NR602-Final Questions
Approximately what percentage of women experience severe recurring symptoms associated with their menstrual cycle?
10%
Routine HPV vaccination is recommended for girls of what age?
11-12
Vulvovaginal candidiasis (yeast) accounts for what percentage of all vaginal infections?
20-25%
An initial or primary genital herpes infection characteristically lasts about:
3 weeks
How many different fiber sections subdivide the levator ani muscular sheet?
4
What is the approximate number of follicles at the initiation of puberty?
400,000
Which complaint made by a client at 35 weeks gestation requires additional assessment?
Abdominal pain
Breast masses are presumed malignant, until proven otherwise, among women:
Aged 55 years and older
The most common sites of metastatic spread of invasive breast cancer include all of the following:
Bones Lungs Lymph nodes
An adolescent is diagnosed with major depression, and the mental health specialist has prescribed SSRI fluoxetine (Prozac). What other treatment is important to protect against suicide risk?
Cognitive behavioral therapy.
What causes the epithelium to thicken, differentiate, and accumulate glycogen?
Estrogen
The client who is being treated for endometritis (inflammation of the endometrium / lining of the uterus) is placed in the Fowler position because it:
Facilitates drainage of lochia.
The parent of a school aged child reports that the child doesn't like being alone in rooms because of a fear of aliens hiding in his closest. What will the NP tell the parent?
Fear of imaginary creatures does not usually occur at this age.
Products from which of the following herbs have been associated with alterations in estrogen levels, resulting in AUB?
Gingko
A multiparous client is admitted to the postpartum unit after a rapid labor and birth of a 4000-g (8lbs 13oz) infant. Her fundus is boggy, lochia is heavy, and vital signs are unchanged. The nurse has the client void, and massages her fundus, but the fundus remains difficult to find and the rubra lochia remains heavy. Which action should the nurse take next?
Notify the provider
In preparing a pregnant client for a nonstress test (NST), which of the following should be included in the plan of care?
Position the client in comfort, adjusting the tocotransducer belt to locate fetal heart rate.
What initiates contractions of the uterine muscle leading to menstruation?
Prostaglandins
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?
Refer the adolescent immediately to a pediatric urologist or surgeon.
Which advice to the client is one of the most effective methods for preventing venous statis?
Rest often with the feet elevated.
Which laboratory result would be a cause for concern if exhibited by a client at her first prenatal visit during the second month of her pregnancy?
Rubella titer 1:6
Research suggests a link between PMS and:
Seasonal affective disorder
Why should a woman in her third trimester of pregnancy expect to visit her health care provider every 4 weeks?
The conditions of the expectant mother and fetus can be monitored.
How does vaginosis differ from vaginitis?
The discharge does not contain white blood cells
What is the definition of primary amenorrhea?
The failure to begin menses by age 14 in the absence of puberty, or by 16, regardless of the development of secondary sexual characteristics
What is the best definition of abnormal uterine bleeding (AUB)?
Uterine bleeding that is irregular in amount of frequency.
What is the term for the inflammation of the vagina characterized by an increased vaginal discharge containing numerous white blood cells?
Vaginitis
Who should be screened regularly for STIs?
Women who are sexually active.
Which arteries supply blood to the clitoris?
dorsal and clitoral cavernosal arteries
A woman's lifetime risk of being diagnosed with breast cancer is:
1 in 8
About how many openings are in the nipple?
15-20
The least variation in menses occurs during the ages of:
20-40 years old.
Of the more than 100 known serotypes of HPV, approximately how many can infect the genital tract?
40
The prevalence of chlamydia is how many times higher in black women than in white women?
5 times higher
The primary care pediatric nurse practitioner is performing a well child examination on a 5yearold girl. The parents ask if the child's adult height can be predicted. The nurse practitioner learns that the mother is 5'8" tall, and the father is 5'11" tall. The nurse practitioner will estimate which expected adult height for this child?
5'7"
Approximately how many Americans will contract one or more sexually transmitted infections during their lifetime?
