Walden university nurs 6541 final exam

NURS 6541 Midterm Exam / NURS6541 Midterm Exam (Latest): Primary Care of Adolescents and Children: Walden University

· Question 1

When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?

· Question 2

Miguel, age 14, was hit in the eye with a baseball and developed eye pain, decreased visual acuity, and injection of the globe. Upon exam you note blood in the anterior chamber and confirm diagnosis of hyphema. What treatment do you recommend while Miguel is waiting to see the ophthalmologist

· Question 3

The father of a 3-year-old is concerned because the child stutters. What should your approach be?

· Question 4

A 2-day-old newbornwith conjunctivitis is likely due to

· Question 5

You see a 13-year-old who reports she is learning some basic geometry (areas, volume etc.). The ability to successfully master these concepts occurs during which Piaget developmental stage?

· Question 6

For adolescent girls, peak height velocity should occur by Tanner Stage (SMR):

· Question 7

Which is the correct order for introduction of solid foods to an infant?

· Question 8

I can walk well on tiptoes, my speech is 50% understandable, I know six body parts, but I cannot balance on one foot for 1 second. I am:

· Question 9

You receive a phone call from the mother of a 2-year-old. She states her child has sleep refusal. You suggest the child should be able to:

· Question 10

A 15-month-old boy says “mama” and “dada,” points and gestures if he wants things, and follows simple one-step commands. Your best response is which of the following?

· Question 11

At what age would a child be expected to remember a string of numbers and repeat them backwards?

· Question 12

A 13-month-old child is noted to be at the 25th percentile for weight, the 10th percentile for height, and less than the 5th percentile for head circumference. She was born at term. She was noted to have a small head at birth, to be developmentally delayed throughout her life, and to have required cataract surgery shortly after birth. She currently takes phenobarbital for seizures. Which of the following would most likely explain this child’s small size?

· Question 13

A child's head circumference is routinely measured on each well visit until what age?

· Question 14

A 14-year-old female comes into the office for an urgent visit after taking 10 valium tablets. Following the initial emergent care and stailization, the most important part of the management is:

· Question 15

All of the following are consistent with peritonsillar abscess except:

b.

Trismus

· Question 16

Which of the following complication of strep pharyngitis cannot be prevented with antibiotics?

b.

Glomerulonephritis

· Question 17

A 4-year-old believes there is more juice in a tall, thin glass than a shorter, wider one. The child has not yet achieved which of the principles of Piaget?

b.

Conservation

· Question 18

Josh, age 13, has some enlargement of the scrotum and testes, a reddened scrotal sac, and some hair texture alteration. His penis is not enlarged. He is in Tanner stage

d.

II

· Question 19

A breastfed infant is expected to have a lower incidence of which of the following?

e.

Diarrhea

· Question 20

A 12-year-old male states he noticed an enlargement of his testes and scrotum. When counseling him about the next step in pubertal development, you state:

d.

The penis will grow in length and width.

· Question 21

You see a 7-year-old with complaints of "having accidents at night." Physical exam and history are unremarkable. Urinalysis, urine culture, and specific gravity are normal. His parents ask about the best treatment for this problem. The best response is

a.

Fluid restriction and voiding prior to the night may be effective.

· Question 22

Chelsea, age 8, complains that she feels as if something is stuck in her ear. What action is contraindicated?

c.

Flushing the ear with water.

· Question 23

By what age should most children be able to sit well without support?

a.

9 months

· Question 24

A typically developing 8-year-old girl will have which of the following genital development?

a.

No pubic hair at all

· Question 25

John is diagnosed with allergic conjunctivitis. What type of discharge do you expect to see upon exam?

c.

Serous and clear

· Question 26

Which of the following vaccines is routinely recommended at 4 months of age?

a.

Diphtheria, tetanus, acellular pertussis (DTaP)

· Question 27

An 8-year-old female has an edematous, mildly erythematous right upper eyelid for 2 days with a fever of 102.9 (F). Which important eye assessment do you need to consider?

d.

Ocular mobility

· Question 28

Role-play with equipment during the course of the physical exam would be the most beneficial with which age group?

b.

Preschoolers

· Question 29

Conductive hearing loss can be caused by

c.

Serous otitis

· Question 30

You see a 30-month-old who speaks in mixed Spanish and English. The child’s vocabulary is normal but at the low end of the normal language spectrum. The parent is worried the child’s development will not be normal because she mixes up the two languages. You respond:

d.

"Your child's speech is normal and bilingual children commonly intermix the words from both languages until about 3 years of age."

· Question 31

Mark is in the exam room. You are concerned he may have epiglottitis. In what position do these patients prefer to sit?

d.

Sitting up and leaning forward

· Question 32

The mother of a 4-year-old tells you he likes to "play with himself" while playing and watching television. You advise the mother to

a.

Explain to the child that masturbation is something that should be done in private.

