peds review

A schoolage child has recurrent diarrhea with foulsmelling stools, excessive flatus, abdominal distension, and failuretothrive. A 2week lactosefree trial failed to reduce symptoms. What is the next step in diagnosing this condition? A. Lactose hydrogen breath test B. Serologic testing for celiac disease C. Stool for ova and parasites D. Sweat chloride test for cystic fibrosis

Serologic testing for celiac disease

. A dipstick urinalysis is positive for leukocyte esterase and nitrites in a schoolage child with dysuria and foulsmelling urine but no fever who has not had previous urinary tract infections. A culture is pending. What will the pediatric nurse practitioner do to treat this child? A. Order ciprofloxacin ER once daily for 3 days if the culture is positive. B. Prescribe trimethoprimsulfamethoxazole (TMP) twice daily for 3 to 5 days. Correct C. Reassure the child's parents that this is likely an asymptomatic bacteriuria. D. Wait for urine culture results to determine the correct course of treatment.

TMP

A child whose family has been camping in a region with endemic Lyme disease suffered several tick bites. The parents report removing the ticks but are not able to or the length of time the ticks were attached. The child is asymptomatic. What is the action? A. Administer a prophylactic single dose of doxycycline. B. Perform serologic testing for IgG or IgM antibodies. C. Prescribe amoxicillin three times daily for 14 to 21 days. D. Teach the parents which signs and symptoms to report.

Teach the parents which signs and symptoms to report.

An infant is brought to clinic with bright erythema in the neck and flexural folds after recent treatment with antibiotics for otitis media. What is the treatment for this condition? A. 1% hydrocortisone cream to affected areas for 1 to 2 days B. Oral fluconazole 6 mg/kg on day 1, then 3 mg/kg/dose for 14 days C. Topical keratolytics and topical antibiotics for 7 to 10 days D.Topical nystatin cream applied several times daily

Topical nystatin cream applied several times daily

A 4yearold female who has had two urinary tract infections has persistent dysuria and genital redness. The physical exam reveals a thin, flat membrane from the posterior fourchette almost to the clitoris. Which treatment is indicated? A. Application of A&D ointment B. Counseling about hygiene C. Reassurance and observation D.Use of estrogencontaining cream

Use of estrogencontaining cream

A 3-month-old infant who was previously healthy now has a persistent cough, bilateral lung crackles, and poor appetite. The primary care pediatric nurse practitioner auscultates a grade III/VI, low-pitched, holosystolic murmur over the left lower sternal border and palpates the liver at one centimeter below the ribs. What diagnosis is likely? a. Atrial septal defect b. Coarctation of the aorta c. Patent ductus arteriosis d. Ventricular septal defect

Ventricular septal defect

2-year-old child who has SCA comes to the clinic with a cough and a fever of 101.5°C. Takes penicillin V prophylaxis . what to do?

a. Admit the child to the hospital to evaluate for sepsis.

temperature of 102.2°F swelling and erythema of the upper lid of one eye and moderate pain Which course of treatment is correct?

a. Admit to the hospital for intravenous antibiotics. periorbital cellulitis

In a respiratory disorder causing a check-valve obstruction, which symptoms will be present?

a. Air entry on inspiration with expiratory occlusion

The primary care pediatric nurse practitioner is examining a 2-week-old infant and auscultates a wide splitting of S2 during expiration. What condition may this finding represent?

a. Atrial septal defect

Which lab value is most concerning in an infant with fever and a suspected bacterial infection?

a. C-reactive protein of 11.5 mg/L

A schoolage 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 pressureequalizing tubes and a pearlywhite lesion on one tympanic membrane. Which condition is most likely?

a. Cholesteatoma

Hemoglobin of 8.5 g/dL and a hematocrit of 31%. what to do?

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

Neisseria gonorrhea conjunctivitis causes discharge look like?

acute conjunctival inflammation and excessive purulent discharge.

