PEDSCE PNP-PC EXAM PRACTICE
QUESTIONS WITH 100% VERIFIED
ANSWERS!!
1 of 29
Term
A pediatric primary nurse practitioner evaluates an established
patient who has completed treatment for acute otitis media. The
nurse practitioner documents the resolution of the current illness, a
review of previous upper respiratory infections, and the findings of
an otoscopic examination and a brief head-to-toe assessment.
Previous documentation includes a diagnosis of otitis media
with effusion and a referral to an otolaryngologist. For which
level of service does the nurse practitioner bill?
a.Comprehensive
,b. Detailed
c. Expanded problem-focused
d. Problem-focused
Give this one a try later!
b. Interpret the patient's speech performance against expected standards and
recommend a referral to an audiologist
Rationale: The PNP should consider the speech development against expected
standards and recommend further evaluation of hearing. The 3 year old should
have 90% intelligible speech and if delayed it requires further assessment. Delays
should be addressed immediately to promote the best outcome for children.
(Burns)
d. Problem-focused
Rationale: The practitioner is not providing a comprehensive assessment
because she does not include enough components of the history and
physical, expanded problem focused would be a more extensive Hx
with ROS, PE, and medical decision making process. This visit is only
focused on the immediate problem that is now resolved without new
diagnosis and
limited assessment so it should be coded as problem focused (Burns;
Stewart & Denisco, Chapter 13)
d. Shigella flexneri
Rationale: Shigella causes 4-7 days of fever and diarrhea-that may contain
blood and mucus. Most susceptible children are between 6 months to 3 years of
age.
The child in this scenario has developed reactive arthritis which is a
known complication of a shigella infection. Rotavirus and giardia do not
cause this illness. E. Coli usually infects the urinary
tract system and not other areas of the body. (Burns and Red Book)
, d. An ear, nose, and throat consultation for recurrent otitis media
Rationale: The AAP guidelines states you can offer PE tubes if the child has 3 or
more episodes of AOM in a six month period. This child has concern for speech
delay as well which is another indication that he/she might be having hearing
issues secondary to recurrent AOM or Otitis with Effusion (AAP guidelines)
Don't know?
2 of 29
Term
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
Give this one a try later!
c. Moderate persistent
Rationale: Moderate persistent asthma in the child between 5-11 years is defined
by daily syptoms, night time awakingenings more than once per week, daily
SABA use, and some limitation in normal activity. Any child taking a SABA daily
is classified as having persistent asthma. Because the child's symptoms happen
on a daily basis, the severity is greater than "mild". Additionally, because the
child has "some" limitation innormal activity but is not "extremely limited" the
, classification would not rank as severe. (Guidelines from the National Asthma
Education and Prevention Program)
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)
d. Refer the patient to a neurologist
Rationale: Multiple (6 or more) café-au-lait spots of large diameter is
associated with neurofibromatosis. Other manifestations in children can include
freckling in the axilla and groin region. Tumors can occur in the brain, skin, eye
and along
nerve tracks throughout the body. If present, this finding warrants further
evaluation for neurofibromatosis. Genetic counseling may be part of the process
but should not be the first referral because may be benign finding if no
other
associated tumors. The creams will not improve these spots. (Burns 6th edition,
chapter 37)
b. Prescribe topical tretinoin (Retin-A)
Rationale: Because over the counter treatment of mild to moderate acne was
ineffective, topical tretinoin (Retin-A) is recommended as the next line of
treatment. Patients with mild to moderate comedonal and/or inflammatory acne
usually respond well to a combination of topical retinoids, benzoyl peroxide, and
antibiotics. Moderate to severe papulopustular acne warrants the use of oral
antibiotics in combination with topical agents. (Zitelli and Davis' Atlas of
Pediatric Physical Diagnosis, Chapter 8)
Don't know?
QUESTIONS WITH 100% VERIFIED
ANSWERS!!
1 of 29
Term
A pediatric primary nurse practitioner evaluates an established
patient who has completed treatment for acute otitis media. The
nurse practitioner documents the resolution of the current illness, a
review of previous upper respiratory infections, and the findings of
an otoscopic examination and a brief head-to-toe assessment.
Previous documentation includes a diagnosis of otitis media
with effusion and a referral to an otolaryngologist. For which
level of service does the nurse practitioner bill?
a.Comprehensive
,b. Detailed
c. Expanded problem-focused
d. Problem-focused
Give this one a try later!
b. Interpret the patient's speech performance against expected standards and
recommend a referral to an audiologist
Rationale: The PNP should consider the speech development against expected
standards and recommend further evaluation of hearing. The 3 year old should
have 90% intelligible speech and if delayed it requires further assessment. Delays
should be addressed immediately to promote the best outcome for children.
(Burns)
d. Problem-focused
Rationale: The practitioner is not providing a comprehensive assessment
because she does not include enough components of the history and
physical, expanded problem focused would be a more extensive Hx
with ROS, PE, and medical decision making process. This visit is only
focused on the immediate problem that is now resolved without new
diagnosis and
limited assessment so it should be coded as problem focused (Burns;
Stewart & Denisco, Chapter 13)
d. Shigella flexneri
Rationale: Shigella causes 4-7 days of fever and diarrhea-that may contain
blood and mucus. Most susceptible children are between 6 months to 3 years of
age.
The child in this scenario has developed reactive arthritis which is a
known complication of a shigella infection. Rotavirus and giardia do not
cause this illness. E. Coli usually infects the urinary
tract system and not other areas of the body. (Burns and Red Book)
, d. An ear, nose, and throat consultation for recurrent otitis media
Rationale: The AAP guidelines states you can offer PE tubes if the child has 3 or
more episodes of AOM in a six month period. This child has concern for speech
delay as well which is another indication that he/she might be having hearing
issues secondary to recurrent AOM or Otitis with Effusion (AAP guidelines)
Don't know?
2 of 29
Term
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
Give this one a try later!
c. Moderate persistent
Rationale: Moderate persistent asthma in the child between 5-11 years is defined
by daily syptoms, night time awakingenings more than once per week, daily
SABA use, and some limitation in normal activity. Any child taking a SABA daily
is classified as having persistent asthma. Because the child's symptoms happen
on a daily basis, the severity is greater than "mild". Additionally, because the
child has "some" limitation innormal activity but is not "extremely limited" the
, classification would not rank as severe. (Guidelines from the National Asthma
Education and Prevention Program)
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)
d. Refer the patient to a neurologist
Rationale: Multiple (6 or more) café-au-lait spots of large diameter is
associated with neurofibromatosis. Other manifestations in children can include
freckling in the axilla and groin region. Tumors can occur in the brain, skin, eye
and along
nerve tracks throughout the body. If present, this finding warrants further
evaluation for neurofibromatosis. Genetic counseling may be part of the process
but should not be the first referral because may be benign finding if no
other
associated tumors. The creams will not improve these spots. (Burns 6th edition,
chapter 37)
b. Prescribe topical tretinoin (Retin-A)
Rationale: Because over the counter treatment of mild to moderate acne was
ineffective, topical tretinoin (Retin-A) is recommended as the next line of
treatment. Patients with mild to moderate comedonal and/or inflammatory acne
usually respond well to a combination of topical retinoids, benzoyl peroxide, and
antibiotics. Moderate to severe papulopustular acne warrants the use of oral
antibiotics in combination with topical agents. (Zitelli and Davis' Atlas of
Pediatric Physical Diagnosis, Chapter 8)
Don't know?
