Exam 3

Question 1

The primary care pediatric nurse practitioner is discussing newborn care
with parents prior to the delivery of their first child. What will the nurse practitioner
tell them about circumcision?

I. Circumcision is a relatively painless procedure.

J. The benefits of the procedure outweigh the risks of the procedure.

K. There is a slight increase in penile cancer in circumcised males.

L. There is no good evidence to support the practice.

Answer 1

J. The benefits of the procedure outweigh the risks of the

procedure.

Question 2

The primary care pediatric nurse practitioner performs a well baby exam
on a 2 day old infant and notes clusters of firm, yellow white papules with a
surrounding erythematous flare. What will the nurse practitioner do?

I. Encourage frequent cleansing with mild soap.

J. Obtain a Wrightstained smear of the lesions.

K. Prescribe a topical antibiotic medication.

L. Reassure the parents that no treatment is necessary.

Answer 2

L. Reassure the parents that no treatment is necessary.

Question 3

A well-baby examination of a 3 day old infant born to a primigravida mother
reveals swelling on the right parietal area of the scalp that stops at the
suture line. What action will the primary care pediatric nurse practitioner take based on this finding?

F. Assess the infant for sacral dimpling.

G. Observe the infant for hyperbilirubinemia.

H. Obtain a computerized tomography scan.

I. Perform serum coagulation studies.

Answer 3

G. Observe the infant for hyperbilirubinemia.

Question 4

The parent of a 2weekold infant reports that the infant was diagnosed with
transient tachypnea of the newborn shortly after birth. The primary care pediatric nurse practitioner understands that, in this condition.

D. antibiotic therapy is generally necessary to prevent severe
infection.

E. home oxygen therapy is needed until the infant grows out of the
condition.

F. recovery is usually complete with minimal intervention and
treatments.

G. treatment with exogenous surfactant and mechanical ventilation is
needed.

Answer 4

F. recovery is usually complete with minimal intervention and
treatments.

Question 5

The parent of a 4weekold infant reports that the infant began having forceful vomiting 1 week prior, which has worsened over time. The infant continues to nurse well but is losing weight. A physical examination reveals a 90g weight loss over the past 2 weeks, dry mucous membranes, and a sunken fontanel. What will the primary care pediatric nurse practitioner do?

A. Encourage the mother to nurse the infant more frequently for shorter
duration.

B. Obtain serum electrolytes and hospitalize for surgical
intervention.

C. Recommend oral rehydration fluids for 24 to 48 hours to correct
dehydration.

D. Suggest trying a soy based or hydrolyzed protein formula until
vomiting resolves.

Answer 5

B. Obtain serum electrolytes and hospitalize for surgical

intervention

Question 6

A 5 day old infant who was delivered at home has abdominal distension and poor feeding. The mother is worried that the infant is constipated because he didn’t have a first stool until yesterday and has only passed a small amount of meconium. What will the primary care pediatric nurse practitioner do?

K. Obtain a sweat chloride skin test to evaluate for possible cystic fibrosis.

L. Order an abdominal radiograph and refer the infant to a pediatric surgeon.

M. Prescribe glycerin suppositories to use as needed until bowel
function is normal.

N. Suggest that the mother increase her fluid intake to help with
constipation.

Answer 6

L. Order an abdominal radiograph and refer the infant to a pediatric surgeon.

Question 7

The parent of a 4dayold
infant tells the primary care pediatric nurse
practitioner that the infant was diagnosed with hydronephrosis while in utero and asks what
will be done. What will the nurse practitioner tell this parent?

S. Renal function will be abnormal and will require lifetime treatment.

T. Spontaneous resolution often occurs within 6 months to a year of age.

U. The affected kidney will be nonfunctional
but the other kidney will
compensate.

V. The infant will eventually require renal transplantation for that
kidney

Answer 7

T. Spontaneous resolution often occurs within 6 months to a year of age.

Question 8

A 2monthold infant has increased head circumference from the 10th
percentile at the 2week exam to the 30th percentile today. What will the
primary care pediatric nurse practitioner do?

E. Order a magnetic resonance imaging exam of the infant’s head.

F. Refer the infant immediately to a pediatric neurosurgeon.

G. Schedule frequent clinic visits to monitor head growth.

H. Watch the infant closely over time if the rest of the exam is normal.

Answer 8

F. Refer the infant immediately to a pediatric neurosurgeon.

Question 9

A 3 day old infant has a total serum bilirubin (TSB) level of 15.7 mg/dL after
having a TSB of 10.8 mg/dL 24 hours prior. The infant nursed 8 times, had 7
wet diapers, and passed 4 stools in the past 24 hours. What is the indicated treatment for this
infant?

