. Evaluate serum ferritin.
137
The primary care pediatric nurse practitioner sees a 12monthold infant who is being fed goat's milk and a vegetarian diet. The child is pale and has a beefy red, sore tongue and oral mucous membranes. Which tests will the nurse practitioner order to evaluate this child's condition?
a. Hemoglobin electrophoresis
b. RBC folate, iron, and B12 levels
c. Reticulocyte levels
d. Serum lead levels
b. RBC folate, iron, and B12 levels
138
A toddler who presents with anemia and reticulocytopenia has a history of a gradual decrease in energy and increase in pallor beginning after a recent viral infection. How will the primary care pediatric nurse practitioner treat this child?
a. Closely observe the child's symptoms and lab values.
b. Consult with a pediatric hematologist.
c. Prescribe supplemental iron for 4 to 6 months.
d. Refer for transfusions to correct the anemia.
a. Closely observe the child's symptoms and lab values.
139
The pediatric nurse practitioner provides primary care for a 30monthold child who has sickle cell anemia who has had one dose of 23valent pneumococcal vaccine. Which is an appropriate action for health maintenance in this child?
a. Administer an initial meningococcal vaccine.
b. Begin folic acid dietary supplementation.
c. Decrease the dose of penicillin V prophylaxis.
d. Give a second dose of 23valent pneumococcal vaccine.
a. Administer an initial meningococcal vaccine.
140
A 2yearold child who has SCA comes to the clinic with a cough and a fever of 101.5°C. The child currently takes penicillin V prophylaxis 125 mg orally twice daily. What will the primary care pediatric nurse practitioner do?
a. Admit the child to the hospital to evaluate for sepsis
b. Give intravenous fluids and antibiotics in clinic.
c. Increase the penicillin V dose to 250 mg.
d. Order a chest radiograph to rule out pneumonia.
a. Admit the child to the hospital to evaluate for sepsis
141
A school age child comes to the clinic for evaluation of excessive bruising. The primary care pediatric nurse practitioner notes a history of an upper respiratory infection 2 weeks prior. The physical exam is negative for hepatosplenomegaly and lymphadenopathy. Blood work reveals a platelet count of 60,000/mm3 with normal PT and aPTT. How will the nurse practitioner manage this child's condition?
a. Admit to the hospital for IVIG therapy.
b. Begin a short course of corticosteroid therapy.
c. Refer to a pediatric hematologist.
d. Teach to avoid NSAIDs and contact sports.
d. Teach to avoid NSAIDs and contact sports.
142
The primary care pediatric nurse practitioner is examining a 5yearold child who has had recurrent fevers, bone pain, and a recent loss of weight. The physical exam reveals scattered petechiae, lymphadenopathy, and bruising. A complete blood count shows thrombocytopenia, anemia, and an elevated white cell blood count. The nurse practitioner will refer this child to a specialist for
a. bone marrow biopsy.
b. corticosteroids and IVIG.
c. hemoglobin electrophoresis.
d. immunoglobulin testing.
a. bone marrow biopsy.
143
The primary care pediatric nurse practitioner is performing a well child examination on a school age child who has a history of cancer treated with cranial irradiation. What will the nurse practitioner monitor in this child?
a. Cardiomyopathy and arrhythmias
b. Leukoencephalopathy
c. Obesity and gonadal dysfunction
d. Peripheral neuropathy and hearing loss
b. Leukoencephalopathy
144
The parent of an infant asks about using a probiotic medication. What will the primary care pediatric nurse practitioner tell this parent?
a. Probiotic medications have demonstrated efficacy in treating colic.
b. Probiotics are not safe to use to treat infants who have colic.
c. There are no studies showing usefulness of probiotics to manage colic.
d. There is no conclusive evidence about using probiotics to treat colic.
d. There is no conclusive evidence about using probiotics to treat colic.
145
A toddler who was born prematurely refuses most solid foods and has poor weight gain. A barium swallow study reveals a normal esophagus. What will the primary care pediatric nurse practitioner consider next to manage this child's nutritional needs?
a. Consultation with a dietician
b. Fiberoptic endoscopy evaluation
c. Magnetic resonance imaging
d. Video fluoroscopy swallowing study
d. Video fluoroscopy swallowing study
146
A toddler is seen in the clinic after a 2day history of intermittent vomiting and diarrhea. An assessment reveals an irritable child with dry mucous membranes, 3second capillary refill, 2 second recoil of skin, mild tachycardia and tachypnea, and cool hands and feet. The child has had two wet diapers in the past 24 hours. What will the primary care pediatric nurse practitioner recommend?
