Questions 2

A parent comes in with an 8-year-old girl who is complaining of a headache. What headache symptoms would not be of immediate concern for an NP? A. Unilateral headache made worse by light B. Headache that gets worse with laying down C. Headache that wakes her up at night D. Headache in the back of the head

A - Red flag warnings include new onset headache with an explosive quality; fever of unknown origin; worst headache ever; headache that wakes a patient with or without vomiting; Posterior headaches; headaches with confusion; change in consciousness or other neurological symptoms; or headaches with postural changes/changes in position.

A 4-year-old female patient presents to your office with her mother for a complaint of decreased oral intake following a stomach virus and she is not urinating as she normally does. On exam, you find decrease capillary refill, tachycardiac at 144, pale in color, and hypotension. You decide to send the child to the local hospital for IV rehydration. How much isotonic fluid would you order to bolus this child? a. 20-ml/kg b. 30-ml/kg c. 10-ml/kg d. You would not bolus this child

A Correct answer a. 20-ml/kg given as rapidly as possible.

A 13-year-old female presents to the clinic with complaints of right upper quadrant abdominal pain, nausea, vomiting, and poor appetite. What diagnostic test should be ordered? A. CT scan of abdomen B. Ultrasound C. MRI D. EGD

B : Right upper quadrant abdominal pain is consistent with cholelithiasis, for which the diagnostic standard is ultrasound. Pregnancy cannot be ruled out, so a pregnancy test should be done prior to any imaging. Since that is not noted in the question, the safest, least invasive, and most cost effective option is an ultrasound.

If a child is diagnosed with Meckel Diverticulum, what color will the rectal bleeding be? A. Bright red B. Maroon or melanotic C. Dark brown D. Light Pink

B Maroon or melanotic— Due to the bleeding being in a deep ileal ulcer adjacent to the diverticulum caused by acid secreted by heterotopic gastric tissue and may be voluminous enough to cause shock and anemia.

What is the chief indication for anticoagulation after a patient experiences a TIA is atrial fibrillation. The treatment of choice is warfarin. What is your targeted INR? a. 2.5-3.5 b. 3.0-4.0 c. 2.0-3.0 d. 3.5-4.5

C correct answer c. 2.0-3.0 is your targeted INR for warfarin post-TIA to prevent atrial fibrillation

When evaluating a patient with potential appendicitis the most helping imaging study to support appendicitis would be which of the following: A.HIDA scan B.Abdominal CT scan C.Abdominal MRI D.Abdominal US

B The gold standard for diagnosing appendicitis is abdominal CT scan

What is the most common chronic disease of childhood and largely affects lower income families? A. Natal Teeth B. Ankyloglossia (tongue tie) C. Dental Carries D. Periodontal Disease

C 80% of children / adolescents living in low income families are affected by dental carries.

A 10 year old female comes into the clinic for her yearly physical exam. She has previously been up to date on all vaccinations. Which of the following vaccinations could you recommend? A. MMR B. Tdap C. HPV D. IPV

C HPV is associated with cancer in males and females. The HPV vaccine covers against 7 cancer-causing types and 2 genital wart types of HPV. The AAP recommends starting the series between the ages of 9 and 12 as there is some evidence uptakes is increased when introduced at a younger age.

All of the following are examples of primary prevention strategies for hypertension, EXCEPT: A. Taking Metoprolol Succinate 25 mg daily. B. Consuming a diet high in fresh fruits and vegetables. C. Participating in 150 minutes a week of moderate intensity exercise. D. Reducing sodium and increasing potassium intake.

A : Behavioral risk factors for hypertension include inactivity, excessive food, alcohol, and salt, and a diet low in potassium. Effective interventions for primary prevention of hypertension include decreasing sodium intake and alcohol consumption, losing weight, exercising regularly, eating a diet high in fruits and vegetables and low in fat and red meats, decreasing the amount of sugar containing beverages, and increasing potassium in the diet. Taking Metoprolol Succinate 25 mg daily would not be an example of primary prevention.

A 63-year-old female presents to your clinic with complaint of left lower quadrant abdominal pain, bloating and hard stools without rectal bleeding that began after eating popcorn. On examination, she has a low grade 100.9 fever and LLQ tenderness on palpation. CBC has resulted with WBC of 13. What is your presumptive diagnosis and what would be an appropriate step in the plan of care? A. diverticulitis, start on clear liquid diet B. ulcerative colitis, refer to GI for sigmoidoscopy C. diverticulosis, encourage high fiber diet for the next 3 days D. irritable bowel syndrome, order lactulose for constipation

A : The patient's symptoms represent exacerbation of diverticulosis. The NP can hold off on starting antibiotics in healthy individuals and manage symptoms conservatively. Resting the gut with clear liquids, then progressing to the BRAT diet is recommended before adding fiber back into diet.

A 22-year-old female presents to the clinic with classic common cold symptoms with a chief complaint of ongoing nasal congestion and was prescribed phenylephrine nasal spray. As the NP you instruct her of all the following except _____? a. it may take up to a day before you see relief of symptoms b. discontinue this medication after no more than 3 days c. withdrawal after extended use may cause rebound congestion d. this medication can be somewhat addictive when used for prolonged periods

A B, C, and D are all appropriate education for phenylephrine nasal spray. Phenylephrine and oxymetazoline nasal sprays provide rapid relief of symptoms, but when used for more than a few days it may lead to rhinitis medicamentosa which is an almost addictive need to continue the spray.

Blepharitis that occurs in children has a strong correlation with which disease? a. Rosacea b. Eczema c. Psoriasis d. Pityriasis rosea

A Blepharitis is an inflammatory condition that effects the eyelids, usually caused by an overgrowth of bacteria, specifically staphylococci. Meibomian glandular dysfunction is another cause of blepharitis, which is strongly correlated with rosacea. Symptoms of blepharitis include redness, tearing, photophobia, and a foreign body sensation that feels dry and gritty. Treatment usually consists of good eyelid hygiene and washing the eyelids with baby shampoo.

A 15-month-old pediatric patient with a history of type 1 diabetes and severe yeast allergy presents for a routine well-child visit. Which of the following vaccines would be contraindicated for administration based on the child's health history? A) Hepatitis B (HepB) B) Haemophilus influenzae type B (Hib) C) Tetanus, diptheria, & purtussis (TDaP) D) Influenza (IIV)

A Cases of hepatitis B have steadily decreased in the United States, largely due to increased vaccination rates. In 1991, immunization of all infants, screening of pregnant mothers, and vaccination of all at-risk adults have also promoted this decline in hepatitis B infections. HepB vaccine should not be given to those who have had previous anaphylaxis to the HepB vaccine, if they are allergic to any vaccine components, or if they have a serious allergic reaction to yeast. Vaccination for HepB is appropriate for patients with a history of Guillain-Barre syndrome, multiple sclerosis, autoimmune diseases, and in the pregnant mother

A 39-year-old male presents to your clinic with a complaint of new onset severe headache, periorbital pain and drooping eyelid on the left side of his face along with rhinorrhea. He said the headache will last 1-2 hours and has had 3 of these episodes this week. You highly suspect the following diagnosis: a.) Cluster headache b.) TIA c.) Migraine with aura d.) Trigeminal Neuralgia

A Cluster headache affects predominantly middle-aged men. Episodes can occur daily and last between 15 minutes and 3 hours. Cluster headaches are often are described as unilateral periorbital pain, accompanied by the following: rhinorrhea, lacrimation, redness of the eye and Horner syndrome.

