Pediatric Primary Care PNCB 2
COMPREHENSIVE QUESTIONS AND
VERIFIED ANSWERS
A female athlete experiences anaphylaxis during a soccer game. The only significant
history is that she had lunch about 1 hour before the incident. Food-dependent
exercise-induced anaphylaxis is diagnosed. Of the following, the MOST likely cause is:
chocolate milkshake
pineapple
tomatoes
whole wheat bread - <<<<ANSWERS>>>whole wheat bread
Exercise is a known co-factor in some children who experience anaphylaxis. Food-
dependent exercise-induced anaphylaxis (FDEIA) is defined as a food induced allergic
reaction that occurs during or soon after exercise. Children should not exercise within 2-
3 hours of ingesting the triggering food. Nuts, wheat, apples, bananas, kiwi, peaches
and eggs frequently are the cause for anaphylaxis.
A healthy 24 month old can be expected to have achieved which of the following
language milestones?
counts three objects correctly
speaks using 30 - 50 words
states full name
tells a story - <<<<ANSWERS>>>speaks using 30 - 50 words
Utilizing the Early Language Milestone Scale, beginning at the age of 11 months and
continuing to 24 months of age, the child should have a vocabulary of 50 words. This
child should be able to put words together in short, 2 - 3 word sentences and name at
least one object in a picture. The child at age 3 - 4 years will be able to tell a short story
,and begin to count. A 2 year old may know his first name, but usually cannot state full
name until he/she is older.
Which is the MOST important safety question to ask a 17 year old?
"Are you aware of ways to avoid accidents?"
"Do you play violent video games more than 2 hours a day?"
"Do you always wear a seat belt when driving or riding in a car?"
"Is there a gun anywhere in your house?" - <<<<ANSWERS>>>"Do you always wear a
seat belt when driving or riding in a car?"
Motor vehicle accidents are the leading cause of death among children in the United
States, with 78% of all unintentional injury deaths related to MVA among adolescents.
When correctly used, restraint systems can prevent fatalities and reduce the number
and severity of injuries to children and adolescents. As adolescents begin to drive and
carry peer passengers, it is especially important to remind them of basic safety issues,
including the use of seat belts, emphasizing the danger of driving, drinking and drug use
as well as appropriate behavior while in the car. Reinforcing pedestrian safety is another
important issue with adolescents. Firearm injuries have decreased over recent years,
especially among older children, and there is no link between violent video games and
increased accidents.
The parent of an 8 month old, reports switching the baby's formula to cow's milk due to
the continued expense of formula. Which is the BEST response?
Cow's milk does not contain adequate nutrition, and poses a higher risk for allergy.
Cow's milk has a lower protein and fat content, which will impede growth of the baby.
Switching to cow's milk sooner than 1 year will not cause any harm.
There is no need to continue formula as long as the child is receiving other baby foods.
- <<<<ANSWERS>>>Cow's milk does not contain adequate nutrition, and poses a
higher risk for allergy.
During the first year of life, infants should receive only formula or breast milk. The use of
cow's milk is contraindicated because of its high protein content, inappropriate nutrition
composition, especially lack of iron sources, and the risk of gastrointestinal bleeding
and allergic reactions. If an infant is switched sooner than one year, the practitioner
should encourage the family to resume use of formula or breast milk until the one year
birthday. Despite the addition of table foods or baby solid foods, formula and breast milk
are still the dietary mainstay.
,A 10 month old has had apparent abdominal pain for the past 4 hours. During episodes
of pain, the infant screams inconsolably and draws his legs towards the abdomen, has
vomited twice, but has had no diarrhea. Between episodes the infant is calm and quiet.
The MOST likely diagnosis is:
Meckel's diverticulum
intussusception
acute appendicitis
acute gastroenteritis - <<<<ANSWERS>>>intussusception
Acute onset of abdominal pain requires immediate investigation. The nurse practitioner
must be able to distinguish between conditions that can safely be managed at home
and those requiring immediate referral. Meckel's diverticulum usually involves painless
rectal bleeding. Acute appendicitis can occur in infants and must be considered in the
differential diagnosis. The pain history of acute appendicitis is usually more continuous,
and there is no palpable mass. Acute gastroenteritis may involve intermittent pain and
cramping, but more typically the child appears ill, and vomiting and diarrhea play a more
prominent role. The pain of intussusception is very severe, with periods of well-being in
between. There is frequently vomiting, however stools initially are normal. Later stools
can be like red jelly in appearance. A sausage shaped mass is frequently palpable in
the right upper quadrant and aids in diagnosis.