a. Antidiarrheal medication and clear fluids for 24 hours
b. Bolus of IV normal saline
in the clinic until improvement
c. Hospital admission for IV rehydration and oral fluids
d. Oral rehydration solution with follow up in 24 hours
d. Oral rehydration solution with follow up in 24 hours
147
A 9yearold girl has a history of frequent vomiting and her mother has frequent migraine headaches. The child has recently begun having more frequent and prolonged episodes accompanied by headaches. An exam reveals abnormal eye movements and mild ataxia. What is the correct action?
a. Begin using an antimigraine medication to prevent headaches.
b. Prescribe ondansetron and lorazepam to help manage symptoms.
c. Reassure the parent that this is expected with cyclic vomiting syndrome.
d. Refer to a pediatric gastroenterologist for further workup
d. Refer to a pediatric gastroenterologist for further workup
148
The parent of a 3monthold reports that the infant arches and gags while feedingand spits up undigested formula frequently. The infant's weight gain has dropped to the 5th percentile from the 12th percentile. What is the best course of treatment for this infant?
a. Begin a trial of extensively hydrolyzed protein formula for 2 to 4 weeks.
b. Institute an empiric trial of acid suppression with a proton pump inhibitor (PPI).
c. Perform esophageal pH monitoring to determine the degree of reflux.
d. Reassure the parent that these symptoms will likely resolve by 12 to 24 months.
a. Begin a trial of extensively hydrolyzed protein formula for 2 to 4 weeks.
149
A school age child has a 3month history of dull, aching epigastric pain that worsens with eating and awakens the child from sleep. A complete blood count shows a hemoglobin of 8 mg/dL. What is the next step in management?
a. Administration of H2RA or PPI medications
b. Empiric therapy for H. pylori (HP)
c. Ordering an upper GI series
d. Referral for esophagogastroduodenoscopy (EGD)
d. Referral for esophagogastroduodenoscopy (EGD)
150
A 2monthold infant cries up to 4 hours each day and, according to the parents, is inconsolable during crying episodes with fists and legs noted to be tense and stiff. The infant is breastfeeding frequently but is often fussy during feedings. The physical exam is normal and the infant is gaining weight normally. What will the primary care pediatric nurse practitioner recommend?
a. A complete workup, including laboratory and radiologic tests
b. Eliminating certain foods
from the mother's diet
c. Empiric treatment with a proton pump inhibitor
medication
d. Stopping breastfeeding and beginning a hydrolyzed formula
b. Eliminating certain foods
| from the mother's diet
151
A child is in the clinic after swallowing a metal bead. A radiograph of the GI tract shows a 6 mm cylindrical object in the child's stomach. The child is able to swallow without difficulty and is not experiencing pain. What is the correct course of treatment?
a. Administer ipecac to induce vomiting.
b. Have the parents watch for the object in the child's stool.
c. Insert a nasogastric tube to flush out the object.
d. Refer the child for endoscopic removal of the object.
b. Have the parents watch for the object in the child's stool.
152
A 10yearold child has had abdominal pain for 2 days, which began in the periumbilical area and then localized to the right lower quadrant. The child vomited once today and then experienced relief from pain followed by an increased fever. What is the likely diagnosis?
a. Appendicitis with perforation
b. Gastroenteritis
c. Pelvic inflammatory disease (PID)
d. Urinary tract infection (UTI)
a. Appendicitis with perforation
153
An 18monthold child has a 1day history of intermittent, cramping abdominal pain with nonbilious vomiting. The child is observed to scream and draw up his legs during pain episodes and becomes lethargic in between. The primary care pediatric nurse practitioner notes a small amount of bloody, mucous stool in the diaper. What is the most likely diagnosis?
a. Appendicitis
b. Gastroenteritis
c. Intussusception
d. Testicular torsion
c. Intussusception
154
A schoolage child has had abdominal pain for 3 months that occurs once or twice weekly and is associated with a headache and occasional difficulty sleeping, often causing the child to stay home from school. The child does not have vomiting or diarrhea and is gaining weight normally. The physical exam is normal. According to Bishop, what is included in the initial diagnostic workup for this child?
a. CBC, ESR, amylase, lipase, UA, and abdominal ultrasound
b. CBC, ESR, CRP, and fecal calprotectin
c. CBC, ESR, CRP, UA, stool for ova, parasites, and culture
d. Stool for H. pylori antigen and serum IgA, IgG, tTg
a. CBC, ESR, amylase, lipase, UA, and abdominal ultrasound
155
An adolescent is diagnosed with functional abdominal pain (FAP). The child's symptoms worsen during stressful events, especially with school anxiety. What will be an important part of treatment for this child?
a. Informing the parents that the pain is most likely not real
b. Instituting a lactose free diet along with lactobacillus supplements
c. Teaching about the brain gut interaction causing symptoms
d. Using histamine2blockers to help alleviate symptoms
c. Teaching about the brain gut interaction causing symptoms
156
A school age child has recurrent diarrhea with foul smelling stools, excessive flatus, abdominal distension, and failure to thrive. A 2week lactose free trial failed to reduce symptoms. What is the next step in diagnosing this condition?
