PEDD Exam 4 Compilation

Routine screening for GDM should be performed at: a. 24 to 28 weeks' gestation b. 18 to 22 weeks' gestation c. 10 to 14 weeks' gestation d. 32 to 36 weeks' gestation

*a. 24 to 28 weeks' gestation Human placental lactogen (hPL) alters maternal glucose metabolism and causes a state of maternal insulin resistance, particularly toward the end of the second trimester.

Which clinician action(s) would be most effective when the screening of an individual indicates that more discussion is needed about his or her substance use, including opportunities for treatment? a. Acknowledging that the individual has the choice to change and advising him or her that he or she can b. Completing a random drug screen to prove that the individual needs intervention c. Organizing a formal intervention to confront the individual's denial d. Referring the individual to the best option for treatment as determined by the clinician

*a. Acknowledging that the individual has the choice to change and advising him or her that he or she can Inherent in an effective approach is the recognition that an individual can make the choice to change, that the primary care provider can be a partner in the process, and that individuals have options, no matter what treatment level is needed. Authentic feedback offered with respect and empathy by the clinician supports and encourages self-determination and motivation to change.

A patient experienced a physical assault 2 weeks ago and has symptoms such as nightmares, irritability, sleep disturbance, and intrusive thoughts of being harmed. What is the most likely current diagnosis? a. Acute stress disorder b. PTSD c. Adjustment disorder with disturbance of conduct d. Anxiety disorder

*a. Acute stress disorder Acute stress disorder—symptoms begin at time of event and past 3 days to 1 month; PTSD— symptoms or disturbance occur after 1 month.

Which statement best applies to the care of the adolescent? a. Adolescents are more likely to share personal information with the clinician if confidentiality is guaranteed. b. More adolescents are willing to seek healthcare if the clinician can provide a private, confidential encounter. c. The clinician should be aware of state and federal law regarding adolescent consent and confidentiality. d. Adolescents are minors and are therefore not entitled to a confidential conversation with the clinician unless the caregiver consents.

*a. Adolescents are more likely to share personal information with the clinician if confidentiality is guaranteed. *b. More adolescents are willing to seek healthcare if the clinician can provide a private, confidential encounter. *c. The clinician should be aware of state and federal law regarding adolescent consent and confidentiality.

Which of the following statements about the preventative considerations for the care of children is false? a. BP in children needs to be checked only if children are showing signs or symptoms of cardiovascular or renal disease. b. According to the AAP, BMI should be measured for all children annually beginning at age 2. c. Children should be screened for dyslipidemia once between ages 9 to 11 and 17 to 21 years. d. Adolescents between 12 and 18 years should be screened for major depressive disorder.

*a. BP in children needs to be checked only if children are showing signs or symptoms of cardiovascular or renal disease.

What three regions of the brain are involved in the neuroadaptations underlying the development and persistence of substance use disorders? Choose three. a. Basal ganglia b. Cerebellum c. Extended amygdala d. Hypothalamus e. Prefrontal cortex

*a. Basal ganglia *c. Extended amygdala *e. Prefrontal cortex

A contributor to the development of mastitis in a woman is a. Breastfeeding b. Chest radiation c. Malignancy d. Breast cysts

*a. Breastfeeding Mastitis is an infection of the breast that occurs in approximately 10% of lactating females. Prolonged breast engorgement is a contributor.

Which of the following injuries should prompt the clinician to be concerned about physical abuse? Select all that apply. a. Ear bruising in a 4-year-old b. Abrasion to the elbow in a 6-year-old c. Bilateral shin bruising in a 2-year-old d. Subconjunctival hemorrhage in a 3-month-old e. Abdominal bruising in a 22-month-old

*a. Ear bruising in a 4-year-old *d. Subconjunctival hemorrhage in a 3-month-old *e. Abdominal bruising in a 22-month-old Answers a, d, and e are all concerning injuries in these aged patients and should prompt further workup to look for occult injuries. TEN-4, the clinical decision rule by Pierce et al., described the characteristics predictive of abuse as bruising to the torso, ears, or neck for any child less than or equal to 4 years old and bruising in any location on an infant less than 4 months old. When these injuries are found, it should prompt the clinician to initiate a workup for physical abuse, investigating for other occult injuries. Although bruises to the face, back, abdomen, arms, buttocks, ears, and hands are suggestive of physical abuse, any injury can be inflicted and no injury should be interpreted in isolation.

It is generally recommended that beyond mammogram screening, clinicians routinely endorse which strategies to support early detection of breast malignancy in asymptomatic women at average risk for breast cancer? a. Education to support breast awareness b. Monthly self-breast examinations (SBE) c. Annual clinical breast examination (CBE) d. Genetic testing

*a. Education to support breast awareness The answer (a) is in the text section Current Recommendations for Breast Cancer Screening. Routine SBE and CBE in asymptomatic women at average risk for breast cancer are not currently recommended. CBE is recommended for physical evaluation of the breast in high-risk and symptomatic women. Routine testing to screen for genetic mutations associated with breast cancer is not recommended unless a detailed history reveals the potential for an inherited cancer syndrome.

Which best describes the signs and symptoms of vaginal candidiasis? a. External dysuria, pruritus, and thick, clumpy white vaginal discharge b. Foul fishy odor, frothy yellow-green vaginal discharge c. Malodorous and thin milky-white vaginal discharge d. None, the condition is asymptomatic in women.

