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\Q\.The primary care pediatric nurse practitioner is examining a 5-year-old child who has had
recurrent fevers, bone pain, and a recent loss of weight. The physical exam reveals scattered
petechia, lymphadenopathy, and bruising. A complete blood count shows thrombocytopenia,
anemia, and an elevated white cell blood count. The nurse practitioner will refer this child to
a specialist for
a. bone marrow biopsy.
b. corticosteroids and IVIG.
c. hemoglobin electrophoresis.
d. immunoglobulin testing.
a. bone marrow biopsy.
A toddler who presents with anemia and reticulocytopenia has a history of a gradual decrease
in energy and increase in pallor beginning after a recent viral infection. How will the primary
care pediatric nurse practitioner treat this child?
a. Closely observe the child's symptoms and lab values.
b. Consult with a pediatric hematologist.
c. Prescribe supplemental iron for 4 to 6 months.
d. Refer for transfusions to correct the anemia.
a. Closely observe the child's symptoms and lab values.
The primary care pediatric nurse practitioner is performing a well child examination on a
school-age child who has a history of cancer treated with cranial irradiation. What will the
nurse practitioner monitor in this child?
a. Cardiomyopathy and arrhythmias
b. Leukoencephalopathy
,c. Obesity and gonadal dysfunction
d. Peripheral neuropathy and hearing loss
b. Leukoencephalopathy
The primary care pediatric nurse practitioner reviews hematology reports on a child with
beta-thalassemia minor and notes an Hgb level of 8 g/dL. What will the nurse practitioner do?
a. Evaluate serum ferritin.
b. Order Hgb electrophoresis.
c. Prescribe supplemental iron.
d. Refer for RBC transfusions.
a. Evaluate serum ferritin.
The primary care pediatric nurse practitioner evaluates a 5-year-old child who presents with
pallor and obtains labs revealing a hemoglobin of 8.5 g/dL and a hematocrit of 31%. How will
the nurse practitioner manage this patient?
a. Prescribe elemental iron and recheck labs in 1 month.
b. Reassure the parent that this represents mild anemia.
c. Recommend a diet high in iron-rich foods.
d. Refer to a hematologist for further evaluation.
a. Prescribe elemental iron and recheck labs in 1 month.
A school-age child comes to the clinic for evaluation of excessive bruising. The primary care
pediatric nurse practitioner notes a history of an upper respiratory infection 2 weeks prior.
The physical exam is negative for hepatosplenomegaly and lymphadenopathy. Blood work
reveals a platelet count of 60,000/mm° with normal PT and aPTT. How will the nurse
practitioner manage this child's condition?
a. Admit to the hospital for IVIG therapy.
b. Begin a short course of corticosteroid therapy.
c. Refer to a pediatric hematologist.
d. Teach to avoid NSAIDs and contact sports.
d. Teach to avoid NSAIDs and contact sports.
The primary care pediatric nurse practitioner is treating an infant with lacrimal duct
obstruction who has developed bacterial conjunctivitis. After 2 weeks of treatment with
topical antibiotics along with massage and frequent cleansing of secretions. the infant's
symptoms have not improved. Which action is correct?
a. Perform massage more frequently.
b. Prescribe an oral antibiotic.
, c. Recommend hot compresses.
d. Refer to an ophthalmologist.
d. Refer to an ophthalmologist.
The primary care pediatric nurse practitioner observes a tender, swollen red furuncle on the
upper lid margin of a child's eye. What treatment will the nurse practitioner recommend?
a. Culture of the lesion to determine causative organism
b. Referral to ophthalmology for incision and drainage
c. Topical steroid medication
d. Warm, moist compresses 3 to 4 times daily
d. Warm, moist compresses 3 to 4 times daily
During a well child assessment of an African-American infant, the primary care pediatric nurse
practitioner notes a dark red-brown light reflex in the left eye and a slightly brighter, red-
orange light reflex in the right eye. The nurse practitioner will
a. dilate the pupils and reassess the red reflex.
b. order auto-refractor screening of the eyes.
c. recheck the red reflex in 1 month.
d. refer the infant to an ophthalmologist.
d. refer the infant to an ophthalmologist.
A toddler exhibits exotropia of the right eye during a cover-uncover screen. The primary care
pediatric nurse practitioner will refer to a pediatric ophthalmologist to initiate which
treatment?
a. Botulinum toxin injection
b. Corrective lenses
c. Occluding the affected eye for 6 hours per day
d Patching of the unaffected eye for 2 hours each day
d Patching of the unaffected eye for 2 hours each day
A 14-year-old child has a 2-week history of severe itching and tearing of both eyes. The
primary care pediatric nurse practitioner notes redness and swelling of the eyelids along with
stringy, mucoid discharge. What will the nurse practitioner prescribe?
a. Saline solution or artificial tears
b. Topical mast cell stabilizer
c. Topical NSAID drops
d. Topical vasoconstrictor drops
c. Topical NSAID drops