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PC-PNCB Exam Topics

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QUESTION: List the minor manifestations of the Jones criteria.

ANSWER: 1) Arthralgia 2) Fever 3) Elevated acute phase reactants (ESR, CRP) 4) Prolonged PR on ECG

QUESTION: What do the following symbols mean in a familial pedigree? A) Filled Square or Circle B) Empty Square or Circle C) Dot in middle of empty shape D) Triangle E) Diagonal Dash

ANSWERS A) Diseased M (sq) or F (circ) B) Healthy M (sq) or F (circ) C) Carrier D) Sex unknown E) Death

QUESTION: List the major manifestations of Jones criteria

ANSWERS: 1) C - Chorea 2) R - Erythema Marginatum (transient pink serpiginous rash on arms/thighs/trunk) 3) A - Polyarthritis (ankles/knees initially) 4) S - Subcutaneous nodules (pea-sized on extensor surfaces of fingers/toes/elbows/other jts) 5) H - Carditis (mitral valve most commonly affected)

QUESTION: Describe what each study does. A) Case-Control B) Cross-Sectional C) Randomized Controlled Trial D) Cohort Study

ANSWERS: A) Analyzes an outcome and looks back in time to assess exposure (ex = did smoking cause schizophrenia) B) Analyze a population at a single point in time & are used to assess disease incidence/prevalence C) An experiment/clinical trial that studies effect of an intervention D) Follows a group of similar individuals w/o a disease over time to determine the risk of developing the disease.

QUESTION: Describe each of the following A) Hydrocele B) Spermatocele C) Hernia D) Varicocele

ANSWERS: A) Collections of fluid b/t parietal/visceral alyers of tunica vaginalis; soft, painless, & fluctuant on exam; will transilluminate B) Retention cysts of epididymis that contains sperm; usually small (<1cm) and painless; will transilluminate C) Protrusions of bowel through inguinal ring into the scrotum; usually reduced when pt is supine; do not transilluminate D) Elongated, dilated, tortuous internal and external spermatic veins w/in spermatic cord; are most common scrotal mass in adolescents; "bag of worms"; do not transilluminate

QUESTION: What is the histologic finding in biopsied intestinal tissue for each of the following? A) Celiac Disease B) Whipple Disease C) Crohn's Disease D) Ulcerative Colities

ANSWERS: A) Flattened villi B) Foamy macrophages w/PAS+ granules in cytoplasm C) Small Granulomas D) Crypt Abscesses

QUESTION: Describe the four types of powers by French and Raven A) Expert Power B) Legitimate Power C) Power of Numbers D) Reward Power

ANSWERS: A) Power derived from skill or knowledge that others lack B) Power referring to potential to exert influence (important for human interaction); Legitimate = Licensure through state board of nursing C) Power derived from being part of a group with similar goals D) Ability to give others what they want & to ask them to do things in exchange (hold rewards as punishment)

QUESTION: Describe these leadership models? A) Transformational B) Transactional C) Strategic D) Democratic

ANSWERS: A) Shapes & transforms goals/values of other staff to achieve collective purpose B) Episodic, short-lived, & task-based - leader only intervenes when something has gone wrong, providing negative feedback C) 3-circle model via Adair; needs of task, individual and team are all taken into consideration to promote better cooperation for support of common goals D) Those who carry out task are individuals & groups are involved in decision-making processes that affect their work

QUESTION: Describe each of the following. A) Predictive Genetic Testing B) Predispositional Testing C) Pharmacogenic Testing D) Linkage Testing

ANSWERS: A) Testing healthy people at risk for developing genetic DO as they get older based on fam hx. B) Predicts risk of dz based on multifactorial etiologies in order to personalize health care prevention C) Determines genetic difference in drug metabolism genes D) Tracks a genetic trait through a family to determine the likelihood of developing a genetic DO

S/S of mono

Bilateral cervical lymphadenopathy Mild fever & tachycardia Recent rash & sore throat x5 days Amox --> fine reticulated maculopapular rash

QUESTION: Rank the types of studies based on quality (highest to lowest)?

CORRECT ANSWER(S): 1) Systematic Reviews/Meta-Analysis of RCTs 2) RCTs 3) Cohort Studies 4) Case-Control Studies 5) Cross-Sectional Studies 6) Case Reports

BACKGROUND: - 10yo male w/Constitutional Growth Delay QUESTION: Kid asks, "When will I be as tall as my Dad?" A) Eventually, you'll hit a growth spurt B) Little chance you'll be as tall as your dad C) Unsure what final height will be, but should be less than Dad D) Eat well, otherwise you'll always be short

CORRECT ANSWER(S): A

QUESTION: What is most significant risk factor in suicide in male adolescents? A) Prev suicide attempt B) Major Depressive Disorder C) Panic Disorder D) Substance Abuse

CORRECT ANSWER(S): A)

QUESTION: Which of the following = std of care for primary stroke prevention in SCA w/abnormal transcranial dopplers? A) Chronic transfusion therapy B) Aspirin C) Warfarin D) Hydroxyurea

CORRECT ANSWER(S): A)

BACKGROUND: - stridor, coarse wheezing & croupy cough that worsens in supine position - feeding difficulties (dysphagia + vom) recurrent - Barium swallow = Esophageal compression - CXR = abnormal aortic arch QUESTION: What is the diagnosis? A) Vascular Ring B) Esophageal Atresia C) Laryngotracheoesophageal cleft D) Laryngocele

CORRECT ANSWER(S): A) WRONG ANSWERS: B) C) D)

QUESTION: Cough, HA, and pharyngitis is most likely caused by... A) Influenza B) Rotavirus C) Arbovirus D) Sapovirus

CORRECT ANSWER(S): A) WRONG ANSWERS: B) C) D)

QUESTION: In an ambulatory care setting, NP might find it difficult to utilize nursing research because...? A) Little time for research utilization B) Procedures not well defined in the literature C) Research published in prof journals too difficult to access D) Amb care settings have little in common with the settings being researched

CORRECT ANSWER(S): A) WRONG ANSWERS: B) C) D)