J. Admit to an inpatient setting for phototherapy and every 12hour bilirubin
monitoring.

V. Have the mother supplement with extra fluids and return to the clinic in
24 hours for a repeat TSB.

W. Recommend nursing every 2 hours, order a biliblanket, and
recheck TSB in 24 hours.

X. Suspend breastfeeding for 24 to 72 hours and have the mother
save pumped breast milk

Answer 9

W. Recommend nursing every 2 hours, order a biliblanket, and

recheck TSB in 24 hours.

Question 10

The primary care pediatric nurse practitioner is performing a well baby
examination on a 7dayold infant born to a Chlamydia positive mother. The infant’s eyes are clear without exudate. The infant is free from cough and lungs are clear. What will the primary care pediatric nurse practitioner do to prevent illness in this infant?

C. Administer a single dose of intramuscular ceftriaxone.

D. Obtain bacterial cultures of both conjunctivae.

E. Prescribe prophylactic erythromycin suspension.

F. Schedule a follow-up appointment in 1 week.

Answer 10

F. Schedule a follow-up appointment in 1 week.

Question 11

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?
U. Apply lubricating agents at least 1 hour after the bath.
V. Have the child soak in a lukewarm water bath.
W. Keep the child in the bath until the skin begins to “prune.”
X. Soaping should be done at the beginning of the bath.

Answer 11

V. Have the child soak in a lukewarm water bath.

Question 12

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?

U. Apply ointment before the dressing.

V. Plastic wrap should not be used.

W. The dressing should be applied to dry skin.

X. Change the dressing twice daily.

Answer 12

U. Apply ointment before the dressing.

Question 13

When prescribing topical glucocorticoids to treat inflammatory skin
conditions, the primary care pediatric nurse practitioner will

P. initiate therapy with a high potency
glucocorticoid.

Q. order lotions when higher potency is necessary.

R. prescribe brand name preparations for consistent effects.

S. use fluorinated steroids to minimize adverse effects.

Answer 13

R. prescribe brand name preparations for consistent effects.

Question 14

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

Answer 14

B. Amoxicillin clavulanate 90 mg/kg/day for 10 days

Question 15

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?

K. Hospitalize the child for intravenous antibiotics and possible I&D of the
lesions.

L. Initiate empiric antibiotic therapy and follow up in 24 hours to
assess response.

M. Obtain blood cultures prior to beginning antibiotic treatment.

N. Perform gram stain and culture of the lesions before initiating
antibiotics.

Answer 15

L. Initiate empiric antibiotic therapy and follow up in 24 hours to
assess response.

Question 16

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?

V. Culture the lesions and treat with appropriate IM antibiotics.

W. Hospitalize for incision and drainage and intravenous antibiotics.

X. Order an anti-staphylococcal betalactamase resistant
antibiotic.

Y. Prescribe topical keratolytics and topical antibiotics.

Answer 16

Y. Prescribe topical keratolytics and topical antibiotics.

Question 17

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?

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

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

G. Topical keratolytics and topical antibiotics for 7 to 10 days

H. Topical nystatin cream applied several times daily

Answer 17

H. Topical nystatin cream applied several times daily

Question 18

A schoolage 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?

Q. Fluoresce the lesions with a Wood’s lamp.

R. Obtain fungal cultures of the lesions.

S. Perform KOH treated scrapings of the lesion borders.

T. Treat empirically with antifungal cream.

Answer 18

T. Treat empirically with antifungal cream.

Question 19

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?

Z. Obtain scrapings of the lesions for fungal cultures.

A. Order prescription strength
antifungal creams.

G. Prescribe oral griseofulvin for 2 to 4 weeks.

H. Recommend OTC antifungal creams and shampoos.

Answer 19

G. Prescribe oral griseofulvin for 2 to 4 weeks.

Question 20

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

Answer 20

A. Application of selenium sulfide 2.5% lotion twice weekly for 2 to 4
weeks

Question 21

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?

W. Direct fluorescent antibody test

X. Enzyme-linked immunosorbent assay

Y. Tzanck smear

Z. Viral culture

Answer 21

Z. Viral culture

Question 22

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?

