FNP

When approaching a toddler to complete a cardiac assessment, the family nurse practitioner would: 1. Allow the toddler to handle the stethoscope while the history is being taken. 2. Explain in detail what procedures will take place and get the toddler involved. 3. Keep the child warm and covered to minimize discomfort. 4. Approach the child by cheerfully calling out his name.

1. Allow the toddler to handle the stethoscope while the history is being taken. Rationale: Toddlers like to make the first move (i.e., let them move closer and initiate eye contact first; do not call out their name because this might frighten them). Allowing them to handle the stethoscope will decrease their fear. Detailed explanations and involvement are more appropriate when assessing a school-age child.

According to ChooseMyPlate, what foods are included in the vegetable group? Select two responses. 1. Chickpeas. 2. Quinoa. 3. Beans. 4. Popcorn. 5. Wild rice.

1. Chickpeas. 3. Beans. Rationale: Beans and peas are legumes, which are included in the vegetable group and are excellent sources of plant proteins. Quinoa, popcorn, and wild rice belong to the grains group.

A father (height 74 inches; onset of puberty was at age 16) is concerned that his 15-year-old son is going to be short. On physical exam, the family nurse practitioner finds Tanner stage II, height 62 inches, and physical exam essentially normal for a well-nourished adolescent. After reviewing his growth records, which indicate a growth pattern of height at the fifth percentile, the most likely diagnosis is: 1. Constitutional growth delay. 2. Familial short stature. 3. Hypopituitarism. 4. Idiopathic gonadotropin deficiency.

1. Constitutional growth delay. Rationale: Familial short stature is not indicated in this case because the father is of normal height. Hypopituitarism would be associated with other findings (micropenis, small testes, immature facies, olfactory defects). Gonadotropin deficiency might be a possibility, but considering all findings in the situation and based on the father having a pubertal onset at age 16 and achieving an average height, the more likely diagnosis is constitutional growth delay.

As an individual ages, which physiologic change would affect sleep? 1. Decreased REM sleep. 2. Increased delta or stage IV sleep. 3. Decreased nocturnal awakenings. 4. Decreased sleep latency.

1. Decreased REM sleep. Rationale: REM sleep begins approximately 120 minutes from sleep onset and recurs in three or four regularly spaced, 10- to 15-minute cycles. REM sleep, associated with skeletal muscle atonia and dreaming, decreases with aging. Delta sleep, or stage IV, is deep sleep and also decreases with age. Nocturnal wakening and sleep latency increase. Sleep is generally less efficient in older patients, who spend more time in bed and less time sleeping.

What is true about the developmental process of sperm or spermatozoa? 1. Each mature sperm contains 23 chromosomes. 2. Sperm become motile immediately at maturation. 3. Spermatogenesis takes place in the prostate. 4. Higher than normal body temperature contributes to sperm

1. Each mature sperm contains 23 chromosomes. Rationale: Each mature sperm develops from mitotic division of diploid (46-chromosome) germ cells (spermatogonium) found on the basement membrane of each seminiferous tubule and becomes primary spermatocytes with 23 chromosomes each. Each of these two cells further divides into two more cells (spermatids), each of which has 23 chromosomes. Motility depends on the biochemicals in semen and in the female reproductive tract. Sperm production needs a temperature that is less than normal body temperature by at least 1°-2°F.

The aging process causes what normal physiologic changes in the heart? 1. Heart size stays the same, and the valves thicken and become rigid secondary to fibrosis and sclerosis. 2. Cardiomegaly occurs along with the prolapse of the mitral valve and regurgitation. 3. Dilation of the right ventricle with sclerosis of pulmonic and tricuspid valves. 4. Hypertrophy of the right ventricle with decreasing capacity and compromised efficiency of the coronary arteries.

1. Heart size stays the same, and the valves thicken and become rigid secondary to fibrosis and sclerosis. Rationale: The heart does not increase in size with normal aging. An enlarged heart is a result of cardiac dysfunction. Dilation of the left ventricle occurs with myocardial infarction and altered cardiac functioning secondary to cardiac disease, not from normal aging. The aging process does cause fibrosis and sclerosis of the cardiac valves; all valves are equally affected.

A child will be able to do which of the following fine motor skills first? 1. Imitate a circle. 2. Imitate a square. 3. Copy a triangle. 4. Copy a diamond.

1. Imitate a circle. Rationale: A child should be able to imitate a circle at 21⁄2 years, copy a square at 4 years, copy a triangle at 5 years, and copy a diamond at 6 years. The ability to draw a shape after watching someone else draw it first is called imitation. Children are always able to imitate a shape or form before being able to copy it.

An appropriate test to check for color perception in a preschooler would be: 1. Ishihara's test. 2. Bruchner's test. 3. Hirschberg's test. 4. Jaeger's test.

1. Ishihara's test. Rationale: Ishihara's test checks for color perception; Bruchner's test checks for the red reflex; Hirschberg's test checks for corneal light reflex; and Jaeger's test checks for near vision.

In the presence of dyslipidemia and diabetes, the National Cholesterol Education Program guidelines set the goal for lipid levels as: 1. LDL <100 mg/dL and triglyceride levels <200 mg/dL. 2. LDL <160 mg/dL and triglyceride levels <240 mg/dL. 3. LDL <100 mg/dL and triglyceride levels <180 mg/dL. 4. LDL <150 mg/dL and triglyceride levels <220 mg/dL.

1. LDL <100 mg/dL and triglyceride levels <200 mg/dL. Rationale: The recommendation is low-density lipoprotein (LDL) <100 mg/dL and triglyceride levels <200 mg/dL for individuals with risk factors for coronary heart disease. All other choices have inaccuracies of goals.

What are the current American Cancer Society (ACS) dietary recommendations for cancer prevention? 1. Maintaining a desirable body weight and eating a variety of foods, including fruits and vegetables, and foods that are high in fiber. 2. Increasing the amount of protein in the diet. 3. Alcohol use in small to moderate amounts. 4. Increase in fresh fruits, fish, and dairy products.

1. Maintaining a desirable body weight and eating a variety of foods, including fruits and vegetables, and foods that are high in fiber. Rationale: The American Cancer Society (ACS) recommends maintenance of a desirable body weight; research has shown an association between increased mortality from various cancers and varying degrees of being overweight. Another recommendation is to eat a wide variety of foods, consistent with the ChooseMyPlate of the U.S. Department of Agriculture and U.S. Department of Health and Human Services. A variety of fruits and vegetables should be included in the daily diet (make half your plate fruits and vegetables) because research has shown an association between lower cancer rates and high fruit and vegetable consumption. High-fiber foods are also recommended; a lower risk of colon cancer is seen in those who consume a high-fiber diet. There are no recommendations to increase the amount of protein in the diet at this time. Due to the high consumption of red meat in the American diet, many people are already receiving large quantities in their current diets. The ACS recommends limiting the daily consumption of alcohol to two drinks for males, one drink for females, and no drinks for pregnant females. They also state that ideally no alcohol should be consumed; regular alcohol consumption has been shown to increase the risk of various cancers.

Which functional assessment tool should the family nurse practitioner use to evaluate the safety of a patient who had a stroke and is planning to return to a home environment? 1. OARS ADL Scale. 2. Bennet Social Isolation Scale. 3. Mini Mental State Examination. 4. Norton Scale.

1. OARS ADL Scale. Rationale: The OARS ADL Scale is the more appropriate screening tool for identifying at-risk populations. The Bennet Social Isolation Scale would be appropriate to evaluate social interactions and resources. The Mini Mental State Examination is used to evaluate memory, orientation, and attention. The Norton Scale is used to evaluate pressure ulcer risk.

Precocious puberty is defined as: 1. Onset of puberty before age 8 in females and 9 in males. 2. Onset of puberty before age 5 in females and 7 in males. 3. Onset of puberty before age 10 in females and 12 in males. 4. Onset of puberty for either gender before older siblings enter into puberty.