The parent of a preschoolage child calls the clinic to report that the child has clear, watery drainage from both eyes, mild erythema of the conjunctiva, and no fever or other symptoms. What will the primary care pediatric nurse practitioner recommend? A. Allow the child to go to preschool. Correct B. Bring the child to the clinic for a culture. C. Keep the child home for 2 days. D. Use antibiotic eyedrops for 3 days..

allow child to go back to school

Hx of a pustular rash at the site of a cat scratch on one arm now has warm tender swollen axillary lymph nodes +induration and erythema of these nodes? Order

an immunofluorescent assay (IFA) for serum antibodies.

1-week-old infant moderate eyelid swelling bulbar conjunctival injections

and moderate amounts of thick purulent discharge. What is the likely diagnosis?, Chlamydia trachomatis conjunctivitis

A school-age child steps on a nail while wearing tennis shoes and develops cellulitis in that foot. The child's immunizations are up-to-date. What antibiotic will the pediatric nurse practitioner empirically prescribe? a. Amoxicillin-clavulanate b. Ciprofloxacin c. Clindamycin d. Trimethoprim-sulfamethoxazole

b. Ciprofloxacin Plantar puncture wounds, particularly those wounds that occur following puncture of sneakers/shoes, require ciprofloxacin to cover potential Pseudomonas infection and to protect against an osteomyelitis. Amoxicillin-clavulanate is used in other puncture wounds with signs of infection. Clindamycin is used for similarly wounded children allergic to penicillins. TMPSMX is used if MRSA is cultured.

A 12-year-old child has a recent history of increased thirst and frequent urination. The child's weight has been in the 95th percentile for several years. A dipstick UA is positive for glucose, and random plasma glucose is 350 mg/dL. Which test will the primary care pediatric nurse practitioner order to determine the type of diabetes in this child? a. Fasting plasma glucose b. Hemoglobin A1C levels c. Pancreatic autoantibodies d. Thyroid function tests

c. Pancreatic autoantibodies ANS: C If the type of diabetes is uncertain, screening for pancreatic antibodies should be considered to confirm the diagnosis of type 1 diabetes. Fasting plasma glucose may be elevated in both types. Hemoglobin A1C does not distinguish among types. Thyroid function tests are not indicated unless there is a suspicion of concomitant associated autoimmune conditions.

The pediatric nurse practitioner observes that the child has difficulty pronouncing "t" "d" "k" and "g" sounds. Which action is correct?

c. Reassure the parent that this is normal. Intelligibility of speech reaches about 66% between the ages of 24 and 36 months. Tongue-contact sounds are more intelligible by age 5 years. This child exhibits normal speech for age. It is not

A schoolage child has had abdominal pain for 3 months that occurs once or twice weekly and is associated with a headache and occasional difficulty sleeping, often causing the child to stay home from school. The child does not have vomiting or diarrhea and is gaining weight normally. The physical exam is normal. According to Bishop, what is included in the initial diagnostic workup for this child? A. CBC, ESR, amylase, lipase, UA, and abdominal ultrasound B. CBC, ESR, CRP, and fecal calprotectin C. CBC, ESR, CRP, UA, stool for ova, parasites, and culture D. Stool for H. pylori antigen and serum IgA, IgG, tTg

cBC, ESR, amylase, lipase, UA, and abdominal ultrasound

An adolescent is diagnosed with major depression, and the mental health specialist has prescribed fluoxetine. What other treatment is important to protect against suicide risk? A. Addition of risperidone therapy B. Cognitivebehavioral therapy C. Family therapy D. Hospitalization

cognative beh therapy

The mother of a female infant is concerned that her daughter is developing breasts. The primary care pediatric nurse practitioner notes mild breast development but no pubic or axillary hair. What is the likely diagnosis? a. Congenital adrenal hyperplasia causing breast development b. Precocious puberty needing endocrinology management c. Premature adrenarche which will lead to pubic hair onset d. Premature thelarche which will resolve over time

d. Premature thelarche which will resolve over time ANS: D Infant and toddler girls may have isolated breast development, or premature thelarche, which usually resolves over time and rarely progresses to true precocious puberty. CAD will have other symptoms and is associated with premature adrenarche, which is the early development of pubic and axillary hair. Precocious puberty involves the early onset of multiple features of puberty and not just breast development.