*a. External dysuria, pruritus, and thick, clumpy white vaginal discharge Common presenting symptoms include vulvar itching/irritation, dysuria, and dyspareunia. On physical examination, the classic presentation of vulvovaginal candidiasis (VVC) is white, curd-like discharge that is adherent to the vaginal walls.

Which approach by the clinician can increase a younger child's cooperation with the physical exam? a. Finding ways to transform the physical exam into a play activity. b. Move quickly through the exam, performing the most distressing assessment first to get it over with, and then move toward the least distressing assessments to comfort the child. c. Ask the child if it is okay to begin the physical exam to promote autonomy and trust. d. Only examine the physical systems that the child permits so the child does not become distressed and develop a fear of healthcare providers.

*a. Finding ways to transform the physical exam into a play activity. The clinician should not ask a child's permission to perform aspects of a physical exam if it is not actually optional. The best approach is to give a child a choice: "Do you want me to check your ears or your mouth first?" The clinician should always perform the necessary elements of a physical exam and employ the "quiet to active" approach.

______ is recommended for adjuvant screening by the USPSTF for asymptomatic women at average risk for breast cancer who have dense breasts and a normal mammogram. a. No additional imaging b. Ultrasound c. MRI d. Digital breast tomosynthesis (DBT)

*a. No additional imaging The answer (a) is in the text section Imaging Considerations for the Breasts and Axillae. As evidence is insufficient at this time, the USPSTF does not recommend adjuvant testing (ultrasound, MRI, or DBT) as a method to improve earlier detection of breast cancers in women with dense breasts who are asymptomatic, have a negative screening mammogram, and are not at increased risk for breast cancer.

Which of the following statements about pediatric considerations of the male genitourinary examination is FALSE? a. The clinician may need to apply moderate force to retract the foreskin to view the urethral meatus of a young infant. b. It is recommended for a caregiver or another healthcare provider to chaperone the adolescent during a genitourinary examination. c. Children and adolescents should be assessed for sexual maturity by determining the Tanner stage. d. Routine genitourinary examinations should be performed at all infant and child wellness examinations.

*a. The clinician may need to apply moderate force to retract the foreskin to view the urethral meatus of a young infant. The foreskin of uncircumcised newborns and young infants may be tightly adhered to the glans penis and should never be forcefully retracted. Forceful retraction will be traumatic and may result in paraphimosis.

Which of the following statements are TRUE regarding child sexual abuse (select all that apply)? a. The majority of child sexual abuse victims will have a normal/nonspecific anogenital examination. b. Most children disclose their victimization soon after experiencing sexual abuse. c. Healthcare clinicians must be knowledgeable regarding state laws/protocols defining acute versus nonacute child sexual abuse. d. The ultimate goal of the anogenital examination for child sexual abuse is to provide reassurance to patients and families that their bodies are normal and/or will heal despite their experience of sexual abuse.

*a. The majority of child sexual abuse victims will have a normal/nonspecific anogenital examination. *c. Healthcare clinicians must be knowledgeable regarding state laws/protocols defining acute versus nonacute child sexual abuse. *d. The ultimate goal of the anogenital examination for child sexual abuse is to provide reassurance to patients and families that their bodies are normal and/or will heal despite their experience of sexual abuse.

Which are TRUE about traumatic experience? Select all that apply. a. Traumatic experience overwhelms a person's capacity to cope. b. One-time incidents are generally not considered to be traumatic. c. No two individuals will experience trauma in the same way. d. There are consistent patterns of responses commonly seen in survivors of trauma.

*a. Traumatic experience overwhelms a person's capacity to cope. *c. No two individuals will experience trauma in the same way. *d. There are consistent patterns of responses commonly seen in survivors of trauma.

Which is true about therapeutic communication? a. Using effective communication is standard of practice in completing patient assessment. b. Trauma-informed care is outside the scope of practice for most clinicians. c. Clinicians do not have time to integrate motivational interviewing in health assessment. d. Using communication strategies is important, but not likely to impact patient outcomes.

*a. Using effective communication is standard of practice in completing patient assessment. Use of therapeutic communication is an expected, evidence-based standard of care in clinician- patient encounters, including advanced assessment, with consideration of patient age, developmental level, health literacy level, cultural perspectives, and unique dimensions of health and well-being.

Healthcare assessment findings that are highly suggestive of sexual abuse include a. a spontaneous disclosure of sexual abuse made by the child b. genital warts noted on examination of an 18-month-old female delivered vaginally to a mother known to have genital warts c. urine NAAT positive for chlamydia in a 6-year-old female d. absence of hymenal tissue at 6 o'clock when examined in both supine and knee-chest position

*a. a spontaneous disclosure of sexual abuse made by the child *c. urine NAAT positive for chlamydia in a 6-year-old female *d. absence of hymenal tissue at 6 o'clock when examined in both supine and knee-chest position Attention should be focused on the posterior rim between 3 and 9 o'clock, as this is where abnormalities from sexual abuse generally occur (Adams et al., 2018). Nonacute/residual/healed findings are more difficult to detect, but may include healed hymenal transections in the posterior rim extending to the base of the hymen or to the vaginal wall, missing hymenal tissue in the posterior rim, scarring of the posterior fourchette, or perianal scarring (Adams et al., 2018). Always confirm nonacute anogenital findings in supine and knee-chest position wherever possible (see pages 44-46 and Box 24.8).

