Final Exam Nur 439
14. Medicare Part A covers a. hospital, SNF, and hospice care b. all medically necessary services c. SNF care only d. hospice care
a
15. In a diagnostic work up and management plan for a child with osteomyelitis, which of the following is not accurate or recommended a. elevated ESR confirms diagnosis b. aspiration is usually indicated c. antibiotic treatment for identified pathogen 4-6 weeks is recommended d. burger is recommended if abscess is present
a
15. Medicare Part B covers a. all medically necessary services b. inpatient hospital care c. outpatient physician services only d. skilled nursing facility and hospice care
a
15. a 3 week old infant has a 1 day history of irritability, pallor, and poor feeding. He is afebrile. on exam, his heart rate is 240 while asleep. The most likely diagnosis is a. SVT b. premature ventricular contractions c. sinus tachycardia d. cyanotic heart defect
a
15. in a child with suspected meningitis, the lumbar puncture should be delayed and a CT scan obtained first in which of the following circumstances a. there are signs of increased intracranial pressure b. the child is tachycardic c. the child has a negative brudzinski sign d. the WBC is greater than 10,000
a
15. in mild to moderate attacks of acute asthma, albuterol should be given every 4-6 hours pro and routine medication should be a. continued as usual b. discontinued until albuterol treatments are deemed unnecessary c. given only if the albuterol is ineffective d. decreased to the minimum recommended dose
a
15. which of the following findings could be expected to occur in a baby with intussusception a. inconsolable screaming b. olive shaped mass c. left to right peristaltic waves d. weight loss
a
16. Varicella zoster infection is most commonly associated with which of the following skin lesions? a. Vesicle b. Comedone c. Nodule d. Macule
a
16. congenital complete heart block may be associated with: a. maternal lupus erythematous b. wolff-parkinson-white syndrome c. alcohol consumption during pregnancy d. Kawasaki disease
a
16. which of the following may occur with suspected appendicitis a. pain not relieved with ambulation b. young children appear very ill in the early phase c. fever is 102-103 d. leukopenia with left shift
a
18. the most common trigger for an acute asthma episode in the very young child is a. respiratory infections b. exercise c. tabacco smoke d. outdoor allergens
a
7. The most common clinical presentation of pneumonia includes a. cough, fever, tachypnea, and abdominal pain b. hemoptysis, putrid breathing, and weight loss c. sudden chest pain, cyanosis d. retractions, stridor
a
12. In evaluating Billy, a child with bloody diarrhea, which of the following would not be appropriate first action? a. Check growth chart b. Stool culture c. Upper GI d. Hemoccult test stools
c
14. A child with chickenpox and temperature of 102F should receive which medication for fever? a. Aspirin b. Amoxicillin c. Acetaminophen d. Acyclovir
c
8. ANA seropositivity for antibodies is: a. A valuable diagnostic marker for JIA b. Is not + in any other childhood diseases c. More commonly found in older boys or in systemic disease d. Present in over 75% of cases
a
9. The expected clinical severity of hemoglobin sickle C disease (Hgb SC) is: a. Asymptomatic b. Marked to moderate c. Mild to moderate d. Severe
c
9. unilateral wheezing is a finding suggestive of a. croup b. asthma c. foreign body aspiration d. cystic fibrosis
c
23. The peak incidence of osteosarcoma is a. 4-7 years of age b. 8-11 yrs of age c. 12-14yrs of age d. 15-19yrs of age
d
9. Rubeola is: a. Preventable by active immunization b. Caused by human herpesvirus 6 c. Treated with intravenous acyclovir d. Not associated with severe complications (e.g., encephalitits, pneumonia
a
9. standards of practice may be used to: a. establish minimal levels of performance b. establish reimbursement schemes for APRNs c. mandate nursing practice across the nation d. mandate nursing practice in certain states
a
1. Baseline management of all neonates with ABO incompatibility includes: a. Phototherapy b. Serial monitoring of bilirubin & hemoglobin levels c. Exchange transfusion d. Simple transfusion of packed RBCs
b
1. The most common congenital heart defect in children is a. tricuspid atresia b. ventricular septal defect c. aortic stenosis d. pulmonary atresia
b
1. a 10 month old child has been diagnosed with gastroenteritis He attends a child care facility. what is the most likely cause of his illness a. C diff b. rotavirus c. salmonella d. cryptosporidium
b
17. which of the following is not a complication of mumps a. meningitis b. pneumonia c. oophoritis d. pancreatitis
b
18. In most states, a learning disability is defined on the basis of a. the childs IQ as determined by a psychological evaluation b. a discrepancy between the childs actual and expected achievements c. a diagnosis of attention deficit disorder d. all of the above
b
8. the classic radiographic finding for croup is a. hyperinflation b. perihilary lymphadenopathy c. thumb sign d. steeple sign
d
9. What clinical signs would you expect to see in Sally on your examination (with 7% dehydration)? a. Normal capillary refill b. Normal fontanel c. Cool mottled skin d. Dry mucous membranes
d
9. which of the following is true regarding innocent murmurs a. the murmur is often holosytolic b. prompt referral to cardiologist is indicated c. a precordial thrill is present d. the murmur is low intensity, grade 1 -3
d
10. You are examining a child who has fever, coryza, cough, conjunctivitis, malaise, & anorexia. During the oral examination, you observe red eruptions with white centers on the buccal mucosa. What are these eruptions called? a. Pastia's spots b. Rubelola spots c. Koplik's spots d. Strawberry spots
c
19. What is the important aspect of the MACRA of 2015 a. the MACRA shifts the fee for service reimbursement payment model to a value based payment plan for medicare part B providers b. the MACRA elminates incident to billing for APRNS for medicare part A c. the MACRA allows 100% reimbursement of the physician fee schedule for all medicare part B providers d. The MACRA reduces reimbursement to 85% of the usual physician
a
19. Which of the following is a measure of childhood intellegence a. Wechsler scale b. denver II c. Bailey scales d. vineland scales
a
19. a child has mild persistent asthma. appropriate daily mediations should include a. an inhaled low dose corticosteroid b. short acting beta 2 agonist c. an oral systemic corticosteroid d. a cough suppresant
a
20. a potential childhood risk factor for development of artherosclerortic or coronary heart disease as an adult is a. obesity b. tachycardia c. easy fatiguability d. aerobic exercise
a
11. Duchenne muscular dystrophy is characterized by which of the following s/s? a. A birth, affected infants are notably hypotonic, "floppy" babies b. Earliest symptom is often refusal to bear weight c. Abnormalities of gait and posture become evident during preschool years d. Unable to keep up with peers when running by school age
c
20. in working with a child with tourette syndrome and his family the nurse practitioner should be aware that a. symptoms become more unpredictable during adolescence b. boys are more likely than girls to exhibit behavioral problems such as obsessive compulsive disorder c. sleep disturbance from ics increases with age d. several medications are now available to control the tics without interfering with daily function
a
22. Consistent with Hirschsprungs Disease, Jamie's findings on rectal exam would be which of the following? a. Tight anal canal with no stool in vault b. Impacted stool with fissure c. Large dilated rectum d. Soft stool, normal tone
a
22. a 14 year old diagnosed with JIA is not up to date on his immunizations and is currently on methotrexate. Which of the following vaccinations would be cautioned in this case a. varicella b. influenza c. inactive polio d. Tdap
a
22. a head injury in which bruising or tearing of the cerebral structures occurs is a a. contussion b. concussion c. hematoma d. diffuse axonal injury
a
11. prophylactic penicillin should be initiated in children with sickle cell anemia by: a. 3yrs of age b. 12mo of age c. 2-3mo of age d. 9mo of age
c
31. In a newborn, a diagnosis of hip dislocation is suspected when" a. +galeazzi, Barlow, and Ortolani b. wide hip abduction that is symmetric c. flaccidity of the left leg following extension of both legs with return to flexion d. tonic neck reflex in which the left leg is flexed
a
12. which of the following blood levels is not considered lead poisioning a. < 5 ug/dl b. 10-14 ug/dl c. > 15 ug/dl d. > 25 ug/dl
a
13. Medicare reimbursement for services a. is not dependent on the patients income level b. depends on the patients income level c. is not avilable to APRNS under any circumstance d. is only available to APRNS who are employed by a physicaian