A 5-month-old infant who has a 3-day history of cough and rhinorrhea has developed symptoms of respiratory distress with audible expiratory wheezes and increased coughing. The infant's immunizations are up-to-date. The physical exam reveals a respiratory rate of 50 breaths per minute, coarse expiratory wheezing, and prolonged expiration. An oxygen saturation is 96% on room air. What is the recommended treatment for this infant? a. Administer a trial of bronchodilators. b. Obtain a viral culture of nasal washings. c. Order an oral corticosteroid medication. d. Recommend increased fluids and close follow-up.

d. Recommend increased fluids and close follow-up. ANS: D The infant has bronchiolitis and is stable. Increasing fluids and following up closely are indicated as long as oxygen saturations and hydration are normal. Bronchodilator trials are not recommended because of the risk of adverse effects and questionable efficacy. Viral cultures are performed if hospitalization is necessary or when symptoms are severe. Corticosteroid medications are not indicated.

Serum procalcitonin (Pro-CT) is used to?

differentiate viral from bacterial infections.

A 4yearold child who has asthma has teeth with smooth, cuppedout teeth on the chewing surfaces. Which is the most likely explanation for this finding? A. Bruxism B. Bulimia C. Decreased saliva D.Gastroesophageal reflux

gerd

18. An adolescent has acne with lesions on the cheeks and under the chin. Which distribution is this? A. Athletic B. Frictional C. Hormonal D. Pomadal

hormonal

A 9-month-old infant has had a fever of 103°F for 2 days and now has a diffuse maculopapular rash that blanches on pressure.?

roseola infantum = Reassure the parent that this is a mild self-limiting disease.

4yearold child with an upper respiratory tract infection has cloudy nasal discharge and moderate nasal congestion interfering with sleep. The parent asks what product to use to help with symptoms. What will the primary care pediatric nurse practitioner recommend? A. Antihistamines B. Decongestant sprays C. Saline rinses D. Zinc supplements

saline rinse

How is Herpes simplex virus (HSV) conjunctivitis discharge looks like?

serosanguinous

A 3-year-old child who attends day care has had a fever nausea and vomiting several weeks prior and now has darkened urine and constipation along with hepatomegaly and right upper quadrant tenderness

supportive care Hep A

"Want puppy!" what kind of speech?

telegraphic speech.

ankyloglossia

tongue-tie; a defect of the tongue characterized by a short, thick frenulum

An adolescent female has grouped vesicles on her oral mucosa. To determine whether these are caused by HSV1 or HSV2, the primary care pediatric nurse practitioner will order which test? A. Direct fluorescent antibody test B. Enzymelinked immunosorbent assay C. Tzanck smear D. Viral culture

viral culture

An unimmunized schoolage child whose mother is in her first trimester of pregnancy is diagnosed with rubella after a local outbreak. What will the primary care pediatric nurse practitioner recommend? A. Assessment of maternal rubella titers B. Intravenous immunoglobulin for the child C. MMR vaccine for the mother and child D. Possible termination of the pregnancy

A. Assessment of maternal rubella titers Correct

Child to sit on the exam room floor moving a toy truck back and forth in a repetitive manner. Which disorder does the nurse practitioner suspect?

Autism spectrum disorder

cystic fibrosis. Which medication regimen is used to facilitate airway clearance for this child?

Inhaled dornase alfa

light is left on at night and won't leave the house unless both shoes are tied equally tight.type of sensory processing disorder?

Over-responder

infant with fever and cough. A WBC is 14000/mm3 next step?

Performing a catheterized urinalysis to screen for leukocytes and nitrites

The parent of a 6-year-old child expresses concern that the child may have ADHD.. What tool to use?

The Conner's Parent and Teacher Rating Scale is used to assess ADHD symptoms in children aged 6 to 18 years.

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

Topical erythromycin with benzoyl peroxide

Child with beta-thalassemia minor and notes an Hgb level of 8 g/dL. What will the nurse practitioner do?

a. Evaluate serum ferritin.

Dyspraxia refers to

difficulty recognizing and distinguishing shapes and textures.