X. Mupirocin ointment applied to lesions 3 times daily

Y. Oral acyclovir 20 to 40 mg/kg/dose for 7 to 10 days

Z. Topical acyclovir applied to lesions 4 times daily

D. Topical diphenhydramine and magnesium hydroxide

Answer 22

D. Topical diphenhydramine and magnesium hydroxide

Question 23

A previously healthy school age child develops herpes zoster on the lower
back. What will the primary care pediatric nurse practitioner do to manage
this condition?

A. Order Burrow 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.

Answer 23

A. Order Burrow solution and warm soothing baths as comfort

measures

Question 24

A child has small, firm, flesh colored
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

D. Referral to a dermatologist for manual removal of lesions with
curettage

Answer 24

C. Reassuring the parents that these are benign and may disappear
spontaneously

Question 25

A school age 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?

M. Excoriated macules along the child’s collar and underwear lines

N. Inflammation and pustules on the face and neck

O. Itching of the scalp, with skin excoriation on the back of the head

P. Linear or S-shaped lesions in webs of fingers and sides of hands

Answer 25

O. Itching of the scalp, with skin excoriation on the back of the head.

Question 26

A 3-yearold child has head lice. What will the initial treatment recommendation be to treat this child?

A. Lindane

B. Permethrin

C. Pyrethrin

D. Spinosad

Answer 26

B. Permethrin

Question 27

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?

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 the infant with permethrin 5% cream and
ivermectin

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

Answer 27

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

Question 28

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

Answer 28

C. Hormonal

Question 29

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

Answer 29

C. Topical erythromycin with benzoyl peroxide

Question 30

A child has an area of inflammation on the neck that began after wearing
a hand knot woolen sweater. On examination, the skin appears chafed with mild erythematous patches. The lesions are not pruritic. What is an appropriate initial treatment?

K. Application of a lanolin based emollient

L. Burrow solution soaks and cool compresses

M. Oral antihistamines given 4 times daily

D. Topical corticosteroids applied 2 to 3 times daily

Answer 30

D. Topical corticosteroids applied 2 to 3 times daily

Question 31

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. High potency topical corticosteroids applied daily

C. Mineral oil and shampoo on the affected areas

D. Selenium sulfide shampoo twice weekly to the face

Answer 31

A. Daily application of ketoconazole 2% topical cream

Question 32

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?

I. Aqueous epinephrine 1:1000 subcutaneously

J. 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

Answer 32

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

Question 33

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?

E. Consult with a pediatric intensivist for admission to a pediatric intensive care
unit.

F. Order oral acyclovir 20 mg/kg/day in two doses for 6 to 12 months.

G. Prescribe systemic antihistamines and antimicrobial medications as
prophylaxis.

H. Recommend analgesics, cool compresses, and oral antihistamines for
comfort.

Answer 33

E. Consult with a pediatric intensivist for admission to a pediatric intensive care
unit.

Question 34

A school-age 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?

E. Obtain a KOH preparation of a skin scraping to verify the diagnosis.

F. Prescribe topical steroid creams to shorten the course of the disease.

G. Reassure the child’s parents that the rash is benign and self-limited.

H. Recommend topical antihistamines and emollients to control the
spread.

Answer 34

G. Reassure the child’s parents that the rash is benign and self-limited.

Question 35

A child who has psoriasis, who has been using a moderate potency
topical steroid on thick plaques on the extremities and a high potency
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

E. Calcipotriol cream applied liberally each day to the entire body

F. Oral steroids and methotrexate therapy until plaques resolve

G. Wideband ultraviolet therapy for 15 minutes twice daily

Answer 35

F. Oral steroids and methotrexate therapy until plaques resolve

Question 36

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?

I. Endocrine disorders

J. Malignancy

C. Neurofibromatosis

D. Sturge Weber syndrome

Answer 36

C. Neurofibromatosis

Question 37

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

Answer 37

B. Performing metabolic laboratory tests

Question 38

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?

D. Monitor CBC, LFT, and renal function during therapy.

E. Order oral prednisone daily for 5 to 14 days.

F. Perform fungal cultures on family members and pets.

G . Prescribe oral itraconazole or terbinafine.

Answer 38

F. Perform fungal cultures on family members and pets.

Question 39

A school age 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 physics.