1. Onset of puberty before age 8 in females and 9 in males. Rationale: Precocious puberty is defined as beginning at age 8 for females and at age 9 for males.

Which of the following components should be included when taking a history from a patient who is new to the clinic? 1. Past medical and surgical history, family medical and surgical histories, psychosocial history, diet and exercise habits, chemical use, sexual practices, and review of systems. 2. Interval history, past medical history, family medical history, dietary habits, substance use, and sexual practices. 3. Past medical and surgical histories, family medical history, psychosocial history, physical activity, tobacco and other substance use, and sexual practices. 4. The history listed on the form provided to patients for completion before the physical examination is sufficient, and no interview needs to be done.

1. Past medical and surgical history, family medical and surgical histories, psychosocial history, diet and exercise habits, chemical use, sexual practices, and review of systems. Rationale: All areas are important to probe in the initial interview of a new patient. The history will help determine the necessary components of the physical examination and laboratory or radiologic studies that are ordered and the counseling that is done during the appointment.

The family nurse practitioner understands that the infant mortality rate is: 1. The number of infant deaths per 1000 live births. 2. The total number of infant deaths per 1000 persons in the population. 3. The number of infant deaths attributed to specific illnesses. 4. The monthly infant death rate per 100 live births.

1. The number of infant deaths per 1000 live births.

In explaining the purpose of primary prevention programs to a group of nursing students, the family nurse practitioner states that primary prevention programs: 1. Work to lower the incidence of birth defects. 2. Emphasize early diagnosis and treatment of pediatric anomalies. 3. Minimize the handicapping effect of mental retardation. 4. Focus on the prevention of complications and rehabilitation.

1. Work to lower the incidence of birth defects. Rationale: Primary prevention programs exist to prevent disease, malfunctioning, or maladaptation from occurring (e.g., work to lower the incidence of birth defects). Examples of these types of programs include the promotion of a healthy diet, practice of safe sex, and avoidance of alcohol and tobacco. Secondary prevention is early diagnosis and treatment (e.g., screening for tuberculosis or sickle cell disease, breast and testicular self-examination). Tertiary prevention is the prevention of complications and rehabilitation after the disease or condition has occurred (e.g., cardiac rehabilitation; complete blood count done before chemotherapy).

The mother of a 3-month-old infant is concerned because her baby seems to sleep most of the time. The family nurse practitioner's response is based on the knowledge that a 3-month-old infant usually spends: 1. 10 hours daily sleeping. 2. 15-16 hours daily sleeping. 3. 18-19 hours daily sleeping. 4. Most hours of the day sleeping, waking only to eat.

2. 15-16 hours daily sleeping. Rationale: Normally, 3-month-old infants sleep 15-16 hours in a 24-hour period.

Genu valgum is considered normal from: 1. 1-2 years old. 2. 2-6 years old. 3. 8-10 years old. 4. 12-16 years old.

2. 2-6 years old. Rationale: Genu valgum (knock knee) is considered normal from age 2 to 6 years.

The American Diabetes Association recommends screening adults starting at age 45 with a fasting plasma glucose (FPG) test every: 1. 1 year. 2. 3 years. 3. 5 years. 4. 10 years.

2. 3 years. Rationale: The American Diabetes Association recommends screening adults starting at least by age 45 and repeating the fasting plasma glucose (FPG) every 3 years.

The family nurse practitioner understands which factor is most influential in the driving ability of an older adult? 1. Ability to coordinate a clutch transmission. 2. Acuity of vision. 3. Comprehension of the details of road rules. 4. Reaction times.

2. Acuity of vision. Rationale: The most age-dependent factor is sensory change. The older adult patient being assessed for driving capacity should use any prescribed corrective devices for optimal performance. Poor hearing by itself is generally not a limiting factor for motor vehicle operation, and vision assessment has received the greatest emphasis in assessing older drivers. Documenting the best-corrected binocular visual acuity, color perception, and dark vision is basic in assessing driving visual acuity. Laboratory performance studies have not clearly demonstrated that the other factors are highly applicable to the on-the-road skills of the older adult driver.

Which statement is correct concerning healthy sexual developmental tasks? 1. At 9 years of age, children are less self-conscious and readily expose themselves to younger children or parents of the opposite sex. 2. At 16 years of age, adolescents are significantly influenced by the media in terms of sexual content and conduct. 3. At 4 years of age, children distinguish organs associated with each sex and demonstrate increased sexual curiosity. 4. At 5 years of age, children begin to have concerns about body image and begin to investigate their own sexual organs.

2. At 16 years of age, adolescents are significantly influenced by the media in terms of sexual content and conduct. Rationale: Adolescents are greatly influenced by the media and tend to identify with their parents as sexually functioning people. At age 9, children are more interested in their own body and are quite self- conscious. Distinguishing organs and sexual curiosity is true for 6-year- olds, not 4-year-olds. Having concerns about body image and own sexual organs is true for 10-year-olds not 5-year-olds.

A 10-day-old breast-fed infant is brought to the clinic because the mother is concerned about the infant's "yellow-orange" color. History and findings are as follows: mother's blood type is AB-positive; infant's blood type is B-negative and total bilirubin 15 mg/dL. The family nurse practitioner understands that this is most likely caused by: 1. Hemolytic jaundice. 2. Breast-fed jaundice. 3. Obstructive jaundice. 4. Physiologic jaundice.

2. Breast-fed jaundice. Rationale: This is a type of exaggerated physiologic jaundice that occurs frequently in breast-fed babies because of the infant's inadequate caloric intake before the mother's milk comes in. It typically occurs between 7 and 15 days of life, whereas physiologic jaundice occurs most often between the second and fourth day of life. Hemolytic jaundice occurs in an Rh-negative mother who has an Rh-positive infant who becomes isoimmunized.

The family nurse practitioner is discussing making lifestyle changes that will decrease the older adult's risks for cardiovascular disease. Which of the following is most important to include in this discussion? 1. Decrease smoking, increase vitamin supplements, and increase protein intake. 2. Control hypertension, stop smoking, maintain normal weight, and exercise regularly. 3. Maintain normal levels of serum blood sugar and decrease cholesterol intake. 4. Have a yearly physical examination, increase fiber in the diet, and exercise regularly.

2. Control hypertension, stop smoking, maintain normal weight, and exercise regularly. Rationale: Hypertension, smoking, and hyperlipidemia are the major risk factors in the development of cardiovascular disease. Controlling hyperglycemia, increasing high dietary fiber intake, and taking vitamin supplements assist in maintaining a healthy lifestyle but are not as important in preventing cardiovascular disease.

Which pulmonary physiologic change is commonly associated with the aging process? 1. Increased cough response. 2. Decrease in vital capacity. 3. Decreased AP diameter of the thorax. 4. Increase in residual pCO2.

2. Decrease in vital capacity. Rationale: A decrease in the vital capacity, along with a 50% increase in residual volume, occurs during the aging process. Other aging changes include a less effective cough, impaired ciliary action, and weaker respiratory muscles. Increased AP diameter is associated with aging and in COPD patients. pCO2 usually decreases, but pCO2 usually remains unchanged.

In assessing the nutritional status of an older adult patient, the family nurse practitioner identifies the common physiologic change in the gastrointestinal system to be: 1. Increased peristalsis. 2. Decreased absorption of iron. 3. Maintenance of normal fat metabolism. 4. Increased drug metabolism.

2. Decreased absorption of iron. Rationale: Decreased hydrochloric acid, which occurs with aging, leads to decreased absorption of iron and vitamin B12. Fat absorption would decrease, as would peristalsis and drug metabolism.

A nurse practitioner is assessing a 47-year-old patient who has come to the office for an annual physical examination. One of the first physical signs of aging is: 1. Having more frequent aches and pains. 2. Diminished eyesight, especially close vision. 3. Increasing loss of muscle tone. 4. Diminished hearing or taste.