BACKGROUND: - 16 yo F w/secondary amenorrhea, acne, hirsutism, & wt gain for endo eval - Never sexually active - LH:FSH = 3:1, estradiol normal, androgens mildly elevated QUESTION: What is most likely DX? A) PCOS B) Late-Onset CAH C) Turner Syndrome D) Hypothyroidism E) Outflow Tract Obstrxn

CORRECT ANSWER(S): A) WRONG ANSWERS: B) Late-onset CAH ruled out based on normal 17-OH-progesterone levels C) Assoc w/PRIMARY amenorrhea D) Detected via elevated TSH level E) Typically assoc'd w/PRIMARY amenorrhea & dx'd via US

BACKGROUND: - 16yo girl w/von Willebrand disease - bruising, gingival bleeding, menorrhagia refractory to desmopressin therapy QUESTION: Which of the following is the next step in tx? A) Factor VIII w/von Willebrand factor complex B) Ristocetin co-factor assay C) Drotecogin alpha D) Factor 8 Replacement Therapy

CORRECT ANSWER(S): A) WRONG ANSWERS: B) Used to initially dx vWF C) No longer available in US D) Used for Hemophilia A

QUESTION: What % of adolescents who commit suicide suffered from associated psychiatric disorder at the time of their death? A) 90% B) 75% C) 50% D) 30%

CORRECT ANSWER(S): A) 90% Preceding stressful events include romantic breakups, school/legal probs, & death in the family

BACKGROUND: - 6yo boy - Unilateral hip pain relieved by rest, referred to knee/groin QUESTION: ? A) Boys>Girls B) Usually bilateral C) Most common in obese children D) Almost all pts require surgy

CORRECT ANSWER(S): A) Avascular Necrosis of femoral head (LCP Dz) - Jt aspiration to r/o septic arthritis, but MRI & XR are cornerstones of LCP Dx - Promptly refer to ortho to see if surg needed - Long-term sequelae = leg-length discrepancy, deformity, & limitation of movement WRONG ANSWERS: B) Usually unilateral, but CAN be bilateral C) This is true for SCFE, not LCP D) Possibly, but can be mg'd other ways

BACKGROUND: - 1 wk old infant - "Clunk" with adducting legs while applying downward and lateral pressure on knees QUESTION: What sign is this? A) Barlow B) Psoas C) Ortolani D) Galeazzi

CORRECT ANSWER(S): A) Barlow --> DDH WRONG ANSWERS: B) Pain elicited by passively extending thigh of pt lying on side --> appendicitis C) Hip relocation and "clunk" w/abduction of legs and lifting up on trochanters -->DDH D) Discrepancy in height of flexed thighs (affected limb is shortened) -->DDH

BACKGROUND: - 2 wk old infant - spontaneous vag deliv at 38 wks - Exclusively breastfeeds - Elevated phenylalanine levels - No PE abnormalities QUESTION: What is the next step in mgmt? A) Order plasma amino acids B) Order assay for dihydropteridine reductase C) Switch to low-phenylalanine formula D) Switch to soy formula

CORRECT ANSWER(S): A) Do this to confirm PKU (def of phenylalanine hydroxylase) WRONG ANSWERS: B) C) Don't do this until confirmed DX D) This is required for those with galactosemia, no PKU

QUESTION: What labs would you see following pyloric stenosis vomiting x5days? A) Hypochloremic Hypokalemic Metabolic Alkalosis B) Hyperchloremic Hypokalemic Metabolic Acidosis C) Hyperchloremic Hyperkalemic Metabolic Acidosis D) Respiratory Alkalosis

CORRECT ANSWER(S): A) Hypokalemic d/t vomiting Metabolic Alkalosis d/t stomach acid loss WRONG ANSWERS: B) C) D)

BACKGROUND: - Recurrent abscesses + FTT - Nitroblue Tetrazolium Test is Positive. QUESTION: What is the DX? A) Chronic granulomatous dz B) Job's Syndrome C) Chediak Higashi Syndrome D) Schwachman Diamond Syndrome

CORRECT ANSWER(S): A) Inherited X-linked - neutrophils lack NADPH needed to destroy bacteria/fungi; TX = lifelong bactrim prophylaxis WRONG ANSWERS: B) C) D)

BACKGROUND: - 9 yo fever x2 days, peaking at 103.6F + occasional productive cough & rhinorrhea - somewhat lethargic, eating poorly, drinking well - Pulse ox at 89%, appears moderately ill, bibasilar rales w/scattered rhonchi - Bacterial PNA suspected --> pt hospitalized - CXR = discrete infiltrate in right middle lobe w/air bronchograms QUESTION: What is this pattern termed? A) Lobar PNA B) Pneumatocele C) Miliary PNA D) Interstitial PNA

CORRECT ANSWER(S): A) Lobar = discrete, unilateral infiltrate in single lobe (usually bacterial) WRONG ANSWERS: B) Pneumatocele = gas-filled cavity in lung parenchyma C) MIliary PNA = MULTIPLE discrete lesions d/t hematogenous spread of pathogen to lungs D) Interstitial PNA = patchy or diffuse infiltrates of the interstitium in preference to the parenchyma (usually viral)

QUESTION: What is the screentime recommendation for 16mo? A) No screen time for children under age of 18 mo except videochat B) NMT 2 hrs/day for <2yo C) Screentime fine so long as high-quality educational material D) No set recommendation for <2yo

CORRECT ANSWER(S): A) None for <18mo 18-24 mo? Intro high-quality shows 2-5yo? 1 hr/day Average American = 7hrs/day, but this can cause attn probs, sleep/eating DOs, & obesity

QUESTION: Which of the following statements regarding physiological peripheral pulm stenosis (PPPS) is true? A) May resolve spontaneously by 2-6 mo B) Majority of cases have an associated syndrome C) Detailed w/u to be done in neonatal period to find the etiology D) Usually associated w/mild cyanosis

CORRECT ANSWER(S): A) PPPS d/t persistent fetal anatomy - soft, harsh systolic ejection murmur best heard at axilla WRONG ANSWERS: B) C) D)