What finding would indicate a late sign of severe dehydration in a 2-year-old patient? A. Hypotension B. Dry mucous membranes C. Lack of tears D. Oliguria

A Dry mucous membranes, lack of tears, and oliguria are signs of dehydration in pediatric patients. Children compensate for dehydration with an increased pulse rate. Children's blood pressure will maintain within normal limits with severe dehydration. Hypotension is considered a late sign of severe dehydration/shock and this finding requires emergent treatment.

A 29 year old male patient is being seen for his annual wellness exam. He tells you that he has just finished his masters in archeology and plans to spend 3 months traveling across Africa. Which of the following vaccinations would you recommend he receive before traveling? A. Hepatitis A B. Hepatitis B Booster C. Hepatitis C D. Hepatitis D

A Healthy travelers are advised to receive a single dose of the Hepatitis A vaccine before their trip to developing countries. Hepatitis A is transmitted by the fecal-oral route such as in poorly prepared/cooked foods and contaminated drinking water. The CDC does not recommend a hepatitis B booster for healthy patients. There are no Hepatitis C or D vaccines.

A 3-year-old-boy presents to clinic with his mother with honey-colored crusted sores around his mouth and nose. The mother states her son started attending daycare a couple of weeks ago and noticed the sores starting to develop earlier this week. Which highly contagious childhood illness do you suspect? A. Impetigo B. Varicella C. Herpes Simplex D. Molluscum contagiosum

A Macules, vesicles, pustules, that are often honey-colored and crust over are the tell-tale sign of impetigo. This highly contagious infection is caused by staphylococcus and streptococci and is common in infants and children as it is spread by skin-to-skin contact.

A patient was working in his wood shop and felt "something in his eye". He presents to the clinic today for evaluation. Suspecting a corneal foreign body is present in his eye, what is your initial intervention? A. obtain a visual acuity B. apply a local anesthetic like proparacaine drops to better assess the eye. C. Refer to ophthalmologist. D. Use a sterile cotton-tipped applicator to retrieve the foreign body.

A Obtaining a visual acuity is the first intervention done prior to treatment to assess how severe the injury is and provide a baseline to have as comparison in case complications or an event occurs during the removal process. Local anesthetic drops should be applied prior to eye examination with a slit lamp or handheld flashlight. Referral to ophthalmologist should be initiated if the foreign body cannot be removed or if a corneal infection is suspected. A cotton-tipped applicator is used to remove a foreign body, but this is not the initial intervention.

A 3-year-old with a history of not being vaccinated presents to the clinic with complaints of vomiting, diarrhea, and visible jaundice. What labs should the provider order? A. CBC, CMP, HBsAg, anti-HBcIgM, and anti-HCV IgG B. CBC, CMP, and ANA C. CMP, lipid panel, and UA D. CBC, CMP, and a LP

A The appearance of visible jaundice is typically the first sign of Hepatitis B infection in young children. The history of being unvaccinated puts this child at great risk for contracting Hepatitis infections. In Hepatitis B infections, liver enzymes will be elevated and HBsAg and anti-HBcIgM will be present. Differentiating between Hep B & C can be done through testing both anti-HBcIgM and anti-HCV IgG.

A mother reports her 13 month old has been very fussy and pulling at his ears for the past 24 hours. She had to remove him from daycare this morning due to fever of 101℉. The patient weighs 9.9kg and has no known allergies. As the nurse practitioner you prescribe: A. Amoxicillin 446 mg/5.5ml BID for 10 days B. Clindamycin 132mg TID for 7 days C. Observation period of 24 hours without antibiotics D. Azithromycin 300mg oral single dose

A This 13-month-old has bilateral otitis media based on the information provided. Bilateral otitis media has to be treated with antibiotic therapy in children less than 2 years of age. The recommended treatment is amoxicillin 80-90mg/kg/day; in this case the child weighs 9.9kg, so 9.9kg x 90kg= 891mg per day. So, this child will be given amoxicillin 446mg BID for 10 days.

A mother brings her 2-year-old daughter to the clinic, reporting that her daughter hasn't been able to keep any fluids down for a couple of days. The NP is concerned that the patient may be dehydrated. Which finding would require emergent treatment? a. low blood pressure b. decreased tears c. oliguria d. increase heart rate

A To evaluate the degree of dehydration in children, the NP would assess for altered mental status, capillary refill time, postural blood pressure, changes in heart rate, dry lips/mucosal, lack of tears, sunken fontanelle in an infant, and decreased urine output. Blood pressure can remain normal during minor to moderate dehydration, while a falling/low blood pressure is a late sign of shock and requires emergent intervention.

Inflammatory bowel disease can be differentiated into Crohn's Disease (CrD) or Ulcerative Colitis (UC). Which statement correlates to Ulcerative Colitis? A. Involves the entire colon. B. Involves the GI tract from the lips to the anus. C. Does not present with bloody diarrhea. D. Does not present with abdominal pain

A UC is limited to the colon, and in children it usually involves the entire colon (pancolitis). CrD can affect any part of the GI tract from lips to anus. UC usually presents with abdominal pain and bloody diarrhea.

A five-year-old female was brought to pediatric urgent care for possible eye injury. The mother states her daughter was playing with their new puppy and got scratched in the face. The daughter had sudden onset of severe eye pain, decreased vision, and eyelid edema. Which medication should never be given to parents to use at home for corneal abrasion? A. Topical Anesthetic B. Erythromycin ointment C. Topical Analgesics D. Oral Analgesics

A When giving parents topical anesthetics to use at home, it could leave corneal melting with overuse. Topical ointments such as erythromycin help lubricate the surface of the cornea and will help prevent infection and should be given.

A 12-year-old male comes in with his mother who states "His teacher called and told me that he repeatedly is not paying attention in class and is staring off into space and doesn't answer her when she calls his name. He takes a few moments and then responds as if he did not hear her. He is normally very attentive and engaged." A NP would assess for what for? A. ADHD B. Absence seizure C. Complex partial seizure D. Autism

B Absence seizures have an onset between 5-18 years consisting of vacant stares that can occur in cluster. There is no aura or postictal phase. Complex partial seizures have impaired consciousness and a postictal phase with purposeful movements. ADHD is noticed in younger age children and is associated with inattentiveness, impulsivity and hyperactivity and requires 6 or more symptoms to be diagnosed. Autism is diagnosed in the DMS- 5 with clinically significant impairment and typically is diagnosed before age 3.

A mother brings her 7-year-old son to the clinic reporting acute onset of upper abdominal pain, nausea and vomiting for two days. He recently got over influenza. The Nurse Practitioner assessment reveals abdominal tenderness with distention and elevated lipase greater than three times normal limit. This is concerning for what diagnosis: A. Cirrhosis B. Acute Pancreatitis C. Gastroenteritis D. Chronic Pancreatitis

B : An acute pancreatitis is an onset of persistent, moderate or severe upper abdominal pain frequently associated with vomiting or nausea. Most cases of acute pancreatitis are the results of drugs, viral infections, systemic diseases, or abdominal trauma. Acute pancreatitis is defined as at least two of the following three: abdominal pain consistent with acute pancreatitis. Amylase and or lipase greater than three times the upper limit of normal. US, CT, or MRI imaging consistent with acute pancreatitis

A healthy 2 month old is in clinic today for a routine visit. The child received the Hep B vaccine at birth. All of the following 1st dose vaccinations should be given on this visit except? A. Pneumococcal Conjugate (PCV13) B. Influenza C. DTaP D. Rotavirus E. Inactivated Poliovirus (IPV)

B : The two month visit for a healthy child includes vaccination for 1st doses of PCV13, DTaP, Rotavirus, Haemophilus Influenza Type B (HiB), and Inactivated Polio. The influenza vaccine is not administered until 6 months of age.

