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1

What will the primary care pediatric nurse practitioner recommend to the parent of an infant who is
teething who asks about comfort measures?

QQQ. Administer oral ibuprofen or apply topical salicylates.

RRR. Apply a topical anesthetic such a benzocaine to the gums.

SSS. Give the infant a cold teething ring
or wet washcloth to chew.

TTT. Try Baby Orajel on the infant’s gums several times daily.

SSS. Give the infant a cold teething ring
or wet washcloth to chew. Correct

2

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.

MMM. If the child or the parents are brushing the
teeth

NNN. If they are brushing the child’s teeth twice daily

OOO. If they have taken the child to a
dentist

A. If the child is still drinking milk from a bottle.

3

An infant is brought to the 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?

EEEE. 1%
hydrocortisone cream to affected areas for 1 to 2 days

FFFF. Oral fluconazole 6 mg/kg on day 1, then 3
mg/kg/dose for 14 days

GGGG. 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

4

17. A 9monthold 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?

N. Ivermectin 200 mcg/kg for 7 to 14 days, along with symptomatic treatment for itching

O. Permethrin 5%
cream applied to face, neck, and body and rinsed off in 8 to 14 hours.

P. Treatment of all family
members except for the infant with permethrin 5% cream and ivermectin

Q. Treatment with permethrin 5%
cream for 7 days in conjunction with ivermectin 200 mcg/k

O. Permethrin 5%
cream applied to face, neck, and body and rinsed off in 8 to 14 hours.

5

An adolescent has acne characterized by papules and pustules mostly on the forehead and chin.
What will the primary care pediatric nurse practitioner prescribe?

O. Azelaic acid applied daily at nighttime

P. 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

6

The primary care pediatric nurse practitioner performs a Hirschberg test to evaluate

PPPPPP. color
vision.

QQQQQQ. ocular alignment.

RRRRRR. peripheral vision.

SSSSSS. visual acuity.

QQQQQQ. ocular alignment.

7

A school-age 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?

U. Refer immediately to an ophthalmologist.

V.Attempt to visualize the glass fragment.

W. Irrigate the eye with sterile saline.

X. Instill a topical
anesthetic.

U. Refer immediately to an ophthalmologist.

8

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?

AAA. Perform massage more frequently.

BBB. Prescribe an oral antibiotic.

CCC. Recommend
hot compresses.

DDD. Refer to an ophthalmologist.

DDD. Refer to an ophthalmologist. Correct

9

During a well-baby 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. Chemicalinduced conjunctivitis

B. Chlamydia trachomatis conjunctivitis

UUUU. Herpes simplex virus (HSV) conjunctivitis

VVVV. Neisseria gonorrhea conjunctivitis

B. Chlamydia trachomatis conjunctivitis

10

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?

RRRR. Order ototopical
antibiotic/corticosteroid drops.

SSSS. Prescribe a prophylactic antibiotic medication.

TTTT. Reassure the parent that this is a normal exam.

UUUU. Refer the child to an otolaryngologist for
followup

RRRR. Order ototopical
antibiotic/corticosteroid drops.

11

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

KKKK. Swimming only in chlorinated pools

LLLL. Using
cerumenolytic agents daily

B. Drying the ear canal with a hair dryer

12

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?

EEE. Administering ceftriaxone IM

FFF. 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

13

A school-age 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

GG. Mastoiditis

HH. Otitis external

II. Otitis media with effusion

A. Cholesteatoma

14

A school-age 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, beefy red 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?

VVVV. Consider a sexual abuse diagnosis.

WWWW. Obtain an
antistreptococcal antibody titer.

XXXX. Perform a follow-up throat culture.

YYYY. Prescribe
amoxicillin for 10 days.

XXXX. Perform a follow-up throat culture.

15

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
Does the practitioner perform to confirm the diagnosis?

A. Complete blood count

B. EBVspecific antibody testing

GGGG. Heterophile antibody testing

HHHH. Throat culture

B. EBV specific antibody testing

16

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

MMMM. Amoxicillin 8090 mg/kg/day

NNNN. Amoxicillin clavulanate
8090 mg/kg/day

OOOO. Saline irrigation for symptomatic relief

A. Amoxicillin 45 mg/kg/day

17

15. 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

Y. Bacterial pneumonia

Z. Bronchiolitis

AA. Bronchitis

A. Atypical pneumonia

18

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

S. Azithromycin

T. Ceftriaxone

U. Oseltamivir

A. Amoxicillin

19

A 2yearold child is brought to the clinic after developing a hoarse, barklike 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?