a. Lactose hydrogen breath test
b. Serologic testing for celiac disease
c. Stool for ova and parasites
d. Sweat chloride test for cystic fibrosis
b. Serologic testing for celiac disease
157
A child is diagnosed with Crohn disease. What are likely complications for this child?
a. Cancer of the colon and possible colectomy
b. Intestinal obstruction with scarring and strictures
c. Intestinal perforation and hemorrhage
d. Liver disease and sepsis
b. Intestinal obstruction with scarring and strictures
158
A 12monthold 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?
a. Complete blood count and electrolytes
b. Feeding and stooling history and 3day diet history
c. Stool cultures for ova and parasites
d. Swallow study with video fluoroscopy
b. Feeding and stooling history and 3day diet history
159
A 2yearold child has an acute diarrheal illness. The child is afebrile and, with oral rehydration measures, has remained well hydrated. The parent asks what can be done to help shorten the course of this illness. What will the primary care pediatric nurse practitioner recommend?
a. Clear liquids only
b. Lactobacillus
c. Loperamide
d. Peppermint oil
b. Lactobacillus
160
A 30monthold girl who has been toilet trained for 6 months has daytime enuresis and dysuria and a low grade fever. A dipstick urinalysis is negative for leukocyte esterase and nitrites. What is the next step?
a. Begin empiric treatment with trimethoprim sulfamethoxazole.
b. Discuss behavioral interventions for toilet training.
c. Reassure the child's parents that the child does not have a urinary tract infection.
d. Send the urine to the lab for culture
d. Send the urine to the lab for culture
161
The clean catch urine specimen of a child with dysuria, frequency, and fever has a colony count between 50,000 and 100,000 of E. coli. What is the treatment for this child?
a. Obtain a complete blood count and C-reactive protein
b. Perform sensitivity testing before treating with antibiotics
c. Repeat the culture is symptoms persist or worsen
d. Treat with antibiotics for urinary tract infection
d. Treat with antibiotics for urinary tract infection
162
A dipstick urinalysis is positive for leukocyte esterase and nitrites in a school age child with dysuria and foul smelling urine but no fever who has not had previous urinary tract infections. A culture is pending. What will the pediatric nurse practitioner do to treat this child?
a. Order ciprofloxacin ER once daily for 3 days if the culture is positive
b. Prescribe trimethoprim-sulfamethoxazole (TMP) twice daily for 3 to 5 days.
c. Reassure the child's parents that this is likely an asymptomatic bacteriuria
d. Wait for urine culture results to determine the correct course of treatment.
b. Prescribe trimethoprim-sulfamethoxazole (TMP) twice daily for 3 to 5 days.
163
A pre-schoolage child with no previous history has mild flank pain and fever but no abdominal pain or vomiting. A urinalysis is positive for leukocyte esterase and nitrites. A culture is pending. Which is the correct course of treatment for this child?
a. Hospitalize for intravenous antibiotics
b. Order amoxicillin clavulanate
c. Prescribe trimethoprim-sulfamethoxazole
d. Refer for a voiding cysto urethrogram
b. Order amoxicillin clavulanate
164
A 3yearold child has just completed a 7day course of amoxicillin for a second febrile urinary tract infection and currently has a negative urine culture. What is the next course of action?
a. Obtain a renal and bladder ultrasound
b. Prescribe prophylactic antibiotics to prevent recurrence
c. Refer the child for a voiding cystourethrogram
d. Screen urine regularly for leukocyte esterase and nitrites
a. Obtain a renal and bladder ultrasound
165
A 9-month-old infant with a history of three urinary tract infections is diagnosed with grade II vesicoureteral reflux. Which medication will be prescribed?
a. Amoxicillin 10 mg/kg as a single daily dose
b. Ceftriaxone IM 50 mg/kg as a single daily dose
c. Nitrofurantoin 1-2 mg/kg as a single daily dose
d. TMP-SMX; TMP 2 mg/kg as a single daily dose
d. TMP-SMX; TMP 2 mg/kg as a single daily dose
166
The parent of a toddler diagnosed with grade V vesicoureteral reflux asks the primary care pediatric nurse practitioner how the disease will be treated. What will the nurse practitioner tell this parent?
a. That long-term antibiotic prophylaxis will prevent scarring
b. That surgery to correct the condition is possible
c. That the child will most likely require kidney transplant
d. That the condition will probably resolve spontaneously
b. That surgery to correct the condition is possible
167
A healthy 14yearold female has a dipstick urinalysis that is positive for 56 RBCs per hpf but otherwise normal. What is the first question the primary care pediatric nurse practitioner will ask this patient?
a. "Are you sexually active?"
b. "Are you taking any medications?"
c. "Have you had a recent fever?"
d. "When was your last menstrual period (LMP)?"
d. "When was your last menstrual period (LMP)?"