· Question 33

Parents bring their 6-month-old son to see you. He is symmetrically less than the 5th percentile for height, weight and head circumference. He was born at 30 weeks’ gestation and weighed 1000g. He was a planned pregnancy, and his mother’s prenatal course was uneventful until an automobile accident initiated the labor. He was ventilated for 3 days in the intensive care unit but otherwise did well without ongoing problems. He was discharged at 8 weeks of life. Which of the following is the most likely explanation for his small size?

e.

Normal ex-preemie infant growth

· Question 34

You assess a 15-year-old's visual acuity and note her vision to be 20/50 in the right eye. She asks you what that means and you respond

d.

"You can see at 20 feet with your right eye what most people can see at 50 feet."

· Question 35

During a “well-child” visit, the parents of a healthy 5-month-old offer a great amount of information. Which of the following bits of information is of most concern?

a.

Limited eye contact with parents.

· Question 36

You are performing an examination of a 3-year-old who is new to your office. Which finding requires immediate further evaluation?

d.

Heart rate increases during inspiration and decreases during expiration

· Question 37

A 9-year-old who weighs 70 pounds asks why she can't sit in the front passenger seat of the family car. Your best response is

c.

The safest place for children under 12 years old and 100 pounds is in the backseat of the car.

· Question 38

Which of the following would not suggest an eating disorder with a purging component?

d.

Finger calluses

· Question 39

A fifteen-year-old female makes a statement to you during a well visit. Which of the following statements should not be kept confidential?

b.

"Sometimes I feel like ending my life."

· Question 40

Sarah, age 15, presents with pain and pressure over her cheeks and discolored nasal discharge. You cannot transilluminate the sinuses. You suspect which common sinus to be affected?

d.

Maxillary sinus

· Question 41

A 6-month-old infant has been growing poorly. His parents have changed his formula three times without success. His examination is remarkable for a pale, emaciated child with little subcutaneous fat and anterior fontanelle fullness. His laboratory test results are notable for a hemolytic anemia and prolonged bleeding times. Which of the following is the most appropriate next step?

d.

Obtain a sweat chloride concentration

· Question 42

Medicaid provides health insurance coverage to

a.

Certain categories of people whose personal income falls below a certain percentage of the federal poverty level.

· Question 43

The mother of a 5-year-old informs you that her daughter cheats when playing board games. What is the best response?

b.

Tell the mother to spend time clarifying board game rules before starting games.

· Question 44

Which of the following substances is associated with pupillary constriction?

b.

Heroin

· Question 45

A 7-year-old has just been diagnosed with attention deficit hyperactivity disorder (ADHD). Her parents report that she is doing poorly in school and is disruptive in the classroom. They ask you what they can do. Your best response is:

a.

"Use a consistent approach with behavioral cues both at home and at school."

· Question 46

Flourescein staining of the eye is used to detect a

c.

Corneal abrasion

· Question 47

0 out of 1 points

Luke, a 17-month-old, failed treatment with amoxicillin for otitis media. At the two-week recheck, his TM was still erythematous and you cannot see the landmarks. He has persistent nasal congestion, he is not sleeping at night, and he has a 101°F fever. What is the next best step for Luke?

a.

Ceftriaxone and an antihistamine

· Question 48

All of the following may predispose a patient to thrush except:

c.

Poor oral hygiene

· Question 49

Head and chest circumferences should be equal at:

c.

1 year of age

· Question 50

The diagnostic criteria for autism spectrum disorder include all of the following except

c.

Tolerance of flexibility with routines

· Question 51

Which of the following statements about bullying is true?

b.

It occurs most commonly during unstructured times (lunch, recess, etc.).

· Question 52

The most likely weight of a 1-year-old whose birth weight was 6-1/2 pounds would be:

a.

19 to 20 pounds

· Question 53

An eye that deviates in when covered but that returns to midline when uncovered is an

c.

esophoria

· Question 54

A 7-year-old boy with mental retardation was born at home at 26 weeks gestation to a 28-year-old mother who had received no prenatal care. An evaluation is likely to suggest his MR is related to which of the following?

e.

Complications of prematurity

· Question 55

The most common substance used in middle school is

a.

Alcohol

· Question 56

A 2-day-old infant has significant nasal and rectal bleeding. He was delivered by a midwife at home; the pregnancy was without complications. His Apgar scores were 9 at 1 minute and 9 at 5 minutes. He has breastfed well and has not required a health care professional visit since birth. Which of the following vitamin deficiencies might explain his condition?

a.

Vitamin K

· Question 57

Tammy, age 3, is at the office for her well-child visit. She has trouble removing her own shirt as requested. Her mother yanks off her shirt after smacking her wrist and saying, "you must do as you're told quickly." Which action is indicated?

d.

Observe Tammy for signs of child abuse.