A preschool age child has honeycrusted lesions on erythematous, eroded skin around the nose and mouth, with satellite lesions on the arms and legs. The child's parent has several similar lesions and reports that other children in the day care have a similar rash. How will this be treated? A. Amoxicillin 40 to 5 mg/kg/day for 7 to 10 days B. Amoxicillinclavulanate 90 mg/kg/day for 10 days C. Bacitracin cream applied to lesions for 10 to 14 days D. Mupirocin ointment applied to lesions until clear

. Amoxicillinclavulanate 90 mg/kg/day for 10 days

realism mean

1 name for everything. when baby know that All dogs are dogs and not various breeds.

A child is diagnosed with tinea versicolor. What is the correct management of this disorder?

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

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

A school-age child has had nasal discharge and daytime cough but no fever for 12 days without improvement in symptoms. The child has not had antibiotics recently and there is no significant antibiotic resistance in the local community. What is the appropriate treatment for this child? a. Amoxicillin 45 mg/kg/day b. Amoxicillin 80-90 mg/kg/day c. Amoxicillin-clavulanate 80-90 mg/kg/day d. Saline irrigation for symptomatic relief

ANS: A This child meets criteria for treatment of acute rhinosinusitis (ARS) based on duration of symptoms without clinical improvement. The initial treatment is amoxicillin 45 mg/kg/day. The higher dose is used to treat ARS in communities with resistant S. pneumonia. If antibiotics have been used previously, amoxicillin-clavulanate is used. The use of buffered isotonic saline into the nasal cavity by squeeze bottle or neti pot (in late childhood and adolescence) may be helpful, but the clinical guidelines do not support or negate the use of saline.

The primary care pediatric nurse practitioner is treating a toddler who has a lower respiratory tract illness with a low-grade fever. The child is eating and taking fluids well and has normal oxygen saturations in the clinic. The nurse practitioner suspects that the child has a viral pneumonia and will : a. order an anti-viral medication and schedule a follow-up appointment. b. prescribe a broad-spectrum antibiotic until the lab results are received. c. teach the parents symptomatic care and order labs to help with the diagnosis. d. write a prescription for an antibiotic to be given if the child's condition worsens.

ANS: C To decrease antibiotic overuse and resistance the PNP should order an antibiotic only if laboratory data confirm a bacterial infection. This child is mildly ill and can be treated symptomatically. It is not necessary to treat with an anti-viral medication. A broad-spectrum antibiotic will only increase the risk of antibiotic resistance. Writing a prescription for the parents to fill if needed is not recommended; parents may give an antibiotic believing that it is indicated when it is not.

5-day-old infant and notes mild conjunctivitis corneal opacity and serosanguinous discharge in the right eye. Which course of action is correct?

Admit the infant to the hospital immediately.

A 3yearold child has had one episode of acute otitis media 3 weeks prior with a normal tympanogram just after treatment with amoxicillin. In the clinic today the child has a type B tympanogram a temperature of 102.5°F and a bulging tympanic membrane. What will the primary care pediatric nurse practitioner order?

Amoxicillinclavulanate twice daily

An 18monthold child with no previous history of otitis media awoke during the night with right ear pain. The primary care pediatric nurse practitioner notes an axillary temperature of 100.5°F and an erythematous bulging tympanic membrane. A tympanogram reveals of peak of +150 mm H2O. What is the recommended treatment for this child?

An analgesic medication and watchful waiting

A 14yearold female comes to the clinic with amenorrhea for 3 months. A pregnancy test is negative. The adolescent's body weight is at 82% of expected for height and age. The mother reports that her daughter often throws up and refuses to eat most foods. Which condition does the primary care pediatric nurse practitioner suspect? A. Anorexia nervosa B. Bulimia nervosa C. Depression D. Substance abuse

Anorexia nervosa Correct

A child who has psoriasis, who has been using a moderatepotency topical steroid on thick plaques on the extremities and a highpotency topical steroid on more severe plaques on the elbows and knees, continues to have worsening of plaques. In consultation with a dermatologist, which treatment will be added? A. Anthralin ointment in high strength applied for 10 to 30 minutes daily B. Calcipotriol cream applied liberally each day to the entire body C. Oral steroids and methotrexate therapy until plaques resolve D. Wideband ultraviolet therapy for 15 minutes twice daily

