NURS 629 Exam 4 V3 | NURS 629 Peds |
Actual Q&A with Rationale (NURS629
Exam 4) | Maryville University
1. A 9-month-old infant is brought to the clinic for a well-child visit. During the neurological
assessment, the nurse practitioner looks for signs of increased intracranial pressure (ICP).
Which of the following findings would suggest increased ICP in this patient? (Select All That
Apply)
A. Bulging anterior fontanel
B. High-pitched, shrill cry
C. Brisk capillary refill
D. Prominent scalp veins
E. Symmetrical Moro reflex
F. Increased head circumference crossing percentiles
Correct Answer: A, B, D, F
Clinical manifestations of increased intracranial pressure in infants often include physical
changes to the skull and behavioral changes. A bulging fontanel and rapidly increasing head
circumference are direct indicators of pressure within the non-fused cranial vault.
Behavioral signs such as a high-pitched cry and physical signs like prominent scalp veins
further support the diagnosis of neurosurgical or medical urgency.
,2. A 14-year-old male athlete presents with a complaint of pain and swelling just below the
knee at the tibial tuberosity. He notes the pain worsens during basketball practice. What is
the most likely diagnosis?
A. Osgood-Schlatter disease
B. Legg-Calvé-Perthes disease
C. Slipped capital femoral epiphysis
D. Septic arthritis
Correct Answer: A
Osgood-Schlatter disease is a common cause of knee pain in active adolescents,
specifically characterized by inflammation of the patellar ligament at the tibial tuberosity.
It is typically a clinical diagnosis based on the location of the pain and its association with
growth spurts and repetitive sports activity. Management is usually conservative, focusing
on rest, ice, and activity modification until the growth plate closes.
3. When evaluating a 12-month-old for iron deficiency anemia (IDA), the nurse practitioner
understands that which of the following dietary habits is a significant risk factor?
A. Consumption of leafy green vegetables
B. Drinking more than 24 ounces of cow’s milk per day
C. Early introduction of pureed meats
D. Exclusive breastfeeding until six months of age
,Correct Answer: B
Excessive intake of cow’s milk in toddlers is a leading cause of nutritional iron deficiency
because milk is low in iron and can displace other iron-rich foods in the diet. Additionally,
cow’s milk can cause microscopic intestinal bleeding in very young children, further
depleting iron stores. Current guidelines recommend limiting cow’s milk intake to no more
than 16 to 24 ounces per day after the age of 12 months.
4. A mother brings in her 5-year-old child who had a brief, generalized tonic-clonic seizure
earlier today during a fever of 102.8°F. The child has no prior history of seizures. Which
statement regarding simple febrile seizures is correct?
A. They generally carry an excellent prognosis and do not require long-term treatment.
B. Prophylactic daily anticonvulsant therapy is required.
C. They are highly likely to lead to epilepsy in adulthood.
D. The seizure must last longer than 15 minutes to be considered ‘simple’.
Correct Answer: A
Simple febrile seizures are benign events occurring in children between 6 months and 5
years of age associated with a rapid rise in temperature. By definition, they are generalized,
last less than 15 minutes, and do not recur within 24 hours. The risk of developing
subsequent epilepsy is only slightly higher than that of the general population, so
reassurance and fever management are the mainstays of care.
, 5. A 13-year-old girl is screened for scoliosis using the Adams Forward Bend test. The nurse
practitioner notes a prominent right rib hump. What is the next most appropriate step in
management?
A. Order a standing posterior-anterior (PA) spinal radiograph to measure the Cobb angle
B. Prescribe a rigid back brace immediately
C. Schedule a follow-up visit in 12 months to monitor progression
D. Refer to physical therapy for core strengthening exercises
Correct Answer: A
The Adams Forward Bend test is a screening tool, and any positive finding such as a rib
hump or trunk asymmetry necessitates radiographic confirmation. The Cobb angle,
measured via X-ray, is the gold standard for diagnosing scoliosis and determining the
severity of the curve. Treatment decisions, including bracing or referral to orthopedics, are
based on the degree of the angle and the child’s skeletal maturity.
6. A 4-year-old child presents with bruising, petechiae, and a low platelet count of
22,000/mm³. The child recently recovered from a viral upper respiratory infection. Which
condition is most likely?