· Question 58

A 4-month-old child has poor weight gain. Her current weight is less than the 5th percentile, height about the 10th percentile, and head circumference at the 50th percentile. The planned pregnancy resulted in a normal, spontaneous, vaginal delivery; mother and child were discharged after a 48-hour hospitalization. Feeding is via breast and bottle; the quantity seems sufficient. The child has had no illness. The examination is unremarkable except for the child’s small size. Screening laboratory shows the hemoglobin and hematocrit are 11 mg/dL and 33% respectively, with a platelet count of 198,000/mm3. Serum electrolyte levels are sodium 140, chloride 105, potassium 3.5, bicarbonate 17, blood urea nitrogen 15, and creatinine 0.3. Liver function tests are normal. Urinalysis reveals a pH of 8 with occasional epithelial cells but no white blood cells, bacteria, protein, ketones, or reducing substances. Which of the following is the most appropriate therapy for this child?

d.

Oral supplementation with bicarbonate

· Question 59

A teenage female who is overweight has moderate acne on the face and chest, and irregular menses. Elevation of which laboratory test provides the test evidence of polycystic ovarian syndrome?

a.

free testosterone

· Question 60

A 2-year-old boy has been slightly less than the 50th percentile for weight, height and head circumference, but in the last 6 months he has fallen to slightly less than the 25th percentile for weight. The pregnancy was normal, his development is as expected, and the family reports no psychosocial problems. The mother says that he is now a finicky eater (wants only macaroni and cheese at all meals), but she insists that he eat a variety of foods. The meals are marked by much frustration for everyone. His examination is normal. Which of the following is the best next step in his care?

c.

Reassurance and counseling for family about childhood normal developmental stage

· Question 61

I like to use my pincer grasp that involves the ablitily to pick up a small object such as a raisin or piece of cereal with the thumb and forefinger, and that is mastered around what age?

b.

9 months

· Question 62

An 11-year-old girl has dizziness, pupillary dilation, nausea, fever, techycardia, and facial flushing. She says she can "see" sound and "hear" colors. The agent likely to be responsible is which of the following?

d.

Lysergic acid diethylamide (LSD)

· Question 63

An 8-year-old female is brought into the office by her mother. She has complaints of fever and sore throat for the past 2 days. She denies difficulty swallowing but has loss of appetite and mild diarrhea. A few classmates have similar symptoms. A review of systems reveals clear nasal drainage, dry cough, and hoarseness. On exam she has a 101.5 temperature, 3+ erythematous tonsils, and anterior cervical lymphadenopathy. What is the likely diagnosis?

c.

Viral pharyngitis

· Question 64

Appropriate advice for a mother of a 2-week-old child here for a “well child” visit includes which of the following?

c.

Sleep in the supine position is recommended

· Question 65

0 out of 1 points

What is the most traumatic, yet common form and of child abuse seen in pediatric primary care?

d.

Soft tissue injuries

· Question 66

Which of the following is a priority nurse practitioner role to help children and adolescents to have healthy sexual development?

a.

Begin anticipatory guidance related to sexuality and normal pubertal development in the early school-age visits.

· Question 67

Appropriate anticipatory guidance for the parents of an 8-year-old girl includes

c.

Information that the child will start to value personal idols and role models.

· Question 68

Max, a 9-year-old boy, is a very active child with limited self-control. He is easily distracted and has difficulty staying on task. You determine that he should have a neurodevelopmental evaluation because he is showing signs of

d.

ADHD

· Question 69

Which of the following injuries is most likely to be caused by abuse of a toddler?

c.

A displaced posterior rib fracture.

· Question 70

Which of the following issues or concepts is relevant to the school-age child?

a.

Erikson's initiative versus guilt

· Question 71

While assessing the skin of an infant, you note cafe-au-lait spots. Which disease should be ruled out?

c.

Neurofibromatosis

· Question 72

The first sign of the onset of female puberty is usually:

d.

Breast buds

· Question 73

A mother states that her 4-year-old son constantly grinds his teeth at night. You document this as:

d.

Bruxism

· Question 74

Which of the following characterizes middle adolescence (14 to 16 years old)?

c.

Intense peer group involvement, feelings of immortality, sexual experimentation

· Question 75

I can roll over, grasp a rattle, and reach for things and have begun feeding myself finger foods, but I can’t wave bye-bye yet. How old am I?

a.

6 months

· Question 76

You would be concerned about the language development of a child who:

b.

Stutters when excited or tired at the age of 7

· Question 77

Most children can independently get dressed by themselves by age:

d.

5 years

· Question 78

A differential diagnosis for child abuse would include all of the following except.

b.

Prader-Wlli syndrome

· Question 79

Which of the following eye findings would be considered an ophthalmic emergency?

b.

Unilateral vesicular lesions on the upper eyelid in a 3-week old.

· Question 80

A 2-year-old child weighs 34 lb. What type of car seat should the child use?

b.

A forward-facing car seat in the back of the vehicle.

· Question 81

An expected milestone of a 4-year-old is the ability to

c.

