leik peds review

Which of the following is considered an abnormal finding? A. A "clunk" sound heard while performing the Ortolani maneuver B. A 6-month-old infant who starts to babble C. Flat pink patches found on the forehead of a 12-month-old infant D. A 12-month-old who is "cruising"

A) A "clunk" sound heard while performing the Ortolani maneuver The "clunk" sound during the Ortolani maneuver is a positive finding and signifies a possible hip abnormality (hip dysplasia) in infants. Refer the infant to a pediatric orthopedist. Infants start to babble at 6 months. At 12 months, babies learn to "cruise" or hold onto furniture while walking. Flat pink patches found on the forehead, eyelids, and the nape of the neck of infants are salmon patches, which typically fade by 18 months.

103.What dietary guidance will the nurse practitioner provide to a patient newly diagnosed with celiac disease? A.Avoid all gluten-containing foods indefinitely B.Eat wheat breads sparingly C.Avoid all milk and dairy products D.Consume pasta in moderation

A) Avoid all gluten-containing foods indefinitely. Persons with celiac disease must avoid gluten and gluten-containing cereals and foods throughout their lifetime. Wheat and pasta contain gluten and must be avoided. Milk and dairy products are gluten-free.

6.A 13-year-old girl has a throat culture that is positive for strep throat. She reports that her younger brother was recently diagnosed with strep throat and treated. The patient has a severe allergy to penicillin and reports that erythromycin makes her very nauseated. Which of the following antibiotics is the best choice? A.Azithromycin (Zithromax) B.Cephalexin (Keflex) C.Cefuroxime axetil (Ceftin) D.Levofloxacin (Levaquin)

A) Azithromycin (Zithromax). If the patient has a severe penicillin allergy, there is a 10% chance of cross-reactivity to cephalosporins (especially first generation). Because the patient is a child, the levofloxacin is contraindicated. Nausea is a common adverse reaction to erythromycin (it is not an allergic reaction). The best option is to use azithromycin because of its minimal gastrointestinal (GI) adverse effects. Azithromycin has fewer drug interactions compared with other macrolides.

31.A young adult presents for reassessment of uncontrolled asthma symptoms. The patient is currently taking an inhaled short-acting beta2-agonist (SABA) as needed and reports daytime symptoms more than 3 days/week, but not daily, and nighttime awakenings 4 to 5 times/week. The patient's forced expiratory volume (FEV1) is 80% of predicted. The nurse practitioner upgrades the patient to the next stage of treatment, which includes: A.Budesonide with formoterol B.Budesonide with montelukast C.Cromolyn or nedocromil D.Fluticasone with salmeterol

A) Budesonide with formoterol. The patient has moved from step 2 to step 3 on the asthma classification scale; therefore, a low-dose inhaled corticosteroid (ICS) plus long-acting beta-agonist (LABA) such as budesonide with formoterol is an appropriate starting point. Fluticasone with salmeterol is prescribed if the patient is at step 4; budesonide with montelukast is an alternative. Cromolyn and nedocromil have been discontinued in the United States.

#101- A 2-day-old full-term infant presents with jaundice symptoms. Which of the following interventions should be implemented first? A.Check bilirubin level B.Schedule a follow-up visit C.Advise parent to feed infant 5 to 6 times per day D.Prescribe phototherapy

A) Check bilirubin level. The first intervention is to assess the bilirubin level of the infant before treatment is initiated. If the bilirubin level is >15 mg/dL, phototherapy should be prescribed. The parent should be advised to feed the infant 10 to 12 times per day, and a follow-up visit is indicated once a diagnosis is confirmed.

#26- While performing a newborn assessment, the nurse practitioner notes discharge, swelling, and redness on one of the infant's lacrimal ducts. The mother reports crusting on the infant's eyes. Which diagnosis is most likely? A.Dacryostenosis B.Jaundice C.Red reflex abnormality D.Myopia

A) Dacryostenosis. Dacryostenosis is an obstruction of the lacrimal duct(s). Any discharge should be cultured and treated with an appropriate antibiotic. Newborn jaundice is a yellowing of an infant's skin and eyes. Newborn jaundice is very common and can occur when infants have a high level of bilirubin, a yellow pigment produced during normal breakdown of red blood cells. Red reflex testing is vital for early detection of vision and potentially life-threatening abnormalities in infants, such as cataracts, glaucoma, retinoblastoma, retinal abnormalities, systemic diseases with ocular manifestations, and high refractive errors. Dark spots in the red reflex, a markedly diminished reflex, the presence of a white reflex, or asymmetry of the reflexes require referral to an ophthalmologist. Myopia or nearsightedness is when the eyeball is slightly longer than normal from front to back. Light rays focus in front of the retina.

#124- The mother of an 8-year-old boy reports the presence of a round red rash on the child's left lower leg. It appeared 1 week after the child returned from visiting his grandparents, who live in Massachusetts. During the skin exam, the maculopapular rash is noted to have areas of central clearing, making it resemble a round target. Which condition is most likely? A.Erythema migrans B.Rocky Mountain spotted fever C.Meningococcemia D.Larva migrans

A) Erythema migrans. Erythema migrans is a symptom of early Lyme disease. It is an annular lesion that slowly enlarges with time (days to weeks) and has central clearing. It is caused by a bite from an infected (Borrelia burgdorferi) blacklegged tick. If untreated, infection will spread to the joints, nervous system, and heart. Most cases of Lyme disease occur in the Northeast, mid-Atlantic states, Wisconsin, Minnesota, and northern California.

# 29- A young adult with myasthenia gravis is diagnosed with pertussis. Which antibiotic is contraindicated in a patient with this condition? A.Erythromycin B.Doxycycline C.Clarithromycin D.Azithromycin

A) Erythromycin. Erythromycin and telithromycin are contraindicated in patients with myasthenia gravis because of potential respiratory collapse. Antibiotics that are safe to prescribe for a patient with myasthenia gravis and pertussis are azithromycin and clarithromycin. Doxycycline is not indicated for the treatment of pertussis.

145.When teaching an overweight prehypertensive 16-year-old patient about the importance of potassium, magnesium, and calcium in the diet, which dietary guidelines will the nurse practitioner recommend? A.Four or five servings of fruits and vegetables a day B.Lean red meats twice a day C.Three servings of beans and legumes a day D.Omega-3 oils daily

A) Four or five servings of fruits and vegetables a day. Calcium is found in low-fat dairy products, and potassium is found in most fruits and vegetables. Several servings of beans are recommended each week, not several times daily. Reduction of red meat consumption is advised. Omega oils (fatty acids) are nutrients that are shown to assist in the prevention of heart disease; they are not minerals.

25.A child diagnosed with eczema was treated with over-the-counter 1% hydrocortisone ointment. During a follow-up visit, the mother reports that the rash does not seem to be improving. What level steroid should the nurse practitioner prescribe next? A.Group 6 B.Group 5 C.Group 4 D.Group 3

A) Group 6. The patient is currently using a potency Group 7 (over-the-counter topical hydrocortisone, 0.5%-1.0%) for eczema. The nurse practitioner should prescribe the next level of topical steroids, a Group 6, such as desonide cream or lotion (0.05%) and then reevaluate for effectiveness. The topical steroid strengths range from 7 (least potent) to 1 (very potent). For example, a Group 5 is fluticasone propionate cream (0.05%), a Group 4 is triamcinolone acetonide cream (0.1%), and a Group 3 is amcinonide (0.1%). Children should not be prescribed topical steroids for more than 2 weeks.

157.The nurse practitioner is reviewing the bilirubin level of a 3-day-old, full-term neonate and notes that it is 10 mg/dL. The infant has a slight yellow color to his skin, mucous membranes, and sclerae. The infant is feeding well, is not irritable, and has 8 to 10 wet diapers per day. Which of the following is a true statement? A.Keep monitoring the infant's bilirubin level until it returns to normal in about 1 week B.Recommend that the infant be treated with phototherapy 10 minutes a day until the bilirubin level is back to a normal range C.Refer the infant to a neonatologist as soon as possible D.Refer the infant to the neonatal intensive care unit

A) Keep monitoring the infant's bilirubin level until it returns to normal in about 1 week. Bilirubin is excreted through the urine and feces. Increased fluids and wetting 8 to 10 diapers a day is sufficient fluid intake/excretion to help bring down the bilirubin level. Levels should continue to be monitored and should improve in approximately 1 week.

125.The nurse practitioner is assessing a 14-year-old female who is 20% underweight for her height. The nurse practitioner notes the patient has thinning hair and brittle nails as well as fine, downy body hair on her back. How will the nurse document the body hair finding on the back? A.Lanugo B.Actinic keratosis C.Russell's sign D.Telogen effluvium

A) Lanugo. The appearance of fine, downy body hair should be documented as lanugo, commonly associated with anorexia nervosa. Actinic keratosis is a rough, scaly patch on the skin that develops from years of exposure to the sun. It is most commonly found on the face, lips, ears, back of the hands, forearms, scalp, or neck. Russell's sign is a sign defined as calluses on the knuckles or back of the hand due to repeated self-induced vomiting over long periods of time. Telogen effluvium is a scalp disorder characterized by the thinning or shedding of hair, resulting from the early entry of hair in the telogen phase (temporary hair loss).

128.A red, raised serpiginous-shaped rash is noted by the nurse practitioner on the right foot of a 4-year-old child brought in for a preschool physical by the mother. The child complains of severe itch and keeps scratching the lesion. The mother reports that the child frequently plays in the yard without wearing shoes or sandals. Which of the following is most likely? A.Larva migrans B.Erythema migrans C.Tinea pedis D.Insect bites

A) Larva migrans. Larva migrans results from infection with the eggs of parasites (worms) that are commonly found in the intestines of dogs and cats. Children are at high risk of developing this infection if they come in contact with dirt that is contaminated with dog or cat feces. Eating foods that are grown in contaminated soil and/or raw liver are other means of transferring the infection. After the eggs hatch, the parasite can migrate to other organs of the body if left untreated.

