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NSG 6435 Midterm Exam Latest Version 2019 South University

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NSG 6435 Midterm Exam Latest Version 2019 South University NSG6435 Week 5 Assignment 4 Midterm Exam / NSG 6435 Week 5 Midterm Exam -Family Health - Pediatrics- South University Question1. The incidence of congenital heart defects is estimated to be ________ of all live births. 20% 10% 5% 1% Question2. 2 Breastmilk can be safely stored in a freezer below 0 degrees Fahrenheit for how long? Three months Six months One year Two years Question3. 3 Which foreign body needs immediate removal from a five-year-old boy’s nose? Bean Bead Stone Battery Question4. 4 The most useful diagnostic test in delayed puberty is _____________________. complete thyroid panel X-Ray of the left wrist and hand X-Ray of the right wrist and hand X-Ray of the spinal column Question5. 5 An average vision of a two-year-old child is approximately: 20/150 20/400 20/70 20/30 Question6. 6 A five-year-old female presents for a follow-up emergency room visit with a diagnosis of bronchitis. You would expect which treatment to have been prescribed? Oral steroids Azithromycin Increase rest and fluid Albuterol Question7. 7 An adolescent with a chronic asthma cough notes that symptoms are usually worse _____________. only with exertion only during the daytime only at night at night and with exertion Question8. 8 An average adolescent female usually experiences her biggest growth spurt at approximately what age? Ten and half years Eleven and half years Twelve and half years Thirteen and half years9. Question 9 If an adolescent has a bone age of 10 but is actually 13 years of age, this patient has ______. an increased risk of fracture in the next three years an increased risk of osteoporosis as an adult a higher potential for bone growth a lower potential for bone growth Question10. 10 Gardasil results in greater antibody responses for females who are administered the three-dose series between what ages? Six to twenty-six years of age Prior to eleven years of age Nine to fifteen years of age Nine to twenty-six years of age Question11. 11 An eight-year old has chronic intermittent nasal congestion. All but which of the following would support allergic rhinitis? Red swollen turbinates Darkened areas below eyes Increased basophils on complete blood count (CB Itchy, watery eyes Question12. 12 A fifteen-month old failed treatment with amoxicillin for an otitis media. At his two-week recheck, his tympanic membrane remained red with distorted landmarks and he persisted with nasal discharge that is thick and yellowish. The best action for the nursing practitioner should be to prescribe: A ten-day-course of augmentin A three-week-course of a cephalexin A higher dose amoxicillin Ceftriaxone and an antihistamine Question13. 13 An infant should be able to say his or her first word by: four to five months eight to nine months twelve to fifteen months twenty four to twenty six months Question14 The latter part of adolescence includes the ability to develop ________ and _______ means to be a part of society. strong attachments; sexuality career; marriage critical thinking; basic life skills moral; intellectual means Question15 A fourteen-year-old adolescent presents with fatigue, endocarditis, pulmonary hypertension, arrhythmias, and congestive heart failure. You suspect he may have ____________. ASD pulmonary valve stenosis aortic valve stenosis a ventricular septal defect (VSD) Question16 A four-year-old male patient presents with his mother with a school referral regarding red eyes. Which questions would not assist in establishing a list of differential diagnoses? Unilateral vs. bilateral presentation Type of drainage Vision status History of a bacterial infection one month ago Question17 ______________ adolescents should be screened for sexually transmitted diseases. Males Females All Sexually active Question18 An infant should no longer have a head lag when pulled from the supine to sitting position at what age? Two months Four months Six months Nine months Question19 ____________ should be given as a supplement in the management of delayed puberty. Vitamins B1 and B12 Vitamins D and E Vitamin A and Calcium Calcium and Vitamin D Question20 Parents or guardians of adolescents should ___________________. not be included in the adolescent's health care receive health guidance information at least twice during adolescence encourage reasonable use of alcohol and tobacco by the adolescent encourage early sexual activity by providing condoms to the adolescent Question21 How does cultural sensitivity