168
A child has gross hematuria, abdominal pain, and arthralgia as well as a rash. What diagnosis is most likely?
a. Henoch-Schonlein purpura
b. Rhabdomyosarcoma
c. Sickle cell disease
d. Systemic lupus erythematosus
a. Henoch-Schonlein purpura
169
An adolescent has 2+ proteinuria in a random dipstick urinalysis. A subsequent first-morning void specimen is negative. What will the primary care pediatric nurse practitioner do to manage this condition?
a. Monitor for proteinuria at each annual well child examination.
b. Order a 24-hour timed urine collection for creatinine and protein excretion.
c. Reassure the parents that this is a benign condition with no follow-up needed.
d. Refer the child to a pediatric nephrologist for further evaluation.
a. Monitor for proteinuria at each annual well child examination.
170
A child is diagnosed with nephrotic syndrome, and the pediatric nurse practitioner provides primary care in consultation with a pediatric nephrologist. The child was treated with steroids and responded well to this treatment. What will the nurse practitioner tell the child's parents about this disease?
a. "Future episodes are likely to have worse outcomes."
b. "Steroids will be used when relapses occur."
c. "This represents a cure from this disease"
d. "Your child will need to take steroids indefinitely."
b. "Steroids will be used when relapses occur."
171
A child who has nephrotic syndrome is on a steroids and a salt restricted diet for a relapse of symptoms. A dipstick urinalysis shows 1+ protein, down from 3+ at the beginning of the episode. In consultation with the child's nephrologist, what is the correct course of treatment considering this finding?
a. Being a taper of the steroid medication while continuing salt restrictions.
b. Continue with steroids and salt restrictions until the urine is negative for protein.
c. Discontinue the steroids and salt restrictions now that improvement has occurred
d. Relax salt restrictions and continue administration of steroids until proteinuria is gone.
b. Continue with steroids and salt restrictions until the urine is negative for protein.
172
A child who had GABHS 2 weeks prior is in the clinic with periorbital edema, dyspnea, and elevated blood pressure. A urinalysis reveals tea colored urine with hematuria and mild proteinuria. What will the primary care pediatric nurse practitioner do to manage this condition?
a. Prescribe a 10- to 14-day course of high-dose amoxicillin
b. Prescribe high-dose steroids in consultation with a nephrologist
c. Reassure the parents that this condition will resolve spontaneously
d. Refer the child to a pediatric nephrologist for hospitalization
d. Refer the child to a pediatric nephrologist for hospitalization
173
An adolescent has rightsided flank pain without fever. A dipstick urinalysis reveals gross hematuria without signs of infection or bacteriuria, and the primary care pediatric nurse practitioner diagnoses possible nephrolithiasis. What is the initial treatment for this condition?
a. Extracorporeal shockwave lithotripsy (ESWL)
b. Increasing fluid intake up to 2L daily
c. Percutaneous removal of renal calculi
d. Referral to a pediatric nephrologist
b. Increasing fluid intake up to 2L daily
174
During a well child examination of a 2yearold 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?
a. Order a CT scan of the chest, abdomen, and pelvis
b. Perform urinalysis, CBC, and renal function tests
c. Reevaluate the mass in 1 to 2 weeks
d. Refer the child to an oncologist immediately
d. Refer the child to an oncologist immediately
175
A 6monthold infant has a retractile testis that was noted at the 2month well baby exam. What will the primary care pediatric nurse practitioner do to manage this condition?
a. Reassure the parent that the testis will most likely descend into place on its own
b. Refer the infant to a pediatric urologist or surgeon for possible orchiopexy
c. Teach the parent to manipulate the testis into the scrotum during diaper changes
d. Tell the parent that hormonal therapy may be needed to correct the condition
b. Refer the infant to a pediatric urologist or surgeon for possible orchiopexy
176
A 9monthold infant is brought to the clinic with scrotal swelling and fussiness. The primary care pediatric nurse practitioner notes a tender mass in the affected scrotum that is difficult to reduce. What is the correct action?
a. Obtain an abdominal radiograph
b. Refer immediately to a pediatric surgeon
c. Schedule an appointment with a pediatric urologist
d. Teach the parents signs of incarceration
b. Refer immediately to a pediatric surgeon
177
The mother of a 12monthold uncircumcised male infant reports that the child seems to have pain associated with voiding. A physical examination reveals a tight, pinpoint opening of the foreskin, which thickened and inflamed. What will the primary care pediatric nurse practitioner do?
a. Attempt to retract the foreskin to visualize the penis
b. Order corticosteroid cream 3 times daily for 4 weeks
c. Refer the child to a pediatric urologist
d. Teach the mother to gently stretch the foreskin with cleaning.