26.The nurse practitioner is examining a child diagnosed with impetigo. Which symptom will the nurse practitioner identify as the primary manifestation? A.Lesions filled with pus B.Superficial area of local edema C.White plaques in the throat D.Pinpoint areas of bleeding (purple or red) in the skin

A) Lesions filled with pus. Pustules, the primary lesions with impetigo, are pus-filled lesions. Impetigo is a superficial skin infection caused by gram-positive bacteria. A wheal is a superficial area of localized edema. White plaques in the throat are associated with candidiasis or thrush. Pinpoint areas of bleeding (purple or red) in the skin are petechiae, which are not associated with impetigo.

119.Upon review of the chest x-ray results of a 4-year-old patient, tiny white spots in a distinctive pattern are noted throughout the lungs. Which diagnosis is most likely to manifest in this manner? A.Miliary tuberculosis (TB) B.Reactivated TB C.Latent TB infection D.Pleural TB

A) Miliary tuberculosis (TB). Miliary tuberculosis (TB; found in children under age 5 and the elderly) is seen on x-ray with milia seed patterns. Reactivated TB is when the infection returns and is noted on x-ray by lesions, nodules, and cavitation. Latent TB is when bacteria is in the lymph nodes and is not infectious. It is noted on x-ray as calcification and fibrosis. Pleural TB is in the pleural space and is very contagious; it is indicated by a mass with obtuse angles on x-ray.

10.Visual fields by confrontation is used to evaluate for: A.Peripheral vision B.Central distance vision C.Narrow-angle glaucoma D.Accommodation

A) Peripheral vision. The visual fields by confrontation test is used to evaluate peripheral vision. The Snellen chart is used to measure central distance vision. A tonometer is used to assess for glaucoma. The ophthalmoscope is used to assess for cataracts.

68.A patient presents with fever, severe throat pain, difficulty swallowing, a "hot potato" voice, and trismus. On examination, there is unilateral swelling of the peritonsillar and soft palate area. The uvula is deviated to the left. Which diagnosis is most likely? A.Peritonsillar abscess B.Infectious mononucleosis C.Pharyngitis D.Aphthous stomatitis

A) Peritonsillar abscess. The most likely diagnosis is peritonsillar abscess. Peritonsillar abscess is classically associated with severe sore throat, difficulty swallowing, trismus, and a muffled "hot potato" voice. The abscess displaces the uvula. Infectious mononucleosis refers to a group of symptoms usually caused by the Epstein-Barr virus. Symptoms include fatigue, fever, rash, and swollen glands. Pharyngitis is the inflammation of the back of the throat, known as the pharynx. It typically results in a sore throat and fever. Other symptoms may include a runny nose, cough, headache, and a hoarse voice. Aphthous stomatitis is a common condition characterized by the repeated formation of benign and noncontagious mouth ulcers.

71.A 10-year-old girl who plays on an intramural soccer team has a history of exercise-induced asthma. She wants to know when she should use her albuterol inhaler. The nurse practitioner advises the patient to: A.Premedicate 10 to 15 minutes before starting exercise B.Wait until she starts to exercise before using the inhaler C.Premedicate 30 minutes before starting exercise D.Wait until she finishes her exercise before using the inhaler

A) Premedicate 10 to 15 minutes before starting exercise. Exercise-induced asthma is best controlled by using the Proventil inhaler (bronchodilator) approximately 10 to 15 minutes before exercise to prevent vasospasm of the bronchioles and shortness of breath with exercise. The effects of these bronchodilators usually last approximately 4 hours. They also work quickly to open up the bronchioles if an acute attack/shortness of breath occurs.

81.A mother brings her 1-month-old infant to the clinic for evaluation, stating the infant has poor weight gain despite constant hunger and projectile vomits after eating. The nurse practitioner notes that the infant has a distended abdomen. Upon palpation, the nurse practitioner detects an olive-shaped mass in the epigastrium. The nurse practitioner will: A.Refer the child for ultrasound testing B.Perform blood analysis to determine red blood cell (RBC) status C.Provide the mother with education on infant feeding D.Place the infant on lactose-free feedings

A) Refer the child for ultrasound testing. The infant presents with signs and symptoms of pyloric stenosis: abdominal distention, dehydration, projectile vomiting, and failure to thrive. The infant requires an ultrasound to view the pylorus and confirm this diagnosis. Fluid and electrolyte status must be assessed in order to determine hydration and imbalances. The infant will require surgery if pyloric stenosis is confirmed. Educating the mother on feedings is not required until the diagnosis is confirmed. Placing the infant on lactose-free feeding will not treat the condition.

#15- When assessing a patient using a Snellen chart, the nurse practitioner records the visual acuity as 20/80. What does this assessment mean? A.The patient can see at 20 feet what a person with normal vision sees at 80 feet B.The patient can see at 80 feet what a person with normal vision sees at 20 feet C.The patient has experienced a 20% decrease in acuity in one eye and an 80% decrease in the opposite eye D.The patient has presbyopia

A) The patient can see at 20 feet what a person with normal vision sees at 80 feet. The top number is the patient's distance in feet from the chart. The bottom number is the distance at which a person with normal eyesight can read the same line. A patient with 20/80 vision can see at 20 feet what a person with normal vision sees at 80 feet. Presbyopia is caused by loss of elasticity of the lenses, which makes it difficult to focus on close objects.

147.Upon assessment of a patient, the nurse practitioner notes several small, smooth, and round papules on the abdominal area. These papules are bright red and blanchable with pressure. Which of the following is a true statement regarding the findings? A.The lesions are cherry angiomas, which are benign and require no treatment B.The lesions are lipomas, which require surgical excision C.The lesions are acrochordons, which can be treated with steroids D.The lesions are actinic keratosis, which must be biopsied

A) These lesions are cherry angiomas, which are benign and require no treatment. These small lesions are cherry angiomas. A cherry angioma is a smooth, cherry-red bump on the skin. Although cherry angiomas usually appear on the trunk of the body, they can occur nearly anywhere. The cause of cherry angiomas is malformed arterioles in the skin, and the growths usually appear on people over the age of 40. Lipomas are soft, fatty cystic tumors usually located in the subcutaneous layer of the skin. They can be located on the trunk and are round or oval in shape. They measure 1 to 10 cm. Acrochordons, or skin tags, are painless outgrowths of the patient's skin and therefore are the same color as the patient's skin. Actinic keratosis presents as a rough, scaly patch on the skin that develops from years of exposure to the sun. It is most commonly found on the face, lips, ears, back of the hands, forearms, scalp, or neck.

123.Café au lait spots look like tan to light-brown stains that have irregular borders. They can be located anywhere on the body. Which of the following is a correct statement? A.They are associated with neurofibromatosis or von Recklinghausen's disease B.They may be identified as precancerous after a biopsy C.They are more common in children with darker skin D.They are associated with Wilson's disease

A) They are associated with neurofibromatosis or von Recklinghausen's disease. Café au lait spots are caused by an increase in melanin content, often with the presence of giant melanosomes. They have irregular borders and vary in color from light to dark brown. Neurofibromatosis causes tumors to grow in the nervous system, and these tumors commonly cause skin changes.

135.A 20-year-old man is being seen for a physical exam by the nurse practitioner. He complains of pruritic macerated areas in his groin that have been present for the past 2 weeks. Which of the following is the most likely? A.Tinea cruris B.Tinea corporis C.Tinea capitis D.Tinea pedis

A) Tinea cruris. Tinea cruris (jock itch) is a common skin infection that is caused by a type of fungus called tinea. The fungus thrives in warm, moist areas of the body, and as a result, infection can affect the genitals, inner thighs, and buttocks. Infections occur more frequently in the summer or warm, wet climates. Tinea cruris appears as a red, itchy rash that is often ring shaped. Tinea corporis involves the body, tinea capitis involves the head, and tinea pedis involves the feet.

46.What is the most common sign or symptom of allergic rhinitis? A.Transverse nasal crease B.Yellow nasal discharge C.Under-eye circles D.Inability to sleep through the night

A) Transverse nasal crease. The classic sign of allergic rhinitis is a transverse nasal crease (allergic salute) from frequent rubbing and wiping away of nasal discharge. Allergic rhinitis generally produces clear nasal discharge unless there is also sinusitis. It may also cause under-eye circles from vasodilation or lack of sleep from sneezing and itchiness.

29.When an infant is found to have tufts of fine dark hair on the sacrum, which of the following tests is recommended? A.Ultrasound of the sacrum B.Plain radiograph of the lumbar sacral spine C.No imaging test is necessary D.Genetic testing

A) Ultrasound of the sacrum. An infant with tufts of fine dark hair on the sacrum should be evaluated for occult spina bifida. The first imaging test to order is an ultrasound of the lower spine.

65.An 8-year-old boy with type 1 diabetes is being seen for a 3-day history of urinary frequency and nocturia. He denies flank pain and is afebrile. The urinalysis result is negative for blood and nitrites but is positive for a large amount of leukocytes and ketones. He has a trace amount of protein. Which of the following is the best test to order initially? A.Urine culture and sensitivity (C&S) B.24-hour urine for protein and creatinine clearance C.24-hour urine for microalbumin D.Intravenous pyelogram

A) Urine culture and sensitivity (C&S). An 8-year-old male patient with the diagnosis of diabetes has a high risk of urinary tract infections (UTIs). A large amount of leukocytes in the urinalysis is abnormal, and he has been having symptoms of frequency and nocturia for the past 3 days. The urine culture would be ordered because he has a high risk of infection. The urine C&S is the best evaluation for diagnosing a UTI.