50%
Approximately what percentage of women with bacterial vaginosis are asymptomatic?
50%
What percentage of Toxic Shock Syndrome cases are related to menses?
50%
The primary reason for evaluating alpha-fetoprotein (AFP) levels in maternal serum, is to determine whether the fetus has:
A neural tube defect.
The sheet made up of dense fibrous tissue that spans the opening of the anterior pelvic outlet is/are the:
A sphincter muscles.
The nurse recognizes that infection may be present in her postpartum client when the client exhibits:
A temperature of 100.4 on the second postpartum day and 100.8 on the fourth.
The parent of a child diagnosed with ADHD tells the PNP that the child gets overwhelmed by homework assignments, doesn't seem to know which ones to do first, and then doesn't do any assignments. The NP tells the parent that this represents impairment in which executive function?
Activation
Following a difficult vaginal birth of a singleton pregnancy, the client starts bleeding heavily. Clots are expressed, and a foley catheter is inserted to empty the bladder, because the uterine fundus is soft, and displaced laterally from midline. Vital signs are 99.8 F, pulse 90 beats/min, respirations 20 breaths/min, and BP 130/90 mm Hg. Which pharmacologic intervention is indicated?
Administration of prostaglandin analogue to reduce r/o hemorrhaging
How is secondary dysmenorrhea defined?
An underlying pathology causing pain symptoms during menstrual flow.
A 14-year-old 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 her daughter often throws up and refuses to eat most foods. Which condition does the NP suspect?
Anorexia nervosa.
A 10-year-old child has had abdominal pain for 2 days, which began in the periumbilical area and then localized to the right lower quadrant. The child vomited once today and then experienced relief from pain followed by an increased fever. What is the likely diagnosis?
Appendicitis with perforation
A newly divorced mother of a toddler reports that the child began having difficulty sleeping and nightmares along with exhibiting angry outburst and tantrums 2 months prior. The NP learns that the child refused to play with usual playmates and often spends time sitting quietly. What will the NP do initially?
Ask the mother about the child's relationship with the father.
The parent of a 4-year-old child reports the child seems to be having trouble adjusting to a new day care and reportedly is always engaging in solitary play. What will the nurse practitioner do?
Ask the parent if the child is slow to warm up to other new situations.
PNP is performing an exam on a 5 year old who exhibits ritualistic behaviors, avoids contact with other children, and has limited speech. Parents report having concerns > 2 years ago about Autism, but were told it was too early to diagnose. What will the NP do first?
Ask the parents to describe the child's behaviors from infancy through preschool
A 9 year old child exhibits school refusal and a reluctance to attend sleepovers with classmates. The parent is concerned because the child has recently begun sleeping in the parents' bed. Which initial action by the NP is appropriate?
Asses for environmental stress, parental dysfunction, and maternal depression (these are risk factors for separation anxiety)
Which nursing measure would be appropriate to prevent thrombophlebitis in the recovery period following a cesarean birth?
Assist the client in performing leg exercises every 2 hours.
Patients presenting for STI treatment should be screened for HIV:
At each visit
The PNP is examining a 3 year old who speaks loudly, in a monotone voice, does not make eye contact, and prefers to sit on the exam room floor moving a toy truck back and forth in a repetitive manner. Which disorder does the NP expect?
Autism spectrum disorder
Women who have had TSS should be instructed to not use tampons or?
Barrier contraception methods
Why shouldn't symptoms such as bloating, and breast tenderness be considered disordered premenstrual symptoms?
Because these symptoms affect the majority of women
The parent of a 3-month-old reports that the infant arches and gags while feeding and spits up undigested formula frequently. The infant's weight gain has dropped to the 5th percentile from the 12 th percentile. What is the best course of treatment for this infant?
Begin a trial of extensively hydrolyzed protein formula for 2-4 weeks.
The primary care pediatric nurse practitioner diagnoses an 8-year-old child with type 1 diabetes after a routine urine screen is positive for glucose and negative for ketones and plasma glucose is 350 mg/dL. The child's weight is normal and the parents report a mild increase in thirst and urine output in the past few days. Which course of action is correct?
