Final Exam Questions PEDS
The primary care pediatric nurse practitioner is performing a well baby examination on a 2 week old infant. The parent is concerned that the infant sleeps too much. The nurse practitioner asks the parent to keep a sleep log and will teach the parent that which amount of sleep per day is optimal for this infant? a. 10 to 12 hours b. 12 to 15 hours c. 15 to 18 hours d. 18 to 20 hours
c. 15 to 18 hours
In infants, solid foods are best introduced no earlier than: a. 1 to 3 months b. 3 to 5 months c. 4 to 6 months d. 6 to 8 months
c. 4 to 6 months
The primary care pediatric nurse practitioner diagnoses a high school basketball player with mononucleosis. The adolescent asks when she may resume play. What will the nurse practitioner tell her? a. After 3 weeks, she may begin lifting weights but not full sports. b. After 4 weeks, she may return to full play and practice. c. At 4 weeks, she must have an exam to determine fitness for play d. She may engage in moderate exertion and practice after 3 weeks.
c. At 4 weeks, she must have an exam to determine fitness for play
At least how many months apart should hepatitis A doses vaccine be administered? a. At least one month apart b. At least 3 months apart c. At least 6 months apart d. At least one year apart
c. At least 6 months apart
The parent of a 12-year-old child who has sickle cell trait (SCT) asks the primary care pediatric nurse practitioner whether the child may play football. What will the nurse practitioner tell this parent? a. Children with SCT should not play any contact sports. b. Children with SCT may not play for NCAA schools in college. c. Children with SCT should follow heat acclimatization guidelines. d. Children with SCT should not participate in organized sports.
c. Children with SCT should follow heat acclimatization guidelines.
The parent of a child newly diagnosed with epilepsy asks the primary care pediatric nurse practitioner if the child will ever be able to participate in gym or sports. What will the nurse practitioner recommend? a. Bicycle riding is not safe for children with seizures. b. Contact sports should be avoided. c. Direct supervision of some activities is necessary d. Underwater sports are not recommended.
c. Direct supervision of some activities is necessary
The parent of a newborn infant asks the primary care pediatric nurse practitioner when to intervene to help the infant's future intellectual growth. What will the nurse practitioner tell the parent? a. Cognitive learning begins during the toddler years. b. Intellectual growth begin when speech develops. c. Language and literacy skills begin at birth. d. Preschool is an optimal time to begin general learning.
c. Language and literacy skills begin at birth.
Limping and pain in a child's leg of insidious onset may be indicative of what? a. Intertrochanteric fracture b. Hip dislocation c. Legg-Calve-Perthes disease d. Hip impingement
c. Legg-Calve-Perthes disease Legg-Calve Perthes disease occurs when the blood supply is temporarily interrupted to the femoral head of the hip joint. Without sufficient blood flow, the bone begins to die and can break easily, and subsequently may heal poorly.
A child who was treated with amoxicillin and then amoxicillin-clavulanate for acute otitis media is seen for follow-up. The primary care pediatric nurse practitioner notes dull-gray tympanic membranes with a visible air-fluid level. The child is afebrile and without pain. What is the next course of action? a. Administering ceftriaxone IM b. Giving clindamycin orally c. Monitoring ear fluid levels for 3 months d. Watchful waiting for 48 to 72 hours
c. Monitoring ear fluid levels for 3 months
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
c. Monogenetic
During a well child examination of an infant, the primary care pediatric nurse practitioner notes 10 café au lait spots on the infant's trunk. What is the potential concern associated with this finding? a. Endocrine disorders b. Malignancy c. Neurofibromatosis d. Sturge-Weber syndrome
c. Neurofibromatosis Café au lait spots are significant for neurofibromatosis and should be referred if more than 5 lesions are present. Atypical nevi are concerning for malignancy. Port-wine stains are concerning for Sturge-Weber syndrome. Acanthosis is a sign of diabetes.
A child is brought to the clinic with a fever, headache, malaise, and a red, annular macule surrounded by an area of clearing and a larger, erythematous annular ring. The child complains of itching at the site. What will the primary care pediatric nurse practitioner do to determine the diagnosis? a. Ask about recent tick bites b. Obtain a skin culture c. Order blood cultures d. Perform serologic testing
a. Ask about recent tick bites
An adolescent who had cradle cap as an infant is in the clinic with thick crusts of yellow, greasy scales on the forehead and behind the ears. What will the primary care pediatric nurse practitioner recommend? a. Daily application of ketoconazole 2% topical cream b. Highpotency topical corticosteroids applied daily c. Mineral oil and shampoo on the affected areas d. Selenium sulfide shampoo twice weekly to the face
a. Daily application of ketoconazole 2% topical cream
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? a. Evaluate the safety and efficacy of each product and monitor use. b. Incorporate these therapies into standard care practices. c. Recommend not using the products until the child is older. d. Suggest that most of these treatments are not safe for children.
a. Evaluate the safety and efficacy of each product and monitor use.