2. Diminished eyesight, especially close vision. Rationale: Refractive errors are the most frequent eye problems in the United States. Blurred vision results from an inappropriate length of the eye and/or shape of the eye or cornea, and almost all errors—myopia (nearsightedness), hyperopia (farsightedness), astigmatism (distorted vision at all distances), and presbyopia (a form of farsightedness that usually occurs between 40 and 45 years of age)—can be corrected by eyeglasses, contact lenses, or, in some cases, surgery. Recent studies conducted by the National Eye Institute showed that proper refractive correction could improve vision among 11 million Americans who are 12 years and older.

The major influence on the timing of puberty is: 1. Exposure to light. 2. Genetics. 3. General health. 4. Nutrition.

2. Genetics. Rationale: Genetics is the primary determinant of the timing of puberty. Factors such as geographic location, exposure to light, nutritional status, and health status play a role, but genetics is the major influence.

Which assessment is a normal physiologic change of the respiratory system that occurs with aging? 1. Decreased residual lung volume. 2. Hyper-resonance. 3. Increased forced vital capacity. 4. Increased tactile fremitus.

2. Hyper-resonance. Rationale: A normal age-related change is an increase in the anteroposterior diameter that results in hyperresonance. Age-related changes result in an increase in the residual lung volume (RV) and decrease in the forced vital capacity (FVC). An increased tactile fremitus is a deviation that is of diagnostic significance.

When treating an infection in the older adult, the family nurse practitioner must consider that: 1. Thymus-derived immunity is increased. 2. Immune function declines with age. 3. Immune function increases with age. 4. Antibody production increases.

2. Immune function declines with age. Rationale: Immune function declines with age, making the older adult more susceptible to infection. The older adult has less thymus-derived immunity because of the shrinking of the thymus gland, thus making it more difficult for the older adult to produce antibodies.

The family nurse practitioner is discussing anticipatory guidance with the parents of a 26-week-gestation premature infant who is now 2 months old and being discharged from the neonatal intensive care unit (NICU). Which of the following would be most important to include in the discussion? 1. Fluoride supplement due to lack of breast-feeding. 2. Lights to be on 24 hours a day. 3. Decreased handling and stimulation. 4. Bright colors and continuous music for stimulation.

2. Lights to be on 24 hours a day. Rationale: Premature infants who have spent an extended period in the neonatal intensive care unit (NICU) take 6-10 months to be deinstitutionalized to the noise and light. These must be decreased slowly over time.

The most common cause of infant deaths worldwide is: 1. Pneumonia. 2. Malnutrition. 3. Acquired immunodeficiency syndrome (AIDS). 4. Beta-streptococcal infections.

2. Malnutrition. Rationale: Malnutrition results in the deaths of more infants worldwide than any other syndrome.

The characteristics of an innocent heart murmur in children include: 1. Asymptomatic, loud diastolic rumble, grades I to V. 2. Mid-systolic, no thrill, and asymptomatic. 3. Asymptomatic with an S4 heard at lower left sternal border. 4. May disappear on sitting and following any type of physical activity.

2. Mid-systolic, no thrill, and asymptomatic. Rationale: Characteristics of innocent murmurs include mid-systolic; asymptomatic; less than a grade III; loudest in pulmonic area (2-3 left intercostal space at the left sternal border); no radiation to other areas; may disappear on sitting; and may intensify with fever, activity, anemia, and stress. Any S4 sound is considered pathologic in children as well as in adults.

What are tertiary prevention activities for an older adult woman who has had a stroke? 1. Annual influenza vaccination. 2. Physical therapy program. 3. Annual mammogram. 4. Annual ophthalmologic examination to evaluate for glaucoma.

2. Physical therapy program. Rationale: The physical therapy program will assist the older adult woman in restoring her optimum level of functioning after a stroke. An annual influenza vaccination is a primary prevention activity nonspecific to the care of a patient with a stroke. An annual mammogram and ophthalmologic examination to evaluate for glaucoma are examples of secondary prevention activities nonspecific to the care of a patient with a stroke.

At a school clinic, a 14-year-old girl comes in complaining of dizziness midmorning and then later that morning. The practitioner should question the adolescent regarding diet/nutrition, drug use, and: 1. Asthma. 2. Pregnancy. 3. Heart disease. 4. Stress.

2. Pregnancy. Rationale: Although all areas would be assessed, pregnancy is a common reason for midmorning syncope in adolescents associated with altered nutrition.

The family nurse practitioner notices that a 9-month-old infant who was born 2 months prematurely only reaches for an object with his left hand. The nurse would: 1. Record these findings as normal for a premature infant. 2. Refer the infant for further evaluation. 3. Order a muscle biopsy to rule out muscular dystrophy. 4. Make a note on the chart that the child will probably be left-handed.

2. Refer the infant for further evaluation. Rationale: The infant should be referred for further evaluation. Handedness before 1 year of age may be an early sign of cerebral palsy. The history of prematurity could be an indication of anoxia at birth and would warrant further investigation. The earlier a child is diagnosed; the earlier intervention can be started.

Growth hormone secretion tests, along with a history and physical exam, have indicated a positive diagnosis for delayed puberty. The next step for the family nurse practitioner is to: 1. Treat with hormone replacement. 2. Refer to a pediatric endocrinologist. 3. Treat with hormone stimulation therapy. 4. Refer for possible pituitary tumor.

2. Refer to a pediatric endocrinologist. Rationale: Once the tentative diagnosis is made, the family nurse practitioner should refer to a pediatric endocrinologist for further workup. It is beyond the scope of the family nurse practitioner's practice to treat the patient at this point.

An adolescent female with breast budding and sparse, straight, lightly pigmented pubic hair along the medial border of the labia is at which Tanner stage of sexual maturity? 1. Stage I. 2. Stage II. 3. Stage III. 4. Stage IV.

2. Stage II. Rationale: Tanner has five stages of sexual maturity for both males and females. Stage I for both is preadolescent, and stage V for both is mature or adult development. Stages II, III, and IV chronicle development of breasts, pubic hair distribution, penis, and testes. This young female is demonstrating characteristics of Tanner stage II. Tanner Stage Pubic Hair I None II Countable; straight; increased pigmentation and length III Darker; begins to curl; increased quantity on mons pubis IV Increased quantity; coarser texture; labia and mons well covered V Adult distribution; with feminine triangle and spread to medial thighs Breast Development I None II Breast bud present; increased areolar size III Further enlargement of breast; no secondary contour IV Areolar area forms secondary mound on breast contour V Mature; areolar area is part of breast contour; nipples project

A 13-year-old male is seen by the family nurse practitioner for a sports physical. The genital exam reveals straight dark pubic hair at the base of the penis and testicular enlargement. Using the Tanner scale, the family nurse practitioner would record these findings as: 1. Tanner stage I. 2. Tanner stage II. 3. Tanner stage III. 4. Tanner stage IV.

2. Tanner stage II. Pubic Hair I None II Countable; straight; increased pigmentation and length III Darker; begins to curl; increased quantity IV Increased quantity; coarser texture; covers most of pubic area V Adult distribution; spread to medial thighs and lower abdomen Genital Development I Prepubertal II Testicular enlargement; slight rugation of scrotum III Further testicular enlargement; penile lengthening begins IV Testicular enlargement continues; increased rugation of scrotum; increased penile length V Adult genitalia

A mother of a 2-year-old brings her child to see the family nurse practitioner because the child has been irritable and has a small "knot" under the left ear. The child has no history of fever, upper respiratory infection, or pulling at the ears. What condition is the most likely reason for these symptoms? 1. Otitis media. 2. Teething. 3. Tonsillitis. 4. Otitis externa.

2. Teething. Rationale: At approximately 20 months of age, the lower second molars erupt and, at 24 months, the upper second molars erupt. With a history of irritability and lymph node enlargement without fever or other symptoms, teething is the most likely cause of discomfort. With otitis media and tonsilitis, the family nurse practitioner would not observe a temperature elevation. The child with otitis externa would have pain (around the tragus) and more than likely would not be pulling at the ears.