A. Acute Lymphoblastic Leukemia (ALL)
B. Hemophilia A
C. Immune Thrombocytopenic Purpura (ITP)
D. Von Willebrand disease
Actual Q&A with Rationale (NURS629
Exam 4) | Maryville University
1. A 9-month-old infant is brought to the clinic for a well-child visit. During the neurological
assessment, the nurse practitioner looks for signs of increased intracranial pressure (ICP).
Which of the following findings would suggest increased ICP in this patient? (Select All That
Apply)
A. Bulging anterior fontanel
B. High-pitched, shrill cry
C. Brisk capillary refill
D. Prominent scalp veins
E. Symmetrical Moro reflex
F. Increased head circumference crossing percentiles
Correct Answer: A, B, D, F
Clinical manifestations of increased intracranial pressure in infants often include physical
changes to the skull and behavioral changes. A bulging fontanel and rapidly increasing head
circumference are direct indicators of pressure within the non-fused cranial vault.
Behavioral signs such as a high-pitched cry and physical signs like prominent scalp veins
further support the diagnosis of neurosurgical or medical urgency.
,2. A 14-year-old male athlete presents with a complaint of pain and swelling just below the
knee at the tibial tuberosity. He notes the pain worsens during basketball practice. What is
the most likely diagnosis?
A. Osgood-Schlatter disease
B. Legg-Calvé-Perthes disease
C. Slipped capital femoral epiphysis
D. Septic arthritis
Correct Answer: A
Osgood-Schlatter disease is a common cause of knee pain in active adolescents,
specifically characterized by inflammation of the patellar ligament at the tibial tuberosity.
It is typically a clinical diagnosis based on the location of the pain and its association with
growth spurts and repetitive sports activity. Management is usually conservative, focusing
on rest, ice, and activity modification until the growth plate closes.
3. When evaluating a 12-month-old for iron deficiency anemia (IDA), the nurse practitioner
understands that which of the following dietary habits is a significant risk factor?
A. Consumption of leafy green vegetables
B. Drinking more than 24 ounces of cow’s milk per day
C. Early introduction of pureed meats
D. Exclusive breastfeeding until six months of age
,Correct Answer: B
Excessive intake of cow’s milk in toddlers is a leading cause of nutritional iron deficiency
because milk is low in iron and can displace other iron-rich foods in the diet. Additionally,
cow’s milk can cause microscopic intestinal bleeding in very young children, further
depleting iron stores. Current guidelines recommend limiting cow’s milk intake to no more
than 16 to 24 ounces per day after the age of 12 months.
4. A mother brings in her 5-year-old child who had a brief, generalized tonic-clonic seizure
earlier today during a fever of 102.8°F. The child has no prior history of seizures. Which
statement regarding simple febrile seizures is correct?
A. They generally carry an excellent prognosis and do not require long-term treatment.
B. Prophylactic daily anticonvulsant therapy is required.
C. They are highly likely to lead to epilepsy in adulthood.
D. The seizure must last longer than 15 minutes to be considered ‘simple’.
Correct Answer: A
Simple febrile seizures are benign events occurring in children between 6 months and 5
years of age associated with a rapid rise in temperature. By definition, they are generalized,
last less than 15 minutes, and do not recur within 24 hours. The risk of developing
subsequent epilepsy is only slightly higher than that of the general population, so
reassurance and fever management are the mainstays of care.
, 5. A 13-year-old girl is screened for scoliosis using the Adams Forward Bend test. The nurse
practitioner notes a prominent right rib hump. What is the next most appropriate step in
management?
A. Order a standing posterior-anterior (PA) spinal radiograph to measure the Cobb angle
B. Prescribe a rigid back brace immediately
C. Schedule a follow-up visit in 12 months to monitor progression
D. Refer to physical therapy for core strengthening exercises
Correct Answer: A
The Adams Forward Bend test is a screening tool, and any positive finding such as a rib
hump or trunk asymmetry necessitates radiographic confirmation. The Cobb angle,
measured via X-ray, is the gold standard for diagnosing scoliosis and determining the
severity of the curve. Treatment decisions, including bracing or referral to orthopedics, are
based on the degree of the angle and the child’s skeletal maturity.
6. A 4-year-old child presents with bruising, petechiae, and a low platelet count of
22,000/mm³. The child recently recovered from a viral upper respiratory infection. Which
condition is most likely?
A. Acute Lymphoblastic Leukemia (ALL)
B. Hemophilia A
C. Immune Thrombocytopenic Purpura (ITP)
D. Von Willebrand disease