impact the care of infants in the primary care setting? Health-care providers may possess cultural biases that can impact care. Cultural sensitivities do not exist in health care. Cultural sensitivity only impacts the parents of infants. Cultural sensitivity increases access to timely health-care services for infants. Question22 The most typical chest radiographic finding consistent with the diagnosis of asthma is ______________. normal chest film diffuse airway edema right upper-lobe infiltrate hyperinflation Question23 A 10 yo has a single painful ulcerated lesion on an erythematous base on the inner buccal mucosa. The most likely diagnosis and treatment would be: herpes simplex stomatitis--oral acyclovir herpangina--viscous xylocaine apthous ulcer--triamcinalone in orabase Hand, foot, mouth syndrome--antibiotic mouthwash Question24 A 9 month old is noted to have a bifid uvula. This would increase his risk of developing which disorder? otitis media retropharyngeal abscess sinusitis dental malocclusion Question25 All of the following may predispose a patient to thrush except: age steroid therapy antibiotics poor oral hygiene Question26 Patients with sinusitis should be instructed not to participate in what activity? swimming/ diving boxing/ wrestling weight lifting cross country running Question27 What complication of sinusitis are adolescent males more prone to? intracranial abscess potts puffy tumor orbital cellulitis dental infection Question28 Acceptable management options for allergic rhinitis include all of the following except: oral cetirizine oral montelukast nasal beclomethsone nasal neosynephrine Question29 A 7 yo has experienced recurrent nose bleeds in the past 2 months. What finding on the physical exam would suggest an underlying medical cause for the epistaxis? wheezing grade II murmur petechiae tonsil hypertrophy Question30 A 2 yo male with a history of chronic serous OM is noted to have a pearly white opacity in the upper outer quadrant of his TM. He currently has no symptoms and appears to be ok. The most likely diagnosis and appropriate managment would be: tympanosclerosis; no treatment is necessary persistent perforation; prescribe topical antibiotic drops foreign body; perform an ear wash for removal cholesteatoma; refer to otolaryngology Question31 A 15 mo failed treatment with amoxicillin for OM. At his 2 week re-check his TM remained red with distorted landmarks and he persisted with nasal congestion, poor sleep, and fever. The next best step would be to treat with: a 10 day course of augmentin a 3 week course of cephalosporin a higher dose of amoxicillin and topical abx ceftriaxone and an antihistamine Question32 All but which one of the following patients are at an increased risk of developing otitis media? 2 yo with cleft palate repair at 1 year of age 15 mo with down syndrome 9 mo with lactose intolerance 3 yo with IgA immune deficiency Question33 Patients with otitis externa should be instructed to do which one of the following: keep ear dry until symptoms improve limit swimming for the remainder of summer wear ear plugs at all times with swimming use alcohol drops before swimming each day Question34 A 10 yo has marked ear pain, not wanting anyone to touch his ear. The canal is edematous and exudate is present. TM is normal. How should this be managed? topical fluoroquinolone oral steroids and topical neomycin oral amoxicillin and topical anesthetic oral amoxicillin and topical steroid Question35 A 16 yo was hit in the eye 1 day ago and now has ecchymoses on the upper and lower lids with 5/10 eye pain. All but which of the following would be appropriate to obtain at this time: visual acuity intraocular pressure CT scan fluorescein stain Question36 The greatest risk in a patient with a hyphema is which of the following? glaucoma infection rebleed cataracts Question37 Corneal abrasions can be managed with topical application of which of the following: anesthetic for pain control steroids to prevent adhesions antibiotics to prevent infection atropine to prevent ciliary spasm Question38 Trauma to the eye increases the risk of developing all but which one of the following? strabismus glaucoma cataracts hyphema Question39 Fluorescein staining of the eye is used to detect a: keratitis foreign body corneal abrasion hyphema Question40 Prematurity increases the risk of developing which one of the following? nystagmus astigmatism myopia glaucoma Question41 A 3 month old has a mild asymmetrical corneal light reflex on physical exam. What is the next appropriate step? observe and reevaluate at the next well check refer immediately to ophthalmology begin atropine drops or eye patching