D. This will require anatomic reduction using an open approach.

Answer 39

B. There is a metaphyseal fragment on the compression side of fracture.

Question 40

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

Answer 40

A. Dislocation of an unstable hip

Question 41

A 3 year old 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?

U. Consider maltreatment as a possible cause of injury.

V. Gently attempt a supination and flexion technique.

W. Immobilize the arm with a sling and refer to orthopedics.

X. Obtain a radiograph of the child’s right arm and elbow.

Answer 41

V. Gently attempt a supination and flexion technique.

Question 42

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

Answer 42

C. Immobilization with a sling to support the affected extremity

Question 43

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?

O. Obtain a chest radiograph to evaluate possible causes for these symptoms.

P. Order an electrocardiogram to rule out potential cardiovascular disease.

Q. Recommend NSAIDs, stretching exercises, and ice packs to the area.

R. Refer the child to a pediatric orthopedist for evaluation and treatment.

Answer 43

Q. Recommend NSAIDs, stretching exercises, and ice packs to the area.

Question 44

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?

X. Discuss posture and exercise and ask about backpacks and books.

Y. Obtain radiographic studies of the entire spine and neck.

Z. Reassure the child’s parent that functional scoliosis will self resolve.

A. Refer to an orthopedic specialist for evaluation and possible bracing

Answer 44

X. Discuss posture and exercise and ask about backpacks and books.

Question 45

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?

D. Pavlik harness

E. Spica cast

C. Surgical intervention

D. Triple diapering

Answer 45

C. Surgical intervention

Question 46

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?

W. Place the child on crutches or in a wheelchair to prevent weight bearing.

X. Provide information about weight loss to minimize further injury.

Y. Recommend seeing an orthopedic specialist as soon as possible.

Z. Refer the child to physical therapy to improve range of motion.

Answer 46

W. Place the child on crutches or in a wheelchair to prevent weight bearing.

Question 47

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?

T. Observe the child’s condition over time to assess progression.

U. Order physical therapy to prevent progression of symptoms.

V. Reassure the parent that the child will outgrow this deformity.

D. Refer to a pediatric orthopedic specialist for treatment.

Answer 47

D. Refer to a pediatric orthopedic specialist for treatment.

Question 48

A child who plays soccer is in the clinic reporting pa in 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?

I. Apply ice packs to both knees and avoid activities that cause pain.

J. Begin quadriceps stretching exercises now to prevent further injury.

K. Obtain radiographic studies to rule out fractures or ligament tears.

L. Refer to a pediatric orthopedic specialist to evaluate the
need for surgery.

Answer 48

I. Apply ice packs to both knees and avoid activities that cause pain.

Question 49

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?

M. Grasp the heel with one hand and abduct the forefoot with the other hand.

N. Observe both legs for medial and lateral rotations.

O. Order anterior posterior and lateral radiographs of both feet.

P. Refer the infant immediately to a pediatric orthopedic specialist.

Answer 49

M. Grasp the heel with one hand and abduct the forefoot with the other hand.

Question 50

A child is brought to the clinic after falling from a swing and scraping both knees and hands. An examination reveals abraded skin with oozing serous fluid and blood,
along with dirt and grime from the playground surface. What will the primary
care pediatric nurse practitioner do to minimize the risk of infection?

E. Apply povidone iodine to all areas.

F. Irrigate gently with normal saline.

G. Rinse with hydrogen peroxide.

H. Scrub the abraded areas with alcohol.

Answer 50

F. Irrigate gently with normal saline.

Question 51

A school age child steps on a nail while wearing tennis shoes and develops
cellulitis in that foot. The child’s immunizations are up to date. What antibiotic will the pediatric nurse practitioner empirically prescribe?

A. Amoxicillin clavulanate

B. Ciprofloxacin

C. Clindamycin

D. Trimethoprim sulfamethoxazole

Answer 51

B. Ciprofloxacin

Question 52

A child has a 1cm laceration on the forehead proximal to the hairline after
running into a pole while playing sports. To minimize the risk of infection, the primary care pediatric nurse practitioner will irrigate the wound and

Y. allow the wound to heal by secondary intention.

Z. delay closure of the wound for several days.

A. refer the child to a plastic surgeon for wound closure.

B. suture the wound within 6 hours.

Answer 52

B. suture the wound within 6 hours.

Question 53

The primary care pediatric nurse practitioner is preparing to close a
laceration on a child’s forehead using topical skin adhesive. What is the
correct way to apply this product?