Begin insulin and refer the child to a children's diabetes center.
A genetic counsellor has a significant role in the care of women because BRCA1 and BRCA2 genetic mutations amount for 5-10% of all :
Breast cancer cases
To determine an adverse response to carboprost tromethamine (Hemabate) {used to treat postpartum uterine hemorrhage}, the nurse should frequently assess:
Breath sounds.
A school age 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?
CBC ESR Amylase Lipase UA Abdominal ultrasound
Which dietary supplement has been shown to help treat PMS?
Calcium
Which organism causes 90% of vulvovaginal candidiasis (yeast infection) episodes in women?
Candida albicans
What is the major source of normal vaginal secretions?
Cervical mucosa
What is one of the most frequent reasons women visit their clinician?
Changes in menstruation
The only botanical treatment with Level I evidence to support its use in PMS is:
Chaste tree berry.
The parent of a school age girl reports that the child has difficulty getting ready for school, and is often late, because of a need to check and recheck whether her teeth are clean, and that her room light has been turned off. What will the NP recommend to this parent?
Cognitive behavioral therapy.
Following a vaginal birth, a client has lost a significant amount of blood and is starting to experience signs of hypovolemic shock. Which clinical signs would be consistent with this clinical diagnosis?
Compensatory response of tachycardia and decreased pulse pressure.
In women of reproductive age, the most common cause of a bleeding pattern that is suddenly different is a:
Complication of a pregnancy.
The primary care pediatric nurse practitioner is performing a well child examination on a 12yearold child who was diagnosed with type 1 diabetes at age 9. The child had a lipid screen at age 10 with an LDL cholesterol < 100 mg/dL. What will the nurse practitioner recommend as part of ongoing management for this child?
Comprehensive ophthalmologic exam.
The primary care pediatric nurse practitioner is evaluating a child who has short stature. Although bone age studies reveal a delay in bone age, the child's growth is consistent with bone age. Which diagnosis is most likely?
Constitutional growth delay.
An initial key part of management for a child suspected of having an inborn error of metabolism is -
Consulting a metabolic specialist.
The results of a contraction stress test (CST) are positive. Which intervention is necessary based on the test results?
Contact the health care provider to discuss birth options for the client.
PNP is conducting a f/u exam on a child who recently began taking low-dose stimulant medication to treat ADHD. School performance and home behavior have improved, but parents report noticing a few "tics" (i.e. twitching of eyelids). The child, however, appears unaware these "tics" & is not bothered by them. What will the NP recommend?
Continue the medication as prescribed
A child who has nephrotic syndrome is on a steroid and a salt restricted diet for a relapse of symptoms. A dipstick urinalysis shows 1+ protein, down from 3+ at the beginning of the episode. In consultation with the child's nephrologist, what is the correct course of treatment considering this finding?
Continue with steroids and salt restrictions until the urine is negative for protein.
The primary care pediatric nurse practitioner is reviewing lab work and diabetes management with a school-age child whose HbA1C is 7.6% who reports usual blood sugars before meals as being 80 to 90 mg/dL. The nurse practitioner will consult with the child's endocrinologist to consider which therapy?
Continuous glucose monitoring.
The parents of a 4-year-old boy are concerned because he has begun twisting and pulling out his hair, especially when he is tired or stressed. What will the NP recommend as part of an initial approach to treat this behavior?
Cutting his hair so that it is too short to pull.
An adolescent has recently begun doing poorly in school and has stopped participating in sports and other extracurricular activities. During the history interview, the adolescent reports feeling tired, having difficulty concentrating, and experiencing a loss of appetite for the past few weeks but cannot attribute these changes to any major life event. Which is an important next step in managing this patient?
Determining suicidal ideation and risk of suicide.
If nonsurgical treatment for subinvolution (uterus does not return to its normal size s/p birth) is ineffective, which surgical procedure is appropriate to correct the cause of this condition?
Dilation and curettage (D&C).
To relieve a leg cramp, what should the client be instructed to perform?