Anthralin ointment in high strength applied for 10 to 30 minutes daily

A previously healthy schoolage child develops a cough and a lowgrade fever. The primary care pediatric nurse practitioner auscultates wheezes in all lung fields. Which diagnosis will the nurse practitioner suspect? A. Atypical pneumonia Correct B. Bacterial pneumonia C. Bronchiolitis D. Bronchitis

Atypical pneumonia Correct

A parent brings a 4monthold infant to the clinic who has had a lowgrade fever for 24 hours. The primary care nurse practitioner notes that the infant has a weak cry, slightly dry oral mucosa, mottled skin, and a respiratory rate of 65 breaths per minute and sleeps unless stimulated by the examiner,. What will the nurse practitioner do? A. Administer oral fluids in the clinic. B. Admit the infant to the hospital. C. Order outpatient laboratory tests. D. Send the infant home with close followup.

B. Admit the infant to the hospital. Correct

A child is brought to clinic with several bright red lesions on the buttocks. The primary care pediatric nurse practitioner examines the lesions and notes sharp margins and an "orange peel" look and feel. The child is afebrile and does not appear toxic. What is the course of treatment for these lesions? A. Hospitalize the child for intravenous antibiotics and possible I&D of the lesions. B. Initiate empiric antibiotic therapy and follow up in 24 hours to assess response. C. Obtain blood cultures prior to beginning antibiotic treatment. D. Perform gram stain and culture of the lesions before initiating antibiotics.

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

The parent of a 4weekold infant reports that the infant began having forceful vomiting 1 week prior, which has worsened over time. The infant continues to nurse well but is losing weight. A physical examination reveals a 90g weight loss over the past 2 weeks, dry mucous membranes, and a sunken fontanel. What will the primary care pediatric nurse practitioner do? A. Encourage the mother to nurse the infant more frequently for shorter duration. B. Obtain serum electrolytes and hospitalize for surgical intervention. Correct C. Recommend oral rehydration fluids for 24 to 48 hours to correct dehydration. D. Suggest trying a soybased or hydrolyzed protein formula until vomiting resolves.

B. Obtain serum electrolytes and hospitalize for surgical intervention.

A preschoolage child with no previous history has mild flank pain and fever but no abdominal pain or vomiting. A urinalysis is positive for leukocyte esterase and nitrites. A culture is pending. Which is the correct course of treatment for this child? A. Hospitalize for intravenous antibiotics. B. Order amoxicillin clavulanate. C. Prescribe trimethoprimsulfamethoxazole. D. Refer for a voiding cystourethrogram.

B. Order amoxicillin clavulanate.

A child who has attentiondeficit/ hyperactivity disorder (ADHD) has difficulty stopping activities to begin other activities at school. The primary care pediatric nurse practitioner understands that this is due to difficulty with the selfregulation component of

B. flexibility.

A sexually active adolescent female tests positive for N. gonorrhoeae and C. trachomatis. She tells the primary care pediatric nurse practitioner that she wants to be treated today since she is moving out of town the next day. What will the nurse practitioner order?

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

A 16yearold sexually active female has a fever, bilateral lower abdominal pain, and malaise. A speculum and bimanual exam reveals adnexal tenderness. The urinalysis is normal and cervical cultures are pending. What medications will the primary care pediatric nurse practitioner prescribe for this patient? A. Azithromycin, doxycycline, and penicillin B. Cefotaxime, azithromycin, and penicillin C. Ceftriaxone, doxycycline, and metronidazole D. Doxycycline, penicillin, and metronidazole

Ceftriaxone, doxycycline, and metronidazole

A 5-year-old child has an elevated blood pressure during a well child exam. The primary care pediatric nurse practitioner notes mottling and pallor of the child's feet and lower legs and auscultates a systolic ejection murmur in the left infraclavicular region radiating to the child's back. The nurse practitioner will suspect which condition?

Coarctation of the aorta

A 5-year-old child has an elevated blood pressure during a well child exam. The primary care pediatric nurse practitioner notes mottling and pallor of the child's feet and lower legs and auscultates a systolic ejection murmur in the left infraclavicular region radiating to the child's back. The nurse practitioner will suspect which condition? a. Aortic stenosisb. Coarctation of the aortac. Patent ductus arteriosusd. Pulmonic stenosis

Coarctation of the aorta

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?

