AGNP BOARD EXAM QUESTIONS Pediatrics Assessment (127 Questions)

AGNP BOARD EXAM QUESTIONS Pediatrics Assessment (127 Questions) Question: A child sustained a "full-thickness" burn injury. This type injury involves tissue destruction down to the: epidermis. dermis. subcutaneous tissue. Correct internal organs. Explanation: A full-thickness burn involves all skin layers, including the epidermis, dermis, and the subcutaneous tissue and fat. Muscles and tendons may be involved. A superficial thickness burn involves the epidermis only. A superficial partial thickness burn involves the epidermis and the dermis. A deep thickness burn involves the entire layer of dermis, and is more severe than a superficial partial thickness burn. Question: A child was involved in a vehicular accident and sustained burns on the lower extremities. Examination reveals a dry, waxy, whitish appearance of both lower legs and some visualization of the tibialis anterior. This type of burn would be classified as a: superficial thickness burn. superficial partial thickness burn. deep partial thickness burn. full thickness burn. Correct Explanation: Types of burn injuries are chemical, electric, radiation, or thermal and are classified by the depth of damaged skin it caused. Full thickness burns involve the destruction of all skin elements with coagulation of subdermal plexus, muscle, and or tendons. Symptoms of superficial partial thickness burns include: moist areas that are red to ivory white in color, blisters forming almost immediately, and painful to touch. Since the pain receptors are intact, pain is perceived. Superficial thickness burns appear erythematous without blisters and usually have local pain. Deep partial thickness burns have a dry waxy, whitish appearance and resemble full thickness burns. Sometimes grafts are needed. Question: The earliest recognizable clinical manifestation(s) of cystic fibrosis in an infant is: History of poor intestinal absorption Foul smelling, frothy, greasy stools Meconium ileus Salty taste on the skin Correct Explanation: The signs and symptoms of cystic fibrosis (CF) vary from person to person and over time. Sometimes there will be few symptoms and other times, symptoms may become more severe. One of the first signs of CF that parents may notice is that their baby's skin tastes salty when kissed, or the baby doesn't pass stool when first born. Most of the other signs and symptoms of CF happen later. They're related to how CF affects the respiratory, digestive, or reproductive systems of the body. Question: An infant presents with a rash in the diaper area. Which description likely indicates candidal diaper rash? Red, moist, maculopapular patch with poorly defined borders in diaper area Bright red, moist patches with sharply demarcated borders, some loose scales noted in the diaper area Correct Moist, thin-roofed vesicles with a thin, erythematous base noted in the diaper area Erythematous and symmetric rash noted in the diaper area Explanation: Candidiasis is characteristic of a rash appearing with bright red, moist patches with sharply demarcated borders, with some loose scales noted in the diaper area. Red, moist, maculopapular patch with poorly defined borders in diaper area is diaper dermatitis. Moist, thin-roofed vesicles with a thin, erythematous base noted in the diaper area would be consistent with impetigo. Hives appear as erythematous and symmetric and can be generalized over the body including the diaper area. Question: Examination of a child who experienced a burn from a curling iron on the forearm appears red without blistering but is painful to touch. This type of burn would be classified as a: superficial thickness burn. Correct superficial partial thickness burn. deep partial thickness burn. full thickness burn. Explanation: Types of burn injuries are chemical, electric, radiation, or thermal and are classified by the depth of damaged skin. Superficial thickness burns appear erythematous without blisters and usually have local pain. Symptoms of superficial partial thickness burns include: moist areas that are red to ivory white in color, blisters forming almost immediately, and painful to touch. Since the pain receptors are intact, pain is perceived. Deep partial thickness burns have a dry waxy, whitish appearance and resemble full thickness burns. Sometimes grafts are needed. Full thickness burns involve the destruction of all skin elements with coagulation of subdermal plexus, muscle, and or tendons. Question: A small child sustained burns to the posterior trunk and posterior surface of both arms. According to the "Rule of Nines" for small children, what percentage of the total body surface area was involved? 9%. 18%. 