Copy a cross

· Question 82

Sam has an otitis media. He also presents with conjunctivitis. This is due to which organism?

a.

Haemophilus influenza

· Question 83

A 14-year old has ataxia. He is brought to the local emergency department, where he appears euphoric, emotionally labile, and disoriented. Many notice his abusive language. Which of the following agents is most likely responsible for his condition?

a.

Alcohol

· Question 84

What method can be safely used to remove cerumen in a 15-month-old child's ear?

d.

Irrigation using warm water from a soft bulb syringe

· Question 85

The appropriate lab tests in assessment of cervical adenitis include all of the following except:

a.

Blood culture

· Question 86

Which of the following represents normal sequencing of development in a toddler?

b.

Feeds self, can undress self with help, washes hands, imitates housework.

· Question 87

You see a young child who has tripled her birth weight and looks for hidden objects. When given blocks, she places one in each hand. She has a fine pincer grasp. On the floor, she walks around holding objects and is trying to take independent steps. This child is most likely how old?

c.

12 months

· Question 88

During a domestic health assessment, the CDC recommends screening every refugee child for which of the following diseases?

d.

tuberculosis

· Question 89

A 4-month-old presents with both eyes turning inward. What is this called?

b.

Esotropia

· Question 90

A mother brings her 4-week-old infant into the office because she noticed small yellow-white glistening bumps on her infant's gums. She says they look like teeth but is concerned that they may be cancer. You diagnose these bumps as

d.

Epstein's pearls

· Question 91

The parents of a 7-year-old are concerned their son does not want to attend school. Which of the historical findings are not usually associated with the diagnosis of school phobia?

d.

Chronic medical illness

· Question 92

You are doing a kindergarten physical on a 5-year-old girl. Which of the following scenarios would suggest the child is not ready to start kindergarten in the fall?

d.

Counts to 4 and draws a person with three parts.

· Question 93

Which of the following children should be referred for a comprehensive developmental evaluation?

a.

A 3-year-old who consistently tracks at the 5th percentile for height and weight since birth.

· Question 94

Sarah, 7 years old, is in the office today. All of the following are acceptable management options for allergic rhinitis, except

b.

Nasal neosynephrine

· Question 95

You see a 3-year-old for a well-child visit. His mother informs you that potty training has been very easy because he “has an amazing internal clock. He falls asleep, gets hungry, and has bowel movements at the same time every day.” This describes which aspect of temperament?

a.

Rhythmicity

· Question 96

You see a healthy 18-month-old for a well-child visit. At the 12-month visit he received the diphtheria, tetanus, and acellular pertussis (DTaP) third dose; hepatitis B second dose; measles, mumps, and rubella (MMR) first dose; injected poliovirus (IPV) second dose; pneumococcal conjugate (PCV13) fourth dose; and Haemophilus influenzae type B (Hib) fourth dose. Which of the following do you order today?

c.

DTaP, varicella, hepatitis A, and hepatitis B

· Question 97

The results of the hemoglobin A1c test are LESS reliable in children with which of the following conditions? (Hint: select two)

Selected Answers:

a.

Cystic Fibrosis

b.

Sickle Cell Disease

· Question 98

You see a 5-month-old who is fussy, has interrupted sleep, and is drooling. You note large lower lateral incisor bulges. You recommend:

· Question 99

A 7-month-old male is found to have a spiral fracture of the femur that his father says he got by climbing onto a chair and then jumping off. Which of the following statements is true regarding this situation?

· Question 100

The nurse practitioner role was initially established to

· Question 101

Which of the following is a true contraindication of vaccinating a child?

NURS 6541 Midterm Exam / NURS 6541 Midterm Exam (Latest): Primary Care of Adolescents and Children: Walden University

· Question 1

1 out of 1 points

Medicaid provides health insurance coverage to

Selected Answer:

b.

Certain categories of people whose personal income falls below a certain percentage of the federal poverty level.

· Question 2

1 out of 1 points

A differential diagnosis for child abuse would include all of the following except.

Selected Answer:

c.

Prader-Wlli syndrome

· Question 3

1 out of 1 points

Which of the following injuries is most likely to be caused by abuse of a toddler?

Selected Answer:

d.

A displaced posterior rib fracture.

· Question 4

1 out of 1 points

You are doing a kindergarten physical on a 5-year-old girl. Which of the following scenarios would suggest the child is not ready to start kindergarten in the fall?

Selected Answer:

a.

Counts to 4 and draws a person with three parts.

· Question 5

1 out of 1 points

The first sign of the onset of female puberty is usually:

Selected Answer:

b.

Breast buds

· Question 6

1 out of 1 points

You see a 7-year-old with complaints of "having accidents at night." Physical exam and history are unremarkable. Urinalysis, urine culture, and specific gravity are normal. His parents ask about the best treatment for this problem. The best response is

Selected Answer:

b.

Fluid restriction and voiding prior to the night may be effective.

