MARYVILLE NURS 612 FINAL EXAM (VERIFIED QUESTIONS, CORRECT
ANSWERS, AND DETAILED RATIONALES FOR COMPREHENSIVE REVIEW)
On your patient schedule see a diagnosis of plagiocephaly on your patient schedule. You vaguely
recall learning something about this in Nurse 612 so you check UpToDate and are able to explain
the etiology of this head growth disturbance is to the parents of this 4-month-old:
A. Your child's head appears small. His head size is 2 SD below the mean; this can result
abnormal brain development from a genetic or teratogenic exposure
B. Your child's head appears flat. This form of craniostenosis can result from premature
fusion of lambdoidal or coronal skull sutures and often results in brain injury.
C. Your child's head appears large. His head size is 2 SD above the mean; this can result
from hydrocephalus while skull sutures are open.
D. Your child's head appears flat. This form of craniostenosis can result from premature
fusion of lambdoidal or coronal skull sutures and is often only cosmetic and can be treated with a
s
D. Your child's head appears flat. This form of craniostenosis can result from premature fusion of
lambdoidal or coronal skull sutures and is often only cosmetic and can be treated with a special
helmet.
During a 1-week-old male well child check the head circumference is 3 S.D. (standard
deviations) below the predicted mean. What risk factors increases the risk of this finding?
A. Positioning infant on their back
B. Prenatal Zika virus exposure
C. Hydrocephaly
D. Subdural hematoma or tumor
B. Prenatal Zika virus exposure
You are seeing a 6-month-old today for follow-up after a febrile seizure yesterday. On exam you
expect to find:
A. the anterior fontanel closed.
B. the posterior fontanel closed
C. sleepiness from a post-ictal state
D. nuchal rigidity
B. the posterior fontanel closed
During a well-child examination of an infant, the primary care nurse practitioner counts 8 light
brown flat lesions on the infant's trunk. What potential concern is associated with this finding?
A. Turner's syndrome
B. Neurofibromatosis
C. Sturge-Weber syndrome
D. Hypothyroidism
,B. Neurofibromatosis
16-year-old Michael presents with his 60-year-old father with a concern about delayed puberty,
physical exam is remarkable for scant body hair, tall stature, mild gynecomastia and
hypogonadism. The treatment for Michael's suspected diagnosis is:
A. Reassurance, close observation, with anticipated catch-up sexual maturity
B. Endocrine referral for growth hormone, with anticipated catch-up sexual maturity
C. Endocrine referral for likely Klinefelter syndrome and consideration of testosterone therapy
D. D. Endocrine referral for likely Klinefelter syndrome for consideration of growth hormone
therapy
C. Endocrine referral for likely Klinefelter syndrome and consideration of testosterone therapy
15-year-old Dana presents with her 60-year-old mother w a concern about delayed puberty with
amenorrhea, physical exam is remarkable noting short stature, low set ears and hair line, cubitus
valgus and web necked. The treatment for Dana's suspected diagnosis is:
A. Reassurance, close observation, with anticipated catch-up sexual maturity
B. Endocrine referral for likely Turner's syndrome and consideration of estrogen, progesterone
AND growth hormone therapy
C. Endocrine referral for likely Turner's syndrome and consideration of estrogen, and
progesterone hormone therapy
D. Endocrine referral for growth hormone, with anticipated catch-up sexual maturity
B. Endocrine referral for likely Turner's syndrome and consideration of estrogen, progesterone
AND growth hormone therapy
A 4-year-old girl presents with her mother with concerned about her breast development. Her
family history is negative for endocrine disorders. Physical exam is unremarkable except for
stage 1 breast development, no pubic with no signs of axillary or pubic hair. Her height and
weight are above the 95th percentile. Which of the following BEST describes this child's
physical findings? A. Normal variant
B. Precocious puberty
C. Premature thelarche
D. Premature adrenarche
C. Premature thelarche
Identified risk factors for nonorganic failure to thrive include all of the following EXCEPT A.
Diabetes Type I
B. Parental neglect
C. Underfeeding
D. Inadequate caloric intake
, A. Diabetes Type I
You are seeing a 2-month-old infant girl that you suspect has Turner's syndrome. Based on your
knowledge of the physical manifestations of Turner's syndrome, what would you expect to see at
this 2-month exam?
A. Webbed neck, cubitus valgus
B. Hypertelorism, low-set ears
C. Micrognathia, hip dysplasia
D. Microcephaly, cubitus valgus
A. Webbed neck, cubitus valgus
A 5-year-old presents with lethargy; on exam you note a1-kg weight loss since her WCC 8
months ago. Your differential diagnosis includes diabetes. Which of the following is THE MOST
common presenting complaint of Type 1 diabetes in children?
A. Polyphagia and BMI >85%
B. Ketoacidosis
C. Arrested growth
D. Polyuria, polydipsia or nighttime enuresis
D. Polyuria, polydipsia or nighttime enuresis
At her 2-week follow-up you note 8-month-old TL's otitis media has resolved following a course
of Amoxil. On exam you also note bright red papules in a diaper distribution with areas of
confluence in the skin folds, and satellite lesions.
Your 12-year-old male patient has a history of cord compression and anoxia at birth presents with
spasticity and partial paralysis. His likely diagnosis is:
A. Erb’s palsy
B. brachial plexus palsy
C. cerebral palsy
D. muscular dystrophy
C. cerebral palsy
You are examining a 22-month-old today for follow-up after a with a new sudden onset of
jerking movements while febrile earlier today. Which of the following is not typical of this type
seizure?