Dorsiflexion of the foot.
A 2-month-old infant cries up to 4 hours each day and, according to the parents, is inconsolable during crying episodes with fists and legs noted to be tense and stiff. The infant is breastfeeding frequently but is often fussy during feedings. The physical exam is normal, and the infant is gaining weight normally. What will the primary care pediatric nurse practitioner recommend?
Eliminating certain foods from the mother's diet.
What treatment was introduced in the 1960s as a less invasive alternative to hysterectomy?
Endometrial ablation (minimally-invasive procedure that destroys the endometrial lining of the uterus, to decrease the amount of blood loss during menstruation)
A toddler has begun hitting and biting other children at a day care center and is exhibiting temper tantrums and bad language at home. The parent reports that these behaviors began shortly after a sibling was born. What will the NP do?
Engage the parent in positive parenting strategies to facilitate appropriate child coping.
What is the hallmark sign of bipolar disorder in adolescents?
Episodes of highs and lows with periods of stability
Ovulation is dependent on an increased level of?
Estrogen and the LH surge
A pregnant client has come to the emergency department with complaints of nasal congestion and epistaxis. Which is the correct interpretation of these symptoms by the health care provider?
Estrogen causes increased blood supply to the mucous membranes, and can result in congestion and nosebleeds.
Which of the following is one of the key criteria for a diagnosis of PMS?
Exclusion of other diagnoses that may better explain the symptoms.
PNP cares for a preschool-age child who was exposed to drugs prenatally. The child bites other children and has tantrums when asked to stop, but is able to state later why this behavior is wrong. This child most likely has a disorder r/t what process?
Executive function
A 12 month old infant exhibits poor weight gain after previously normal growth patterns. There is no history of vomiting, diarrhea, or irregular bowel movements, and the physical exam is normal. What is the next step in evaluating these findings?
Feeding hx Stooling history and a 3-day diet history
The most common benign breast masses are:
Fibroadenomas and cysts
What is the most common symptom of bacterial vaginosis?
Fishy odor
A child diagnosed with attention-deficit/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 what self-regulation ability?
Flexibility
The primary care pediatric nurse practitioner performs a physical examination on a 9 month old infant with congenital hypothyroidism who takes daily levothyroxine sodium and notes a recent slowing of the infant's growth rate. What will the nurse practitioner order?
Free serum T4 and TSH levels.
All menstruating women report that which type of symptoms is highest during menses?
Gastrointestinal
The parent of a school age child reports that the child becomes frustrated when unable to perform tasks well and often has temper tantrums and difficulty sleeping. Which disorder may be considered in this child?
Generalized anxiety disorder - GAD.
Exercise-induced amenorrhea is probably due to the combination of low body fat and decreased secretion of:
GnRH
The 2nd most commonly reported STI after Chlamydia is:
Gonorrhea
What is the most important step in preventing vaginal infections?
Good personal hygiene
Mammary duct ectasia is indicated by:
Green, brown, or black colored discharge
While the vital signs of a pregnant client in her third trimester are being assessed, the client complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate?
Have the client turn on her left side and recheck her blood pressure in 5 minutes.
A child is in the clinic after swallowing a metal bead. A radiograph of the GI tract shows a 6 mm cylindrical object in the child's stomach. The child is able to swallow without difficulty and is not experiencing pain. What is the correct course of treatment?
Have the parents watch for the object in the child's stool.
A child has gross hematuria, abdominal pain, and arthralgia as well as a rash. What diagnosis is most likely?
Henoch Schonlein Purpura (HSP)
Cyclic mastalgia (breast pain) is caused by:
Hormonal changes associated with menstruation
During a well child examination on a 4-month-old infant, the primary care pediatric nurse practitioner evaluates mental health issues. Which statement by the parent indicates a potential problem with the parent/infant relationship?
I let my baby cry a while to learn to be patient.
When is a pelvic examination unnecessary for a woman who is experiencing AUG?
If she has recently begun menstruation.
