NSG 5442 PEDIATRIC PRIMARY CARE EXAM 3 (PDF)
| 2027| SOUTH COLLEGE PEDIATRICS
During a well-child visit, a 16-year-old male is receiving anticipatory
guidance from the family nurse practitioner (FNP) regarding safe driving
practices. The patient has a new intermediate driver's license, which in
his state, permits unsupervised driving. When counseling the patient and
his parents about the highest-risk conditions for motor vehicle crashes
among adolescent drivers, the FNP should emphasize that crash risk is
significantly increased under which of the following circumstances?
Driving on a rural road with a mature adult passenger
Daytime driving with a parent in the vehicle
Weekend nighttime driving with multiple teen passengers
Driving during the week with no passengers
Weekend nighttime driving with multiple teen passengers
A 3-year-old patient presents to the clinic with a 5-day history of fever,
lethargy, and decreased oral intake. During the physical exam, you note
cervical lymphadenopathy and a petechial rash. The complete blood
count (CBC) shows a white blood cell (WBC) count of 45.0 x 109 /L with
65% blasts, hemoglobin of 8.2 g/dL, and a platelet count of 40.0 x 109 /L.
Based on these findings, what is the most appropriate next step in
managing this patient?
Refer the patient for immediate hospital admission to a pediatric
hematology/oncology specialist.
Explain to the parents that this is a benign viral infection and reassure
,them that the symptoms will resolve on their own.
Prescribe a broad-spectrum antibiotic and have the patient follow up in
24 hours.
Schedule the patient for a repeat CBC with differential in one week to
monitor the leukocyte count.
Refer the patient for immediate hospital admission to a pediatric
hematology/oncology specialist.
A 10 y/o male presents to the clinic with a 6-week hx of a progressively
enlarging, firm, non-tender supraclavicular lymph node. His mom reports
he has also experienced intermittent low-grade fevers, drenching night
sweats, and a 10 lb weight loss over the past 3 mos. A recent course of
abx for a presumed URI did not affect the lymph node's size. His past
medical hx is otherwise unremarkable. Based on these findings, which of
the following is the most appropriate next step for the Family Nurse
Practitioner?
Order a complete blood count (CBC) with differential, C-reactive protein
(CRP), and a monospot test.
Prescribe a second, more broad-spectrum abx and have the pt return if
there is no improvement.
Reassure mother that the lymph node is likely reactive and schedule a
follow-up in 3 mos.
Refer the pt urgently to a pediatric oncologist for further evaluation,
including a lymph node biopsy.
Refer the patient urgently to a pediatric oncologist for further evaluation,
including a lymph node biopsy.
, A 9-year-old child presents to the clinic for a well-child checkup. During
auscultation, the Family Nurse Practitioner (FNP) notes an irregular heart
rhythm that speeds up with inspiration and slows down with expiration.
The child is asymptomatic, and the rest of the physical examination is
unremarkable. An ECG confirms a respiratory sinus arrhythmia. What is
the most appropriate next step in managing this patient?
Reassure the parents that this is a normal, benign finding and requires no
further intervention.
Refer immediately to a pediatric cardiologist for further evaluation and
management.
Initiate the child on a low-dose beta-blocker to regulate the heart
rhythm.
Order a 24-hour Holter monitor to assess the frequency and severity of
the arrhythmia
Reassure the parents that this is a normal, benign finding and requires no
further intervention.
A 7-year-old patient presents to the clinic with a history of a recent
Group A Streptococcus (GAS) pharyngitis infection. The patient now
complains of fatigue, dyspnea on exertion, and mild, migratory joint
pain. On physical examination, the family nurse practitioner (FNP) notes
a new cardiac murmur and a slightly elevated heart rate. The patient is
diagnosed with acute rheumatic fever with carditis. Which of the
following is the most critical component of the management plan to
prevent long-term cardiac damage?