31.new mother is planning to breastfeed her newborn infant for at least 6 months. She wants to know whether she should give the infant vitamins. Which of the following vitamin supplements is recommended by the American Academy of Pediatrics (AAP) during the first few days of life? A.Vitamin D drops B.Vitamin E drops C.It is not necessary to give breastfed infants vitamin supplements, because breast milk contains enough vitamins and minerals that are necessary for the infant's growth and development. D.Folic acid drops

A) Vitamin D drops. According to the American Academy of Pediatrics (APA), all infants should be given vitamin D supplementation within the first few days of life. Mothers who plan to breastfeed their infants should be taught how to use vitamin D drops. Infant formula is supplemented with vitamin D (and many other vitamins, minerals, and omega-3 oil), so there is no need to give it separately.

130.A 4-year-old child presents with a red, swollen, painful blister-type lesion on his lower back, fever of 101°F, and vomiting for 24 hours. His mother reports that the child was playing with a box of toys that were brought down from the attic the day before. The nurse practitioner will: A.Wash the lesion and apply antibiotic cream B.Prescribe tazarotene 0.1% cream C.Apply hydrocolloid and silver-impregnated dressings D.Prescribe doxycycline 100 mg BID × 10 days

A) Wash the lesion and apply antibiotic cream. The history indicates the probability that the child was bitten by a brown recluse spider living in the box from the attic, as spiders prefer dark places to hide. The bite should be washed with soap and water and then treated with an antibiotic cream. A poisonous spider bite generally will form a blister (eschar) and then ulcerate. It can take several weeks to heal. Tazarotene cream is a retinoid prescribed for psoriasis. Hydrocolloid and silver-impregnated dressings are used to treat burns. Doxycycline is first-line treatment for the tick-borne diseases Rocky Mountain spotted fever and Lyme disease, which are generally contracted outside the house.

103.Which class of antibiotics is first-line treatment for an unvaccinated infant diagnosed with pertussis? A.Penicillins B.Macrolides C.Cephalosporins D.Quinolones

B) Macrolides. The first-line antibiotic treatment for an infant with pertussis are macrolides (azithromycin, erythromycin, or clarithromycin). Penicillins are indicated for strep throat and otitis media. Cephalosporins are appropriate for gram-positive cocci bacteria. Quinolones are effective against gram-negative and atypical bacteria.

42.A bulla is defined as: A.A solid nodule <1 cm in size B.A superficial vesicle filled with serous fluid >1 cm in size C.A maculopapular lesion D.A shallow ulcer

B) A superficial vesicle filled with serous fluid larger >1 cm. This is a blister—a circumscribed, fluid-containing, elevated lesion of the skin, usually >5 mm in diameter.

69.A high-school wrestler is recovering from infectious mononucleosis. Which intervention must be completed to inform whether it is safe for the patient to return to play? A.MRI B.Abdominal ultrasound C.Complete blood count D.Strep culture

B) Abdominal ultrasound. An athlete who plays a contact sport such as wrestling should have an abdominal ultrasound before returning to play to determine risk of splenic rupture. An MRI is not required. Atypical lymphocytes would not necessarily prevent an athlete from returning to play but should be monitored until within normal limits. A strep culture would not be necessary unless the athlete had symptoms.

A concerned new mother reports to you that her son, who is 3 years of age, is not toilet trained yet. Which of the following is an appropriate reply? A. Recommend a referral to a pediatric urologist B. Advise the mother that her child is developing normally C. Recommend a bed-wetting alarm D. Recommend a voiding cystogram

B) Advise the mother that her child is developing normally Toilet training begins at approximately 2 years of age and may take 1 to 2 years to complete. Boys who are not toilet trained by 3 years of age may still be developing normally.

174.A mother brings in her 6-year-old daughter to see the nurse practitioner (NP). She complains that the school nurse found a few nits in her daughter's hair. The mother states that the school has a "no nits" policy regarding head lice and her daughter cannot go back to school until all the nits have been removed. The child was treated with permethrin shampoo (Nix) twice about 3 months ago. During the physical exam, the NP sees a few nits that are about 2 inches away from the scalp. The child denies itchiness on her scalp. Which of the following is the best action for the NP to follow? A.Prescribe lindane (Kwell) for the child because she may have head lice that are resistant to permethrin B.Advise the mother to use a nit comb after spraying the child's hair with white distilled vinegar, wait for 15 minutes, and then rinse the hair C.Advise the mother to re-treat the child with permethrin cream instead of sh

B) Advise the mother to use a nit comb after spraying the child's hair with white distilled vinegar, wait for 15 minutes, and then rinse the hair. According to the Centers for Disease Control and Prevention (CDC), nits that are more than ¼ inch from the scalp are usually not viable. The child also does not have an itchy scalp. One method of removal is to soak the patient's head with distilled vinegar (and then rinse after), which will break down the protein of the nit casings, making it easy to comb them out of the hair.

76.Which medication will the nurse practitioner include in the treatment plan for a 7-year-old child with acute otitis media? A.Cefaclor B.Amoxicillin C.Erythromycin D.Azithromycin

B) Amoxicillin. Amoxicillin is the first line of therapy for the treatment of acute otitis media. Cefaclor is a second-generation cephalosporin and is not the first line of treatment for acute otitis media unless the infection is caused by gram-positive cocci and gram-negative rods. Erythromycin is not prescribed as the first line of treatment for acute otitis media. Azithromycin can be administered as the first line of treatment for acute otitis media if amoxicillin is contraindicated.

The mother of a 7-year-old boy tells the family nurse practitioner that his teacher has complained to her of her son's frequent episodes of daydreaming. The mother reports that sometimes when her son is at home, he seems not to hear her, "blanking out" for a short period of time. Which of the following is most likely? A. Partial seizure B. Absence seizure C. Grand mal seizure D. Atonic seizure (drop attack)

B) An absence seizure An absence seizure is a brief seizure that usually lasts <15 seconds. During the seizure, the child may appear not to be listening, to have "blanked out," or to be daydreaming.

140.A adult student is seen in the school health clinic with complaints of a hacking nonproductive cough, rhinorrhea, pharyngitis, and malaise for the past 2 weeks. He does not take any medications, denies any allergies, and has no significant medical history. Physical examination reveals a low-grade temperature of 99.9°F, respirations of 16 breaths/min, pulse of 90 beats/min, and scattered rales and wheezing of the lungs. The patient does not appear toxic. The total white blood cell count is 10,500/µL. Which diagnosis is most likely? A.Bacterial pneumonia B.Atypical pneumonia C.Acute bronchitis D.Pertussis

B) Atypical pneumonia. The most common organism causing community-acquired atypical pneumonia is Mycoplasma pneumoniae, an atypical bacterium. The populations with the highest infection rates are college students, school-age children, and military recruits. Respiratory symptoms (cough) are accompanied by pharyngitis, rhinorrhea, and sometimes ear pain. It is easily spread from aerosol droplets.

89.An infant who does not have a history of reactive airway disease and allergy has both inspiratory and expiratory wheezing accompanied by fever and profuse, clear nasal discharge. Which of the following is most likely? A.Tracheobronchitis B.Bronchiolitis C.Croup D.A small foreign body is lodged on the left main bronchus.

B) Bronchiolitis. Symptoms of tracheobronchitis include prominent dry, nonproductive cough; later, coughing up phlegm is common. Bronchiolitis is a viral infection caused by respiratory syncytial virus (RSV), which is commonly seen during the winter/spring months in infants and young children. Typical signs/symptoms include fever and inspiratory/expiratory wheezing with clear drainage. Croup is a viral infection with a classic "barking" cough; the patient may have a runny nose, but typically no fever. When a child swallows a foreign object, choking, wheezing, and shortness of breath may occur, but no fever or clear drainage is present.

#136- A school-age child presents with low-grade fever and suspected hearing loss. Upon examination, the nurse practitioner notes erythema and bullae on the bulging tympanic membrane. There is decreased motility of the tympanic membrane on insufflation. Which diagnosis is most likely? A.Otitis externa B.Bullous myringitis C.Purulent otitis media D.Serous otitis media

B) Bullous myringitis. Bullous myringitis is an ear infection in which small, fluid-filled blisters form on the eardrum. This finding distinguishes the diagnosis of the condition. Otitis externa, also called swimmer's ear, is inflammation of the ear canal. Purulent otitis media is an inflammation of the middle ear in which there is fluid in the middle ear accompanied by signs or symptoms of ear infection: a bulging eardrum usually accompanied by pain or a perforated eardrum, often with drainage of purulent material. In serous otitis media, sterile serous fluid is trapped inside the middle ear.

72.Which of the following is considered an objective finding in patients who have a case of suppurative otitis media? A.Erythema of the tympanic membrane B.Decreased mobility of the tympanic membrane as measured by tympanogram C.Displacement of the light reflex D.Bulging of the tympanic membrane

B) Decreased mobility of the tympanic membrane as measured by tympanogram. Acute suppurative otitis media is an acute infection affecting the mucosal lining of the middle ear and the mastoid air system. Suppurative stage: The tympanic membrane bulges and ruptures spontaneously through a small perforation in the pars tensa. Ear discharge is usually present. Diagnosis is usually made simply by looking at the eardrum through an otoscope. The eardrum will appear red and swollen, and may appear either abnormally drawn inward or bulging outward. Using the tympanogram with the otoscope allows a puff of air to be blown lightly into the ear. Normally, this should cause movement of the eardrum. In an infection, or when there is fluid behind the eardrum, this movement may be decreased or absent.