protect eyes from sunlight Question42 Which of the following may cause microcephaly? Hypocalcemia Craniosynostosis Skull fracture Seizure disorder Question43 What finding may accompany macrocephaly? Pulsating anterior fontanel Sunken fontanel Premature closure of suture lines Widened suture lines Question44 Obtaining a CT of the head would be indicated in which of these conditions? Macrocephaly Cephalohematoma Craniosynostosis Caput succedaneum Question45 Which one of the following conditions increases the risk of developing hydrocephalus? Bilateral cephalohematomas Craniosynostosis Prematurity Familial macrocephaly Question46 A conjunctivitis appearing in a 2 day old newborn is likely due to: chemical irritation from eye drops group B streptocuccus chlamydia gonorrhea Question47 Confirming the diagnosis of chlamydia conjunctivitis in a newborn would best be done by obtaining which one of the following? cervical swab of the mother urine PCR from the mother culture of the eye discharge culture of the conjunctival scrapings Question48 Which one of the following eye findings would be considered an ophthalmic emergency? unilateral vesicular lesions on the upper eyelid of a 3 week old presence of chemosis in a 5 yo with bilateral upper eyelid edema cobblestone-like appearance along the inner aspect of the upper eyelid in a 15 yo bilateral redness along the eyelid margins with tiny ulcerated areas in a 16 yo Question49 The most appropriate management of a 5 yo with a firm, nontender nodule in the mid-upper eyelid for 3 weeks would be: cool compresses topical ophthalmic ointment oral antibiotics oral steroids Question50 Daily eyelid cleansing with diluted baby shampoo and a cotton tipped applicator would be appropriate in the treatment of which one of the following conditions? Dacryostenosis Chalzion Hordeolum Blepharitis Question51 A 3 year old has an edematous, mildly erythematous right upper eyelid for one day with a fever of 103. An important eye assessment would be: ocular mobility conjunctival inflammation pupillary reaction optic disk papilledema Question52 Concurrent otitis media and conjunctivitis is likely due to which organism? streptococcus pneumoniae haemophilus influenza moraxella catarrhalis staphylococcus aureus Question53 A 16 yo girl makes the following statements to you during her health visit. Which of the following pieces of information should not be kept confidential? I have been sexually active with three of my boyfriends I sometimes smoke marijuana I want to get pregnant Sometimes I feel like ending my life Question54 In performing a physical examination on a nine month old infant, which of the following developmental fears would not be appropriate for you to consider? Stranger anxiety Pain Separation from parents Bodily harm Question55 When performing a physical examination on a toddler, which of the following body parts would you examine last: Heart and lungs abdomen and genitals Ears and throat Hips and extremities Question56 Role play with equipment during the course of a physical examination would be most beneficial with which of the following age groups: Toddlers Preschoolers Young school-age children Older school-age children Question57 Providing reassurance of "normalcy" during the course of an examination would be most important for: Preschool children Young school-age children Older school-age children Adolescents Question58 Which of the following would not elevate the pulse of a child: Fever Anemia Hypothyroidism Exercise Question59 The PNP recognizes which of the following signs as indicators that baby is not receiving sufficient breastmilk? Sleepiness, jaundice, decreased urine and stool Diarrhea, nausea, and vomiting Bulging fontanel and irritability Sleeplessness and excitability Question60 Blood pressure should be measured at WCC beginning at age: 2 3 4 5 Question61 A wide pulse pressure that results from a high systolic blood pressure is usually not due to which of the following: Fever Exercise Excitement A patent ductus arteriosus Question62 Head and chest circumferences should be equal at: 6 months 1 year 2 years 3 years Question63 The anterior fontanel usually closes by: 2 months 6 months 18 months 24 months Question64 Diffuse edema of the soft tissue of the scalp which usually crosses suture lines in the newborn is: Bossing Caput seccedaneum Cephalohematoma Macrocephaly Question65 An infant should no longer have head lag when pulled from the supine to sitting position at what age? 2 months 4 months 6 months 9 months Question66 "Boggy" nasal mucous membranes with serous drainage upon examination usually suggests: Sinusitis Polyps URI Allergic rhinitis Question67 A white