Exam (elaborations) NR 501 PEDS

Exam (elaborations) NR 501 PEDS A 6-month-old male has a palpable cystic mass in his scrotum. His mother states that sometimes the size of his scrotum varies. What should the nurse practitioner do next? Referral to urology if this has not resolved in 6 more months Referral to urology if this has not resolved in 6 more months Correct A congenital heart abnormality often discovered during the newborn period is coarctation of the aorta. How is this assessed? By comparing upper and lower extremity blood pressures By comparing upper and lower extremity blood pressures Correct According to the Tanner stages of development (Sexual Maturity Rating), breast development in Stage 4 in females includes the: projection of areola and nipple to form a secondary mound above the level of the breast. projection of areola and nipple to form a secondary mound above the level of the breast. Correct The most common cause of pneumonia in an otherwise healthy 3-year-old child is: a viral infection. S. pneumonia. Incorrec t What is the earliest age that an average child would be able to copy a triangle, know his colors, and count on his fingers? 5 years 5 years Correct A nurse practitioner is assessing the head of a 3- day-old infant. What would be a normal observation in a healthy 3-day-old infant who is crying? There are palpable pulsations over the anterior fontanel. There are palpable pulsations over the anterior fontanel. Correct NR 501 PEDS A pregnant mother in her first trimester has a 5-yearold who has Fifth Disease. What implication does this have for the mother? There is a risk of fetal death if she becomes infected. There is a risk of fetal death if she becomes infected. Correct What Tanner stage corresponds to an average 8- year-old male? Stage 1 Stage 1 Correct A young female has breast buds bilaterally. This represents Tanner Stage: II II Correct A 2-year-old has a sudden onset of high fever while at daycare. The daycare attendant describes a seizure in the child. The child is brought to the clinic; neurologically he appears normal. His body temperature is 99.9° F after receiving ibuprofen. He is diagnosed with otitis media. How should the nurse practitioner manage this? Treat the otitis media and give education about fever management Treat the otitis media and give education about fever management Correct Which of the following is an appropriate initial intervention for gastroesophageal reflux disease (GERD) in an 8- week-old? Small, frequent thickened feedings Small, frequent thickened feedings Correct The pneumococcal immunization in infants has: shifted the pathogenesis to fewer cases of S. pneumoniae. shifted the pathogenesis to fewer cases of S. pneumoniae. Correct A mother presents with her 1-month-old infant. She Provide education, parental reassurance, and Provide education, parental reassurance, and Correct reports that he cries inconsolably every evening after his first evening feeding. She asks for help. What should be done? encouragement. encouragement. Pharmacologic treatment for children who have hypertension should be initiated for: diabetics with hypertension. diabetics with hypertension. Correct A 2-month-old infant has an asymmetric Moro reflex. Which statement is true? The infant could have a birth injury. The infant could have a birth injury. Correct An infant is diagnosed with diaper dermatitis. Satellite lesions are visible. This should be treated with a: topical antifungal agent. topical antifungal agent. Correct A 5-year-old female’s playmate has been diagnosed with pinworms. The mother brings her child in for an exam. The 5 yearold denies rectal itching. How should the NP proceed? Perform the “scotch tape” test and look at the collection under the microscope. Perform the “scotch tape” test and look at the collection under the microscope. Correct A positive Trendelenburg’s test could be used to identify a child with: slipped capital femoral epiphysis. slipped capital femoral epiphysis. Correct The initial step in the management of encopresis is: client and family education. client and family education. Correct A mother reports that her child is not allergic to chickens but is allergic to ducks and duck feathers. The child is 4 years old today. None are contraindicated None are contraindicated Correct Which immunizations should he receive? A 4-year-old has been diagnosed with measles. The nurse practitioner identifies Koplik’s spots. These are: found on the inside of the cheek and are granular. found on the inside of the cheek and are granular. Correct A 6-year-old being treated for community-acquired pneumonia (CAP) has been taking azithromycin in therapeutic doses for 72 hours. His temperature has gone from 102° F to 101° F. What should be done? Change antibiotics to a penicillin Change antibiotics to a penicillin Correct The test of choice to confirm and assess developmental dysplasia of the hip (DHH) in a 3-month-old is: ultrasound of the hip. ultrasound of the hip. Correct MMR immunization is safe in children: who are allergic to eggs. who are allergic to eggs. Correct A child who is 15 months old is referred to as a(n): toddler. toddler. Correct A 7-year-old has a complaint of ear pain. If he has otitis externa, which complaint is most likely? He