A client in her third trimester is asking about safe travel. Which statement should the nurse give about safe travel during pregnancy?
If you are traveling by car, stop to walk every 1-2 hours.
A newly pregnant patient tells the nurse that she has irregular periods and is unsure of when she got pregnant. Scheduling an ultrasound is a standing prescription for the patients' health care provider. When is the best time for the nurse to schedule the patient's ultrasound?
Immediately.
Women who report experiencing the most severe symptoms of PMS tend to be :
In their late 30s.
An adolescent has right sided 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 (kidney stones). What is the initial treatment for this condition?
Increasing fluid intake up to 2L daily.
The four segments of a fallopian tube are the: -pars interstitialis -isthus -ampulla -
Infundibulum
Which nursing intervention is necessary prior to a second-trimester transabdominal ultrasound?
Instruct the client to drink 1-2 quarts of water.
A child is diagnosed with Crohn's disease. What are likely complications?
Intestinal obstruction with scarring and strictures.
An 18-month-old child has a 1 day 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?
Intussusception
The possibility of cancer is associated with mastalgia when the pain:
Is accompanied by skin changes or palpable abnormalities.
A child has a difficult temperament. What will the primary care pediatric nurse practitioner tell the parent about managing this child's behavior?
It is important for the parent to learn to manage criticism and power struggles.
A client in her third trimester complains of nausea and vomiting. She asks, Why does this happen? What is the nurse's best response?
It may be due to changes in hormones.
What is different about syphilis as compared to other bacterial STIs?
It persists past age 25, into the 30s and 40s
A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests?
Laceration to the genital tract.
A 2-year-old child has an acute diarrheal illness. The child is afebrile and, with oral rehydration measures, has remained well hydrated. The parent asks what can be done to help shorten the course of this illness. What will the primary care pediatric nurse practitioner recommend?
Lactobacillus
The primary care pediatric nurse practitioner is providing nutritional counseling for a 9 year old female whose weight is at the 95th percentile for her age. What is the goal for this patient?
Maintenance of her current weight.
The nurse notes that the fundus of a postpartum patient is boggy, shifted to the left of the midline, and 2cm above the umbilicus. What is the nurse's priority action?
Massage the fundus of the uterus.
Signs of endometrial or cervical cancer may present abnormal uterine bleeding, often as heavy, prolonged bleeding or:
Menometrorrhagia.
What is considered a 1st line treatment for ADHD?
Methylphenidate (Quillivant) - stimulant Behavioral therapy for ages 4-5
An adolescent has 2+ proteinuria in a random dipstick urinalysis. A subsequent first morning voided specimen is negative. What will the primary care pediatric nurse practitioner do to manage this condition?
Monitor for proteinuria at each annual well child examination.
Which breast tissue sampling procedure is best to use when density or calcification is seen on a mammogram in a location that cannot be effectively assessed with a core biopsy?
Needle-localized breast biopsy
To learn more about the emotional health of an 18-month-old which assessment strategy will be used?
Observation of the child with caretakers in structured and unstructured situations.
What is generally the cause of Bartholin's cyst?
Obstruction of a duct in Bartholin's gland
A 3 year old child has just completed a 7day course of amoxicillin for a second febrile urinary tract infection and currently has a negative urine culture. What is the next course of action?
Obtain a renal and bladder ultrasound.
The primary care pediatric nurse practitioner evaluates children's growth to screen for endocrine and metabolic disorders. Which is a critical component of this screening?
Obtain serial measurements to assess patterns overtime.
The client has just learned she is pregnant and overhears the gynecologist saying that she has a positive Chadwick's sign. When the client asks the nurse what this means, how should the nurse respond?
Occurs normally in pregnancy, when estrogen causes increased blood flow in the area of the cervix. Bluish discoloration of cervix, vagina, & vulva and can be seen as early as 6-8 weeks s/p conception
A toddler is seen in the clinic after a 2 day history of intermittent vomiting and diarrhea. An assessment reveals an irritable child with dry mucous membranes, 3 second capillary refill, 2 second recoil of skin, mild tachycardia and tachypnea, and cool hands and feet. The child has had two wet diapers in the past 24 hours. What will the primary care pediatric nurse practitioner recommend?