BACKGROUND: - 28 yo F breastfeeding last 3 mo - C/o breast tenderness w/fever --> mastitis - Start abx & analgesics QUESTION: What should she do re: breastfeeding? A) Continue - decreases chance of mastitis progressing to abscess B) Continue - allow small bacterial load to aid in dev of infant immune system C) DC - allow proper healing D) DC - to decrease bacterial spread

CORRECT ANSWER(S): A) S. aureus = most common - swelling, pain, and redness in a wedge-shaped area on the breast - avoid tight bras, empty all areas of breast while feeding, airing nipples when possible - WRONG ANSWERS: B) Infant receives passive immunity for direct immunoglobulins in breast milk C) D)

QUESTION: Which is true regarding self-injurious behaviors? A) SSRIs = useful pharm treatment B) Self-injury in intellectually delayed ps is a choice/decision, similar to those w/personality-disordered pts C) Behaviors = random acts that occur in an unpredictable manner D) Behavioral therapy is a second-line treatment

CORRECT ANSWER(S): A) SSRIs are useful following the first line treatment of behavioral therapy WRONG ANSWERS: B) C) They actually present as idiosyncratic, repetitive acts that occur in stereotypic manner D) This is 1st line treatment

BACKGROUND: - 15yo boy, nonpruritic patches of lightened skin - No meds - PE = 12 slightly scaly patches on the chest, back, and upper abd (most hypopigmented, but a few with reddish-brown hue) - Wood's lamp = orange flurescence QUESTION: What is the diagnosis? A) Tinea Versicolor B) Pityriasis Rosea C) Tinea Corporis D) Vitiligo

CORRECT ANSWER(S): A) Superficial skin infxn w/fungi KOH Prep = Spaghetti & Meatballs pattern WRONG ANSWERS: B) Single herald patch followed by numerous slightly scaly, salmon-colored lesions in a Christmas tree pattern (caused by human herpes virus 6 or 7) C) Caused by a deeper fungal infxn characterized by pruritic reddish patches w/central clearing and vesicles at borders D) Hypopigmentation only (permanent & autoimmune basis)

BACKGROUND: - 3yo girl - short stature, macroceph, flat midface w/prominent forehead, rhizomelic shortening of limbs - signs of hydrocephalus - MRI = narrowing of foramen magnum & compression of brainstem --> neurosurgery QUESTION: Patient most likely has a mutation in which gene? A) FGFR3 B) FBN1 C) FMR1 D) MECP2 E) MTTL1

CORRECT ANSWER(S): A) These are characteristic of Achondroplasia, a result of mutation in FGFR3 WRONG ANSWERS: B) FBN1 Mutations = Marfans C) FMR1 Mutations = Fragile X D) MECP2 Mutations = Rett Syndrome E) MTTL1 Mutations = MELAS

BACKGROUND: - Term Male weighing 3000g - APGAR 7, 9 - Hypoplastic nasal alae, thin upper lip, mild micrognathia, & submucosal cleft palate - Vibratory holosystolic murmur (no cyanosis) - US --> VSD - Tolerating formula & passed meconium - Day 2 of life, jerky movements in all four extremities QUESTION: What treatment does this child need? A) IV Calcium Gluconate B) IV Phenobarb C) IV 10% Dextrose Soln D) IV Pyridoxine

CORRECT ANSWER(S): A) This is DiGeorge with a sz due to low calcium (from hypoparathyroidism) WRONG ANSWERS: B) DOC for neonatal sz caused by brain disorders C) DOC for when sz caused by hypoglycemia D) Pyridoxine dependency is rare cause of neonatal sz

BACKGROUND: - 6 yo girl - mod, constant periumb pain for sev hrs assoc'd w/nausea - rash on legs/butt for several days - PE = afebrile, diffuse ab tenderness w/o rebounding or guarding, palpable purpura on legs/butt + diffuse jt tenderness QUESTION: What is the next step in evaluation? A) UA B) CT of ab/pelv C) ASO Titers D) Blood Cultures

CORRECT ANSWER(S): A) This is HSP - immune mediated vasculitis - UA reveals hematuria (glomeruloneph); TX = admin corticosteroids or IVIG WRONG ANSWERS: B) C) D) Only do if systemic infxn suspected (fever & focal abd tenderness)

BACKGROUND: - 17yoF - Severe ab pain + n/v + fever + tachycardia - Previously eval'd for appendicitis, & other GYN causes - No cutaneous manifestations - Labs: increase aminolevulinic acid & PBG concentrations in urine; no increase in urinary/fecal coproporphyrin III. QUESTION: Which of the following is correct regarding this condition? A) Affected enzyme = PBG deaminase B) Affected enzyme = coproporphyrinogen oxidase C) Affected enzyme = protoporphyrinogen oxidase D) Sz can occur & should be tx'd w/phenobarb

CORRECT ANSWER(S): A) This is acute intermittent porphyria (AIP) WRONG ANSWERS: B) C) D)

BACKGROUND: - 2yo male - eyes moving rapidly/randomly/erratically in all directions - yesterday, arms/legs jerk sporadically and involuntarily - today, difficulty walking - 2 months ago, had strep pharyngitis treated with 10days of amox QUESTION: What is the next best step? A) Measure urinary vanillylmandelic acid B) Obtain an ASO titer C) Perform EEG D) Reassurance

CORRECT ANSWER(S): A) This is opsoclonus-myoclonus syndrome ("dancing eyes, dancing feet") -- presents prior to 3yo -- 40-50% have neuroblastoma, which secretes vanillylmandelic acid (excreted in urine) -- get a 24-hr measurement of catecholamine levels -- can also get CT/MRI, US, or PET WRONG ANSWERS: B) Pt will have +ASO titer due to recent strep (w/in last 6 mo) C) D)

QUESTION: Researcher believes DASH diet will reduce systolic BP in a population to <140mmHg. Which of the following tests should the researcher use to analyze data? A) One-tailed test B) Two-tailed test C) Correlation D) Standard Deviation

