Leik PEDS questions 2
D) DTaP, IPV DTap and IPV would be due for this 4-year-old child.
A 4-year-old boy is brought in by his mother for a wellness visit. His mother tells the family nurse practitioner that he had a bad case of chickenpox 1 year ago. Which of the following immunizations are indicated? A) IPV, Hib (hemophilus influenzae type B), hepatitis B B) IPV, Hib, MMR C) DTaP, IPV, MMR, hepatitis B D) DTaP, IPV
C) Testicular torsion Testicular torsion signs and symptoms include sudden onset of unilateral scrotal pain, nausea, vomiting, and abdominal pain. Acute epididymitis causes fever, chills, nausea, and unilateral pain and is most commonly seen in sexually active men. Unilateral scrotal pain does not occur with Salmonella infection. Acute orchitis is often based on having a recent mumps infection or parotitis with testicular edema.
A 10-year-old boy complains of a sudden onset of scrotal pain when he woke up that morning. He is also complaining of severe nausea and vomiting. During the physical examination, the nurse practitioner finds a tender, warm, and swollen left scrotum. The cremasteric reflex is negative and the urine dipstick is negative for leukocytes, nitrites, and blood. The most likely diagnosis is: A) Acute epididymitis B) A severe salmonella infection C) Testicular torsion D) Acute orchitis What type of follow-up should this patient receive? A) Refer him within 48 hours to a urologist B) Refer him to the emergency department as soon as possible C) Prescribe ibuprofen (Advil) 600 mg QID for pain D) Order a testicular ultrasound for further evaluation
B) Tdap, MCV4, and the HPV vaccines Vaccine questions usually are not this complicated, but there are several lessons that can be learned with this question. The 2012 CDC recommendations for the ages 13 to 18 years are the Tdap catch-up (if did not receive at age 11- 12 years), HPV or Gardasil catch-up (if did not receive at age 11- 12 years), and the MCV4 or meningococcal conjugate vaccine (Menactra). Only one dose of Tdap is recommended (lifetime). Thereafter, the Td form of the vaccine is indicated every 10 years.
A 13-year-old adolescent female is brought in by her mother for a sports physical. The mother reports that the teen's last vaccines were given at the age of 6 years. Which of the following vaccines is recommended by the CDC for this patient? A) Td and HPV vaccines B) Tdap, MCV4, and the HPV vaccines C) DTap and the flu vaccine D) DT and MCV4 vaccines
C) Retin A 0.25% gel Topical agents are the first-line treatment for acne vulgaris. Retin A 0.25% gel would be the next step. Oral preparations would then be offered for the next step (tetracycline), and Accutane would be the final step of therapy.
A 13-year-old boy wants to be treated for his acne. He has a large number of closed and open comedones on his face. The patient has been treating himself with OTC benzoyl peroxide and salicylic acid topical products. Which of the following would be recommended next? A) Retinoic acid (Accutane) B) Tetracycline C) Retin A 0.25% gel D) Wash face carefully with medicated soap at bedtime
A) Azithromycin (Zithromax) If the patient has a severe penicillin allergy, there is a 10% chance of cross-reactivity to cephalosporins (especially first generation). Because the patient is a child, the levofloxacin is contraindicated. Nausea is a common adverse reaction to erythromycin (it is not an allergic reaction). The best option is to use azithromycin because of its minimal GI adverse effects. Azithromycin has fewer drug interactions compared with other macrolides.
A 13-year-old patient has a throat culture that is positive for strep throat. She reports that her younger brother was recently diagnosed with strep throat and treated. The patient has a severe allergy to penicillin and reports that erythromycin makes her very nauseated. Which of the following antibiotics is the best choice? A) Azithromycin (Zithromax) B) Cephalexin (Keflex) C) Cefuroxime axetil (Ceftin) D) Levofloxacin (Levaquin)
D) Celiac disease Celiac disease is also known as celiac sprue. Patients should avoid foods containing gluten, which causes malabsorption (diarrhea, gas, bloating, abdominal pain, etc.). Foods to avoid are wheat, rye, and barley. Oats do not damage the mucosa in celiac disease. Antigliadin IgA and IgG are elevated in almost all patients (90%). L
A 14-year-old is brought in by his mother who reports that her child has been complaining for several months of recurrent bloating, stomach upset, and occasional loose stools. She reports that her son has difficulty gaining weight and is short for his age. She has noticed that his symptoms are worse after eating large amounts of crackers, cookies, and breads. She denies seeing blood in the child's stool. Which of the following conditions is most likely? A) Amebiasis B) Malabsorption C) Crohn's colitis D) Celiac disease
B) Roseola infantum The signs/ symptoms of roseola infantum include high fever for a few days with a maculopapular rash occuring after the fever breaks. Fifth disease is a lacy-appearing rash that usually begins on the face and moves to the extremities and trunk. It is known by the "slapped cheek " appearance at onset. Erythema infectiosum is the same as Fifth disease. Scarlet fever is a red rash that feels like sandpaper that usually begins on the neck and trunk and spreads to the extremities. Patients will have other symptoms such as fever, sore throat, and beefy red tongue. This is caused by the Group A Streptococcus bacterium.
A 15-month-old child who is eating and behaving normally is found to have a high fever. After a few days, the fever resolves and the infant breaks out in a maculopapular rash. This is a description of which of the following conditions? A) Erythema infectiosum B) Roseola infantum C) Fifth disease D) Scarlet fever
D) DTap, IPV, MMR, varicella Immunizations for a 15-month-old child include DTap, IPV, MMR, and varicella vaccine.
A 15-month-old infant is in your office for a well baby check. The mother denies history of chickenpox infection. Which of the following immunizations is indicated at this visit? A) DTaP, Hib, IPV, hepatitis B B) DTaP, Hib, PCV, IPV, MMR C) MMR, hepatitis B, varicella D) DTaP, IPV, MMR, varicella
A) Small smooth testicles with no pubic or facial hair Small, smooth testicles with no pubic or facial hair (Tanner Stage I) is a worrisome finding at the age of 14 years because it signifies that the boy is not in the pubertal stage yet. The average age of onset of puberty among boys is 12 years (range 10 to 14 years). The maximum growth spurt in boys occurs about 2 years after the onset of puberty. Boys start about 1 year later than girls and continue to grow until their early 20s (college).