The family nurse practitioner is examining a 6-month-old infant. What would be the anticipated findings on examining the infant's fontanels? 1. Both anterior and posterior should be open. 2. The anterior should be open, the posterior closed. 3. Both anterior and posterior should be closed. 4. The anterior should be closed, the posterior open.

2. The anterior should be open, the posterior closed. Rationale: The posterior fontanel is usually closed by 2 months of age; the anterior fontanel closes at about 24 months of age.

The mother of a 6-month-old infant tells the family nurse practitioner that her infant is now taking homogenized milk instead of an iron-fortified infant formula. The family nurse practitioner's response would be based on the knowledge that: 1. Homogenized milk has the same solute load as formula and is a safe alternative to iron-fortified formula if vitamin supplements are given. 2. There is an increased incidence of occult gastrointestinal bleeding and the development of iron-deficiency anemia in infants fed homogenized milk before 1 year of age. 3. Once the infant is taking solid foods regularly, there is no need to continue offering iron-fortified formula. 4. Homogenized milk has too high of a fat content and needs to be diluted 2:1 with water.

2. There is an increased incidence of occult gastrointestinal bleeding and the development of iron-deficiency anemia in infants fed homogenized milk before 1 year of age. Rationale: There is an increased incidence of occult gastrointestinal bleeding and iron-deficiency anemia in infants fed homogenized milk before 1 year of age. Homogenized milk does not have the same solute load as formula and is not a safe alternative to iron-fortified formula, even if vitamin supplements are given. The solute load of whole milk is too much for the infant's immature kidneys. The infant needs to continue taking iron-fortified formula for the first year of life, if possible.

The family nurse practitioner selects which assessment tool to evaluate balance and gait problems in older adult patients? 1. Lawton & Brody Balance and Coordination Scale. 2. Tinetti Balance and Gait Evaluation. 3. Instrumental Activities of Daily Living Scale. 4. Index of Independence of Activities of Daily Living.

2. Tinetti Balance and Gait Evaluation. Rationale: The Tinetti Balance and Gait Evaluation is an activity-based test that asks the patient to perform tasks, such as sitting and rising from a chair, turning, and bending. It requires no more than 15 to 20 minutes to perform. Another appropriate test for the assessment of falls is the timed "Up and Go" test, which assesses balance and gait speed. The Instrumental Activities of Daily Living Scale assesses complex tasks such as shopping, laundry, and food preparation. The Index of Independence of Activities of Daily Living helps identify daily activities with which the patient needs assistance.

In performing a physical exam, the family nurse practitioner allows the child to touch the medical equipment first, and then begins by examining the extremities. This sequence would be most appropriate for a patient in what age group? 1. Infant. 2. Toddler. 3. School-age child. 4. Adolescent.

2. Toddler. Rationale: Allow a toddler to explore the instruments and start with the extremities. Save the most invasive exam (of the head) for last. In infants, auscultate the heart and lungs while the infant is quiet, then proceed to do a head-to-toe assessment. In school-age and adolescent children, a head-to-toe sequence is preferred.

The family nurse practitioner is performing a physical exam on a 13- year-old female. It is important for the family nurse practitioner to incorporate developmental principles such as: 1. Maintain a comfortable silence. 2. Verbally affirm normalcy of physical findings. 3. Discuss only the major areas of abnormality. 4. Verbally address problems of sexually transmitted diseases.

2. Verbally affirm normalcy of physical findings.

The parents of a newborn state, "We will probably not have our baby immunized because we are concerned about the risk of our child being injured." Which is the best response for the family nurse practitioner to make? 1. "It is your decision, and I think it is wrong." 2. "Have you talked with your parents about this? They can probably help you think about this decision." 3. "The risks of not immunizing your baby are greater than the risks from the immunizations, not only to your child but to others around him." 4. "You are making a mistake, but we don't need any permission to administer it anyway."

3. "The risks of not immunizing your baby are greater than the risks from the immunizations, not only to your child but to others around him." Rationale: The benefits provided by most vaccines extend beyond benefit to the individual who is immunized. There is also a significant public health benefit. Parents who choose not to immunize their own children increase the potential for harm to other persons in four important ways. First, should an unimmunized child contract disease, that child poses a potential threat to other unimmunized children. Second, even in a fully immunized population, a small percentage of immunized individuals will either remain or become susceptible to disease. These individuals have done everything they can to protect themselves through immunization, yet they remain at risk. Third, some children cannot be immunized because of underlying medical conditions. These individuals derive important benefit from herd immunity and may be harmed by contracting disease from those who remain unimmunized. Finally, immunized individuals are harmed by the cost of medical care for those who choose not to immunize their children and whose children then contract vaccine-preventable diseases.

The family nurse practitioner would expect a child to follow a one-step command that is given without a gesture and with only four to six individual words at what age? 1. 7 months. 2. 9 months. 3. 14 months. 4. 20 months.

3. 14 months. Rationale: A child should be expected to follow a one-step command (using no gestures and only four to six individual words) between 101⁄2 and 161⁄2 months of age.

Genu varum up to 20 degrees is normal until age: 1. 18 years. 2. 5 years. 3. 18 months. 4. 6 months.

3. 18 months. Rationale: Genu varum (bowleg) of up to 20 degrees is a normal finding in children until the age of 18 months.

The following sequence is recommended for well-child examinations up to the age of 5 years: 1. 2 weeks, 2 months, 4 months, 6 months, 1 year, 15 months, 18 months, and every year from ages 2-5. 2. 2 months, 4 months, 6 months, 9 months, and annually from years 1- 5. 3. 2 weeks, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, and annually years 2-5. 4. The same intervals recommended for immunizations.

3. 2 weeks, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, and annually years 2-5. Rationale: These are the recommended health evaluation intervals for children to obtain regular assessment information regarding growth and development and to administer recommended immunizations.

The plantar fat pad, which makes a young child appear to have pes planus, is normal until: 1. 6 months-1 year old. 2. 1-2 years old. 3. 2-5 years old. 4. 6-8 years old.

3. 2-5 years old. Rationale: Most children are flat-footed (pes planus) up to 2-5 years of age due to the plantar fat pad under the medial longitudinal arch, which protects it while the arch develops.

At what age should a routine screening mammography begin for women who have no increased risk of breast cancer? 1. Before 30 years old. 2. At age 35. 3. At age 40. 4. Before age 50.

3. At age 40. Rationale: In the summer of 1997, the National Institutes of Health (NIH) and American Cancer Society changed the recommendation to begin yearly mammography screenings at age 40. This was supported by the U.S. Preventive Services Task Force (USPSTF) in implementing the 2002 recommendation on breast cancer screening.

During a routine well-child exam, a mother reports that her 5-month- old who weighs 15 lb and was sleeping all night at 3 months of age is now waking up hungry in the middle of the night? A diet history reveals that the infant is taking six 6-oz bottles of formula in a 24-hour period and has 2 tbsp of rice cereal in the morning. What teaching should the family nurse practitioner give the mother? 1. Increase the amount of formula at each feeding to 8 oz. 2. Take the child off formula and switch to homogenized milk. 3. Decrease the amount of formula to 32 oz in 24 hours and add fruits, cereals, and juices. 4. Continue the same amount of formula and introduce a variety of baby foods.

3. Decrease the amount of formula to 32 oz in 24 hours and add fruits, cereals, and juices. Rationale: Consumption of 32 oz of formula per day is usually an indicator of the need for solids. Formula is recommended for the first year of life. Nutritional requirements are 110-120 cal/kg/day. Introduction of solids usually occurs between 4 and 6 months of age.

The production of sperm usually begins during the: 1. Eighth week of gestation. 2. Beginning of puberty. 3. End of puberty. 4. Eighth month of gestation.

3. End of puberty. Rationale: Between the ages of 9 and 12 years, the gonads produce more of the sex hormones, which trigger sexual maturation or puberty. Puberty in males begins at approximately age 11 and lasts for 2-3 years, ending with the first ejaculation that contains mature sperm.