Which of the following is the hallmark sign of a patient with Ulcerative Colitis? A. RUQ pain B. bloody diarrhea C. LLQ pain D. heartburn

B Bloody diarrhea is the hallmark sign of UC, LLQ pain is diverticulitis, heartburn is GERD, and RUQ pain would be related to the patients gallbladder

A mother brings in her 18 month old with the complaint of fever (101.2), left ear pain, and swelling for 2 days. On exam you discover severe tenderness while palpating the mastoid. The child is diagnosed with mastoiditis. The best way to determine the extent of the disease is by ordering which of the following? A) X-ray B) CT scan C) MRI D) Ultrasound

B CT scan is the only test to reveal combined air cells with bone destruction

A young mother presents to your office today with her 9-month-old child. During the physical examination, the child becomes inconsolable while on the exam table. The child's mother becomes agitated and embarrassed. You as the perceptive FNP assess the situation and provide what initial solution? A. Explain to the mother today's visit will be postponed to a later date B. Have the mother hold the child in her lap for the physical examination C. Exit the exam room and return once the child is quiet D. Ask an assistant to come aid you in holding the child down

B For the pediatric physical examination, the provider must provide a gentle, welcoming approach to build a safe rapport with the patient. While the examination tables provide the best area for evaluation, a parent's lap can bring comfort to the crying child. A physical examination can adequately be performed when a table is formed between the provider and parent's legs facing each other.

A 5-year-old presents to a primary care clinic with his mother. The mother states the child has had decreased appetite and fever for 2 days. The child's physical assessment shows lethargy, dry mucous membranes, fever of 102.3 degrees Fahrenheit, hypotension, and tachycardia. Which intervention is most appropriate for the child? A. Weight-based oral acetaminophen (Tylenol) B. Emergent intravenous therapy C. Weight-based oral Amoxicillin (Amoxil) D. Obtain a detailed history and physical exam

B Hypotension is a late sign of severe dehydration and shock in pediatric patients due to their ability to compensate with an increase in pulse rate. Hypotension in a dehydrated pediatric patient would require emergent intravenous therapy to improve perfusion and prevent circulatory collapse. Weight-based Tylenol, weight-based amoxicillin, and a detailed history and physical exam may be a part of the interventions for the patient, but intravenous therapy is considered an emergent intervention.

At Will's 7-month-old well visit, his mother tells his Pediatrician that he has been prescribed a proton pump inhibitor (PPI) for GERD but is still having break through vomiting after feedings. He has been on the PPI for 6 months. What is the next step for treating Will's GERD? A. Continue PPI until he is 12 months old. B. Obtain a referral to a Gastroenterologist. C. Switch PPI to a histamine 2 receptor antagonist. D. Stop medication completely and give him a medication holiday.

B If a child has symptoms requiring ongoing acid suppressant therapy, or if symptoms fail to improve with empiric therapy, consider referral to a pediatric gastroenterologist to assist in evaluation for complicated GERD, or nonreflux diagnoses including eosinophilic esophagitis (EoE).

A mother brings her 18-month-old infant to the office today with new onset of irritability, poor feeding, and strong-smelling urine. What other clinical presentation of a UTI would an NP expect to see in an 18-month old infant? a. abdominal pain b. fever c. urgency d. dysuria

B Infants and newborns may present with nonspecific symptoms with UTIs. They may have unexplained fever, poor feeding, vomiting, failure to thrive, hypothermia, jaundice, irritability, and sepsis. Preschool children may present with urgency, abdominal/flank pain, frequency, dysuria. Once they are school-aged, they are more likely to exhibit classic signs and symptoms of UTIs

Kerri is a 57 year old female with a 30 pack year history. She presents to the clinic today for her annual wellness exam. Which of the following screenings would be appropriate to order? A. Chest X-ray B. Low dose CT C. Pulmonary function testing D. Sleep apnea screening

B The current recommendation for lung cancer screening is a low dose CT in current smokers aged 55-80 years with a 30 pack year history and in smokers who have quit in the last 15 years. Once a person has stopped smoking for 15 years or they develop a health issue that limits life expectancy, screening can be stopped.

A father brings his 2-month-old child into the clinic for a well child check. He is concerned because it seems as if her baby has a lazy eye. Which of the following would you tell the patients father about his child's strabismus. A. Your child has strabismus; we must refer to an ophthalmologist right away. B. Intermittent strabismus is a normal finding in infancy. If it persists beyond 4 months we will send you child to see an ophthalmologist. C. This is because of an infection. We will start ofloxacin 0.3 eye drops four times daily. D. Strabismus is another name for "lazy eye." We will begin patching the strong eye to help the weaker eye become stronger.

B Intermittent strabismus is a normal finding in infancy up to 4 months of age. If this persist beyond 4 months, it is important to refer to ophthalmology because of the risk for amblyopia. Interventions will begin once the diagnosis has been made to prevent permanent changes to vision.

An 11 yr. old male presents to your clinic for his annual wellness exam. You note that the child is in the 95% percentile for weight. You have screened the child for nonalcoholic fatty liver disease although he is asymptomatic. The plan of care should include which intervention? A. 500mg Metformin taken once daily by mouth. B. Recommend lifestyle modifications which include dietary changes and exercise. C. No intervention recommended due to the child being asymptomatic. D. Prescribe a ursodeoxycholic acid (UDCA) to prevent gallstone disease.

B Most children are diagnosed with nonalcoholic fatty liver disease through routine screening typically between the ages of 9-11 yrs. old. Obesity and insulin resistance are risk factors. Treatment is focused on making lifestyle changes like diet and exercise to gradually reduce body weight by 10% or greater to improve this disorder. Metformin and UDCA have been studied to reduce nonalcoholic fatty liver disease but have not been proven. Even though the child is asymptomatic, he still needs to make lifestyle changes to improve the disorder and prevent cirrhosis and liver failure.

An 8yo pediatric patient presents with her mother with complaints of a stomachache for 24-hours, nausea, and vomiting that occurs after eating breakfast, lunch, and dinner for the past 24 hours. The patient reports the pain occurred after eating McDonald's breakfast and continued throughout the day. The patient is pointing to her right upper quadrant that radiates to her back. She reports the pain worsens when she takes a deep breath. What is your top differential diagnosis based on your findings? A. PUD B. Pancreatitis C. Coarctation of the Aorta D. Gastritis

B Pancreatitis pain generally occurs after a fatty meal. Symptoms include nausea, vomiting, abdominal pain, RUQ/epigastric pain, and may even radiate to the right shoulder or substernal area. Risk factors include patients with a Native Americans and Hispanic heritage, pediatric patients with a personal history of Crohn's disease or cystic fibrosis, and patients with a history of prolonged parental feedings, female gender, teenagers, patients with a prior pregnancy history, patients who experience significant weight loss in a short period, and obesity

A 16-year-old female presents to clinic accompanied by her mother. She has a rash that appears as erythematous plaques with thick, white, silvery overlying scales on her elbows, knees, and umbilicus. She reports this has been going on for about 2 years and tends to come and go. The mother reports her father has psoriasis. The patient is not on any medications and she is not currently treating her rash with anything. She has tried various moisturizers in the past but has never had a prescription to treat this. She weighs 130 pounds and has no allergies. You diagnose her with psoriasis with body surface area involvement less than 10%. Which is the best option as first line therapy? A. Ketoconazole (Nizoral) 2% cream B. Clobetasol (Temovate) 0.05% ointment C. Over the counter hydrocortisone (Cortizone-10) 1% cream D. Oral prednisone 40 mg x 3 days, 30 mg x 3 days, 20 mg x 3 days, 10 mg x 3 days