170.An 8-year-old child is seen as a walk-in appointment by the nurse practitioner. The mother reports that her child has been febrile for 2 days and is not eating well because of painful sores inside the mouth. The child's temperature is 101°F, pulse is 88 beats/min, and respirations are 14 breaths/min. During the physical exam, the nurse practitioner notices several small blisters and shallow ulcers on the child's pharynx and oral mucosa. The child has small, round red rashes on both palms and soles. Which of the following conditions is most likely? A.Herpes simplex infection B.Hand, foot, and mouth disease (HFMD) C.Varicella infection D.Secondary syphilis infection

B) Hand, foot, and mouth disease (HFMD). HFMD is caused by the coxsackievirus. The virus is found in the saliva, sputum, nasal mucus, feces, and blister fluid. It is transmitted through direct contact of the secretion or in fomites (e.g., preschool toys). Treatment is symptomatic.

62.Which diagnosis describes a chronic disease of the apocrine follicles and glands, characterized by clusters of abscesses and pustules in the axilla, groin, and perianal area? A.Mulloscum contagiosum B.Hidradenitis suppurativa C.Folliculitis D.Furuncle

B) Hidradenitis suppurativa. Hidradenitis suppurativa is a chronic disease and recurrent inflammatory disorder of the apocrine glands that results in painful pustules, nodules, and abscesses in areas such as the axilla, groin, perianal, and mammary areas. It is more common in women; risk factors include obesity and a history of smoking. Mulloscum contagiosum is a relatively common viral infection of the skin that results in round, firm, painless bumps ranging in size from a pinhead to a pencil eraser. Folliculitis is a common skin condition in which hair follicles become inflamed. It is usually caused by a bacterial or fungal infection. At first, it may look like small red bumps or white-headed pimples around hair follicles. It is not a chronic condition. A furuncle, also known as a boil, is a painful infection that forms around a hair follicle and contains pus. It is not a chronic condition.

33.A 3-year-old child with a respiratory virus was given aspirin for an elevated temperature. The child subsequently became lethargic and developed severe vomiting and diarrhea. The nurse practitioner assesses for all of the following findings, except: A.Elevated alanine aminotransferase (ALT) B.Hyporeflexia C.Confusion D.Cerebral edema

B) Hyporeflexia. The patient likely has Reye's syndrome, which is a rare condition that can develop in children and young adults recuperating from febrile viral infections who ingest aspirin or salicylate medications. The condition can progress very quickly. Stage 1 symptoms are severe vomiting, diarrhea, lethargy, stupor, and elevated ALT and AST. Stage 2 includes personality changes, irritability, aggression, and hyperactive (not hypoactive) reflexes. Stages 3 to 5 present with confusion, delirium, cerebral edema, coma, seizures, and death.

1.A 10-year-old boy has type 1 diabetes. His late-afternoon blood sugar levels over the past 2 weeks have ranged from 210 mg/dL to 230 mg/dL. He currently injects 10 units of regular insulin and 25 units of neutral protamine Hagedorn (NPH) insulin in the morning and 15 units of regular insulin and 10 units of NPH insulin in the evening. Which of the following is the best treatment plan for this patient? A.Increase both types of insulin in the morning dose B.Increase only the NPH insulin in the morning dose C.Decrease the afternoon dose of NPH insulin D.Decrease both NPH and regular insulin doses in the morning

B) Increase only the NPH insulin in the morning. Regular insulin is rapid/short-acting insulin. Depending on the type of regular insulin, the onset is 10 to 15 minutes, and the insulin peaks within an average of 1.5 hours, with a duration of 3 to 5 hours. NPH insulin is an intermediate-acting insulin. Depending on the type of NPH insulin, the onset is 1.5 to 3 hours. NPH peaks in 4 to 12 hours, and the duration is from 18 to 24 hours. By increasing the morning NPH, the peak will occur in the afternoon, bringing down the blood glucose.

85.The nurse practitioner is performing a vision assessment on a 10-week-old infant. All of the following assessment finding(s) require a referral to a pediatric ophthalmologist, except: A.Pseudostrabismus B.Intermittent esotropia C.White reflex D.Positive Hirschberg test

B) Intermittent esotropia. Abnormal vision screenings that require a referral to a pediatric ophthalmologist include pseudostrabismus (epicanthal folds appear "crossed-eyed"); white reflex, which could indicate cataracts, leukocoria, or retinoblastoma; and a positive Hirschberg test. Intermittent esotropia is common in infants younger than 20 weeks and usually resolves spontaneously. Refer if esotropia is still present after age 20 weeks.

A 14-year-old girl with short stature, swollen hands and feet, and a webbed neck presents to the primary care clinic. Upon assessment she is found to be at Tanner stage I. Which test will the nurse practitioner order to confirm a diagnosis? A.CT scan B.Karyotype C.Prolactin level D.X-ray of the hand

B) Karyotype. Tanner stage I is prepubertal. At 14 years of age, an absence of Tanner stage II characteristics, along with a webbed neck, swollen hands and feet, and short stature, suggests Turner's syndrome. Confirmation of Turner's syndrome is done with karyotype analysis to confirm the partial or complete absence of the second sex chromosome. Prolactin level would indicate the presence of a tumor in the pituitary as the possible cause of delayed puberty but would need to be confirmed with a CT scan. An x-ray of the hand is used for estimating "bone age." A prolactin level to rule out prolactinoma-induced amenorrhea and a CT scan and x-ray of the hand to determine if true age matches stated age would all be useful for determining the cause of delayed puberty; however, in the presence of a webbed neck, swollen hands and feet, and short stature, Turner's syndrome is the primary suspect.

152.The nurse practitioner diagnoses a child with measles after observing which signs? A.Hairy leukoplakia B.Koplik's spots C.Boggy turbinates D.Enlarged parotid gland

B) Koplik's spots. One of the classic symptoms of measles is Koplik's spots, groups of small-sized red papules with white centers in the cheeks. The other signs include fever, rash, red eyes, and sneezing. Oral hairy leukoplakia is related to secondary infections from HIV and is caused by the Epstein-Barr virus (EBV). Boggy turbinates would be found in allergic rhinitis, in addition to an itchy nose and congestion. An enlarged parotid gland is more indicative of mumps.

#93- A toddler who was born prematurely is being assessed for hearing loss. Which history finding places this child at high risk for hearing loss? A.Hypobilirubinemia B.Low Apgar scores C.Ear infection in newborn period D.Exposure to chlamydia in utero

B) Low Apgar scores. The mnemonic for high-risk factors for hearing loss is HEARS: hyperbilirubinemia; ear infection frequency; low Apgar scores (<6); rubella, cytomegalovirus (CMV), or toxoplasmosis infections; and seizures. Exposure to chlamydia in utero is not a risk factor for hearing loss.

28.An otherwise healthy 4-year-old child presents with painful, itchy clusters of pustules around the nose and mouth. On assessment, the nurse practitioner notes honey-colored crusted lesions over an erythematous base. How will the nurse practitioner treat this condition initially? A.Hydrocortisone cream B.Mupirocin ointment C.Topical azole antifungal D.Sulfadiazine cream

B) Mupirocin ointment. The child likely has impetigo, an acute superficial skin infection caused by gram-positive bacteria, which is common in young children. As the lesions associated with impetigo rupture, the serous fluid dries and appears as honey-colored crusts. Mupirocin, a topical antibiotic ointment, is used to treat impetigo. Hydrocortisone cream is used to treat a variety of skin conditions featuring inflammation and pruritus by reducing swelling, itching, and redness. It is not used to treat infection and is contraindicated in the treatment of impetigo. Azole antifungals are used in the treatment of tinea infections. Sulfadiazine cream is a sulfa-type antibiotic used to prevent and treat infections in patients with serious burns.

#39- A 4-year-old boy diagnosed with acute otitis media returns in 48 hours with a possible rupture of the tympanic membrane (TM) of the right ear. The mother reports seeing pus and a small amount of blood on the pillow that morning. The child states that his ear is no longer painful. During the ear exam, the otoscope is used to visualize the TM, which has a perforation on the lower edge that is draining a small amount of purulent discharge. All of the following topical ear medications should be avoided in patients with perforation of the TM, except: A.Gentamycin ear drops B.Ofloxacin ear drops C.Tobramycin ear drops D.Neomycin sulfate ear drops

B) Ofloxacin ear drops. Ofloxacin ear drops are not considered to be ototoxic. Aminoglycoside otic drops (gentamycin, tobramycin) are ototoxic and should not be used to treat otitis media or perforation of the TM. In addition, ear drops with alcohol, benzocaine, or olive oil should be avoided in patients with TM perforation. Swimming or water inside the ear should be avoided until the TM is healed. Topical therapy with topical quinolone drops may be equivalent to oral therapy, but some experts prefer oral antibiotic therapy, such as amoxicillin or amoxicillin-clavulanate (Augmentin) for 10 days, to treat TM perforations.

100.A college student is brought to the college health clinic with a stiff neck, photophobia, severe headache, and changes in mental status. The nurse practitioner assesses for: A.Cerebrospinal fluid with high levels of glucose B.Positive Kernig's sign C.Negative Brudzinski's sign D.Negative Babinski's reflex

B) Positive Kernig's sign. Acute bacterial meningitis presents with nuchal rigidity, light sensitivity, petechiae, severe headache, mental status changes, and in some cases, nausea and vomiting. Meningitis is highly contagious, and droplet precautions should be implemented. A lumbar puncture with large numbers of white blood cells (WBCs), elevated levels of protein, and low glucose levels is indicative of meningitis. A positive Kernig's sign (resistance to leg strengthening due to inflammation of lumbar nerve roots) assesses for meningeal irritation. The Brudzinski's sign would also be positive, not negative. A Babinski's reflex (plantar reflex) should be negative in adults.