Cervical cancer screening should be considered for: a. anyone with a cervix b. only cisgender women c. only transgender men d. lesbians and bisexual women

*a. anyone with a cervix It is important to explain the process and rationale for cervical cancer screening in transmasculineindividuals and in women who have sex with women, regardless of vaginal penetration.

Clinicians ought to suspect the presence of BRCA-1 and BRCA-2 genetic mutations in families with a history of (select all that apply) a. breast and/or ovarian cancers (often diagnosed at a younger age) b. ovarian, fallopian, or endometrial cancers c. pancreatic or prostate cancers d. Ashkenazi Jewish heritage

*a. breast and/or ovarian cancers (often diagnosed at a younger age) *b. ovarian, fallopian, or endometrial cancers *c. pancreatic or prostate cancers *d. Ashkenazi Jewish heritage

For a woman with a uterus, menopause is defined as a. cessation of menstrual bleeding for 12 consecutive months b. cessation of menstrual bleeding for 6 consecutive months c. fluctuating estrogen and androgen levels in response to low FSH levels d. undetectable levels of FSH, LH, estrogen, and androgen

*a. cessation of menstrual bleeding for 12 consecutive months Menopause is defined as the cessation of menstrual bleeding for 12 consecutive months in women with a uterus.

Which is the most useful, empathetic, and patient-centered response by the clinician after assessing that an individual is misusing opioids? a. "You need to stop before your overdose." b. "Tell me more about what leads you to use opioids." c. "Let us discuss options to decrease the risk of overdose." d. "Here is more information about overdose."

*b. "Tell me more about what leads you to use opioids." Motivational support should be engaging, empathetic, and patient centered.

Which statement is true about musculoskeletal considerations in young children? a. Closure of the growth plates occurs during Tanner stage 3. b. All infants should be routinely assessed for developmental dysplasia of the hip (DDH) until they are walking normally. c. The bones of young children are more brittle than those of adults. d. Clinicians rarely need to worry about growth plate fractures because growth plates are more calcified.

*b. All infants should be routinely assessed for developmental dysplasia of the hip (DDH) until they are walking normally.

What are the steps of assessment and intervention when an individual has tobacco use disorder? a. Admit, Assess, Analyze, Admonish, Admire b. Ask, Advise, Assess, Assist, Arrange c. Seek, Stop, Solve, Support, Succeed d. Start, Stop, Strengthen, Support, Succeed

*b. Ask, Advise, Assess, Assist, Arrange 5 A's from Box 23.3.

Which best describes how pediatric health history and physical exam are different from adults? a. The clinician can use the same approach to history and physical with a child if the clinician is highly skilled and efficient. b. Compared with adults, children experience rapid periods of growth and development, so the clinician should tailor the approach to the child's developmental level. c. Children are unable to provide reliable information for the health history and exam; therefore, the clinician should rely solely on the information from the caregiver.

*b. Compared with adults, children experience rapid periods of growth and development, so the clinician should tailor the approach to the child's developmental level. Children should always be included when gathering a health history, especially children over age 4 to 5 years who can typically speak well and convey the symptoms they are experiencing. Children's growth and development is dynamic. In addition to rapid physical growth, particularly in infancy and adolescence, children are also continuously developing their motor, language, cognitive, and psychosocial skills. As such, the clinician must employ a developmental approach to the history taking and physical exam of children and adolescents.

Which one of these is one of the four processes of MI that are relevant to health assessments? a. Distraction b. Evoking c. Imagination d. Deter

*b. Evoking There are four processes of MI that are relevant to health assessments: Engaging, Focusing, Evoking, and Planning. Evocation includes the MI spirit and a process of evoking change talk from clients.

If you ask a person whether he or she is thinking about killing himself or herself, it will give him or her the idea and increase the risk he or she will now attempt suicide? a. True b. False

*b. False False. Asking about suicide will not put that idea in a patient's mind. In fact, being asked is often a relief to patients who need to talk about their thoughts and fears.

Which risk factor is associated with cervical cancer? a. Endometriosis b. HPV infection c. Irregular menstrual cycles d. Vaginal infection

*b. HPV infection Cervical cancer is the third most common gynecological cancer. The majority of cervical cancers are squamous cell carcinomas. Most cervical cancers are a result of HPV infection.

In the study by Pakpour regarding childhood obesity and MI, which strategies showed the most effective results? a. MI solely b. MI plus parental engagement c. Not using MI d. Partially using MI and a dietary plan suggested by a physician

*b. MI plus parental engagement MI in additional to parental involvement is an effective strategy in changing obesity-related outcomes and has additional effects-surpassing benefits of MI with adolescents solely.

Which hormone is responsible for sustaining a pregnancy through uterine quiescence? a. Estrogen b. Progesterone c. hCG d. hPL

*b. Progesterone One of progesterone's actions during pregnancy is to "quiet" the uterus and thus maintain the pregnancy.