instead of red reflex upon eye examination of a 1 yo child would suggest: An accommodative error Retinoblastoma Papilledema Retinal detachment Question68 A cobblestone appearance of the palpebral conjunctiva usually indicates: Bacterial infection Chemical irritation Viral infection Severe allergy Question69 An eye that deviates in when covered but returns to midline when uncovered is an: Esophoria Exophoria Esotropia Exotropia Question70 Pain produced by manipulation of the auricle or pressure on the tragus suggests: Acute otitis media Otitis externa Otitis media with effusion Mastoiditis Question71 A hypernasal voice and snoring in a child is suggestive of: Polyps of the larynx Nasopharyngeal tumor Hypertrophied adenoids Cleft palate Question72 Physiological splitting of the second heart sound during inspiration in a child: is normal should be evaluated with an EKG Suggests ASD Should be referred to a cardiologist Question73 Which of the following is not characteristic of innocent heart murmurs in children? Systolic in timing Varies in loudness with positioning Usually transmitted to the neck Usually loudest at lower left sternal border or at second or third intercostal space Question74 A grade II musical or vibratory murmur heard best at the lower left sternal border that changes with positioning is suggestive of a: Pulmonary ejection murmur Ventricular septal defect Venous hum Vibratory or Still's murmur Question75 Wheezing in a child may not be found in which of the following conditions: Asthma Bronchiolitis Pleural friction rub Cystic fibrosis Question76 Gynecomastia in a male may not be a finding in which of the following: Normal pubertal development Steroid usage Hyperthyroidism Testicular tumor Question77 Which of the following would usually not be considered a sign of a pituitary tumor in an adolescent female? Dysfunctional uterine bleeding Galactorrhea Loss of peripheral vision Increase in headaches Question78 Which of the following is not a specific examination test for a dislocated hip? Barlow's test Ortolani's test Trendelenburg test Gower's test Question79 In addition to the knee, which of the following should be examined in a child complaining of knee pain? Foot Ankle Hip Spine Question80 Which of the following infant reflexes should not disappear by 6 months of age? Moro rooting tonic neck plantar grasp Question81 Spasticity in an infant may be an early sign of: Neurofibromatosis Hydrocephalus Cerebral palsy Muscular dystrophy Question82 A shift to the left is present when which of the following are elevated? Neutrophils Bands or stabs Lymphocytes Eosinophils Question83 Which of the following is usually elevated with viral infections? Neutrophils Eosinophils Lymphocytes Basophils Question84 Decreased platelets may not be found in which of the following: Leukemia Anemia Idiopathic thrombocytopenic purpura Medication usage (e.g. ampicillin, cephalothin) Question85 Which of the following does not suggest a urinary tract infection? Increased protein Increased WBCs Increased RBCs Increased nitrites NSG6435 Week 5 Assignment 4 Midterm Exam / NSG 6435 Week 5 Midterm Exam -Family Health - Pediatrics- South University QuestionA 16 year old girl makes the following statements to you during her health visit. Which of the following pieces of information should not be kept confidential?
a) I have been sexually active with three of my boyfriends
b) I sometimes smoke marijuana
c) I want to get pregnant
d) Sometimes I feel like ending my lifed) Sometimes I feel like ending my life2In performing a physical examination on a nine month old infant, which of the following developmental fears would not be appropriate for you to consider? 
a) Stranger anxiety
b) Pain
c) Separation from parents
d) Bodily harmd) Bodily harm3When performing a physical examination on a toddler, which of the following body parts would you examine last: 
a) Heart and lungs
b) abdomen and genitals
c) Ears and throat
d) Hips and extremitiesc) Ears and throat4Role play with equipment during the course of a physical examination would be most beneficial with which of the following age groups: 
a) Toddlers
b) Preschoolers
c) Young school-age children
d) Older school-age childrenb) Preschoolers5Providing reassurance of "normalcy" during the course of an examination would be most important for: 
a) Preschool children
b) Young school-age children
c) Older school-age children
d) Adolescentsd) Adolescents6Which of the following would not elevate the pulse of a child: 
a) Fever
b) Anemia
c) Hypothyroidism
d) Exercisec) Hypothyroidism7The PNP recognizes which of the following signs as indicators that baby is not receiving sufficient breastmilk?