B Potent topical corticosteroids like clobetasol are first line treatment for psoriasis (Hay et al., 2020). This is needed to penetrate through the plaques which occur because of epidermal cell proliferation beyond normal turnover (Hay et al., 2020). Ketoconazole is not a topical steroid. Hydrocortisone 1% is a topical steroid but is low potency (Papadakis et al., 2019). Systemic steroids like prednisone can cause severe rebound in psoriasis and are not appropriate (Papadakis et al., 2019

A 66 yo female patient presents to your clinic for their annual wellness exam. The patient reports she is having difficulty moving around due to back pain, therefore is not exercising as much and is a previous smoker. Based on this information you recommend weight bearing exercise 2-3x weekly, continued smoking cessation and an increase in her calcium and vitamin in her diet to reduce disease risk factors of osteoporosis. What type of disease prevention is this? A. Secondary B. Primary C. Tertiary D. Early detection

B Primary prevention intends to reduce disease risk factors (Papadakis et al. 2020). Osteoporosis is characterized by low bone mineral density and increases risk for fracture. Primary prevention strategies for osteoporosis include calcium and vitamin diet supplementation and exercise programs as well as modifying risk factors such as smoking and alcohol cessation

A 65-year-old female patient presents to your clinic with her daughter. The daughter reports her mother has a lot of short term memory loss over the last year. She is concerned she is showing signs of Alzheimer's disease as it runs in their family. You noticed on assessment the patient had some difficulty recalling words. What is the most appropriate response? a.) Your mother is showing signs of delirium. Is she taking any new medications? b.) You have a good reason to be concerned with Alzheimer's with her age and family history, however with any new cognitive impairment, we should get an MRI to be sure we exclude other potential causes. c.) Your mother is having a stroke, you should immediately go the emergency department. d.) You mother does not seem to be at risk for Alzheimer's disease.

B Risk factors for Alzheimer's include age of 60 or greater, family history, diabetes mellitus and history of head injury. The risk of Alzheimer's doubles every 5 years after the age of 60. The goal of imaging when suspicious of Alzheimer's is to exclude other potential causes such as tumor, cerebrovascular disease or other structural abnormalities. Delirium is not the same as dementia. Delirium is an acute state of confusion that often occurs after triggers such as medications, infection, drug intoxication or metabolic disturbances.

Blake, a 49-year-old fair skinned man who owns a landscaping business, presents to clinic with a small erythematous, scaly plaque to his right ear. The area in question has raised margins and an indurated center. As the advanced care provider, what do you expect is Blake's diagnosis? A. Basal cell carcinoma B. Squamous cell carcinoma C. Seborrheic keratosis D. Melanoma

B Squamous cell carcinoma are irregular shaped plaques that occur in fair-skinned individuals, and more commonly males, with prolonged sun exposure. Actinic keratosis is often the precursor to SCC and if caught soon enough, can prevent the progression into cancer.

A mother brings her 4-month-old son in requesting a flu shot. She states that they are leaving for vacation next week, so she would like for him to have his Flu shot before going. He is up to date on all other vaccinations. As the provider, what should you tell the mom? A) Sure, I will get the nurse to administer it shortly. B) The minimal age for the influenza vaccine is 6 months old. C) The minimal age for the influenza vaccine is 9 months old. D) The minimal age for the influenza vaccine is 12 months old.

B The minimal age for the influenza vaccine is 6 months old, so the child should not receive the vaccine. Annual influenza vaccination is recommended for all healthy individuals aged 6 months and up.

A patient presents to your clinic with complaint of new onset reflux and epigastric pain after meals that began 1 month ago. The patient has taken Tums over the counter with minimal relief. He admits to drinking 2 oz. whiskey every night stating he has been under extra stress at work. What is an inappropriate intervention in the treatment of this patient's GERD? A. Avoid reclining until at least 60 mins after eating. B. Take Omeprazole 20 mg po as needed for your symptoms. C. Decrease alcohol intake. D. If your symptoms do not improve within 4-8 weeks, we can consider referring for further diagnostic testing.

B The patient should be started on PPI daily, not PRN, for at least 4-8 weeks for maximal symptom management. Initial diagnostic testing is unnecessary until medication is ruled ineffective and/or there is minimal improvement in symptoms. Lifestyle modifications including head-of-bed elevation, weight loss, smoking cessation and decreasing alcohol intake are effective in preventing worsening of reflux symptoms.

A 21 year old male comes into the clinic to ear pain for the past 3 days after returning home from a beach trip. He reports swimming in the ocean every day for a week. Upon examination, the right external ear canal appears erythematous with purulent drainage. Moving the auricle on exam causes him pain. The nurse practitioner prescribes the following: A. cefdinir 300mg PO BID x 7 days B. neomycin/polymyxin B/hydrocortisone otic solution 4gtt in right ear TID x 10 days C. amoxicillin 500mg PO TID x 5 days D. amoxicillin/clavulanate 875mg BID x 5 days

B This 21 year old has otitis external which is treated with an antibiotic/steroidal otic solution preferably, unless a co-existing otitis media is present.

A mother brings her 2-year-old to the clinic for a well child check. During the nutritional assessment, the mother states she has the child on a vegetarian diet. As the NP, you know a vegetarian diet places the toddler at risk for all the following nutritional deficiencies EXCEPT: A: Iron B: Folic Acid C: Zinc D: B12

B Vegetarian foods such as, breast milk, dairy, soy, legumes, and other vegetables contain efficient amounts of protein for growth, but they do not contain adequate levels of iron and zinc required for the rapid growth of older infants and toddlers. This places them at risk for deficiencies in iron and zinc. High levels of B12 are found in animal proteins such as eggs, dairy, liver, and meats. Excluding meats as a primary source of B12 places the child at risk for B12 deficiencies (Abzug et al., 2020).

A 10-year-old is in the FNP office for complaints of sore throat and fever without tonsillar exudate or lymphadenopathy. A rapid antigen swab was performed and is negative for Strep pyogenes. The next best action by the FNP is: A. Diagnose with viral pharyngitis and treat symptoms B. Order a throat culture C. Order a Monospot test D. Prescribe Amoxicillin

B Viral pharyngitis is likely however, a throat culture must be sent on any negative rapid strep test. A Monospot test would be ordered if there are symptoms of exudate on tonsils, and cervical adenitis. Amoxicillin would not be ordered until there is a positive bacterial infection confirmed

A 12-year-old male patient presents to your clinic today with mother who reports for the past week he has been expecting muscle weakness, tingling all over his body that is worse in his feet and hand and muscle spasms throughout the day. You obtained a 12-lead ECG in the office which revealed peaked T waves and widening QRS. What electrolyte abnormality would you suspect based on symptoms and ECG findings? a. Hypokalemia b. Hyperkalemia c. Hyponatremia d. Hypercalcemia

B correct answer b. hyperkalemia. Elevated potassium is characterized by muscle weakness, paresthesia, tetany, ascending paralysis, and cardiac arrhythmia including elevated T wave, widening QRS complex, sinus bradycardia, or sinus arrhythmia. Hypokalemia has similar symptoms, but ECG changes include shallow T wave and ST depression. Hyponatremia symptoms include confusion, decreased tendon reflex, headache, and orthostatic hypotension. Hypercalcemia symptoms include lethargy, confusion, nausea, vomiting, palpations, and increased thirst,

A pediatric patient presents to the clinic for blunt head trauma. What is the best test for detecting small hemorrhages? A. EEG B. CT C. MRI D. PET

B CT is faster and superior to MRI for detecting small hemorrhages. MRI is more sensitive in detecting stroke and anoxic brain injury. EEG evaluates for the presence of seizures. PET "positron emission tomography" is usually performed during a seizure to determine the specific locations of elliptic zones.