The primary care pediatric nurse practitioner is considering use of a relatively new drug for a 15-month-old child. The drug is metabolized by the liver, so the nurse practitioner will consult a pharmacologist to discuss giving the drug: a. Less often or at a lower dose. b. More often or at a higher dose. c. Via a parenteral route. d. Via the oral route.
a. Less often or at a lower dose.
A traction injury to the tibial tuberosity in adolescents is termed what? a. Osgood-Schlatter disease b. Prepatellar bursitis c. Infrapatellar bursitis d. Quadriceps tendonopathy
a. Osgood-Schlatter disease Osgood-Schlatter disease is a common cause of knee pain in growing adolescents. it is an inflammation of the area just below the knee where the patellar tendon attaches to the tibia.
What is the most common cause of heel pain? a. Plantar fasciitis b. Achilles tendinopathy c. Ankle sprain d. Compartment syndrome
a. Plantar fasciitis
An adolescent female reports facial pain and frequent popping of her jaw. An exam reveals unilateral tender facial muscles and a deviation of the mandible to the affected side with opening of the mouth. What will the primary care pediatric nurse practitioner do? a. Recommend ice packs, NSAIDs, and a soft diet. b. Refer to a pediatric mental health specialist. c. Refer to an orthodontist for a surgical intervention. d. Suggest obtaining Botox injection treatments
a. Recommend ice packs, NSAIDs, and a soft diet.
The primary care pediatric nurse practitioner is performing a pre-participation sports physical examination on a 14-year-old male who will be on the wrestling team at school. What will the nurse practitioner include when discussing healthy practices with this adolescent? a. Risks associated with repeatedly losing and gaining weight b. The need for an electrocardiogram or echocardiogram prior to participation c. The need to consume 20 to 30 grams of protein after exercise d. To consume water with CHO prior to activity lasting up to an hour
a. Risks associated with repeatedly losing and gaining weight
Breast buds and papilla elevated in girls: a. Tanner stage 2 b. Tanner stage 3 c. Tanner stage 4 d. Tanner stage 5
a. Tanner stage 2
The parent of a 5-month-old is worried because the infant becomes fussy but doesn't always seem interested in nursing. What will the nurse practitioner tell this parent? a. The infant may be expressing a desire to play or to rest. b. The parent should give ibuprofen for teething pain before nursing. c. This is an indication that the infant is ready for solid foods. d. This may indicate gastrointestinal discomfort such as constipation.
a. The infant may be expressing a desire to play or to rest.
Which of the following is true about the MMR vaccine? a. The vaccine contains live virus. b. Its use is contraindicated in person with a history of egg allergy. c. Revaccination of an immune person is associated with risk of allergic reaction. d. One dose is recommended for young adults who have not been previously immunized.
a. The vaccine contains live virus.
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
b. Carrier testing
The primary care pediatric nurse practitioner is counseling the parents of a toddler about appropriate discipline. The parents report that the child is very active and curious, and they are worried about the potential for injury. What will the pediatric nurse practitioner recommend? a. Allow the child to explore and experiment while providing appropriate limits. b. Be present while the child plays to continually teach the child what is appropriate. c. Let the child experiment at will and to make mistakes in order to learn. d. Say "no" whenever the child does something that is not acceptable.
a. Allow the child to explore and experiment while providing appropriate limits.
The mother of a 6-month-old infant is distressed because the infant can say "dada" but not "mama" and asks the primary care pediatric nurse practitioner why this is when she is the one who spends more time with the infant. How will the nurse practitioner respond? a. "At this age, your baby does not understand the meaning of sounds." b. "Babies at this age cannot make the 'ma' sound." c. "Most sounds made by babies at this age are accidental." d. "This may mean that your baby doesn't hear well."
a. "At this age, your baby does not understand the meaning of sounds."
A preschool-age child is seen in the clinic after waking up a temperature of 102.2°F, swelling and erythema of the upper lid of one eye, and moderate pain when looking from side to side. Which course of treatment is correct? a. Admit to the hospital for intravenous antibiotics. b. Obtain a lumbar puncture and blood culture. c. Order warm compresses 4 times daily for 5 days. d. Prescribe a 10- to 14-day course of oral antibiotics.
a. Admit to the hospital for intravenous antibiotics.
The primary care pediatric nurse practitioner is counseling an adolescent who was recently hospitalized for an asthma exacerbation and learns that the child usually forgets to use twice- daily inhaled corticosteroid medications that are supposed to be given at 0800 and 2000 each day. Which strategy may be useful in this case to improve adherence? a. Ask the adolescent to identify two times each day that may work better. b. Consider having the school nurse supervise medication administration. c. Prescribing a daily oral corticosteroid medication instead. d. Suggest that the parent enforce the medication regimen each day.
a. Ask the adolescent to identify two times each day that may work better.