A 15-year-old White male is brought in by his father for a physical exam. He is concerned that his son is "too short" for his age. The father reports that when he was the same age, he was much taller. His son wants to try out for the football team, but the father is concerned because his son might be "too short" to join. Which of the following physical exam findings is worrisome? A) Small smooth testicles with no pubic or facial hair B) Smooth testicles with rugated scrotum that is a darker color than his normal skin color C) Smooth testicles with coarse and curly pubic hair D) Straight pubic and axillary hair with a long thin penis
C) Osgood-Schlatter disease Osgood-Schlatter disease is characterized by having pain over the tibial tuberosity with palpation of a bony mass over the anterior tubercle of one or both knees. Exercise worsens the pain.
A 15-year-old basketball player who is 6 ft tall is seen for complaints of painful lumps on his knees. Upon inspection, the nurse practitioner notes a bonelike growth on the upper tibia midline below the kneecap on both knees. The patient has full range of motion with no joint tenderness, redness, or swelling. Which of the following conditions is best described? A) Osteosarcoma of the tibia B) Juvenile rheumatoid arthritis C) Osgood- Schlatter disease D) Paget's disease of the bone
B) Secondary prevention The nurse practitioner is evaluating the teenager for major depression. Because the teenager already has the disease (depression), it is a screening "test." All screening tests/ labs (mammography, Pap smears, etc.) are secondary prevention activities. Leik MSN, Maria T. Codina (2013-08-12). Family Nurse Practitioner Certification Intensive Review: Fast Facts and Practice Questions, Second Edition (p. 603). Springer Publishing Company. Kindle Edition.
A 15-year-old female who attends a public school is referred to the nurse practitioner by one of her teachers. The teen has been missing school and is falling behind in her schoolwork. After closing the exam room door, the nurse practitioner starts to interview the teen, asking about her moods, her appetite, her sleep, whether she any plan of hurting herself or others, and other questions. What is the level of health prevention that the nurse practitioner is performing? A) Primary prevention B) Secondary prevention C) Tertiary prevention D) Dropout prevention program
B) Scarlet fever Scarlet fever is a bacterial infection caused by the group A Streptococcus infection. The patient will exhibit sore throat, high fever, and a fine sandpaper rash, which is characteristic of scarlet fever.
A 16-year-old complains of a severe sore throat for 3 days along with a generalized rash and fever. The skin has the texture of fine sandpaper. This best describes: A) Kawasaki's disease B) Scarlet fever C) German measles D) Rubeola
D) Clean the wound with soap and water and prescribe Augmentin 500 mg PO BID x 10 days for the patient Cat wounds are more likely to become infected compared with dog bites; in addition, this patient's bite is located on an extremity. These facts justify the prescription of Augmentin 500 mg PO BID x 10 days for the patient.
A 16-year-old male with a recent history of a cat bite is brought in by his father. The bite occurred about 2 hours before the visit. The nurse practitioner evaluates the wound and notes 2 small puncture wounds. There is no redness or purulent discharge. The father reports that the teenager received a tetanus booster when he was 12 years old. Which of the following is the correct action to take? A) Clean the wound with soap and water and apply topical antibiotic and a bandage B) Because the wound is clean and does not appear infected, there is no need for antibiotics C) Give the patient a tetanus booster using the Tdap form of the vaccine D) Clean the wound with soap and water and prescribe Augmentin 500 mg PO BID x 10 days for the patient
A) Meniscal injury With an acute knee injury, the knee should be assessed using McMurray's sign. A positive McMurray's sign indicates a meniscal injury. Inflammation of the knee, osteophytes, and tenosynovitis would not elicit a positive McMurray's sign.
A 19-year-old male athlete complains of acute knee pain after a football game. The nurse practitioner elicits McMurray's sign, which is positive on the patient's injured knee. This is a test for: A) Meniscal injury B) Inflammation of the knee joint C) Osteophytes of the knee joint D) Tenosynovitis
C) Cholesteatoma Cholesteatoma is an abnormal growth that occurs in the middle ear that can cause hearing loss. Difficulty hearing is common.
A cauliflower-like growth with foul-smelling discharge is seen during an otoscopic exam of the left ear of an 8-year-old boy with a history of chronic otitis media. No tympanic membrane or ossicles are visible and the patient seems to have difficulty hearing the nurse practitioner's instructions. Which of the following conditions is best described? A) Chronic perforation of the tympanic membrane with secondary bacterial infection B) Chronic mastoiditis C) Cholesteatoma D) Cancer of the middle ear
D) Oral prednisone (Medrol Dose Pack) Symptomatic treatment for viral URI are saline nasal sprays (Ocean spray), decongestants (pseudoephedrine), NSAIDs (Advil), increased fluid intake, and alternative herbal remedies (echinachea, astralagus, elderberry syrup, high doses of Vitamin C).
A college student is seen as a walk-in appointment in a college health clinic. She complains of the abrupt onset of sore throat, nasal congestion, runny nose, and malaise. Vital signs are a temperature of 99.8 degrees Fahrenheit, pulse 84, and respiratory rate 14 breaths/ minute. The physical exam reveals an erythematous throat, swollen nasal turbinates, and rhinitis. The NP suspects viral URI. All of the following treatments are appropriate except: A) Saline nasal spray (Ocean nasal spray) B) Pseudoephedrine (Sudafed) C) Ibuprofen (Advil) D) Oral prednisone (Medrol Dose Pack)
B) Advise the mother that her child is developing normally Toilet training begins at approximately 2 years of age and may take 1- 2 years to complete. Males who are not toilet trained by 3 years of age may still be developing normally.