63.A patient presents to the clinic complaining of a painful, itchy rash on the elbows and knees that appears as raised erythematous patches of silvery, scaly skin. The patient states that the rash has occurred before but resolved without treatment. For which condition should the nurse practitioner treat? A.Impetigo B.Psoriasis C.Xerosis D.Contact dermatitis

B) Psoriasis. Psoriasis causes rapid cell build-up on the skin, causing red, dry, itchy, raised patches covered with silvery lesions. Plaques frequently occur on the elbows and knees but can occur on other body areas. Impetigo is an infection caused by gram-positive bacteria; the lesions are small, red, and pus-filled. Impetigo occurs most frequently in small children. Xerosis is an inherited skin disorder characterized by extremely dry mucosal skin surfaces. Contact dermatitis is an inflammatory skin reaction caused by direct exposure with an irritant. It can occur as a single lesion or generalized rash.

153.The mother of a 12-month-old infant reports to the nurse practitioner that her child had a high fever for several days, which spontaneously resolved. After the fever resolved, the child developed a maculopapular rash. Which diagnosis is most likely? A.Fifth disease (erythema infectiosum) B.Roseola infantum (exanthema subitum) C.Varicella D.Infantile maculopapular rashes

B) Roseola infantum (exanthema subitum). Roseola infantum is a common viral rash that is caused by the human herpesvirus. The most common ages of onset are between 6 months and 2 years. The rashes are maculopapular (small, round, pink colored) rashes that first appear on the trunk and then spread to the extremities.

171.The mother of a 4-month-old girl calls your office and reports that the infant has a fever of 101.4 °F. The infant received her immunizations yesterday. Which of the following is correct? A.The fever is most likely due to the combination of the measles-mumps-rubella (MMR) and polio vaccines B.The fever is most likely due to the pertussis component of the diphtheria, tetanus, acellular pertussis (DTaP) vaccine C.The infant is probably starting a viral upper respiratory infection D.The infant had an allergic reaction to one of the vaccines given and should be brought to the ED

B) The fever is most likely due to the pertussis component of the diphtheria, tetanus, acellular pertussis (DTaP) vaccine. The pertussis component of the vaccine is most likely the cause of the fever.

159.During a sports participation exam, a 16-year-old patient is noted to have a few beats of horizontal nystagmus on extreme lateral gaze that disappear when the eyes move back toward midline. Which statement best describes this clinical finding? A.It is caused by occult bleeding of the retinal artery B.This is a normal finding C.It is a sign of a possible brain mass D.This is a borderline result and requires further evaluation

B) This is a normal finding. Horizontal nystagmus is a normal variation on physical exam. Full movement of the eyes is controlled by the integrated function of cranial nerves III (oculomotor), IV (trochlear), and VI (abducens). Holding the patient's chin to prevent movement of the head, ask the patient to watch your finger as it moves through the six cardinal fields of gaze. Then ask the patient to look to the extreme lateral (temporal) positions. A few horizontal nystagmic beats are within normal limits (WNL).

84.Which of the following pathogenic bacteria are commonly found in the lungs of older children and adults with cystic fibrosis? A.Streptococcus pneumoniae B.Chlamydia pneumoniae C.Pseudomonas aeruginosa D.Staphylococcus aureus

C) Pseudomonas aeruginosa. P. aeruginosa is a common chronic lung infection seen in older children and adults with cystic fibrosis. This infection is difficult to eliminate and sometimes is the cause of death.

#91- A 5-year-old child is assessed for dysuria and frequency. Which antibiotic would the nurse practitioner prescribe upon finding the urine culture positive for gram-negative bacteria? A.Ciprofloxacin (Cipro) B.Trimethoprim-sulfamethoxazole (Bactrim DS) C.Levofloxacin (Levaquin) D.Doxycycline

B) Trimethoprim-sulfamethoxazole (Bactrim DS). Trimethoprim-sulfamethoxazole (Bactrim DS) is appropriate for treating gram-negative bacteria such as Escherichia coli, which is a common cause of urinary tract infections. It is also appropriate for patients older than 2 months. Ciprofloxacin and levofloxacin are quinolones and should not be administered to children younger than 18 years of age. Doxycycline should not be prescribed for children younger than 9 years of age.

139.Which effect will the nurse practitioner take into consideration when prescribing oral pharmacologic treatment for a 2-week-old infant with omphalitis? A.Increased renal excretion B.Undeveloped blood-brain barrier C.Increased gastric emptying time D.Increased ability of protein drugs to bind

B) Undeveloped blood-brain barrier. The infant's blood-brain barrier is not fully developed for several months; therefore, the infant has an increased risk of central nervous system toxicity and sensitivity to pharmacologic agents that act on the brain. Renal excretion is decreased in an infant. Gastric emptying time in infants is prolonged and irregular. Therefore, enhanced absorption of a pharmacologic agent may occur as a result of delayed gastric emptying. Because of the low level of serum albumin, protein-binding drugs are less able to bind in infants, and endogenous compounds that compete with drugs for binding sites result in a higher concentration of free drug levels.

66.Which assessment finding is expected in a 3-year-old male with penopubic epispadias? A.Fused pelvic bones B.Urine leakage with stress C.Narrow penis that curves down D.Urinary meatus found along shaft of penis

B) Urine leakage with stress. In penopubic epispadias, the urethral meatus is found near the pubic bone. The position of the meatus helps predict how well the bladder stores urine. When the bladder sphincter is shaped more like a horseshoe than a ring, it does not close all the way. Because of this, urine leaks out. Most boys with penopubic epispadias and about two of three with penile epispadias leak urine with stress. In most cases of penopubic epispadias, the bones of the pelvis do not come together in the front. In boys with epispadias, the penis tends to be broad, short, and curved up. In penile epispadias, the urinary meatus is found along the shaft. In penopubic epispadias, it is found on or near the pubic bone.

102- A nurse practitioner sees a fair-skinned patient who is experiencing recurrent small acne-like pustules and papules on the cheeks, nose, and chin, as well as chronic dry eyes. Which diagnosis is most likely? A.Rocky Mountain spotted fever (RMSF) B.Herpes zoster ophthalmicus C.Acne rosacea D.Actinic keratosis

C) Acne rosacea. The patient is presenting with acne rosacea, a chronic inflammatory disease of the cheeks, chin, and nose, with dry, reddened eyes. First-line treatment is to determine triggers such as spicy foods and alcohol. Herpes zoster ophthalmicus affects one side of the head with sudden vesicular lesions on the scalp, nose, and forehead. The patient may also report photophobia, eye pain, and blurred vision. RMSF causes a rash, an abrupt onset of a high fever, chills, severe headache, photophobia, and nausea and vomiting. A petechial rash starts on the wrists, forearms, and feet and then moves up to the trunk. RMSF is caused by the bite of a dog tick that is infected with the parasite Rickettsia ricksettsii. Actinic keratosis is more common in older to elderly adults. Numerous dry, round, and red-colored lesions do not heal and mostly occur in sun-exposed areas. They may be precancerous lesions to squamous cell carcinoma.

69.A 12-year-old girl is complaining of a 2-week history of facial pressure that worsens when she bends over. She complains of tooth pain in her upper molars on the right side of her face. On physical exam, her lung and heart sounds are normal. Which diagnosis is most likely? A.An acute dental abscess B.Chronic sinusitis C.Acute sinusitis D.Severe allergic rhinitis

C) Acute sinusitis. Signs and symptoms of acute sinusitis include headache, facial pain that worsens with bending over, eye/ear pressure and pain, aching in upper jaw/teeth, reduced smell and taste, cough (especially at night due to the nasal drainage), sore throat, bad breath, and fatigue.

8.A nurse practitioner assesses a child who is experiencing severe otalgia and has a temperature of 100.7°F. The Rinne test result shows BC > AC, and the Weber exam shows lateralization in the affected ear. The nurse practitioner notes blisters on an erythematic tympanic membrane (TM). Which of the following conditions is most likely? A.Acute otitis media (AOM) B.Otitis media with effusion C.Bullous myringitis D.Otitis externa

C) Bullous myringitis. Bullous myringitis is a severe type of AOM with painful blisters (bullae) on a reddened TM. The patient may exhibit conductive hearing loss, otalgia, muffled hearing, and a low-grade fever. With otitis media with effusion, the TM may bulge or retract, but it is not red. It may follow AOM and be caused by chronic allergic rhinitis. Otitis externa (swimmer's ear) is more common in the warm and humid seasons. There is external otalgia, swelling, discharge, pruritus, and hearing loss if the canal is blocked with pus.

All of the following are true about strawberry hemangiomas found in infants, except: A. Most will involute spontaneously by the age of 18 to 24 months B. Watchful waiting is the most useful strategy C. Hemangiomas should be treated with laser therapy if they have not resolved by the age of 12 months D. Strawberry hemangiomas are benign

C) Hemangiomas should be treated with laser therapy if they have not resolved by the age of 12 months True strawberry hemangiomas will eventually resolve by the time the child goes to kindergarten. Most will reduce or disappear in the first 2 years. Laser treatment is rarely needed.