27%. Correct 32.5%. Explanation: The "Rule of Nines" assigns percentage of body surface area burned based on the location of the burn. The percentages are as follows: head and neck = 18%, anterior and posterior chest = 18% each, arms (anterior and posterior) = 4.5% each, legs (anterior and posterior) = 6.7% each, and perineum = 1%. For this example, 18% for posterior trunk plus 9% for arms = 27%. Question: If a newborn is suspected of having congenital hypothyroidism, which clinical manifestation would be evident? Prematurity Hyperthermia Hyperactivity Enlarged anterior fontanel Correct Explanation: Infants with congenital hypothyroidism are usually born at term or after term. Most practitioners now depend on the screening test in newborns to diagnose this condition since the symptoms or signs take time to develop. The symptoms of congenital hypothyroidism may include some of the following: puffy face, coarse facial features, enlarged anterior fontanel, thick protruding tongue, poor feeding, constipation or reduced stooling, prolonged jaundice, decreased activity with hypotonia, hypothermia and cool and pale skin, goiter, birth defects (e.g., heart valve abnormality), poor weight gain due to poor appetite, and swollen hands, feet and genitals. Question: A child has a maculopapular, blotchy rash and on examination of his mouth, red eruptions with white centers on the buccal mucosa are visualized. These eruptions are called: rubella spots. aphthous ulcers. Pastia's spots. Koplik spots. Correct Explanation: Koplik spots are seen with measles. They are small, white spots (often on a reddened background) that occur on the inside of the cheeks early in the course of red measles, rubeola. Pastia's spots are pink or red lines that are formed of confluent petechiae found in skin creases and are seen in patients who have scarlet fever. Aphthous ulcers are recurrent small, round, or ovoid ulcers with circumscribed margins, erythematous haloes, and yellow or gray floors occurring in the mouth. Question: When suspecting pediculosis capitis, the chief complaint is: itching. Correct hives. alopecia. vesicles. Explanation: With pediculosis capitis (lice), itching is the most common symptom and is caused by an allergic reaction. Lice will bite the skin in order to feed on the infected person's blood. Saliva from these bites causes the allergic reaction and itching. The lice lay eggs that eventually hatch which causes more irritation. Vesicles, fluid filled lesions, are not usually seen in this condition. Alopecia may be seen with tinea capitis. Question: A reddish blue, irregularly shaped, solid and spongy mass of blood vessels that may be present at birth and enlarge during the first 10 to 15 months is characteristic of a: cavernous hemangioma. Correct strawberry mark. telangiectasia. port-wine stain. Explanation: A cavernous hemangioma appears as a reddish blue, irregularly shaped, solid and spongy mass of blood vessels. It may be present at birth, may enlarge during the first 10 to 15 months, and will not involute spontaneously. A port-wine stain is a large, flat, macular dark red or purplish patch covering the scalp or face, frequently along the distribution of cranial nerve V and intensifies with crying, exertion, or exposure to heat or cold. A strawberry mark is a type of hemangioma that has a raised bright red area with well-defined borders about 2 to 3 cm in diameter. It does not blanch with pressure. Telangiectasia are caused by vascular dilation and are permanently dilated blood vessels that are visible on the skin surface. Question: The infant with the lowest risk of developing elevated levels of bilirubin is the one who: is feeding poorly or whose feedings are delayed for several hours. has developed a cephalhematoma. is the second birth to an Rh negative mother. breast feeds within the first hour of life. Correct Explanation: The infant who is fed early will be less likely to retain meconium and reabsorb bilirubin from the intestines back into the circulation. Additionally, lack of adequate intestinal flora hinders excretion of conjugated bilirubin so by feeding soon after birth, this speeds up the development of bacteria and creation of good intestinal flora. The other choices are all examples of situations that increase the risk for jaundice in the newborn. Question: A seven- year -old is suspected of having conduct disorder. Which one of the following topics should the nurse practitioner include in the assessment history? Stuttering Animal abuse Correct Worrying excessively about mother Refusing to perform chores Explanation: Animal abuse is often seen in children who display conduct disorder behaviors and would be a topic of concern if the child was abusing animals. Stuttering, worrying excessively about mother, and refusing to perform chores fall into other behavioral disorders. Question: With Duchenne muscular dystrophy: boys inherit the condition from their father. the onset of symptoms occurs in late childhood and adolescence. symptoms include tremors, hypertonicity, and seizures. characteristics include a waddling gait, lordosis and presence of Gower's sign. Correct Explanation: Duchenne muscular dystrophy (DMD) is an X-link inherited recessive disorder and is passed from mother to male offspring. DMD is a congenital disorder with symptoms appearing during the 2nd and 3rd year of life. Tremors, hypertonicity and seizures