CORRECT ANSWER(S): A) Used where "region of rejection" of the null hypothesis is only on one side of the sampling distribution (2 options = below 140, above 140) WRONG ANSWERS: B) "Region of rejection" is on both sides of the sampling distribution (3 options = below 120, 120-140, and above 140) C) Determines relationship b/t 2 variables, but does not distinguish b/t dep and indep variables D) Measure of how much scores deviate from the mean

BACKGROUND: - 25-OH Vitamin D Level of 19ng/mL - Normal Xrays QUESTION: What is the diagnosis? A) Vitamin D Deficiency B) Rickets C) Vitamin D Insufficiency D) Nothing, this child is normal

CORRECT ANSWER(S): A) Vit D Deficiency levels are <20 WRONG ANSWERS: B) Can't be this because normal Xray C) Vit D Insuff levels are 20-30 D) Incorrect

BACKGROUND: - Unexplained resp distress as newborn - Chronic bronchitis, sinusitis, & otitis w/age - Upper resp tract probs = year-round nasal drainage - Conductive hearing loss w/chronic middle ear effusion - Imaging = normal organ anatomy QUESTION: Exam of ciliary ultra-structure by transmission electron microscopy who lead to which of the following DX? A) Primary Ciliary Dyskinesia (PCD) B) Chronic Sinusitis C) Kartagener Syndrome D) Situ Abnormalities

CORRECT ANSWER(S): A) defects causing inability of cilia to beat normally --> chronic cough, chronic rhinitis, chronic sinusitis WRONG ANSWERS: B) C) Chronic sinusitis, bronchiectasis, & situs inversus D)

SATA QUESTION: Which are the 3 major issues central to the expansion of the NP in a collaborative role? A) Prescriptive Authority B) Reimbursement Privileges C) Legal Scope of Practice D) Political Activism

CORRECT ANSWER(S): A, B, C - These are the three major issues central to the expansion of the NP WRONG ANSWERS: D - This is important, but not specific to a collaborative practice

QUESTION: In which scenario is breastfeeding contraindicated? A) Mom + for Hep C Virus Antibody B) Baby + for Galactose 1-Phosphate Uridyltransferase Deficiency on NS C) Hyperbilirubinemia admitted for phototherapy D) Mom + for CMV

CORRECT ANSWER(S): B) WRONG ANSWERS: A) C) D)

QUESTION: Broad jumping milestone reached at what age? A) 12 mo B) 36 mo C) 15 mo D) 18 mo

CORRECT ANSWER(S): B) WRONG ANSWERS: A) C) D)

QUESTION: Which of the following is true regarding acute salicylate toxicity? A) Tx w/Done nomogram B) Initial S/S = tinnitus & altered hearing C) Metab Alk = characteristic D) Significant GI bleeding in most pts E) Hyperkalemia

CORRECT ANSWER(S): B) WRONG ANSWERS: A) C) Metab ACIDosis is characteristic D) For chronic use, not acute toxicity E) Should result in HYPOkalemia

QUESTION: Which of the following is the most common cause for multiple rib fx in children? A) MVA B) Abuse C) Fall D) Sports Injury

CORRECT ANSWER(S): B) WRONG ANSWERS: A) B) C) D)

QUESTION: At what age should a child be walking up and down steps? A) 6 mo B) 18 mo C) 9 mo D) 12 mo

CORRECT ANSWER(S): B) WRONG ANSWERS: A) C) D)

QUESTION: Implementation of EHR improves health care quality, safety, and efficiency. What is this term? A) Privacy Rule B) Meaningful Use C) Electronic Health Systems D) Efficiency Rule

CORRECT ANSWER(S): B) WRONG ANSWERS: A) C) D)

BACKGROUND: - Chronic Renal Disease - Labs = normocytic anemia, low retic count QUESTION: Cause of her anemia is...? A) Hemolysis B) Decreased erythropoietin prodxn C) Iron def D) Assoc'd hypothyroidism

CORRECT ANSWER(S): B) WRONG ANSWERS: A) C) 2nd major cause of anemia in CKD D)

BACKGROUND: - 12yo eval for fever x2 days, peaking at 103.5 + productive cough & rhinorrhea - somewhat lethargic and eating poorly, but drinking well - Pulse = 112, Normal BP, T 102.2, O2 at 89% - Appears moderately ill, rhinorrhea, bibasilar rales w/scattered rhonchi - CXR = patchy infiltrates in R upper and R/L lower lobes QUESTION: What is this pattern termed? A) Pleural Effusion B) Bronchopneumonia C) Miliary PNA D) Lobar PNA

CORRECT ANSWER(S): B) WRONG ANSWERS: A) C) Multiple lobes with discrete lesions (no patchy infiltrates) D) Discrete, unilateral infiltrate in 1 lobe

BACKGROUND: - 14mo w/head injury after fall QUESTION: When assessing children with injuries, which of the following findings does the nurse consider most concerning for possible child abuse or neglect? A) Bruise in crawling, but not walking child B) Delay by parents in seeking care C) Bruising on legs D) Any scald injury in child under age of 5

CORRECT ANSWER(S): B) WRONG ANSWERS: A) 2 or more bruises in child not yet crawling = red flag C) Red Flag Bruising on torso, neck, ears, or buttocks; bite marks also D) Immersion scald injuries w/clear demarcation line (rather than splatter patter) are consistent w/abuse

QUESTION: Which of the following statements is true regarding the oversight of the functions of the APN? A) National laws regulate scope of practice for NPs B) Nursing profession articulates the scope of professional nursing practice and defines its boundaries C) NPs licensed in one state are bound by that state's scope of practice when practicing throughout the country D) Employers are responsible for ensuring that NPs practice w/in boundaries defined by state practice acts

CORRECT ANSWER(S): B) WRONG ANSWERS: A) Each state develops own laws C) Must practice in licensed state D) Individual NPs are responsible

QUESTION: Which is true re: pediatric community-acquired PNA (CAP)? A) Most common cause of PNA in neonate is Mycoplasma PNA B) Toddler/Young Children more freq dev CAP than middle-aged adults C) Easier to differentiate b/t typical and atypical PNA in ped pts D) Strep PNA is most common org in 5-15yo