136.Which statement made by a 24-year-old patient with diabetes mellitus indicates that education about hypo- and hyperglycemic awareness was effective? A.Eating fewer meals each day will keep my blood sugars stable B.Eating small meals every 2 hours will keep my blood sugars stable C.If I feel really tired or cannot concentrate, I will call you D.I will stop taking my oral medications and just take insulin

C) If I feel really tired or cannot concentrate, I will call you. A patient with diabetes should eat small meals every 3 to 4 hours to keep blood sugars as normal as possible. Patients who have a blood sugar >300 mg/dL, level of consciousness changes, or dehydration should contact the provider for advice. Blood sugars should be checked more frequently when a patient is sick, and they should not stop taking oral medications or insulin unless their fasting blood glucose (FBG) is lower than expected and as per their provider's orders.

#45- Which skin condition produces "honey-crusted," pruritic vesiculopustules that rupture and crust? A.Psoriasis B.Scabies C.Impetigo D.Measles

C) Impetigo. Impetigo is caused by gram-positive bacteria (streptococcus or Staphylococcus aureus) and is very contagious among young children, particularly those aged 2 to 5 years. It produces "honey-crusted," pruritic vesiculopustules that rupture and crust. Measles presents with Koplik's spots on the mucosa by the rear molars and is also highly contagious. Psoriasis is an inherited disorder in which the squamous epithelial cells rapidly turn over and cause plaques. Psoriasis can be located on the scalp, elbows, knees, sacrum, and intergluteal folds. Scabies is caused by an itch mite via skin-to-skin contact and causes a very pruritic rash in the webs of the hands, waist, and genital area, especially at night.

# 68- An adolescent patient uses a sliding scale in conjunction with a long-acting insulin to manage type 1 diabetes. Which insulin should the patient prepare for an elevated blood sugar between breakfast and lunch? A.Insulin isophane and insulin regular B.Insulin glargine (Lantus) C.Insulin lispro (Humalog) D.Neutral protamine Hagedorn (NPH)

C) Insulin lispro (Humalog). Lispro is a rapid-acting insulin that is used on a sliding scale to work from meal to meal. Insulin isophane and insulin regular is a mixture of intermediate- and short-acting insulins and would not be appropriate for a sliding scale. Insulin glargine is given once a day. NPH is an intermediate-acting insulin that is not appropriate for a sliding scale.

36.A 4-year-old child presents with a high fever and enlarged lymph nodes in the neck area. The nurse practitioner notes dry, cracked lips and a "strawberry tongue" upon a physical assessment. Which diagnosis is most likely? A.Pharyngitis B.Allergic rhinitis C.Kawasaki disease D.Tonsillitis

C) Kawasaki disease. Kawasaki disease classically presents with high fever; enlarged lymph nodes in the neck; conjunctivitis; dry, cracked lips; and a "strawberry" (bright-red) tongue. Most cases occur in children under 5 years of age. Pharyngitis is an acute infection of the pharynx and presents with a stuffy nose, rhinitis with clear mucus, and watery eyes. Allergic rhinitis is inflammatory changes of the nasal mucosa due to an allergy response. Tonsillitis is inflammation of the tonsils, which are two oval-shaped pads of tissue at the back of the throat. Signs and symptoms of tonsillitis include swollen tonsils, sore throat, difficulty swallowing, and tender lymph nodes on the sides of the neck.

96.A 7-year-old is brought to the clinic by his mother, who is concerned about "bumps" on his trunk and armpits lasting for several weeks. There are no complaints of pain or itching, and the child is afebrile. Upon examination, the nurse practitioner notes a cluster of 2-mm papules that are flesh-colored, dome-shaped, and smooth with a central umbilication. Which diagnosis is most likely? A.Secondary milia B.Verruca vulgaris C.Molluscum contagiosum D.Folliculitis

C) Molluscum contagiosum. Molluscum contagiosum is a viral condition common in children spread by direct contact. The condition is self-limiting, does not produce pain or itching, and resolves over several months. Milia are keratin-filled cysts that usually occur around the nose and eyes. Verruca vulgaris (warts) are viral and appear as irregular, raised, flesh-colored growths that feel rough to the touch. Folliculitis is an inflammation of the hair follicles, which can become pus-filled sores.

#8- An Asian mother presents to the clinic with her newborn. Upon examination, the nurse practitioner notes black-colored patches on the newborn's lumbosacral area. How will the nurse practitioner document these findings? A.Milia B.Erythema toxicum neonatorum C.Mongolian spots D.Port wine stain

C) Mongolian spots. Mongolian spots are the most common type of skin lesions in neonates and are present in a great percentage of Asian newborns. The lumbosacral area is a common location for these blue- to black-colored spots that usually fade by age 3 years. Milia are tiny white papules located on the forehead, nose, and cheeks. They contain sebaceous material and keratin and appear during the first week of life. Erythema toxicum neonatorum are small whitish pustules surrounded by a red base. A port wine stain (nevus flammeus) is a pink/red congenital, cutaneous, vascular malformation "birthmark" that usually appears on the face of the newborn.

15.An overweight male teenager presents with complaints of fatigue and lethargy. His mother states that he has been falling asleep in school. Upon examination, he is found to be hypertensive with an average blood pressure of 164/92 mmHg. The nurse practitioner suspects secondary hypertension, which can be caused by disorders of all of the following systems, except: A.Renal B.Endocrine C.Musculoskeletal D.Respiratory

C) Musculoskeletal. Secondary hypertension can be caused by disorders of the following systems: renal (e.g., renal artery stenosis, polycystic kidneys, chronic kidney disease), endocrine (e.g., hyperthyroidism, hyperaldosteronism, pheochromocytoma), and respiratory (e.g., sleep apnea). Musculoskeletal disorders do not cause hypertension.

#69- The nurse practitioner is performing a vision screening on a newborn. Which finding would prompt a referral to a pediatric ophthalmologist? A.Inability to produce tears B.Fixation on mother's face C.One eye turned inward D.Bluish-gray eyes

C) One eye turned inward. During the first 2 months of life, a newborn's eyes may appear crossed or wander at times (normal). If one eye is turned in or out consistently, the newborn should be referred to a pediatric ophthalmologist for further evaluation. The lacrimal ducts are immature at birth, but typically a newborn can shed tears by 2 weeks. It is normal for Caucasian newborns to be born with bluish-gray eyes, which change as they mature. A newborn will often fixate on their mother's face.

A neighbor's 14-year-old son, who is active in basketball, complains of pain and swelling on both knees. On physical exam, there is tenderness over the tibial tuberosity of both knees. Which of the following is most likely? A. Chondromalacia patella B. Left knee sprain C. Osgood-Schlatter disease D. Tear of the medial ligament

C) Osgood-Schlatter disease Osgood-Schlatter disease is characterized by bilateral pain over the tibial tuberosity upon palpation, along with knee pain and edema with exercise.

30.A 10-year-old child presents with external pain, swelling, and decreased hearing in the left ear. The child is on a swimming team and practices daily. Upon physical examination, the child flinches when the affected ear is touched. There are no other abnormal findings. Which diagnosis is most likely? A.Otitis media B.Rhinosinusitis C.Otitis externa D.Bullous myringitis

C) Otitis externa. The symptoms and history of the patient make otitis externa the most likely diagnosis. Otitis externa, also called swimmer's ear, is inflammation of the ear canal. It often presents with ear pain, swelling of the ear canal, and, occasionally, decreased hearing. Typically, there is pain with movement of the outer ear. Otitis media is inflammation or infection located in the middle ear. Otitis media can occur because of a cold, sore throat, or respiratory infection. Rhinosinusitis is defined as inflammation of the sinuses and nasal cavity. Bullous myringitis is a type of ear infection in which small, fluid-filled blisters form on the eardrum. These blisters usually cause severe pain. The infection is caused by the same viruses or bacteria that lead to other ear infections.

Which of the following statements is false regarding physiologic jaundice in newborns? A. Physiologic jaundice is the most common type of jaundice in infants B. The level of unconjugated bilirubin is increased in the newborn's body C. Phototherapy is usually indicated for these infants D. It starts on the second to fourth day of life

C) Phototherapy is usually indicated for these infants The majority of infants with physiologic jaundice do not need phototherapy. This form of jaundice is caused by the buildup of unconjugated bilirubin because the infant's immature liver cannot metabolize and excrete it quickly enough.

51.A 6-year-old girl who attends preschool part time is brought to the clinic by her mother as a walk-in patient. The mother reports that her daughter has recently begun swim lessons. The symptoms began as redness on the left eye and spread to the second eye within 2 days. The child's eyes are watery and crusted in the morning when she wakes up. Her vital signs are temperature of 98.8°F, pulse of 90 beats/min, and respirations of 16 breaths/min. The eye exam reveals bilateral injected conjunctivae. When the lower eyelid is examined, the nurse practitioner notes that it is pink with a cobblestone appearance. There is ipsilateral preauricular adenopathy. All of the following treatment measures are appropriate, except: A.Prescribe a topical ophthalmic vasoconstrictor to be used two times per day as needed for up to 3 days to reduce redness B.Write a note excusing the child from school because she should not attend un

C) Prescribe ophthalmic topical antibiotic eye drops, two or three drops to be applied in each eye QID for 7 days. Treatment for viral keratoconjunctivitis (pink eye) is symptomatic. Cold compresses and slightly chilled artificial tears may help with the itching. Educate the parent and/or child to avoid touching the eyes with hands, avoid sharing towels, perform frequent handwashing, and use tissues if touching the eyes. Viral keratoconjunctivitis is usually caused by an adenovirus (but other viruses can also cause it). It is contagious for 10 to 12 days after the onset of symptoms and is a self-limiting condition. It can be transmitted through swimming pools, fomites, and hands. Children should not attend school until symptoms resolve.