a
13. the most useful test for evaluation of suspected acute rheumatic fever is a. antistreptolysin-o ASO titier b. electrocardiogram c. CRP d. urinalysis
a
1. Which of the following is congruent with the APRN Consensus Model? a. APRN licensure occurs at the level of role and population foci b. APRN education programs must be at the doctoral level c. National certification by a recognized APRN certifying body is optional d. Accreditation by the U.S. department of education is the minimum requirement for APRN programs
a
1. a 5 month old boy, former 28 seeker, is being evaluated because of a concern about delayed motor development. In formulating the differential diagnosis, you keep in mind that spastic cerebral palsy is characterized by a. increased deep tendon reflexes and sustained clonus b. dystonic posturing c. abnormal involuntary movements nystagmus
a
1. septicemia in the newborn period is most likely caused by which organism a. listeria monocytogenes b. haemophilius influenza c. neissera meningititids d. streptococcus pneumonia
a
10. For a newborn, the correct management of hip dislocation should include: a. Use of flexion-abduction device such as Pavlik harness to stabilize hip b. Follow and observe closely for 3-4 weeks then refer to ortho c. Surgical reduction d. Traction for 6 weeks
a
10. The expected hemoglobin range for sickle cell anemia is: a. 6.5-9.5g/dl b. 13.5-16.5g/dl c. 8.5-12.5g/dl d. 9.5-13.5g/dl
a
10. an ex preemie with bronchopulmonary dysplasia has been discharged to home from the NICU. a potential problem area that requires close monitoring is: a. insufficient caloric intake b. atrophy of abdominal muscles due to abdominal breathing patterns c. lack of tactile stimuli due to restrictions on parental handling d. the predisposition to development of nasal polyps
a
11. Medicaid provides health insurance coverage to: a. certain categories of people whose personal income falls below a certain percentage of the federal poverty level b. anyone whose personal income falls below the federal poverty level c. newborns pregnant women, and those older than 65 years whose personal income falls below the federal poverty level d. those who are elderly
a
11. a 10 day old is brought to the clinic because the parent is concerned about his breathing. The parents report that while the baby is feeding, he often stops breathing for periods of a bout 10 seconds. hx reveals that the baby eats well, has never appeared pale or cynaotic, and has never become limp during these episodes. Your management plan is based on which of the following a. this is a normal breathing pattern for an infant b. these episodes likely indicate aspiration of formula c. a variety of pathologic processes are associated with the episodes described d. neurologic deficits in infants are often manifested by such episodes
a
11. which of the following best describes the treatment of roseola a. acetaminophen or ibuprofen for fever, parental reasurrance b. warm compresses for salivary gland swelling c. oral acyclovir 20mg/kg/day 4 times a day d. bed rest, saline gargles for sore throat
a
12. Fifth disease is usually: a. Seen in age 5-14yo children b. Transmitted via the deer tick c. Treated with oral erythromycin d. Characterized by prolonged coughing episodes
a
22. which of the following is one of the four general core competency domains of interprofessional collaborative practice according to the IECEP a. working with individuals of other professions to maintain a climate of mutual respect and shared values b. maintaining a silo perspective so that all benefit from expert knowledge c. understanding that hierachical team-based care is the best care, and therefore teams should be led by physicans d. accepting that the patient is the most important member of the interprofessional team
a
23. Initial treatment of a sprain includes which of the following? a. Rest, ice, compression, elevation, & NSAIDs b. Heat, ROM exercise, compression, elevation, & NSAIDs c. Rest, heat, compression, elevation, & NSAIDs d. Rest, ice, ibuprofen, compression, & NSAIDs
a
23. the most significant major contributor or contributors to asthma morbidity and mortality is/are a. under diagnosis and inappropriate treatment b. an increase in indoor allergens c. overuse of anti-inflammatory medication d. an increase in air pollution
a
24. The most definitive features for a diagnosis of "growing pains" includes: a. Exclusion of other causes of lower extremity pain b. Pain, swelling, erythema c. Loss of ambulation d. Decreased ROM
a
24. When evaluating a child with suspected IBD, which of the following diagnostic tests would not be helpful? a. Amylase & lipase b. ESR c. Serum total protein & albumin d. CBC with diff
a
24. which of the following would not be associated with an uncomplicated concussion a. focal motor signs b. brief loss of consciousness c. headache d. confusion or amnesia from the event
a
25. Systemic-onset JIA is most commonly associated with: a. High, daily intermittent spiking fevers & rash b. Single joint involvement c. Positive RF factor d. Painless joint involvement
a
25. an essential test in the evaluation of a 2 year old being managed for Kawasaki disease is a. an echocardiogram b. electrolyes c. cholesterol d. antistreptolysin-o titer
a
25. which of the following is the greatest risk factor in the development of bronchopulmonary dysplasia a. birth weight b. maternal age c. maternal education d. respiratory infections
a
26. Which of the following is not one of the four major recommendations of the RWJF/IOM report The future of nursing: leading change, advancing health? a. nurses should practice to a limited extent of their education and training as defined by boards of medicine b. nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression c. nurses should be full partners with physicians and other healthcare professionals in redesigning health care in the U.S d. effective workforce planning and policy making require better data collection and an improved information infrastructure
a
27. Complications of SLE commonly include with of the following? a. Pericarditis, arthritis, nephritis b. Encephalitis, nephritis, pericarditis c. Nephritis, arthritis, rheumatic fever d. Nepthritis, hemolytic anemia, contact dermatitis
a
27. Lyme disease is most closely associated with which of the following skin lesions? a. Erythema migrans b. Nodule c. Scale d. Pustule
a
27. Which of the following is not congruent with U.S. prescribing laws and nurse practitioners a. physician signature on prescriptions written by NP is required in all states b. controlled substance prescriptions must include the NP's name and DEA number c. as of 1998, all states have approved and/or implemented some degree of prescriptive authority of NP d. pharmacology education within graudate programs and CE is required to maintain authority specific requirements vary by state
a
27. a neonate is being worked up for meningitis after experiencing a seizure preceded by fever, irritability and poor feeding for 1 day. On physical exam which of the following findings would be most consistent with a diagnosis of meningitis a. bulging fontanelle b. positive brudzinski sign c. nuchal rigidity d. positive kernels sign
a
27. follow an ALTE, management and treatment are based on findings from a. a thorough history and physical exam b. an electroencephalogram c. a chest radiograph d. a sleep study
a
27. initial therapy for neurocardiogenic syncope is a. ensuring adequate hydration b. pharmacologic therapy with a beta blocker c. a 24 hour hotter monitor to ensure there are no arrhythmias d. antiepoleptic therapy
a
28. Many infectious diseases present with rashes along with general complaints of fever, malaise, and headaches. Which of the following clusters of symptoms would make you consider Lyme disease as a likely diagnosis? a. Fever, malaise, headace, arthalgia, and well circumscribed, erythematous, annular rash with central clearing b. Fever, malaise, headache, transient bone pain, and generalized erythematous, maculopapular rash that began on the face and spread to trunk and extremities c. Fever, malaise, anorexia, and confluent, erythematous, brownish maculopapular rash d. Fever, malaise, anorexia, and erythematous rash beginning on wrists and ankles then spreading to the trunk
a
28. which of the following would not be consistent with a diagnosis of function constipation in an infant a. vomiting b. anal fissure c. straining d/ starting solids
a
3. When evaluating a child with abdominal pain, what symptom would lead to a likely organic etiology? a. Night waking b. Pallor c. Suprapubic pain d. Sweating
a
3. management of an infant with suspected heart disease and a reported cyanotic spell should include a. prompt referral to cardiology b. an apnea monitor c. instructing the parents to keep a diary of these events d. continuous administration of oxygen
a
30.