Which action is most consistent with the principles of motivational interviewing (MI)? a. Recognizing that every individual needs to be educated about health b. Reviewing an individual's thoughts and beliefs about health and wellness c. Showing the client problems that resulted from his or her poor health choices d. Teaching every individual the correct way to care for his or her own health

*b. Reviewing an individual's thoughts and beliefs about health and wellness

Which statements describe the approach to the physical exam of infants and young children? Choose all that apply. a. It is best to perform the otoscopic exam while the caregiver is cradling the newborn. b. Safe positioning of the infant or young child may require caregiver assistance. c. The clinician can generate cooperation from young children by allowing them to become familiar with exam equipment like the otoscope or stethoscope. d. If the young child requires restraint to perform the exam safely, the clinician should forego that part of the exam.

*b. Safe positioning of the infant or young child may require caregiver assistance. *c. The clinician can generate cooperation from young children by allowing them to become familiar with exam equipment like the otoscope or stethoscope.

Which statement about evaluating growth in children is false? a. Deviation in growth patterns may indicate a serious underlying condition. b. The CDC growth charts should be used for children aged 0 to 18 years. c. BMI is evaluated by comparing the BMI calculation with a reference population of children of the same age and natal sex. d. Accurate growth measures are essential for a reliable evaluation.

*b. The CDC growth charts should be used for children aged 0 to 18 years. Growth measures are not evaluated in the same manner in children as adults. Accurate and reliable growth measures are essential. Weight, height/length, head circumference, and BMI are compared with a reference population of children of the same age and natal sex. The Centers for Disease Control and Prevention (CDC, 2010) recommends using the World Health Organization (WHO) international growth charts for children aged 0 to 23 months, and the 2002 CDC growth charts for children and adolescents aged 2 to 18 years.

Which of the following describes the best approach to detecting developmental delays in young children? a. The clinician should conduct developmental surveillance only when a caregiver is concerned about slow development. b. The clinician should perform developmental surveillance at every routine health encounter. c. The clinician should complete standardized developmental screening at ages 9, 18, and 24 to 30 months. d. If a caregiver is offended by the suggestion that his or her child may have a developmental delay, the clinician should drop the issue until the next visit.

*b. The clinician should perform developmental surveillance at every routine health encounter. *c. The clinician should complete standardized developmental screening at ages 9, 18, and 24 to 30 months.

Which history statement is an indication for increased antepartum fetal surveillance? a. The mother will be 33 years old on her EDD. b. The fetus has intrauterine growth restriction. c. The fetus has been diagnosed with an extra digit on the right hand. d. The mother has a history of PCOS.

*b. The fetus has intrauterine growth restriction. Intrauterine growth restriction carries an increased risk of stillbirth; therefore, increased fetal surveillance would be indicated in the third trimester.

An order for what lab test would be indicated for a person experiencing fatigue, low mood, and sleep problems? a. C-reactive protein b. Thyroid studies, including TSH c. Serotonin level d. Low-density lipoprotein and high-density lipoprotein

*b. Thyroid studies, including TSH Order thyroid studies with the rationale that hypothyroidism presents like depression, and hyperthyroidism presents like an anxiety disorder.

Which level of alcohol consumption would be defined as moderate drinking? a. Any level of consumption, as long as it is not daily *b. Up to one 6-ounce glass of wine per day for women c. Up to three 12-ounce cans of beer per day for men d. Any level of consumption, as long as it is only beer or wine

*b. Up to one 6-ounce glass of wine per day for women Based on the 2015 to 2020 Dietary Guidelines for Americans, a standard drink contains 14 g (0.6 ounce) of pure alcohol, which equates to one 12-ounce can of beer, one 5-ounce glass of wine, or one shot of 1.5 ounces of a distilled beverage. Moderate drinking is up to 1 standard drink per day for women and 2 per day for men.

Who does the USPSTF recommends routine screening for IPV at all preventive health encounters at regular intervals? a. Children aged 0 to 18 b. Women of childbearing age c. People of low socioeconomic status d. Heterosexual couples

*b. Women of childbearing age Children should be routinely evaluated for signs and symptoms of abuse, but caregivers may be screened for occurrence of IPV within the family. IPV can occur among all people without regard to socioeconomic status or sexual orientation. The USPSTF recommends routine IPV screening for all women of childbearing age.

PrEP is indicated for a. any man who has sex with men b. any one at risk for HIV c. anyone who has sex with men and women d. someone who is HIV positive

*b. any one at risk for HIV Anyone at risk for HIV includes HIV-positive partner, unprotected intercourse, intravenous drug use or sexually active with intravenous drug user.

Characteristics of a benign breast mass typically include all of the following except a. well-defined borders with a distinct shape and size b. dimpling, edema, or nipple retraction c. smooth, soft, or rubbery consistency d. scattered, symmetrical tissue thickening in the upper outer breast quadrants

*b. dimpling, edema, or nipple retraction Dimpling, edema, and/or nipple retraction are characteristics of malignant breast masses, not benign ones.

Having an empathetic approach to discussing substance misuse with patients implies that the clinician a. feels sorry for these individuals because they lack will power b. has the ability to share emotions and consider patients' perceptions c. is justifiably angry at their choices but is able to treat them with sympathy d. can treat individuals with tolerance despite their low motivation to change

*b. has the ability to share emotions and consider patients' perceptions Clinician empathy is the ability to recognize and share the emotions and perceptions of the patient.