Oral rehydration solution with follow-up in 24 hours.
A preschool age 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?
Order Augmentin (Amoxicillin / Clavulanate).
A 13 year old Native American female has a BMI at the 90th percentile for age. The primary care pediatric nurse practitioner notes the presence of a hyperpigmented velvetlike rash in skin folds (Acanthosis Nigricans). The child denies polydipsia, polyphagia, and polyuria. The nurse practitioner will -
Order a fasting blood sample for a metabolic screen for type 2 diabetes.
What are the 4 types of AUB?
P: polyps A: adenomyosis (presence of endometrial tissue in uterus) L: leiomyomas (aka uterine fibroids) M: malignancy & hyperplasia
The primary care pediatric nurse practitioner notes a musty odor when examining a newborn at a 2-week checkup. What will the nurse practitioner suspect?
PKU (phenylketonuria)
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?
Pancreatic antibodies
What can bacterial vaginosis lead to?
Pelvic inflammatory disease
If a woman is complaining of bilateral, milky nipple discharge, the clinician is to first:
Perform a pregnancy test
The parent of a preschool age child reports that the child often appears anxious and nervous and that this is associated occasionally with a rapid heart rate and tremor. What is the best type of referral to recommend?
Play therapy
A 16yearold adolescent female whose BMI is at the 90th percentile reports irregular periods. The primary care pediatric nurse practitioner notes widespread acne on her face and back and an abnormal distribution of facial hair. The nurse practitioner will evaluate her further based on a suspicion of which diagnosis?
Polycystic ovarian syndrome (PCOS)
A 7 year old female has recently developed pubic and axillary hair without breast development. Her bone age is consistent with her chronological age, and a pediatric endocrinologist has diagnosed idiopathic premature adrenarche. The primary care pediatric nurse practitioner will monitor this child for which condition?
Polycystic ovarian syndrome (PCOS)
Which should be considered a contraindication for transcervical chorionic villus sampling?
Positive for group B streptococcus
A white blood cell (WBC) count of 35,000 cells/mm3 on the morning of the first postpartum day indicates:
Possible infection
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?
Premature thelarche which will resolve over time.
What term refers to the period from about 7 to 10 days before menstrual flow begins, until the first or second day of menstrual flow?
Premenstrual
Which of the following is a diagnostic label that is listed in the Diagnostic and Statistical Manual IV-TR?
Premenstrual dysphoric disorder
What is the term for the exacerbation of somatic or mood symptoms in the late luteal or menstrual phase of the cycle?
Premenstrual magnification
A dipstick urinalysis is positive for leukocyte esterase and nitrites in a schoolage child with dysuria and foul-smelling 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?
Prescribe Bactrim (Trimethoprim - Sulfamethoxazole) twice daily 3-5 days. Bactrim = 1st line treatment in children w/ no prior h/o UTIs
What hormone has been shown to help with relieving the mood discomfort cluster of symptoms of PMS?
Progesterone
What test should be ordered for a woman who is experiencing AUB as well as headaches and peripheral vision changes?
Prolactin level test
What is the term for a nonstress test, in which there are two or more fetal heart rate accelerations with fetal movement, of 15BPM or more, in a 20-minute period?
Reactive
The most effective first line treatment for 85% of women who have mild or moderate symptoms of mastalgia (breast pain) is:
Reassurance. A common, typically benign condition
A school age child has a 3-month 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?
Refer for EGD.
A 9 month old infant is brought to the clinic with scrotal swelling and fussiness. The primary care pediatric nurse practitioner notes a tender mass in the affected scrotum that is difficult to reduce. What is the correct action?
Refer immediately to a pediatric surgeon.
A 13-year-old child has exhibited symptoms of mild depression for several weeks. The parent reports feeling relieved that the symptoms have passed but concerned that the child now seems to have boundless energy and an inability to sit still. What will the primary care pediatric nurse practitioner do?