During a well child exam of a school age child, the primary care pediatric nurse practitioner learns that the child has been having angry episodes at school. The nurse practitioner observes the child to appear withdrawn and sad. Which action is appropriate? a. Ask the child and the parent about stressors at home b. Make a referral to a child behavioral specialist c. Provide information about anger management d. Suggest consideration of a different
a. Ask the child and the parent about stressors at home
The primary care pediatric nurse practitioner is evaluating a 2-year-old with a documented speech delay. Screenings to assess motor skills and cognition are normal, and the child passed a recent hearing test. What will the pediatric nurse practitioner do next? a. Ask the child's parents whether they read to the child. b. Give parents educational materials to encourage speech. c. Refer the child to an early intervention program. d. Suggest that they purchase age-appropriate music videos.
a. Ask the child's parents whether they read to the child.
The primary care pediatric nurse practitioner sees a 3 year old child whose parents report is a picky eater in spite of their continued efforts to provide nutritious meals. The parents ask whether a multivitamin is necessary. How will the nurse practitioner respond? a. Ask the parents to provide a 3 day food diary. b. Prescribe a daily multivitamin with iron. c. Reinforce the need to meet DRIs each day. d. Tell them that supplements are unnecessary
a. Ask the parents to provide a 3 day food diary.
The primary care pediatric nurse practitioner is discussing fitness and exercise with the parents of a 5-year-old child who ask what kinds of activities are developmentally appropriate for their child. What will the nurse practitioner recommend? a. Bike riding b. Interactive play c. Martial arts d. Organized sports
a. Bike riding
The onset of puberty in girls is marked by: a. Breast budding b. Menarche c. Peak of growth spurt d. Presence of axillary hair
a. Breast budding
Which of the following is noted in a child with premature thelarche? a. Breast enlargement b. Accelerated linear growth c. Pubic hair d. Body odor
a. Breast enlargement
The primary care pediatric nurse practitioner has a cohort of patients who have special health care needs. Which is an important role of the nurse practitioner when caring for these children? a. Care coordination and collaboration b. Developing protocols for parents to follow c. Monitoring individual education plans (IEPs) d. Providing lists of resources for families
a. Care coordination and collaboration
When considering a person's risk for measles, mumps, and rubella, the NP considers the following: a. Children should have two dose of the measles, mumps, and rubella (MMR) vaccine before their sixth birthday. b. Considerable mortality and mobility occur with all three diseases. c. Most cases of the three disease in the United States occur in infants. d. The use of the vaccine is often associated with protracted arthralgia.
a. Children should have two dose of the measles, mumps, and rubella (MMR) vaccine before their sixth birthday.
A school-age child has a history of chronic otitis media and is seen in the clinic with vertigo. The primary care pediatric nurse practitioner notes profuse purulent otorrhea from both pressure-equalizing tubes and a pearly-white lesion on one tympanic membrane. Which condition is most likely? a. Cholesteatoma b. Mastoiditis c. Otitis externa d. Otitis media with effusion
a. Cholesteatoma
A 10-month-old infant who is new to the clinic has chronic hepatitis B infection. What will the primary care pediatric nurse practitioner do to manage this infant's disease? a. Consult a pediatric infectious disease specialist. b. Prescribe interferon-alfa. c. Provide supportive care. d. Consider use of lamivudine.
a. Consult a pediatric infectious disease specialist. A specialist in hepatitis B in children should be consulted for children with chronic hepatitis B infection because of the risk for developing hepatocellular carcinoma. Interferon-alfa and lamivudine are not used in infants. Supportive care only is not recommended.
A child who has been taking antibiotics is brought to the clinic with a rash. The parent reports that the child had a fever associated with what looked like sunburn and now has "blisters" all over. A physical examination shows coalescent target lesions and widespread bullae and areas of peeled skin revealing moist, red surfaces. What will the primary care pediatric nurse practitioner do? a. Consult with a pediatric intensivist for admission to a pediatric intensive care unit. b. Order oral acyclovir 20 mg/kg/day in two doses for 6 to 12 months. c. Prescribe systemic antihistamines and antimicrobial medications as prophylaxis. d. Recommend analgesics, cool compresses, and oral antihistamines for comfort.
a. Consult with a pediatric intensivist for admission to a pediatric intensive care unit.