EEE. Administer intramuscular dexamethasone.

FFF. Admit the child for
inpatient hospitalization.

GGG. Give the child a racemic epinephrine treatment in the office.

HHH. Prescribe oral dexamethasone for 2 days.

HHH. Prescribe oral dexamethasone for 2 days.

20

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

HHHHH. Coarctation of the aorta

V. Patent ductus arteriosis

JJJJJ. Ventricular septal defect

A. Atrial septal defect

21

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

N. Echocardiogram

O. Tilt table testing

P. Treadmill exercise testing

A. 12lead electrocardiogram

22

The primary care pediatric nurse practitioner is performing a well-child examination on a school-age
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

WWW. Restriction
of physical activity to avoid pulmonary complications

XXX. Subacute bacterial endocarditis prophylaxis
precautions

YYY. Teaching about management of hypercyanotic episodes

A. Cardiology clearance for sports participation

23

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?

III. Avoidance of all
sports to prevent sudden death

JJJ. Clearance for any sports since this is mild

C. Evaluation by a
cardiologist prior to participation

D.Lowintensity sports, such as golf or bowling

C. Evaluation by a
cardiologist prior to participation

24

A 5 year old 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

NN. Patent ductus
arteriosus

OO. Pulmonic stenosis

B. Coarctation of the aorta

25

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?

PPPP. Follow Up in 1 week to assess the infant’s weight.

QQQQ. Order a chest
radiograph and an electrocardiogram.

RRRR. Reassure the parents that the exam is within normal limits.

SSSS. Refer the infant to a pediatric cardiologist.

SSSS. Refer the infant to a pediatric cardiologist.

26

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?

BBBBB. Get a complete blood count to rule out severe anemia.

CCCCC. Obtain an electrocardiogram to assess
for arrhythmia.

DDDDD. Order a chest radiograph to evaluate for cardiomegaly.

EEEEE. Refer to a
pediatric cardiologist for further evaluation.

EEEEE. Refer to a
pediatric cardiologist for further evaluation.

27

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

KKKKK. a decreased eosinophil count.

LLLLL. a decreased lymphocyte count.

MMMMM. an elevated monocyte count.

NNNNN. an elevated
neutrophil count.

NNNNN. an elevated
neutrophil count.

28

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?

FFFFF. Prescribe elemental iron and recheck labs in 1 month.

GGGGG. Reassure the parent that this represents mild anemia.

HHHHH. Recommend a diet high in iron rich foods.

IIIII. Refer to a hematologist for further evaluation.

FFFFF. Prescribe elemental iron and recheck labs in 1 month.

29

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?

KKK. Admit to the hospital for IVIG therapy.

LLL. Begin a short course of corticosteroid therapy.

MMM. Refer to a pediatric hematologist.

NNN. Teach to avoid NSAIDs and contact sports.

NNN. Teach to avoid NSAIDs and contact sports.

30

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

VVVV. Empiric
treatment with a proton pump inhibitor medication

WWWW. Stopping breastfeeding and beginning a hydrolyzed formula

B. Eliminating certain foods from the mother’s diet

31

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?

KKKKK. Administer ipecac to induce vomiting.

LLLLL. Have the parents watch for the object in the child’s stool.

MMMMM. Insert a
nasogastric tube to flush out the object.

NNNNN. Refer the child for endoscopic removal of the object.

LLLLL. Have the parents watch for the object in the child’s stool.

32

A school
age 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

DDDD. CBC, ESR, CRP, and fecal calprotectin

EEEE. CBC, ESR, CRP, UA, stool for ova, parasites, and culture

FFFF. Stool for H. pylori antigen and serum
IgA, IgG, tTg

A. CBC, ESR, amylase, lipase, UA, and abdominal ultrasound

33

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

BBBBBB. Gastroenteritis

CCCCCC. Pelvic inflammatory disease (PID)

DDDDDD. Urinary tract
infection (UTI)

A. Appendicitis with perforation

34

An adolescent has right sided flank pain without fever. A dipstick ur inalysis 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 2 L daily

UU. Percutaneous removal of renal calculi

VV. Referral to a pediatric nephrologist

B. Increasing fluid intake up to 2 L daily

35

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?

QQQ. Begin a taper of the steroid medication while continuing salt restrictions.

RRR. Continue
with steroids and salt restrictions until the urine is negative for protein.

SSS. Discontinue the
steroids and salt restrictions now that improvement has occurred.