Refer the child to a child psychiatrist for evaluation of bipolar disorder.
A middle school age child is skipping school frequently and getting poor grades since the child's father was killed while deployed in the military. How will you manage this situation?
Refer the child to a mental health specialist for evaluation and treatment.
The primary care pediatric nurse practitioner is performing a well child examination on a 2yearold child with a history of intrauterine growth retardation (IUGR) whose height remains less than the 3 rd percentile on a WHO growth chart. What will the nurse practitioner do?
Refer the child to a pediatric endocrinologist.
A child who had GABHS 2 weeks prior is in the clinic with periorbital edema, dyspnea, and elevated blood pressure. A urinalysis reveals tea colored urine with hematuria and mild proteinuria. What will the primary care pediatric nurse practitioner do to manage this condition?
Refer the child to a pediatric nephrologist for hospitalization.
During a well child examination of a 2 year old child, the primary care pediatric nurse practitioner palpates a unilateral, smooth, firm abdominal mass which does not cross the midline. What is the next course of action that?
Refer the child to an oncologist immediately.
The mother of a 12 month old uncircumcised male infant reports that the child seems to have pain associated with voiding. A physical examination reveals a tight, pinpoint opening of the foreskin, which thickened and inflamed. What will the primary care pediatric nurse practitioner do?
Refer the child to pediatric urologist.
A 6 month old infant has a retractile testis that was noted at the 2month well baby exam. What will the primary care pediatric nurse practitioner do to manage this condition?
Refer the infant to a pediatric urologist or surgeon for possible orchiopexy.
An infant has congenital adrenal hyperplasia. At a routine well baby checkup, the primary care pediatric nurse practitioner notes vomiting, poor feeding, lethargy, and dehydration. Which action is correct?
Refer the infant to the Emergency Department for fluids, dextrose, and steroids.
A 6 year old female has had a recent growth spurt and an exam reveals breast and pubic hair development. Her bone age is determined to be 8 years. What will the primary care pediatric nurse practitioner do next?
Refer to a pediatric endocrinologist for management.
A 9-year-old 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?
Refer to a pediatric gastroenterologist for further workup.
A pregnant client has received the results of her triple-screen testing (measures AFP, HCG, and unconjugated Estriol), and it is positive. She provides you with a copy of the test results that she obtained from the lab. What would the nurse anticipate as being implemented in the clients plan of care?
Refer to the physician for additional testing
A 30 month old girl who has been toilet trained for 6 months has daytime enuresis and dysuria and a low-grade fever. A dipstick urinalysis is negative for leukocyte esterase and nitrites. What is the next step?
Send the urine to the lab for culture.
A school age child has recurrent diarrhea with foul smelling stools, excessive flatus, abdominal distension, and failure to thrive. A 2-week lactose free trial failed to reduce symptoms. What is the next step in diagnosing this condition?
Serologic testing for celiac disease.
A postpartum client would be at increased risk for postpartum hemorrhage if:
She delivered a 6.5lb infant after a 2-hr labor.
A child is diagnosed with nephrotic syndrome, and the pediatric nurse practitioner provides primary care in consultation with a pediatric nephrologist. The child was treated with steroids and responded well to this treatment. What will the nurse practitioner tell the child's parents about this disease?
Steroids will be used when relapses occur.
What is the function of the Bartholin gland?
Stimulated during sexual arousal Secrete lubricating mucous in to the introitus
A 9 month old infant with a history of three urinary tract infections is diagnosed with grade II vesicoureteral reflux (abnormal flow of urine back up the tubes). Which medication will be prescribed?
TMPSMX; TMP (Bactrim) 2mg/kg as a single daily dose.
During a well child assessment of a preschool age child, the parent voices concerns that, because the child has behavior problems at school, the child may have a mental health disorder. Which initial approach will provide the best information?
Take time to actively listen to the parent's and child's perceptions of the problem.
An adolescent is diagnosed with functional abdominal pain (FAP). The child's symptoms worsen during stressful events, especially with school anxiety. What will be an important part of treatment for this child?