U. Apply the adhesive between the wound margins and then hold the edges together.

V. Apply the adhesive to the wound and then secure the edges with surgical tape.

W. Have the child remain still for 15 to 20 minutes after the adhesive is applied.

X. Hold the wound edges together and apply the adhesive on top of the skin.

Answer 53

X. Hold the wound edges together and apply the adhesive on top of the skin.

Question 54

A toddler is brought to the clinic after grabbing the hot end of his mother’s curling iron. An examination reveals a pale, yellow burned area to the palm of one hand. What is true about this burn?

S. It may take up to 3 weeks to heal with scarring likely.

T. Scarring is unlikely, with healing expected in 3 to 7 days.

U. Surgical intervention and skin grafting are usually required.

V. This type of burn usually heals without scarring in 7 to 14 days.

Answer 54

S. It may take up to 3 weeks to heal with scarring likely.

Question 55

A school age child sustained a contusion on the front of one thigh while playing football and reports some difficulty flexing his foot on the affected side. What will the
primary care pediatric nurse practitioner do to treat this injury?

B. Place the child on crutches and limit weightbearing until symptoms subside.

C. Prescribe acetaminophen with hydrocodone along with NSAIDs.

D. Recommend rest, ice packs, compression, and elevation of the
extremity.

E. Refer the child to an orthopedic specialist for immediate evaluation and treatment.

Answer 55

E. Refer the child to an orthopedic specialist for immediate evaluation and treatment.

Question 56

A child is bitten on one arm by a neighbor’s dog. The dog is immunized against rabies and the child’s last tetanus immunization was 4 years prior. The wound edges are gaping and avulsed. What is an important initial intervention when treating this injury?

F. Administration of rabies prophylaxis and a tetanus booster

G. Debriding and suturing the wound to prevent infection

C. Irrigation of the wounds with high pressure normal saline

D. Reporting the animal bite to the local animal control authority

Answer 56

C. Irrigation of the wounds with high pressure normal saline

Question 57

A child is brought to the clinic immediately after being stung by a wasp while
playing in the yard. The physical examination reveals localized redness and edema at the site, along with abdominal tenderness, watery eyes, and generalized hives. What is the initial treatment?

A. Administer intramuscular epinephrine.

B. Apply a topical glucocorticoid cream.

C. Give oral diphenhydramine.

D. Order a bronchodilator treatment

Answer 57

A. Administer intramuscular epinephrine.

Question 58

A child is bitten by a snake near a swimming pool in an area where
copperhead snakes are known to inhabit, although the parents cannot describe the snake. An examination of the bite reveals a severe local reaction at the site with edema
and intense pain. What will the primary care pediatric nurse practitioner do first?

A. Administer narcotic analgesics to provide comfort.

B. Begin treatment with oral amoxicillin clavulanate for 5 days.

C. Clean the wound and administer tetanus prophylaxis.

D. Transport the child by ambulance to a medical center.

Answer 58

D. Transport the child by ambulance to a medical center.

Question 59

What is true about haploid cells?

C. Each contains 23 paired chromosomes.

D. Each one contains 23 chromosomes.

E. Replication produces two identical cells.

F. They replicate via the process of mitosis.

Answer 59

D. Each one contains 23 chromosomes.

Question 60

What does the following genetic notation symbol mean 47,XX,6q?

A. Male with deletion of chromosome 6

B. Female with deletion of chromosome 6

C. Male with deletion on the long arm of chromosome 6

D. Female with deletion on the long arm of chromosome 6

Answer 60

D. Female with deletion on the long arm of chromosome 6

Question 61

A child has a recessive genetic disorder that is homozygous for that
mutation. What is most likely about this child’s parents?

What is most likely about this child’s parents?
A. Neither parent has a copy of that gene mutation.

B. Only the mother has a copy of that gene mutation.

C. Only the father has a copy of that gene mutation.

D. Each parent has one copy of that gene mutation.

Answer 61

D. Each parent has one copy of that gene mutation.

Question 62

Which type of mutation is responsible for many single gene genetic disorders?

A. Copy number variations

B. Nucleotide repeat expansions

C. Point mutations

D. Single nucleotide polymorphisms (SNP)

Answer 62

C. Point mutations

Question 63

Cystic fibrosis is a recessive disease requiring the presence of a gene
mutation on both alleles inherited from the parents. Which type of genetic disorder is this?