The number one cause of accidental death in patients older than 65 years of age is: 1. Motor vehicle accidents. 2. Poisoning. 3. Falls. 4. Drowning.

3. Falls. Rationale: Falls are the major cause of morbidity and mortality in the elderly. A fall is often the precipitating event for a cascade of problems leading to death. Complications from falls include fractures, pneumonia, pressure ulcers, pain, and immobility.

The family nurse practitioner understands the following about birth defects and growth and developmental problems in mothers who have prenatal alcohol exposure: 1. If alcohol is ingested late in the pregnancy, there is a higher incidence of post-maturity syndrome. 2. The practice of drinking alcohol while eating a meal significantly reduces the risk of fully expressed fetal alcohol syndrome. 3. If alcohol is ingested in large amounts early in the pregnancy, there is an increased incidence of fully expressed clinical features of fetal alcohol syndrome. 4. Growth retardation is associated with early trimester alcohol consumption and post-maturity syndrome.

3. If alcohol is ingested in large amounts early in the pregnancy, there is an increased incidence of fully expressed clinical features of fetal alcohol syndrome. Rationale: Large amounts of alcohol early in the pregnancy have the most devastating effects on the maturing fetus. There is no safe, established dose for alcohol in pregnancy. Food consumption along with alcohol intake does not reduce the risk of defects. Ingesting alcohol in the later months of pregnancy is associated with an increased incidence of premature and small-for-gestational-age neonates.

A mother asks the family nurse practitioner if an infant walker will help her 6-month-old learn to walk faster. The family nurse practitioner's response is based on the knowledge that: 1. Infant walkers help strengthen the infant's extremities and prepare them to walk. 2. Infants who are placed in walkers usually walk about 1 month earlier than other infants. 3. Infant walkers are dangerous and should not be recommended for use. 4. There have been very few injuries related to the use of infant mobile walkers.

3. Infant walkers are dangerous and should not be recommended for use. Rationale: The American Academy of Pediatrics (AAP) Committee on Injury and Poison Control issued a policy statement on the use of infant walkers (Pediatrics 108: 790-792). Because data indicate a considerable risk of major and minor injury and even death from the use of infant walkers, and because there is no clear benefit from their use, AAP recommends a ban on the manufacture and sale of mobile infant walkers. If a parent insists on using a mobile infant walker, it is vital that they choose a walker that meets the performance standards of ASTM F977-96 to prevent falls down stairs. Stationary activity centers should be promoted as a safer alternative to mobile infant walkers.

A mother is concerned that her 7-month-old breast-fed infant is not getting enough to eat. The infant weighed 7 lb, 8 oz at birth and was 19 inches long. At 6 months of age, he weighed 15 lb and was 25 inches long. He now weighs 15 lb and is 251⁄2 inches long. The family nurse practitioner's response is based on the knowledge that: 1. Infants should gain 2-4 oz per week and 1⁄2 inch in height per month during the first 6 months of life. 2. Infants should triple their birth weight by 6 months of age. 3. Infants should gain 3-4 oz per week and 1⁄2 inch in height per month from 6-12 months of age. 4. Infants should gain 1-2 oz per week and 1 inch in height per month from 6-12 months of age.

3. Infants should gain 3-4 oz per week and 1⁄2 inch in height per month from 6-12 months of age. Rationale: Infants should gain 3-4 oz per week and 1⁄2 inch in height per month from 6-12 months of age. This child also doubled his birth weight by 6 months of age, as expected. Age Weight Length/Height 0-6 months - 6-8 oz/week (doubles birth weight by 5-7 months) and 1 in/month 6-12 months - 3-4 oz/week (triples birth weight by 1 year) and 1⁄2 in/month

Which of the following guidelines should the family nurse practitioner follow when developing educational materials? Select two guidelines. 1. Present the most important material first using all capital letters for emphasis. 2. Provide the information in English along with three other languages. 3. Keep sentences short and to the point using graphic images for clarification. 4. Keep a readability level no higher than an eighth grade level. 5. Use only brightly colored paper and a bold typeface to enhance learning.

3. Keep sentences short and to the point using graphic images for clarification. 4. Keep a readability level no higher than an eighth grade level. Rationale: The average adult in the United States reads at about the sixth to eighth grade level. Printed materials must be written to a level of readability so that they can be understood. Do not use all capital letters or all bolding because such words are difficult to read. In addition, it is helpful to write in the active versus the passive voice, to use one- and two- syllable words, to avoid complex grammatical structures, and to express only one idea in each sentence. Well-chosen and easily understood graphics can significantly enhance the literature, as does the selection of paper on which to print the material.

An 18-month-old's feet turn inward. The mother is concerned, although the child is unaware of the problem. The differential diagnosis includes all except: 1. Femoral anteversion. 2. Metatarsus adductus. 3. Legg-Calvé-Perthes disease. 4. Adducted great toe.

3. Legg-Calvé-Perthes disease. Rationale: In-toeing is a common problem in children and can result from femoral anteversion, adduction of the great toe, medial tibial torsion, and metatarsus adductus. Legg-Calvé-Perthes disease is commonly seen in older children (ages 4 to 8 years) who have loss of hip medial rotation.

What is the most common occupationally related health problem? 1. Repetitive motion injury. 2. Hearing loss. 3. Lung disease. 4. Cancer.

3. Lung disease. All these disorders can be associated with workplace exposure, but currently, lung disease is still the most common occupationally related disease. Representing approximately 10% of the chronic occupational diseases, lung disease has been named as one of 10 leading work-related disease and injury categories by the National Institute for Occupational Safety and Health (NIOSH). Musculoskeletal injuries are on the rise.

A healthy 4-month-old infant weighing 13 lb 3 oz has started waking up at night after previously sleeping for periods of 9-11 hours. The infant takes 32 oz of formula in a 24-hour period. The family nurse practitioner recommends: 1. Increase the formula to 38 oz in a 24-hour period. 2. Start introducing one food item at a time, beginning with vegetables. 3. Maintain current formula intake and introduce small amounts of rice cereal. 4. Switch to whole milk instead of formula.

3. Maintain current formula intake and introduce small amounts of rice cereal. Rationale: If the infant has been satisfied up to this point (by sleeping for long intervals), the infant probably needs additional calories in the form of rice cereal. Adding increased amounts of formula can lead to iron-deficiency anemia.

The mother of a 6-month-old infant tells the family nurse practitioner that the baby was spitting up his formula so she put him on goat milk. The family nurse practitioner is concerned because goat milk places the infant at risk of developing: 1. Rickets. 2. Scurvy. 3. Megaloblastic anemia secondary to folic acid deficiency. 4. Botulism.

3. Megaloblastic anemia secondary to folic acid deficiency. Rationale: Goat milk can cause folic acid deficiency, which can lead to megaloblastic anemia. Rickets is caused by the lack of vitamin D. Scurvy is caused by a lack of ascorbic acid (vitamin C) in the diet. Botulism is food poisoning caused by an endotoxin produced by the bacillus Clostridium botulinum. Most botulism cases occur after eating improperly canned or cooked foods. Infants have been known to develop botulism from raw honey that is placed on their pacifiers.

When assessing the cranial nerves in a young child, the family nurse practitioner should: 1. Obtain help from the parents to enlist the child's cooperation. 2. Defer assessing the cranial nerve until the child is older. 3. Modify the physical exam technique based on the child's developmental level. 4. Expect minimal variations among age groups.

3. Modify the physical exam technique based on the child's Rationale: Because assessing cranial nerves can be a challenging task, the family nurse practitioner should employ techniques that consider the child's developmental level.

An appropriate treatment for overweight children under 8 years of age would be to: 1. Administer an appetite suppressant. 2. Eliminate all carbohydrates in the diet. 3. Plan a program of activity, balanced diet, and exercise. 4. Use vitamin therapy and herbal teas.