c. Refer the child to a pediatric urologist
178
An adolescent male comes to the clinic reporting unilateral scrotal pain, nausea, and vomiting that began that morning. The primary care pediatric nurse practitioner palpates a painful, swollen testis and elicits increased pain with slight elevation of the testis (a negative Phren's sign). What will the nurse practitioner do?
a. Administer IM ceftriaxone and prescribe doxycycline twice daily for 10 days
b. Encourage bed rest, scrotal support, and ice packs to the scrotum as tolerated.
c. Prescribe NSAIDs, limited activities, and warm compresses to the scrotum
d. Refer the adolescent immediately to a pediatric urologist or surgeon
d. Refer the adolescent immediately to a pediatric urologist or surgeon
179
A 16yearold sexually active female has a fever, bilateral lower abdominal pain, and malaise. A speculum and bimanual exam reveals adnexal tenderness. The urinalysis is normal and cervical cultures are pending. What medications will the primary care pediatric nurse practitioner prescribe for this patient?
a. Azithromycin, doxycycline, and penicillin
b. Cefotaxime, azithromycin, and penicillin
c. Ceftriaxone, doxycycline, and metronidazole
d. Doxycycline, penicillin, and metronidazole
c. Ceftriaxone, doxycycline, and metronidazole
180
A sexually active adolescent female tests positive for N. gonorrhoeae and C.trachomatis. She tells the primary care pediatric nurse practitioner that she wants to be treated today since she is moving out of town the next day. What will the nurse practitioner order?
a. Azithromycin 1 g PO in a single dose
b. Ceftriaxone 250 mg IM and azithromycin 1 g PO one time each
c. Doxycycline 100 mg PO bid for 7 days
d. Erythromycin base 500 mg PO qid for 7 days
b. Ceftriaxone 250 mg IM and azithromycin 1 g PO one time each
181
A 14yearold female has menometrorrhagia with moderate increase in menstrual flow and irregular periods. Her hemoglobin is 13.1 g/dL. How will this be managed?
a. Iron supplementation and prostaglandin inhibitors
b. One OCP twice daily for 3 to 4 days and then daily
c. Progestin every day for 10 to 14 days
d. Referral to a pediatric gynecologist for treatment
a. Iron supplementation and prostaglandin inhibitors
182
An adolescent female has heavy periods that are also irregular. The physical exam is normal. A complete blood count reveals a hemoglobin of 8.9 g/dL. What test will the primary care pediatric nurse practitioner order next?
a. Coagulation studies
b. C-reactive protein
c. Thyroid function
d. Ultrasound of pelvis
a. Coagulation studies
183
An adolescent female has periods every 30 days that are consistently heavy and last from 5 to 8 days. What is her diagnosis?
a. Menometrorrhagia
b. Menorrhagia
c. Metrorrhagia
d. Polymenorrhea
b. Menorrhagia
184
A 16yearold female has not had a menstrual period yet and is concerned. She denies sexual activity. An exam reveals an adult sexual maturity rating. Which laboratory test will the primary care pediatric nurse practitioner order initially?
a. Genetic test for Turner syndrome
b. Pituitary hormone tests
c. Pregnancy test
d. Thyroid function tests
c. Pregnancy test
185
A 16yearold female reports breast tenderness and a "lump." The primary care pediatric nurse practitioner palpates a small fluidfilled mass in her right breast. A pregnancy test is negative. Which action is correct?
a. Obtain a CBC to rule out infection.
b. Order an ultrasound of the mass.
C. Prescribe NSAIDs to treat her discomfort.
D. Reassure her that the findings are normal.
b. Order an ultrasound of the mass.
186
A 15yearold female has a positive pregnancy test and asks the primary care pediatric nurse practitioner not to tell her parents. She is tearful and says she isn't sure she wants to keep the baby. What will the nurse practitioner do first?
a. Determine the state mandated reporting laws.
b. Encourage the adolescent to talk to her parents.
c. Obtain a social work consult to discuss adoption options.
d. Refer her to a prenatal care specialist for followup.
a. Determine the state mandated reporting laws.
187
A 17yearold sexually active female who began having periods at age 14 reports having moderate to severe dull lower abdominal pain associated predominantly with periods but that occurs at other times as well. The history reveals a recent onset of these symptoms. A pregnancy test is negative. Which course of action is most important?
a. Perform a full diagnostic workup to evaluate potential causes.
b. Prescribe a prostaglandin synthetase inhibitor.
c. Start a 3 to 6month trial of oral contraceptive pills.
d. Suggest using transcutaneous electrical nerve stimulation.
a. Perform a full diagnostic workup to evaluate potential causes.