CORRECT ANSWER(S): B) WRONG ANSWERS: A) GBS = most common cause in neonate. Chlamydia trachomatis = most common at 3wks to 3 mo Viral etiologies = most common at 4mo to 4 years M PNA is most common in SCHOOL AGE C) Just wrong D) Pneumococcla vaccine has decreased this as most common org

QUESTION: What is true re: atomoxetine? A) 2D6 Inhibitors inhibit atomoxetine, requiring a higher dose of atomoxetine B) Pts who are slow metabolizers of atomoxetine may have more side effects and may need a lower dose C) Nausea is increased when taken with food D) Pts experience fewer SE when taken in AM

CORRECT ANSWER(S): B) WRONG ANSWERS: A) Pts taking meds that are strong 2D6 Inhibitors need a LOWER dose of atomoxetine C) Taking with food decreases N D) Should take in PM for fewer side effects

QUESTION: Which is true regarding clonidine? A) Alpha-adrenergic agent for HTN; at high doses it is assoc'd w/ stim of inhibitory presynaptic autoreceptors in CNS B) Particularly helpful in ADHD pts w/comorbid tics, conduct DOs, or ODD C) Overdoses of clonidine in children <5yo = minor effects D) EKG monitoring is necessary when tapering off

CORRECT ANSWER(S): B) WRONG ANSWERS: A) Would be correct if said at LOW doses C) Can be life-threatening D) Primary effect = on HTN, but can use EKG when adding to a stimulant

BACKGROUND: - 10mo w/hypotonia, alopecia, & sz - Labs = ketoacidosis, hyperammoniemia, elevated urine organic acid - Biotinidase deficiency is suspected QUESTION: What is true regarding Biotinidase deficiency? A) Biotin levels are elevated & should not be supplemented B) Hearing/Vision loss occur C) Biotin is a fat soluble B-complex vitamin D) Biotinidase does not participate in the processing of dietary protein-bound biotin

CORRECT ANSWER(S): B) - Manifestations = sz, hypotonia, ataxia, dev delay, hearing/vision loss, spastic paraparesis, & cutaneous abnormalities (including alopecia) WRONG ANSWERS: A) Tx = biotin supp (prevents dev delay & reverses most symptoms) C) Biotin = water-soluble B-complex vit D) It is involved

QUESTION: If complaining of difficulty swallowing, what should you do with pt that has potentially swallowed a bottle of bleach but shows not evidence of oral cavity or oropharyngeal burns? A) Send home B) OR w/esophagoscopy w/in 24 hours C) OR w/esophagoscopy immediately

CORRECT ANSWER(S): B) Bleach is a base and burns may not show immediately WRONG ANSWERS: A) C)

BACKGROUND: - 4 day old male - ab pain w/sudden green/yellow vomiting - fussy all day, ill a few hours earlier - mildly distended abdomen - backwards L on ab XR QUESTION: What is the next best step in mgmt? A) Barium enema B) Emergency Surgery C) Broad Spectrum abx for presumed NEC D) Obtain US to r/o pyloric stenosis

CORRECT ANSWER(S): B) Gastric and Duodenal dilation on XR = malrotation w/midgut volvulus - Double Bubble on XR - Surg reduces volvulus & relieves ischemia caused by constriction of the bowel's mesenteric blood supply - Necrosis can occur in as little as 3 hours

BACKGROUND: - 9 day old neonate + seizures - remains afebrile - mom has been diluting formula QUESTION: What is most likely cause of seizures? A) Hypokalemia B) Hyponatremia C) Hypocalcemia D) Hypomagnesemia

CORRECT ANSWER(S): B) In newborn w/o fever, hyponatremia = most common cause for seizure - Water intoxication is most common cause of hyponatremia during infancy (unable to concentrate urine adequately) WRONG ANSWERS: A) Uncommon in infancy & does not typically cause seizures C) Possible, but would be more likely if mom was diabetic, baby was preterm or had hx of anoxic enceph D) Possible, but even less likely than Hypocalcemia

QUESTION: Which of the following is a legal requirement to practice as an NP? A) Certification B) Licensure C) Collaborative Agreement D) NPI

CORRECT ANSWER(S): B) Licensure = legal requirement WRONG ANSWERS: A) "Voluntary" process granted by nongov agency (but now mandated in most states as a condition of licensure) C) Written agreement b/t supervising physician & NP D) Required for billing

BACKGROUND: - 6 yo presents p sz - Acute gastroenteritis x2 days - Electrolytes are normal QUESTION: What is most likely the cause? A) Salmonella B) Shigella C) Campylobacter D) Yersinia

CORRECT ANSWER(S): B) Most common bacteria causing acute gastroenteritis, esp w/sz when electrolytes are normal WRONG ANSWERS: A) Not usually assoc w/sz C, D) Mimics appendicitis

BACKGROUND: - Pt in alcohol withdrawal QUESTION: How do you communicate with this pt? A) Cheerful tone & humor B) Short sentences & matter of fact manner C) Loud voice to ensure pt can hear D) Full explanations in a soft voice

CORRECT ANSWER(S): B) Pt may be disoriented & anxious WRONG ANSWERS: A) Leads pt to feeling like the staff member is laughing at him, which may lead to withdrawal C) Loud tone of voice makes pt feel as though he's being yelled at or chastised D) Typically these pts can't follow extensive explanations, so keep sentences short & to the point

QUESTION: Why not restrain pt acutely intoxicated on phenylcyclohexyl piperidine (PCP)? A) Voilate's pt rights B) Increases incidence of rhabdomyolysis C) Must be ordered by medical prof in medical facility D) May exacerbate underlying medical conditions

CORRECT ANSWER(S): B) S/S Fluctuating behavior, motor disturbance, nystagmus, autonomic stimulation (--> HTN, tachypnea, tachycardia, flushing diaphoresis, salivation, & hyperthermia) WRONG ANSWERS: A) C) D)

QUESTION: Which feature is characteristic of Prader-Willi Syndrome? A) Genetic abnormality on chromosome 7 B) Pts w/short stature, hypogonadism, hyperphagia, and obesity C) Generalized Anx DO = most common associated psych DO D) Level of insight w/regard to obsessions & compulsions is low