146.Which treatment is recommended for an infant with noncommunicating hydrocele? A.Surgery B.Medication C.Reassess in 1 year D.Centesis

C) Reassess in 1 year. A noncommunicating hydrocele occurs when the sac closes normally around the testicle during development, but the body does not absorb the fluid inside it. This type of hydrocele is common in newborns and usually disappears without treatment by 1 year of age. Surgery is recommended for a communicating hydrocele (when the sac does not seal) because the scrotum may swell more over time. There are no drugs available to treat hydrocele. Needle aspiration (centesis) is commonly performed on adult men who are at high risk for complications during surgery.

40.A 13-year-old boy wants to be treated for his acne. He has a large number of closed and open comedones on his face. The patient has been treating himself with over-the-counter benzoyl peroxide and topical salicylic acid products. Which of the following would be recommended next? A.Isotretinoin (Accutane) B.Tetracycline C.Retin-A 0.25% gel D.Careful face washing with medicated soap at bedtime

C) Retin-A 0.25% gel. Topical agents are the first-line treatment for acne vulgaris. Retin-A 0.25% gel would be the next step. Oral preparations (tetracycline) would then be offered, and Accutane would be the final step.

While checking for the red reflex on a 3-year-old boy during a well-child visit, the nurse practitioner notes a white reflection on the child's left pupil. Which of the following conditions should be ruled out? A. Unilateral strabismus B. Unilateral cataracts C. Retinoblastoma of the left eye D. Color blindness of the left eye

C) Retinoblastoma of the left eye Retinoblastoma is a congenital tumor of the retina. It usually affects only one eye (rarely both eyes are involved). During infancy, the tumor is a small size, and it continues to grow with the child. This rare cancer is diagnosed by noting a pupil that appears white or has white spots on it. One or both eyes may be affected. It is often first noted in photographs, because a white glow is present in the eye instead of the usual "red eye" that results from the flash.

116.All of the following are risk factors that could lead to hearing loss in an infant who was premature at birth, except: A.Hyperbilirubinemia B.Low Apgar scores C.Rubeola D.Seizures

C) Rubeola. Use the HEARS mnemonic for risk factors that may lead to hearing loss: Hyperbilirubinemia; Ear infections that are frequent; low Apgar scores; Rubella/cytomegalovirus (CMV), not rubeola; and Seizures. Sickle cell disease is not a risk factor for hearing loss.

# 140- Which medication is contraindicated in a 4-year-old child diagnosed with impetigo? A.Amoxicillin B.Dicloxacillin C.Tetracycline D.Mupirocin

C) Tetracycline. Tetracyclines (category D) should not be prescribed for patients younger than 9 years old. Mupirocin is the preferred first-line therapy for children with impetigo. Dicloxacillin is for penicillinase-producing staph skin infections and is an appropriate antibiotic for impetigo. Amoxicillin (category B), a broad-spectrum penicillin, is also an appropriate antibiotic for impetigo.

46.A mother brings her 4-year-old daughter, who just started attending preschool, to the health clinic. She tells the nurse practitioner that her child is complaining of burning and itching that started in the left eye. Within 2 days it involved both eyes, and the child developed a runny nose and sore throat. During the physical exam, the child's eyes appear injected bilaterally with no purulent discharge. The throat is red, the inferior nasal turbinates are swollen, and lymph nodes are palpable in front of each ear. Which diagnosis is most likely? A.Herpes keratitis B.Corneal ulcer C.Viral conjunctivitis D.Bacterial conjunctivitis

C) Viral conjunctivitis. The causative organisms of viral conjunctivitis (pink eye) include adenovirus and other virus types. It can present with or without cold symptoms. Patient complains of itchy red eyes and may have clear discharge accompanied by preauricular lymphadenopathy. The condition does not affect vision. If a contact lens wearer, assume bacterial infection and obtain culture of eye discharge.

132.All of the following deficiencies are common in pediatric patients with celiac disease, except: A.Folate B.Ferritin C.Vitamin D D.Vitamin B12

C) Vitamin D. Pathophysiologic hematologic manifestations of celiac disease frequently reflect nutritional deficiencies, including folate, ferritin, and vitamin B12. Vitamin D deficiency is not specifically associated with celiac disease.

94.A 3-year-old male toddler was seen in the office 8 days ago and prescribed amoxicillin 200 mg PO (suspension) TID × 10 days for strep throat. He presents for a follow-up visit with fatigue, reduced appetite, and dark-colored urine. A urine dipstick test reveals protein, albumin, and blood in the urine. Which test will the nurse practitioner order next? A.CT scan of the kidneys B.Fasting blood metabolic panel with complete blood count (CBC) with differential C.24-hour urine collection for protein and creatinine clearance D.24-hour urine collection for blood, protein, and creatinine clearance

D) 24-hour urine collection for blood, protein, and creatinine clearance. While urine dipstick testing is useful in gross analysis of urine, the test is not definitive for diagnosing disorders. Therefore, a 24-hour urine collection for blood, protein, and creatinine clearance would be appropriate in this case, as it is more sensitive in evaluation of renal function. Urine dipsticks detect only albumin as creatinine clearance, not microalbuminuria. A CT scan or fasting blood metabolic panel with CBC with differential is not the priority testing to be completed next because overall renal function must be determined first.

121.At what age should healthy full-term infants be screened for anemia? A.0 to 3 months B.3 to 6 months C.6 to 9 months D.9 to 12 months

D) 9 to 12 months Hemoglobin and hematocrit are not routinely screened at birth, because hemoglobin is elevated from maternal red blood cells (RBCs) that are mixed with fetal RBCs. Healthy infants have enough iron stores for 4 to 6 months after birth, and the introduction of complementary foods are typically rich in iron, so they should not be screened until 9 to 12 months.

121.Which skin condition is caused by elevated androgen levels? A.Tinea corporis B.Onychomycosis C.Acne rosacea D.Acne vulgaris

D) Acne vulgaris. Acne vulgaris is most prevalent in the adolescence stage because of elevated androgen levels, bacteria (Propionibacterium acnes), and genetic factors. Severe cystic acne causes painful, indurated cysts and abscesses on the face, back, shoulders, and chest. Tinea corporis is ringworm of the body and creates ringlike pruritic scales that slowly enlarge over the body. Onychomycosis is a fungal infection of the nail, which becomes yellowed and thickened, with scaling under the nail; it is also known as tinea unguium. Acne rosacea is a chronic inflammatory skin disorder that occurs mostly in fair-skinned people and causes small acne-like papules and pustules on the cheeks, mouth, and chin.

105.In a Rinne test, what is considered a normal finding? A.Vibration is louder in the "good" ear B.Sound is heard equally in both ears C.Frequency is heard higher in the "bad" ear D.Air conduction (AC) is heard longer than bone conduction (BC)

D) Air conduction (AC) is longer than bone conduction (BC). A normal finding for a Rinne test is AC heard longer than BC. In the Weber test, a normal finding is when there is no lateralization, where sound is heard equally in both ears when a tuning fork is placed on the midline of the forehead. If vibrations are louder in the "good" ear with a Weber test, that is a normal finding.

#103- A 10-year-old child presents with external ear pain, swelling, and decreased hearing in the left ear. The child is on a swim team and practices daily. Upon physical examination, the child does not want the left ear touched. There are no other abnormal findings. The nurse practitioner will advise the patient to do all of the following, except: A.Use aluminum acetate solution PRN B.Keep water out of the ear during treatment C.Apply polymyxin B-neomycin-hydrocortisone suspension drops QID × 7 days D.Apply steroid nasal spray BID × 1 week

D) Apply steroid nasal spray BID × 1 week. The symptoms and history of the patient make otitis externa the most likely diagnosis. Otitis externa, also called swimmer's ear, is inflammation of the ear canal. A recommended treatment plan includes the use of aluminum acetate solution prophylactically and as needed. Aluminum acetate solution provides soothing, effective relief of minor skin irritations and inflammation. The patient should be advised to keep water out of the ear during treatment, so swimming activities should be adjusted. Recommended treatment includes the application of polymyxin B-neomycin-hydrocortisone suspension drops QID × 7 days and/or ofloxacin otic drops BID × 7 days. A steroid nasal spray would not be included in the treatment of otitis externa.

#2 -A 14-year-old boy is brought in by his mother who reports that her son has been complaining for several months of recurrent bloating, stomach upset, and occasional loose stools. She reports that he has difficulty gaining weight and is short for his age. She has noticed that his symptoms are worse after eating large amounts of crackers, cookies, and breads. She denies seeing blood in the boy's stool. Which of the following conditions is most likely? A.Amebiasis B.Malabsorption C.Crohn's colitis D.Celiac disease

D) Celiac disease. Celiac disease is also known as celiac sprue. Patients should avoid foods containing gluten, which causes malabsorption (diarrhea, gas, bloating, and abdominal pain). Foods to avoid are wheat, rye, and barley. Oats do not damage the mucosa in celiac disease. Antigliadins IgA and IgG are elevated in almost all patients (90%).

#141- Which condition is a core disorder on the recommended uniform screening panel (RUSP) for newborns? A.Hypermethioninemia B.Tyrosinemia type II C.Galactokinase deficiency D.Congenital adrenal hyperplasia

D) Congenital adrenal hyperplasia. Congenital adrenal hyperplasia is an endocrine disorder that is a RUSP core condition. The RUSP is a list of disorders that the Department of Health and Human Services (HHS) recommends for states to screen as part of their universal newborn screening (NBS) programs. Disorders on the RUSP are chosen based on evidence that supports the potential net benefit of screening, the ability of states to screen for the disorder, and the availability of effective treatments. It is recommended that every newborn be screened for all disorders on the RUSP. Hypermethioninemia, tyrosinemia type II, and galactokinase deficiency are all secondary conditions. Secondary conditions are believed to be clinically significant, but some may have an unclear natural history or lack appropriate medical therapy that affects long-term outcome. They are detected during screening for core conditions.