has tragal pain. He has tragal pain. Correct Hirschsprung's disease is characterized by: failure to pass meconium in the first 48 hours of life. failure to pass meconium in the first 48 hours of life. Correct A child received a burn on his chest from a cup of hot coffee. On examination, the injured area appeared moist, red to ivory white in color, and features blisters. It is superficial partial thickness burn. superficial partial thickness burn. Correct painful to touch. This burn would be classified as a: A sexually active adolescent male has a warty growth on the shaft of his penis. It is painless. This is likely: human papilloma virus. human papilloma virus. Correct A 3-year-old has been recently treated for an upper respiratory infection (URI) but drainage from the right nostril persists. What should the NP suspect? Presence of a foreign body Presence of a foreign body Correct What advice should be given to a parent who has a child with Fifth Disease? A parent may experience joint aches and pains. A parent may experience joint aches and pains. Correct A patient has suspected scarlet fever. He likely has a sandpaper rash and: a positive rapid Strept test. a positive rapid Strept test. Correct A young child has developed a circumferential lesion on her inner forearm. It is slightly raised, red and is pruritic. It is about 2.5 cm in diameter. This is probably related to: the child’s new cat. the child’s new cat. Correct A 7-year-old male presents with encopresis. The NP might expect: constipation. constipation. Correct What is the earliest age that an average child would appropriately receive construction paper and a pair of scissors with rounded points? 4 years 4 years Correct Babies up to one year of age are called: infants. infants. Correct Which infant feeding behavior is least likely related to congenital heart disease (CHD)? Infants that burp frequently when feeding Infants that burp frequently when feeding Correct The average age of pubertal growth spurt in North American boys is: 12 - 14 years. 12 - 14 years. Correct A 1-year-old patient’s mother reports allergy to gelatin. The mother describes the reaction as “lips swelling and breathing difficulties that necessitated a trip to the emergency department.” Which immunizations should be avoided? Varicella and MMR Varicella and MMR Correct A 6-week-old male infant is brought to the nurse practitioner because of vomiting. The mother describes vomiting after feeding and feeling a “knot” in his abdomen especially after he vomits. The child appears adequately nourished. What is the likely etiology? Pyloric stenosis Pyloric stenosis Correct The chest circumference of a 12 month-old is: equal to head circumference. 1-2 cm larger than head circumference. Incorrec t When is a child first able to stand on one foot? 3 years 18 months Incorrec t A 15-year-old female has Pregnancy test should be Pregnancy test should be Correct been sexually active since she was 12 years old. She presents today with concerns of pregnancy. How should this be managed? performed today. performed today. According to the Tanner stages of development (Sexual Maturity Rating), breast development in Stage 3 in females includes the: enlargement and elevation of breast and areola with no separation of their contours. enlargement and elevation of breast and areola with no separation of their contours. Correct Which choice below is a risk factor for sudden infant death syndrome (SIDS)? Low birth weight Low birth weight Correct In a 3-year-old with fever, which occurrence might precipitate a febrile seizure? A sudden decrease in body temperature after high fever A sudden decrease in body temperature after high fever Correct What would be age appropriate anticipatory guidance for the parent of a 9-month-old infant? Discuss weaning from a bottle. Stranger anxiety will develop by a year of age. Incorrec t A 4-month-old infant has thrush. The mother is breastfeeding. She reports that her nipples have become red, irritated, and sensitive. What should the nurse practitioner advise the mother of this baby to treat thrush? Treat the infant with an oral antifungal suspension and the mother’s nipples with a topical antifungal agent Treat the infant with an oral antifungal suspension and the mother’s nipples with a topical antifungal agent Correct When is Osgood-Schlatter disease most likely to produce symptoms? During a growth spurt During a growth spurt Correct Which reflexes might a 1-month-old infant be Moro, stepping, rooting Moro, stepping, rooting Correct expected to exhibit? A definitive diagnosis of sickle cell anemia can be made: by a hemoglobin electrophoresis. by a hemoglobin electrophoresis. Correct A sexually active adolescent male reports that he has dysuria. How should this be managed? Urethral/urine cultures should be collected and screening done for STDs Urethral/urine cultures should be collected and screening done for STDs Correct A pregnant patient is concerned because her 12 month-old needs an MMR immunization. What should the NP advise this patient? MMR immunization presents no risk to the child’s mother. Immunize now. MMR immunization presents no risk to the child’s mother. Immunize now. Correct A child's resting heart rate is expected to be between 60 and 100 beats