NR602 Pediatric Midterm Study Set
A 10-year-vintage baby has had belly pain for 2 days, which commenced inside the
periumbilical region after which localized to the proper decrease quadrant. The baby vomited
once these days and then experienced relief from ache observed via an improved fever. What is
the possibly analysis?
Appendicitis with perforation
Gastroenteritis
Pelvic inflammatory disorder (PID)
Urinary tract infection (UTI) - ANS-ANS: A
The child has the development of signs and symptoms standard of appendicitis with perforation
- ache earlier than vomiting that localizes to the RLQ after which comfort of ache with onset of
fever upon perforation. With gastroenteritis, vomiting precedes pain. PID symptomology
includes increasing pain through the years. The symptoms of an UTI include fever, chills, and
urinary signs and symptoms.
A 10-year-old is hit within the head with a baseball at some stage in exercise and is recognized
with concussion, even though no loss of cognizance occurred. The primary care pediatric nurse
practitioner is evaluating the kid 2 weeks after the damage and learns that the child is still
experiencing a few sleepiness each day. The neurological examination is normal. The child and
the figure are adamant that the child be allowed to return to play baseball. What will the nurse
practitioner suggest?
Continuation of cognitive rest only
Continuation of physical and cognitive relaxation
Continuation of bodily relaxation only
Returning to play - ANS-ANS: B
Both physical and cognitive rest is indicated after analysis of concussion in children, in particular
if signs hold following harm. Cognitive recuperation might also lag behind bodily healing and is a
key factor in go back-to-play decisions. Only in any case signs solve might also athletes
progress through steps to progressively go back to play.
A 12-month-vintage toddler exhibits negative weight gain after formerly everyday increase
patterns. There is no records of vomiting, diarrhea, or abnormal bowel actions, and the physical
examination is ordinary. What is the following step in comparing those findings?
Complete blood be counted and electrolytes
Feeding and stooling history and three-day weight loss plan records
Stool cultures for ova and parasites
Swallow have a look at with videofluoroscopy - ANS-ANS: B
Vomiting, diarrhea, and bowel irregularities are greater predictive of organic reasons of FTT,
which aren't present in this infant. A careful history and physical exam and confined laboratory
evaluation are the first steps unless there may be motive to think that an organic reason is
present. The fact that the little one changed into formerly gaining weight accurately makes a
swallowing disorder much less probably.
,A 12-month-old toddler who had cardiopulmonary pass with RBC and plasma infusions at some
stage in surgical operation at eight months is seen for a properly baby examination. Which
vaccine may be administered at this visit?
MMR
OPV
PCV-13
Varivax - ANS-ANS: C
Live vaccines need to be delayed till 6 months after cardiopulmonary skip and exposure to
RBCs and plasma. The PCV-thirteen is not a stay-virus vaccine and the others are.
A 12-yr-antique toddler has a latest history of expanded thirst and common urination. The child's
weight has been inside the ninety fifth percentile for several years. A dipstick UA is fantastic for
glucose, and random plasma glucose is 350 mg/dL. Which test will the primary care pediatric
nurse practitioner order to determine the form of diabetes in this child?
Fasting plasma glucose
Hemoglobin A1C tiers
Pancreatic antibodies
Thyroid feature exams - ANS-ANS: C
If the kind of diabetes is unsure, screening for pancreatic antibodies should be taken into
consideration to verify the prognosis of type 1 diabetes. Fasting plasma glucose can be
improved in each kinds. Hemoglobin A1C does no longer distinguish among types. Thyroid
characteristic assessments aren't indicated unless there is a suspicion of concomitant related
autoimmune conditions.
A 12-yr-old infant who plays football is identified with vocal cord dysfunction. What will the
number one care nurse practitioner say while the child's mother and father ask about
persevered sports activities participation?
The child can also hold to participate in football.
The infant need to restriction pastime to non-cardio sports activities.
This situation is a contraindication for all sports activities.
