PedsCE PNP-PC Exam Questions & Answers

PedsCE PNP-PC Exam Questions & Answers-The most likely cause of bilateral purulent conjunctivitis in a 1-day old infant is a. Gonorrheal opthalmia b. Chlamydia infection c. Symphilitic opthalmia d. Adenovirus infection - a. Gonorrheal ophthalmia Rationale: Gonorrehea usually appears in the first 3-5 days of life. Chlamydia is between days 5-14. The other 2 are less common in neonates. Most common causes of conjunctivitis in newborn includes, Chlamydia, Gonorrhea, HSV, and chemical induced conjunctivitis. (Burns) Which of the following circumstances is most suggestive of excessive stress in a family with a chronically ill child? a. The father takes a second job to meet financial responsibilities b. The mother provides the majority of the care for the child c. The parents stop participation in a support group d. A sibling exhibits decline in school performance - c. The parents stop participation in a support group Rationale: Chronic illness takes a significant stress on the family. It can result in changes in roles as well as the sibling feeling unloved or left out in some way. Can also result in depression/anxiety of parents and other family members. Positive social networks are a positive influence on parents and the PNP should be concerned if the family is withdrawing from supportive social networks. This could indicate depression or extreme stress on the family unit. (Burns) An otherwise healthy 2-year old boy is brought to the emergency room with a four-week history of wheezing and persistent cough. Prior to the start of these symptoms, the parent recalls a coughing event which resolved spontaneously. Of the following the most likely diagnosis is: a. Viral pneumonia b. Acute laryngotracheobronchitis c. Bronchiolitis d. Foreign body aspiration - d. Foreign body aspiration Rationale: An initial choking, gagging, or coughing episode following by spontaneous resolution is often present in history finding of a child with foreign body aspiration. The episode is typically followed by respiratory symptoms such as stridor, wheezing, and prolonged cough in the absence of illness. Acute layngotracheobronchitis, bronchitis, and viral pneumonia are also associated with coughing and wheezing but also involve other symptoms such as fever, rhinorrhea, fatigue and usually resolve within 10-14 days. (Nelson Textbook of Pediatrics 20th edition, Chapter 327) The sexual development of a 14-year old girl is notably delayed. She is very short, slightly obese, and complains of constipation and fatigue. Her skin is sallow and coarse in texture, and her hair is brittle. Which of the following tests should be obtained? a. Serum leutinizing hormone and chromosome analysis b. Serum thyroxine and thryroid-stimulating hormone c. Chromosome analysis and serum thyroxine d. Serum leutinizing hormone and thyroid stimulating hormone - b. Serum thyroxine and thryroid-stimulating hormone Rationale: Classic symptoms of growth failure, goiter, delayed or arrested puberty, delayed dentition, weight gain, fatigue, dry skin, hyperlipidemia, decline in school performance, menorrhagia, and fatigue. It would be most appropriate to test for hypothyroidism first in this patient. If these are normal then you may want to consider the other tests for reasons for her growth delay etc. (Burns) Which of the following children requires a language referral for further evaluation? a. 1-year-old with a 5-word vocabulary b. 2-year-old who cannot put two words together c. 2-year-old with a 30-word vocabulary d. 3-year-old who is understandable to parents - b. 2-year-old who cannot put two words together Rationale: A 1 year old can have ~5 words with normal development, a 2 year old should have 20+ words, and by the age of 3 the child should be fully understandable by parents and 90% intelligible by strangers. A 2 year old should be able to put 2 word sentences together so if this milestone is not present then the patient needs further evaluation to assess for language delays. (Burns, Bright Futures) A pediatric primary care nurse practitioner observes multiple oval macules, both hyperpigmented and hypopigmented, on a child's upper trunk. A fine scale surrounds the borders of the lesions. The diagnosis is: a. Atopic dermatitis b. Keratosis pilaris c. Pityriasis rosea d. Tinea versicolor - d. Tinea versicolor Rationale: Tinea versicolor is a common dermatosis characterized by multiple small, oval, scaly patches measuring 1 to 3 cm in diameter, usually located in a raindrop pattern on the upper chest, back, and proximal portions of the upper extremities. In children, atopic dermatitis lesions are typically dry, papular, and intensely pruritic. Circumscribed scaly patches are distributed on the wrists, ankles, and antecubital and popliteal fossae. Keratosis Pilaris is typically distributed on the posterior upper portion of the arms and lesions are dry and papular. With Pityriasis rosea, a prodrome of malaise, headache, and mild constitutional symptoms occasionally precedes the rash but is not crucial for diagnosis. The typical eruption begins with the appearance of one or multiple "herald patches" which are large, isolated, oval lesions, usually pink in color and slightly scaly; they may occur anywhere on the body. From 5 to 10 days later, other smaller oval lesions appear on the body, frequently concentrated over the trunk but also seen on the proximal extremities, especially the thighs. (Zitelli and Davis' Atlas of Pediatric Physical Diagnosis, Chapter 8) A five-year-old child's physical examination is normal and the child has no known allergies to foods or medications. To date, the child has not been immunized and has had varicelladisease. The pediatric primary care nurse practitioner now administers a poliovirus vaccine, a diphtheria, tetanus, and acellular pertussis vaccine; a measles, mumps, and rubella virus vaccine, and a: a. Haemophilus influenza Type b vaccine b. Hepatitis B vaccine c. Meningococcal vaccined. d. Varicella vaccine (Varivax) - b. Hepatitis B vaccine Rationale: Since the child has not been previously immunized, Hepatitis B should be given. The Haemophilus influenza Type B vaccine should not be given to children over 5 years of age if they are otherwise healthy. The meninogococcal vaccine is not indicated in healthy children until 11 years of age. Because the child has had the varicella disease, the varicella vaccine is not a priority at this visit. (CDC, Immunizations, 2019) In reacting to parental divorce, a child between the ages of 9 and 12 differs from a younger child in his or her: a. Acceptance of the family's dissolution b. Conscious, intense anger c. Positive reaction to the departure of a parent d. Tendency toward emotional decompensation - b. Conscious, intense anger Rationale: Divorce is stressful and depending on the age of the child then you can expect different reactions. Children 2- 5 years of age will often have regression, sleep disturbances, irritability and aggression. Children 6-8 years of age will often express open grieving and feelings of being rejected. They may also experience fussiness, regression, sadness, fear and exhibit immature behaviors. Children 9-12 show fear and intense anger at one or both The child who is 13 + years of age is worried about their own future, may act out or have depression symptoms. (Burns 6 edition, chapter 17)