a) Sleepiness, jaundice, decreased urine and stool
b) Diarrhea, nausea, and vomiting
c) Bulging fontanel and irritability
d) Sleeplessness and excitabilitya) Sleepiness, jaundice, decreased urine and stool8Blood pressure should be measured at WCC beginning at age: 
a) 2
b) 3
c) 4
d) 5b) 39A wide pulse pressure that results from a high systolic blood pressure is usually not due to which of the following: 
a) Fever
b) Exercise
c) Excitement
d) A patent ductus arteriosusd) A patent ductus arteriosus10Head and chest circumferences should be equal at: 
a) 6 months
b) 1 year
c) 2 years
d) 3 yearsb) 1 year11The anterior fontanel usually closes by: 
a) 2 months
b) 6 months
c) 18 months
d) 24 monthsc) 18 months12Diffuse edema of the soft tissue of the scalp which usually crosses suture lines in the newborn is: 
a) Bossing
b) Caput seccedaneum
c) Cephalohematoma
d) Macrocephalyb) Caput seccedaneum13An infant should no longer have head lag when pulled from the supine to sitting position at what age? 
a) 2 months
b) 4 months
c) 6 months
d) 9 monthsc) 6 months14"Boggy" nasal mucous membranes with serous drainage upon examination usually suggests: 
a) Sinusitis
b) Polyps
c) URI
d) Allergic rhinitisd) Allergic rhinitis15A white instead of red reflex upon eye examination of a 1 yo child would suggest: 
a) An accommodative error
b) Retinoblastoma
c) Papilledema
d) Retinal detachmentb) Retinoblastoma16A cobblestone appearance of the palpebral conjunctiva usually indicates: 
a) Bacterial infection
b) Chemical irritation
c) Viral infection
d) Severe allergyd) Severe allergy17An eye that deviates in when covered but returns to midline when uncovered is an: 
a) Esophoria
b) Exophoria
c) Esotropia
d) Exotropiaa) Esophoria18Pain produced by manipulation of the auricle or pressure on the tragus suggests: 
a) Acute otitis media
b) Otitis externa
c) Otitis media with effusion
d) Mastoiditisb) Otitis externa19A hypernasal voice and snoring in a child is suggestive of: 
a) Polyps of the larynx
b) Nasopharyngeal tumor
c) Hypertrophied adenoids
d) Cleft palatec) Hypertrophied adenoids20Physiological splitting of the second heart sound during inspiration in a child: 
a) is normal
b) should be evaluated with an EKG
c) Suggests ASD
d) Should be referred to a cardiologista) is normal21Which of the following is not characteristic of innocent heart murmurs in children?
a) Systolic in timing
b) Varies in loudness with positioning
c) Usually transmitted to the neck
d) Usually loudest at lower left sternal border or at second or third intercostal spacec) Usually transmitted to the neck22A grade II musical or vibratory murmur heard best at the lower left sternal border that changes with positioning is suggestive of a: 
a) Pulmonary ejection murmur
b) Ventricular septal defect
c) Venous hum
d) Vibratory or Still's murmurd) Vibratory or Still's murmur23Wheezing in a child may not be found in which of the following conditions: 
a) Asthma
b) Bronchiolitis
c) Pleural friction rub
d) Cystic fibrosisc) Pleural friction rub24Gynecomastia in a male may not be a finding in which of the following: 
a) Normal pubertal development
b) Steroid usage
c) Hyperthyroidism
d) Testicular tumorc) Hyperthyroidism25Which of the following would usually not be considered a sign of a pituitary tumor in an adolescent female? 
a) Dysfunctional uterine bleeding
b) Galactorrhea
c) Loss of peripheral vision
d) Increase in headachesa) Dysfunctional uterine bleeding26Which of the following is not a specific examination test for a dislocated hip?
a) Barlow's test
b) Ortolani's test
c) Trendelenburg test
d) Gower's testd) Gower's test27In addition to the knee, which of the following should be examined in a child complaining of knee pain? 
a) Foot
b) Ankle
c) Hip
d) Spinec) Hip28Which of the following infant reflexes should not disappear by 6 months of age? 
a) Moro
b) rooting
c) tonic neck
d) plantar graspd) plantar grasp29Spasticity in an infant may be an early sign of: 
a) Neurofibromatosis
b) Hydrocephalus
c) Cerebral palsy
d) Muscular dystrophyc) Cerebral palsy30A shift to the left is present when which of the following are elevated? 
a) Neutrophils
b) Bands or stabs
c) Lymphocytes
d) Eosinophilsb) Bands or stabs31Which of the following is usually elevated with viral infections? 