A concerned new mother reports to you that her son, who is 3 years of age, is not toilet trained yet. Which of the following is an appropriate reply? A) Recommend a referral to a pediatric urologist B) Advise the mother that her child is developing normally C) Recommend a bed-wetting alarm D) Recommend a voiding cystogram
B) Advise the mother to use a nit comb after spraying the child's hair with white distilled vinegar, waiting for 15 minutes, and then rinsing the child's hair According to the CDC, nits that are more than ¼ inch from the child's scalp are usually not viable. The child also does not have an itchy scalp. One method of removal is to soak the child's head with distilled vinegar (and then rinse after), which will break down the protein of the nit casings, making it easy to comb them out of the hair.
A mother brings in her 6-year-old daughter to see the nurse practitioner (NP). She complains that the school nurse found a few nits on her daughter's hair. The mother states that the school has a "no nits" policy regarding head lice and the child cannot go back to school until all the nits have been removed. The child was treated with permethrin shampoo (Nix) twice about 3 months ago. During the physical exam, the NP sees a few nits that are about 2 inches away from the scalp. The child denies itchiness on her scalp. Which of the following is the best action for the NP to follow? A) Prescribe lindane (Kwell) for the child because she may have head lice that are resistant to permethrin B) Advise the mother to use a nit comb after spraying the child's hair with white distilled vinegar, waiting for 15 minutes, and then rinsing the child's hair C) Advise the mother to re-treat the girl with permethrin cream instead of shampoo D) Reassure the mother that the nits will probably drop off after a few weeks Hint: are they alive
A) Vitamin D drops According to the APA, all infants should be given Vitamin D supplementation within the first few days of life. Mothers who plan to breast-feed their infants should be taught how to use Vitamin D drops. Infant formula is supplemented with Vitamin D (and many other vitamins, minerals, and omega-3 oil), so there is no need to give it separately.
A new mother is planning on breastfeeding her newborn infant for at least 6 months. She wants to know whether she should give the infant vitamins. Which of the following vitamin supplements is recommended by the American Academy of Pediatrics (APA) latest guideline during the first few days of life? A) Vitamin D drops B) Multi vitamin drops C) It is not necessary to give breastfed infants vitamin supplements because breast milk contains enough vitamins and minerals that are necessary for the infant's growth and development D) Folic acid drops
C) An infant with a cold can be immunized as long as the infant's temperature is no higher than 100.4 degrees Fahrenheit Immunization is acceptable as long as the temperature is not higher than 100.4 ° F.
A new mother reports to you that her 6-month-old infant has a cold and has a fever of 99.8 degrees Fahrenheit. The infant is not irritable and is feeding well without problems. The mother wants to know whether it is okay for him to be immunized at this time. Which of the following statements is true? A) The infant should not be immunized until he is afebrile B) An infant with a cold can be immunized at any time C) An infant with a cold can be immunized as long as the infant's temperature is no higher than 100.4 degrees Fahrenheit D) Because immunization is so important, it should be given to the infant as scheduled
C) Rocky Mountain spotted fever Given the location in the East, Rocky Mountain spotted fever is most likely the infection causing symptoms of fever, rash on ankles/ wrists moving to the palms of the hands and the trunk. Rocky Mountain spotted fever is a tickborne disease caused by the bacterium Rickettsia rickettsii, which is transmitted by a bit from an infected tick.
A new patient who recently visited a relative in North Carolina complains of an onset of fever and red rashes that started 2 days ago. The rash first appeared on the wrist and the ankles and included the palms of the hands. The patient reports that it is spreading toward his trunk. The patient's eyes are not injected and no enlarged nodes are palpated on his neck. There is no desquamation of the skin. Which of the following is most likely? A) Kawasaki's disease B) Meningococcemia C) Rocky Mountain spotted fever D) Measles
A) Hypocalcemia Chvostek's sign is contraction of the facial muscles when the facial nerve is tapped briskly in front of the ear (anterior to the auditory canal). Low calcium levels cause tetany and neuromuscular disturbances. Acute hypocalcemia with symptoms (tetany, weakness, arrhythmias) should be referred to the emergency department. Conditions such as acute or chronic renal failure, Vitamin D or magnesium deficiency, or acute pancreatitis increase the risk of hypocalcemia.
A positive Chvostek's sign is associated with: A) Hypocalcemia B) Hypernatremia C) Hypokalemia D) Hyperkalemia
A) Acute appendicitis A positive obturator sign may indicate acute appendicitis. The test is performed by having the patient lie down supine, and rotate the hip, using full range of motion. A positive sign is when pain is experienced with movement or flexion of the hip.
A positive obturator sign might signify which of the following conditions? A) Acute appendicitis B) Acute pancreatitis C) Acute cholecystitis D) Acute hepatitis
B) Acute appendicitis Both the psoas and obturator signs are associated with acute appendicitis. When the appendix becomes inflamed or ruptured, the blood and pus irritate the psoas and/ or obturator muscles, which are both located in the retroperitoneal area. Both muscles are hip flexors and assist with hip movement.
A positive psoas and obturator sign is highly suggestive of which of the following conditions? A) Ectopic pregnancy B) Acute appendicitis C) Peritonitis D) Abdominal aortic aneurysm
A) Larva migrans Larva migrans affects the intestines of dogs/ cats and is caused by the eggs of parasites (worms) from the animals' intestine. Children are at high risk of developing this if they come in contact with dirt that is contaminated with dog/ cat feces. Eating foods that are grown in contaminated soil and/ or raw liver are other means of transfer of the infection. After the eggs hatch, the parasite can migrate to other organs of the body if left untreated.
A red, raised serpiginous-shaped rash is noted by the nurse practitioner on the right foot of a 4-year-old child brought in for a preschool physical by the mother. The child complains of severe itch and keeps scratching the lesion. The mother reports that the child frequently played in the yard without shoes or sandals on. Which of the following is most likely? A) Larva migrans B) Erythema migrans C) Tinea pedis D) Insect bites
B) Tanner stage The stem of the question is asking for the important areas to evaluate in this patient "during this visit." This is a priority-type question. The priorities to evaluate in this patient are depression, STD testing, and sexual history. The Tanner staging does not have to be done "during this visit."