a
30. subluxation of the radial head is referred to as "nurse maid's elbow" if the risk for fracture is low or absent which of the following is recommended a. supination and flexion of the forearm maneuver b. extension and supination c. use of finger traps with weight on the humerus d. the hypopronation and extension maneuver
a
31. Steatorrhea is not consistent with which of the following? a. C. diff b. Giardia lamblia c. Celiac disease d. Cystic fibrosis
a
33. the parents of a 5 year old recently diagnosed with muscular dystrophy want an explanation about the hereditary nature of the disease. The best explanation is a. x linked recessive gene transmitted by unaffected female carriers b. recessive gene that is known to skip generations between transmission c. dominant sex linked gene predominantly in white families in Europe d. recessive gene that requires both mother and father to be carriers
a
34. which of the following is true for idiopathic scoliosis which occurs primarily in adolescents a. mild curves occur equally between the sexes b. generally, there is no family history c. back pain is usually associated with curves of 35 degrees of higher d. bracing is indicated for thoracic curves of 10-20 degrees
a
35. A parent requests that her 6mo old child receive immunoglobulin as protection against hepatitis A prior to international travel. Which of the following does this parent need to know? a. After IG administration, a 3mo interval is needed prior to the next measles vaccination b. There is no impact on future immunizations c. No immunizations can be given for 1year d. Since children do not have symptoms with hepatitis A, IG is not necessary
a
35. in legg calve perthes disease which of the following signs and symptoms are seen a. insidious onset of limp with knee and groin pain b. sudden onset of limp and pain in lateral hip c. fever and insidious onset of limp d. afebrile and sudden onset of lip
a
36. signs and symptoms associated with duchenne muscular dystrophy are. a. hx of delayed developmental milestones b. visual motor disturbances, calf hypertrophy c. delayed motor development, positive ortolan maneuver d. history of clumsiness, visual motror disturbances
a
38. sports injuries are commonly associated with a. improper training b. higher frequency in females c. scoliosis d. low socioeconomic status
a
4. Although relatively rare in the U.S., diphtheria can occur among under-immunized children. Which of the following clusters of signs, symptoms, and physicals findings would suggest diphtheria in a child presenting with upper respiratory complaints? a. Low grade fever, sore throat, nasal discharge, grayish-white pseudo-membrane in his/her throat b. Abrupt onset of high fever, severe sore throat, nasal discharge, and grayish-white pseudo-membrane in his/her throat c. Low grade fever, abrupt onset of severe sore throat with difficulty swallowing and drooling d. Abrupt onset of high fever, severe sore throat, with difficulty swallowing & drooling
a
40. growth in muscle length is related to growth in length of a. underlying bone b. underlying ligament c. underlying tendon d. opposing muscle group
a
42. tracy who is 9 years old, complains that she does not like to wear shorts because her knees look funny. Upon examination, you note gene valium angle of greater than 15 degrees. you should: a. reevaluate in 1 year if still present b. consult with an orthopedic specialist c. instrut her to avoid W sitting position d. encourage exervise to strengthen quadracepts
a
48. Which of the following factors most affects outcomes in patients with LCPD a. age of child b. severity of pain and antalgic gait c. family hx of LCPD d. Bilateral involvement
a
5. Standards of practice are: a. authoritative statements used to measure quality b. used to measure outcome but are not authoritative c. designed for legal purposes d. not designed for legal purposes and cannot be used to measure quality.
a
5. what is the most common agent for nonviral pneumonia from school age to adulthood a. mycoplasma pneumonia b. staphylococcus aureus c. ureaplasma urealyticum d. haemophiuls influenza
a
5. which of the following signs is not characteristic of a generalized seizure a. unilateral motor manifestation b. disturbance of consciousness c. tonic stiffening of the trunk d. simultaneous any symmetric cerebral hemisphere discharge
a
51. you have been treating a 14 month old for torticollis since birth. The condition has not resolved and the child still has limited neck rotation. The appropriate management plan would be to a. refer for surgical consulation b. continue with passive motion c. provide environmental stimulation opposite the contrature d. apply cervical collar at night
a
54. a 3 year old presents with a hx of fever for the past several days, pain in his left leg and refusal to bear weight on the left leg. 10 days ago, he fell from a slide and bruised his left leg. His WBC is slightly elevated. You suspect other toxic synovitis or osteomyelitis. Which finding supports a diagnosis of osteomyelitis more so than toxic synovitis a. recent injury b. leg injury c. non weight bearing d. elevated WBC
a
57. a macular salmon to red colored rash with irregular borders and central clearing is typical of which of the following a. systemic juvenile arthritis b. lyme disease c. systemic lupus erythema d. rheumatic fever
a
6. A physical finding not usually associated with talipes equinovarus congenita is: a. Contracture of the illiotibial bands b. Deep crease on medial border of foot c. Atrophy of calf muscles d. Small foot with limited dorsiflexion
a
6. Diagnostic findings consistent with beta-thalassemia are: a. Hemoglobin-normal b. Reticulocytes-normal c. Hgb A2 <3.6 d. Hypochromia, microcytosis
a
6. which of the following is the primary diagnostic tool used in evaluation of seizure disorder a. eeg b. cerebral blood flow studies c. CT scan d. MRI
a
7. A characteristic feature of polyarticular JIA disease is a. the involvement of five or more inflamed joints b. confinement to lower extermity joints, knees and ankles c. aysmmetric involvement d. high, daily intermittent spiking fevers
a
7. Asplenic children are at increased risk for which of the following? a. Bacterial infections b. Fungal infections c. Viral infections d. Parasites
a
7. Most risk management programs are based on the assumption that: a. many injuries to patients are preventable b. most legal liability is a result of poor documentation c. most injuries to patients are not preventable d. malpractice insurance is generally unnecessary.