A child receives her first dose of the Meningococcal vaccine at the age of 11. The next dose of the Meningococcal vaccine should ideally be given at what age? A. 12 B. 14 C. 16 D. 25

C

A new mom brings her 2-month-old to the clinic for his 2-month-old wellness and vaccinations. He was born at 40-weeks-gestation weighing 7 lb 2 oz and did receive his Hepatitis B vaccination at birth. Of the following, which is the best choice of vaccinations recommended for this 2-month-old? A) DTAP, Polio, Hib, Rotavirus B) DTAP, Polio, Hepatitis B, Rotavirus C) DTAP, Polio, Hib, Hepatitis B, Rotavirus, Pneumococcal 13 D) DTAP, Polio, Hib, Rotavirus, Pneumococcal 13

C : All the answers are correct; however, the CDC recommends healthy 2-month-olds receive DTAP, Polio, HIB, Hepatitis B, Pneumococcal 13, and Rotavirus.

What is the most important test of visual function in children 6 and older and when should it be done? a. The eye exam whenever it is suspected that the child has a problem b. Red reflex test; with the school nurse c. Visual acuity; at every well child check d. A screening test; at the yearly school health fair.

C : Obtaining a visual acuity screening at every well child check allows for problems to be detected early and for early referral if needed. The red reflex test is done by the provider on newborns and infants at every well check visit (Jung, 2020

The USPSTF recommends cardiovascular risk prevention to reduce morbidity and mortality rates. All of the following are non-modifiable risk factors except: A. age B. sex C. lipid disorders D. family history

C According to Papadakis et al., 2020, there are numerous risk factors that increase the risk of coronary disease and stroke. Risk factors are divided into two categories, modifiable and non-modifiable. Non-modifiable risk factors include: age, sex, and family history

Mr. Jones is a 62 year old male with a history of Diabetes Mellitus-type 2 and Hypertension. His eGFR is 62 and albumin/creatinine ratio is 28 which is stage II kidney disease. He states he feels "fine." His physical exam is normal. As the NP, your next step is: A. Order an abdominal ultrasound to evaluate for polycystic kidney disease B. Advise Mr. Jones to follow up with nephrology because his kidneys are severely damaged. C. Educate Mr. Jones that patients often feel asymptomatic in early stages of kidney disease. It is important to treat his hypertension and diabetes to delay or halt further kidney damage. D. Start Mr. Jones on 5mg Amlodipine daily to treat his hypertension because of its kidney protective features.

C According to his eGFR and ACR, Mr. Jones is in Stage II of kidney disease. Many patient exhibit no symptoms at this stage and are generally well. It is important to treat his comorbidities of diabetes and hypertension in order to protect his renal function. An ACE inhibitor or an ARB (like losartan or lisinopril) are typically ordered for kidney protective properties, not a CCB.

A 52 year old female comes to the office for an acute visit. She complains of right upper quadrant pain with nausea, vomiting and diarrhea. She reports the pain began after eating a large meal at a family reunion. She denies that any other family members are sick. She has a history of obesity and hyperlipidemia. Which of the following is her most likely diagnosis? A. Diverticulitis B. Acute Appendicitis C. Acute Cholecystitis D. Food poisoning

C Acute Cholecystitis is often precipitated by a large, fatty meal. Diverticulitis is most often felt in the left lower quadrant. While acute appendicitis may be felt in the right upper quadrant in some incidences and include nausea and vomiting, the precipitating meal is the key to this question. Food poisoning is unlikely since no other family members are sick.

The NP should order a fasting lipid profile on which child to screen for familial hyperlipidemia? A: A 15-year-old female with obese parents B: A 3-year-old female with no additional risk factors C: A 9-year-old male with no additional risk factors D: A 14-year-old male with a family history of diabetes

C Children should be routinely screened for familial hyperlipidemia between the ages of 9-11 according to current guidelines. Screening can be completed with a fasting or non-fasting lipid profile. Screening can be considered in those less than 9 years old if they have additional risk factors for developing familial hyperlipidemia such as obesity, diabetes, or a family history of preterm cardiovascular disease. Screening is not recommended after puberty due to hormonal changes which can cause lipid profiles to be unreliable in predicting adult lipids levels (Azbug et al., 2020).

An infant who is thriving presents to the clinic with diarrhea. A stool sample has tested negative for blood, white blood cells, fat, parasites, and bacterial pathogens. What is the most likely cause of the diarrhea? A. Allergic Diarrhea B. Antibiotic Therapy C. Chronic Nonspecific Diarrhea (Also called toddler's Diarrhea) D. Extraintestinal Infections

C Chronic Nonspecific Diarrhea, Rationale- Diet change can make it better or worse just depends, but most of the time this syndrome spontaneously resolves itself but around the age of 3.5 years old.

A mother calls the pediatricians office frantic because her child has his first fever. While trying to calm the mother, you as the on call FNP, ask her questions to gather pertinent information. She states her child is 2 years old, attends daycare daily, developed purplish spots all over his body, and has been "running hot" for about a day. You calmly explain to the mother you would recommend the child be seen in the office immediately. What information provided from the mother prompted this response? A. 2 years of age B. Attends daycare daily C. Purplish spots all over his body D. "Running hot" for about a day

C Evaluating for pediatric fevers requires accurate information provided from the parent. Questions should be directed towards how long the fever has been running, the highest temperature taken, how the temperature was taken, what medication has been given, chronic conditions, sick contact exposures, and any associated symptoms. Table 9-5 in Hay Jr. et al (2020) provides guidelines for evaluating children with fevers, listing purple spots or dots present on the skin as a criterion to be seen immediately.

Gracie is a 3 year old that presents to clinic with her adoptive parents with complaints of a 2 week history of vomiting and diarrhea. No one in the house has been sick and the child does not attend daycare. The only travel has been 3 months ago when the family travelled to China to adopt Gracie. Physical exam reveals a temp of 99.9, right upper quadrant tenderness to palpation, and pale yellow sclera. Which of the following questions would be most appropriate to ask the parents? A. Has Gracie received her flu vaccine this year? B. Has anyone in your family ever been diagnosed with cholecyctitis? C. Has Gracie received three doses of Hepatits B vaccine? D. Has Gracie had an appendectomy?

C Gracie is adopted, which makes her adoptive parent's history noncontributory. She does not attend daycare and has no sick contact in addition to a 2 week history of nausea and vomiting- this makes influenza less likely the cause of her complaints. The appendix is located in the right lower quadrant and Gracie's tenderness is right upper quadrant. The fact that Gracie is newly adopted and Asian descent, along with physical exam findings make HBV a likely diagnosis.

Hepatitis causes symptoms of fatigue, abdominal pain, vomiting, nausea, dark urine and jaundice. Which hepatitis virus is not associated with contaminated blood or blood products, contaminated medical equipment or contaminated injections? a. Hepatitis B b. Hepatitis C c. Hepatitis A d. Hepatitis D

C Hepatitis A source of outbreaks is commonly seen with contaminated water and/or food. Hepatitis A is transmitted through the fecal-oral route.

An epidemic outbreak of gastrointestinal upset is traced back to food from a local food truck. Which virus infection is most likely contributed to the cause of transmission: A. Hepatitis C infected pregnant mother B. Autoimmune Hepatitis child presenting with ALF C. Hepatitis A positive worker D. Hepatitis C positive dishwasher

C Hepatitis A virus causes epidemic outbreak due to contaminated water or food supplies due to food handlers with HAV. This virus causes gastrointestinal upset (vomiting, diarrhea, and anorexia). HAV viral particles are found in stool during the acute phase of Hepatitis A infection.