During an assessment of a 4-week-old infant, the primary care pediatric nurse practitioner learns that a breastfed infant nurses every 2 hours during the day but is able to sleep for a 4-hour period during the night. The infant has gained 20 grams per day in the interval since last seen in the clinic. What will the nurse practitioner recommend? a. Continuing to nurse the infant using the current pattern b. Nursing the infant for longer periods every 4 hours c. Supplementing with formula at the last nighttime feeding d. Waking the infant every 2 hours to nurse during the night
a. Continuing to nurse the infant using the current pattern
A 5-year-old child who has a history of pertussis infection as an infant is in the clinic for immunizations prior to kindergarten. Which vaccine will be given? a. DTaP b. DTP c. Td d. Tdap
a. DTaP The duration of immunity after infection with pertussis in unknown and is thought to be short, so immunization for pertussis must still be provided. The DTP, with whole-cell pertussis vaccine is given in other countries but not in the U.S. Td does not contain pertussis. Tdap is given after age 7 year
A 10-year-old is hit in the head with a baseball during practice and is diagnosed with concussion, even though no loss of consciousness occurred. The primary care pediatric nurse practitioner is evaluating the child 2 weeks after the injury and learns that the child is still experiencing some sleepiness every day. The neurological exam is normal. The child and the parent are adamant that the child be allowed to return to play baseball. What will the nurse practitioner recommend? a. Continuation of cognitive rest only b. Continuation of physical and cognitive rest c. Continuation of physical rest only d. Returning to play
b. Continuation of physical and cognitive rest
A child with a history of otitis externa asks about ways to prevent this condition. What will the primary care pediatric nurse practitioner recommend? a. Cleaning ear canals well after swimming b. Drying the ear canal with a hair dryer c. Swimming only in chlorinated pools d. Using cerumenolytic agents daily
b. Drying the ear canal with a hair dryer
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? a. Children must inherit a gene from both parents to develop the disease. b. Each child born to this couple will have a 50% risk of having the disease. c. This type of disorder characteristically skips generations. d. Unaffected offspring may still pass on the disease to their offspring.
b. Each child born to this couple will have a 50% risk of having the disease.
What is true about haploid cells? a. Each contains 23 paired chromosomes. b. Each one contains 23 chromosomes. c. Replication produces two identical cells. d. They replicate via the process of mitosis
b. Each one contains 23 chromosomes.
A toddler is receiving long-term antibiotics to treat osteomyelitis. Which laboratory test will the primary care pediatric nurse practitioner order to monitor response to therapy in this child? a. Blood cultures b. Erythrocyte sedimentation rate (ESR) c. Serum procalcitonin (Pro-CT) d. White blood count (WBC)
b. Erythrocyte sedimentation rate (ESR) ESR is a late measure of inflammation and is useful in helping monitor response to therapy, especially when long-term antibiotics are used. Blood cultures will most likely be negative during antibiotic treatment. Pro-CT is used to differentiate viral from bacterial infections. The WBC will most likely decrease over time with a treated infection and is not useful for monitoring response to therapy.
The parent of a school age child tells the primary care pediatric nurse practitioner that the child is restless most nights and complains often that bugs are in the bed. After consultation with a sleep disorder specialist and subsequent evaluation of a ferritin level of 30, the nurse practitioner may expect to treat this child with a. Clonazepam. b. Ferrous sulfate. c. Gabapentin. d. Sertraline.
b. Ferrous sulfate.
The primary care pediatric nurse practitioner provides patient teaching for children newly diagnosed with irritable bowel syndrome (IBS). At which stage of development will children be able to understand the link between stress and the symptoms of the disease? a. Concreteoperational stage b. Formal operational stage c. Preconceptual stage d. Sensorimotor stage
b. Formal operational stage
Which of the following is true of the Ottawa foot and ankle rules? a. Has a high specificity for foot and ankle fractures b. Has high sensitivity for foot and ankle fractures c. Is specific for fractures of the cuboid bone d. Is correlated with decreased foot and ankle ROM
b. Has high sensitivity for foot and ankle fractures Evidence supports the Ottawa ankle rule as an accurate instrument for excluding fractures of the ankle and mid-foot. The instrument has a sensitivity of almost 100% and a modest specificity, and its use should reduce the number of unnecessary radiographs by 30-40%.
The primary care pediatric nurse practitioner is teaching a parent of a child with dry skin about hydrating the skin with bathing. What will the nurse practitioner include in teaching? a. Apply lubricating agents at least 1 hour after the bath. b. Have the child soak in a lukewarm water bath. c. Keep the child in the bath until the skin begins to "prune." d. Soaping should be done at the beginning of the bath.
b. Have the child soak in a lukewarm water bath.
The Monospot test used to diagnose mononucleosis tests for the presence of: a. Viral antigen b. Heterophile antibody c. Viral RNA d. Immunoglobulin G
b. Heterophile antibody
The mother of a 3-month-old child tells the primary care pediatric nurse practitioner that it is "so much fun" now that her infant coos and smiles and wants to play. What is important for the nurse practitioner to teach this mother? a. Appropriate ways to stimulate and entertain the infant b. How to read the infant's cues for overstimulation c. The importance of scheduling "play dates" with other infants d. To provide musical toys to engage the infant
b. How to read the infant's cues for overstimulation
The primary care pediatric nurse practitioner is evaluating a 10 year old child who is describing shooting pain in both legs associated with aching, tingling, and burning. The child is unable to pinpoint specific locations for this pain. Which type of pain does the nurse practitioner suspect? a. Chronic pain b. Neuropathic pain c. Somatic pain d. Visceral pain
b. Neuropathic pain
A child complains of itching in both ears and is having trouble hearing. The primary care pediatric nurse practitioner notes periauricular edema and marked swelling of the external auditory canal and elicits severe pain when manipulating the external ear structures. Which is an appropriate intervention? a. Obtain a culture of the external auditory canal. b. Order ototopical antibiotic/corticosteroid drops. c. Prescribe oral amoxicillin-clavulanate. d. Refer the child to an otolaryngologist.
b. Order ototopical antibiotic/corticosteroid drops.