Teaching about the brain gut interaction causing symptoms.
What data in the client's history should the nurse recognize as being pertinent to a possible diagnosis of postpartum depression?
Teenage depression episode.
The parent of a toddler diagnosed with grade V vesicoureteral reflux asks the primary care pediatric nurse practitioner how the disease will be treated. What will the nurse practitioner tell this parent?
That surgery to correct the condition is possible.
What has contributed to the decreased incidence of Hep B over the past 20 years?
The HBV vaccination
Why is it often more difficult to detect STIs in women than in men?
The anatomy of women's genital tracts makes examination more difficult.
A pregnant clients mother is worried that her daughter is not big enough at 20 weeks of gestation. The nurse palpates and measures the fundal height at 20 cm, which is even with the woman's umbilicus. Which should the nurse report to the client and her mother?
The body of the uterus is at the belly button level, just where it should be, at this time.
A major contributor to pelvic stability is:
The ilium and its ligaments
The primary care pediatric nurse practitioner prescribes metformin for a 15 year old adolescent newly diagnosed with type 2 diabetes. What will the nurse practitioner include when teaching the adolescent about this drug?
The importance of checking blood glucose 3 or 4 times daily
The parent of a school age child is concerned because the child has started to express anger about a grandparent's death even though this occurred when the child was a toddler. What will the nurse practitioner tell the parent?
The significance of this loss must be reworked at each developmental level.
A pregnant clients biophysical profile score is 8. She asks the nurse to explain the results. What is the nurses best response?
The test results are within normal limits. A score of 8 points with good amniotic fluid volume is considered reassuring (A score of 6 points could indicate a problem & warrants further testing)
Gonadotropin hormone-releasing agonists are recommended only for short-term use, to treat heavy bleeding, due to:
Their many side effects, such as hot flashes.
The parent of a colicky infant asks about using a probiotic medication. What will you tell them?
There is no conclusive evidence about using probiotics to treat colic.
In 85% of women with breast cancer:
There is no identifiable risk factor, other than age
While providing education to a primiparous (1st pregnancy) client, regarding the normal changes of pregnancy, What is important for the nurse to explain about Braxton Hicks contractions?
These occur throughout pregnancy, but you may not feel them until the third trimester.
How do systemic antiviral drugs treat genital herpes?
They can control the symptoms.
Why do adolescents have the highest r/o developing PID?
They have decreased immunity to infectious organisms
How can liver and renal disease result in abnormal uterine bleeding?
They result in an inability to adequately clear estrogen from the body.
What is the objective of the endometrial cycle?
To prepare a site to nourish and maintain the ovum
Why does the cervical mucus become thick, viscous, and opaque after ovulation?
To reduce the risk of ascending infection at the time of implantation
The clean catch urine specimen of a child with dysuria, frequency, and fever has a colony count between 50,000 and 100,000 of E. coli. What is the treatment for this child?
Treat with antibiotics for urinary tract infection
Which of the following is caused by an anaerobic one-celled protozoan that commonly lives in the vagina?
Trichomoniasis
Of the four symptom clusters of perimenstrual symptoms identified by Woods, Mitchell, Lentz (1999), which was the dominant one in terms of explaining variance in premenstrual symptoms?
Turmoil
Progesterone breakthrough bleeding is sometimes seen in women who:
Use progesterone-only contraception.
A toddler who was born prematurely refuses most solid foods and has poor weight gain. A barium swallow study reveals a normal esophagus. What will the primary care pediatric nurse practitioner consider next to manage this child's nutritional needs?
Video fluoroscopy swallowing study
What is the most common symptom of vulvovaginal candidiasis?
Vulvar pruritis (itching)
What is a good first question to ask women who presents with a concern about abnormal bleeding?
What is a normal pattern for you?
A healthy 14 year old female has a dipstick urinalysis that is positive for 56 RBCs per hpf but otherwise normal. What is the first question the primary care pediatric nurse practitioner will ask this patient?
When was your last menstrual period.