New mom brings 2-week infant into the clinic for a newborn checkup. Mom has concerns about a possible eye infection. Mom is reporting symptoms started at 4 days old with redness, discharge, and slight swelling of the upper right eyelid. Mom states she declined eye ointment after birth because he was not sick. What is the most common cause of Neonatal conjunctivitis? A. Neisseria gonorrhea B. Herpes simplex C. Chlamydia D. Group B streptococcal

C In well-developed countries, Chlamydia is the most common cause of neonatal conjunctivitis. Treatment with prophylaxis erythromycin eye ointment is used as a routine medication immediately after birth to prevent ophthalmic neonatorum

A 56-year-old female visits her family practice clinic for follow up after being recently diagnosed with Gastroesophageal Reflux Disease (GERD). All are appropriate statements made by the Family Nurse Practitioner except: A) "Tums offer quick relief for heartburn symptoms" B) "Weight loss can reduce symptoms greatly" C) "Carbonated sodas should not worsen your heartburn" D) "Omeprazole may be given if symptoms are severe"

C Lifestyle recommendations for patients with GERD include weight loss and avoidance of foods and beverages that have high acidic contents. Consuming excess beverages, such as carbonated sodas, that have a high acidic content can exacerbate GERD symptoms (McQuaid, 2020, P. 625). Antacids, such as Tums, offer quick relief for heartburn symptoms. Proton Pump Inhibitors, such as Omeprazole, may be considered if symptoms are troublesome or if complications are present

A 65 year old woman with a history of diabetes mellitus comes into your office for a sore throat the past 4 days after completing a course of antibiotics for a UTI last week. When examining the patient you note erythema of the oropharynx with cream colored white patches. You identify this disease process as: A. Reactive keratosis B. Plaque-type lichen planus C. Oral candidiasis D. Acute pharyngitis

C Oral candidiasis is diagnosed by clinical findings which include: painful mouth/throat, creamy white patches over erythematous oral mucosa, and typically an immunocompromised host. This patient has diabetes and just completed a course of antibiotic therapy, which makes her susceptible to oral candidiasis.

Hepatitis B cannot be spread by: A. Blood B. Semen C. Kissing D. Sharing contaminated needles

C Percutaneous, nonintact skin exposure, or mucosal to infectious semen, blood, and additional body fluids. The highest concentration of HBV is in the blood, and percutaneous exposure is an effective mode to spread HPV. HBV is transmitted primarily through: Sexual contact thru HPV + person, Birth from HPV + mother, Sharing HPV infected needles. Less commonly spread by: Dialysis, Needle-sticks or additional sharp instrument accidents, Organ transplantation, sharing items (razors, toothbrushes, or contact with open sores of HPV + person.

A 2-year-old patient presents to your clinic with recurrent UTIs. What is the most appropriate test for the NP to order? a. CT b. Xray c. Renal ultrasound d. CBC

C Renal ultrasound is the safest and most useful tool to evaluate for abnormalities of the kidneys or urinary tracts. Congenital urologic defects can increase the risk of recurrent UTIs in children.

A one-time seizure in a 14-month-old child that lasted about 1 minute while the child had a fever of 103.2F is most consistent with which diagnosis? A) Status Epilepticus; B) Narcolepsy; C) Febrile Seizure; D) Restless Leg Syndrome

C Status Epilepticus is incorrect because these seizures usually last at least 15 minutes. Narcolepsy is incorrect because this is a sleep disorder in which a person sleeps at inappropriate times during the day with no control. Restless Leg Syndrome is incorrect as this refers to the feeling of having to move the legs at night during sleep or rest. Febrile seizure is the correct answer. These fevers usually happen due to a fever and are most common in early childhood.

NP offers fluoride varnish during a 2-year-old wellness check to prevent dental caries. You educate parents about fluoride and paint the fluoride onto the toddler's teeth. You inform parents to allow the best absorption of the fluoride into enamel by doing what? A. Wipe with gauze after 15 minutes B. Floss teeth before bedtime C. Do not brush or floss until next morning D. Avoid soft foods

C The application of fluoride during well-child visits is an effective way of reducing dental caries among the vulnerable patient population. Fluoride varnish should be applied once the teeth have been wiped with gauze. It's applied with a small brush and parents are reminded to give soft foods, no brushing or flossing until the following morning to allow the best absorption of the fluoride.

A 29-year-old female comes into your clinic with complaints of an itchy, red, watery left eye that began two days ago. Upon completing her physical exam, you notice she has an enlarged preauricular lymph node on the left side. What is the best presumptive diagnosis for this patient? a. Bacterial conjunctivitis b. Atopic keratoconjunctivitis c. Viral conjunctivitis d. Allergic conjunctivitis

C The most common symptoms associated with viral conjunctivitis include red eyes with clear watery discharge and preauricular adenopathy. Enlarged preauricular lymph nodes are not seen with bacterial conjunctivitis. Bacterial conjunctivitis is usually associated with yellow-green purulent discharge with matted eyelids. Atopic keratoconjunctivitis is associated with large bumps that form underneath the eyelid, known as papillary conjunctivitis. Allergic conjunctivitis is associated with inflammation and stringy eye discharge.

A 5-month-old presents with mom to the FNP's office for wellness exam with no previous medications prescribed. Upon exam, the FNP notes bilateral reddened TM's that are bulging without otorrhea. What is the best treatment option? A. Watchful waiting for 48 hours B. Ciprodex drops 4 gtts BID x 7 days C. Amoxicillin po BID x 10 days D. Augmentin po BID x 10 days

C Watchful waiting is not recommended for children less than 6 months of age. Ciprodex drops are recommended with otitis externa or if the TM is perforated. Augmentin is the second line treatment if there has been Amoxicillin therapy within 1 month or antibiotic failure with Amoxicillin

A one week old infant is brought to the clinic for a check-up following hospital discharge. Upon reviewing the hospital discharge records you note that the mother was HBsAg-positive. What treatment do you expect to find in the infant's chart to prevent perinatal transmission of hepatitis B? A. Hepatitis B vaccine given within 24 hours after birth. B. Hepatitis B immunoglobulin within 24 hours after birth. C. Both hepatitis B immunoglobulin and hepatitis B vaccine within 24 hours after birth. D. Hepatitis B vaccine and hepatitis B immunoglobin given to the mother prior to delivery.

C nfants born to HBsAg-positive mothers are 70-90% more likely to develop hepatitis B if postexposure prophylaxis is not given within 24 hours after birth. Prophylaxis includes hepatitis B vaccine AND hepatitis B immunoglobulin. Prophylaxis reduces the infant's chance of getting hepatitis B by 85-95%. Hepatitis B immunoglobulin can be given up to 7 days postpartum if the infant has been given the hepatitis B vaccine. All infants will receive the hepatitis B vaccine series as part of universal screening regardless of the mother's hepatitis B status

Mr. Brown is a 68 year old male with a history of uncontrolled hypertension and history of an MI. After ordering fasting labs, the nurse practitioner notices his eGFR of 28 and ACR of 282. The nurse practitioner knows this is Stage IV kidney disease. Which of the following are appropriate dietary recommendations are appropriate for Mr. Jones: Select all that apply: A. A large amount of protein in the diet (1-2 gm/kg/day ) is required to prevent further kidney damage. B. Potassium will need to be limited once the GFR has fallen below 10-20 C. A goal of 2g of sodium per day is reasonable for most patients with CKD. D. Processed foods have high amounts of phosphorus and should be avoided in patients with CKD

C, B ,D High protein diets can lead to higher glomerular pressure and hyperfiltration. This can further damage the kidney. Patients with CKD typically need to LIMIT their protein intake to 0.6-0.8g per day. As the eGFR decreases, electrolytes can begin to become off kilter, which typically results in hyperkalemia, hyperphosphatemia and dysnatremia. It is important for patients with CKD to limit potassium intake as eGFR decreases. It is easy to become either hyper- or hypo-natremic because of compromised renal water regulation, so it is important for the patient to stay around 2 grams of sodium intake per day. Processed foods contain a very high amount of sodium and phosphate. These should be avoided in the patient with CKD.