188
A 16yearold female reports dull, achy cramping pain in her lower abdomen lasting 2 or 3 hours that occurs between her menstrual periods each month. The adolescent is not sexually active. What is the treatment for this condition?
a. Abdominal ultrasound to rule out ovarian cyst
b. Oral contraceptives to suppress ovulation
c. Prostaglandin inhibitor analgesics and a heating pad
d. Referral to a pediatric gynecologisT
c. Prostaglandin inhibitor analgesics and a heating pad
189
A schoolage female has had vulvovaginitis for 2 months. All cultures and tests are negative, but the symptoms persist after treatment with both topical antibiotics and oral amoxicillin. What is the next course of action to treat this condition?
a. Estrogen cream at bedtime for 2 to 3 weeks
b. Referral to a pediatric gynecologist for further evaluation
c. trimethoprimsulfamethoxazole daily for 1 to 2 months
d. Workup for possible sexual abuse
a. Estrogen cream at bedtime for 2 to 3 weeks
190
A 4yearold female who has had two urinary tract infections has persistent dysuria and genital redness. The physical exam reveals a thin, flat membrane from the posterior fourchette almost to the clitoris. Which treatment is indicated?
a. Application of A&D ointment
b. Counseling about hygiene
c. Reassurance and observation
d. Use of estrogen containing cream
d. Use of estrogen containing cream
191
An adolescent female tells the primary care pediatric nurse practitioner that she had unprotected sexual intercourse 4 days prior and is worried she might become pregnant. What will the nurse practitioner do?
a. Prescribe ulipristal acetate (Ella).
b. Recommend levonorgestrel (Plan B One Step).
c. Start a combination OCP at regular doses.
d. Suggest using the less expensive After Pill preparation.
a. Prescribe ulipristal acetate (Ella).
192
The primary care pediatric nurse practitioner is prescribing contraception for an adolescent who has not used birth control previously. The adolescent has a normal exam and has no family history of cardiovascular and peripheral vascular disease or diabetes. Which preparation is used initially?
a. A combination oral contraceptive pills (OCP) with 30 to 35 mcg of estrogen and low progestin
b. A combination OCP with low androgenic potency, such as OrthoCyclen
c. A progestin only minipill oral contraceptive
d. A subdermal implant contraception, such as Implanon or Nexplanon
a. A combination oral contraceptive pills (OCP) with 30 to 35 mcg of estrogen and low progestin
193
The primary care pediatric nurse practitioner needs to assess a potential hymenal tear in a prepubertal female who is apprehensive about the exam. Which approach will the nurse practitioner use?
a. Have the child sit frog legged on the parent's lap.
b. Place the child in the knee-chest position on the exam table.
c. Put the child supine on the exam table with her feet in the stirrups.
d. Refer the child for a speculum exam under sedation.
b. Place the child in the knee-chest position on the exam table.
194
During a well baby examination of a newborn, the primary care pediatric nurse practitioner notes adduction of the right forefoot, with normal position of the mid and hindfoot, along with a convex shaped lateral border of the foot. What will the nurse practitioner do to evaluate this deformity?
a. Grasp the heel with one hand and abduct the forefoot with the other hand.
b. Observe both legs for medial and lateral rotations.
c. Order anterior posterior and lateral radiographs of both feet.
d. Refer the infant immediately to a pediatric orthopedic specialist.
a. Grasp the heel with one hand and abduct the forefoot with the other hand.
195
A child who plays soccer is in the clinic reporting pain and swelling in both knees. A physical examination reveals swelling and focal tenderness at the tibial tuberosities, with pain worsening when asked to extend the knees against resistance. What is the treatment for this condition?
a. Apply ice packs to both knees and avoid activities that cause pain.
b. Begin quadricep stretching exercises now to prevent further injury.
c. Obtain radiographic studies to rule out fractures or ligament tears.
d. Refer to a pediatric orthopedic specialist to evaluate the need for surgery.
a. Apply ice packs to both knees and avoid activities that cause pain.
196
A parent is concerned that a 12monthold child is "bowlegged." A physical examination reveals internal tibial torsion bilaterally. A radiograph reveals asymmetric bowing of the legs with an angle greater than 15 degrees. What is the correct action for the primary care pediatric nurse practitioner?
a. Observe the child's condition over time to assess progression.
b. Order physical therapy to prevent progression of symptoms.
c. Reassure the parent that the child will outgrow this deformity
d. Refer to a pediatric orthopedic specialist for treatment.
d. Refer to a pediatric orthopedic specialist for treatment.
197
A 14yearold boy who is overweight develops a unilateral limp with pain in the hip and knee on the affected side. An exam reveals external rotation of the hip when flexed and pain associated with attempts to internally rotate the hip. What is most important initially when managing this child's condition?
a. Place the child on crutches or in a wheelchair to prevent weightbearing.
b. Provide information about weight loss to minimize further injury.
c. Recommend seeing an orthopedic specialist as soon as possible.
d. Refer the child to physical therapy to improve range of motion.
a. Place the child on crutches or in a wheelchair to prevent weightbearing.