For the parents of an 8 month old, the MOST appropriate age-related anticipatory
guidance regarding safety includes which of the following?
cover electrical outlets, keep small objects out of reach, turn car seat to forward-facing
position
keep medications out of reach, continue to use car seat in rear-facing position, cover
electrical outlets
avoid finger foods that can be easily aspirated, teach stranger safety, place Mr. Yuk
stickers on toxic materials
keep matches out of reach, place Mr. Yuk stickers on toxic materials, teach stranger
safety - <<<<ANSWERS>>>keep medications out of reach, continue to use car seat in
rear-facing position, cover electrical outlets
An 8 month old is beginning to cruise, crawl and develop a fine pincer grasp. Keeping
medications and small objects out of reach in this age group assists in avoiding choking
or toxic ingestions. Covering electrical outlets helps to prevent accidental electrocution
while the infant is exploring his surroundings. An infant should maintain the rear-facing
position of the car seat until the age of one year. An 8 month old is not at a
, developmental level to understand stranger caution nor Mr. Yuk stickers. Keeping
matches out of reach is important, although it is not as likely that an 8 month old would
have the dexterity to strike a match.
The INITIAL treatment for a school-age female with well-demarcated erythema and
mucoid discharge in the vulva area includes:
discontinuation of bubble baths.
instruction on front to back cleansing.
oral penicillin.
topical Premarin. - <<<<ANSWERS>>>instruction on front to back cleansing.
Vulvovaginitis is the most common genital complaint among prepubertal girls due to the
thin hypo estrogenized mucosal tissue with an alkaline pH, small labia minora, and
location proximal to the anus. Vulvovaginitis, caused by streptococcal bacterial
infections, is identified by well-demarcated areas of erythema with a mucoid discharge.
A 10-day regimen of oral penicillin or amoxicillin is the treatment for a streptococcal
infection which is the most common organism. Vulvovaginitis can be caused by poor
hygiene in girls who may be wiping inadequately or inappropriately (e.g. from back to
front), leading to local irritation. Prepubertal females should be instructed in proper
hygiene and wiping of perianal area. Soaps, shampoos, and bubble baths are the most
common cause of dysuria due to chemical urethritis. Topical Premarin is used in the
initial treatment of labial adhesions.
Emphasis on promoting healthy behavioral changes for the overweight child should
include which of the following?
establishing family goals
maintaining family holiday meal rituals
weighing child daily
using weight loss as a sign of success - <<<<ANSWERS>>>establishing family goals
Effective weight loss planning and implementation need to involve the entire family.
Emphasis should be placed on family change and family goals as children will copy their
parents' behaviors. In addition, parents have control over some aspects of the change
process that can occur in relation to goals and meals in the home. Daily weights are not
recommended, and weight loss should not be used as the measure of success.
Changing behaviors is a success by itself and should be celebrated. New family and
holiday rituals should be established for a focus on non-food related events.
COMPREHENSIVE QUESTIONS AND
VERIFIED ANSWERS
A female athlete experiences anaphylaxis during a soccer game. The only significant
history is that she had lunch about 1 hour before the incident. Food-dependent
exercise-induced anaphylaxis is diagnosed. Of the following, the MOST likely cause is:
chocolate milkshake
pineapple
tomatoes
whole wheat bread - <<<<ANSWERS>>>whole wheat bread
Exercise is a known co-factor in some children who experience anaphylaxis. Food-
dependent exercise-induced anaphylaxis (FDEIA) is defined as a food induced allergic
reaction that occurs during or soon after exercise. Children should not exercise within 2-
3 hours of ingesting the triggering food. Nuts, wheat, apples, bananas, kiwi, peaches
and eggs frequently are the cause for anaphylaxis.
A healthy 24 month old can be expected to have achieved which of the following
language milestones?
counts three objects correctly
speaks using 30 - 50 words
states full name
tells a story - <<<<ANSWERS>>>speaks using 30 - 50 words
Utilizing the Early Language Milestone Scale, beginning at the age of 11 months and
continuing to 24 months of age, the child should have a vocabulary of 50 words. This
child should be able to put words together in short, 2 - 3 word sentences and name at
least one object in a picture. The child at age 3 - 4 years will be able to tell a short story
,and begin to count. A 2 year old may know his first name, but usually cannot state full
name until he/she is older.
Which is the MOST important safety question to ask a 17 year old?
"Are you aware of ways to avoid accidents?"
"Do you play violent video games more than 2 hours a day?"
"Do you always wear a seat belt when driving or riding in a car?"
"Is there a gun anywhere in your house?" - <<<<ANSWERS>>>"Do you always wear a
seat belt when driving or riding in a car?"
Motor vehicle accidents are the leading cause of death among children in the United
States, with 78% of all unintentional injury deaths related to MVA among adolescents.
When correctly used, restraint systems can prevent fatalities and reduce the number
and severity of injuries to children and adolescents. As adolescents begin to drive and
carry peer passengers, it is especially important to remind them of basic safety issues,
including the use of seat belts, emphasizing the danger of driving, drinking and drug use
as well as appropriate behavior while in the car. Reinforcing pedestrian safety is another
important issue with adolescents. Firearm injuries have decreased over recent years,
especially among older children, and there is no link between violent video games and
increased accidents.
The parent of an 8 month old, reports switching the baby's formula to cow's milk due to
the continued expense of formula. Which is the BEST response?