a
1. a 4 week old presents to your office in mid january with a 1 week history of nasal congestion and occasional cough. On the evening prior to this visit the infant developed a temperature of 102 F, refused to breastfeed and had paroxysmal coughing and noisy labored breathing. On exam you not an ill appearing infant who is lethargic with tachypnea wheezing and intercostal retractions. The infant does not attend day care but has a 3 year old sibling who is in day care and who recently had a cold. Considering the clinical presentation, what is the most likely cause of the infants illness a. mycoplasma pneumonia b. RSV bronchiolitis c. aspiration pneumonia d. streptococcal infection of the pharynx
b
1. which of the following disorders is usually associated with adduction of the forefoot a. internal femoral torsion b. talipes equinovarus congenita c. genu valgum d. internal tibial torsion
b
10. sally's vomiting and diarrhea have stopped. If she needs oral replacement therapy today, what would be the appropriate amount to recommended a. 325-350 cc over 4 hours b. 600-700 cc over 4 hours c. 600-700 cc over 12 hours d. 325-350 cc over 8 hours
b
10. which of the following history points would not alert the practitioner to the possibility of a brain tumor a. headache in the morning associated with vomiting b. sleep apnea c. school failure and personality changes in older children d. none of the above
b
11. Pinworms can cause which of the following? a. Constipation b. Anal itching c. Abdominal pain d. Diarrhea
b
11. a 12 year old girl seen at a routine visit has a blood pressure of 138/90. This blood pressure is in the 99th percentile for a height at the 95th percentile. She denies any symptoms such as headache or blurred vision. there is no family history of hypertension. The initial management would include a. intravenous pyelogram b. return for two repeat blood pressure measurements c. no follow up needed - blood pressure likely related to anxiety d. a diuretic therapy
b
12. Most children with Duchenne muscular dystrophy become wheel-chair dependent by what age? a. 7-9 yo b. 10-12 yo c. 14-16yo d. highly variable depending on response to treatment
b
12. Mr. Harris calls the pediatric clinic to say that josh, his 2 year old son, has tripped on the sidewalk and hit his head on concrete. Which of the following symptoms reported would require that josh be seen in the emergency room a. uncontrollable crying b. loss of consciousness c. scalp laceration d. history of febrile seizures
b
12. a 9 year old boy presents with a fever of 102 F and complaints of leg pains. His mother reports that he had an upper respiratory infection with a sore throat approximately 2 weeks ago, which subsided with out therapy. On physical exam, he has tender, swollen knees bilaterally . His heart rate is 120 and a blowing systolic murmur is heard at the apex. No murmur was noted at a previous well visit. The most likely diagnosis is a. kawasaki disease b. rheumatic fever c. sickle cell anemia d. viral illness
b
13. Billy's family eats at fast food restaurants 4-5x/week. If you suspect the diarrhea is infectious in nature, what is likely causative organism? a. Adenovirus b. E. coli c. Giardia lamblia d. S. aureus
b
13. what is the appropriate management of a child with asthma who presents with acute wheezing and or coughing a. administered an inhaled corticosteroid b. administer short acting beta agonist c. administer an expectorant d. administer an oral corticosteroid
b
13. which of the following is not precipitating factor for heolyisis in G-6 PD deficiency a. drugs b. exposure to extreme temperatures c. ingestion of fava beans d. infection
b
13. which of the following statements is not true regarding the transmission of chickenpox a. susceptible individuals can contract chicken pox from patients with varicella zoster (shingles) b. children with chickenpox are infectious only during the period of time when skin lesions are present c. children with chicken pox are no longer infectious once crusting of skin lesions has occurred d. varicella zoster immune globulin should be administered to susceptible immunocompromised individuals who are exposed to a patient with varicella zoster infection
b
14. the initial attack of acute rheumatic fever is preceded by a. a viral illness b. a group a streptococcal infection c. exposure to mites d. exposure to chicken pox
b
15. The most appropriate agent for use in treating varicella zoster infection in an immunocompromised host is: a. Ganciclovir b. Acyclovir c. Cetriaxone d. Chloramphenicol
b
15. a newly circumcised infant is still bleeding an hour after the circumcision. Your differential diagnosis would include all except a. hemophilia b. sickle cell anemia c. von willebrand disease d. wiskott aldrich syndrome
b
16. Absence seizures a. often begin between 1 and 2 years of age b. appear as altered awareness and blank stare for a brief period c. more commonly occur in first born children d. usually progress to a more severe seizure disorder beyond childhood
b
16. which of the following medications should be avoiding in children with ITP a. decongestants b. aspirin c. acetaminaphen d. sulfa drugs
b
17. Which of the following statements is true about acute osteomyelitis a. it occurs more frequently in females than in males b. peak age are infants (younger than 1 year) and preadolescent (9-11 years) c. most common sites are radius and ulna d. it is a self limiting disorder
b
17. in addition to airway hyper responsiveness and reversible airway obstruction, asthma is a chronic lung disease characterized by a. bronchiectasis b. inflammation c. pleural effusion d. pulmonary edema
b
17. the most common cause of myocarditis in north American is a. bacterial b. viral c. drug reaction d. radiation therapy
b
17. the term incident to refers to: a. the occasions when an APRN practices independently but occasionally consults with a physician b. the notion that the physician must be present in the office suite and immediately available to provide assistance in order for the APRN to bill for services rendered c. the notion that a physician must examine the patient along with the APRN if Medicare is to be billed for services rendered d. Mediciaid only and is not pertinent to medicare billing.
b
18. What recommendation would you make to a parent whose son has been diagnosed with mumps and wants to know when he can return to child-care? a. He can return once he becomes afebrile and can tolerate eating b. He can return 9 days after onset of symptoms c. He can return when he is well enough participate in activities d. He can return after a minimum of 5 days of antibiotic therapy
b
18. which of the following serological findings indicate chronic HBV infections a. HBsAg negative for 6 months b. anti HBc positive and HBsAg positive c. IgM anti HBc positive d. anti HBs positive
b
19. Children in child-care facilities are at greater risk of being exposed to which of the following infections? a. HAV b. HBV c. HCV d. HDV
b
19. Genu varum is considered an abnormal condition when: a. Extreme knock-knees continues after 7 yrs of age b. Extreme bowing continues after 2yrs of age c. Parents are concerned about their child's appearance d. Evident before 2yo
b
19. which of the following tests is required to diagnose leukemia a. CBC with differential b. bone marrow aspiration/biopsy c. chest radipgraph d. biopsy of an enlarged lymph node
b
2. A 4 year old child with a hx of myelomeningocele and a VP shunt presents to the clinic with a headache, nausea, vomiting and lethargy. The most probable diagnosis is a. viral gastroenteritis b. shunt malfunction c. meningitis d. shunt infection
b
2. which of the following is not associated with Rh incompatibility a. mother Rh negative, baby Rh positive b. mother Rh positive, baby Rh Negative c. more severe in subsequent sensitized pregnancies d. hemolysis may occur up to 6 weeks or more
b
21. Malpractice insurance: a. protects APRNs from charges of practicing medicine without a license when they are practicing outside the legal scope of practice b. does not protect APRNs from charges of practicing medicine without a license when they are practicing outside the legal scope of practice c. does not pay for legal defense if the APRN is practicing beyond the legal scope of practice d. is important but should not be purchased if the facility in which the APRN is employed carriess good coverage
b
21. an 8 year old with moderate persistent asthma presents with a daily cough. At her clinic visit, she reports that three times a day she uses a short acting inhaled beta 2 agonist and twice daily she uses an inhaled corticosteroid, cromolyn sodium. Your management plan should include a. broad spectrum antibiotics and recheck in 2 weeks b. addition of oral systemic corticosteroids for 5 days c. increased use of short acting beta 2 agonist and replace cromolyn sodium with inhaled corticosteroids d. addition of an inhaled anticholinergic
b
21. which of the following diagnoses is associated with contractors of one of the sternocleidomastoid muscles a. lordosis b. toriticollois c. scholiosis d. kyphosis
b
21. which of the following is not likely to cause secondary hypercholesterolemia a. nephrotic syndrome b. hypertension c. corticosteroids d. obstructive liver disease
b
22. which of the following statements is true about immunizations during treatment of childhood cancer a. children continue to receive immunizations as usual b. immunizations are not given during active chemotherapy c. only live vaccines are held during active chemotherapy d. no family member should be immunized while the child is receiving chemotherapy
b
23. Kawasaki disease is most common in a. neonates b. children younger than 5 years of age c. children older than 6 years of age d. females
b
23. What treatment would be appropriate for Jamie's Hirschsprungs Disease? a. Emulsified mineral oil, ½ tablespoons per day b. Referral to gastroenterologist/surgeon c. Malt soup extract, 2 tsp for 3 days d. Rectal dilation with thermometer