This circumstance predisposes the kid to surprising cardiac death. - ANS-ANS: A
Vocal twine dysfunction causes shortness of breath and have to be controlled however does not
prevent kids from participation in sports activities. It does no longer indicate underlying cardiac
problems and does not mean kids ought to keep away from any game which could boom heart
or breathing charges.
A 12-12 months-old toddler whose BMI is extra than the 95th percentile has a blood strain on
the 98th percentile for age, sex, and top. After way of life changes that include weight loss
program and exercise, the kid's BMI drops to the ninetieth percentile, however the blood stress
stays the same. What is the primary care pediatric nurse practitioner's next step in treating this
toddler?
Continued close tracking of blood pressure
Ordering an echocardiogram or MRI
,Prescribing an ACE inhibitor medicine
Referral to a nephrologist or heart specialist - ANS-ANS: D
Children who have chronic BP elevation after life-style changes are made should be noted a
nephrologist or heart specialist who has revel in the usage of antihypertensive sellers in kids.
The professional orders necessary exams and medicinal drugs, now not the number one care
company.
A 12-12 months-vintage child whose weight and BMI are in the 75th percentile has a diastolic
blood strain this is among the 95th and 99th percentiles for age, sex, and height on 3 separate
events. Initial exams for this baby will consist of
whole blood matter.
Erythrocyte sedimentation rate.
Renal function and plasma renin assessments.
Urinalysis and electrolytes. - ANS-ANS: C
Since the majority of children with stage 1 or 2 high blood pressure have renal or renovascular
causes for elevated BP, renal feature and plasma renin checks need to be accomplished.
Children underneath 10 years of age with stage 2 hypertension must have greater competitive
laboratory evaluation, which includes CBC, ESR, UA, and electrolytes.
A thirteen-12 months-antique Native American woman has a BMI at the 90th percentile for age.
The primary care pediatric nurse practitioner notes the presence of a hyperpigmented velvet-like
rash in pores and skin folds. The infant denies polydipsia, polyphagia, and polyuria. The nurse
practitioner will
suggest the kid to lose weight to prevent type 2 diabetes.
Diagnose type 2 diabetes if the kid has a random glucose of one hundred eighty mg/dL.
Order a fasting blood pattern for a metabolic display screen for type 2 diabetes.
Refer the kid to a pediatric endocrinologist. - ANS-ANS: C
This baby has three threat elements for kind 2 diabetes: Native American ethnicity, overweight,
and acanthosis nigricans. The PNP ought to carry out metabolic screening on a fasting blood
pattern to diagnose this. Lifestyle changes can be essential to manipulate the ailment if
diagnosed, however this baby can also already have the disorder, and management alternatives
aren't clean till the prognosis is made. Diagnosis is primarily based on a random glucose >200
mg/dL. It isn't important to refer this child until a analysis is made.
A 14-12 months-vintage boy who's overweight develops a unilateral limp with ache within the
hip and knee at the affected side. An examination well-knownshows external rotation of the hip
while flexed and pain associated with tries to internally rotate the hip. What is most essential
initially when coping with this infant's situation?
Place the child on crutches or in a wheelchair to prevent weight-bearing.
Provide statistics about weight loss to minimize in addition damage.
Recommend seeing an orthopedic specialist as quickly as viable.
Refer the kid to physical remedy to enhance variety of movement. - ANS-ANS: A
This toddler's age, records, and signs and symptoms are regular with slipped capital femoral
epiphysis. The toddler should be placed on crutches or in a wheelchair to save you weight
, bearing. Obesity is frequently a part of the history and have to be managed, but the on the spot
need is to save you further damage to the hip. Referral to orthopedics must right now observe
prevention of weight bearing. Physical therapy can be part of treatment after the epiphysis is
stabilized.
A 14-12 months-old child has a 2-week history of intense itching and tearing of both eyes. The
primary care pediatric nurse practitioner notes redness and swelling of the eyelids along side
stringy, mucoid discharge. What will the nurse practitioner prescribe?