Serious mental disorders (bipolar disorder, thought disorders, and severe persistent mental health disorders) generally are first diagnosed a. in childhood b. in late adolescence c. in middle age d. in preschool years

*b. in late adolescence The usual age of onset of serious mental disorders (bipolar disorder, thought disorders, and severe persistent mental health disorders) is generally in late adolescence and young adulthood, but can occur earlier or later.

The presence of cervical motion tenderness may indicate a. ovulation b. pelvic inflammatory disease c. uterine pregnancy d. vulvovaginitis

*b. pelvic inflammatory disease Cervical motion tenderness (CMT) is found in several pathological conditions including pelvic inflammatory disease (PID), appendicitis, and ectopic pregnancy.

The short length of the urethra in females makes it easier a. to empty the bladder during micturition b. to become contaminated c. for the detrusor muscle to contract with urination d. to palpate the bladder

*b. to become contaminated

Which BP readings would meet the criteria for a diagnosis of gestational hypertension? a. 132/89 and 141/86, 30 minutes apart, 28 weeks' gestation b. 150/80 and 146/87, 4 hours apart, 12 weeks' gestation c. 141/93 and 148/95, 4 hours apart, 22 weeks' gestation d. 125/74 and 118/72, 4 weeks apart, 22 and 26 weeks' gestation

*c. 141/93 and 148/95, 4 hours apart, 22 weeks' gestation

Which was the fifth A added to the "4 A's" by The Canadian Task Force? a. Advise b. Arrange c. Agree d. Assess

*c. Agree A fifth A "agree" was added by the Canadian Task Force, and the model was recommended as a general approach for behavioral counseling.

Which area of the brain is responsible for normal regulation of emotions, such as fear, anger, anxiety, and panic? a. Thalamus b. Hippocampus c. Amygdala d. Frontal lobe

*c. Amygdala The study of the structure and function of the nervous system, or neuroanatomy, identifies the amygdala within the temporal lobe as the component of the brain and limbic system most associated with strong emotions, anxiety, and panic. The amygdala of the brain evolved to detect danger and mediate the fear response.

A 2-month-old presents to clinic for routine well-child check. Upon physical examination, a bruise is found on the chest. What do you do next? a. Call in a report to Children Services because of the concern for physical abuse. b. Obtain a head CT and skeletal survey. c. Ask the caregiver about the injury. d. Obtain hematology laboratory studies.

*c. Ask the caregiver about the injury. Answer c should be the first step when an injury is found. However, owing to patient's age, all of the other steps should be performed as well. Bruising, although a common accidental injury in a mobile child, is a critical injury in a young infant.

Which statement about breast cancer is true? a. Men cannot get breast cancer. b. Breast cancer usually presents as a painful mass. c. Breast cancer skin changes may mimic benign conditions such as dermatitis or eczema. d. Diet and exercise do not significantly influence breast cancer risk.

*c. Breast cancer skin changes may mimic benign conditions such as dermatitis or eczema. The answer (c) is in the text section Paget's Disease of the Breast. Paget's disease of the breast is a rare breast cancer that can present with subtle skin changes on or around the nipple, often misdiagnosed as eczema or dermatitis. Although rare, men can develop breast cancer. Breast cancer has a variety of presentations and may or may not be painful. Obesity and alcohol intake increase the risk of developing breast cancer.

Which is most accurate about components of the SBIRT clinical model? a. Screening is a discussion between the patient and clinician using the clinician's experience of working with patients with addiction. b. SBIRT is focused on diagnosing substance use disorder. c. Brief intervention is meaningful conversation about a patient's opioid use. d. After a brief intervention, the clinician is able to decide whether the patient should complete a standardized screening tool. e. At a follow-up appointment, the clinician should reassess if a referral to treatment is necessary.

*c. Brief intervention is meaningful conversation about a patient's opioid use. SBIRT is a model emphasizing the use of a standardized screening tool to guide the brief intervention, which is a meaningful conversation regarding the patient's opioid use. Referral to treatment is immediately offered.

Which statement is TRUE regarding the relationship between IPV and child abuse? a. There is no correlation between IPV and child abuse. b. When IPV occurs in a home, children are not affected unless they become involved in the violent episode between caregivers. c. In a family in which IPV is occurring, it is more likely that child abuse is also occurring. d. Pregnancy decreases a woman's risk of experiencing IPV.

*c. In a family in which IPV is occurring, it is more likely that child abuse is also occurring. Pregnancy increases a woman's risk of experiencing IPV and subsequent poor effects on the infant such as low birth weight or premature birth. Children who witness IPV are also at risk for significant psychosocial trauma from experiencing traumatic events. In up to 60% of families in which IPV or child abuse is occurring, the other form of abuse is also occurring.

According to the ACE study, childhood adversity and household dysfunction impact all but which of the following later in life? a. Healthcare utilization b. Disease incidence and risk factors c. Incidence of criminal behavior in adulthood d. Quality of life

*c. Incidence of criminal behavior in adulthood The aims of the study were to determine retrospectively and prospectively the impact that childhood adversity and household dysfunction have on the following outcomes later in life: disease incidence and risk factors, healthcare utilization, quality of life, and mortality. Researchers first described the prevalence and interrelation among exposures to child abuse and household dysfunctions. Researchers then studied how the number of exposures to childhood adversity may later be related to the incidence of chronic diseases that are the underlying causes of death in adults.

