NRNP 6541 PEDS MIDTERM EXAM

Appropriate advice for a mother of a 2-week-old child here for a "well child" visit includes which of the following? - Sleep in the supine position is recommended Parents bring their 6-month-old son to see you. He is symmetrically less than the 5th percentile for height, weight and head circumference. He was born at 30 weeks' gestation and weighed 1000g. He was a planned pregnancy, and his mother's prenatal course was uneventful until an automobile accident initiated the labor. He was ventilated for 3 days in the intensive care unit but otherwise did well without ongoing problems. He was discharged at 8 weeks of life. Which of the following is the most likely explanation for his small size? - Normal ex-preemie infant growth A Mantoux test in a child with no risk factors is considered positive with a reaction of - at least 15 mm induration A 4-year-old believes there is more juice in a tall, thin glass than a shorter, wider one. The child has not yet achieved which of the principles of Piaget? - Conservation I can roll over, grasp a rattle, and reach for things and have begun feeding myself finger foods, but I can't wave bye-bye yet. How old am I? - 6 months A 4-month-old child has poor weight gain. Her current weight is less than the 5th percentile, height about the 10th percentile, and head circumference at the 50th percentile. The planned pregnancy resulted in a normal, spontaneous, vaginal delivery; mother and child were discharged after a 48-hour hospitalization. Feeding is via breast and bottle; the quantity seems sufficient. The child has had no illness. The examination is unremarkable except for the child's small size. Screening laboratory shows the hemoglobin and hematocrit are 11 mg/dL and 33% respectively, with a platelet count of 198,000/mm3. Serum electrolyte levels are sodium 140, chloride 105, potassium 3.5, bicarbonate 17, blood urea nitrogen 15, and creatinine 0.3. Liver function tests are normal. Urinalysis reveals a pH of 8 with occasional epithelial cells but no white blood cells, bacteria, protein, ketones, or reducing substances. Which of the follow - Oral supplementation with bicarbonate Which of the following vaccines is routinely recommended at 4 months of age? - Diphtheria, tetanus, acellular pertussis (DTaP) I can walk well on tiptoes, my speech is 50% understandable, I know six body parts, but I cannot balance on one foot for 1 second. I am - 2-1/2 years old (30 months) You see a healthy 18-month-old for a well-child visit. At the 12-month visit he received the diphtheria, tetanus, and acellular pertussis (DTaP) third dose; hepatitis B second dose; measles, mumps, and rubella (MMR) first dose; injected poliovirus (IPV) second dose; pneumococcal conjugate (PCV13) fourth dose; and Haemophilus influenzae type B (Hib) fourth dose. Which of the following do you order today? - DTaP, varicella, hepatitis A, and hepatitis B Which is the correct order for introduction of solid foods to an infant? - Cereal, vegetables, fruits, and meats I like to use my pincer grasp that involves the ability to pick up a small object such as a raisin or piece of cereal with the thumb and forefinger, and that is mastered around what age? - 9 months The first sign of the onset of female puberty is usually - Breast buds A mother of a 6-month-old asks you about normal sleep patterns for an infant this age. The best response is: - 10 hours at night and 3-4 hours during the day Medicaid provides health insurance coverage to - Certain categories of people whose personal income falls below a certain percentage of the federal poverty level. You see a 5-month-old who is fussy, has interrupted sleep, and is drooling. You note large lower lateral incisor bulges. You recommend: - A and D You see a young child who has tripled her birth weight and looks for hidden objects. When given blocks, she places one in each hand. She has a fine pincer grasp. On the floor, she walks around holding objects and is trying to take independent steps. This child is most likely how old? - 12 months Sally, age 4, presents to the office with her mother for a well-child visit. To assess for age-appropriate fine motor skills, what activity would you ask her to perform? - Cut on a line with scissors Which adolescent would be at greatest risk for developing anorexia nervosa? - 14-year-old female gymnast Which of the following injuries is most likely to be caused by abuse of a toddler? - A displaced posterior rib fracture. You see a 3-year-old for a well-child visit. His mother