· Question 7

1 out of 1 points

Which of the following statements about bullying is true?

Selected Answer:

d.

It occurs most commonly during unstructured times (lunch, recess, etc.).

· Question 8

1 out of 1 points

The mother of a 5-year-old informs you that her daughter cheats when playing board games. What is the best response?

Selected Answer:

b.

Tell the mother to spend time clarifying board game rules before starting games.

· Question 9

0 out of 1 points

Which of the following conditions requires urgent inpatient admission?

Selected Answer:

d.

Epiglottis

· Question 10

1 out of 1 points

All of the following are consistent with peritonsillar abscess except:

Selected Answer:

d.

Trismus

· Question 11

1 out of 1 points

The parents of a 7-year-old are concerned their son does not want to attend school. Which of the historical findings are not usually associated with the diagnosis of school phobia?

Selected Answer:

d.

Chronic medical illness

· Question 12

1 out of 1 points

You are performing an examination of a 3-year-old who is new to your office. Which finding requires immediate further evaluation?

Selected Answer:

c.

Heart rate increases during inspiration and decreases during expiration.

· Question 13

1 out of 1 points

A child's head circumference is routinely measured on each well visit until what age?

Selected Answer:

a.

2 years

· Question 14

1 out of 1 points

Which of the following children has abnormal language development?

Selected Answer:

c.

Speech is 50% understandable at 36 months of age

· Question 15

1 out of 1 points

Please interpret the following labs for an adolescent. The adolescent has a history of obesity and acanthosis nigricans.

Test

Results

Fasting blood glucose

112 mg/dL

2 hour postprandial glucose

138 mg/dL

Selected Answer:

d.

Impaired fasting glucose, postprandial glucose within normal limits

· Question 16

1 out of 1 points

Which of the following issues or concepts is relevant to the school-age child?

Selected Answer:

c.

Erikson's initiative versus guilt

· Question 17

1 out of 1 points

The diagnostic criteria for autism spectrum disorder include all of the following except

Selected Answer:

d.

Tolerance of flexibility with routines

· Question 18

1 out of 1 points

Conductive hearing loss can be caused by

Selected Answer:

d.

Serous otitis

· Question 19

1 out of 1 points

The most common substance used in middle school is

Selected Answer:

a.

Alcohol

· Question 20

1 out of 1 points

The results of the hemoglobin A1c test are LESS reliable in children with which of the following conditions? (Hint: select two)

Selected Answers:

a.

Cystic Fibrosis

b.

Sickle Cell Disease

· Question 21

1 out of 1 points

A teenage female who is overweight has moderate acne on the face and chest, and irregular menses. Elevation of which laboratory test provides the test evidence of polycystic ovarian syndrome?

Selected Answer:

d.

free testosterone

· Question 22

1 out of 1 points

Mark is in the exam room. You are concerned he may have epiglottitis. In what position do these patients prefer to sit?

Selected Answer:

a.

Sitting up and leaning forward

· Question 23

1 out of 1 points

You see a 30-month-old who speaks in mixed Spanish and English. The child’s vocabulary is normal but at the low end of the normal language spectrum. The parent is worried the child’s development will not be normal because she mixes up the two languages. You respond:

Selected Answer:

b.

"Your child's speech is normal and bilingual children commonly intermix the words from both languages until about 3 years of age."

· Question 24

1 out of 1 points

Which of the following characterizes middle adolescence (14 to 16 years old)?

Selected Answer:

b.

Intense peer group involvement, feelings of immortality, sexual experimentation

· Question 25

1 out of 1 points

You see a 4-year-old for a well-child visit. He has received four diphtheria, tetanus, and acellular pertussis vaccines (DTaP); three injected polio vaccines (IPV); one measles, mumps, and rubella vaccine (MMR); one varicella vaccine; and two hepatitis B (Hep B) vaccines. What do you order today?

Selected Answer:

c.

DTaP, IPV, MMR, and Varivax

· Question 26

1 out of 1 points

A 14-year old has ataxia. He is brought to the local emergency department, where he appears euphoric, emotionally labile, and a bit disoriented. He has nystagmus and hypersalivation. Many notice his abusive language. Which of the following agents is most likely responsible for his condition?

Selected Answer:

d.

Alcohol

· Question 27

1 out of 1 points

Parents bring their 6-month-old son to see you. He is symmetrically less than the 5th percentile for height, weight and head circumference. He was born at 30 weeks’ gestation and weighed 1000g. He was a planned pregnancy, and his mother’s prenatal course was uneventful until an automobile accident initiated the labor. He was ventilated for 3 days in the intensive care unit but otherwise did well without ongoing problems. He was discharged at 8 weeks of life. Which of the following is the most likely explanation for his small size?

Selected Answer:

b.

Normal ex-preemie infant growth

· Question 28

1 out of 1 points

A fifteen-year-old female makes a statement to you during a well visit. Which of the following statements should not be kept confidential?