are more consistent with cerebral palsy. Waddling gait, lordosis and Gower's maneuver are signs of DMD. Gower's sign is classic for DMD. The patient has to use his hands and arms to "walk" up his own body from a squatting position due to lack of hip and thigh muscle strength. Question: Which of the following would help a 9-year-old develop a sense of industry? Providing large plastic blocks for him to build things Helping him make a collection of several objects Correct Encouraging running for short distances Explaining the workings of his heart Explanation: The school age child likes to collect things and keep them as memoirs. Large plastic blocks are characteristic of preschoolers and would not accomplish this task. Running short distances is a more appropriate activity for this child. Explaining how the heart works requires more cognitive abilities than a 9-year-old may have. Question: When assessing a 3-year-old African American child, the most likely cause of black, dusky mucous membranes is related to: jaundice. pallor. erythema. cyanosis. Correct Explanation: In dark skinned children, black, dusky mucous membranes are significant for cyanosis. The mucous membranes are the best areas to identify cyanosis in African American children. Erythema is denoted as a dusky red or violet color over the body. The other choices are not characteristic of cyanosis. Question: The first sign of puberty in a male is: increased vertical height. a change in voice. testicular enlargement. Correct facial hair. Explanation: Puberty begins sexual maturity. It is a process that usually occurs between ages 10 and 14 for girls, and ages 12 and 16 for boys. It causes physical changes, and affects boys and girls differently. In boys, puberty usually begins with the testicles and penis getting bigger. Then hair grows in the pubic area and armpits. Question: After attempting to elicit the Moro reflex in a newborn, the nurse practitioner identifies absence of movement of the left arm. The next assessment would be to: perform the Ortolani maneuver. elicit the Babinski reflex. examine the clavicle. Correct check the brachial pulses. Explanation: A positive Moro reflex occurs when both arms are extended. If this response is not elicited bilaterally, the nurse practitioner should assess the clavicle. If the clavicle is fractured, the Moro response will be demonstrated on the unaffected side only. Babinski reflex assesses for neurological abnormalities. Gallant reflex is checked while the infant is prone and assesses for trunk incurvation. Ortolani maneuver assesses for congenital hip dysplasia. Question: A 6-month-old presents today for a well child visit. He is sitting in his mother's lap. Assessment should begin with: eliciting reflexes. palpating the liver and spleen sizes. auscultating the heart and lungs. Correct examining the head and eyes. Explanation: When assessing a quiet infant, auscultate the heart and lungs first. The other parts of the exam may cause the infant to cry making auscultation of heart and breath sounds difficult to hear. Question: In which of the following situations would a one-year-old child be at risk for lead poisoning? Ceiling tiles have just been replaced in the child's home. Refinishing of all painted woodwork has occurred recently in the child's home. Correct The family moved into a twenty-year- old brick house. The family moved from a trailer home to a new apartment complex. Explanation: Painted woodwork may contain lead, especially in older homes and during refinishing, the paint would have to be scraped off, placing it in easy reach of a one year-old. Ceiling tiles are not a source of lead or lead paint. Any house built after 1978 is considered "lead free" because at that time paint no longer contained lead. Mobile homes generally do not contain lead. Question: During the newborn’s physical assessment of the mouth, the soft and hard palates are palpated to detect: a tight frenulum. an opening in the palates. Correct thrush. the presence of a tracheoesophageal fistula. Explanation: The presence of a cleft palate, or an opening in the hard or soft palates, would need immediate interventions as the child could aspirate with the first feeding. Thrush can be detected by observation and appears as white patches in the mouth. A tight or shortened frenulum would be denoted by observation. A tracheoesophageal fistula is associated with choking, increased salivation, coughing, cyanosis and vomiting when feeding. This is a medical emergency. Question: An eight-year-old complains of itching in the right ear and an increase in pain when the pinna is pulled or the tragus is palpated. Examination reveals slight redness in the ear canal with a clear odorless fluid. This could be suggestive of: otitis media. otitis externa. Correct mastoiditis. a tympanic membrane rupture. Explanation: Otitis externa, swimmer's ear, is an infection or inflammation of the external ear or the ear canal. Symptoms include itching and tragal pain. The external canal may have a discharge. Otitis media is a middle