Saline solution or artificial tears
Topical mast cell stabilizer
Topical NSAID drops
Topical vasoconstrictor drops - ANS-ANS: C
This child has symptoms of allergic conjunctivitis. Topical NSAIDs paintings for acute signs to
lessen irritation and may be utilized in kids over age 12 years. Saline answer or artificial tears
are beneficial for milder signs and symptoms. Topical mast cell stabilizers are beneficial for
chronic signs and renovation therapy. Topical vasoconstrictors have to be avoided because of
rebound hyperemia.
A 14-yr-antique lady has menometrorrhagia with slight growth in menstrual drift and abnormal
intervals. Her hemoglobin is thirteen.1 g/dL. How will this be managed?
Iron supplementation and prostaglandin inhibitors
One OCP twice daily for three to 4 days after which each day
Progestin each day for 10 to 14 days
Referral to a pediatric gynecologist for remedy - ANS-ANS: A
This affected person has moderate AUB and may be managed by means of remark and
reassurance together with iron to prevent anemia and prostaglandin inhibitors to lessen heavy
bleeding. Patients with mild AUB can be prescribed OCPs or progestins. Referral to a
gynecologist is warranted with excessive AUB.
A 15-yr-vintage female basketball player who has secondary amenorrhea is evaluated by way of
the primary care pediatric nurse practitioner who notes a BMI within the third percentile. What
will the nurse practitioner suggest this patient?
That amenorrhea in female athletes isn't always regarding
That she need to begin a application of plyometrics and power trainin
To recall a one-of-a-kind game, which include volleyball
To paintings with a dietician to improve wholesome weight gain - ANS-ANS: D
Female athletes who've amenorrhea have an extended chance of strain fractures. The
adolescent ought to work to attain a wholesome weight, which must permit regular periods to
return and decrease this chance. Even though amenorrhea in female athletes is not unusual, it's
far regarding. Plyometrics and volleyball can growth the chance of strain fractures considering
the fact that each involve leaping and hence not be cautioned.
A 10-year-vintage baby has had belly pain for 2 days, which commenced inside the
periumbilical region after which localized to the proper decrease quadrant. The baby vomited
once these days and then experienced relief from ache observed via an improved fever. What is
the possibly analysis?
Appendicitis with perforation
Gastroenteritis
Pelvic inflammatory disorder (PID)
Urinary tract infection (UTI) - ANS-ANS: A
The child has the development of signs and symptoms standard of appendicitis with perforation
- ache earlier than vomiting that localizes to the RLQ after which comfort of ache with onset of
fever upon perforation. With gastroenteritis, vomiting precedes pain. PID symptomology
includes increasing pain through the years. The symptoms of an UTI include fever, chills, and
urinary signs and symptoms.
A 10-year-old is hit within the head with a baseball at some stage in exercise and is recognized
with concussion, even though no loss of cognizance occurred. The primary care pediatric nurse
practitioner is evaluating the kid 2 weeks after the damage and learns that the child is still
experiencing a few sleepiness each day. The neurological examination is normal. The child and
the figure are adamant that the child be allowed to return to play baseball. What will the nurse
practitioner suggest?
Continuation of cognitive rest only
Continuation of physical and cognitive relaxation
Continuation of bodily relaxation only
Returning to play - ANS-ANS: B
Both physical and cognitive rest is indicated after analysis of concussion in children, in particular
if signs hold following harm. Cognitive recuperation might also lag behind bodily healing and is a
key factor in go back-to-play decisions. Only in any case signs solve might also athletes
progress through steps to progressively go back to play.
A 12-month-vintage toddler exhibits negative weight gain after formerly everyday increase
patterns. There is no records of vomiting, diarrhea, or abnormal bowel actions, and the physical
examination is ordinary. What is the following step in comparing those findings?