A. Chromosome
B. Mitochondrial
C. Monogenetic
D. Multifactorial

Answer 63

C. Monogenetic

Question 64

The primary care pediatric nurse practitioner is counseling a couple about
genetic risks and learns that one parent has neurofibromatosis, an autosomal dominant disorder, and the other parent does not. What will the nurse practitioner include when discussing this disorder and its transmission?
C. Children must inherit a gene from both parents to develop the disease.

D. Each child born to this couple will have a 50% risk of having the
disease.

E. This type of disorder characteristically skips generations.

F. Unaffected offspring may still pass on the disease to their offspring.

Answer 64

D. Each child born to this couple will have a 50% risk of having the
disease.

Question 65

A family medical history conducted during a well baby exam for a newborn
girl reveals that hemophilia A, an X-linked recessive disorder, is present in males in three previous generations in the mother’s family, whose father had the disease. What will the primary care pediatric nurse practitioner tell the parents about the risk of this disease in their children?

E. All of their sons will be affected by the disease.

F. Any sons they have will not be affected by the disease.

G. Daughters have a 50% chance of being carriers of the disease.

H. Their daughter has a 25% chance of having the disease.

Answer 65

G. Daughters have a 50% chance of being carriers of the disease.

Question 66

What is an important responsibility of the primary care pediatric nurse
practitioner to help determine genetic risk factors in families?

E. Assessing physical characteristics of genetic disorders

F. Knowing which genetic screening tests to perform

G. Making appropriate referrals to pediatric geneticists

D. Obtaining a three generation pedigree for each family

Answer 66

D. Obtaining a three generation pedigree for each family

Question 67

Which diagnostic study may be ordered when the provider wishes to
detect the presence of additional genetic material on a chromosome?

A. Chromosomal microarray

B. FISH

C. Karyotype

D. Molecular testing

Answer 67

B. FISH

Question 68

Which type of testing will the primary care pediatric nurse practitioner
recommend for a couple concerned about the potential for having children with cystic fibrosis?
A. Biochemical testing

B. Carrier testing

C. FISH testing

D. Karyotype testing

Answer 68

B. Carrier testing

Question 69

What has been the result of passage of the Toxic Substances Control Act.
(TSCA) of 1976?

G. A mandate for corporations to disclose known toxic chemicals

H. A requirement that all manufactured chemicals undergo toxicity testing

I. Authorization of the EPA to require testing and reporting of some chemicals

J. Development of a mechanism to report reactions to toxic chemicals

Answer 69

I. Authorization of the EPA to require testing and reporting of some chemicals

Question 70

Many European nations use the “precautionary principle” to help regulate
potentially toxic chemicals. What does this mean?

G. Chemicals must be proven to be safe before being introduced
into the environment.

H. Corporations may be exempt from testing if their costs in doing so
are too high.

I. Regulators must demonstrate risk to the public before banning a
chemical.

J. W/o a strong risk, corporations need not release data about their
products.

Answer 70

G. Chemicals must be proven to be safe before being introduced
into the environment.

Question 71

During a clinic visit, a child’s rapid capillary screening test for lead reveals
a level of 11 mcg/dL. What will the primary care pediatric nurse practitioner do next?

I. Institute lead abatement measures in the child’s home.

J. Monitor lead levels monthly until decreased.

K. Order a venous sample to test for lead levels.

L. Test the child’s siblings and parents for lead.

Answer 71

K. Order a venous sample to test for lead levels.

Question 72

A child has a lead level of 25 mcg/dL. Once lead abatement measures are
instituted, what is an important intervention to help prevent permanent
damage

H. Chelation therapy

I. Dietary changes

C. Follow up testing

D. Testing family members

Answer 72

C. Follow up testing

Question 73

A child whose parent works in a factory presents with swelling of the extremities, pain and weakness in the pelvis, and an erythematous
maculopapular rash. Which
industrial toxin will the primary care pediatric nurse practitioner suspect in
this child?

A. Lead

B. Mercury

C. Organophosphates

D. Phthalates

Answer 73

C. Organophosphates

Question 74

When counseling a mother who smokes about preventing exposure to
smoking related risks to her nursing newborn, what will the primary care pediatric nurse practitioner tell her?