A sexually active 16-year-old female is brought in by her mother for a physical exam. During the exam, the nurse practitioner notices some bruises on both breasts. All of the following are important areas to evaluate in this patient during this visit except: A) Depression B) Tanner stage C) Sexual history D) STDs
C) 3 years Developmental stages in children include the following: 1 year: walk; 2 years: walks up steps with the same foot; 3 years: pedals a tricycle and copies a circle; 4 years: rides a bicycle and copies a cross and draws a person with 2 parts.
At what age can a child copy a circle and ride a tricycle? A) 1 year B) 2 years C) 3 years D) 4 years
D) Tinea versicolor Acanthosis nigricans is a benign skin condition. It appears as hyperpigmented velvety areas of skin that are usually located on the neck and the axillae. It is a sign of insulin resistance. It is rarely associated with some types of adenocarcinoma of the gastrointestinal tract. Tinea versicolor is a superficial infection of the skin (stratum corneum layer) that is caused by dermatophytes (fungi) of the tinea family. Another name for it is "sunspots."
Acanthosis nigricans is associated with all of the following disorders except: A) Obesity B) Diabetes C) Colon cancer D) Tinea versicolor
B) Increase physical activity and outdoor play Lifestyle changes such as increasing physical activity and spending more time outdoors are appropriate recommendations for children. Consider referral to a registered dietician for dietary recommendations and counseling. Participation in an exercise program designed for children (if available) is also appropriate. Severe caloric and/ or carbohydrate restriction is not recommended for this age group.
About one-third of children in the United States are considered obese. Which of the following methods are appropriate interventions for obese school-aged children? A) Severe restriction of dietary carbohydrates B) Increase physical activity and outdoor play C) Prescribe appetite suppressants D) Over-the-counter herbal weight-loss pills
C) Hemangiomas should be treated with laser therapy if they have not resolved by the age of 12 months True strawberry hemangiomas will eventually resolve by the time the child goes to kindergarten. Most will reduce or disappear in the first 2 years. Laser treatment is rarely needed.
All of the following are true about strawberry hemangiomas found in infants except: A) Most will involute spontaneously by the age of 18 to 24 months B) Watchful waiting is the most useful strategy C) Hemangiomas should be treated with laser therapy if they have not resolved by the age of 12 months D) Strawberry hemangiomas are benign
B) The CDC does not recommend the HPV vaccine for males. The HPV vaccine is now recommended for both males and females. It can be given until the age of 26 years, especially if the individual is at high risk. Do not use the vaccine if age is less than 9 years
All of the following are true statements about the human papilloma virus vaccine (Gardasil) except: A) The Centers for Disease Control and Prevention (CDC) recommends the first dose at age 11 to 12 years B) The CDC does not recommend the HPV vaccine for males C) The vaccine is not complete until a total of 3 doses have been administered D) The minimum age the vaccine can be given is 9 years
B) Can draw a cross Developmental stages in children include the following: 1 year: walk; 2 years: walks up steps with the same foot; 3 years: pedals a tricycle and copies a circle; 4 years: rides a bicycle and copies a cross and draws a person with 2 parts.
All of the following describe normal behavior for a 3-year-old child except: A) Speaks in 3- to 4-word sentences that are understood by most strangers B) Can draw a cross C) Can draw a circle D) Can ride a tricycle
B) Anorexia nervosa Anorexia nervosa increases the risk for osteopenia in teenage girls due to the poor intake of foods that are high in calcium and Vitamin D.
All of the following factors are not associated with an increased risk of osteopenia in teenage girls except: A) Drinking one glass of low-fat milk daily B) Anorexia nervosa C) Participation in sports D) A normal BMI (basal metabolic index)
A) Rice cereal Patients can eat any food except those that contain the protein gluten. Foods containing wheat, barley, and rye should be avoided.
All of the following foods are best avoided by individuals with celiac sprue except: A) Rice cereal B) Blueberry muffins C) Organic wheat bread D) Rye bread
C) Chewing breath mints GERD is a condition in which food comes up from the stomach/ esophagus through a weak sphincter. It usually worsens with lying down, from the reflux, and can cause a cough and esophageal irritation if not treated. Effective treatment may include weight loss, decreased caffeine intake, and avoidance of alcohol.
All of the following may help relieve the symptom( s) of GERD except: A) Losing weight B) Stopping caffeine intake C) Chewing breath mints D) Stopping alcohol intake
C) Advise the mother that you suspect that her daughter has been sexually abused and that she is legally required to report the case to the child protection program The NP is legally required to report the case to the child protection program. If the child is in danger, child protective services may ask for a court order to take the child away for protection until the investigation is completed. Talking about the boyfriend's behavior will not be effective and may put the child and/ or mother in danger if the boyfriend suspects that he is being watched.
An 13-year-old girl is brought in by the mother because her daughter is complaining of vaginal discharge and pain. The mother tells the nurse practitioner that her daughter is not sexually active yet. The mother is divorced and lives with her boyfriend and works full time. During the exam, the nurse practitioner notes that the vaginal introitus is red, with tears and a torn hymen. The cervix is covered with green discharge. The nurse practitioner suspects that the child has been sexually abused by the mother's boyfriend. What is the best action for the nurse practitioner to take? A) Ask the mother questions about her boyfriend's behaviors B) Advise the mother to watch how her boyfriend interacts with her daughter and to call within 1 week to discuss his behavior with her C) Advise the mother that you suspect that her daughter has been sexually abused and that she is legally required to report the case to the child protection program D) Report the child abuse to the local police department
D) Large testes Signs/ symptoms of Klinefelter's syndrome include gynecomastia, long limbs, and lack of secondary sexual characteristics. Testes are usually small. Infertility is a major concern for these boys. If treated early, they may have a normal sexual/ reproductive system in the future.