Prescribing a course of high-dose nonsteroidal anti-inflammatory drugs
(NSAIDs) for 1-2 weeks
Initiating a supervised exercise program to improve cardiac function
| 2027| SOUTH COLLEGE PEDIATRICS
During a well-child visit, a 16-year-old male is receiving anticipatory
guidance from the family nurse practitioner (FNP) regarding safe driving
practices. The patient has a new intermediate driver's license, which in
his state, permits unsupervised driving. When counseling the patient and
his parents about the highest-risk conditions for motor vehicle crashes
among adolescent drivers, the FNP should emphasize that crash risk is
significantly increased under which of the following circumstances?
Driving on a rural road with a mature adult passenger
Daytime driving with a parent in the vehicle
Weekend nighttime driving with multiple teen passengers
Driving during the week with no passengers
Weekend nighttime driving with multiple teen passengers
A 3-year-old patient presents to the clinic with a 5-day history of fever,
lethargy, and decreased oral intake. During the physical exam, you note
cervical lymphadenopathy and a petechial rash. The complete blood
count (CBC) shows a white blood cell (WBC) count of 45.0 x 109 /L with
65% blasts, hemoglobin of 8.2 g/dL, and a platelet count of 40.0 x 109 /L.
Based on these findings, what is the most appropriate next step in
managing this patient?
Refer the patient for immediate hospital admission to a pediatric
hematology/oncology specialist.
Explain to the parents that this is a benign viral infection and reassure
,them that the symptoms will resolve on their own.
Prescribe a broad-spectrum antibiotic and have the patient follow up in
24 hours.
Schedule the patient for a repeat CBC with differential in one week to
monitor the leukocyte count.
Refer the patient for immediate hospital admission to a pediatric
hematology/oncology specialist.
A 10 y/o male presents to the clinic with a 6-week hx of a progressively
enlarging, firm, non-tender supraclavicular lymph node. His mom reports
he has also experienced intermittent low-grade fevers, drenching night
sweats, and a 10 lb weight loss over the past 3 mos. A recent course of
abx for a presumed URI did not affect the lymph node's size. His past
medical hx is otherwise unremarkable. Based on these findings, which of
the following is the most appropriate next step for the Family Nurse
Practitioner?
Order a complete blood count (CBC) with differential, C-reactive protein
(CRP), and a monospot test.
Prescribe a second, more broad-spectrum abx and have the pt return if
there is no improvement.
Reassure mother that the lymph node is likely reactive and schedule a
follow-up in 3 mos.
Refer the pt urgently to a pediatric oncologist for further evaluation,
including a lymph node biopsy.
Refer the patient urgently to a pediatric oncologist for further evaluation,
including a lymph node biopsy.
, A 9-year-old child presents to the clinic for a well-child checkup. During
auscultation, the Family Nurse Practitioner (FNP) notes an irregular heart
rhythm that speeds up with inspiration and slows down with expiration.
The child is asymptomatic, and the rest of the physical examination is
unremarkable. An ECG confirms a respiratory sinus arrhythmia. What is
the most appropriate next step in managing this patient?
Reassure the parents that this is a normal, benign finding and requires no
further intervention.
Refer immediately to a pediatric cardiologist for further evaluation and
management.
Initiate the child on a low-dose beta-blocker to regulate the heart
rhythm.
Order a 24-hour Holter monitor to assess the frequency and severity of
the arrhythmia
Reassure the parents that this is a normal, benign finding and requires no
further intervention.
A 7-year-old patient presents to the clinic with a history of a recent
Group A Streptococcus (GAS) pharyngitis infection. The patient now
complains of fatigue, dyspnea on exertion, and mild, migratory joint
pain. On physical examination, the family nurse practitioner (FNP) notes
a new cardiac murmur and a slightly elevated heart rate. The patient is
diagnosed with acute rheumatic fever with carditis. Which of the
following is the most critical component of the management plan to
prevent long-term cardiac damage?
Prescribing a course of high-dose nonsteroidal anti-inflammatory drugs
(NSAIDs) for 1-2 weeks
Initiating a supervised exercise program to improve cardiac function