Complete blood be counted and electrolytes
Feeding and stooling history and three-day weight loss plan records
Stool cultures for ova and parasites
Swallow have a look at with videofluoroscopy - ANS-ANS: B
Vomiting, diarrhea, and bowel irregularities are greater predictive of organic reasons of FTT,
which aren't present in this infant. A careful history and physical exam and confined laboratory
evaluation are the first steps unless there may be motive to think that an organic reason is
present. The fact that the little one changed into formerly gaining weight accurately makes a
swallowing disorder much less probably.
,A 12-month-old toddler who had cardiopulmonary pass with RBC and plasma infusions at some
stage in surgical operation at eight months is seen for a properly baby examination. Which
vaccine may be administered at this visit?
MMR
OPV
PCV-13
Varivax - ANS-ANS: C
Live vaccines need to be delayed till 6 months after cardiopulmonary skip and exposure to
RBCs and plasma. The PCV-thirteen is not a stay-virus vaccine and the others are.
A 12-yr-antique toddler has a latest history of expanded thirst and common urination. The child's
weight has been inside the ninety fifth percentile for several years. A dipstick UA is fantastic for
glucose, and random plasma glucose is 350 mg/dL. Which test will the primary care pediatric
nurse practitioner order to determine the form of diabetes in this child?
Fasting plasma glucose
Hemoglobin A1C tiers
Pancreatic antibodies
Thyroid feature exams - ANS-ANS: C
If the kind of diabetes is unsure, screening for pancreatic antibodies should be taken into
consideration to verify the prognosis of type 1 diabetes. Fasting plasma glucose can be
improved in each kinds. Hemoglobin A1C does no longer distinguish among types. Thyroid
characteristic assessments aren't indicated unless there is a suspicion of concomitant related
autoimmune conditions.
A 12-yr-old infant who plays football is identified with vocal cord dysfunction. What will the
number one care nurse practitioner say while the child's mother and father ask about
persevered sports activities participation?
The child can also hold to participate in football.
The infant need to restriction pastime to non-cardio sports activities.
This situation is a contraindication for all sports activities.
This circumstance predisposes the kid to surprising cardiac death. - ANS-ANS: A
Vocal twine dysfunction causes shortness of breath and have to be controlled however does not
prevent kids from participation in sports activities. It does no longer indicate underlying cardiac
problems and does not mean kids ought to keep away from any game which could boom heart
or breathing charges.
A 12-12 months-old toddler whose BMI is extra than the 95th percentile has a blood strain on
the 98th percentile for age, sex, and top. After way of life changes that include weight loss
program and exercise, the kid's BMI drops to the ninetieth percentile, however the blood stress
stays the same. What is the primary care pediatric nurse practitioner's next step in treating this
toddler?
Continued close tracking of blood pressure
Ordering an echocardiogram or MRI
,Prescribing an ACE inhibitor medicine
Referral to a nephrologist or heart specialist - ANS-ANS: D
Children who have chronic BP elevation after life-style changes are made should be noted a
nephrologist or heart specialist who has revel in the usage of antihypertensive sellers in kids.
The professional orders necessary exams and medicinal drugs, now not the number one care
company.
A 12-12 months-vintage child whose weight and BMI are in the 75th percentile has a diastolic
blood strain this is among the 95th and 99th percentiles for age, sex, and height on 3 separate
events. Initial exams for this baby will consist of
whole blood matter.
Erythrocyte sedimentation rate.
Renal function and plasma renin assessments.
Urinalysis and electrolytes. - ANS-ANS: C
Since the majority of children with stage 1 or 2 high blood pressure have renal or renovascular
causes for elevated BP, renal feature and plasma renin checks need to be accomplished.
Children underneath 10 years of age with stage 2 hypertension must have greater competitive
laboratory evaluation, which includes CBC, ESR, UA, and electrolytes.
A thirteen-12 months-antique Native American woman has a BMI at the 90th percentile for age.
The primary care pediatric nurse practitioner notes the presence of a hyperpigmented velvet-like
rash in pores and skin folds. The infant denies polydipsia, polyphagia, and polyuria. The nurse
practitioner will
suggest the kid to lose weight to prevent type 2 diabetes.