An 18-year-old male is found to have a 47, XXY karyotype and is diagnosed with Klinefelter's syndrome. The patient is most likely to have all of the following physical characteristics except: A) Gynecomastia B) Long limbs C) Lack of secondary sexual characteristics D) Large testes
B) Hand, foot, and mouth disease (HFMD) Hand, foot, and mouth disease (HFMD) is caused by the coxsackie virus A16. The virus is found in the saliva, sputum, nasal mucus, feces, and blister fluid. It is transmitted through direct contact of the secretion or in fomites (e.g., preschool toys). Treatment is symptomatic.
An 8-year-old is seen as a walk-in appointment by the nurse practitioner. The mother reports that her child has been febrile for 2 days and is not eating well due to painful sores inside the child's mouth. The child's temperature is 101 degrees Fahrenheit, the pulse is 88 beats/ minute, and the respirations are at 14 breaths per minute. During the physical examination, the nurse practitioner notices several small blisters and shallow ulcers on the child's pharynx and the oral mucosa. The child has small round red rashes on both palms and soles. Which of the following conditions is most likely? A) Herpes simplex infection B) Hand, foot, and mouth disease (HFMD) C) Varicella infection D) Secondary syphilis infection
D) 4 years Developmental stages in children include the following: 1 year: walk; 2 years: walks up steps with the same foot; 3 years: pedals a tricycle and copies a circle; 4 years: rides a bicycle and copies a cross and draws a person with 2 parts.
At what age can a child copy a cross and ride a bicycle? A) 1 year B) 2 years C) 3 years D) 4 years
642. A) Fragile X disorder Fragile X syndrome is the most common form of inherited intellectual disability. The disorder is associated with a higher incidence of autism (especially boys). Males are affected more severely than females. The facial features can vary. The classic facie is a long, narrow face with a prominent forehead and chin and large ears. Other features include hyperlaxity of the joints, flat feet, high arched palate, and others. Definitive diagnosis is by genetic testing. Leik MSN, Maria T. Codina (2013-08-12). Family Nurse Practitioner Certification Intensive Review: Fast Facts and Practice Questions, Second Edition (p. 608). Springer Publishing Company. Kindle Edition.
An adolescent male presents to the nurse practitioner for a wellness exam. The patient's face is long and narrow with a prominent forehead and chin, and he has large ears. The mother reports that her son has intellectual disabilities and autistic disorder. Which of the following conditions is being described? A) Fragile X disorder B) Marfan's syndrome C) Turner's syndrome D) Down syndrome Hint: Phelps
D) 5-6 years of age
At what age can a child ride a bicycle? A) 2 to 3 years of age B) 3 to 4 years of age C) 4 to 5 years of age D) 5 to 6 years of age
B) Tanner Stage II Puberty is defined as the period in life when secondary sexual characteristics begin to develop, identified as Tanner Stage II for boys and girls.
At what Tanner stage does puberty start? A) Tanner Stage I B) Tanner Stage II C) Tanner Stage III D) Tanner Stage IV
C) Early in the morning The scotch tape test is best done in the morning for several days in a row. The females do not lay eggs every day and therefore testing for several days will be more accurate.
At what time of the day would you recommend a scotch tape test be done to evaluate for a suspected case of enterobiasis? A) In the evening after dinner B) At night before bed C) Early in the morning D) It does not matter what time of the day the test is done
D) Vesicular breath sounds in the lower lobe Normal sounds of the chest wall include vesicular breath sounds in the lower lobes. Bronchial breath sounds are heard best at the second and third intercostal spaces. Tracheal breath sounds are heard over the trachea.
Auscultation of normal breath sounds of the chest will reveal: A) Bronchial breath sounds heard at the lower bases B) High-pitched vesicular breath sounds heard over the upper lobes C) Vesicular breath sounds heard over the trachea D) Vesicular breath sounds in the lower lobe
C) The areas of the body where skin is rubbing together, such as under the breast or in the groin area Candidal intertrigo infections are more common in the obese and in women with pendulous breasts. It is found in areas where skin rubs against skin (under breasts, in the groin area, and on stomach folds in the obese). It is more common in warm and humid weather (summer).
Candidal intertrigo is the name for an infection that is caused by the yeast Candida albicans. What is the location of this type of candida infection? A) The scalp B) The flexor areas of the elbows and the knees C) The areas of the body where skin is rubbing together, such as under the breast or in the groin area D) The hands
C) Tanner Stage III Tanner stages for breast development: I, prepuberty; II, breast bud; III, breast and areola one mound; IV, breast and areola secondary mound; V, adult pattern.
During a sports physical of a 14-year-old female, you note her breast development. The areola and the breast tissue are all in one mound. In which Tanner stage is this patient? A) Tanner Stage I B) Tanner Stage II C) Tanner Stage III D) Tanner Stage IV
B) Acute appendicitis Symptoms of an acute abdomen, such as appendicitis, include extreme tenderness and involuntary guarding at McBurney's point.
Extreme tenderness and involuntary guarding at McBurney's point is a significant finding for possible: A) Acute cholecystitis B) Acute appendicitis C) Acute gastroenteritis D) Acute diverticulitis
A) Acute pancreatitis Grey-Turner's sign is the acute onset of bluish discoloration located on the flank area that is caused by bruising. It is usually associated with severe acute pancreatitis, but it can also be found in some cases of ruptured ectopic pregnancy.
Grey-Turner's sign is highly suggestive of which of the following conditions? A) Acute pancreatitis B) Acute appendicitis C) Acute diverticulitis D) Gastric cancer
D) Tetanus vaccine and systemic antibiotics A break in the skin with a compound fracture is an indication for use of a tetanus vaccine (if last dose is more than 5 years ago) and systemic antibiotics.