3. Plan a program of activity, balanced diet, and exercise. Rationale: An approach with a well-balanced diet, activity, and exercise is necessary for weight reduction. This allows for a slow approach to weight loss that incorporates healthy behavior habits.

An African American mother and her newborn are seen by the family nurse practitioner for a well-baby visit. The mother is responsive to the baby's cries, and the baby comforts easily and makes frequent eye contact with the mother. On exam, the family nurse practitioner notes the following: height and weight are at the 75th percentile on growth charts, there is a strong sucking reflex, and there is a large blue-black macular area over the lumbosacral area. The family nurse practitioner should: 1. Contact a social worker and report the mother to Child Protective Services immediately. 2. Refer the mother and infant to a dermatologist. 3. Recognize that the blue-black spot is a congenital skin spot, and counsel the mother that no treatment is necessary. 4. Prescribe clotrimazole cream 1% (Mycelex) bid for 4 weeks.

3. Recognize that the blue-black spot is a congenital skin spot, and counsel the mother that no treatment is necessary. Rationale: Congenital dermal melanocytosis, also known as Mongolian spots, are often found in infants of African American, Hispanic, Native American, and Asian descent. These spots are benign and tend to fade and disappear by age 3, requiring no intervention or treatment. Abuse is not suspected because signs of a healthy mother-infant relationship are noted (e.g., mother and infant respond positively to each other, and the baby is thriving).

A patient is continuing his recovery at home after an extensive surgery. The family nurse practitioner would instruct the patient to increase intake of what foods to promote healing? 1. Tomatoes, rice, and whole-bran cereal. 2. Milk, poultry, and yellow vegetables. 3. Red meat, oranges, and green beans. 4. Liver, corn, and eggs.

3. Red meat, oranges, and green beans. Rationale: The patient needs an increased intake of protein and vitamin C to promote healing. Red meat, citrus fruits, and green vegetables will give the highest amounts of these elements from the selections offered.

During a teaching session, the family nurse practitioner instructs the patient regarding normal skin lesions in the older population. These would include: 1. Seborrheic dermatitis. 2. Senile keratosis. 3. Senile lentigo. 4. Squamous cell.

3. Senile lentigo. Rationale: The senile lentigo is a gray-brown, irregular, macular lesion on sun-exposed areas of the face, arms, and hands that are normal skin lesions. The other lesions are common abnormal skin lesions in the older adult.

When an older adult patient has an alteration in the sensory-perceptual function of hearing, which plan would be most appropriate for the family nurse practitioner to implement during a health promotion session? 1. Increase the pitch of the voice. 2. Stand behind the patient when speaking. 3. Speak in a tone that does not include shouting. 4. Use typical complex sentences to prevent insulting the patient.

3. Speak in a tone that does not include shouting. Rationale: Shouting increases the pitch of the voice. In presbycusis, or hearing loss in older adults, high-pitched consonant sounds are the first to be affected, and the change may occur gradually. The family nurse practitioner should face the patient when speaking. If the nurse needs to stand behind the patient, touch is used to get the patient's attention. Simple sentences should be used to facilitate understanding.

A mother of 2-year-old twins is concerned that the twins do not talk very much and seem to have their own "private" language. The family nurse practitioner should: 1. Tell the mother to spend some individual time with the twins so that they learn language skills. 2. Perform a pure-tone audiometry. 3. Tell the mother that this is normal for twins or siblings that are close in age. 4. Refer to a speech pathologist for further testing.

3. Tell the mother that this is normal for twins or siblings that are close in age. Rationale: It is normal for twins or siblings close in age to develop a "private" language understood only by them. Although it is important for the mother to spend individual time with each child, this is not what the question is asking. Pure-tone audiometry is done after age 3. There is no need for a referral to a speech pathologist at this time.

What is produced by the testes? 1. Alkaline phosphate. 2. Gonadotropin. 3. Testosterone. 4. Acid phosphate.

3. Testosterone. Rationale: The testes have two functions: production of gonadotropin (androgens and testosterone) and production of gametes (sperm). The sperm are produced in the seminiferous tubules of the testes. The androgens and testosterone are produced mainly by Leydig cells of the testes (androgens and testosterone are also produced by the adrenal glands). Gonadotropin hormone is produced and secreted by the anterior pituitary gland.

The family nurse practitioner understands that as the patient ages changes occur in the cells of the immune system. Which statement reflects these changes? 1. The cells are able to proliferate as they would in the younger patient. 2. The total number of T cells is decreased. 3. There is an increased ability to respond to infections with previously produced "remembered" antibodies. 4. The immune system is able to respond to antigenic stimulation as in the younger patient.

3. There is an increased ability to respond to infections with previously produced "remembered" antibodies. Rationale: Older adult patients are able to respond to infections with previously produced "remembered" antibodies, but they are less able to respond to antigenic stimulation (new antigens) than younger patients. In the older adult patient, the cells of the immune system also are less likely to proliferate. The total number of T cells remains the same with age, but T-cell function decreases and cells have decreased cytotoxicity.

The mother of a 5-month-old infant brings her child to the clinic because the infant awakens frequently at night and cries. The family nurse practitioner understands that the most common cause of night awakening in healthy infants is: 1. Night terrors and nightmares. 2. Separation anxiety. 3. Trained night crying. 4. Hunger pain and wet diaper.

3. Trained night crying. Rationale: Trained night crying can become a problem in infants who are not allowed to learn to "self-quiet." Activities such as rocking to sleep, exciting play activities before bedtime, and picking up the infant as soon as he cries can lead to trained night crying. Separation anxiety occurs in infants after 6 months of age. The majority of infants after 4 months of age are able to sleep throughout the night. Nightmares and night terrors occur at a later age.

The family nurse practitioner examines a 2-week-old newborn during a first clinic visit. The family nurse practitioner notes dysmorphic facial features. The family nurse practitioner's evaluation includes: 1. Ordering a chromosome analysis. 2. Completing a postnatal history. 3. Writing a detailed physical exam and perinatal history. 4. Avoiding discussion with parents until diagnostic studies are completed.

3. Writing a detailed physical exam and perinatal history. Rationale: The first and most important part of all data gathering starts with a detailed history and physical exam. A detailed, objective description of the dysmorphic features is essential for comparison to textbook descriptions and other data. Although chromosome analysis will probably be ordered, it is not done initially. Parents should be included in the discussion of the findings and kept informed of the progress throughout the evaluation process.

A routine well-child visit for a healthy full-term infant should include a hemoglobin and hematocrit test at: 1. 1 month of age. 2. 4 months of age. 3. 6-9 months of age. 4. 1 year of age.

4. 1 year of age. Rationale: It is important in a healthy infant to check the hemoglobin and hematocrit levels at 1 year, as per current American Academy of Pediatrics (AAP) recommendations. For the first 4-6 months infants can rely on their body's own storage supply of iron.

The family nurse practitioner knows that language is the best single measure of normal cognitive development in early childhood. At what age do children begin to combine two words together? 1. 8-10 months. 2. 10-12 months. 3. 12-15 months. 4. 14-23 months.

4. 14-23 months. Rationale: Two-word combinations are expected at 14-23 months of age.

The family nurse practitioner understands that sulfonamide medications are not recommended for children under which age? 1. 18 months. 2. 12 months. 3. 6 months. 4. 2 months.

4. 2 months. Rationale: Newborns and infants up to 2 months of age may develop kernicterus because sulfonamides displace bilirubin from the plasma proteins.

Which of the following is NOT a developmental screening tool used for children? 1. Modified Checklist for Autism in Toddlers (M-CHAT). 2. Ages and Stages Questionnaire (ASQ). 3. Denver Developmental Screening Test (DDST). 4. Activities-specific Balance Confidence (ABC) Scale.

4. Activities-specific Balance Confidence (ABC) Scale. Rationale: The Activities-specific Balance Confidence Scale (ABC) is used in older adults to assess for fall risk. All other scales and tests are pediatric related.