TTT. Relax salt restrictions and continue administration of steroids until proteinuria is gone

RRR. Continue
with steroids and salt restrictions until the urine is negative for protein.

36

A preschool-age 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?

LLLLLLL. Hospitalize for intravenous antibiotics.

MMMMMMM. Order amoxicillin clavulanate.

NNNNNNN. Prescribe trimethoprim-
sulfamethoxazole.

OOOOOOO. Refer for a voiding cystourethrogram.

MMMMMMM. Order amoxicillin clavulanate.

37

3. A dipstick urinalysis is positive for leukocyte esterase and nitrites in a schoolage 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?

MMMMM. Order ciprofloxacin ER once daily for 3 days if the culture is positive.

NNNNN. Prescribe trimethoprimsulfamethoxazole (TMP) twice daily for 3 to 5 days.

OOOOO. Reassure the child’s parents that this is likely an asymptomatic
bacteriuria.

PPPPP. Wait for urine culture results to determine the correct course of treatment.

NNNNN. Prescribe trimethoprimsulfamethoxazole (TMP) twice daily for 3 to 5 days.

38

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?

T. Obtain an abdominal radiograph.

U. Refer immediately to a pediatric surgeon.

V. Schedule an appointment with a pediatric urologist.

W. Teach the parents signs of incarceration.

U. Refer immediately to a pediatric surgeon.

39

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?

U. Attempt to
retract the foreskin to visualize the penis.

V. Order corticosteroid cream 3 times daily for 4 weeks.

W. Refer the child to a pediatric urologist.

X. Teach the mother to gently stretch the foreskin with cleaning.

W. Refer the child to a pediatric urologist.

40

A 16yearold female reports breast tenderness and a “lump.” The primary care . pediatric nurse
practitioner palpates a small fluid filled mass in her right breast. A pregnancy test is negative. Which
action is correct?

HHHHHH. Obtain a CBC to rule out infection.

IIIIII. Order an ultrasound of the mass.

GGGGG. Prescribe NSAIDs to treat her discomfort.

HHHHH. Reassure her that the findings are
normal.

IIIIII. Order an ultrasound of the mass.

41

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

UUU. Metrorrhagia

VVV. Polymenorrhea

B. Menorrhagia

42

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

JJ. Doxycycline 100 mg PO bid for 7 days

KK. Erythromycin base 500 mg PO qid for 7 days

B.Ceftriaxone 250 mg IM and azithromycin 1 g PO one time each

43

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?

VVVV. Abdominal ultrasound to rule out ovarian cyst

WWWW. 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

44

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

KKKKKK. bending the infant at the waist to touch fingers to toes.

LLLLLL. extending the leg at the knee with the infant supine.

MMMMMM. flexing the infant’s neck to touch chin to chest.

NNNNNN. turning the infant’s head from
side to side

LLLLLL. extending the leg at the knee with the infant supine.

45

A child who has had a single nonfebrile seizure has a normal neurologic exam. Which diagnostic test is
indicated?
A. Computerized tomography (CT)

B. Electroencephalogram (EEG)

NNNNN. Magnetic
resonance imaging (MRI)

OOOOO. Polysomnography

B. Electroencephalogram (EEG)

46

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?

UUUU. Order a lumbar puncture, complete blood count, and
urinalysis.

VVVV. Prescribe an antibiotic for the ear infection and reassure the parents.

WWWW. Refer to a pediatric neurologist for anticonvulsant and antipyretic prophylaxis.

XXXX. Send the child to
the emergency department for EEG and possible MRI.

VVVV. Prescribe an antibiotic for the ear infection and reassure the parents.

47

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?

BBBB. Admit the child to the hospital for a neurology consult.

CCCC. Observe the child in the clinic for several hours.

DDDD. Order a head
CT and observe the child at home.

EEEE. Send the child home with instructions for follow-up.

BBBB. Admit the child to the hospital for a neurology consult.

48

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?

SSS. Attempt to remove the mass gently using alligator
forceps.

TTT. Perform a saline nasal rinse using a water jet device.

UUU. Refer the child to a
pediatric otolaryngologist.

VVV. Suction the mucoid mass using a bulb syringe.

SSS. Attempt to remove the mass gently using alligator
forceps.

49

A school age 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?

QQQQ. Cauterize
the mucosa with silver nitrate sticks.

RRRR. Order a topical vasoconstrictor medication.

SSSS. Prescribe a
barrier agent such as petrolatum jelly.

TTTT. Refer to an otolaryngologist for further evaluation.

TTTT. Refer to an otolaryngologist for further evaluation. Correct