CORRECT ANSWER(S): B) Short stature, hypogonadism, hyperphagia, and obesity WRONG ANSWERS: A) Prader-Willi abnormality is a deletion on chromosome 15 C) OCD = most associated psych DO D) Level of insight varies

BACKGROUND: - 4yo male - Progressive periorbital edema, wt gain, anorexia, & nausea for several weeks - PE = HTN - UA = 4+ Protein QUESTION: What is also most likely? A) Hyperalbuminemia B) Thrombophilia C) Hypotriglyceridemia D) Urinary bacteria

CORRECT ANSWER(S): B) This is Nephrotic Syndrome -- May have microscopic hematuria -- Acute mgmt = fluid restriction, systemic corticosteroid therapy, and admission for possible renal biopsy WRONG ANSWERS: A) Should be HYPOalbuminemia C) Should be HYPOlipidemia D) UTI usually not assoc'd

BACKGROUND: - 12 yo F - Low grade fevers on/off x5 wks - Butterfly rash on cheeks, jt pain, ankle edema, HA, fatigue QUESTION: What condition do you suspect? A) Thrombocytosis B) Elevated ANA C) + Blood Cultures D) Skin scrapings + for scabies

CORRECT ANSWER(S): B) This is SLE WRONG ANSWERS: A) Should have thrombocytopenia C) No an infection D) Not scabies

BACKGROUND: - 5yo girl - Fever + pruritic rash on several areas of her trunk - Sick contact w/similar symptoms at school - No cough, SOB, HA, or stiff neck - PE = nontoxic/playful child, crop of vesicles in 1 area & dried crusted lesions in other areas QUESTION: What is the most appropriate management? A) Aspirin B) Acetaminophen C) IV Acyclovir D) Varicella-Zoster Vaccine

CORRECT ANSWER(S): B) This is chickenpox/Varicella-Zoster Virus - Fever, myalgias, maculopapular rash progressing to vesicles that rupture & form dry/crusted lesions WRONG ANSWERS: A) C) Only used for immune-compromised pts & those w/signs of encephalitis or pneumonitis D) Indicated for prevention, not acute mgmt

BACKGROUND: - 15mo boy - Met all developmental milestones - Eye Exam = white reflex w/strabismus QUESTION: Next step in mgmt? A) Antibiotics B) Oph referral C) Cover affected eye D) Cover the normal eye

CORRECT ANSWER(S): B) This is retinoblastoma (most common malignant eye tumor in children) WRONG ANSWERS: A) C) D) In amblyopia, patch dominant eye to allow weak eye to get stronger

BACKGROUND: - 9yo returned from India 1 wk ago - 2 day hx of progressive fever, H/A, malaise, N without V, and generalized ab pain w/minimal loose stools (no frank diarrhea) - UTD on immunizations + Hep A & Yellow Fever prior to trip - Took Mefloquine for malaria prophylaxis throughout her visit - PE = dehydrated, HR in 50s, faint/blanching/erythematous rash over chest & upper ab - Labs = mild high WBC and mod high LFTs QUESTION: Which of the following is true? A) Req admission for likely dengue fever, start IV clinda B) Relative bradycardia + high fever may indicated typhoid fever C) Contracted strain of malaria resistant to mefloquine D) WBC diff most likely reveals a high eosinophils

CORRECT ANSWER(S): B) Typhoid Fever WRONG ANSWERS: A) Dengue = viral, not tx'd with abx (mosquito-borne infxn); usually present w/fever, malaise, and severe myalgias/arthralgias C) Unlikely since prophylaxis (mefloquine is very effective) D) Traveler's w/fever and elevated eosinophils = helminth infxn (ascaris or hookworm)

QUESTION: Which of the following has demostrated to have the single greatest impact on incident reduction? A) Quality of professional education B) Years of personnel experience C) Development of safety culture D) Penalties for violation of safety rules

CORRECT ANSWER(S): C) WRONG ANSWERS: A) B) D)

BACKGROUND: - Screening test to detect gonorrhea - 200 people studied - Positive test = 75 (25 false) - Negative test = 125 (50 false) QUESTION: Which of the following represents the negative predictive value of this test? A) 75/200 B) 50/125 C) 75/125 D) 25/100

CORRECT ANSWER(S): C) Negative Predictive Value = #TrueNegs / (#TrueNegs+#FalseNegs)

BACKGROUND: - Cultures of safety - Fosters learning environment - EB-care - Promote positive working environments for nurses - Committed to improving the safety & quality of care QUESTION: Which of the following organizations describes the above characteristics? A) Preferred Provider Org B) Health Maintenance Org C) High Reliability Org D) Accredited Health Org

CORRECT ANSWER(S): C) WRONG ANSWERS: A) B) D)

QUESTION: What condition is associated with a uni- or bi-lateral uveal coloboma involving the iris that can cause blindness? A) Turner's B) Cr-du-chat C) CHARGE D) Down's

CORRECT ANSWER(S): C) WRONG ANSWERS: A) B) D)

QUESTION: What type of attitude should you use towards someone with depression? A) Serious B) Humorous C) Empathetic D) Cheerful

CORRECT ANSWER(S): C) WRONG ANSWERS: A) B) D)

QUESTION: Which is true regarding ICD10? A) Results in simplification of coding process for HCPs B) Results in universal improvements in all medical practices C) Increases 10-fold amount of data that describes clinical conditions D) Implementation req'd by state laws that govern professional licensure

CORRECT ANSWER(S): C) WRONG ANSWERS: A) B) D)

QUESTION: Which of the following is true regarding consent to participate in research? A) Ages 7-17 can give legal consent B) Assent for study must be obtained from parent C) NP must have parental permission to speak w/minor in order to obtain assent of the minor D) Only an emancipated minor can give assent for study participation

CORRECT ANSWER(S): C) WRONG ANSWERS: A) B) D)

QUESTION: At what age should a child be able to make a tower of 7 cubes and draw a horizontal line? A) 15 mo B) 18mo C) 24 mo D) 30 mo