The primary care pediatric nurse practitioner notes velvety, brown thickening of skin in the axillae, groin, and neck folds of an adolescent Hispanic female who is overweight. What is the initial step in managing this condition? a. Consultation with a pediatric dermatologist b. Performing metabolic laboratory tests c. Prescribing topical retinoic acid cream d. Referral to a pediatric endocrinologist
b. Performing metabolic laboratory tests The initial step is to determine whether metabolic syndrome is the underlying cause for these lesions, which, according to the other physical findings, is most likely. If hyperinsulinemia is present, referral to a pediatric endocrinologist is the next step. A dermatology referral is not indicated. Unless the lesions are thick or cause discomfort, prescribing retinoic acid is not necessary.
The parents of a 3-year-old child are concerned that the child has begun refusing usual foods and wants to eat mashed potatoes and chicken strips at every meal and snack. The child's rate of weight has slowed, but the child remains at the same percentile for weight on a growth chart. What will the primary care pediatric nurse practitioner tell the parents to do? a. Allow the child to choose foods for meals to improve caloric intake. b. Place a variety of nutritious foods on the child's plate at each meal. c. Prepare mashed potatoes and chicken strips for the child at mealtimes. d. Suggest cutting out snacks to improve the child's appetite at mealtimes.
b. Place a variety of nutritious foods on the child's plate at each meal.
You examine a 15 year old boy who has infectious mononucleosis with marked tonsillar hypertrophy, exudative pharyngitis, significant difficulty swallowing, and a patent airway. You consider prescribing a course of oral: a. Amoxicillin b. Prednisone c. Ibuprofen d. Acyclovir
b. Prednisone
The primary care pediatric nurse practitioner is performing a well child examination on a 9-month-old infant whose hearing is normal but who responds to verbal cues with only single syllable vocalizations. What will the nurse practitioner recommend to the parents to improve speech and language skills in this infant? a. Provide educational videos that focus on language. b. Read simple board books to the infant at bedtime. c. Sing to the child and play lullabies in the baby's room. d. Turn the television to Sesame Street during the day.
b. Read simple board books to the infant at bedtime.
The most common mode of influenza virus transmission is via: a. Contact with contaminated surface b. Respiratory droplet c. Saliva contact d. Skin to skin
b. Respiratory droplet
Onset of growth spurt in boys or girls: a. Tanner stage 2 b. Tanner stage 3 c. Tanner stage 4 d. Tanner stage 5
b. Tanner stage 3
The parents of a formula fed newborn report that they get their drinking water from a well. What will the primary care pediatric nurse practitioner recommend to provide adequate fluoride for this infant? a. Giving the infant a fluoride supplement b. Testing the fluoride level of their water source c. Using bottled water to prepare the infant's formula d. Using powdered formula with added fluoride
b. Testing the fluoride level of their water source
The primary care pediatric nurse practitioner performs a Hirschberg test to evaluate a. color vision. b. ocular alignment. c. peripheral vision. d. visual acuity.
b. ocular alignment.
The mother of a newborn asks the primary care pediatric nurse practitioner about the benefits of breastfeeding. What will the nurse practitioner tell her? a. Breastfeeding for 9 months or longer will reduce the incidence of food allergies. b. Breast milk is an excellent source of vitamin D, iron, and other essential nutrients for the baby. c. Nursing her baby exclusively for at least 4 months will help her infant to resist infections. d. There is a decreased risk of atopic dermatitis in babies who nurse for 12 months or longer.
c. Nursing her baby exclusively for at least 4 months will help her infant to resist infections. There is evidence that infants who exclusively breastfeed for at least 4 months have less risk for infection than infants breastfed for less time. However, infants who breastfeed exclusively for 9 months or for longer than 12 months may have increased risks for food hypersensitivities and atopic dermatitis. Breast milk is a poor source of vitamin D and iron.
The primary care pediatric nurse practitioner enters an exam room and finds a 2-month-old infant in a car seat on the exam table. The infant's mother is playing a game on her smart phone. The nurse practitioner interprets this behavior as a. A sign that the mother has postpartum depression. b. Extremely concerning for potential parental neglect. c. Of moderate concern for parenting problems. d. Within the normal range of behavior in early parenthood.
c. Of moderate concern for parenting problems.
During a well child assessment of an 18-month-old child, the primary care pediatric nurse practitioner observes the child becoming irritable and uncooperative. The parent tells the child to stop fussing. What will the nurse practitioner do? a. Allow the parent to put the child in a "timeout." b. Ask the parent about usual discipline practices. c. Offer the child a book or a toy to look at. d. Stop the exam since the child has reached a "meltdown."
c. Offer the child a book or a toy to look at.