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

A child with a recent history of URI reports tingling and pain in one ear followed by sagging of one side of the face. The primary care pediatric nurse practitioner observes that the child cannot close the eye or mouth on the affected side but does not elicit limb weakness on that side. What will the nurse practitioner do? A. Initiate a short course of antibiotic therapy. B. Perform diagnostic testing to rule out serious causes. C. Prepare the parents for lifelong complications. D. Prescribe oral prednisone 1 mg/kg/day initially.

CorrectD. Prescribe oral prednisone 1 mg/kg/day initially.

A 30monthold girl who has been toilet trained for 6 months has daytime enuresis and dysuria and a lowgrade fever. A dipstick urinalysis is negative for leukocyte esterase and nitrites. What is the next step? A. Begin empiric treatment with trimethoprimsulfamethoxazole. B. Discuss behavioral interventions for toilet training. C. Reassure the child's parents that the child does not have a urinary tract infection. D. Send the urine to the lab for culture.

D. Send the urine to the lab for culture. Correct

A 9monthold infant with a history of three urinary tract infections is diagnosed with grade II vesicoureteral reflux. Which medication will be prescribed? A. Amoxicillin 10 mg/kg as a single daily dose B. Ceftriaxone IM 50 mg/kg as a single daily dose C. Nitrofurantoin 12 mg/kg as a single daily dose D.TMPSMX; TMP 2 mg/kg as a single daily dose

D.TMPSMX; TMP 2 mg/kg as a single daily dose

A 4yearold child has clusters of small, clear, tense vesicles with an erythematous base on one side of the mouth along the vermillion border, which are causing discomfort and difficulty eating. What will the primary care pediatric nurse practitioner recommend as treatment? A. Mupirocin ointment applied to lesions 3 times daily B. Oral acyclovir 20 to 40 mg/kg/dose for 7 to 10 days C. Topical acyclovir applied to lesions 4 times daily D.Topical diphenhydramine and magnesium hydroxide

D.Topical diphenhydramine and magnesium hydroxide

17-year-old male who "lumps" on his chest. increase in weight since the last visit along with worsening of the adolescent's acne. caused by ?

Dehydroepiandrosterone (DHEA) DHEA is a prohormone that is converted to either testosterone or estrone and will cause adverse changes similar to anabolic steroids such as increased weight gynecomastia and acne. Creatine is taken because athletes believe it enhances endurance.

An adolescent has suspected infectious mononucleosis after exposure to the virus in the past week. notes exudate on the tonsils, soft palate petechiae, and diffuse adenopathy. which test?

EBV-specific antibody testing

schoolage female has had vulvovaginitis for 2 months.

Estrogen cream at bedtime for 2 to 3 weeks

an intense red eruption on the child's cheeks and circumoral pallor. What will the nurse practitioner tell the parents about this rash?

Expect a lacy maculopapular rash to develop on the trunk and extremities.

An adolescent has rightsided flank pain without fever. A dipstick urinalysis reveals gross hematuria without signs of infection or bacteriuria, and the primary care pediatric nurse practitioner diagnoses possible nephrolithiasis. What is the initial treatment for this condition? A. Extracorporeal shockwave lithotripsy (ESWL) B. Increasing fluid intake up to 2 L daily C. Percutaneous removal of renal calculi D. Referral to a pediatric nephrologist

Increasing fluid intake up to 2 L daily Correct

n 18monthold child has a 1day history of intermittent, cramping abdominal pain with nonbilious vomiting. The child is observed to scream and draw up his legs during pain episodes and becomes lethargic in between. The primary care pediatric nurse practitioner notes a small amount of bloody, mucous stool in the diaper. What is the most likely diagnosis? A. Appendicitis B. Gastroenteritis C. Intussusception D. Testicular torsion

Intussusception

what vaccine can be given after exposure?

MMR

diagnosed with ADHD who has a primarily hyperactive presentation. Which medication will the nurse practitioner select initially?