CORRECT ANSWER(S): C) WRONG ANSWERS: A) 15 mo = 3 cube tower + line w/crayon B) 18 mo = 4 cube tower + vertical line D) 30 mo = 9 cube tower + imitates circular stroke

QUESTION: Which of the following statements about gender role behavior in children is correct? A) Boys less likely to engage in rough-and-tumble play than girls B) Girls more likely to express aggression through physical means C) Most children exhibit preference for same-sex playmates in middle childhood D) Gender role behavior generally correlates with erotic feelings

CORRECT ANSWER(S): C) WRONG ANSWERS: A) Boys more likely to engage in rough-and-tumble play than girls B) Girls more likely to express aggression through verbal means D) Gender role behaviors (toy preferences, gesture, speech, social rules, and expression of aggression) are distinct from erotic feelings

QUESTION: Which of the following is true of evidence-based practice in medicine? A) Most evidence is rapidly integrated to clinical practice B) EBP refers only to use of current research evidence to formulate sound interventions C) National guidelines close gap b/t research outcomes & practice D) EBP is an approach that does not allow personalization of evidence to the pt

CORRECT ANSWER(S): C) WRONG ANSWERS: A) May take 17 years to implement B) Uses current research, clinical expertise, and pt values to formulate interventions for pt care D) Should be personalized

QUESTION: Which of the following is true of teamwork training for interprofessional collaborative practice in health professions education? A) Outcomes-based competency expectations required B) Includes training with other nurses only C) Has lagged behind practice changes D) Primary responsibility for developing core competencies = w/state Nursing Board

CORRECT ANSWER(S): C) WRONG ANSWERS: A) Often not outcomes-based competencies expectations B) Includes all healthcare professions D) Primary responsibility for developing core competencies = health professions schools

QUESTION: Nonmaleficence is a principle ethic in nursing. It is best described as: A) Compassion, desire to do good B) Dedication, fairness, honesty, agreement to keep promises C) Avoidance of harm D) Equal and fair distribution of resources based on impartial analysis of benefits

CORRECT ANSWER(S): C) WRONG ANSWERS: A) This is Beneficence B) This is Fidelity D) This is justice

BACKGROUND: - 3yo boy during WCC - Speech delay, but possible other delays QUESTION: What important screening test can you do on older kids with dev delays? A) TSH B) Metabolic Studies C) Venous Blood Lead Levels D) ECG

CORRECT ANSWER(S): C) WRONG ANSWERS: A, B) Not indicated in child growing well w/normal NS D) Not indicated w/o hx of staring spells or other suspicious behav

QUESTION: What % of child maltreatment is neglect (vs. physical, sexual, and emotional abuse)? A) 10% B) 25% C) 60% D) 90%

CORRECT ANSWER(S): C) WRONG ANSWERS: Physical = 20% Sexual = 10% Emotional = 5%

QUESTION: Which of the following is a characteristic of qualitative research? A) Random Sampling B) Meta-Analysis of Data C) Research is Fundamentally Interpretive D) Use of a control group

CORRECT ANSWER(S): C) - Broadly stated q's ab human experiences - Defines "how" instead of "how many" WRONG ANSWERS: A)Sampling techniques = purposive B) Data analysis is not statistical D) No control group

QUESTION: According to Piaget, when does object permanence happens at what age? A) 4mo B) 7mo C) 8mo D) 12mo

CORRECT ANSWER(S): C) 8mo

BACKGROUND: - 5yo boy - bloody diarrhea x several days - fatigue, pallor, and malaise - several kids at school = similar complaints - Labs = severe anemia, thrombocytopenia, renal insuff QUESTION: Which of the following most likely cause of symptoms? A) Shigella B) Salmonella C) E. coli D) Rotavirus

CORRECT ANSWER(S): C) E Coli - Triad of anemia, thrombocytopenia, and renal insuff = HUS or TTP (E. Coli is responsible for most HUS) - Tx = supportive & preventing complications of anemia + thrombocytopenia WRONG ANSWERS: A) Shigella (less common) B, D) Salmonella species & RV are not implicated

BACKGROUND: - 8 yo white male - 3wk hx of diarrhea, explosive for the first 4 days progressing to greasy loose stools w/out blood or mucus - Occasional cramping/bloating w/belching - Afebrile - UO = normal, but 4 lb weight loss since onset - Exam = hyperactive bowel sounds, moderate abdominal bloating without tenderness, no tenderness on rectal exam QUESTION: What is the etiology of his diarrhea? A) Norwalk Virus B) Shigella C) Giardia Intestinalis D) Enteroinvasive E. coli

CORRECT ANSWER(S): C) Giardia Intestinalis --> Most common intestinal parasite in US & UK --> Explosive watery diarrhea progressing to subacute greasy/malodorous stools w/foul flatulence, abdominal bloating, and sulphurous eructation --> Weight loss is common --> Acquired from contaminated water sources or from oral-fecal contamination WRONG ANSWERS: These all present a more acute picture with dehydration. A) Norwalk Virus B) Shigella D) Enteroinvasive E. coli

QUESTION: Which common electrolyte & BP abnormalities would be expected in a 4wk male w/severe congenital adrenal hyperplasia? A) Hyper Na, K, -tension B) Hypo Na, K, -tension C) Hypo Na, -tension, HyperK D) Hypo Na, Hyper K, -tension

CORRECT ANSWER(S): C) Hyponatremia, Hyperkalemia, Hypotension - Salt-Wasting! - Could also have recurrent vomit, dehydration, and shock - Females have ambiguous genitalia at birth - 21-Hydroxylase Deficiency --> insufficient cortisone, aldosterone WRONG ANSWERS: A) B) D)

QUESTION: Which of the following is the most specific in DX'ing NEC? A) Ab XR w/multiple dilated loops of small bowel B) Ab XR w/a "double bubble" sign C) Ab XR w/pneumatosis intestinalis D) Ab distention, bilious emesis, & guaiac + stools