F. If she quits now, her child will not have long term
effects from exposure.

G. Prenatal smoke exposure does not cause respiratory effects after the
infant is born.

H. Smoking outdoors or near an open window prevents exposure to tobacco smoke.

I. Third hand smoke exposure risks may last for years even if the
mother quits now.

Answer 74

I. Third hand smoke exposure risks may last for years even if the mother quits now.

Question 75

A child who has been playing in a public park is brought to the clinic with wheezing, vomiting, diarrhea, and drooling. A physical exam reveals a low heart rate and diaphoresis. What will the primary care pediatric nurse practitioner suspect as a cause for these symptoms?

B. Arsenic consumption

C. Lead poisoning

D. Organophosphate exposure

E. Phthalate ingestion

Answer 75

D. Organophosphate exposure

Question 76

A parent asks about ways to limit exposure to risks associated with plastics. Besides avoiding using plastic containers when possible, what else will the
primary care pediatric nurse practitioner recommend?

A. Avoid heating foods and liquids in plastic containers.

B. Clean plastic containers well using the dishwasher.

C. Use only plastics stamped with “#7” on the bottom.

D. Used canned food products whenever possible.

Answer 76

A. Avoid heating foods and liquids in plastic containers.

Question 77

A parent desires to buy only organic produce to avoid exposing a child to
pesticides but complains that these foods are expensive. The primary care
pediatric nurse practitioner provides a list of foods that are relatively safe whether they are organic or not.
Which foods are on this list?

A. Apples, celery, and peaches

B. Potatoes, cherry tomatoes, and peaches

C. Strawberries, grapes, and cucumbers

D. Sweet corn, cantaloupe, and kiwi

Answer 77

D. Sweet corn, cantaloupe, and kiwi

Question 78

Trisomy 13, also known as Patau syndrome, is the least common and most
severe of the autosomal
trisomies. It has an average survival of:
1. Less than three days.
2. Less than two weeks.
3. Less than six months.
4. Less than five years.

Answer 78

1. Less than three days.

Question 79

HIV testing should be done on all teens or young adults at a minimum of:

1. Annually.
2. Once.
3. Every 2 years.
4. Every 5 years.

Answer 79

2. Once.

Question 80

All the following are true of pelvic inflammatory disease (PID) except
that:
1. It is caused most often by genital gonorrhea.
2. It may result in oophoritis, which is an infection of the ovaries.
3. It may result in peritonitis, which is an infection of the abdominal lining.
4. Frequent douching does not increase risk of developing PID.

Answer 80

4. Frequent douching does not increase risk of developing PID.

Question 81

Select the statement that best describes the thelarche stage of puberty in
females.
1. Appearance of pubic hair
2. Appearance of breast tissue maturation
3. Onset of first menstrual period
4. All the above

Answer 81

4. All the above

Question 82

Congenital Syphilis occurs when the spirochete Treponema palladium is
transferred from the pregnant woman to her fetus. Education to the parent should include all of the following except:

1. Infants can be asymptomatic for up to two years after birth.
2. Any rash involving the palms and soles can have an appearance of copper.
3. The central nervous system is rarely affected.
4. Long bone abnormalities with possible fractures may limit movement and
   give an appearance of paralysis.

Answer 82

3. The central nervous system is rarely affected.

Question 83

Congenital Hypothyroidism is common in infants with Downs syndrome.
Newborn screening for
Congenital Hypothyroidism is required in all 50 states. Thyroid studies should
be performed several times
during the first years of life, and then a minimum of:

1. Every two months.
2. Every month.
3. Every six months.
4. Yearly.

Answer 83

4. Yearly.

Question 84

The only known disorder where a fetus can survive despite loss of an
entire X chromosome is known as:
1. Edwards syndrome.
2. Sturge-Weber syndrome.
3. Turners syndrome.
4. Williams syndrome.

Answer 84

3. Turners syndrome.

Question 85

Which of the following statements is true of Turners syndrome?

1. It affects only girls. There are no living males with Turners syndrome.
2. It is the result of the loss of an entire X chromosome.
3. Both 1 and 2
4. None of the above

Answer 85

3. Both 1 and 2

Question 86

Malignancies are common in children with Downs syndrome. The incidence
is 18 times that of the
general population for developing:
1. Colon cancer.
2. Leukemia.
3. Pancreatic cancer.
4. Bladder cancer.