Selected Answer:

c.

"Sometimes I feel like ending my life."

· Question 29

1 out of 1 points

Most children can independently get dressed by themselves by age:

Selected Answer:

b.

5 years

· Question 30

1 out of 1 points

A 13-month-old child is noted to be at the 25th percentile for weight, the 10th percentile for height, and less than the 5th percentile for head circumference. She was born at term. She was noted to have a small head at birth, to be developmentally delayed throughout her life, and to have required cataract surgery shortly after birth. She currently takes phenobarbital for seizures. Which of the following would most likely explain this child’s small size?

Selected Answer:

e.

Congenital cytomegalovirus infection

· Question 31

1 out of 1 points

A 4-month-old child has poor weight gain. Her current weight is less than the 5th percentile, height about the 10th percentile, and head circumference at the 50th percentile. The planned pregnancy resulted in a normal, spontaneous, vaginal delivery; mother and child were discharged after a 48-hour hospitalization. Feeding is via breast and bottle; the quantity seems sufficient. The child has had no illness. The examination is unremarkable except for the child’s small size. Screening laboratory shows the hemoglobin and hematocrit are 11 mg/dL and 33% respectively, with a platelet count of 198,000/mm3. Serum electrolyte levels are sodium 140, chloride 105, potassium 3.5, bicarbonate 17, blood urea nitrogen 15, and creatinine 0.3. Liver function tests are normal. Urinalysis reveals a pH of 8 with occasional epithelial cells but no white blood cells, bacteria, protein, ketones, or reducing substances. Which of the following is the most appropriate therapy for this child?

Selected Answer:

d.

Oral supplementation with bicarbonate

· Question 32

1 out of 1 points

Chelsea, age 8, complains that she feels as if something is stuck in her ear. What action is contraindicated?

Selected Answer:

b.

Flushing the ear with water.

· Question 33

1 out of 1 points

Which of the following substances is associated with pupillary constriction?

Selected Answer:

c.

Heroin

· Question 34

1 out of 1 points

Which of the following children should be referred for a comprehensive developmental evaluation?

Selected Answer:

a.

A 3-year-old who consistently tracks at the 5th percentile for height and weight since birth.

· Question 35

0 out of 1 points

John is diagnosed with allergic conjunctivitis. What type of discharge do you expect to see upon exam?

Selected Answer:

c.

Serous and clear

· Question 36

1 out of 1 points

You diagnose a 16-year-old with acute otitis media and need to prescribe an antibiotic with beta-lactamase coverage. What do you choose?

Selected Answer:

d.

amoxicillin and potassium clavulanate (Augmentin)

· Question 37

1 out of 1 points

A new mom calls the NP on postpartum day 5. She reports her newborn wants to nurse for 30 minutes every 1-1/2 to 2 hours. Which of these is the best response?

Selected Answer:

d.

"This is a very healthy breastfeeding pattern. Be sure to rest when you can. You are doing a great job."

· Question 38

1 out of 1 points

Which of the following represents normal sequencing of development in a toddler?

Selected Answer:

b.

Feeds self, can undress self with help, washes hands, imitates housework.

· Question 39

1 out of 1 points

By what age should most children be able to sit well without support?

Selected Answer:

a.

9 months

· Question 40

1 out of 1 points

A common feature of 2-year-old behavior is:

Selected Answer:

b.

Stranger anxiety

· Question 41

1 out of 1 points

You assess a 15-year-old's visual acuity and note her vision to be 20/50 in the right eye. She asks you what that means and you respond

Selected Answer:

d.

"You can see at 20 feet with your right eye what most people can see at 50 feet."

· Question 42

1 out of 1 points

Flourescein staining of the eye is used to detect a

Selected Answer:

b.

Corneal abrasion

· Question 43

1 out of 1 points

Blood pressure should be measured at well-child visits starting at age:

Selected Answer:

a.

3 years

· Question 44

1 out of 1 points

Sarah, 7 years old, is in the office today. All of the following are acceptable management options for allergic rhinitis, except

Selected Answer:

a.

Nasal neosynephrine

· Question 45

1 out of 1 points

During a “well-child” visit, the parents of a healthy 5-month-old offer a great amount of information. Which of the following bits of information is of most concern?

Selected Answer:

b. Limited eye contact with parents.

· Question 46

1 out of 1 points

At what age would a child be expected to remember a string of numbers and repeat them backwards?

Selected Answer:

a.

12 years

· Question 47

1 out of 1 points

During a domestic health assessment, the CDC recommends screening every refugee child for which of the following diseases?

Selected Answer:

b.

tuberculosis

· Question 48

1 out of 1 points

Which of the following signs may indicate a baby is not receiving sufficient breastmilk?

Selected Answer:

a.

Sleepiness, jaundice, and vomiting

· Question 49

1 out of 1 points

Which of the following eye findings would be considered an ophthalmic emergency?