informs you that potty training has been very easy because he "has an amazing internal clock. He falls asleep, gets hungry, and has bowel movements at the same time every day." This describes which aspect of temperament? - Rhythmicity Which of the following statements regarding adolescent substance use is true? - Tobacco is the most commonly abused substance during adolescence. You see a 4-year-old for a well-child visit. He has received four diphtheria, tetanus, and acellular pertussis vaccines (DTaP); three injected polio vaccines (IPV); one measles, mumps, and rubella vaccine (MMR); one varicella vaccine; and two hepatitis B (Hep B) vaccines. What do you order today? - DTaP, IPV, MMR, and Varivax The parents of a 7-year-old are concerned their son does not want to attend school. Which of the historical findings are not usually associated with the diagnosis of school phobia? - Chronic medical illness Chelsea, age 8, complains that she feels as if something is stuck in her ear. What action is contraindicated? - Flushing the ear with water You see a 7-year-old with complaints of "having accidents at night." Physical exam and history are unremarkable. Urinalysis, urine culture, and specific gravity are normal. His parents ask about the best treatment for this problem. The best response is - Fluid restriction and voiding prior to the night may be effective You are doing a kindergarten physical on a 5-year-old girl. Which of the following scenarios would suggest the child is not ready to start kindergarten in the fall? - Counts to 4 and draws a person with three parts. Upon eye examination of a newborn, you note inner canthal folds and Brushfield spots. What do you suspect? - Down syndrome I like to use my pincer grasp that involves the ability to pick up a small object such as a raisin or piece of cereal with the thumb and forefinger, and that is mastered around what age? - 9 months Mark, a 10-year-old, has a lot of ear pain. He does not want anyone to touch it and is crying in pain. The ear canal is swollen and exudate is present. The TM is normal. What is the proper management for his patient? - Topical Fluoroquinolone The diagnostic criteria for autism spectrum disorder include all of the following except - Tolerance of flexibility with routines Luke, a 17-month-old, failed treatment with amoxicillin for otitis media. At the twoweek recheck, his TM was still erythematous and you cannot see the landmarks. He has persistent nasal congestion, he is not sleeping at night, and he has a 101°F fever. What is the next best step for Luke? - A 10 day course of Augmentin Which of the following would not suggest an eating disorder with a purging component? - Diarrhea Role-play with equipment during the course of the physical exam would be the most beneficial with which age group? - Preschoolers While assessing the skin of an infant, you note cafe-au-lait spots. Which disease should be ruled out? - Neurofibromatosis An expected milestone of a 4-year-old is the ability to - Copy a cross You receive a phone call from the mother of a 2-year-old. She states her child has sleep refusal. You suggest the child should be able to: - Set his own bedtime based on his internal clock. A healthy, well-developed 6-year-old child arrives as a new patient to your clinic. His immunization card reveals that he received immunization at birth and some when he was 2 months old, but none since. Which of the following statements about him is correct? - He is too old to receive the Haemophilus influenzae Type B vaccine Which of the following issues or concepts is relevant to the school-age child? - Erikson's initiative versus guilt You would be concerned about the language development of a child who - Stutters when excited or tired at the age of 7 You diagnose a 16-year-old with acute otitis media and need to prescribe an antibiotic with beta-lactamase coverage. What do you choose? - amoxicillin and potassium clavulanate (Augmentin) A 2-year-old boy has been slightly less than the 50th percentile for weight, height, and head circumference, but in the last 6 months, he has fallen to slightly less than the 25th percentile for weight. The pregnancy was normal, his development is as expected, and the family reports no psychosocial problems. The mother says that he is now a finicky eater (wants only macaroni and cheese at all meals), but she insists that he eat a variety of foods. The meals are marked by much frustration for everyone. His examination is normal. Which of the following is the best next step in