In addition to surgical repair of a compound fracture that has broken through the skin, which of the following treatment plans is important to consider in this patient? A) Application of a topical antibiotic BID until the wound is healed B) Wound irrigation C) Tdap vaccine D) Tetanus vaccine and systemic antibiotics
A) First molars The first molars are the first permanent teeth to develop; they appear at approximately 6 years of age.
In the majority of children, the first permanent teeth start to erupt at the age of 6 years. Which of the following are the first permanent teeth to erupt in this time period? A) First molars B) Second molars C) Lower or upper incisors D) Canines
404 C) Bactrim
Julia, a 16-year-old patient, is being treated for her first urinary tract infection. Julia had an allergic reaction with hives after taking sulfa as a child. Which of the following antibiotics would be contraindicated? A) Cephalexin (Keflex) B) Ampicillin (Amoxil) C) Trimethoprim-sulfamethoxazole (Bactrim) D) Nitrofurantoin crystals (Macrobid)
C) Plasma cells Myeloma is a cancer of the plasma cells (or mature B-cells/ lymphocytes), which affects the bone marrow. Plasma cells produce antibodies and reside mainly in the bone marrow. Signs/ symptoms are bone pain, fractures, hypercalcemia, depressed immunity, and anemia. The bone marrow produces WBCs (neutrophils, lymphocytes, eosinophils, basophils), RBCs, and platelets. The typical patient is an older adult who is age 60 years or older.
Multiple myeloma is a malignancy of the: A) White blood cells (WBC) B) Red blood cells (RBC) C) Plasma cells D) Platelets
B) 4 year old According to the Denver II Developmental Stages, a 4-year-old child can copy a cross and draw a person with 3 body parts. At this age, some children can start to ride a bicycle (with or without training wheels). In contrast, a 3-year-old can only ride a tricycle and can copy a circle.
One of the developmental milestones for this age group is the ability to draw a stick figure "person" with 2 to 3 separate body parts. What is the age group that this finding is associated with? A) 3 year old B) 4 year old C) 5 year old D) 6 year old
A) Mumps virus Orchitis is caused by the mumps virus.
Orchitis is caused by which of the following? A) Mumps virus B) Measles virus C) Chlamydia trachomatis D) Chronic urinary tract infections that are not treated adequately
B) Age 8 in girls and age 9 in boys Precocious puberty is defined as onset of secondary sexual characteristics by the age of 8 years in girls and 9 years in boys.
Precocious puberty is defined as the onset of secondary sexual characteristics before the age of: A) Age 7 in girls and age 8 in boys B) Age 8 in girls and age 9 in boys C) Age 9 in girls and age 10 in boys D) Age 9 for both girls and boys
A) Onset of puberty before age 8 in girls and age 9 in boys The definition of precocious puberty is the onset of puberty before age 8 in girls and age 9 in boys.
Precocious puberty is defined as: A) Onset of puberty before age 8 in girls and age 9 in boys B) Onset of puberty before age 9 in girls and age 10 in boys C) Onset of puberty before age 10 in girls and age 11 in boys D) Onset of puberty at an earlier age than the child's parent( s)
C) Testes Spermatogenesis occurs in the testes, taking approximately 3 months to develop.
Spermatogenesis occurs at the: A) Vas deferens B) Seminal vesicles C) Testes D) Epididymis
C) Weight gain Symptoms of ulcerative colitis includes bloody diarrhea mixed with mucus, nausea/ vomiting, abdominal pain, and possible weight loss with long-term diarrhea.
Symptoms suggestive of ulcerative colitis include all of the following except: A) Bloody diarrhea mixed with mucus B) Nausea and vomiting C) Weight gain D) Abdominal pain
C) Cranial nerve 8 The Rinne and Weber tests are used to assess cranial nerve 8 or the acoustic nerve. The patient's hearing is tested by air conduction (Rinne and Weber) and bone conduction (Rinne only).
The Rinne and the Weber tests are used to assess which of the following cranial nerve( s)? A) Cranial nerves 3, 4, and 6 B) Cranial nerve 7 C) Cranial nerve 8 D) Cranial nerves 9 and 10
D) The cerebellum The Romberg test evaluates the cerebellum, which is responsible for balance. This test is performed by having the client stand up straight with feet together and then having him/ her close the eyes and stand still for at least 20 seconds. A positive Romberg exam would demonstrate loss of balance.
The Romberg test is done to check for problems with balance. Which area of the brain is responsible for balance? A) Frontal lobe B) Temporal lobe C) The midbrain D) The cerebellum
B) It is the physiologic spike of serum blood glucose in the early morning The Somogyi phenomenon is when nocturnal hypoglycemia (2- 3 a.m.) stimulates the liver to produce glucagon to raise the blood sugar. The fasting blood glucose levels will be elevated from this glucagon production.
The Somogyi effect is characterized by which of the following? A) It is a complication of high levels of growth hormone B) It is the physiologic spike of serum blood glucose in the early morning C) It is characterized by high fasting blood glucose in the morning D) It is a rare phenomenon that only occurs in type 1 diabetic patients
A) S3 and S4 and low-pitched tones The bell of the stethoscope is used to auscultate the S3, S4, and low-pitchd tones. Remember the word "below" (Bell- Low).
The bell of the stethoscope is best used for auscultation of which of the following? A) S3 and S4 and low-pitched tones B) S3 and S4 only C) S1 and S2 and high-pitched tones D) S1 and S2 only
D) Stroking the inner thigh of a male client and watching the testicle on the ipsilateral side rise up toward the body The cremasteric reflex test is done by stroking the inner thigh of a male client and watching for the testicle on the ipsilateral side to rise up toward the body.
The cremasteric reflex is elicited by: A) Asking the patient to open his or her mouth and touching the back of the pharynx with a tongue blade B) Hitting the biceps tendon briskly with a reflex hammer and watching the lower arm for movement C) Hitting the patellar tendon briskly with a reflex hammer and watching the lower leg for movement D) Stroking the inner thigh of a male client and watching the testicle on the ipsilateral side rise up toward the body
D) 12 months The earliest age that MMR is recommended is 12 months. This age is recommended because giving it any earlier may be less effective because the infant still has antibodies from the mother. Antibodies still present from the mother may interfere with the production of the antibodies stimulated by the MMR vaccine.