Selected Answer:

d.

Unilateral vesicular lesions on the upper eyelid in a 3-week old.

· Question 50

1 out of 1 points

Which of the following statements regarding adolescent substance use is true?

Selected Answer:

c.

Tobacco is the most commonly abused substance during adolescence.

· Question 51

1 out of 1 points

Which of the following vaccines is routinely recommended at 4 months of age?

Selected Answer:

a.

Diphtheria, tetanus, acellular pertussis (DTaP)

· Question 52

1 out of 1 points

The nurse practitioner role was initially established to

Selected Answer:

c.

Improve access to care and partially solve physician shortage.

· Question 53

1 out of 1 points

Mark, a 10-year-old, has a lot of ear pain. He does not want anyone to touch it and is crying in pain. The ear canal is swollen and exudate is present. The TM is normal. Mark should be instructed to do which of the following?

Selected Answer:

b.

Keep ear dry until symptoms improve.

· Question 54

1 out of 1 points

A 4-year-old believes there is more juice in a tall, thin glass than a shorter, wider one. The child has not yet achieved which of the principles of Piaget?

Selected Answer:

b.

Conservation

· Question 55

1 out of 1 points

Early reflexive responses that are not related to survival include all but:

Selected Answer:

a.

Swimming

· Question 56

1 out of 1 points

You would be concerned about the language development of a child who:

Selected Answer:

b.

Stutters when excited or tired at the age of 7

· Question 57

1 out of 1 points

The appropriate lab tests in assessment of cervical adenitis include all of the following except:

Selected Answer:

a.

Blood culture

· Question 58

1 out of 1 points

A 4-month-old presents with both eyes turning inward. What is this called?

Selected Answer:

c.

Esotropia

· Question 59

1 out of 1 points

An 8-year-old female is brought into the office by her mother. She has complaints of fever and sore throat for the past 2 days. She denies difficulty swallowing but has loss of appetite and mild diarrhea. A few classmates have similar symptoms. A review of systems reveals clear nasal drainage, dry cough, and hoarseness. On exam she has a 101.5 temperature, 3+ erythematous tonsils, and anterior cervical lymphadenopathy. What is the likely diagnosis?

Selected Answer:

c.

Viral pharyngitis

· Question 60

1 out of 1 points

You see a 13-year-old who reports she is learning some basic geometry (areas, volume etc.). The ability to successfully master these concepts occurs during which Piaget developmental stage?

Selected Answer:

a.

Concrete operational

· Question 61

1 out of 1 points

An 8-year-old female has an edematous, mildly erythematous right upper eyelid for 2 days with a fever of 102.9 (F). Which important eye assessment do you need to consider?

Selected Answer:

a.

Ocular mobility

· Question 62

1 out of 1 points

Tammy, age 3, is at the office for her well-child visit. She has trouble removing her own shirt as requested. Her mother yanks off her shirt after smacking her wrist and saying, "you must do as you're told quickly." Which action is indicated?

Selected Answer:

a.

Observe Tammy for signs of child abuse.

· Question 63

1 out of 1 points

Which of the following is a true contraindication of vaccinating a child?

Selected Answer:

a.

Previous vaccination reaction that consisted of wheezing and hypotension

· Question 64

1 out of 1 points

The parent of a 2-year-old tells you her daughter recently started having breath-holding spells. She tells you the older sibling “did the same thing” and asks you for help. You advise her that after a breath-holding event:

Selected Answer:

c.

Act as if nothing abnormal happened.

· Question 65

1 out of 1 points

You see a healthy 18-month-old for a well-child visit. At the 12-month visit he received the diphtheria, tetanus, and acellular pertussis (DTaP) third dose; hepatitis B second dose; measles, mumps, and rubella (MMR) first dose; injected poliovirus (IPV) second dose; pneumococcal conjugate (PCV13) fourth dose; and Haemophilus influenzae type B (Hib) fourth dose. Which of the following do you order today?

Selected Answer:

c.

DTaP, varicella, hepatitis A, and hepatitis B

· Question 66

1 out of 1 points

A 7-year-old boy with mental retardation was born at home at 26 weeks gestation to a 28-year-old mother who had received no prenatal care. An evaluation is likely to suggest his MR is related to which of the following?

Selected Answer:

a.

Complications of prematurity

· Question 67

1 out of 1 points

Which is the correct order for introduction of solid foods to an infant?

Selected Answer:

d.

Cereal, vegetables, fruits, and meats

· Question 68

1 out of 1 points

Which of the following foreign body in the nose requires immediate removal?

Selected Answer:

c.

battery

· Question 69

1 out of 1 points

A Mantoux test in a child with no risk factors is considered positive with a reaction of:

Selected Answer:

c.

at least 15 mm induration

· Question 70

1 out of 1 points

Parents bring their 16-year-old daughter for a “well-child” checkup. She looks normal on examination. As part of your routine care you plan a urinalysis. The father pulls you aside and asks you to secretly run a UDS on his daughter. Which of the following is the most appropriate course of action?