ear infection and usually the tympanic membrane is bulging with fluid or pus behind it. Mastoiditis is an infection of the mastoid process (temporal bone adjacent to the middle ear). A ruptured tympanic membrane is usually secondary to infection that causes pus and fluid to build up behind the eardrum and as the pressure increases, the eardrum may rupture. Ear pain decreases when the membrane ruptures and the discharge can be pus, blood, or a clear fluid. Question: An otherwise healthy two-year-old presents with a heart rate that varies with inspiration and expiration. Which statement is true? The child has ingested too much caffeine. A cardiology referral is prudent. This is a normal exam. Correct There is a need for an echocardiogram. Explanation: Sinus arrhythmia occurs when an irregular heart rate increases with inspiration and decreases with respiration and is considered normal in children. There is no need for an echo or referral to a cardiologist nor should the child be evaluated for caffeine intake. Question: The nurse practitioner differentiates physiologic jaundice from pathologic jaundice by assessment of the: degree of jaundice of the skin. timing of the onset of the jaundice. Correct maternal history of drugs/medications. level of bilirubin in the blood. Explanation: Physiologic jaundice is identified after 24 hours. Pathologic jaundice is identified before the infant is 24 hours of age. The fetus produces more red blood cells (RBCs) than the normal adult or child has, with a hematocrit of up to 60% being normal. At birth, structural and functional changes take place which enable the fetus to breathe room air, bringing the baby's paO2 up to the normal child-adult range. Thus, the excess RBCs are no longer needed for O2 carrying capacity, and they begin to break down. This is a normal, physiologic change that occurs at birth. The breakdown of these RBCs releases bilirubin into the blood stream. So, a rise in bilirubin within 24-48 hours of life is normal. If something causes an excessive number of RBCs to break down (such as ABO or Rh incompatibility, birth trauma or infection) or impairs the baby's ability to excrete bilirubin out of the GI tract (NPO status, delayed stooling, meconium ileus), the bilirubin level can rise to dangerous levels, requiring treatment to prevent buildup in the brain, (kernicterus) which can cause brain damage and death. The other choices are not specific to either type. Question: A six-year-old child presents with sore throat, difficulty swallowing, and a temperature of 102 °F. Findings reveal lymphadenopathy and pharyngeal erythema. This is probably: sinusitis. exudative tonsillitis. pharyngitis. Correct the flu. Explanation: Pharyngitis is caused by swelling between the tonsils and the larynx secondary to either viral or bacterial infections. The most common bacterial pharyngeal infections in children are caused by group A beta-hemolytic strep. A patient with sinusitis is more likely to present with nasal congestion, nasal discharge, headache, and an absence of fever. Exudative tonsillitis presents with tonsillar exudate. There is no mention of this in the question stem. Influenza infection typically presents with these symptoms and cough, headache, and body aches. Question: When a child presents with a history of a head injury sustained within the past four hours, a subdural hematoma should be expected because: the X-ray reveals bleeding between the dura and the skull. the child is answering questions appropriately. the X-ray reveals bleeding between the dura and the cerebrum. Correct retinal hemorrhages are absent. Explanation: Classic symptoms of subdural hemorrhages include: bleeding between the dura and the cerebrum, retinal hemorrhages, confusion, drowsiness, headaches, and possible seizures. Because this is a slow bleed, symptoms may develop slowly. Bleeding between the dura and the skull are consistent with the epidural bleeds. Question: Symptoms of acrocyanosis in the newborn include: bluish color of the tongue. bluish color of the mucous membranes. bluish color of the feet. Correct bluish color of the abdomen. Explanation: Shortly after birth, cyanosis of the hands, feet, and perioral area are common findings and typically resolve in 24 - 48 hours. A blue color around the lips and philtrum is a relatively common finding shortly after birth. The skin in the infant is usually well perfused, and the tongue and mucous membranes in the mouth are pink, a finding that assures that central cyanosis is not present. Question: A 9 year old girl had a history of tuberculosis when she was 6 years old. She presents with recent weight loss and anorexia. Along with her presenting symptoms, which one of the following assessment findings would be most indicative of Addison's disease? Thin, fragile skin and multiple bruises Hyperpigmentation and low blood pressure Correct Blurred vision, headaches and enuresis Constipation Explanation: The symptoms of Addison's disease can include any or all of the following: loss of appetite and weight loss, nausea, vomiting