a) Neutrophils
b) Eosinophils
c) Lymphocytes
d) Basophilsc) Lymphocytes32Decreased platelets may not be found in which of the following:
a) Leukemia
b) Anemia
c) Idiopathic thrombocytopenic purpura
d) Medication usage (e.g. ampicillin, cephalothin)b) Anemia33Which of the following does not suggest a urinary tract infection? 
a) Increased protein
b) Increased WBCs
c) Increased RBCs
d) Increased nitritesa) Increased protein34A Mantoux test in a child with no risk factors is considered positive with a reaction of: 
a) At least 5 mm induration
b) At least 8 mm induration
c) At least 10 mm induration
d) At least 15 mm indurationjavascript:void(0)d) At least 15 mm induration35The PNP teaches new parents that when breast feeding is well established they can expect baby to have: 
a) as many as 4 wet diapers each day
b) a stool every 2-3 days
c) 1 wet diaper an hour
d) 5-6 wet diapers and 2-3 stools each dayjavascript:void(0)d) 5-6 wet diapers and 2-3 stools each day36Cholesterol screening should be done: 
a) Children 2 years of age and older who have a parent with a total cholesterol level of 240 or greater
b) Once for all children at 6 years of age
c) Overweight children with a family history of premature cardiovascular disease
d) Once for all children at 12 years of agejavascript:void(0)a) Children 2 years of age and older who have a parent with a total cholesterol level of 240 or greater37For which of the following screening tests should children fast for 12 hours before the test is done?
a) Total cholesterol
b) Serum chemistry profile
c) Serum lipid profile
d) Hematocritjavascript:void(0)c) Serum lipid profile38Which of the following is the most important history-taking question for a sports evaluation? 
a) Has the child ever had a head injury? 
b) Has the child ever fainted or lost consciousness during exercise? 
c) does the child every get short of breath with exercise? 
d) Has the child ever had prior surgeries?javascript:void(0)b) Has the child ever fainted or lost consciousness during exercise?39Which of the following conditions would not exclude a child from participating in contact collision sports?
a) Fever
b) Absence of a paired organ
c) Atlantoaxial instability
d) Prior head injuryjavascript:void(0)a) Fever40Which of the following topics would not be appropriate to include when providing anticipatory guidance to the parent of a 4-month-old infant? 
a) Introduction of solid food
b) Teething
c) Negativism
d) Introduction of a cupjavascript:void(0)c) Negativism41Which is the correct order for introduction of solid foods to an infant? 
a) Fruits, cereal, vegetables, and meats
b) Cereal, meats, vegetables, and fruits
c) Fruits, cereal, meats, and vegetables
d) Cereal, vegetables, fruits, and meatsjavascript:void(0)d) Cereal, vegetables, fruits, and meats42Which of the following topics is not appropriate to include when providing anticipatory guidance to the parent of an 18 month old? 
a) Temper tantrums
b) Toilet training
c) Dental care
d) Stranger anxietyjavascript:void(0)d) Stranger anxiety43Appropriate anticipatory guidance for the parents of an 8 yo girl should not include: 
a) Preparation for an increase in nervous mannerisms and restless activity
b) Preparation for pubertal changes
c) Information that friends begin to serve as allies against adults
d) Information that their daughter will take on idols and herosjavascript:void(0)a) Preparation for an increase in nervous mannerisms and restless activity44A new mom calls te PNP on post partum day 5. She reports that her newborn wants to nurse for 30 minutes every 2 hours. Which of the following is your best response? 
a) This is a very healthy breastfeeding pattern. Be sure to rest when you can. You are doing great
b) Yor baby is too demanding. If you continue to feed that often you will spoil your child
c) You are not making enough milk and your baby will need to go to the ED to be evaluated
d) Your baby has an oral fixation and you should offer a pacifier to relieve stressjavascript:void(0)a) This is a very healthy breastfeeding pattern. Be sure to rest when you can. You are doing great45A pelvic exam should not be performed on which of the following adolescents? 