59.Which is the most effective chart or test to screen for color blindness? A.Snellen chart B.Confrontation exam C.Extraocular movement test D.Ishihara chart

D) Ishihara chart. The Ishihara chart is the most appropriate method for screening a patient for color blindness. The Snellen chart is used to evaluate central distance vision, while the confrontation exam evaluates peripheral vision. The extraocular movement test reveals whether the eyes move together when following an object.

An 18-year-old male patient is found to have a 47,XXY karyotype and is diagnosed with Klinefelter's syndrome. The patient is likely to have all of the following physical characteristics, except: A.Gynecomastia B.Long limbs C.Lack of secondary sexual characteristics D.Large testes

D) Large testes. Signs and symptoms of Klinefelter's syndrome include gynecomastia, long limbs, and lack of secondary sexual characteristics. Testes are usually small. Infertility is a major concern for these boys. If treated early, they may have a normal sexual/reproductive system in the future.

56.What is a positive Kernig's sign? A.Flexing of hips and knee to relieve pain B.Inability to touch chin to chest C.Toes spread like a fan with plantar stroke D.Resistance to leg straightening from back pain

D) Resistance to leg straightening from back pain. A patient with a positive Kernig's sign will resist leg straightening when the hip is flexed as a result of painful hamstrings from lumbar nerve root inflammation. A positive Brudzinski sign is seen when the patient's neck is passively flexed and there is flexing of the hips and knees to relieve pressure and pain. Nuchal rigidity is present when touching the chin to the chest causes pain. A positive Babinski reflex is seen when the toes fan when the plantar surface is stroked from the heel to the great toe. Adults should have a negative Babinski reflex.

78.A 4-week-old boy is seen in the family practice clinic for a complaint of forceful vomiting that occurs immediately after feeding. The vomitus is composed of infant formula and is not bilious. The infant is bottle-fed with infant formula that was recommended by the pediatrician. The mother reports that the infant seems hungry and sucks on the bottle without any problems. His birth weight was 7 lb, 5 oz (3.4 kg). The current weight is 7 lb (3.2 kg). Which of the following clinical findings is an important clue regarding the possible cause of the infant's vomiting? A.Irritable and crying infant B.Sunken anterior fontanel and dry lips C.Positive rooting reflex D.Round olive-like mass located in the right upper quadrant of the abdomen

D) Round olive-like mass located in the right upper quadrant of the abdomen. The stem of the question is asking about the "possible cause of the infant's vomiting" (it is not asking about symptoms). Projectile or forceful vomiting after feeding (postprandial vomiting) is a classic symptom of infantile hypertrophic pyloric stenosis. A hypertrophied pylorus is a pathognomonic finding of the disease. An ultrasound of the pylorus is the imaging study of choice. The other signs and symptoms are dehydration (sunken anterior fontanel, dry lips, weight loss), irritability, and crying (usually due to hunger). A positive rooting reflex is a normal finding in a 4-week-old infant.

A child complains of severe pruritus that is worse at night. Several family members also have the same symptoms. Upon examination, areas of excoriated papules are noted on some of the interdigital webs of both hands and on the axillae. This finding is most consistent with: A. Contact dermatitis B. Impetigo C. Larva migrans D. Scabies

D) Scabies Scabies is a parasitic disease (infestation) of the skin caused by the human itch mite Sarcoptes scabiei. The rash is generally characterized as red, raised excoriated papules. The scabies mite is generally transmitted from one person to another by direct contact with the skin of the infested person and can also be acquired by wearing an infested person's clothing (fomites), such as sweaters, coats, or scarves. Following the incubation period, the infested person will complain of pruritus (itching), which intensifies at bedtime under the warmth of the blankets. Common sites of infection are the webs of fingers, wrists, flexors of the arms, axillae, lower abdomen, genitalia, buttocks, and feet.

82.The nurse practitioner will consider referring patients with all of the following burns to the ED or a specialist, except: A.Facial burns B.Electrical burns C.Burns that involve the cartilage of the ear D.Second-degree burn on the lower arm

D) Second-degree burn on the lower arm. Burns are described according to the depth of injury to the dermis and are loosely classified into first, second, third, and fourth degrees. A second-degree (superficial partial thickness) burn extends into the superficial (papillary) dermis. It appears red with clear blisters, blanches with pressure, has a moist texture, and is painful to sensation. A second-degree burn takes 2 to 3 weeks to heal. First- and second-degree burns are appropriately treated by a nurse practitioner. Third-degree burns should be referred to a physician. Examples of third-degree burns include electrical burns, severe burns on the face, and burns involving cartilage, such as the ear and nose.

2. male patient complains of a bright-red-colored spot in his left eye for 2 days. He denies eye pain, visual changes, or headaches. He has a new-onset cough from a recent viral upper respiratory infection. The only medicine he is taking is Bayer aspirin one tablet daily. 2.Which of the following is most likely? A.Corneal abrasion B.Acute bacterial conjunctivitis C.Acute uveitis D.Subconjunctival hemorrhage

D) Subconjunctival hemorrhage. Bright-red blood in a sharply defined area surrounded by normal-appearing conjunctiva indicates subconjunctival hemorrhage. The blood stays red because of direct diffusion of oxygen through the conjunctiva. Risk factors include diabetes, hypertension, illnesses that cause severe coughing or sneezing, blood-thinning medications and aspirin, and herbal supplements such as ginkgo.

43.Acanthosis nigricans is associated with all of the following disorders, except: A.Obesity B.Diabetes C.Colon cancer D.Tinea versicolor

D) Tinea versicolor. Acanthosis nigricans is a benign skin condition that is a sign of insulin resistance. It appears as hyperpigmented velvety areas that are usually located on the neck and the axillae. It is rarely associated with some types of adenocarcinoma of the gastrointestinal tract. Tinea versicolor is a superficial infection of the skin (stratum corneum layer) that is caused by dermatophytes (fungi) of the tinea family. Another name for it is sunspots.

112.A 16-year-old female patient who wears contact lenses presents to the clinic with eye pain, redness, and excessive tearing in the right eye. She tells the nurse practitioner that she frequently sleeps with her contact lenses because she forgets to take them out. During slit-lamp testing, the nurse practitioner notes there is an oval-shaped lesion in the right cornea. Which treatment will the nurse practitioner prescribe? A.Oral steroid B.Oral antibiotic C.Topical steroid D.Topical antibiotic

D) Topical antibiotic. Sleeping with contact lenses is an unhygienic practice that may result in contact lens keratitis. Symptoms include eye pain, redness, excessive tearing, and a lesion on the cornea. Topical antibiotics are the first line of treatment for the condition. Oral steroids, antibiotics, and topical steroids are not used as the first line of treatment for contact lens keratitis.

21.Which initial treatment will the nurse practitioner recommend for a patient experiencing mild allergic conjunctivitis? A.Nonsteroidal anti-inflammatory drugs (NSAIDs) B.Oral antihistamines C.Topical corticosteroids D.Topical antihistamines/mast cell stabilizers

D) Topical antihistamines/mast cell stabilizers. Mild allergic conjunctivitis occurs because of a mast cell response to an allergen. An over-the-counter topical antihistamine/mast cell stabilizer can be used to treat the initial symptoms of mild allergic conjunctivitis. NSAIDs are not the first line of treatment for mild allergic conjunctivitis. Patients with allergic conjunctivitis often produce an inadequate amount of tears, which results in dryness of the eyes. Although oral antihistamines can be used for mild allergic conjunctivitis, they may induce dry eye syndrome, which impairs the protective barrier of tears and worsens allergic conjunctivitis. Artificial tears may be needed if oral antihistamines are prescribed. Topical corticosteroids are not the first line of treatment for mild allergic conjunctivitis.

39.The parent of a 5-year-old states, "My child has had a rash for the past week and cannot stop scratching it." Physical assessment reveals 1-mm papules and pustules, grayish-white burrows on the child's palms and soles of the feet, and excoriated skin with honey-colored crusting on the face and neck. The nurse practitioner will prescribe: A.Topical nystatin B.Oral griseofulvin C.Oral ketoconazole (Nizoral) D.Topical permethrin (Elimite)

D) Topical permethrin (Elimite). The assessment findings are consistent with scabies and require the application of a scabicide such as topical permethrin (Elimite). Topical nystatin is used to treat candidal infections. Oral griseofulvin is used to treat different fungal infections. Oral ketoconazole (Nizoral) is reserved for severe fungal infections.

#125- Which oral antibiotic will the nurse practitioner prescribe for an 18-month-old infant with a symptomatic urinary tract infection? A.Ampicillin B.Ceftriaxone C.Ciprofloxacin D.Trimethoprim-sulfamethoxazole

D) Trimethoprim-sulfamethoxazole. In children younger than 24 months, the American Academy of Pediatrics (AAP) recommends empiric treatment of suspected UTI. If the child is being treated with oral antibiotics, first-line choices include trimethoprim-sulfamethoxazole, first-generation cephalosporins, and amoxicillin-clavulanate, although due to resistance to amoxicillin, this may be avoided as a first line. The top choice for empiric parental (IM/IV) therapy is ceftriaxone. Ampicillin can be used as a treatment choice for more serious genitourinary infections, and it is dosed as an IV or IM formulation in this age group. Currently, fluoroquinolones such as ciprofloxacin are approved only for complicated UTIs (including pyelonephritis) and for postexposure prophylaxis and treatment of inhalation anthrax in individuals younger than 18 years of age.