Head and chest circumferences

Head and chest circumferences

NURS 6541 MIDTERM EXAM  / NURS6541 MIDTERM EXAM / NURS 6541N MIDTERM EXAM (2 VERSIONS) (100 CORRECT Q & A IN EACH VERSION, TOTAL: 200 Q & A)

 

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?

 

Selected Answer:

a.

Vitamin K

· Question 90 

1 out of 1 points

 

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

 

Selected Answer:

e.

A and D

· Question 91 

1 out of 1 points

 

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

 

Selected Answer:

c.

19 to 20 pounds

· Question 92 

1 out of 1 points

 

Head and chest circumferences should be equal at:

 

Selected Answer:

d.

1 years of age

· Question 93 

1 out of 1 points

 

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?

 

Selected Answer:

a.

Lysergic acid     diethylamide (LSD)

· Question 94 

1 out of 1 points

 

FIRST-LINE therapy   for preschoolers (4-5 years of age) diagnosed with attention-deficit   hyperactive disorder is:

 

Selected Answer:

c.

Behavior therapy

· Question 95 

1 out of 1 points

 

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

 

Selected Answer:

a.

ADHD

· Question 96 

1 out of 1 points

 

A 3-year-old (37 months) refuses   to have bowel movements on the toilet. He is bladder trained. He goes and   hides and squats when having bowel movements. Positive encouragement and   praise is not working. You advise:

 

Selected Answer:

b.

Tell the parent     this is normal; the child will eventually train himself, but it is     difficult to wait.

· Question 97 

1 out of 1 points

 

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

 

Selected Answer:

c.

No pubic hair at     all

· Question 98 

0 out of 1 points

 

Which of the following are important considerations when   screening child refugees for tuberculosis? SELECT TWO (2)

 

Selected Answers:

c.

IGRA may be     falsely positive in children who have autoimmune disorders.

 

d.

Mantoux TST     should not be used in a child who has received a Bacille Calmette-Guerin     vaccination.

· Question 99 

1 out of 1 points

 

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

 

Selected Answer:

b.

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

· Question 100 

1 out of 1 points

 

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:

 

Selected Answer:

a.

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

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