A 16-year old basketball player who is 6 ft. tall is seen for complaints of painful lumps on his knees. Upon inspection, you note 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. Osteosarcoma of the tibia c. Osgood-Schlatter disease d. Paget's disease of the bone
c. Osgood-Schlatter disease
The primary care pediatric nurse practitioner is examining a newborn infant recently discharged from the neonatal intensive care unit after a premature birth. The parent is upset and expresses worry about whether the infant will be normal. What will the nurse practitioner do in this situation? a. Explain to the parent that developmental delays often do not manifest at first. b. Perform a developmental assessment and tell the parent which delays are evident. c. Point out the tasks that the infant can perform while conducting the assessment. d. Refer the infant to a developmental specialist for a complete evaluation.
c. Point out the tasks that the infant can perform while conducting the assessment.
Which of the following is noted in a child with premature adrenarche? a. Breast development b. Accelerated linear growth c. Pubic hair d. Menstruation
c. Pubic hair
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? a. Obtain a KOH preparation of a skin scraping to verify the diagnosis. b. Prescribe topical steroid creams to shorten the course of the disease. c. Reassure the child's parents that the rash is benign and self-limited. d. Recommend topical antihistamines and emollients to control the spread.
c. Reassure the child's parents that the rash is benign and self-limited.
The primary care pediatric nurse practitioner performs a developmental assessment on a 32-month-old child. The child's parent reports that about 70% of the child's speech is intelligible. The pediatric nurse practitioner observes that the child has difficulty pronouncing "t," "d," "k," and "g" sounds. Which action is correct? a. Evaluate the child's cognitive abilities. b. Obtain a hearing evaluation. c. Reassure the parent that this is normal. d. Refer the child to a speech therapist.
c. Reassure the parent that this is normal.
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
c. Reassuring the parents that these are benign and may disappear spontaneously
The primary care pediatric nurse practitioner performs a well baby examination on a 7-day-old infant who is nursing well, according to the mother. The nurse practitioner notes that the infant weighed 3250 grams at birth and 2990 grams when discharged on the second day of life. The infant weighs 3080 grams at this visit. Which action is correct? a. Follow up at the 2-month checkup. b. Refer to a lactation consultant. c. Schedule a weight check in 1 week. d. Suggest supplementing with formula.
c. Schedule a weight check in 1 week.
The primary care pediatric nurse practitioner is performing a well child examination on a 4 year old child. The parent reports that the child snores frequently, often awakens during the night, and seems cranky during the day. What will the nurse practitioner tell this parent? a. Most sleep disorders are benign and will be outgrown. b. Sleep disorders are symptomatic of underlying behavior problems. c. Sleep disorders at this age can have longterm impacts on learning. d. The child will need longer daytime naps to compensate for lost sleep.
c. Sleep disorders at this age can have longterm impacts on learning.
During a well child exam on a 13 year old female, the primary care pediatric nurse practitioner notes that the child is at Tanner Stage 3. During the exam, when the nurse practitioner initiates a conversation about healthy sexuality education, the parent states that this topic is "off limits." What will the nurse practitioner do? a. Ask the adolescent whether she wishes to discuss these matters since she is becoming an adult. b. Separate the parent from the adolescent to discuss the adolescent's concerns in private. c. Spend private time with the parent to discuss how sexuality education reduces the risk of early sexual intercourse and risky sexual behaviors. d. Tell the parent that this information is a routine part of adolescent well child examinations and must be included.
c. Spend private time with the parent to discuss how sexuality education reduces the risk of early sexual intercourse and risky sexual behaviors.
During a well child exam, the primary care pediatric nurse practitioner learns that the parents of a young child fight frequently about finances. The parents state that they do not fight in front of the child and feel that the situation is temporary and related to the father's job layoff. What will the nurse practitioner do? a. Reassure them that the child is too young to understand. b. Recommend that they continue to not argue in front of the child. c. Suggest counseling to learn ways to handle stress. d. Tell them that the conflict will resolve when the situation changes.
c. Suggest counseling to learn ways to handle stress.
In boys, increase in penile length and width with development of glans: a. Tanner stage 2 b. Tanner stage 3 c. Tanner stage 4 d. Tanner stage 5
c. Tanner stage 4
The primary care pediatric nurse practitioner is performing a well baby examination on a 2-month-old infant who has gained 25 grams per day in the last interval. The mother is nursing and tells the nurse practitioner that her infant seems fussy and wants to nurse more often. What will the nurse practitioner tell her? a. She may not be making as much breastmilk as before. b. She should keep a log of the frequency and duration of each feeding. c. The infant may be going through an expected growth spurt. d. The infant should stay on the previously established nursing schedule.
c. The infant may be going through an expected growth spurt.