b
23. which of the following interventions would not be appropriate for a 6 month old infant with suspected diagnosis of infantile botulism a. stool and blood cultures b. immediate administration of equine antitoxin c. stool softeners d. supportive care
b
24. Licensure: a. is a federal process that is used to standardize healthcare facilities b. is the granting of authority to practice c. cannot be used to prohibit anyone from practicing a given profession d. is a federal process that is used to standardize education programs
b
24. which of the following are associated with paralytic poliomyelitis a. lacy, erythematous, pruitic rash b. respiratory compromise, speech disturbances, urinary incontinance c. abdominal swelling, lymphadenopathy, and jaundice d. nonspecific abdominal pain, nausea and vomiting
b
25. The APRN consensus model is a. a mandate from the NCSBN that defines advanced practice nursing b. a proposed regulatory model for advanced practice nursing c. a proposal for federal legislation for advanced practice nursing d. approved only by the ANA
b
25. for children 2 to 4 years of age, the most common cause of head injury is a. MVA b. falls c. child abuse d. bicycle accidents
b
25. which of the following diagnostic findings is consistent with X linked agammaglobulinemia a. IgG - normal b. B cells - decreased c. T cells - decreased d. IgA - normal
b
26. which of the following is not characteristic of an apparent life threatening event a. change in muscle tone b. fever c. change in skin color d. apnea
b
27. The diagnostic finding that is pathognomonic for Wiskott-aldich syndrome is a. Absent B cells b. small platelets c. CD4 cytopenia d. decreased hemoglobin
b
28. the predominant characteristic of a young infant with BPD is a. prolonged fevers b. hypoxemia on room air c. recurrent pneumonias d. chronic hypoinflation
b
29. A child has developed her 2nd perirectal abscess in 6mo. She should be evaluated for which condition? a. Giardia lamblia b. Crohn's disease c. Ulcerative colitis d. Enterobiasis
b
29. How many states have enacted the APRN compact model legislation a. 32 states b. 2 states c. 11 states d. None
b
3. of the following children, which one should not have tuberculin skin testing a. 14 year old whose uncle was recently granted parole after 5 years in prison and who is currently living with the child b. a 2 year old who was infected with RSV 3 months ago and who is currently asymptomatic c. a 3 month old whose family emigrated from cambodia to the US 1 month ago d. an 18 month old whose mother is infected with HIV
b
30. if a nurse practitioner bills "incident to" a physician, what is the allowed reimbursement rate for Medicare Part B patients a. 100% b. 85% c. 75% d. 65%
b
33. Of the following advice, which would be most helpful for the parents of a baby with gastroesophageal reflux? a. Most babies continue to vomit until they are walking, at around 1 yr of age b. Laying prone after eating will decrease the amount of vomiting c. Increase the interval between feedings to a minimum of 4hrs d. Medications are generally necessary to prevent further problems
b
34. which of the following foods would be appropriate for a child with celiac disease a. oatmeal for breakfast b. boiled rice with butter c. commercially baked bread d. cream of wheat
b
37. which of the following is an appropriate goal for a child being treated for osteomyelitis a. prohibiting activity b. complete course of antibiotic therapy c. encouraging a low fat diet d. restricting visitors
b
39. an injury at which of the following sites will cost likely result in a bone length discrepancy a. diaphysis b. epiphysis c. medullary cavity d. metaphysis
b
4. Chest pain in young children is usually a. a symptom of congenital heart disease b. non cardiac in origin c. a sign of hypercholesterolemia d. a symptom of congestive heart failure
b
45. a child with growing pains is most likely to experience a. a mild limp b. bilateral lower extremity pain c. lower extremity pain primarily during the day d. lower extremity pain associated with decreased range of motion
b
47. which of the following represents appropriate anticipatory guidance for a child diagnosed with slipped capital femoral epiphysis a. avoid contact sports until pain resolves b. use crutches to facilitate mobility during acute plase c. apply ice to the affected area d. perform range of motion and strengthening exercises
b
5. Infants younger than 6mo of age with pertussis frequently require hospitalization to manage: a. Fever, cough, dehydration b. Coughing paroxysms, apnea, cyanosis, feeding difficulties c. Coughing paroxysms, dehydration, renal failure d. Seizure, fever, pneumonia
b
5. a common cause of congestive heart failure the first year of life is a. pulmonary stenosis b. ventricular septal defect c. rheumatic fever d. complete heart block
b
50. The appropriate management of osgood-schlatter disease includes a. local injections of soluble corticosteroids b. decreasing activity, applying ice and taking prescribing NSAIDS c. program of strengthening and stretching for quadraceps d. casting in adduction for 6 weeks
b
55. which of the following suggests internal tibial torsion rather than internal femoral torsion in a 2 year old child presenting with an in toeing gait a. sitting in W position b. knees face forward when walking c. generalized ligament laxity d. limited external rotation of the hip
b
6. One of the most appropriate agents used to treat influenza A is: a. Acyclovir b. Osteltamivirc c. Erythromycin d. Tetracycline
b
6. Quality improvement activities include: a. patient satifiscation surveys only b. peer review, patient satisfaction survey, and chart audits c. defining four practice domains d. systems to decrease risk of injury to patients
b
7. a vibratory systolic ejection murmur is heard at the lower left sternal border in a healthy 4 year old at her preschool physical. The cardiovascular exam is otherwise normal. A likely diagnosis is a. venous hum b. stills murmur c. transposition of the great arteries d. rheumatic heart disease
b
7. which of the following symptoms are characteristic of rubella a. vesicular crusted lesions and high fevers b. post auricular lymphadenopathy and low grade fever c. intense pruritus usually in fingers webs, buttocks, thighs and ankles d. rough textured maculopapular rash that blanches with pressure
b
8. Although uncommon, a potential sequela of rubella may include: a. Pneumonia & chronic otitis media b. Arthritis, thrombocytopenia & encephalitis c. Oophoritis & infertility d. Arthritis, carditis, and neurological involvement
b
8. Baby Sally was in your office last week for her 6mo check up. Her weight was 7kg. Today she presents with diarrhea and vomiting for 4 days. Today her weight was 6.5kg. What is her percentage of dehydration? a. 5% b. 7% c. 10% d. <1%
b
8. What is regarded as the national standard for nurse pracitioner education? a. APRN consensus Model b. Criteria for Evaluation of Nurse Practitioner programs, 5th edition, 2016 c. IOM future of nursing report d. AACN essentials of masters education
b
8. which of the following is not considered preventive management for iron deficiency anemia a. iron forced cereal from 6-12 months of age b. iron fortified formula until 6 months of age c. no cows milk until 1 year of age d. if breastfeeding supplemental iron drops or iron fortified cereal by 4-5 months of age
b
9. An 18 year old college freshman is seen in the student clinic with a complaint of migraine headaches. In collecting the hx you would expect him to say he experiences pain a. throughout his head without any localization b. restricted to one side of his head during an episode c. mostly in the occipital region d. across his head from one temporal side to another
b
10. SBE prophylaxis is recommended for a. all children with congenital heart disease on a daily basis b. all children with congenital heart disease before dental, GI, and GU procedures c. children with repaired congenital heart disease with a residual defect at the repair site d. five years after repair of all congenital heart disease
c
14. a 12 month old child whose parents have a hx of noncompliance for routine care, presents to the clinic with fever, irritability, and nuchal rigidity. The most critical diagnostic step in the child with suspected meningitis is a. the hx b. the physical examination c. evaluation of the CSF d. blood culture
c
16. In order to bill medicare, an NP must meet which conditions? a. have a DNP and state authorization to practice b. have a PhD and be nationally certified c. have a state authorization to practice and be nationally certified d. have a masters in nursing, national certification optional
c
18. Incident to billing is specific only to: a. medicare and medicaid b. medicaid c. medicare d. private insurance companies
c
18. a 1 day old child is evaluated in the newborn nurse for a fever. A CBC reveals a WBC of 18 with a differential of 82% PMNs, 4% lymphocytes, 9% monos, 3 % eco, and 2% bands. Which of the following would be highest on your list of differential diagnoses a. necrotizing enterocolitis b. maternally transmitted bacterial infection (group b strep) c. severe combined immunodeficiency D. torch infection
c
19. which of the following are symptoms of cat scratch disease a. joint pain, conjunctivitis, mild neck stiffness b. irritability, fever, hypotension c. fever, malaise, lymphadenopathy d. severe coughing, vomiting, anorexia
c
2. Signs & symptoms of bacterial sepsis in children beyond the neonatal period include? a. Cough, fever, abdominal pain b. Vesicular rash, pruritus, fever c. Irritability, fever, lethargy d. Abdominal pain, diarrhea, vomiting
c
2. The most common rheumatoid disease of childhood is: a. Systemic lupus erythemtosus b. Kawasaki disease c. JRA d. Legg-Calve-Perthes disease
c
20. Infant immunizations for hepatitis B often raises many parental questions about the disease. Which of the following is not true about Hep B virus? a. It can survive for more than 1 week on fomites b. It is most common form of hepatitis in the world c. Contaminated water & shellfish are the major source d. Perinatally infected infants are likely to become carriers