per minute once he reaches: 10 years of age. 10 years of age. Correct An adolescent complains of knee pain. He is diagnosed with Osgood-Schlatter disease. What assessment finding is typical? Pain worsens with quadriceps contraction. Pain worsens with quadriceps contraction. Correct A male child has swelling in the upper left thigh below the inguinal ligament. He complains of cramping and intermittent lower abdominal pain. What should be included in the differential diagnosis? Femoral hernia Testicular torsion Incorrec t A 15-year-old male has worked this summer as a lifeguard at a local swimming pool. He well marginated half-moon macules on the inner thigh. well marginated half-moon macules on the inner thigh. Correct complains of itching in the groin area. He is diagnosed with tinea cruris. The nurse practitioner is likely to identify: At what age would it be unusual to see thrush? At birth At birth Correct A 4-year-old female is brought in to the clinic by her mother, who reports that she is constantly scratching “her private part.” The patient states that it itches. On exam, the vagina is red and irritated. How should the NP proceed? Collect a vaginal swab of the external vagina for microscopic evaluation Collect a vaginal swab of the external vagina for microscopic evaluation Correct An adolescent takes isotretinoin for nodulocystic acne. She is on oral contraceptives. Both were prescribed by the dermatologist. The adolescent presents to your clinic with a sinus infection. Her temperature is 99.5° F and her blood pressure is 160/100 mmHg. How should this be managed? Call the dermatologist to report the elevated BP Call the dermatologist to report the elevated BP Correct A 4-year-old was diagnosed and treated for acute otitis media in the left ear 4 weeks ago. She is here today for a well-child visit. There is an effusion in the left ear. She denies complaints. How should this be managed? This should be monitored. This should be monitored. Correct A 3-year-old female had a fever of 102° F for the last 3 days. Today she woke up from a nap and is afebrile. She has a maculopapular rash. Which statement is true? The rash will blanch. The rash will blanch. Correct Medications considered first line to treat attention deficit disorder and attention deficit hyperactivity disorder are Schedule: II. II. Correct Which statement below best characterizes scoliosis in an adolescent? There can be unequal rib prominences or shoulder heights. There can be unequal rib prominences or shoulder heights. Correct What is the usual recommendation about administering MMR and varicella immunizations? They should be given on the same day or at least one month apart. They should be given on the same day or at least one month apart. Correct Children with an inguinal hernia: have a history of an intermittent bulge in the groin. are usually irritable and often constipated. Incorrec t A 6-year-old complains that his legs hurt. His mother states that he has complained for the past 2 weeks, and she thought it was from “playing outside too much”. When asked to identify the painful areas, the child points to the midshaft of the femurs. He grimaces slightly when asked to walk. What is the most important initial Complete blood count Complete blood count Correct intervention? A healthy appearing 3-yearold female presents with nonblanchable redness over both knees and elbows. During the exam, she is found to have normal growth and development, and she interacts appropriately with the nurse practitioner. She had an upper respiratory infection about 4 weeks ago that cleared without incident. A CBC and urinalysis were obtained. The most likely diagnosis is: idiopathic thrombocytopenia purpura (ITP). acute lymphocytic leukemia (ALL). Incorrec t A 6-week-old is suspected of having developmental dysplasia of the hip (DDH). What test would best assess for this? Barlow and Ortolani Barlow and Ortolani Correct The most common cause of acute pharyngitis in children is: respiratory viruses. respiratory viruses. Correct Which of the following increases the risk of cryptorchidism? Premature birth Premature birth Correct A nurse practitioner has successfully reduced a nursemaid’s elbow. How can the NP know that it was successful? Child moves the affected arm at the elbow Child moves the affected arm at the elbow Correct Which patient below is most likely to experience stranger anxiety during a physical A 12-month-old female A 12-month-old female Correct exam? Epstein-Barr virus is responsible for: mononucleosis. mononucleosis. Correct An 8-year-old has a painful limp. He reports that his knee hurts medially. On exam he has pain with internal rotation of the hip. How should the NP manage this situation? The NP should order a hip Xray, CBC and ESR. The NP should order a hip Xray, CBC and ESR. Correct A 3-day-old full-term infant has a bilirubin level of 16 mg/dL. How should this be managed? Order phototherapy for the infant Order phototherapy for the infant Correct The term caput succedaneum refers to: scalp edema. scalp edema. Correct When can a child with chickenpox return to daycare? After all lesions have crusted After all lesions have crusted Correct A child has 8-10 medium brown café au lait spots 1 cm in diameter. The differential diagnosis