Moderate-dose stimulant

The primary care pediatric nurse practitioner obtains a tympanogram on a child that reveals a sharp peak of 180 mm H2O. What does this value indicate?

Negative ear pressure

A wellbaby examination of a 3dayold infant born to a primigravida mother reveals swelling on the right parietal area of the scalp that stops at the suture line. What action will the primary care pediatric nurse practitioner take based on this finding? A. Assess the infant for sacral dimpling. B. Observe the infant for hyperbilirubinemia. C. Obtain a computerized tomography scan. D. Perform serum coagulation studies.

Observe the infant for hyperbilirubinemia. Correct

pt taking oral acyclovir. what to check?

Obtain regular absolute neutrophil counts.

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

Order Burow solution and warm soothing baths as comfort measures.

A 5dayold infant who was delivered at home has abdominal distension and poor feeding. The mother is worried that the infant is constipated because he didn't have a first stool until yesterday and has only passed a small amount of meconium. What will the primary care pediatric nurse practitioner do? A. Obtain a sweat chloride skin test to evaluate for possible cystic fibrosis. B. Order an abdominal radiograph and refer the infant to a pediatric surgeon. C. Prescribe glycerin suppositories to use as needed until bowel function is normal. D. Suggest that the mother increase her fluid intake to help with constipation.

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

A 16yearold female reports breast tenderness and a "lump." The primary care pediatric nurse practitioner palpates a small fluidfilled mass in her right breast. A pregnancy test is negative. Which action is correct? A. Obtain a CBC to rule out infection. B. Order an ultrasound of the mass. C. Prescribe NSAIDs to treat her discomfort. D. Reassure her that the findings are normal.

Order an ultrasound of the mass. Correct

The parent of a toddler and a 4weekold infant tells the primary care pediatric nurse practitioner that the toddler has just been diagnosed with pertussis. What will the nurse practitioner do to prevent disease transmission to the infant? A. Administer the initial diphtheria, pertussis, and tetanus vaccine. B. Instruct the parent to limit contact between the toddler and the infant. C. Order azithromycin 10 mg/kg/day in a single dose daily for 5 days. D. Prescribe erythromycin 10 mg/kg/dose four times daily for 14 days.

Order azithromycin 10 mg/kg/day in a single dose daily for 5 days.

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?

Order ototopical antibiotic/corticosteroid drops.

A 12 monthold infant who had cardiopulmonary bypass with RBC and plasma infusions during surgery at 8 months is seen for a well child examination. Which vaccine may be administered at this visit? A. MMR B. OPV C. PCV13 D. Varivax

PCV13

Could not give twice-daily amoxicillin for 10 days. What will the nurse practitioner do?

Prescribe azithromycin once daily for 5 days.

A 2yearold child is brought to the clinic after developing a hoarse, barklike cough during the night with "trouble catching his breath" according to the parent. The history reveals a 2 day history of lowgrade fever and upper respiratory symptoms. On exam, the child has a respiratory rate of 40 breaths per minute, occasional stridor when crying, and a temperature of 101.3°F. What is the next step in treatment for this child? A. Administer intramuscular dexamethasone. B. Admit the child for inpatient hospitalization. C. Give the child a racemic epinephrine treatment in the office. D. Prescribe oral dexamethasone for 2 days.

Prescribe oral dexamethasone for 2 days.

A 2-year-old child is brought to the clinic after developing a hoarse, bark-like cough during the night with "trouble catching his breath" according to the parent. The history reveals a 2 day history of low-grade fever and upper respiratory symptoms. On exam, the child has a respiratory rate of 40 breaths per minute, occasional stridor when crying, and a temperature of 101.3°F. What is the next step in treatment for this child?

Prescribe oral dexamethasone for 2 days. ANS: D This child has croup with milder symptoms and may be managed at home with oral steroids. IM steroids are given to children who are vomiting. Inpatient admission is considered for children with respiratory distress (rates between 70 and 90 breaths per minute, severe retractions, and stridor at rest). Racemic epinephrine is useful for more severe symptoms, especially for stridor, but is done in the ED or hospital and should always be combined with a steroid.