198
The primary care pediatric nurse practitioner elicits positive Ortolani and Barlow signs in a 6monthold infant not previously noted in the medical record. What is the correct treatment?
a. Pavlik harness
b. Spica cast
c. Surgical intervention
d. Triple diapering
c. Surgical intervention
199
A young adolescent female is observed to have mild unequal scapula prominences on gross examination while standing. In the Adams forward bending position, this inequality disappears. What will the primary care pediatric nurse practitioner do?
a. Discuss posture and exercise and ask about backpacks and books.
b. Obtain radiographic studies of the entire spine and neck.
c. Reassure the child's parent that functional scoliosis will self resolve.
d. Refer to an orthopedic specialist for evaluation and possible bracing.
a. Discuss posture and exercise and ask about backpacks and books.
200
A young adolescent reports chest pain associated with coughing and lifting. Physical examination reveals tenderness over several ribs, radiating to the back. Auscultation of the heart, lungs, and abdomen are normal. There is no history of injury. What will the primary care pediatric nurse practitioner do?
a. Obtain a chest radiograph to evaluate possible causes for these symptoms.
b. Order an electrocardiogram to rule out potential cardiovascular disease.
c. Recommend NSAIDs, stretching exercises, and ice packs to the area.
d. Refer the child to a pediatric orthopedist for evaluation and treatment.
c. Recommend NSAIDs, stretching exercises, and ice packs to the area.
201
A school age child falls off a swing and suffers a closed fracture of the right clavicle. How will this be managed?
a. Application of a figure eight clavicle brace for 6 to 8 weeks
b. Hospitalization for traction of the affected extremity and shoulder
c. Immobilization with a sling to support the affected extremity
d. Referral to an orthopedic specialist for possible surgical reduction
c. Immobilization with a sling to support the affected extremity
202
A 3yearold child is brought to the clinic by a parent who reports that the child refuses to use the right arm after being swung by both arms while playing. The child is sitting with the right arm held slightly flexed and close to the body. There is no swelling or ecchymosis present. What will the primary care pediatric nurse practitioner do?
a. Consider maltreatment as a possible cause of injury.
b. Gently attempt a supination and flexion technique.
c. Immobilize the arm with a sling and refer to orthopedics.
d. Obtain a radiograph of the child's right arm and elbow.
b. Gently attempt a supination and flexion technique.
203
What will the primary care pediatric nurse practitioner elicit when obtaining a positive Barlow maneuver when screening for developmental dysplasia of the hip?
a. Dislocation of an unstable hip
b. Dropping of the iliac crest with a raised leg
c. Reduction of a dislocated hip
d. Unequal knee heights in a supine child
a. Dislocation of an unstable hip
204
A schoolage child has a fractured wrist with a Salter Harris Type II fracture, according to the radiologist. What is true about this type of fracture?
a. Growth disturbance of the long bones of the arm is likely
b. There is a metaphyseal fragment on the compression side of fracture.
c. There is usually a compression or crushing injury to the physis.
d. This will require anatomic reduction using an open approach.
b. There is a metaphyseal fragment on the compression side of fracture.
205
When performing a neurologic exam to assess for meningeal signs in an infant, the primary care pediatric nurse practitioner will attempt to elicit the Kernig sign by
a. bending the infant at the waist to touch fingers to toes.
b. extending the leg at the knee with the infant supine.
c. flexing the infant's neck to
touch chin to chest.
d. turning the infant's head from side to side.
b. extending the leg at the knee with the infant supine.
206
o evaluate brain tissue disorders in infants, which test is useful?
a. Computerized tomography
b. Head radiographs
c. Magnetic resonance imaging
d. Ultrasonography
d. Ultrasonography
207
A female infant who was developing normally stops meeting developmental milestones at age 12 months and then begins losing previously acquired skills. What will the primary care pediatric nurse practitioner expect to tell the parents about this child's prognosis?
a. Cognitive development will be normal but motor skills will be lost.
b. Physical and speech therapy will help the infant regain lost skills.
c. The child's intellectual development will not progress further.
d. This is a temporary condition with full recovery expected.
c. The child's intellectual development will not progress further.
208
A 14yearold child has a headache, unilateral weakness, and blurred vision preceded by fever and nausea. The child's parent reports a similar episode several months prior. The primary care pediatric nurse practitioner will consult with a pediatric neurologist to order
a. a lumbar puncture.
b. an electroencephalogram (EEG).
c. neuroimaging with magnetic resonance imaging (MRI).
d. positron emission tomography (PET) scan.
c. neuroimaging with magnetic resonance imaging (MRI).