The primary care pediatric nurse practitioner is offering anticipatory guidance to the parents of a 6-year-old child who has Down syndrome. What will the nurse practitioner tell the parents about physical activity and sports in school? a. Children with Down syndrome get frustrated easily when engaging in sports. b. Children with Down syndrome should not participate in strenuous aerobic activity. c. Their child should have a cervical spine evaluation before participation in sports. d. Their child should only participate in sports sanctioned by the Special Olympics.
c. Their child should have a cervical spine evaluation before participation in sports.
The parent of a 10-year-old boy tells the primary care pediatric nurse practitioner that the child doesn't appear to have any interest in girls and spends most of his time with a couple of other boys. The parent is worried about the child's sexual identity. The nurse practitioner will tell the parents a. Children at this age who prefer interactions with same-gender peers usually have a homosexual orientation. b. Children experiment with sexuality at this age as a means of deciding later sexual orientation. c. This attachment to other same-gender children is how the child learns to interact with others. d. To encourage mixed-gender interactions in order to promote development of sexual values.
c. This attachment to other same-gender children is how the child learns to interact with others.
The mother of a 3-year-old child takes the child to a play group once a week. She expresses concern that the child plays with toys but does not interact with the other toddlers. What will the primary care pediatric nurse practitioner counsel the mother? a. The child probably is very shy but will outgrow this tendency with repeated exposure to other children. b. The toddler may have a language delay that interferes with socialization with other children. c. Toddlers may be interested in other children but usually do not engage in interactive play. d. Toddlers need more structured play to encourage interaction and socialization with others.
c. Toddlers may be interested in other children but usually do not engage in interactive play.
A 14-year-old child has a 2-week history of severe itching and tearing of both eyes. The primary care pediatric nurse practitioner notes redness and swelling of the eyelids along with stringy, mucoid discharge. What will the nurse practitioner prescribe? a. Saline solution or artificial tears b. Topical mast cell stabilizer c. Topical NSAID drops d. Topical vasoconstrictor drops
c. Topical NSAID drops
The most common reason for precocious puberty in girls is: a. Ovarian tumor b. Adrenal tumor c. Exogenous estrogen d. Early onset of normal puberty
d. Early onset of normal puberty
The rapid strep test can be used to identify the presence of: a. Gram-positive or gram-negative bacteria. b. Gram-negative bacteria only c. Any Streptococcus species d. Group A streptococcus only
d. Group A streptococcus only
The primary care pediatric nurse practitioner is offering anticipatory guidance to the parents of a 12-month-old child. The parents are bilingual in Spanish and English and have many Spanish-speaking relatives nearby. They are resisting exposing the child to Spanish out of concern that the child will not learn English well. What will the pediatric nurse practitioner tell the parents? a. Children who learn two languages simultaneously often confuse them in conversation. b. Children with multi-language proficiency do not understand that others cannot do this. c. Learning two languages at an early age prevents children from developing a dominant language. d. Most bilingual children are able to shift from one language to another when appropriate.
d. Most bilingual children are able to shift from one language to another when appropriate.
A toddler exhibits exotropia of the right eye during a cover-uncover screen. The primary care pediatric nurse practitioner will refer to a pediatric ophthalmologist to initiate which treatment? a. Botulinum toxin injection b. Corrective lenses c. Occluding the affected eye for 6 hours per day d. Patching of the unaffected eye for 2 hours each day
d. Patching of the unaffected eye for 2 hours each day
A school-age child is hit in the face with a baseball bat and reports pain in one eye. The primary care pediatric nurse practitioner is able to see a dark red fluid level between the cornea and iris on gross examination, but the child resists any exam with a light. Which action is correct? a. Administer an oral analgesic medication. b. Apply a Fox shield and reevaluate the eye in 24 hours. c. Instill anesthetic eyedrops into the affected eye. d. Refer the child immediately to an ophthalmologist.
d. Refer the child immediately to an ophthalmologist.
Torticollis is a shortening or spasm of which of the following muscles? a. Anterior scalene b. Subclavius c. Latissimus dorsi d. Sternocleidomastoid
d. Sternocleidomastoid Torticollis results in a fixed or dynamic posturing of the head and neck in tilt, rotation and flexion. Spasms of the sternocleidomastoid, trapezius, and other neck muscles, usually more prominent on one side than the other, may cause turning or tipping of the head.
The primary care pediatric nurse sees a 17 year old client who quit smoking almost a year prior but who reports having renewed cravings when around friends who smoke. Using knowledge of the maintenance stage of change, the primary care pediatric nurse practitioner will: a. Go over with the adolescent about the health risks associated with smoking. b. Recommend avoiding friends who smoke and making new friends. c. Remind the adolescent about the struggles associated with quitting smoking. d. Suggest that the teen consider taking up a sport or other physical activity.
d. Suggest that the teen consider taking up a sport or other physical activity.