16yearold female reports dull, achy cramping pain in her lower abdomen lasting 2 or 3 hours that occurs between her menstrual periods each month. The adolescent is not sexually active. What is the treatment for this condition? A. Abdominal ultrasound to rule out ovarian cyst B. Oral contraceptives to suppress ovulation C.Prostaglandin inhibitor analgesics and a heating pad

Prostaglandin inhibitor analgesics and a heating pad

During a routine well child exam on a 5-year-old child, the primary care pediatric nurse practitioner auscultates a grade II/VI, harsh, late systolic ejection murmur at the upper left sternal border that transmits to both lung fields. The child has normal growth and development. What will the nurse practitioner suspect? a. Aortic stenosis b. Patent ductus arteriosus c. Pulmonic stenosis

Pulmonic stenosis

During a routine well child exam on a 5-year-old child, the primary care pediatric nurse practitioner auscultates a grade II/VI, harsh, late systolic ejection murmur at the upper left sternal border that transmits to both lung fields. The child has normal growth and development. What will the nurse practitioner suspect?a. Aortic stenosisb. Patent ductus arteriosusc. Pulmonic stenosisd. Tricuspid atresia

Pulmonic stenosis

During a routine well child exam on a 5yearold child, the primary care pediatric nurse practitioner auscultates a grade II/VI, harsh, late systolic ejection murmur at the upper left sternal border that transmits to both lung fields. The child has normal growth and development. What will the nurse practitioner suspect? A. Aortic stenosis B. Patent ductus arteriosus C. Pulmonic stenosis D. Tricuspid atresia

Pulmonic stenosis Correct

A schoolage 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 selflimited. D. Recommend topical antihistamines and emollients to control the spread.

Reassure the child's parents that the rash is benign and selflimited.

The primary care pediatric nurse practitioner performs a well baby exam on a 2dayold infant and notes clusters of firm, yellowwhite papules with a surrounding erythematous flare. What will the nurse practitioner do? A. Encourage frequent cleansing with mild soap. B. Obtain a Wrightstained smear of the lesions. C. Prescribe a topical antibiotic medication. Reassure the parents that no treatment is necessary.

Reassure the parents that no treatment is necessary.

An adolescent male comes to the clinic reporting unilateral scrotal pain, nausea, and vomiting that began that morning. The primary care pediatric nurse practitioner palpates a painful, swollen testis and elicits increased pain with slight elevation of the testis (a negative Phren's sign). What will the nurse practitioner do? A. Administer IM ceftriaxone and prescribe doxycycline twice daily for 10 days. B. Encourage bed rest, scrotal support, and ice packs to the scrotum as tolerated. C. Prescribe NSAIDs, limited activities, and warm compresses to the scrotum. D. Refer the adolescent immediately to a pediatric urologist or surgeon.

Refer the adolescent immediately to a pediatric urologist or surgeon.

A 9yearold girl has a history of frequent vomiting and her mother has frequent migraine headaches. The child has recently begun having more frequent and prolonged episodes accompanied by headaches. An exam reveals abnormal eye movements and mild ataxia. What is the correct action? A. Begin using an antimigraine medication to prevent headaches. B. Prescribe ondansetron and lorazepam to help manage symptoms. C. Reassure the parent that this is expected with cyclic vomiting syndrome.

Refer to a pediatric gastroenterologist for further workup.

A schoolage child has a 3month history of dull, aching epigastric pain that worsens with eating and awakens the child from sleep. A complete blood count shows a hemoglobin of 8 mg/dL. What is the next step in management? A. Administration of H2RA or PPI medications B. Empiric therapy for H. pylori (HP) C. Ordering an upper GI series D.Referral for esophagogastroduodenoscopy (EGD)

Referral for esophagogastroduodenoscopy (EGD)

A schoolage child has a 3month history of dull, aching epigastric pain that worsens with eating and awakens the child from sleep. A complete blood count shows a hemoglobin of 8 mg/dL. What is the next step in management? A. Administration of H2RA or PPI medications B. Empiric therapy for H. pylori (HP) C. Ordering an upper GI series D. Referral for esophagogastroduodenoscopy (EGD)

Referral for esophagogastroduodenoscopy (EGD)