HESI EXIT Family Nurse Practitioner FINAL EXAMS.

1. The following sequence is recommended for well-child examinations up to the age of 5 years: 1. 2 weeks, 2 months, 4 months, 6 months, 1 year, 15 months, 18 months, and every year from ages 2-5. 2. 2 months, 4 months, 6 months, 9 months, and annually from years 1- 5. 3. 2 weeks, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, and annually years 2-5. 4. The same intervals recommended for immunizations. 3. 2 weeks, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, and annually years 2-5. Rationale: These are the recommended health evaluation intervals for children to obtain regular assessment information regarding growth and development and to administer recommended immunizations. 2. An appropriate treatment for overweight children under 8 years of age would be to: 1. Administer an appetite suppressant. 2. Eliminate all carbohydrates in the diet. 3. Plan a program of activity, balanced diet, and exercise. 4. Use vitamin therapy and herbal teas. 3. Plan a program of activity, balanced diet, and exercise. Rationale: An approach with a well-balanced diet, activity, and exercise is necessary for weight reduction. This allows for a slow approach to weight loss that incorporates healthy behavior habits. 3. The family nurse practitioner examines a 2-week-old newborn during a first clinic visit. The family nurse practitioner notes dysmorphic facial features. The family nurse practitioner's evaluation includes: 1. Ordering a chromosome analysis. 2. Completing a postnatal history. 3. Writing a detailed physical exam and perinatal history. 4. Avoiding discussion with parents until diagnostic studies are completed 3. Writing a detailed physical exam and perinatal history. Rationale: The first and most important part of all data gathering starts with a detailed history and physical exam. A detailed, objective description of the dysmorphic features is essential for comparison to textbook descriptions and other data. Although chromosome analysis will probably be ordered, it is not done initially. Parents should be included in the discussion of the findings and kept informed of the progress throughout the evaluation process. 4. An 18-month-old's feet turn inward. The mother is concerned, although the child is unaware of the problem. The differential diagnosis includes all except: 1. Femoral anteversion. 2. Metatarsus adductus. 3. Legg-Calvé-Perthes disease. 4. Adducted great toe. 3. Legg-Calvé-Perthes disease. Rationale: In-toeing is a common problem in children and can result from femoral anteversion, adduction of the great toe, medial tibial torsion, and metatarsus adductus. Legg-Calvé-Perthes disease is commonly seen in older children (ages 4 to 8 years) who have loss of hip medial rotation. 5. The characteristics of an innocent heart murmur in children include: 1. Asymptomatic, loud diastolic rumble, grades I to V. 2. Mid-systolic, no thrill, and asymptomatic. 3. Asymptomatic with an S4 heard at lower left sternal border. 4. May disappear on sitting and following any type of physical activity. 2. Mid-systolic, no thrill, and asymptomatic. Rationale: Characteristics of innocent murmurs include mid-systolic; asymptomatic; less than a grade III; loudest in pulmonic area (2–3 left intercostal space at the left sternal border); no radiation to other areas; may disappear on sitting; and may intensify with fever, activity, anemia, and stress. Any S4 sound is considered pathologic in children as well as in adults. 6. The family nurse practitioner is examining a 6-month-old infant. What would be the anticipated findings on examining the infant's fontanels? 1. Both anterior and posterior should be open. 2. The anterior should be open, the posterior closed. 3. Both anterior and posterior should be closed. 4. The anterior should be closed, the posterior open. 2. The anterior should be open, the posterior closed. Rationale: The posterior fontanel is usually closed by 2 months of age; the anterior fontanel closes at about 24 months of age. 7. Genu varum up to 20 degrees is normal until age: 1. 18 years. 2. 5 years. 3. 18 months. 4. 6 months. 3. 18 months. Rationale: Genu varum (bowleg) of up to 20 degrees is a normal finding in children until the age of 18 months. 8. When approaching a toddler to complete a cardiac assessment, the family nurse practitioner would: 1. Allow the toddler to handle the stethoscope while the history is being taken. 2. Explain in detail what procedures will take place and get the toddler involved. 3. Keep the child warm and covered to minimize discomfort. 4. Approach the child by cheerfully calling out his name. 1. Allow the toddler to handle the stethoscope while the history is being taken. Rationale: Toddlers like to make the first move (i.e., let them move closer and initiate eye contact first; do not call out their name because this might frighten them). Allowing them to handle the stethoscope will decrease their fear. Detailed explanations and involvement are more appropriate when assessing a school-age child. 9. In performing a physical exam, the family nurse practitioner allows the child to touch the medical equipment first, and then begins by examining the extremities. This sequence would be most appropriate for a patient in what age group? 1. Infant. 2. Toddler. 3. School-age child. 4. Adolescent. 2. Toddler. Rationale: Allow a toddler to explore the instruments and start with the extremities. Save the most invasive exam (of the head) for last. In infants, auscultate the heart and lungs while the infant is quiet, then proceed to do a head-to-toe assessment. In school-age and adolescent children, a head-to-toe sequence is preferred. 10. An appropriate test to check for color perception in a preschooler would be: 1. Ishihara's test. 2. Bruchner's test. 3. Hirschberg's test. 4. Jaeger's test. 1. Ishihara’s test. Rationale: Ishihara’s test checks for color perception; Bruchner’s test checks for the red reflex; Hirschberg’s test checks for corneal light reflex; and Jaeger’s test checks for near vision.