c
20. Legal authority for APRN practice is granted by a. federal law b. regulations from the U.S. department of health and human services c. state law and regulations d. the board of medicine in most states
c
20. Tibial torsion is commonly associated with: a. Pain b. Restricted ROM c. Internal rotation of lower extremities d. Occurrence in adolescents 13-16 of age
c
20. which of the following is not included as part of the initial therapy for ALL a. Chemotherpay b. radiation therapy c. bone marrow transplant d. intrathecal chemotherapy
c
22. which of the following factors is not associated with increased risk for infantile botulism a. rural environments b. use of honey c. use of corn syrup d. farm families
c
24. The primary treatment for bronchopulmonary dysplasia is: a. pancreatic enzymes b. surgical repair c. adequate oxygenation c. chest physiotherapy
c
24. which of the following types of infection is not associated with humoral immunodeficiencies such as common variable immunodeficiencies a. sinusitis b. pneumonia c. urinary tract infection d. cellultites
c
25. Muscle spasms associated with tetanus are aggravated by which of the following? a. Fever b. Tetanus immunoglobulin c. External stimuli d. NSAID
c
26. Antimicrobials will improve the condition of a 4yo child with diarrhea caused by which of the following organisms? a. Salmonella b. Rotavirus c. Shigella d. E. coli (0157:H7)
c
26. Classic symptoms associated with malaria include: a. Low grade fever, upper respiratory congestion, cough b. Annular rash, conjunctivitis, headache, arthralgia c. High fever, chills, rigors, sweats, headache d. High fever, jaundice, lethargy, vomiting
c
26. a 14 year old has pain in the knee. the pain increases with activity and is relieved with rest. The PNP diagnoses osgood-schlatter disease and orders a. an x ray examination, application of ice to the knee and motrin b. application of hot packs to the knee spirit and rest c. a reduction in activity, application of ice to the knee and ibuprofen d. application of ice to the knee and continued participation in sports
c
28. What is true about the Merit Based incentive payment system a. MIPS allows 100% reimbursement of the physician fee schedule for all medicare part B providers b. MIPS applies to providers who bill both medicare Part A and Part B c. MIPS is one of two quality payment programs (QPP) tracks that adjusts clinicians medicare Part B reimbursement based on quality and value of care provided d. MIPS is a new medicare part b payment model for physicans
c
28. a new patient presents at the age of 4 years. he has a BMI of 19, which is greater than the 95th percentile for his age. His family relates a history of early heart attacks in both sets of grandparents (before the age of 55) and the parents state they have recently been diagnosed with elevated cholesterol. on the basis of this information you will a. counsel the family on limiting the childs saturated fat intake to < 7% and cholesterol intake to 200 mg a day b. do nothing, he is too young for testing to be helpful and a child this age should not have any dietary modifications implemented c. perform two fasting lipid profiles and average the results because the child presents with several high risk factors d. perform one fasting lipid profile and initiate statin therapy immediately given the high BMI
c
28. which of the following children need an orthopedic referral? a. a 6 year old with mild bowing of the lower legs b. a 6 month old with internal tibial torsion c. a 3 week old with equinovarus of feet d. a newborn with positive pavlik sign
c
29. Antonio is a newborn and the PNP notes on physical assessment that both his feet turn in. When attempting range of motion, she finds that both feet move relatively freely in all directions. Antonio has: a. Clubfoot b. Syndactyly c. Matarsus adductus d. Fracture of his feet
c
29. The most useful diagnostic tool for diagnosing epilepsy is a. mri b. emg c. eeg d. CT
c
29. which of the following would be included in patient education regarding lyme disease? a. educate caretakers regarding complications, including hypertension and renal cali due to immobility b. educate caretakers to avoid use of aspirin containing products for fever control due to association with increased risk for eye syndrome c. educate caretakers regarding use of protective clothing and tick repellent in heavily wooded area d. educate caretakers regarding natural history of the illness, and need for specific follow up after infection with rickettsia rickettsia
c
3. Radiographic findings of disease progression and sphericity of femoral head is helpful in the diagnosis and followup of: a. Transient synovitis of the hip b. Osgood-schlatter disease c. Legg-Calve-perthes disease d. Slipped Capital Femoral epiphysis
c
3. an apparently healthy child who is enrolled in head start is suspected of having developmental delays based on Denver II results at two separate clinic visits. The most appropriate next step would be too a. request developmental evaluation from the head start program b. repeat the denver II in 6 months c. refer the child for a more definitive evaluation d. discuss ways in which parents can foster the childs development
c
3. the NP role was initially established to: a. reduce the nursing shortage and improve access to care b. improve working conditions of nurses while improving access to care c. improve access to care and partially solve physician shortage d. improve nursings image through expansion of the role
c
3. which of the following vaccines provides protect against a common type of sepsis meningitis a. small pox vaccine b. hepatitis b vaccine c. hib d. inactivated polio vaccine
c
32. Jamil has had diarrhea for 3 days. His mother calls concerned. Which of the following would not be helpful advice? a. Monitor stool for blood or mucus b. Encourage solid food c. Avoid milk products d. Monitor for urination for at least 6hrs
c
4. B-chain synthesis is absent in a. b-thalassemia minor b. b-thalassemia intermedia c. b-thalassemia major d. a-thalassemia trait
c
4. Early NP related research focused on: a. the response of policy makers to the nursing shortage b. the effectiveness of the NP as a primary caregiver c. an effort to demonstrate quality and cost effectiveness of NP's d. the role of the NP as a physician extended
c
4. Vomiting in infancy has a long list of differential diagnoses. Which accompanying symptom would most likely point to pyloric stenosis? a. Diarrhea b. Appropriate growth c. Acts hungry after vomiting d. Sausage shaped mass in abdomen
c
4. what needs to be included when educating parents about febrile seizures a. the pediatric patient is at increased risk for epilepsy than an adult is b. the pediatric patient would benefit from phenytoin prophylaxis c. children may experience repeated seizures d. the pediatric patient would benefit from phenobarbital prophylaxis
c
4. which of the following clinical presentations least warrants sweat chloride testing a. 10 year old female sibling of a patient with newly diagnosed with CF, sibling is without pulmonary problems and growth parameters are at 50% for age b. 2 year old male with recurrent pneumonia and growth parameters at 5% of age c. 4 year old female with nocturnal cough, which resolves after treatment with bronchodilators and short term steroids, growth parameters at 10% for age d. 7 year old female with nasal polyps, mildly hyper-expanded lungs, growth parameters at 25% for age
c
41. Varus between the tibia and femur of up to 15 degrees followed by a progression to a neutral angle, which then progresses to values between 7 degrees and 9 degrees is associated with which of the following a. blount disease b. internal tibial torsion c. normal developmental growth pattern d. abnormal tibiofemoral growth pattern
c
44. during examination of a 2 week old, you note irritability when lifted, asymmetrical moro reflex and spasms along the right sternocleidomastoid what does this suggest. a. torticollis b. sprengel deformity c. fractured clavicle d. slipped fell syndrome
c
5. which of the following is most often associated with hemoglobin C a. growth retardation b. hepatosplenomegaly c. usually asymtopmatic d. fontal bossing
c
5. which of the following would be the most appropriate initial management of a newborn diagnosed with developmental dysplasia of the hip a. observe and reexamine at 2 week well child check b. tripe diapering in the nursery c. pavlik harness d. surgical reduction
c
52. While completing the hip examination on a newborn, you are able to dislocate the infants right hip. The appropriate management plan would be to a. triple diaper and reevaluate in 3 weeks b. recommend positioning in prone while awake c. refer to orthopedic specialist d. order tight swaddling of the infant
c
56. a full term infant in the newborn nursery is noted to have a deformity in her left foot consisting of a convex lateral border and forefoot, which can be abducted past an imaginary line extending from the middle of the heel through the second toe. Which of the following management strategies is most appropriate. a. reverse last shoe b. out - flare shoes c. stretching exercises d. orthopedic referral
c
58. a baseball coach asks for advice on how to prevent little league elbow in his 8 and 9 year old players. Which of the following would be incorrect advice. a. have each child pitch only three innings b. limit or eliminate curve balls c. use ice massage before and after pitching d. conduct slow warm ups
c
8. characteristics of a venous hum include a. a systolic murmur b. radiation over the precordium c. a marked decrease or disappearance of the murmur when the child is supine d. heard best at the lower left sternal border
c