Jason, age 8 years, is going to South America on vacation with his parents. His parents want to know which vaccinations he needs to keep from getting sick. Assuming he is caught up on all of his other vaccinations, which of the following vaccines would be least necessary for Jason? a. Hepatitis A b. Typhoid vaccine c. Malaria vaccine d. Tdap
d. Tdap
Of the following, which is the most commonly fractured bone in the body? a. The scaphoid b. The humerus c. The ulna d. The radius
d. The radius Arm fractures account for almost 50% of all broken bones. The radius is commonly fractured when a person tries to break their "fall on an outstretched hand" (FOOSH).
The mother of a 3 month old male infant tells the primary care pediatric nurse practitioner that she occasionally notices he has a penile erection just after nursing. What will the nurse practitioner tell the mother? a. Infants should be prevented from masturbating. b. The infant is conscious of the pleasure associated with nursing. c. This is a form of infantile priapism. d. This is a normal, reflexive behavior at this age
d. This is a normal, reflexive behavior at this age
During a well child examination of a 6 year old girl, the primary care pediatric nurse practitioner notes that the child becomes embarrassed and resists taking off her underwear for the exam. What should the nurse practitioner infer from this observation? a. The child has been sexually molested b. The child is feeling violated by the examiner c. The parents is exhibiting regressive behavior d. This is normal reaction in a child of this age
d. This is normal reaction in a child of this age
The mother of a 6-week-old breastfeeding infant tells the primary care pediatric nurse practitioner that her baby, who previously had bowel movements with each feeding, now has a bowel movement once every third day. What will the nurse practitioner tell her? a. Her baby is probably constipated. b. It may be related to her dietary intake. c. She should consume more water. d. This may be normal for breastfed babies.
d. This may be normal for breastfed babies.
The primary care pediatric nurse practitioner performs a physical examination on a 9-month-old infant and notes two central incisors on the lower gums. The parent states that the infant nurses, takes solid foods three times daily, and occasionally takes water from a cup. What will the pediatric nurse practitioner counsel the parent to promote optimum dental health? a. To begin brushing the infant's teeth with toothpaste b. To consider weaning the infant from breastfeeding c. To discontinue giving fluoride supplements d. To make an appointment for an initial dental examination
d. To make an appointment for an initial dental examination
The primary care pediatric nurse practitioner sees a 3-day-old nursing infant whose newborn metabolic screen is positive for galactosemia. The nurse practitioner refers the newborn to a specialist for immediate evaluation and will tell the mother a. To continue to breastfeed her infant. b. To give the infant a cow's milk formula. c. To supplement breast milk with formula. d. To stop breastfeeding immediately.
d. To stop breastfeeding immediately. Infants with galactosemia cannot consume galactose, which is in both cow's milk and breast milk. Since there is a potential for a life-threatening response, the mother should be instructed to stop nursing immediately.
A 15-year-old female basketball player who has secondary amenorrhea is evaluated by the primary care pediatric nurse practitioner who notes a BMI in the 3rd percentile. What will the nurse practitioner counsel this patient? a. That amenorrhea in female athletes is not concerning b. That she should begin a program of plyometrics and strength training c. To consider a different sport, such as volleyball d. To work with a dietician to improve healthy weight gain
d. To work with a dietician to improve healthy weight gain
What is a possible reason for delayed onset of puberty in a 13 year old girl? a. History of abdominal irradiation b. Obesity c. Report of asthma since age 6 years d. Tuner syndrome
d. Tuner syndrome
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? a. Brandname herbal products have been tested for efficacy. b. Natural ingredients are usually safe for use in children. c. There are few interactions between drugs and supplements. d. Use single herb supplements whenever possible.
d. Use single herb supplements whenever possible.
The primary care pediatric nurse practitioner performs an initial well baby exam on a 1 week old infant who is breastfeeding and who is at birth weight. The mother tells the nurse practitioner that her baby is already sleeping 5 or 6 hours at night. What will the nurse practitioner recommend? a. Consultation with a lactation specialist to assess intake b. Pumping her breast during the night to maintain milk supply c. Supplementing the last feeding of the day with formula d. Waking the infant up at least every 3 hours to nurse
d. Waking the infant up at least every 3 hours to nurse
The primary care pediatric nurse practitioner observes a tender, swollen red furuncle on the upper lid margin of a child's eye. What treatment will the nurse practitioner recommend? a. Culture of the lesion to determine causative organism b. Referral to ophthalmology for incision and drainage d. Topical steroid medication d. Warm, moist compresses 3 to 4 times daily
d. Warm, moist compresses 3 to 4 times daily
The parent of a school-age child who has asthma tells the primary care pediatric nurse practitioner that the child often comes home from school with severe wheezing after gym class and needs to use his metered-dose inhaler right away. What will the nurse practitioner do? a. Recommend that the child go to the school nurse when symptoms start. b. Review the child's asthma action plan and possibly increase his steroid dose. c. Suggest asking the school to excuse the child from gym class. d. Write the prescription for two metered-dose inhalers with spacers.
d. Write the prescription for two metered-dose inhalers with spacers.