What is the intended outcome of the ALARA principle? a. Promote the use of computed tomography (CT) in all kids suspected of appendicitis to expedite treatment. b. Promote the use of high-dose radiation to improve image quality. c. Limit radiation doses in children when possible to prevent harm. d. Clinicians should always use ultrasound before CT.

*c. Limit radiation doses in children when possible to prevent harm. The ALARA (As Low as Reasonably Achievable) principle advocates for radiation dose reduction in the pediatric population. When possible, clinicians should use an evidence-based approach to minimize radiation exposure (e.g., utilizing ultrasound as first-line imaging for suspected appendicitis rather than CT).

Which of these is the correct order of the "stages of change"? a. Precontemplation, Maintenance, Contemplation, Determination, Action, Recurrence b. Precontemplation, Contemplation, Determination, Maintenance, Recurrence, Action c. Precontemplation, Contemplation, Determination, Action, Maintenance, Recurrence d. Precontemplation, Contemplation, Recurrence, Action, Maintenance, Determination

*c. Precontemplation, Contemplation, Determination, Action, Maintenance, Recurrence The correct order of the stages of change is as follows: Precontemplation, Contemplation, Determination, Action, Maintenance, Recurrence.

Which statement is not true about depression in adolescents? a. CBT is the first-line intervention for mild-to-moderate depression. b. Irritability and anger are symptoms of depression in adolescents. c. Racing thoughts, rapid speech, and staying up all night are common depression symptoms. d. Hopelessness and acquiring a gun indicate high risk for suicide.

*c. Racing thoughts, rapid speech, and staying up all night are common depression symptoms. Screening for mania is key to identifying assessments that may indicate bipolar disorder; these include not needing sleep for days, excessive enthusiasm, and periods of great excitement and obsession. Key questions are as follows: (a) Do you have racing thoughts? (b) Has your speech been so fast that it is hard to follow? Pressurized speech and flight of ideas are correlated with mania.

Which of the following would not be a reason for performing early screening for gestational diabetes mellitus (GDM) in a woman who has a BMI of 36? a. Her last baby weighed 4,100 g at birth. b. Her father has type 2 diabetes mellitus. c. She has a history of exercise-induced asthma. d. She had GDM in her first pregnancy.

*c. She has a history of exercise-induced asthma. A history of exercise-induced asthma would not indicate an increased risk of gestational diabetes or pregestational diabetes. All of the other choices are risk factors, particularly when combined with a BMI ≥25.

Which woman is most likely to CURRENTLY have ovarian cancer? a. Forty-year-old whose grandmother had breast cancer b. Fifty-year-old with a history of endometriosis and pelvic pain c. Sixty-year-old with fatigue and persistent abdominal bloating d. Seventy-year-old who is a G5P5 and all babies were full-term

*c. Sixty-year-old with fatigue and persistent abdominal bloating Ovarian cancer is most commonly diagnosed in women aged 55 to 64 years. Symptoms of ovarian cancer are often nonspecific. They include abdominal pain, bloating or increased abdominal size, urinary symptoms, constipation, early satiety, or difficulty eating.

A 3-month-old male infant is noted to have an undescended left testicle during his well-child check. The parents are very concerned. Which is TRUE regarding cryptorchidism? a. As long as one testis is palpable, this is not a concern until age 5 years. b. The child needs immediate referral for surgery for this emergent condition. c. There is a high probability that the testicle will spontaneously descend before 1 year of age. d. This is associated with disorder of sexual differentiation.

*c. There is a high probability that the testicle will spontaneously descend before 1 year of age. An undescended testicle is a failure of the testis to descend into the lower third of the scrotum by 4 months of age. The testicle may be located in the intra-abdominal space (cryptorchidism), the inguinal canal, or the upper third of the scrotum. There is no advantage to clinical observation of an undescended testicle longer than 12 months of age. Surgical correction is required before puberty to preserve fertility and decrease the risk of testicular cancer.

The measurement in centimeters from the top of the symphysis pubis to the fundus is known as a. clinical pelvimetry b. cervical dilatation c. fundal height d. total weight gain

*c. fundal height

Which clinician is most likely to be effective in intervening with individuals experiencing opioid use disorder? The clinician who a. is able to strongly confront the patient about his or her destructive behavior b. does not allow the patient's past to be an excuse for the patient's current unethical behavior c. recognizes that stress can add to the patient's vulnerability for opioid use disorder d. successfully holds addicts accountable for their shameful behavior e. uses the patient's fears and guilt to point out to him or her the need to change

*c. recognizes that stress can add to the patient's vulnerability for opioid use disorder Clinicians who are able to recognize that patient stress, adverse childhood events, lack of social support, and other factors contribute to patient vulnerability for opioid use disorder are better able to assist a patient.

Assessment consistent with bacterial vaginosis (BV) includes a. frothy, gray-green cervical discharge with a pH below 4.0 b. thick, white discharge adherent to inflamed vaginal mucosa c. thin, malodorous vaginal discharge with pH above 4.5 d. vaginal itching, dysuria, and severe abdominal pain

*c. thin, malodorous vaginal discharge with pH above 4.5 Women with symptomatic BV infections typically report vaginal itching or irritation, white or gray vaginal discharge, and presence of a strong fishy odor that is particularly noticeable after intercourse.