a) A 14 yo who is sexually active
b) A 15 yo who has jest started menarche
c) A 17 yo who is having irregular menses
d) An 18 yo healthy femalejavascript:void(0)b) A 15 yo who has jest started menarche46Hip is flexed and thigh is adducted which causes displacement of femoral head from acetabulum with a palpable "clunk":javascript:void(0)Barlow's test47Hip is flexed at 90 degree angle and abducted with finger over greater trochanter which reduces dislocated hip; a "clunk" is heard and felt:javascript:void(0)Ortolani's test48Child stands and raises one leg off the ground; lowering of iliac crest on side opposite weight-bearing leg indicates defect in weight-bearing hip:javascript:void(0)Trendelenburg test49Use of hands on legs to push self from sitting to standing position (shows generalized muscle weakness):javascript:void(0)Gower's sign50Genu varum:javascript:void(0)Bow legs. Common in toddlers.51Genu valgum:javascript:void(0)Knock knees. Common in preschool children.52Diffuse edema of the soft tissue of the scalp which usually crosses suture lines; may be seen with bruising:javascript:void(0)Caput succedaneum53Subperiosteal collection of blood which does not cross suture lines; resolves over a few weeks to months:javascript:void(0)Cephalohematoma54Bulging of fontanel area that is associated with rickets and prematurity:javascript:void(0)Bossing55Eye that turns in or out:javascript:void(0)Strabismus56Exophthalmos:javascript:void(0)Protruding eyeballs; seen in hyperthyroidism57When eye is covered it deviates inward:javascript:void(0)Esophoria58When eye is covered it deviates outward:javascript:void(0)Exophoria59Eye deviates inward:javascript:void(0)Esotropia60Eye deviates outward:javascript:void(0)Exotropia61You detect a heart murmur while examining a 3 yo child. In determining whether or not a referral is necessary, you determine it is an "innocent" heart murmur for which of the following reasons:
a) It is best heard during diastole
b) It radiates to the axilla
c) The intensity is no greater than I or II/VI
d) There is no variation with change in positionjavascript:void(0)c) The intensity is no greater than I or II/VI62When providing anticipatory guidance about infant development, you might teach parents that a normal infant could first transfer an object from hand to hand at what age?
a) 2 months
b) 4 months
c) 7 months
d) 9 monthsjavascript:void(0)c) 7 months63A 2 month old infant at your clinic received a combined DTaP/HepB/IPV vaccine and the parents are in need of teaching about possible side effects. Which of the following is not an adverse effect following administration of the DTaP vaccination? 
a) Local reaction
b) Fever
c) Increased fussiness
d) Transient morbilliform rashjavascript:void(0)d) Transient morbilliform rash64When reviewing immunization protocols at your clinic, you are aware that the varicella vaccine can be administered to susceptible children beginning at what age? 
a) 4 months
b) 6 months
c) 12 months
d) 15 monthsjavascript:void(0)c) 12 months65A 2 week old infant is in the clinic for a scheduled weight check. The best indication that a 2 week old infant is receiving adequate breastmilk is that the baby: 
a) Passes at least 4 stools per day
b) Feeds every 3 hours
c) Voids 4 times per day
d) Has regained birthweightjavascript:void(0)d) Has regained birthweight66A mother of an 8 month old infant asks you for advice about continued introduction of solids. Which of the following food groups do you recommend be introduced to the baby last? 
a) Egg yolk
b) Egg white
c) Fruits
d) Vegetablesjavascript:void(0)b) Egg white67The mother of a 15 month old child informs you that she feeds the baby skim milk. You advise the mother to change to whole milk primarily because skim milk: 
a) Is not as easily digested
b) Contains insufficient amounts of calcium
c) Contains too little protein
d) Provides an inadequate amount of essential fatty acidsjavascript:void(0)d) Provides an inadequate amount of essential fatty acids68An adolescent is being evaluated for childhood depression. Which behavior or sign is least likely to be evident?
a) Evidence of hallucinations and delusions
b) A history of recurrent "accidents" 
c) A sense of guilt
d) the presence of eating disordersjavascript:void(0)a) Evidence of hallucinations and delusions69A 12 yo boy is brought into the clinic for an urgent visit after having ingested 10 diazepam tablets. Following the initial emergent care and stabilization of the child, the most important aspect of your management is: 
a) Referring the case to the social services
b) Assessing the family supports available to the child
c) Obtaining a psychiatric consultation
d) Reviewing the history for signs of depressionjavascript:void(0)c) Obtaining a psychiatric consultation70You are seeing a 15 month old boy with leukemia for a check up. If indicated, this child may receive all of the following vaccines except: 
a) Inactivated polio vaccine (IPV)
b) H. influenzae type B (Hib)
c) Diptheria, tetanus, acellular pertussis (DTaP)
d) Varicella (VAR)javascript:void(0)d) Varicella (VAR)71While conducting the Denver II developmental screening test, the mother of an 18 month old child reports to you that the toddler does not imitate activities. You decide to assess the child's development further by giving him tasks from which sector? 