Cow's milk does not contain adequate nutrition, and poses a higher risk for allergy.
Cow's milk has a lower protein and fat content, which will impede growth of the baby.
Switching to cow's milk sooner than 1 year will not cause any harm.
There is no need to continue formula as long as the child is receiving other baby foods.
- <<<<ANSWERS>>>Cow's milk does not contain adequate nutrition, and poses a
higher risk for allergy.
During the first year of life, infants should receive only formula or breast milk. The use of
cow's milk is contraindicated because of its high protein content, inappropriate nutrition
composition, especially lack of iron sources, and the risk of gastrointestinal bleeding
and allergic reactions. If an infant is switched sooner than one year, the practitioner
should encourage the family to resume use of formula or breast milk until the one year
birthday. Despite the addition of table foods or baby solid foods, formula and breast milk
are still the dietary mainstay.
,A 10 month old has had apparent abdominal pain for the past 4 hours. During episodes
of pain, the infant screams inconsolably and draws his legs towards the abdomen, has
vomited twice, but has had no diarrhea. Between episodes the infant is calm and quiet.
The MOST likely diagnosis is:
Meckel's diverticulum
intussusception
acute appendicitis
acute gastroenteritis - <<<<ANSWERS>>>intussusception
Acute onset of abdominal pain requires immediate investigation. The nurse practitioner
must be able to distinguish between conditions that can safely be managed at home
and those requiring immediate referral. Meckel's diverticulum usually involves painless
rectal bleeding. Acute appendicitis can occur in infants and must be considered in the
differential diagnosis. The pain history of acute appendicitis is usually more continuous,
and there is no palpable mass. Acute gastroenteritis may involve intermittent pain and
cramping, but more typically the child appears ill, and vomiting and diarrhea play a more
prominent role. The pain of intussusception is very severe, with periods of well-being in
between. There is frequently vomiting, however stools initially are normal. Later stools
can be like red jelly in appearance. A sausage shaped mass is frequently palpable in
the right upper quadrant and aids in diagnosis.
For the parents of an 8 month old, the MOST appropriate age-related anticipatory
guidance regarding safety includes which of the following?
cover electrical outlets, keep small objects out of reach, turn car seat to forward-facing
position
keep medications out of reach, continue to use car seat in rear-facing position, cover
electrical outlets
avoid finger foods that can be easily aspirated, teach stranger safety, place Mr. Yuk
stickers on toxic materials
keep matches out of reach, place Mr. Yuk stickers on toxic materials, teach stranger
safety - <<<<ANSWERS>>>keep medications out of reach, continue to use car seat in
rear-facing position, cover electrical outlets
An 8 month old is beginning to cruise, crawl and develop a fine pincer grasp. Keeping
medications and small objects out of reach in this age group assists in avoiding choking
or toxic ingestions. Covering electrical outlets helps to prevent accidental electrocution
while the infant is exploring his surroundings. An infant should maintain the rear-facing
position of the car seat until the age of one year. An 8 month old is not at a
, developmental level to understand stranger caution nor Mr. Yuk stickers. Keeping
matches out of reach is important, although it is not as likely that an 8 month old would
have the dexterity to strike a match.
The INITIAL treatment for a school-age female with well-demarcated erythema and
mucoid discharge in the vulva area includes:
discontinuation of bubble baths.
instruction on front to back cleansing.
oral penicillin.
topical Premarin. - <<<<ANSWERS>>>instruction on front to back cleansing.
Vulvovaginitis is the most common genital complaint among prepubertal girls due to the
thin hypo estrogenized mucosal tissue with an alkaline pH, small labia minora, and
location proximal to the anus. Vulvovaginitis, caused by streptococcal bacterial
infections, is identified by well-demarcated areas of erythema with a mucoid discharge.
A 10-day regimen of oral penicillin or amoxicillin is the treatment for a streptococcal
infection which is the most common organism. Vulvovaginitis can be caused by poor
hygiene in girls who may be wiping inadequately or inappropriately (e.g. from back to
front), leading to local irritation. Prepubertal females should be instructed in proper
hygiene and wiping of perianal area. Soaps, shampoos, and bubble baths are the most
common cause of dysuria due to chemical urethritis. Topical Premarin is used in the
initial treatment of labial adhesions.
Emphasis on promoting healthy behavioral changes for the overweight child should
include which of the following?
establishing family goals
maintaining family holiday meal rituals
weighing child daily
using weight loss as a sign of success - <<<<ANSWERS>>>establishing family goals
Effective weight loss planning and implementation need to involve the entire family.
Emphasis should be placed on family change and family goals as children will copy their
parents' behaviors. In addition, parents have control over some aspects of the change
process that can occur in relation to goals and meals in the home. Daily weights are not
recommended, and weight loss should not be used as the measure of success.
Changing behaviors is a success by itself and should be celebrated. New family and
holiday rituals should be established for a focus on non-food related events.