Which of the following contributes to UTI and incontinence in the older adult? Select all that apply. 1. Increased effectiveness of the antidiuretic hormone (ADH) 2. Decreased perfusion of the glomeruli 3. Increased glomerular filtration area 4. Weakened or damaged urethral sphincter 5. Urinary retention 6. Degeneration of the glomeruli a. 1,2,4,5 b. 2,5,6 c. 1,4,5,6 d. 2,4,5,6

*d. 2,4,5,6

What are some ways to help prevent or reduce exposure to emotional maltreatment? a. The Nurse-Family partnership program b. In-home vising program for first-time mothers c. Anticipatory guidance on developmental expectations d. All of these are ways to prevent and reduce exposure to maltreatment.

*d. All of these are ways to prevent and reduce exposure to maltreatment.

A patient is seen for her initial OB visit without complaints. Her urine culture comes back showing E. coli 100,000 cfu/mL. What is your assessment and immediate plan? a. Acute cystitis, no antibiotics needed b. Acute cystitis, antibiotic treatment course initiated c. Asymptomatic bacteriuria, no antibiotics needed d. Asymptomatic bacteriuria, antibiotic treatment course initiated

*d. Asymptomatic bacteriuria, antibiotic treatment course initiated A colony count of 100,000 cfu/mL during pregnancy meets criteria for asymptomatic bacteriuria, and treatment with antibiotics is recommended even if the patient does not have symptoms.

Which is not a mental health screening instrument for children or teens that would identify depression, anxiety, or a mood disorder? a. SCARED b. PSC c. PHQ-9 A d. Audit-C

*d. Audit-C AUDIT-C is for adult substance use screening).

Which of the following statements is true about an individual with a substance disorder being "in recovery"? a. Individuals in recovery rarely stay sober. b. Individuals in recovery often feel more isolated. c. Clinicians should avoid asking an individual in recovery about substance use. d. Clinicians should ask an individual in recovery about his or her substance use.

*d. Clinicians should ask an individual in recovery about his or her substance use Ask about sponsorship and sobriety. Positive clinician feedback can be a significant part of breaking the cycle of shame, guilt, stigma, and secrecy.

What is the most accurate way of dating a pregnancy with an unsure LMP? a. Second trimester ultrasound b. Nagele's rule c. A pregnancy app d. First-trimester ultrasound

*d. First-trimester ultrasound An ultrasound performed before 14 weeks and 0 days' gestation is precise to 5 to 7 days in terms of setting the estimated due date (EDD).

Which of the following statements is true about adolescent substance use? a. Rarely, an adolescent would develop substance use disorder or addiction. b. Rarely, an adolescent would have changes in brain function from substance use. c. Neuroplasticity protects the adolescent brain from the effects of substance use. d. Neuroadaptations from substance use can be dramatic during adolescence.

*d. Neuroadaptations from substance use can be dramatic during adolescence. The American Academy of Pediatrics defines addiction as a developmental disorder and recommends screening for substance use disorder as a routine part of adolescent care (American Academy of Pediatrics, 2015). The rationale for this position is based on the understanding of neurobiology and the neuroadaptations that result from substance use, which can be more dramatic and happen more quickly during adolescence.

Which physical finding can help distinguish inflammatory breast cancer from mastitis? a. Presence of erythema b. Unilateral presentation c. Nipple discharge d. Peau d'orange skin changes

*d. Peau d'orange skin changes Peau d'orange is a physical change of the skin associated with inflammatory breast cancer. Both mastitis and inflammatory breast cancer can present with a unilateral erythematous breast. Neither condition is typically associated with nipple discharge.

Which of the following is not a component of the mental status examination related to appearance? a. Affect b. Posture c. Hygiene d. Reflexes

*d. Reflexes Appearance—(a) Affect: appropriate for the situation? Labile? Pleasant? Flat? Nontoxic? (b) Posture: lying, sitting, or standing? Comfortable? Obvious limitations or defects? (c) Hygiene and grooming: appropriately dressed.... Disheveled? Neatly groomed? (d) Body habitus: height, weight, waist circumference, and BMI?

Which symptoms would be most concerning for the pregnant woman who is reporting bleeding in her first trimester? a. She reports light spotting for 3 days that has now resolved. b. She reports recent intercourse with her partner. c. She reports mild abdominal cramping. d. She reports vaginally passing tissue and clots.

*d. She reports vaginally passing tissue and clots.

According to the American College of Radiology (ACR), which diagnostic imaging test is recommended to evaluate a palpable breast mass in a 28-year-old woman? a. Mammogram b. MRI c. Digital breast tomosynthesis d. Ultrasound

*d. Ultrasound The ACR recommends ultrasound to evaluate palpable breast masses in women under the age of 30.

Which one of these is not a general concept of therapeutic communication? a. Receiver b. Message c. Sender d. Voicing doubt

*d. Voicing doubt

The USPSTF (2016) screening recommendations for women at average risk of breast cancer include a. annual mammography for women aged 40 to 74 years b. annual mammography for women aged 50 years and over c. biennial mammography for women aged 40 to 74 years d. biennial mammography for women aged 50 to 74 years

*d. biennial mammography for women aged 50 to 74 years The answer (d) is in the text section Imaging Considerations for the Breasts and Axillae: Mammogram. USPSTF (2016) recommends biennial mammography for women aged 50 to 74 years at average risk for breast cancer.