209
During a well baby exam on a 9monthold infant, the parent reports that the baby always uses the left hand to pick up objects and asks if the baby will be lefthanded. What will the primary care pediatric nurse practitioner do?
a. Explain that it is too soon to tell which hand the infant will prefer later.
b. Perform a careful assessment of fine and gross motor skill
c. Teach the parent to encourage the infant to use both hands.
d. Tell the parent that a hand preference usually develops between 6 and 12 months.
b. Perform a careful assessment of fine and gross motor skill
210
The pediatric nurse practitioner provides primary care for a 5yearold child who has cerebral palsy who exhibits athetosis and poor weight gain in spite of receiving high calorie formula to supplement intake. The child has had several episodes of pneumonia in the past year. Which specialty consultation is a priority for this child?
a. Feeding clinic to manage caloric intake
b. Neurology to assess medication needs
c. Pulmonology for possible tracheotomy
d. Surgery for possible fundoplication and gastrostomy
d. Surgery for possible fundoplication and gastrostomy
211
Because of their inability to ambulate, children with cerebral palsy should be evaluated for which nutrients?
a. Calcium and vitamin D
b. Fatsoluble vitamins
c. Iron and zinc
d. Sodium and potassium
a. Calcium and vitamin D
212
A child with a recent history of URI reports tingling and pain in one ear followed by sagging of one side of the face. The primary care pediatric nurse practitioner observes that the child cannot close the eye or mouth on the affected side but does not elicit limb weakness on that side. What will the nurse practitioner do?
a. Initiate a short course of antibiotic therapy.
b. Perform diagnostic testing to rule out serious causes.
c. Prepare the parents for lifelong complications.
d. Prescribe oral prednisone 1 mg/kg/day initially.
d. Prescribe oral prednisone 1 mg/kg/day initially.
213
A child who has had a single nonfebrile seizure has a normal neurologic exam. Which diagnostic test is indicated?
a. CT
b. EEG
c. MRI
d. Polysomnography
b. EEG
214
The parents of an 18monthold child bring the child to the clinic after observing a brief seizure of less than 2 minutes in their child. In the clinic, the child has a temperature of 103.1°F, and the primary care pediatric nurse practitioner notes a left otitis media. The child is alert and responding normally. What will the nurse practitioner do?
a. Order a lumbar puncture, complete blood count, and urinalysis.
b. Prescribe an antibiotic for the ear infection and reassure the parents.
c. Refer to a pediatric neurologist for anticonvulsant and antipyretic prophylaxis.
d. Send the child to the emergency department for EEG and possible MRI.
b. Prescribe an antibiotic for the ear infection and reassure the parents.
215
An adolescent female reports unilateral headache pain associated with abdominal pain and nausea occurring just prior to periods each month. The adolescent has been using naproxen sodium for 6 months but reports little relief from symptoms. What will the primary care pediatric nurse practitioner do?
a. Add acetaminophen and ondansetron to the naproxen regimen.
b. Consider prophylactic therapy with a betablocker or anticonvulsant drug.
c. Prescribe sumatriptan nasal spray at the onset of headache and every 2 hours.
d. Refer the adolescent to a pediatric neurologist for neuroimaging studies.
c. Prescribe sumatriptan nasal spray at the onset of headache and every 2 hours.
216
A child who has sustained a head injury after falling on the playground is brought to the clinic. The parents report that the child cried immediately and was able to walk around after falling. The primary care pediatric nurse practitioner notes slight slurring of the child's speech and the child has vomited twice in the exam room. Which course of action is warranted?
a. Admit the child to the hospital for a neurology consult.
b. Observe the child in the clinic for several hours.
c. Order a head CT and
observe the child at home.
d. Send the child home with instructions for follow-up.
a. Admit the child to the hospital for a neurology consult.
217
The primary care pediatric nurse practitioner performs a well baby exam on a term 4monthold infant and observes flattening of the left occiput, bossing of the right occiput, and anterior displacement of the left ear. The parents report performing various positioning maneuvers, but say that the baby's head shape has worsened. What will the nurse practitioner recommend to correct this finding?
a. Allow the infant to sleep on the tummy when the parents are in the room.
b. Lay the infant in the "back to sleep" position, alternating the left and right occiput.
c. Order a head CT to evaluate the infant for craniosynostosis.
d. Refer the infant for orthotic cranial molding helmet therapy.
d. Refer the infant for orthotic cranial molding helmet therapy.
218
A 4yearold child who has previously met developmental milestones is not toiled trained. The primary care pediatric nurse practitioner notes decreased reflexes in the lower extremities and observe a dimple above the gluteal cleft. Which diagnosis may be considered for this child?
a. Arnold Chiari malformation
b. Reye syndrome
c. Spina bifida cystica
d. Tethered cord
d. Tethered cord