a) Personal-social
b) fine motor-adaptive
c) Language
d) Gross motorjavascript:void(0)a) Personal-social72You have ordered routine blood screening for a 2 yo girl who, because of dietary habits, is at risk for iron deficiency anemia. Which of the following finding is not associated with iron deficiency anemia? 
a) Hypochromic RBC
b) Microcytic RBC
c) Low reticulocyte count
d) Low free erythrocyte protoporphyrin (FEP) leveljavascript:void(0)d) Low free erythrocyte protoporphyrin (FEP) level

Iron deficiency anemia is a microcytic, hypochromic anemia associated with low reticulocyte count and elevated FEP level.73During a prenatal visit you review the mother's record for routine prenatal screening results. While educating the mother you explain that the screening of maternal serum alph-fetoprotein (MSAFP) between the 15th and 21st weeks of pregnancy is done primarily to screen for: 
a) Phenylketonuria
b) Galactosemia
c) Cystic fibrosis
d) Neural tube defectsjavascript:void(0)d) Neural tube defects74A tenderness is detected over the tibial tuberosity of a 10 yo boy during a routine examination at a school based clinic. The PNP knows this may be a sign of: 
a) Osgood-Schlatter disease
b) Blount's disease
c) Plantar fasciitis
d) Effusion in the joint spacejavascript:void(0)a) Osgood-Schlatter disease75The parents of a 1 week old infant are concerned about the unusual shape of their child's head. In the physical exam of the infant, which of the following signs would not support a diagnosis of craniosynostosis? 
a) Palpation of a ridge along a given suture line
b) Unusual skull configuration
c) A palpable lesion at the occipital region
d) Abnormal head circumferencejavascript:void(0)c) A palpable lesion at the occipital region76In the ED you encounter a toddler whose injuries are not consistent with the history that is given. Which of the following would be the best step a provider could take in order to foster communication with the abusive parents?
a) Realize that abusive parents have essentially different goals for their children than other caregivers do
b) Understand that parental hostility and resistance are potent symptoms of fear and inadequacy
c) Consider referring parents to a substance abuse program
d) Be cautious when sharing the results of medical findingsjavascript:void(0)b) Understand that parental hostility and resistance are potent symptoms of fear and inadequacy77You are preparing a drug prevention program for middle school students. Your educational approach is based on the knowledge that the most common substance of abuse in adolescence is: 
a) Marijuana
b) Cocaine
c) Heroin
d) Alcoholjavascript:void(0)d) Alcohol78During a check up of a 15 month old girl you note the child has dropped significantly in percentile for weight over the past few months. In evaluating a child with FTT, the most important part of your assessment involves: 
a) The history
b) The physical exam
c) Laboratory studies
d) Observation of family interactionsjavascript:void(0)a) The history79A 7 yo child in your caseload has recently been placed on methylphenidate for behavioral concerns associated with ADHD. Which of the following side effects are not associated with this drug? 
a) Decreased appetite
b) Weight loss
c) Irritability
d) Decreased heart ratejavascript:void(0)d) Decreased heart rate80The parents of an 8 yo child are concerned that their son does not want to attend school. Which of the following historical findings are not usually associated with the diagnosis of school phobia? 
a) Sporadic school absence
b) Chronic medical illness
c) Vague physical symptoms
d) Depression and anxietyjavascript:void(0)b) Chronic medical illness81A 17 yo girl is referred to your clinic by the school nurse to be assessed for an eating disorder. Which of the following dynamics is not characteristic of anorexia nervosa?
a) Excessive eating followed by purging
b) A pervasive sense of helplessness and ineffectiveness
c) Weight loss that gives the patient a sense of mastery and controll
d) Low body temp, pulse rate, and blood pressurea) Excessive eating followed by purging

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good practice questions

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