The earliest age that an MMR can be administered is at: A) 4 months B) 6 months C) 8 months D) 12 months
C) Actinic keratosis Actinic keratosis is a small, raised skin lesion on skin that has been in the sun for a long period of time. Actinic keratoses are usually benign, but can develop into skin cancer; therefore, further evaluation is needed to determine if removal is required.
The following findings are considered benign lesions of the skin except: A) Lentigo B) Seborrheic keratosis C) Actinic keratosis D) Rosacea
D) The tumor commonly crosses the midline of the abdomen when it is discovered A Wilms's tumor is a congenital tumor of the kidney that should never be palpated, once diagnosed, to avoid spread of the tumor cells. Microscopic or gross hematuria may be present.
The following statements are true about Wilms's tumor except: A) The most frequent clinical sign is a palpable abdominal mass B) It is a congenital tumor of the kidney C) Microscopic or gross hematuria is sometimes present D) The tumor commonly crosses the midline of the abdomen when it is discovered
B) Magnetic resonance imaging (MRI) scan MRI provides good visualization of soft tissues of the body (most cancers, brain, cartilage, muscles, inflammation, etc.). It is best used in tissues with high water content. Patients with metal implants such as cochlear implants and cardiac pacemakers should be carefully screened. The MRI does not use radiation, but uses strong magnetic and radio waves to visualize body structures.
The gold-standard test for visualizing a torn meniscus or joint abnormalities is the: A) Computed tomography (CT) scan B) Magnetic resonance imaging (MRI) scan C) X-ray with special views of the affected knee D) Lachman's maneuver
B) Roseola infantum (exanthema subitum) Roseola infantum is a common viral rash that is caused by the human herpes virus; the most common ages of onset are between 6 months and 2 years. The rashes are maculopapular (small round pink-colored) rashes that first appear on the trunk and then spread to the extremities.
The mother of a 12-month-old infant reports to the nurse practitioner that her child had a high fever for several days, which spontaneously resolved. After the fever resolved, the child developed a maculopapular rash. Which of the following is the most likely diagnosis? A) Fifth disease (erythema infectiosum) B) Roseola infantum (exanthema subitum) C) Varicella D) Infantile maculopapular rashes
B) The fever is most likely due to the pertussis component of the DPT vaccine The pertussis component of the vaccine is most likely the cause of the fever.
The mother of a 4-month-old calls your office and reports that the infant has a fever of 101.4 degrees Fahrenheit. The infant received her immunizations yesterday. Which of the following is correct? A) The fever is most likely due to the combination of the MMR and polio vaccines B) The fever is most likely due to the pertussis component of the DTP vaccine C) The infant is probably starting a viral upper respiratory infection D) The infant had an allergic reaction to one of the vaccines given and should be brought to the emergency room
C) Tanner Stage IV Tanner stages for breast development: I, prepuberty; II, breast bud; III, breast and areola one mound; IV, breast and areola secondary mound; V, adult pattern.
What Tanner stage is a girl at when her breasts form a secondary mound? A) Tanner Stage II B) Tanner Stage III C) Tanner Stage IV D) Tanner Stage V
C) A bluish discoloration or bruising that is located on the umbilical area Cullen's sign is the acute onset of bluish discoloration that is located on the umbilical/ periumbilical area; it is caused by bruising underneath the skin. The bluish discoloration
What is the best description of Cullen's sign? A) The onset of hyperactive bowel sound before the onset of ileus B) A reddish-purple discoloration that is located on the flank area C) A bluish discoloration or bruising that is located on the umbilical area D) The acute-onset subcutaneous bleeding seen during acute pancreatitis
A) Instability of the affected knee caused by damage (i.e., rupture) to the anterior cruciate ligament (ACL) of the knee A positive Lachman sign is highly suggestive of damage to the anterior cruciate ligament of the knee. The anterior drawer sign may also be positive. There is laxity of the abnormal knee joint (compared with the normal knee). The Lachman test or maneuver is considered more sensitive for ACL damage compared with the anterior drawer test.
What is the significance of a positive Lachman sign? A) Instability of the affected knee caused by damage (i.e., rupture) to the anterior cruciate ligament (ACL) of the knee B) Posterior cruciate ligament laxity which may cause locking of the affected knee C) Achilles tendon rupture D) Patellar tendon rupture
D) 10 days The minimum number of days to quarantine an animal suspected of rabies is 10 days. If the animal is healthy and has no symptoms of rabies at 10 days, it is not infected with the rabies virus and can be returned to the owner.
When a domestic dog is suspected to be infected with the rabies virus, it can either be killed for a brain biopsy or it can be quarantined. What is the minimum number of days that a dog suspected of rabies must be quarantined? A) 4 weeks B) 21 days C) 14 days D) 10 days
D) Tanner Stage IV At Tanner Stage IV, the breast tissue is still growing. This is the stage in which the areola and the nipple separate to form a distinct mound. The most important clue is "secondary mound." During Tanner Stage III, the breast and areola and nipples grow together in one mound. There is no separation yet.
When an adolescent female's areola and nipples elevate above the level of the breasts to form a secondary mound, which of the following is the correct Tanner stage for this phase of breast development? A) Tanner Stage I B) Tanner Stage II C) Tanner Stage III D) Tanner Stage IV
A) An ultrasound of the sacrum An infant with tufts of fine dark hair on the sacrum should be evaluated for occult spina bifida. The first imaging test to order is an ultrasound of the lower spine.
When an infant is found to have tufts of fine dark hair on the sacrum, which of the following tests is recommended? A) An ultrasound of the sacrum B) A plain radiograph of the lumbo sacral spine C) No imaging test is necessary D) Genetic testing
C) 12 months By the age of 12 months, an infant is expected to have tripled its birth weight.