The neurotransmitter primarily associated with initiative, focus, and energy is a. serotonin b. γ-aminobutyric acid (GABA) c. dopamine d. norepinephrine

*d. norepinephrine Norepinephrine (NE) is associated with an individual's energy, focus, initiative, and active adrenaline response (fight, flight, or freeze).

Accurate pregnancy dating may reduce all of the following except a. frequency of labor induction for postterm pregnancy b. use of tocolysis for suspected preterm labor c. planned cesarean delivery before 39 weeks d. use of prenatal vitamins

*d. use of prenatal vitamins An accurate EDD has been shown to reduce intervention for both suspected postterm and preterm pregnancy, as well as the incidence of planned cesarean deliveries before 39 weeks' gestation.

Symptoms associated with perimenopause, or the transition to menopause, include a. fatigue b. insomnia c. menstrual irregularities d. vasomotor instability e. All of the above

*e. All of the above Physiological changes attributable to the menopausal transition also occur. Women experience a wide range of symptoms, which include vasomotor instability, commonly called "hot flashes," insomnia, mood changes, fatigue, and menstrual irregularities.

In a hospital-based study, a single 3-hour motivational interviewing (MI) training session completed by nurses on an oncology unit resulted in which findings? a. No changes in the nurse participants' MI skills b. Reductions in fall rates during the study intervention c. Reductions in fall rates that lasted for 2 years after the intervention d. Improved nurse participant MI skills e. b, c, and d f. b and d

*f. b and d Fall rates decreased during and for a short time after the study to 0. Fifty-seven percent of the nurses showed improvement in their knowledge scores with the posttest. Their skills in reflective listening and eliciting change talk improved significantly. This was very consistent with expectations for newly trained MI clinicians and reflects that the nurse participants were developing awareness and achieving the spirit of MI.

What parental risk factors may carry an association with emotional maltreatment? Select all that apply. a. Poor parenting skills b. Substance use c. Depression d. Suicidal ideation and/or suicide attempt e. Low self-esteem f. Inadequate social support g. All of the above

*g. All of the above

Which statement best affirms an individual's strengths consistent with MI? a. "The work that you are doing to cope with stress and quit smoking is difficult." b. "Tell me why you have not used your strengths to reach your goals since we last met." c. "As you talk about smoking, I hear your reasons to continue and to quit." d. "Let me stop and summarize what I hear you say and we have talked about."

*a. "The work that you are doing to cope with stress and quit smoking is difficult." Giving the patients affirmation for their strengths and solution-finding will help build trust and confidence in the clinician.

Which race or ethnicity has an increased risk for breast cancer diagnosis at a younger age and with more advanced disease? a. Caucasian b. Asian c. African American d. Hispanic

*c. African American The answer (c) is in the text section Life Span and Unique Population Consideration for History. While Caucasian women have higher breast cancer rates overall, African American women are at increased risk of being diagnosed with breast cancer at a younger age and with more advanced disease.

Normal range of onset for pubertal development in girls is a. ages 8-10 b. ages 10-12 c. ages 8-13 d. ages 13-14

*c. ages 8-13

Alcoholism and drug abuse liver disease occurs more frequently in which population? a. Native Americans and African Americans b. Mexican Americans c. North African and Middle East d. Central and Southern Latin America

a. Native Americans and African Americans

Which statement best describes the ovarian and endometrial cycles on day 10 of a 28-day cycle? a. Follicular phase of ovarian cycle; proliferative phase of endometrial cycle b. Follicular phase of ovarian cycle; secretory phase of endometrial cycle c. Luteal phase of ovarian cycle; secretory phase of endometrial cycle d. Luteal phase of ovarian cycle; proliferative phase of endometrial cycle

*a. Follicular phase of ovarian cycle; proliferative phase of endometrial cycle

The MI core skill continuing the paragraph means to do what? a. Listen and reflect on what may be next (as yet unspoken) by the patient. b. Speculate about what a patient or client is feeling. c. Reflect on both sides of the patient or client's ambivalence. d. Paint a picture that can clarify the individual's position.

*a. Listen and reflect on what may be next (as yet unspoken) by the patient. Continuing the paragraph is a method of reflective listening in which the interviewer offers what could potentially be next (as left unsaid) by the client.

The opening of the cervix is referred to as the a. anterior fornix b. cervical isthmus c. cervical os d. posterior fourchette

*c. cervical os The cervix is the lower, narrow portion of the uterus, the cervical canal is tapered at both ends, opening into the vagina via the external cervical os and connecting to the uterus via the internal cervical os.

When preparing for a pelvic examination, all of these steps are important EXCEPT a. allowing for adequate covering for the patient to preserve modesty and warmth b. answering any questions about the examination before beginning the examination c. instructing the patient about what to expect, including rationale for the examination d. instructing the patient that a full bladder will allow for improved assessment

*d. instructing the patient that a full bladder will allow for improved assessment

A key indicator that the patients meet criteria for a mental disorder is a. their symptoms are interfering with functioning at work and home b. they have had the symptoms for more than a month c. they see a psychotherapist d. they have a family history of schizophrenia

a. their symptoms are interfering with functioning at work and home Note if the symptoms currently interfering with functioning at work (school) and home? This is a key question as interference with functioning is often one important indicator of a mental health diagnosis.