8. michael is a 15 year old high school student who presents for a school sport physical. He appears to be in good health but is concerned about a bad headache he had a few weeks ago. He is concerned because his mothers friend died of a brain tumor. You tell michael the most common type of headache witt onset in adolescence is a. sinus headache b. vascular headache c. tension headache d. migraine headache
c
9. Dislocation in the hip of a child 6mo or older may typically present with: a. Asymmetry of skin folds b. Atrophied hip muscles c. Positive Galeazzi sign d. Negative trendelenburg sign
c
10. Scope of practice: a. is identical across the states b. is determined by the federal government c. is mandated by the federal government d. varies from state to state
d
11. Which of the following signs is not scored in Glasgow coma scale a. Eye opening b. verbal response c. upper limb response d. fine motor response
d
12. Which children do not meet the federal minimum financial eligibility criteria for Medicaid? a. infants born to women who already receive Medicaid ("deemed newborns" b. ages up to 6 years and family income < 133% of FPL c. Ages 6-18 years and family income < 100% of FPL d. Ages 6-18 years and family income > 133% of FPL
d
12. a 4 year old with a hx of asthma presents with wheezing and a cough that has been persistent over the past day. physical exam reveals a respiratory rate of 14 breaths per minute. Respirations are shallow without wheezing, and there are no retractions. what is the most likely reason that wheezes are not auscultated a. the child has faked an asthma attack b. the parent needs education regarding the identification of wheezing c. the childs condition has resolved d. wheezing is not being heard because the breathing is shallow
d
13. a 2 year old is evaluated in the ED for a closed head injury following a 10 ft fall from an open window. When interpreting diagnostic imagining results you are aware that the most common and generally the least serious type of skull fracture is a. basilar fracture b. compound fracture c. depressed fracture d. linear fracture
d
13. an obese 13 year old male with 2 days of right knee pain without trauma or illness has an exam of significant pain upon right hip motion and he maintains his leg in external rotation and adduction. Based on these findings, the most likely diagnosis is a. osgood-schlatter disease b. chondromalacia c. spondylolysis d. Slipped capital femoral epiphysis
d
14. Management of scoliosis depends on the severity of curve as well as the age of the child. Which of the following would require surgical intervention? a. Curves of 15 degrees in a child who is still growing b. Thoracic and/or lumbar curve greater than 25 degrees, even if growth is complete c. Thoracic curve greater than 30 degrees or lumbar curve greater than 40 degrees that has not progressed while in brace d. Thoracic curve greater than 50 degrees or lumbar curve greater than 40 degrees
d
14. a 5 month old is brought to clinic because he has been coughing and has had clear rhinorrhea for the last 2 days. His mother tells you that he has never been sick before. Family history is positive for Allergies and you hear generalized wheezing. you may conclude that: a. the infant has familial asthma b. the infant has asthma exacerbated by a viral infection c. the infant should be referred to the allergy clinic d. asthma should not be diagnosed at this age
d
14. what type of hemorrhage would be expected with severe factor VIII deficiency a. severe hemorrhage following moderate to severe trauma b. gross bleeding following mild to moderate trauma c. gynecologic hemorrhage d. spontaneous hemarthosis
d
14. which of the following conditions would be most likely to occur in a 4 year old boy a. pyloric stenosis b. recurrent abd pain c. intussusception d. guardia infection
d
16. A healthy 6 year old child presents with a limp and knee pain. The PNP finds limited passive internal rotation and abduction of the hip joint on physical exam. The most likely diagnosis is a. slipped capital femoral epiphysis b. osgood-schlatter disease c. transient synovitis of the hip d. legg calve perches diease
d
16. a 4 year old stays with her great aunt during the day while her mother works. The child's mother has brought her to the clinic because the great aunt has just been diagnosed with TB. The child's mantoaux skin test is positive, but there is no clinical or radiographic evidence of disease. Appropriate management includes a. reassuring the mother that no treatment is necessary b. administering another skin test in 3 months c. oral pencil therapy d. oral preventive isoniazid therapy
d
17. In the U.S. parasitic gastroenteritis is most commonly caused by which organism? a. Enterobius vermicularis b. Entamoeba histolytica c. Cryptospordidium parvum d. Giardia lamblia
d
17. a 5 year old is brought to the clinic. her mother reports that she has been lethargic and has been running a low grade fever for about 2 weeks. Physical examination reveals no significant findings other than pallor and lymphadenopathy. A complete blood count reveals decreased hematocrit, neutropenia, and thrombocytopenia. The pracititoners next action should be a. prescribe a broad spectrum antibiotic and ferrous sulfate b. instruct parents on the appropriate use of acetaminophen to treat the childs fever c. reassure the parents that their daughter signs and symptoms are indicative of a viral infection d. refer the child to a pediatric hematologist/oncologist for further evaluation
d
17. the most common type of brain tumor in children is a. ependymoma b. brain stem tumor c. cranippharyngioma d. medulloblastoma
d
18. Which of the following statements is not true of Slipped capital femoral epiphyisis a. it is thought to be precipitated by hormone changes during puberty b. unilateral involvement is more common than bilateral c. it is more common among males and african americans d. it is thought be to caused by repetitive stresses in young althelets prior to growth spurts
d
18. which of the following is not an expected finding in a child with myocarditis a. persistent tachycardia b. history of antecedent illness with nonspecific cold symptoms c. a gallop rhythm d. a significant heart murmur
d
19. hypercolesterolemia in children older than 2 years is defined as a total cholesterol at or above a. 100 b. 130 c. 160 d. 200
d
2. In a healthy, 8mo old with diarrhea but not dehydration, what would be the most appropriate device to give parents? a. Encourage ½ strength formula for 12hrs b. Give oral hydration solution (ORT) for 12hrs c. Give only fluids until stool turns to normal d. Give bananas and cereal as tolerated
d
2. Which of the following leading health indicators from Healthy People 2020 was getting wrose at the midcourse review a. infant deaths b. child obesity c. substance abuse d. adolescent mental health
d
2. in the scenario of an infant with RSV which of the following would be the treatment of choice. a. antihistamine, decongestant, and cough suppresion b. oral antibiotics and follow up chest radiography in 2 weeks c. bronchoscopy with lavage, chest physiotherapy, and respiratory isolation d. fluids and nutritional support and close monitoring
d
2. the mother of a 4 month old infant reports that he turned "blue" and seemed to have fast labored breathing after vigorous crying soon after awakening. He settled down and his color and breathing seemed to improve. On physical examination, the mucous membranes of the lips and mouth appear mildly cyanotic. A systolic murmur is heard best at the upper and left sternal border. Vital signs are normal with normal peripheral pulses. There is no hepatomegaly. A likely diagnosis is a. congestive heart failure b. apnea c. coarctation of the aorta d. cyanotic spells related to TET
d
20. The most typical chest radiographic findings consistent with the diagnosis of asthma is a. normal chest film b. diffuse airway edema c. right up love inflitration d. hyperinflation
d
20. the following describes a characteristic rash associated with which disease? initially erythematous and macular, becoming maculopapuleand petechial. the rash first appears on the wrists and ankles and then speeds proximally to the trunk the palm are soles are often involved. a. lyme disease b. roseola c. rubeola d. rocky mountain spotted fever
d
21. A 10yo child manifests symptoms of fever, sore throat, and swollen lymph nodes. Spleen tip is palpable. Throat culture and monospot test results are negative. The next logical diagnostic test would involve: a. Repeat throat culture b. Chest radiograph c. Bone marrow examination d. Epstein-barr virus titer
d
21. Two day old baby Jamie is in the hospital nursery and still has not passed meconium. This is a red flag for what condition? a. Intussuseption b. Hemolytic uremic syndrome c. Pyloric stenosis d. Hirschsprungs Disease
d
21. Which malignancy is associated with genitourinary anomalies? a. Acute lymphocytic leukemia b. Chronic myelogenous leukemia c. Osteosarcoma d. Wilm's tumor
d
21. there are several skin features seen with tuberous scerlosis. which of the following is most characteristic a. cafe au lait spots b. blue or purple striae c. papules in a christmas tree pattern d. hypoigmented macules in an ash leaf pattern
d
22. a 10 year old has recently been diagnosed with mild intermittent asthma. which of the following is not a routine part of his clinic managment a. spirometry evaluation b. metered dosed inhaler technique demonstration c. environmental triggers and control methods review d. school excuse to not participate in physical education activities
d
22. which of the following is a common cause of acquired coronary artery disease during childhood a. rheumatic fever b. hypertension c. systemic lupus erythematosus d. kawasaki disease
d
23. Certification is: a. a procedure through which the government appraises and grants a certificate to the APRN b. granted by the individual states c. governed by each states board of nursing d. the formal recognition of the knowledge, skills, and experience demonstrated by the achievement of standards identified by the profession.