When does an infant triple its birth weight? A) 3 months B) 6 months C) 12 months D) 15 months
A) The "blue dot" sign The "blue dot" sign is located underneath the skin of the testicle and appears as a round, blue to purple mass. It is not an emergent condition. Also known as the torsion of testicular appendage.
Which of the following clinical findings can mimic a case of testicular torsion but is not considered an emergent condition? A) The "blue dot" sign B) One swollen testicle with yellow-colored penile discharge C) An acute onset of dysuria and frequency D) A varicocele
A) Fifth disease Fifth disease has three stages: Prodromal stage: Begins with symptoms of an upper respiratory infection, such as low-grade fever, headache, chills, and malaise. Second stage: A red rash appears on the cheeks, known as the "slapped cheek" rash. Usually resolves in 2- 3 days. Third stage: The rash moves to the arms and legs and becomes a "lacy"-appearing rash that is flat/ purple in appearance. May last for a few weeks.
Which of the following conditions is associated with three stages of rashes? A) Fifth disease B) Erythema infectiosum C) Varicella D) Rocky Mountain spotted fever
D) Atomoxetine (Strattera) Strattera is classified as a norepinephrine reuptake inhibitor. It is not a stimulant or an amphetamine. Strattera is contraindicated during/ within 14 days of taking an MAOI, narrow-angle glaucoma, heart disorder where increases in BP or heart rate will worsen it, or pheochromocytoma. Children and teenagers should be monitored for suicidal thoughts/ plans.
Which of the following drugs that are used to treat attention deficit hyperactivity disorder (ADHD) is not classified as an amphetamine/ stimulant? A) Dexmethylphenidate (Focalin XR) B) Mixed salts of amphetamine (Adderall) C) Methylphenidate (Ritalin) D) Atomoxetine (Strattera)
B) Chlamydia trachomatis The most common cause of nongonococcal urethritis is Chlamydia trachomatis.
Which of the following is the most common cause of nongonococcal urethritis? A) Escherichia coli B) Chlamydia trachomatis C) Neisseria gonorrhoeae D) Mycoplasma
C) Pseudomonas aeruginosa Pseudomonas aeruginosa is a common chronic lung infection seen in older children and adults with cystic fibrosis. This infection is difficult to get rid of and sometimes is the cause of death.
Which of the following pathogenic bacteria are commonly found in the lungs of older children and adults with cystic fibrosis? A) Streptoccocus pneumoniae B) Chlamydia pneumoniae C) Pseudomonas aeruginosa D) Staphylococcus aureus
C) Cones Rods and cones are photoreceptor cells of the retina. The cones of the eyes are responsible for color vision. Cones are very sensitive to colors (red, blue, or green) and work better in brighter light. Rods are good for night vision and for vision in low light conditions because they are sensitive to light and dark. To remember them, note that both cone and color start with the letter "C."
Which of the following structures of the eyes is responsible for color vision? A) Rods B) Macula C) Cones D) Pupils
A) Hemoglobin electrophoresis Patients with the diagnosis of beta thalassemia and/ or sickle cell anemia would be screened using hemoglobin electrophoresis to identify the blood disorder.
Which of the following tests would you recommend to patients to confirm the diagnosis of beta thalassemia or sickle cell anemia? A) Hemoglobin electrophoresis B) Bone morrow biopsy C) Peripheral smear D) Reticulocyte count
C) Advise the mother that this is a normal finding Explain to the mother that in healthy adolescents, a split S2 during inspiration that disappears during expiration is a normal variation.
While performing a sports physical on a 16-year-old girl, the nurse practitioner notes a split S2 during inspiration that disappears during expiration. The girl is active and her growth and development have been uneventful. What is the best recommendation for the child's mother? A) Her daughter needs to be referred to a pediatric cardiologist B) Her daughter needs to be referred for a stress EKG C) Advise the mother that this is a normal finding D) The child should avoid strenuous physical exertion until further evaluation
B) Hydrocortisone cream 1% BID until it is healed Treatment for contact dermatitis includes using a steroid cream BID until healed.
You have diagnosed Tom J., a 16-year-old male, with contact dermatitis on the left side of the face secondary to poison ivy. You would recommend: A) Washing with antibacterial soap BID to reduce risk of secondary bacterial infection until it is healed B) Hydrocortisone cream 1% BID until it is healed C) Clotrimazole (Lotrimin) cream BID for 2 weeks D) Halcinonide (Halog) 1% ointment BID for 2 weeks
A) 1 to 2 years Menarche normally begins approximately 1- 2 years following Tanner Stage II. Average age is 11.8 years old.
You note that your 11-year-old female patient is at Tanner Stage II. You would advise her mother that menarche will probably start in: A) 1 to 2 years B) 2.5 to 3 years C) 4 years D) It is dependent on the girl's genetic makeup
B) Psoriasis Fingernail pitting is correlated with psoriasis. Psoriasis can cause pitting on all finger and toenails, along with thickening and irregular shape of the nail.
You note, during a physical exam on a 6-year-old child, some pitting on the finger nails. This finding is correlated with: A) Iron-deficiency anemia B) Psoriasis C) Onychomycosis D) Vitamin C deficiency
D) Acute abodmen A positive iliopsoas muscle test is seen with an acute abdomen. This test is performed by asking the patient to actively flex the thigh at the hip. A "positive psoas sign" is noted when the patient exhibits pain in the right lower quadrant due to the inflamed tissue. The right iliopsoas muscle lies under the appendix, so pain may suggest appendicitis.
You would associate a positive iliopsoas muscle test result with: A) Left cerebral vascular accident B) Urinary tract infection C) Heel fractures D) Acute abdomen
D) G6PD deficiency anemia Pneumococcal vaccine should not be given to patients with G6PD deficiency anemia.
You would recommend the pneumococcal vaccine (Pneumovax) to patients with all of the following conditions except: A) Sickle cell anemia B) Splenectomy C) Patients infected with HIV D) G6PD deficiency anemia