Your clinic recently received the new seasonal doses of the influenza vaccine. Which of the following pediatric patients should not be vaccinated for influenza at this time? A) 8-month-old with a temperature of 37.8° C and a mild cough for the last two days B) 7-month-old who is receiving long-term aspirin therapy C) 12-month-old who is HIV positive D) 5-month-old with polydactyly

D : Families with children at increased risk for lower respiratory tract infection or other secondary complications from influenza infection should be encouraged to vaccinate themselves and their children as soon as the seasonal vaccine is available. Annual flu vaccination is recommended for all patients over the age of 6 months. Patients with a history of anaphylaxis to prior flu vaccines should not be vaccinated. Patients with serious allergy to eggs should not receive the flu vaccine unless referred to do so by an allergist.

A mother brings her 7-year-old son into the clinic for their well child visit. The mother asks the NP how much fluid her son should be taking in daily. Her son weighs 30kg at today's visit. How much fluid should this patient be taking in daily? a. 1000 mL b. 1200 mL c. 1500 mL d. 1700 mL

D A child weighing 30kg would require 1700 mL/day. To calculate the daily fluid intake of a child based on their weight, the NP would use the following formula: - For a body weight of 3-10kg, use 100 mL/kg. - For a body weight of 11-20kg, use 1000 mL/kg + 50mL/kg for each kg >10kg. - For a body weight > 20kg, use 1500 mL/kg + 20mL/kg for each kg > 20kg.

27-year-old male presents for same day sick appointment. Pt complains of deep epigastric pain that radiates to the back. Pt admits to binge drinking about 10 beers, 3 times a week, for the last few years. Physical assessment revels absent bowel sounds, fever, tachycardia, pallor, abdominal tenderness without guarding, rigidity or rebound tenderness. As a nurse practitioner what are your next actions? A. Order urinary analysis B. Order TSH and CT of the abdomen C. Refer patient to Gastroenterology D. Refer for hospitalization

D Acute Pancreatitis symptoms include abrupt onset of deep epigastric pain, often radiates to the back. Associated symptoms: weakness, nausea, sweating, vomiting. Physical exam: abdominal tenderness, fever, distention. It is crucial to quantify alcohol use. Pancreatitis is often connected with binge drinking. Amylase/ lipase are elevated in pancreatitis. Papadakis and McPhee 2020: 16-26: Acute Pancreatitis: Most acute pancreatitis will be hospitalized. Treatment of Acute Disease: The pancreas is "rested" by ensuring patient is on bed rest, has nothing by mouth. Patients with vomiting or moderately severe pain and abdominal distention, need nasogastric suctioning. Early IV fluid resuscitation is key and may reduce organ failure and incidence of systemic inflammatory response syndrome.

An 11-year-old male was just diagnosed with allergic rhinitis. Which of the following is the most effective and 1st line treatment? a. Nasal saline irrigations b. Cetirizine 10 mg once daily c. Montelukast 10 mg once daily d. Beclomethasone 42 mcg nasal spray twice daily

D All are appropriate treatments for allergic rhinitis symptoms. However, the best answer is beclomethasone nasal spray. Intranasal corticosteroid sprays are the mainstay of treatment for this condition and are often much more effective and less costly than antihistamines. You should educate the patient that there may be a delay in relief of up to 2 weeks. Nevertheless, they improve the nasal airway and may help to prevent acute bacterial and chronic rhinosinusitis

What 2 findings on exam are critical in diagnosing a patient with acute otitis media? A) Acute onset of pain and ear canal edema B) Amber-colored inner ear fluid and thickened TM C) Red TM and fever D) Bulging TM and middle ear effusion

D Answer A are findings in External Otitis Media, Answer B are findings in Otitis Media Externa, and Answer C are findings in Acute Viral Rhinitis

A mother presents to your clinic with her 3-month-old daughter. She reports her daughter started daycare 11 days ago and reports the school shut down for an outbreak of Hepatitis A that involved six of her daughter's classmates. The mother is concerned and does not understand how this could happen. The mother voices, "I can't believe it! An STD? I need my daughter examined immediately." What is your next step as the provider? A. Educate the mother that Hepatitis A is transmitted from a fecal-oral route and most likely results from the daycare workers not performing adequate hand hygiene after changing the infant's diapers. B. Tell the mother she has every right to be upset, and you can call the department of children and family services to report the incident. C. Tell the mother that it is advised the patient receive a dose of immune globulin IM to protect and provide passive-active immunity against Hepatitis A. D. Both A & C

D D. Educate your patient's mother that Hepatitis A transmission is via fecal-oral routes such as contaminated food, water, unwashed fruits/vegetables, and inadequate hand hygiene after changing diapers or before food preparation-and not by sexual transmission. Inform the patient's mother that passiveactive immunity is encouraged via administration of immune globulin to the patient who is less than 6- months old in post-exposure prophylaxis if more significant than a single case reported.

When should a child establish dental care? A. 1 week after first tooth erupts B. 24 months old C. 1 month after first tooth erupts D. 12 months old

D Establishment of a dental home for a child by 12 months of age is an essential foundation for the prevention of dental disease such as early childhood carries.

A three-month-old female presents to the clinic for a generalized seizure lasting 5 minutes. The seizures never last more than 15 minutes. An accompanying symptom includes a temperature greater than or equal to 39 degrees Celsius. This type of seizure peaks between age six to eighteen months. Risk factors include day care, family history, prolonged neonatal hospital stay, and developmental delay. What type of seizure is this patient having? A. Epileptic spasms B. Myoclonic seizures C. Tonic-clonic seizures D. Febrile convulsions

D Febrile convulsions typically begin between three to six months of age and peak between six and eighteen months. They are second most common type of childhood seizures and they typically last less than fifteen minutes. They may lead to status epilepticus.

What medication is used for Parkinson's Disease that is converted to dopamine which improves the major characteristics of the disease but does not stop the progression of the disease? a. Amantadine (Gocovri) b. Pramipexole (Mirapex) c. Rasagiline (Azilect) d. Levodopa (Sinemet)

D Levodopa. It is converted in the body to dopamine which improves the major symptoms of Parkinson's Disease including bradykinesia but does not decrease the progression of the disease.

Maria is a 16 year old Hispanic-American that presents to clinic with complaints of 4 days nausea and vomiting that usually occurs post prandial. She has recently started working at Kentucky Fried Chicken after school. Her BMI is 28, and her urine hCG is negative. Physical exam reveals positive Murphy's sign, but is otherwise negative. Which of the following would be ordered first? A. CT scan of the abdomen B. HIDA scan C. Pepcid 20mg BID for 8 weeks D. Abdominal ultrasound

D Most likely diagnosis is cholelithiasis with being overweight, and Hispanic origin, presenting symptoms and physical exam. Abdominal US is the best for assessing gallbladder and is less expensive and invasive than the HIDA scan. Pepcid would be more appropriate for GERD.