CORRECT ANSWER(S): C) Initial findings = nonspecific: - Ileus (multiple dilated loops of small bowel) - Asymmetric bowel gas pattern - Progression: air spreading through ulcerated GI mucosal epithelium --> pneumatosis intestinalis or air w/in biliary tract (portal venous) WRONG ANSWERS: A) B) D)

BACKGROUND: - Avoidance QUESTION: What is true when using avoidance as a method of conflict resolution? A) Results in pursuing one's own goals at expense of another B) Results in meeting the goal's of the other person C) It does not address the conflict D) Effective when individuals are of equal power

CORRECT ANSWER(S): C) It does not address the conflict, only postpones it WRONG ANSWERS: A) This is Competition B) This is Accommodation D) This is Compromise

BACKGROUND: - Kid w/microcytic anemia & low retic count QUESTION: What's most likely DX? A) Folate def B) Vit B12 def C) Lead Poisoning D) Anemia of Chronic Disease

CORRECT ANSWER(S): C) Microcytic Anemia = low MCV (small or low vol RBCs) - Common causes = iron def, lead poisoning, & thalassemia WRONG ANSWERS: A) Folate Def = macrocytic anemia (high MCV) and low retic count B) Vit B12 Def = macrocytic anemia + low retic count D) Anemia of Chronic Disease = normocytic anemia, w/low retic count

BACKGROUND: - 3 wk old boy - Poor feeding, lethargy, and vomiting over the last week - Jittery and shaking a bit - Unsuccessful at breastfeeding, so giving him 2-3oz cow's milk q 3-4 hours - Labs: Serum calcium = 4 Ionized calcium = 1.3 QUESTION: Which of the following is true? A) Majority of serum calcium is bound to phosphate B) Vit D should be supplemented C) S/S d/t high levels of phosphate in cow's milk D) TX = IV Calcium Gluconate over 1-2 min

CORRECT ANSWER(S): C) Normal Calcium levels = 8.5-10 Cow's milk = hyperphosphatemia --> hypocalcemia (which is why we don't give cow's milk for first year of life) WRONG ANSWERS: A) B) C) D)

BACKGROUND: - 5 yo w/daily fevers q evening - Flat rash on trunk comes and goes, lasting a few hours - Child c/o jt pains & often limps - Less energy than normal - Mom says she looks ill QUESTION: What is this most consistent with? A) Polyarticular JIA B) Oligoarticular JIA C) Systemic JIA D) Psoriatic Arth

CORRECT ANSWER(S): C) Often presents w/ill appearing child w/chronic daily fevers and a fleeting evanescent rash -- often arthralgias & myalgias, but may delayed years WRONG ANSWERS: A) Polyarticular JIA = 5+ jts w/in 1st 6 mo, wt bearing jts often affected w/some systemic involvement; ANA is positive B) Oligoarticular/Pauciarticular JIA = 4 or fewer jts, often large wt bearing jts --> flexion contractures; NO systemic involvement; ANA can be positive if uveitis present D) Psoriatic Arthritis - monoarticular & precedes rash; pitting nails, sacroilitis, and tenosynovitis

BACKGROUND: - 3yo + myoclonic jerks + jerking eye movements QUESTION: You are concerned he may have which of the following? A) Leukemia B) Medulloblastoma C) Neuroblastoma D) Retinoblastoma

CORRECT ANSWER(S): C) Other S/S = ab pain/mass, diarrhea, fatigue, bone pain, possible chronic cough, "opsoclonus & myoclonus" WRONG ANSWERS: A) Presents w/ bone marrow failure (anemia, thrombocytopenia, & neutropenia) + fevers, pallor, easy bruising, bone pain, and hepatosplenomegaly B) Presents w/increasing ICP (early AM H/A w/vomiting, visual dist, and irritability) D) Presents w/leukocoria (white papillary reflex) + possible strabismus

BACKGROUND: - 21mo fell on playground from 1-foot elevated platform, scraping his head, no LOC - PE = small abrasions on L temple, L palm, and bilat knees; small bruises in various stages of healing on arms/legs, as well as posterior and lateral chest and back of neck at base of hairline - Mom says "plays rough, he is a boy after all" and "is extremely accident-prone) - No previous ED visits QUESTION: What do you order next? A) MRI of brain B) CT scan of head C) Skeletal survey D) Neurology consult

CORRECT ANSWER(S): C) Skeletal Survey for kids <2yo d/t concerns regarding placement of older bruising (abuse = bruises on chest, back, butt, neck, ear, cheeks, & genitals); also r/o bleeding DOs WRONG ANSWERS: A) B) D)

BACKGROUND: - 10wk old boy + murmur - Low set ears, bulbous nose, & submucus cleft palate - Good periph pulses, normal HR, no visible cyanosis, O2 at 90% RA - CXR = cardiomegaly w/absent thymic shadow QUESTION: Which of the following statements is true regarding this child's condition? A) Hypocalcemic sz most common p 1 yo B) May be assoc'd w/significant B cell immunodef C) R sided aortic arch present in 30-50% of cases D) Most common assoc'd cardiac anomaly = aneurysm of coronary arteries

CORRECT ANSWER(S): C) This is DiGeorge WRONG ANSWERS: A) Most hypocalcemia cases present in neonate, not p 1yo B) Not B-cell, but T-cell defect is common D) This isn't true

BACKGROUND: - Low intrauterine AFP levels - PE = almond shaped eyes w/upslant & flat nasal bridge w/midface hypoplasia; short/broad hands w/transverse palmar crease. QUESTION: Which heart defect does this child likely have? A) Truncus arteriosis B) Pulm stenosis C) Common AV valve D) Tetralogy of Fallot

CORRECT ANSWER(S): C) This is Trisomy 21 (Down's) WRONG ANSWERS: A) B) D)

QUESTION: When does birth weight double? A) 2-3 mo B) by 3 mo C) by 3-5 mo D) by 4-6 mo

CORRECT ANSWER(S): D)

QUESTION: Which of the following is a violation of patient confidentiality? Records released to A) Public Health Dept B) Insurance Company C) Referring physician D) Spouse

CORRECT ANSWER(S): D)

QUESTION: What age can jump up and down? A) 9 mo B) 12 mo C) 15 mo D) 24 mo