Selected Answer:

b.

Explore the reasons for the request with the parents and the adolescent and perform a UDS with the adolescent's permission if the history warrants.

· Question 71

1 out of 1 points

A 2-year-old boy has been slightly less than the 50th percentile for weight, height and head circumference, but in the last 6 months he has fallen to slightly less than the 25th percentile for weight. The pregnancy was normal, his development is as expected, and the family reports no psychosocial problems. The mother says that he is now a finicky eater (wants only macaroni and cheese at all meals), but she insists that he eat a variety of foods. The meals are marked by much frustration for everyone. His examination is normal. Which of the following is the best next step in his care?

Selected Answer:

e.

Reassurance and counseling for family about childhood normal developmental stage

· Question 72

1 out of 1 points

You receive a phone call from the mother of a 2-year-old. She states her child has sleep refusal. You suggest the child should be able to:

Selected Answer:

b.

Set his own bedtime based on his internal clock.

· Question 73

1 out of 1 points

All of the following may predispose a patient to thrush except:

Selected Answer:

c.

Poor oral hygiene

· Question 74

1 out of 1 points

Sarah, age 15, presents with pain and pressure over her cheeks and discolored nasal discharge. You cannot transilluminate the sinuses. You suspect which common sinus to be affected?

Selected Answer:

d.

Maxillary sinus

· Question 75

1 out of 1 points

I can walk well on tiptoes, my speech is 50% understandable, I know six body parts, but I cannot balance on one foot for 1 second. I am:

Selected Answer:

b.

2-1/2 years old (30 months)

· Question 76

1 out of 1 points

Which of the following screenings should adolescents have done annually?

Selected Answer:

d.

Psychosocial screening, blood pressure, body mass index

· Question 77

1 out of 1 points

A 6-month-old infant has been growing poorly. His parents have changed his formula three times without success. His examination is remarkable for a pale, emaciated child with little subcutaneous fat and anterior fontanelle fullness. His laboratory test results are notable for a hemolytic anemia and prolonged bleeding times. Which of the following is the most appropriate next step?

Selected Answer:

d.

Obtain a sweat chloride concentration

· Question 78

1 out of 1 points

You see a 3-year-old for a well-child visit. His mother informs you that potty training has been very easy because he “has an amazing internal clock. He falls asleep, gets hungry, and has bowel movements at the same time every day.” This describes which aspect of temperament?

Selected Answer:

a.

Rhythmicity

· Question 79

1 out of 1 points

A 12-year-old male states he noticed an enlargement of his testes and scrotum. When counseling him about the next step in pubertal development, you state:

Selected Answer:

c.

The penis will grow in length and width.

· Question 80

1 out of 1 points

A 14-year-old female comes into the office for an urgent visit after taking 10 valium tablets. Following the initial emergent care and stailization, the most important part of the management is:

Selected Answer:

c.

Assessing the family supports available to the child.

· Question 81

1 out of 1 points

A 2-year-old child weighs 34 lb. What type of car seat should the child use?

Selected Answer:

b.

A forward-facing car seat in the back of the vehicle.

· Question 82

1 out of 1 points

Which of the following is a priority nurse practitioner role to help children and adolescents to have healthy sexual development?

Selected Answer:

b.

Begin anticipatory guidance related to sexuality and normal pubertal development in the early school-age visits.

· Question 83

1 out of 1 points

Epiglottitis has decreased due to which immunization?

Selected Answer:

c.

Hib

· Question 84

1 out of 1 points

Role-play with equipment during the course of the physical exam would be the most beneficial with which age group?

Selected Answer:

a.

Preschoolers

· Question 85

1 out of 1 points

A 2-day-old newbornwith conjunctivitis is likely due to

Selected Answer:

a.

Gonorrhea

· Question 86

1 out of 1 points

A 9-year-old who weighs 70 pounds asks why she can't sit in the front passenger seat of the family car. Your best response is

Selected Answer:

d.

The safest place for children under 12 years old and 100 pounds is in the backseat of the car.

· Question 87

1 out of 1 points

Which of the following would not suggest an eating disorder with a purging component?

Selected Answer:

b.

Finger calluses

· Question 88

1 out of 1 points

You see a 6-month-old for a well-child visit and the mother tells you the child’s grandmother recommends that she give the infant whole milk and eggs when he starts solids. What should you tell the mother?

Selected Answer:

d.

The baby should remain on infant formula and stage 2 and 3 baby foods for now.

· Question 89

1 out of 1 points

A 2-day-old infant has significant nasal and rectal bleeding. He was delivered by a midwife at home; the pregnancy was without complications. His Apgar scores were 9 at 1 minute and 9 at 5 minutes. He has breastfed well and has not required a health care professional visit since birth. Which of the following vitamin deficiencies might explain his condition?