should include: neurofibromatosis. neurofibromatosis. Correct A 4-year-old is being examined today in the NP clinic. He appears shy and does not make eye contact with the examiner. The mother does not make eye contact with the examiner either. The patient lacks animation and does not smile. What likely possibility Neglect is possible. Neglect is possible. Correct must be considered? Most hypertension in preadolescents and children is: secondary hypertension. secondary hypertension. Correct Which of the following is true about metatarsus adductus? Mild flexible metatarsus usually spontaneously corrects. Mild flexible metatarsus usually spontaneously corrects. Correct Which statement about attention deficit disorder (ADD) is correct? DSM V is used to diagnose a child with ADD. DSM V is used to diagnose a child with ADD. Correct A 3-year-old has fluid in the middle ear that does not appear infected. The eardrum appears normal. This is referred to as: middle ear effusion. middle ear effusion. Correct A full-term newborn is diagnosed with hyperbilirubinemia. When would his bilirubin level be expected to peak? 3-4 days 3-4 days Correct Which of the following will decrease the risk of acute otitis media in a 6-monthold? Breastfeeding Cigarette smoke exposure Incorrec t A 3-day-old infant weighed 8 pounds at birth. Today he weighs 7.5 pounds. How should this be managed? Continue feeding every 2-4 hours Continue feeding every 2-4 hours Correct How often should blood pressure be measured in a child who is 3 years old? It should be measured annually. It should be measured annually. Correct A 12-year-old male with hip pain presents to the NP Perform Trendelenburg’s test in the office Perform Trendelenburg’s test in the office Correct clinic. Hip pain has occurred with activity for the past 4-6 weeks, but his pain is worse and now involves the knee. There is no history of trauma. How should the workup be initiated? A child with a sandpapertextured rash probably has: Strept infection. Strept infection. Correct Which reflex may be present at 9 months of age during sleep? Rooting Rooting Correct A 7-year-old enters the nurse practitioner clinic. There is no evidence that he has received any immunizations. What should be administered today? Hepatitis B, Tdap, IPV, varicella, MMR Hepatitis B, Tdap, IPV, varicella, MMR Correct A 12-month-old is here today to receive the varicella immunization. A patient’s mother reports that her 12- month-old child was exposed to chickenpox about a week ago. The NP should recommend that he: be given the vaccine. be given the vaccine. Correct The age at which a child can first walk backwards is: 18 months. 18 months. Correct A 2-month-old is diagnosed with thrush. An exam of this patient’s saliva demonstrates all except: spores. yeast. Incorrec t A mother of a 4-week-old infant visits your office. She His abdomen for an olive shaped mass The position his mother uses when she feeds him Incorrec t states that her baby is vomiting after feeding and then cries as if he is hungry again. What should the nurse practitioner assess? Many factors can contribute to the risk of congenital heart disease. Which maternal disease carries a higher risk of transposition of the great vessels (TGA), ventricular septal defect (VSD), and hypertrophic cardiomyopathy? Diabetes Diabetes Correct A 6-year-old child who has moderate persistent asthma is diagnosed with pneumonia after chest X-ray and laboratory studies. He developed a sudden onset of fever with chills. He is in no distress. What is the preferred treatment for him? Amoxicillin Supportive measures, it is probably viral Incorrec t A 12-month-old was screened for iron deficiency anemia and found to be anemic. The nurse practitioner ordered oral iron. In 1 month, the child’s hemoglobin was reassessed. It increased greatly. Which answer might account for this? The bone marrow is responding appropriately. The mother administered it with his bottle of milk. Incorrec t Risk assessment for dyslipidemia should begin at: 2 years. 2 years. Correct An infant is brought to the nurse practitioner because his gaze is asymmetrical. Which finding indicates a need for referral to ophthalmology? He has persistent strabismus. He has persistent strabismus. Correct A 12-year-old complains of itching in his right ear and pain when the pinna is pulled or the tragus is pushed. Examination revealed slight redness in the ear canal with a clear odorless fluid. This could be suggestive of: otitis externa. otitis externa. Correct A young child has an audible murmur. The nurse practitioner describes it as a grade 4 murmur. How should this be managed? The child should be referred to cardiology. The child should be referred to cardiology. Correct At what age should initial blood pressure screening take place? 3 years 3 years Correct A 6-day-old has bilateral mucopurulent eye discharge. Which historical finding explains the etiology of the discharge? Mother has chlamydia Mother has chlamydia Correct The nurse practitioner is examining a 3-month-old infant who has normal development. She has identified an alopecic area at the occiput. What should be done? Encourage the caregiver to change the infant’s head position Encourage the caregiver to change the infant’s head position Correc