A. Positive family history
B. Age onset between 3 months and 5 years
C. Seizure lasting more than 15 minutes
ANSWERS, AND DETAILED RATIONALES FOR COMPREHENSIVE REVIEW)
On your patient schedule see a diagnosis of plagiocephaly on your patient schedule. You vaguely
recall learning something about this in Nurse 612 so you check UpToDate and are able to explain
the etiology of this head growth disturbance is to the parents of this 4-month-old:
A. Your child's head appears small. His head size is 2 SD below the mean; this can result
abnormal brain development from a genetic or teratogenic exposure
B. Your child's head appears flat. This form of craniostenosis can result from premature
fusion of lambdoidal or coronal skull sutures and often results in brain injury.
C. Your child's head appears large. His head size is 2 SD above the mean; this can result
from hydrocephalus while skull sutures are open.
D. Your child's head appears flat. This form of craniostenosis can result from premature
fusion of lambdoidal or coronal skull sutures and is often only cosmetic and can be treated with a
s
D. Your child's head appears flat. This form of craniostenosis can result from premature fusion of
lambdoidal or coronal skull sutures and is often only cosmetic and can be treated with a special
helmet.
During a 1-week-old male well child check the head circumference is 3 S.D. (standard
deviations) below the predicted mean. What risk factors increases the risk of this finding?
A. Positioning infant on their back
B. Prenatal Zika virus exposure
C. Hydrocephaly
D. Subdural hematoma or tumor
B. Prenatal Zika virus exposure
You are seeing a 6-month-old today for follow-up after a febrile seizure yesterday. On exam you
expect to find:
A. the anterior fontanel closed.
B. the posterior fontanel closed
C. sleepiness from a post-ictal state
D. nuchal rigidity
B. the posterior fontanel closed
During a well-child examination of an infant, the primary care nurse practitioner counts 8 light
brown flat lesions on the infant's trunk. What potential concern is associated with this finding?
A. Turner's syndrome
B. Neurofibromatosis
C. Sturge-Weber syndrome
D. Hypothyroidism
,B. Neurofibromatosis
16-year-old Michael presents with his 60-year-old father with a concern about delayed puberty,
physical exam is remarkable for scant body hair, tall stature, mild gynecomastia and
hypogonadism. The treatment for Michael's suspected diagnosis is:
A. Reassurance, close observation, with anticipated catch-up sexual maturity
B. Endocrine referral for growth hormone, with anticipated catch-up sexual maturity
C. Endocrine referral for likely Klinefelter syndrome and consideration of testosterone therapy
D. D. Endocrine referral for likely Klinefelter syndrome for consideration of growth hormone
therapy
C. Endocrine referral for likely Klinefelter syndrome and consideration of testosterone therapy
15-year-old Dana presents with her 60-year-old mother w a concern about delayed puberty with
amenorrhea, physical exam is remarkable noting short stature, low set ears and hair line, cubitus
valgus and web necked. The treatment for Dana's suspected diagnosis is:
A. Reassurance, close observation, with anticipated catch-up sexual maturity
B. Endocrine referral for likely Turner's syndrome and consideration of estrogen, progesterone
AND growth hormone therapy
C. Endocrine referral for likely Turner's syndrome and consideration of estrogen, and
progesterone hormone therapy
D. Endocrine referral for growth hormone, with anticipated catch-up sexual maturity
B. Endocrine referral for likely Turner's syndrome and consideration of estrogen, progesterone
AND growth hormone therapy
A 4-year-old girl presents with her mother with concerned about her breast development. Her
family history is negative for endocrine disorders. Physical exam is unremarkable except for
stage 1 breast development, no pubic with no signs of axillary or pubic hair. Her height and
weight are above the 95th percentile. Which of the following BEST describes this child's
physical findings? A. Normal variant
B. Precocious puberty
C. Premature thelarche
D. Premature adrenarche
C. Premature thelarche
Identified risk factors for nonorganic failure to thrive include all of the following EXCEPT A.
Diabetes Type I
B. Parental neglect
C. Underfeeding
D. Inadequate caloric intake
, A. Diabetes Type I
You are seeing a 2-month-old infant girl that you suspect has Turner's syndrome. Based on your
knowledge of the physical manifestations of Turner's syndrome, what would you expect to see at
this 2-month exam?
A. Webbed neck, cubitus valgus
B. Hypertelorism, low-set ears
C. Micrognathia, hip dysplasia
D. Microcephaly, cubitus valgus
A. Webbed neck, cubitus valgus
A 5-year-old presents with lethargy; on exam you note a1-kg weight loss since her WCC 8
months ago. Your differential diagnosis includes diabetes. Which of the following is THE MOST
common presenting complaint of Type 1 diabetes in children?
A. Polyphagia and BMI >85%
B. Ketoacidosis
C. Arrested growth
D. Polyuria, polydipsia or nighttime enuresis
D. Polyuria, polydipsia or nighttime enuresis
At her 2-week follow-up you note 8-month-old TL's otitis media has resolved following a course
of Amoxil. On exam you also note bright red papules in a diaper distribution with areas of
confluence in the skin folds, and satellite lesions.
Your 12-year-old male patient has a history of cord compression and anoxia at birth presents with
spasticity and partial paralysis. His likely diagnosis is:
A. Erb’s palsy
B. brachial plexus palsy
C. cerebral palsy
D. muscular dystrophy
C. cerebral palsy
You are examining a 22-month-old today for follow-up after a with a new sudden onset of
jerking movements while febrile earlier today. Which of the following is not typical of this type
seizure?
A. Positive family history
B. Age onset between 3 months and 5 years
C. Seizure lasting more than 15 minutes