d
23. which of the following responses during a tonic clonic seizure is most important to teach the family members of a child who has these seizures a. restrain the child b. insert an airway into the mouth to prevent tongue bitin c. note the time, duration and activity of the seicure d. protect the child from injruy
d
24. principal clinical features of kawasaki disease are a. low grade fever for 24 hours and a pruritic rash b. conjunctivitis with exudate and facial rash c. arthritis and chorea d. fever persisting at least 5 days and acute erythema and or edema of the hands and feet
d
25. Your patient has inflammatory bowel disease. Which finding is most consistent with ulcerative colitis? a. Occult blood b. Perirectal abcess c. Aphthous ulcers d. Left sided abdominal pain
d
26. a 14 year old female, otherwise healthy, presents to your clinic with a complaint of syncope at school. She has just stood up from her chair at the end of the day, felt dizzy and nauseous and then woke up within 30 seconds. Based on this description of the event your initial impression is a. concern for an arrhythmia that precipitated the eent b. she was experiencing an anxiety attack c. this was an attention getting event and she should receive behavioral therapy d. this appears to be a case of neurocardiogenic snycope
d
26. an 11 year old girl is brought in by her mother complaining of severe headaches associated with nausea and vomiting. Which of the following signs and symptoms would lead you to consider a brain tumor as part of your differential. a. throbbing pain accompanied by severe light sensitivity b. bilateral throbbing pain c. headache preceded by a visual aura d. more sever in the morning followed by vomiting
d
26. which of the following characteristics is not a feature of DiGeorge syndrome a. hypertelorism b. cleft palate c. cardiac defects d. frontal bossing
d
27. Katie has functional abdominal pain. When counseling her family on management of painful episodes you would recommend which of the following? a. Take ibuprofen 200mg for pain b. Stay home from school during episode c. Decrease milk products d. Go to school during episode
d
28. Management of a patient with splenectomy does not include: a. Pneumococcal vaccines at least 2 weeks prior to surgery b. Prophylactic penicillin c. Blood culture & parenteral antibiotics for febrile illnesses d. Treating fever with antipyretics only & observing for resolution
d
28. which of the following statements about tourettes is true a. symptoms can improve with age b. it is more common among males than among females c. mean age at onset is between 5 and 7 years d. all of the above
d
3. Clinical jaundice of the distal extremities would be noted at a bilirubin level of: a. <5mg/dl b. 5mg/dl c. 10mg/dl d. >15mg/dl
d
30. which of the following symptoms are most common in the early phase of appendicitis in children a. abdominal pain after eating b. fever and diarrhea c. sever localized rlq pain with pallor and sweating d. anorexia and vague diffuse pain
d
32. which of the following statements is true regarding slipped capital femoral epiphysis a. it is more commonn in females who are underweight b. it generally occurs following severe sudden trauma c. incidence is more common in athletes d. the goal of treatment is to stabilize or improve the position of the femoral head
d
4. a 4 year old boy is brought in by his mother, who is concerned about the sudden onset of a painful limp in his right leg 2 days ago. Today he has a low grade fever. Which of the following diagnoses is most likely a. osgood-schlatter b. juvenile idiopathic arthritis c. osteomyelitis d. transient synovitis of the hip
d
43. what is the appropriate treatment for genu varu in a 15 month old child a. passive exercise with each diaper change b. denis browne splint at night c. blount brace at night d. no treatment is needed
d
46. a 20 month old presents in the ED with a greenstick fracture of his left femur. Physical examination also reveals and enlarged anterior fontanelle and enlarged costochondral junction. What do these findings suggest a. child abuse b. osteogenesis imperfecta c. osteoporosis d. rickets
d
49. during physical examination of Jason, a 2.5 year old, you note large, muscular looking calves and observe he has difficulty rising from a sitting position. The denver A developmental screening examination reveals delays in the gross motor area. Which of the following laboratory tests would be most beneficial a. serum calcium b. serum magnesium c. serum phosphorus d. serum creatine kinase
d
5. Which of the following is the appropriate regimen for pinworm medication a. daily times 7 days, repeat as needed b. three times a day for 10 days, repeat as needed c. twice daily for 3 days, repeat in 2 weeks d. 1 dose/1time, repeat in 2 weeks if needed
d
53. which of the following would not be an appropriate indicator for developmental dysplasia of the hip in a 6 month old child a. allis sign b. skin fold symmmetry c. galeazza sign d. ortolani maneuver
d
6. Mrs. Doyle is upset. 2mo old John's frequent vomiting has her convinced that "something is seriously wrong". Which of the following is most suggestive of GER? a. He's gained 5oz this month b. He has a slight wheeze today c. He eats hungrily after vomiting d. He drinks 7-8oz every 3-4hrs
d
6. the least likely physical finding in a 2 month old with congestive heart failure is a. tachypnea b. tachycardia c. hepatomegaly d. pedal edema
d
6. which one of the following diagnoses would not be part of the differential for recurrent lobar pneumonia in a 2 year old a. CF b. foreign body aspiration c. atelectasis d. bronchitis
d
7. Upon physical examination of a 4 year old boy, you note seven cafe au lait spots greater than 5 mm in diameter. This finding may be indicative of a. tuberous ssclerosis b. sturge weber disease c. duchenne dystrophy d. neurofibromatosis
d
7. You see Jack, a 20mo old toddler with normal growth and development in your office for diarrhea. His mother tells you that he is passing up to three loose stools a day and that he drinks 20oz of apple juice/day. What is the most likely diagnosis? a. Crohns disease b. Giardia lamblia c. Celiac disease d. Nonspecific "toddler" diarrhea
d