A 27-year-old male presents to your clinic with nausea and vomiting. On exam the Family Nurse Practitioner notes rebound tenderness at McBurney's Point. These signs and symptoms are suggestive of: A) Diverticulitis B) Cholecystitis C) Hepatitis D) Appendicitis

D Nausea, vomiting, and tenderness at McBurney's Point are highly suggestive of Appendicitis. Diverticulitis, Cholecystitis, and Hepatitis may present with nausea and vomiting, however, there is no rebound tenderness at McBurney's point with any of these conditions

A 76-year-old male presents to the clinic with complaints of rapid onset of severe pain to his right eye and visual loss. During the assessment it is noted that the right eye is red, the pupil is dilated, and the cornea is cloudy. He states that he sees "halos around lights". What diagnosis is suspected given the assessment findings? A. Age-Related Macular Degeneration B. Cataracts C. Retinal Detachment D. Acute Angle-Closure Glaucoma

D Older adults are the age group typically affected by Acute Angle-Closure Glaucoma. Patients present with rapid onset of severe pain and visual loss. Often reports of "halos around lights" is stated. The eye will be red, have a cloudy cornea, and dilated pupil. The eye will also be hard on palpation. Cataracts produce gradual and progressive blurred vision with lens opacities but do not cause pain or redness to the eye. Retinal detachment causes loss of vision in one eye that is rapid with complaints of a "curtain" spreading across the eye but there is not pain or redness present. Age-related macular degeneration usually presents in the older population and can cause deterioration of central vision along with distortion of images. No pain or redness present to the eye in cases of age-related macular degeneration

A 40-year-old male presents to the clinic with generalized upper abdominal pain. With obtaining a thorough history the NP finds out that he is a moderate-severe alcohol drinker. The NP obtains lab work that is run stat with results of elevated amylase, lipase, and leukocytes. What would be the NP's next step? a. Presume acute pancreatitis, send the patient home with Percocet 5/325mg every 4-6 hours as needed for pain and education to stop drinking. b. Presume acute cholecystitis, order an outpatient ultrasound for diagnosis. c. Presume Diabetes Mellitus, increase basal insulin dose. d. Presume acute pancreatitis, send to the Emergency Room.

D Pancreatitis is commonly seen with heavy alcohol intake <55 years old. Symptoms of upper abdominal pain is present with pain radiating to back, decreased with sitting and leaning forward. Lab findings are elevated amylase, lipase, and leukocytes as well as elevated glucose and bilirubin. The patient should be treated with fluid resuscitation, no food or liquids by mouth and IV/IM pain control

Dental carriers happen from repeated exposure to fermentable carbohydrates and poor feeding habits. You educated parents on the prevention of dental caries by eliminating soda, 100% juice, and powdered beverages. At what age should you transition from a bottle to an uncovered cup? A.6-9 months B. 11 months C. 24-26 months D. 12-18 months

D Poor feeding habits increase the risk of dental caries. Prevention of dental caries should include giving water in bottles at bedtime for nursing infants. Infants should be weaned from the bottle between 12-18 months to an uncovered cup. Training cups such as no-spill cups should be avoided. Avoid placing soda, 100% juice, and powdered beverages in open cups.

A mother brings in her one week old for his newborn exam. She states he received a vaccine in the hospital at birth but cannot recall which one he received. Which of the following vaccines is given at birth? A. PCV13 B. Hepatitis A C. Hib D. Hepatitis B

D Reported cases of hepatitis B have declined dramatically in the United States due to vaccination. One of the central elements of this decline is vaccination at birth, within 12 hours. Routine immunization with three dose of HepB is recommended in infants and those unvaccinated children between the ages of 0-18.

You are seeing a 6-year-old male who was brought in by his mother. The mother reports they recently took a family vacation last week and stayed in a few different hotels. He developed significant itching and a rash the day of returning home. He is noted to continuously scratch during the visit. The father and older sister also have a similar rash that developed at the same time. On exam, you note linear burrows around his wrists, ankles, in the webbing of his fingers, and axillary folds with excoriations present. There is no facial involvement. He has never had anything like this before. The most likely diagnosis would be: A. Atopic Dermatitis B. Impetigo C. Molluscum Contagiosum D. ScabiesD

D Scabies classically presents with linear burrows at the wrists, ankles, webbing of fingers, areola, axillary folds, and genital area and typically does not involve the face except in infants (Hay et al., 2020). Excoriations are also a common finding with this (Hay et al., 2020). The history of recently travel and other family members with similar presentation also supports scabies as the leading choice. All other choices are commonly occurring rashes in pediatrics but have different presentations.

A mother asks what she can give her 4-month-old baby for teething discomfort. The baby weighs 6 kg. Which of the following would be the most appropriate response by the NP? A. Any of the over-the-counter teething gels or tablets would help. B. You may give ibuprofen 60 mg (5-10 mg/kg/dose) by mouth every 6-8 hours as needed for pain. C. The baby should not be cutting teeth until he is at least 7 months old. I need to refer him to a pediatric dentist. D. Give acetaminophen 90mg (10-15 mg/kg/dose) by mouth every 4-6 hours as needed for pain.

D Systemic analgesics are safer than using teething gels that may or may not contain benzocaine. Ibuprofen is not indicated for infants under 6 months of age. It is normal for infants to begin erupting teeth as early as 3 months of age (Hay et al., 2020, pp. 463-464).

A father brings his 18-month-old daughter to the clinic for a check-up. He asks the NP "Shouldn't she have more than 6 teeth by now?" The nurse practitioner's best response would be: A. Yes, she should have her complete set of primary teeth at this age. Does she have a dentist? B. This is normal, but please let me know if she has not cut all of her teeth by 24 months of age. C. Some children do not cut their full set of primary teeth until age 4 D. Some children may cut teeth as late as 16 months old. She is developing normally and should have all 20 teeth by her 3rd birthday.

D Teeth eruption can begin as early as 3 months or as late as 16 months of age. Children should have their full set of primary teeth (20 teeth) by 36 months of age

: As the nurse practitioner you just diagnosed an 8 year old girl with acute pharyngitis. You would expect to find the following upon physical examination: A. Cheilitis, aphthous ulcers, trismus B. Uvula deviation, cervical lymphadenopathy C. Unilateral tonsillar swelling, severe sore throat D. Cervical lymphadenopathy, sore throat, tonsillar exudates

D The hallmark findings of acute bacterial pharyngitis are sore throat, tonsillar exudates, cervical lymphadenopathy, and fever >38.3°C. A diagnostic tool would be a positive group A beta hemolytic streptococcus culture. The CENTOR criteria is also helpful when diagnosing acute bacterial pharyngitis.

You see a 4-year-old female in the sick clinic with bilateral, watery, red eyes. Her temperature is 98.4 and she appears well. Her mother tells you that she had a sore throat and congestion this week but is better now. After assessing the child, you find a small peri auricular lymph node around her left ear. Her tympanic membranes are pearly gray with a cone of light. The rest of your exam is normal. You, as the advanced practice nurse, tell the mother: A. She has bacterial conjunctivitis. I will send the pharmacy a prescription for erythromycin eye drops. B. This is probably a viral conjunctivitis, which is usually self-limiting. She may go back to preschool tomorrow. C. I am concerned that this conjunctivitis will progress into peri-orbital edema and she may lose her eyesight. I will refer her to an ophthalmologist immediately. D. This is probably a viral conjunctivitis, which is usually self-limiting. We will wait for three days and see if it clears on it's own before start treatment.

D Viral conjunctivitis can present in one or both eyes. This child does not have a fever and does not appear to be ill. She does have a history of what seem to be a virus and does not have bulging eardrums or pain. Viral conjunctivitis is self-limiting and it is recommended to watch for three days before implementing treatments such as an antibiotic. It is highly contagious, so she should not return to school until her symptoms have resolved. In the mean time, she and her contacts should practice good hand hygiene and contract precautions. Immediate referral is warranted if this progresses to peri-orbital edema.