Diagnose type 2 diabetes if the kid has a random glucose of one hundred eighty mg/dL.
Order a fasting blood pattern for a metabolic display screen for type 2 diabetes.
Refer the kid to a pediatric endocrinologist. - ANS-ANS: C
This baby has three threat elements for kind 2 diabetes: Native American ethnicity, overweight,
and acanthosis nigricans. The PNP ought to carry out metabolic screening on a fasting blood
pattern to diagnose this. Lifestyle changes can be essential to manipulate the ailment if
diagnosed, however this baby can also already have the disorder, and management alternatives
aren't clean till the prognosis is made. Diagnosis is primarily based on a random glucose >200
mg/dL. It isn't important to refer this child until a analysis is made.
A 14-12 months-vintage boy who's overweight develops a unilateral limp with ache within the
hip and knee at the affected side. An examination well-knownshows external rotation of the hip
while flexed and pain associated with tries to internally rotate the hip. What is most essential
initially when coping with this infant's situation?
Place the child on crutches or in a wheelchair to prevent weight-bearing.
Provide statistics about weight loss to minimize in addition damage.
Recommend seeing an orthopedic specialist as quickly as viable.
Refer the kid to physical remedy to enhance variety of movement. - ANS-ANS: A
This toddler's age, records, and signs and symptoms are regular with slipped capital femoral
epiphysis. The toddler should be placed on crutches or in a wheelchair to save you weight
, bearing. Obesity is frequently a part of the history and have to be managed, but the on the spot
need is to save you further damage to the hip. Referral to orthopedics must right now observe
prevention of weight bearing. Physical therapy can be part of treatment after the epiphysis is
stabilized.
A 14-12 months-old child has a 2-week history of intense itching and tearing of both eyes. The
primary care pediatric nurse practitioner notes redness and swelling of the eyelids along side
stringy, mucoid discharge. What will the nurse practitioner prescribe?
Saline solution or artificial tears
Topical mast cell stabilizer
Topical NSAID drops
Topical vasoconstrictor drops - ANS-ANS: C
This child has symptoms of allergic conjunctivitis. Topical NSAIDs paintings for acute signs to
lessen irritation and may be utilized in kids over age 12 years. Saline answer or artificial tears
are beneficial for milder signs and symptoms. Topical mast cell stabilizers are beneficial for
chronic signs and renovation therapy. Topical vasoconstrictors have to be avoided because of
rebound hyperemia.
A 14-yr-antique lady has menometrorrhagia with slight growth in menstrual drift and abnormal
intervals. Her hemoglobin is thirteen.1 g/dL. How will this be managed?
Iron supplementation and prostaglandin inhibitors
One OCP twice daily for three to 4 days after which each day
Progestin each day for 10 to 14 days
Referral to a pediatric gynecologist for remedy - ANS-ANS: A
This affected person has moderate AUB and may be managed by means of remark and
reassurance together with iron to prevent anemia and prostaglandin inhibitors to lessen heavy
bleeding. Patients with mild AUB can be prescribed OCPs or progestins. Referral to a
gynecologist is warranted with excessive AUB.
A 15-yr-vintage female basketball player who has secondary amenorrhea is evaluated by way of
the primary care pediatric nurse practitioner who notes a BMI within the third percentile. What
will the nurse practitioner suggest this patient?
That amenorrhea in female athletes isn't always regarding
That she need to begin a application of plyometrics and power trainin
To recall a one-of-a-kind game, which include volleyball
To paintings with a dietician to improve wholesome weight gain - ANS-ANS: D
Female athletes who've amenorrhea have an extended chance of strain fractures. The
adolescent ought to work to attain a wholesome weight, which must permit regular periods to
return and decrease this chance. Even though amenorrhea in female athletes is not unusual, it's
far regarding. Plyometrics and volleyball can growth the chance of strain fractures considering
the fact that each involve leaping and hence not be cautioned.