A 1-year-old reaches for the family nurse practitioner's stethoscope with his left hand and the father says, "It looks like he's going to be a lefty, just like his old man!" The nurse's response is based on the knowledge that: 1. Male infants usually have the same hand preference as their fathers. 2. Hand preference is well established by 9 months of age. 3. Children will not demonstrate a hand preference until about age 6. 4. Children usually develop handedness by 18-24 months of age.

4. Children usually develop handedness by 18-24 months of age. Rationale: Children usually develop handedness by 18-24 months of age. The hand preference is usually fixed after 5 years of age.

Which of these clinical findings would indicate a deviation from the normal age-related changes in the neurologic system that may have some diagnostic significance for the older patient? 1. Decreased sense of touch. 2. Increased tolerance to pain. 3. Decreased short-term memory. 4. Decreased ability to maintain balance.

4. Decreased ability to maintain balance Rationale: Decreased ability to maintain balance may indicate a cerebellar complication. The first three findings are normal age-related changes.

As an individual ages, which physiologic change would affect responses to pharmacologic agents? 1. Increased gastric emptying. 2. Increased glomerular filtration rate. 3. Decreased percentage of body fat. 4. Decreased albumin concentration.

4. Decreased albumin concentration. Rationale: Medications are often protein bound (not fat bound); albumin decreases with age. A low albumin level decreases the number of protein-binding sites, causing an increase in the amount of free drug in the plasma. Drug overdose may occur in elderly patients. Gastric emptying and glomerular filtration rate decrease with the aging process.

Which physiologic factor of aging contributes to incontinence in older adults? 1. Decreased vascularity of the bladder mucosa. 2. Increased urethral closing pressure. 3. Increased ability to concentrate urine. 4. Decreased bladder capacity.

4. Decreased bladder capacity. Rationale: Decreased bladder capacity, decreased ability to concentrate urine, and decreased urethral closing pressure after menopause lead to incontinence. Other factors are depression, decreased mobility, decreased vision, and lack of attention to bladder cues of feelings of fullness.

Which of the following is an example of a community health promotion activity? 1. High school-based family planning clinic. 2. Work-site urgent care clinic. 3. Asthma follow-up clinic in an elementary school. 4. Employer-sponsored multi-phasic health screening.

4. Employer-sponsored multi-phasic health screening. Rationale: Multi-phasic health screening is a form of periodic health surveillance in which participants undergo a battery of laboratory or diagnostic tests to determine risk factors and disease detection. The other three settings described are not examples of community health promotion activities; they are secondary care settings. The locations of the two clinics are in community settings.

The father of a 12-year-old male tells the family nurse practitioner that he is afraid that his son is "getting fat." The child is at the 50th percentile for height and the 75th percentile for weight on the growth chart. The most appropriate response would be: 1. Reassure the father that the son is not "fat." 2. Assess family for the presence of obesity and genetic factors. 3. Suggest a low-calorie, low-fat diet. 4. Explain that this is typical of the growth pattern of boys at this age, and encourage exercise and a healthy diet.

4. Explain that this is typical of the growth pattern of boys at this age, and encourage exercise and a healthy diet. Rationale: It is normal for boys at this age to appear heavier before they have their "growth spurt." Reassuring the father, although appropriate, is not the best response. Although the findings are within normal limits, it would not be necessary to assess the family for the presence of obesity. Low-calorie, low-fat diets are contraindicated for the growing child. Encouraging exercise and a healthy diet would be important to prevent obesity.

Which of the following best describes the benefit of sports screening physicals? 1. Screening for undiagnosed cardiomyopathy. 2. Assessment of drug and alcohol use. 3. Estimation of aerobic capacity. 4. Identification of risk for an adverse cardiovascular event.

4. Identification of risk for an adverse cardiovascular event. Rationale: The primary goal and benefit of a sports screening physical is to identify athletes at risk for an adverse cardiovascular event. The physical also screens for athletes at risk for orthopedic injuries secondary to previously unresolved injuries; however, this is not the primary benefit. Even with a thorough history from the screening exam, it is unlikely to completely eliminate injuries or be able to identify all underlying health problems. The other options (assessing drug and alcohol use and estimating aerobic capacity) are not the benefit of the sports screening physical.

What are the normal physiologic changes in the thyroid gland that occur with aging? 1. Hypertrophy with a decrease in triiodothyronine (T3) and thyroxine (T4). 2. Normal size with increase in thyroid-stimulating hormone (TSH) and decrease in T4. 3. Atrophy of the gland with a decrease in TSH, T3, and T4. 4. Increase in nodularity with normal TSH and T4.

4. Increase in nodularity with normal TSH and T4. Rationale: There is usually adequate secretion of thyroid-stimulating hormone (TSH) and a normal serum concentration of thyroxine (T4). Aging may produce fibrosis and increased nodularity, but overall the thyroid function remains within normal limits.

The family nurse practitioner indicates an understanding of the normal aging process with which documentation of the gastrointestinal (GI) system in the physical examination? 1. Increase in the size of the liver (16 cm). 2. Absent bowel sounds. 3. Femoral bruit. 4. Increased adipose tissue.

4. Increased adipose tissue. Rationale: Common age-related changes in the gastrointestinal (GI) system include increased adipose tissue, decreased liver size, reduced motility and peristalsis, decreased acid secretions and motor activity of the stomach, and decreased glomerular filtration rate. Absence of bowel sounds after five full minutes and bruits are deviations of clinical significance.

A new mother presents to the clinic inquiring about when she should start feeding her 2-month-old infant solid foods. The family nurse practitioner should recommend that the mother: 1. Start the infant on meat and eggs now. 2. Wait until the infant is 1 year old before introducing solid foods. 3. Start the infant on cereals now. 4. Introduce one new food at a time when the infant is 4-6 months old.

4. Introduce one new food at a time when the infant is 4-6 months old. Rationale: Solid foods are not recommended until the infant is 4-6 months old. Cereals should be introduced first, followed by fruits, vegetables, meats, and eggs. All foods should be introduced based on the readiness of the child.

An 11-year-old girl who has just begun to show signs of breast development asks the family nurse practitioner when she will start having periods like her friends. The family nurse practitioner's response is based on the knowledge that: 1. The average age of menarche is 12.8 years. 2. Most girls will have a growth spurt following the onset of menarche. 3. Menarche usually occurs about 3-6 months after the onset of breast development. 4. Menarche usually occurs about 18-24 months after the onset of breast development.

4. Menarche usually occurs about 18-24 months after the onset of breast development. Rationale: Menarche usually occurs about 18-24 months after the onset of breast development. Although the average age of menarche is 12.8 years, this should not be the basis for the family nurse practitioner's response. Most girls have a growth spurt at Tanner stage IV. Tanner Stage Pubic Hair I None II Countable; straight; increased pigmentation and length III Darker; begins to curl; increased quantity on mons pubis IV Increased quantity; coarser texture; labia and mons well covered V Adult distribution; with feminine triangle and spread to medial thighs Breast Development I None II Breast bud present; increased areolar size III Further enlargement of breast; no secondary contour IV Areolar area forms secondary mound on breast contour V Mature; areolar area is part of breast contour; nipples project

Which group is at greatest risk for alterations in immune functions related to nutritional status? 1. Young adults. 2. Adults. 3. Premature infants. 4. Older adults.

4. Older adults. Rationale: The older adult is at greatest risk for altered immune function related to nutrition. The older adult often does not receive enough nutrition for a variety of reasons, including altered taste, eating alone, ability to prepare meals, and malabsorption. Adequate nutrition in the older adult has been shown to improve immune status and antibody response to influenza vaccine.

A 48-year-old male presents to the clinic after having his cholesterol checked at a health fair. He states that his results were over 300 and that he needed to see his primary care provider for further testing. Appropriate interventions for the family nurse practitioner include: 1. Prescribing a cholesterol-lowering agent. 2. Ordering an electrocardiogram and an exercise stress test. 3. Starting the patient on an exercise program. 4. Performing a thorough history and physical and drawing a lipid profile.