or diarrhea, muscle weakness, low blood pressure, salt cravings, dehydration and hypoglycemia, increased pigmentation of the skin, particularly around scars and bony areas, and irregular or no menstrual periods in women. Tuberculosis (TB), an infection that can destroy the adrenal glands, accounts for less than 20 percent of cases of Addison's disease in developed countries. When adrenal insufficiency was first identified by Dr. Thomas Addison in 1849, TB was the most common cause of the disease. As TB treatment improved, the incidence of adrenal insufficiency due to TB of the adrenal glands greatly decreased. Question: A child received a burn to the chest from a cup of hot coffee. On examination, the injured area appears moist and red to ivory white in color, blisters are noted, and painful to touch. This burn would be classified as a: superficial thickness burn. superficial partial thickness burn. Correct deep partial thickness burn. full thickness burn. Explanation: Types of burn injuries are chemical, electric, radiation, or thermal and are classified by the depth of damaged skin. Symptoms of superficial partial thickness burns include: moist areas that are red to ivory white in color, blisters forming almost immediately, and painful to touch. Since the pain receptors are intact, pain is perceived. Superficial thickness burns appear erythematous without blisters and usually have local pain. Deep partial thickness burns have a dry waxy, whitish appearance and resemble full thickness burns. Sometimes grafts are needed. Full thickness burns involve the destruction of all skin elements with coagulation of subdermal plexus, muscle, and or tendons. Question: When assessing a normal 5-year-old, the last site to assess would be the: heart. lungs. throat. Correct abdomen. Explanation: The throat and mouth are considered invasive sites and should be performed last. Question: Which developmental area is predominantly affected by lead poisoning? Nutrition Communication Cognition Correct Mobility Explanation: Lead is a naturally-occurring element that can be harmful to humans when ingested or inhaled, particularly to children under the age of 6 years. Lead poisoning can cause a number of adverse human health effects, but is particularly detrimental to the neurological development of children. Question: A teenage complains of itching and burning of his eye. Examination reveals an erythematous eyelid margin with crusting and a clear mucus discharge. These findings are consistent with: conjunctivitis. a chalazion. a corneal ulcer. blepharitis. Correct Explanation: Blepharitis is an inflammation of eyelid margin, glands, and lash follicles. It presents with red-rimmed eyes, irritation, burning, itching of the eyelid margins, and a mucous discharge with crusting and scaling of lid margins. Conjunctivitis is inflammation of the conjunctiva. It presents with erythematous conjunctiva and frequent discharge A chalazion is a granulomatous eyelid cyst or nodule. A corneal ulcer of a local necrosis of the cornea caused by infection, trauma, or misuse of contact lens. Neither of these present with the symptoms described above. Question: Which one of the following would be an abnormal finding in a 6-month-old? Presence of a positive Babinski reflex Extrusion reflex occurs when feeding Correct Able to voluntarily grasp objects Rolls from abdomen to back at will Explanation: Extrusion reflex disappears around 4 months and would be considered abnormal in a 6- month-old. The other choices are signs of normal growth and development in a 6- month-old infant. Question: Symptoms indicative of Shaken Baby Syndrome are related to: poor nutrition and lack of parental bonding. vaso-occlusive crisis and cerebral infarction. uncontrollable cerebral edema and hypoxia. Correct microcephaly and premature closures of the cranial sutures. Explanation: Brain damage resulting from shaking of the body and rapid flexing and extension of the head results in hypoxia and cerebral edema leading to symptoms of blindness, inability to perform previously learned milestones, and very flaccid muscle tone. The other choices are not the culprits of this type injury/abuse. It is caused by someone shaking the child and causing irreversible brain damage in most cases. Question: When assessing a 3-month-old for developmental dysplasia of the hips (DDH), which one of the following symptoms would be suspicious of dysplasia? Limitation of adduction of the affected extremity, shortening of the femur and negative Ortolani's sign Limitation of abduction of the affected extremity, shortening of the femur and positive Ortolani's sign Correct Limitation of adduction of the affected extremity, Trendelenburg's sign and symmetry of gluteal folds Limitation of abduction of the affected extremity, asymmetry of gluteal folds, and lengthening of the femur on the affected side Explanation: Developmental dysplasia of the hips (DDH) presents with limitation of abduction, shortening of the extremity, as the head of the femur does not fit into the acetabulum