his care? - Reassurance and counseling for family about childhood normal developmental stage Which of the following characterizes middle adolescence (14 to 16 years old)? - Intense peer group involvement, feelings of immortality, sexual experimentation Which of the following foreign body in the nose requires immediate removal? - battery Which is the correct order for the introduction of solid foods to an infant? - Cereal, vegetables, fruits, and meats FIRST-LINE therapy for preschoolers (4-5 years of age) diagnosed with the attention-deficit hyperactive disorder is - Behavior therapy A 15-month-old boy says "mama" and "dada," points and gestures if he wants things, and follows simple one-step commands. Your best response is which of the following? - Tell parent, "Your child's language development is normal." A 4-month-old child has poor weight gain. Her current weight is less than the 5th percentile, height about the 10th percentile, and head circumference at the 50th percentile. The planned pregnancy resulted in a normal, spontaneous, vaginal delivery; mother and child were discharged after a 48-hour hospitalization. Feeding is via breast and bottle; the quantity seems sufficient. The child has had no illness. The examination is unremarkable except for the child's small size. Screening laboratory shows the hemoglobin and hematocrit are 11 mg/dL and 33% respectively, with a platelet count of 198,000/mm3. Serum electrolyte levels are sodium 140, chloride 105, potassium 3.5, bicarbonate 17, blood urea nitrogen 15, and creatinine 0.3. Liver function tests are normal. Urinalysis reveals a pH of 8 with occasional epithelial cells but no white blood cells, bacteria, protein, ketones, or reducing substances. Which of the follow - Oral supplementation with bicarbonate Which of the following signs may indicate a baby is not receiving sufficient breastmilk? - Sleepiness, jaundice, and vomiting By what age should most children be able to sit well without support? - 9 months I can roll over, grasp a rattle, and reach for things and have begun feeding myself finger foods, but I can't wave bye-bye yet. How old am I? - 6 months Parents bring their 16-year-old daughter for a "well-child" checkup. She looks normal on examination. As part of your routine care you plan a urinalysis. The father pulls you aside and asks you to secretly run a UDS on his daughter. Which of the following is the most appropriate course of action? - Explore the reasons for the request with the parents and the adolescent and perform a UDS with the adolescent's permission if the history warrants. A teenage female who is overweight has moderate acne on the face and chest and irregular menses. Elevation of which laboratory test provides the test evidence of polycystic ovarian syndrome? - free testosterone Which of the following complication of strep pharyngitis cannot be prevented with antibiotics? - Glomerulonephritis A fifteen-year-old female makes a statement to you during a well visit. Which of the following statements should not be kept confidential? - "Sometimes I feel like ending my life." Which of the following screenings should adolescents have done annually? - Psychosocial screening, blood pressure, body mass index Which of the following substances is associated with pupillary constriction? - Heroin The appropriate lab tests in the assessment of cervical adenitis include all of the following except - Blood culture What method can be safely used to remove cerumen in a 15-month-old child's ear? - Irrigation using warm water from a soft bulb syringe Max, a 9-year-old boy, is a very active child with limited self-control. He is easily distracted and has difficulty staying on task. You determine that he should have a neurodevelopmental evaluation because he is showing signs of - ADHD A mother states that her 4-year-old son constantly grinds his teeth at night. You document this as - Bruxism The father of a 3-year-old is concerned because the child stutters. What should your approach be? - Explain that this can be normal until 4 years of age. A mother of a 6-month-old asks you about normal sleep patterns for an infant this age. The best response is - 10 hours at night and 3-4 hours during the day Josh, age 13, has some enlargement of the scrotum and testes, a reddened scrotal sac, and some hair texture alteration. His penis is not enlarged. He is in Tanner stage - II Which of the following eye findings would be considered an ophthalmic emergency? - Unilateral vesicular lesions on the upper eyelid in a 3-week old.