4. Performing a thorough history and physical and drawing a lipid profile. Rationale: The patient's history and physical will reveal the presence of any coronary heart disease (CHD) risk factors (age, family history of CHD, diabetes, current cigarette smoking, blood pressure, height/weight, cardiovascular exam). A lipid profile is also recommended to assess the level of risk and consists of total cholesterol, high-density lipoprotein (HDL), low-density liproprotein (LDL), and triglyceride levels. It would be prudent to have a precise cholesterol level done because the previous result was from a screening health fair and no written record was taken. These parameters should be assessed first before a cholesterol-lowering agent, ECG, or stress test is ordered. An exercise program is also important but should only be done after a history and physical are taken, and after lipid profile results are known. If the lipid profile or the history and physical results are abnormal, stress testing may be appropriate before undertaking a new exercise program.

During the physical exam of an older patient, the family nurse practitioner indicates an understanding of deviations in the neurologic system from the normal aging processs with which clinical finding? 1. Decrease in short-term memory. 2. Decrease in deep tendon and superficial reflexes. 3. Decreased sense of touch. 4. Positive Romberg's sign.

4. Positive Romberg's sign. Rationale: Romberg's sign indicates the inability to maintain balance, which indicates a need for further evaluation. A decrease in short-term memory, deep tendon and superficial reflexes, and sense of touch are normal age-related changes. If it affects the patient's functional ability, a decrease in short-term memory would be considered a deviation. Also, the testing strategy of looking for similarities in the options applies here, as the three incorrect responses all relate to a decrease in a body change with age.

Which of the following management plans demonstrates an understanding of primary prevention of falls among older adults? 1. Evaluate the need for assistive devices for ambulation after the patient has been injured in a fall. 2. Provide resources to correct hazards that contributed to falling in the home environment. 3. Reinforce the need to use prescribed eyeglasses to prevent further injury from falls. 4. Provide information about medications, side effects, and interactions.

4. Provide information about medications, side effects, and interactions. Rationale: The information about side effects and interactions of medication will prevent complications that may result in a fall. Evaluating for assistive devices following a fall and providing resources to correct hazards in the home are appropriate for tertiary prevention. Reinforcing the need to wear prescribed eyeglasses is appropriate for secondary prevention, which is to prevent the patient from experiencing another fall.

A 14-year-old girl is seen in the clinic by the family nurse practitioner because she has not achieved menarche. Physical exam reveals axillary and pubic hair and breast buds with increased size of areola. Based on these findings, the most appropriate intervention would be: 1. Bone age studies. 2. Labs for luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels. 3. Chromosome analysis to rule out Turner's syndrome. 4. Reassurance that she is developing normally.

4. Reassurance that she is developing normally. Rationale: Menarche usually occurs about 18-24 months after the onset of breast development. Bone age and laboratory studies are not necessary because development is within normal limits. Findings do not indicate a chromosomal abnormality, so chromosome analysis is unnecessary.

While teaching a class to a group of senior citizens, which would be most important for the family nurse practitioner to consider during the presentation? 1. Provide increased overhead lighting to enhance visualization. 2. Provide handouts on blue paper with black print. 3. Review a video narrated by a woman. 4. Recognize that past life experiences are beneficial in learning new information.

4. Recognize that past life experiences are beneficial in learning new information. Rationale: Using past life experiences applies the concept of adult educational principles. Overhead lighting may produce an increase in the glare, which can decrease visualization. There is an alteration of color perception (e.g., blue appears green-blue) as an individual ages. As individuals age, the ability to hear women's and children's voices decreases because these are generally at a higher pitch. The video would not enhance the program if the patients frequently have presbycusis as a result of the normal aging process.

Which of the following is most important for the family nurse practitioner to do each time a child comes in for a health maintenance clinic visit? 1. Order routine laboratory tests. 2. Perform vision and auditory screening. 3. Plot height and weight on charts. 4. Review immunization record.

4. Review immunization record. Rationale: It is essential that the immunization record be reviewed. The other options are important but not essential for a health maintenance visit.

In response to a young adult male's question concerning the production of sperm, the family nurse practitioner knows that sperm is produced in the: 1. Epididymis. 2. Vas deferens. 3. Prostate. 4. Seminiferous tubules.

4. Seminiferous tubules. Rationale: Sperm is produced in the seminiferous tubules of the testes.

Which of these health promotion screenings should be completed annually for the older adult patient who is over age 65? 1. Chest x-ray. 2. Pneumococcal vaccination. 3. Colonoscopy. 4. Stool guaiac test.

4. Stool guaiac test. Rationale: The stool guaiac test will assist in identifying any problems with intestinal bleeding. Option #1 is not necessary. Option #2 is not a screening and would not be administered annually. A colonoscopy is recommended at age 50 and then every 10 years thereafter.

A 50-year-old female presents to the clinic for a first-visit checkup. She states she is in good health and takes no medications. She was adopted and does not know her family history. She is 62 inches tall and weighs 175 lb. She is a secretary and admits to a sedentary lifestyle. She does not smoke and drinks 4-5 alcoholic beverages per week. Which of the following interventions would be most appropriate for the family nurse practitioner to recommend in this patient's plan of care? 1. Recommend that she start an exercise program that includes jogging and weight training. 2. Prescribe vitamin supplements to incorporate into her diet while she eliminates alcoholic beverages. 3. Discuss possible job changes that that will increase her daily amount of exercise. 4. Suggest that she keep a daily record of her food intake and bring it to her next visit.

4. Suggest that she keep a daily record of her food intake and bring it to her next visit. Rationale: An account of the patient's usual intake is necessary so that problem areas can be identified. Before beginning any exercise program, a physical examination should be done to assess the patient's physical condition and to aid in the proper selection of a specific exercise plan. A dietary assessment needs to be completed before recommending vitamin and protein supplements; the patient may already be receiving adequate amounts in her diet. A more active job would be ideal; however, most people do not have options regarding their choice of job, so increasing her activity outside of work would be most appropriate.

The diminished immunity of the older adult can be attributed to a decline in: 1. B-cell function. 2. T-cell production. 3. B-cell production. 4. T-cell function.

4. T-cell function. Rationale: The older adult has diminished cell-mediated immunity because of a decline in T-cell function. The T cells have a decreased ability to produce cytokines, which are needed to facilitate B-cell growth and maturation, and have a decreased ability to proliferate in response to an antigen.

The development of the male sexual characteristics in utero is dependent on: 1. Estrogen. 2. Progesterone. 3. Prolactin. 4. Testosterone.

4. Testosterone. Rationale: The most important sex hormone during embryonic development is the primary male sex hormone, testosterone. Testosterone is produced by the gonads of the genetic male embryo, causing the male gonads to develop into two testes, which produce sperm. The other hormones are female hormones. Estrogen, the major female hormone, is produced by the ovaries (ovarian follicle and corpus luteum) and cortices of the adrenal glands and placenta during pregnancy. Progesterone, the second major female hormone, is produced by the corpus luteum. Prolactin is an anterior pituitary hormone and one of the somatotropic hormones that are secreted by lactotropic cells. Prolactin is also responsible for milk production in the female.

The nurse who volunteers at a senior citizens center is planning activities for the members who attend the center. Which activity would best promote health and maintenance for these senior citizens? 1. Gardening every day for an hour. 2. Cycling 3 times a week for 20 minutes. 3. Sculpting once a week for 40 minutes. 4. Walking 3 to 5 times a week for 30 minutes.

4. Walking 3 to 5 times a week for 30 minutes. Rationale: Exercise and activity are essential for health promotion and maintenance in the older adult and to achieve an optimal level of functioning. About half of the physical deterioration of the older patient is caused by disuse rather than by the aging process or disease. One of the best exercises for an older adult is walking, progressing to 30-minute sessions, 3 to 5 times each week. Swimming and dancing are also beneficial.