Answer 86

2. Leukemia.

Question 87

Downs syndrome children often have instability of the neck at the first and
second cervical vertebrae. As a nurse, you explain to the caregiver that he/she should look for signs and
symptoms of spinal cord changes, such as:
1. Changes in reflexes.
2. Changes in bowel function.
3. All of the above.
4. None of the above.

Answer 87

3. All of the above.

Question 88

Children with Sturge-Webers syndrome are at a high risk for:

1. Pediatric stroke.
2. Congenital heart complications.
3. Juvenile arthritis.
4. Type I diabetes.

Answer 88

1. Pediatric stroke.

Question 89

Stereotypic behaviors of males with Fragile X syndrome include a lack of
eye contact, aggression,
anxiety, and:
1. Jerking legs.
2. Hand flapping.
3. Pill-rolling of the fingers.
4. All of the above

Answer 89

2. Hand flapping

Question 90

Fetal Alcohol Syndrome Disorder (FASD) is divided into four subtypes. As
a nurse,
you know that the most severe type is:
1. Alcohol-Related Birth Defects.
2. Alcohol-Related Neurodevelopmental Disorder.
3. Partial Fetal Alcohol Syndrome.
4. Fetal Alcohol Syndrome

Answer 90

4. Fetal Alcohol Syndrome

Question 91

Angelman syndrome is the deletion of which chromosome?

1. Maternal chromosome 12
2. Maternal chromosome 15
3. Paternal chromosome 17
4. Paternal chromosome 19

Answer 91

2. Maternal chromosome 15

Question 92

The primary care pediatric nurse practitioner is performing a medication
history on a child and learns that the child’s parents use various complementary
treatments and remedies for the child. According to the American Academy of Pediatrics standard for providers, what will the nurse practitioner do?

CCCC. Evaluate the safety and efficacy of each product and monitor use.

DDDD. Incorporate these therapies into standard care practices.

EEEE. Recommend not using the products until the child is older.

FFFF. Suggest that most of these treatments are not safe for children.

Answer 92

CCCC. Evaluate the safety and efficacy of each product and monitor use.

Question 93

According to the 2007 NHIS analysis of the use of CAM therapy, use was higher
among

AAAA. families whose parent or parents had a college education.

BBBB. Hispanic and African American
populations.

CCCC. persons who had not recently taken prescription medications.

DDDD. those living in households earning less than $65,000.

Answer 93

AAAA. families whose parent or parents had a college education.

Question 94

The parent of a child who has numerous allergies reports using herbal
remedies to help treat the child because they are “natural” products. What will the primary care pediatric
nurse practitioner suggest to this parent about using these products?

XXX. Brand name
herbal products have been tested for efficacy.

YYY. Natural ingredients are usually safe for use in children.

ZZZ. There are few interactions between drugs and supplements.

AAAA. Use single herb supplements whenever possible.

Answer 94

AAAA. Use single herb supplements whenever possible.

Question 95

Which label on a CAM therapy product verifies that a product meets standards for contamination, adulteration, manufacturing processes, and pharmacologic properties?

YYYYY. Generally Recognized as Safe (GRAS)

ZZZZZ. National Sanitation Foundation International (NSF)

AAAAAA. Natural Products Association (NPA)

D. United States Pharmacopeia (USP)

Answer 95

D. United States Pharmacopeia (USP)

Question 96

The parent of a newborn reports using echinacea for family members to
help treat viral illnesses and feels that it is usually effective. What will the primary care pediatric nurse
practitioner tell this parent?

A. That echinacea has no known therapeutic effects and should not be given.

B. That the supplement should not be given to children under 2 years of age

C. To give half the recommended adult dose until the child is 5 years old

D. To wait until the infant is at least 1 month old before giving this product

Answer 96

A. That echinacea has no known therapeutic effects and should not be given.

Question 97

A child has wheat allergies and continues to have problems in spite of
consuming a diet without breads and cereals. What will the primary care pediatric nurse
practitioner caution the parents to look for on product labels that may
indicate wheat products are present in foods?

A. Casein

B. Malt

GGG. Miso

HHH. Whey

Answer 97

B. Malt

Question 98

An adolescent will begin taking the combination oral contraceptive pill
(OCP). Which supplement will the primary care pediatric nurse practitioner caution the adolescent to avoid while taking OCPs?

NNN. Ginkgo

OOO. Kava

C. St. John’s wort

D. Valeria

Answer 98

C. St. John’s wort