NR 602,Final Test Bank Pediatric Primary Care 6th Edition Burns, Dunn, Brady

final Test Bank Pediatric Primary Care 6th Edition Burns, Dunn, Brady Questions 1. A child who has attention­deficit/hyperactivity disorder (ADHD) has difficulty ID: 34 stopping activities to begin other activities at school. The primary care pediatric nurse practitioner understands that this is due to difficulty with the self­regulation component of A. emotional control. B. flexibility. Correct C. inhibition. D. problem­solving. 2. The primary care pediatric nurse practitioner cares for a preschool­age child ID: 32 who was exposed to drugs prenatally. The child bites other children and has tantrums when asked to stop but is able to state later why this behavior is wrong. This child most likely has a disorder of A. executive function. Correct B. information processing. C. sensory processing. D. social cognition. 3. The primary care pediatric nurse practitioner uses the Neurodevelopmental ID: 42 Learning Framework to assess cognition and learning in an adolescent. When evaluating social cognition, the nurse practitioner will ask the adolescent A. about friends and activities at school. Correct B. if balancing sports and homework is difficult. C. to interpret material from a pie chart. D. to restate the content of something just read. 4. The primary care pediatric nurse practitioner is evaluating a school­age child ID: 38 who has been diagnosed with ADHD. Which plan will the nurse practitioner recommend asking the child’s school about to help with academic performance? A. 504 Correct B. FAPE C. IDEA D. IEP 5. The parent of a child diagnosed with ADHD tells the primary care pediatric ID: 44 nurse practitioner that the child gets overwhelmed by homework assignments, doesn’t seem to know which ones to do first, and then doesn’t do any assignments. The nurse practitioner tells the parent that this represents impairment in which executive function? A. Activation Correct B. Effort C. Emotion D. Focus 6. The primary care pediatric nurse practitioner is considering medication ID: 26 options for a school­age child recently diagnosed with ADHD who has a primarily hyperactive presentation. Which medication will the nurse practitioner select initially? A. Low­dose stimulant B. Moderate­dose stimulant Correct C. Low­dose non­stimulant D. Moderate­dose non­stimulant 7. The parent of a 4­year­old child reports that the child gets upset when the ID: 24 hall light is left on at night and won’t leave the house unless both shoes are tied equally tight. The primary care pediatric nurse practitioner recognizes that this child likely has which type of sensory processing disorder? A. Dyspraxia B. Over­responder Correct C. Sensory seeker D. Under­responder 8. The parent of a preschool­age child who is diagnosed with a sensory ID: 28 processing disorder (SPD) asks the primary care pediatric nurse practitioner how to help the child manage the symptoms. What will the nurse practitioner recommend? A. Establishing a reward system for acceptable behaviors B. Introducing the child to a variety of new experiences C. Maintaining predictable routines as much as possible Correct D. Providing frequent contact, such as hugs and cuddling 9. The primary care pediatric nurse practitioner is performing an examination on ID: 46 a 5­year­old child who exhibits ritualistic behaviors, avoids contact with other children, and has limited speech. The parent reports having had concerns more than 2 years ago about autism, but was told that it was too early to diagnose. What will the nurse practitioner do first? A. Administer an M­CHAT screen to screen the child for communication and socialization delays. B. Ask the parent to describe the child’s earlier behaviors from infancy through preschool. Correct C. Reassure the parent that if symptoms weren’t present earlier, the likelihood of autism is low. D. Refer the child to a pediatric behavioral specialist to develop a plan of treatment and management. 10. The primary care pediatric nurse practitioner is examining a 3­year­old child ID: 30 who speaks loudly, in a monotone, does not make eye contact, and prefers to sit on the exam room floor moving a toy truck back and forth in a repetitive manner. Which disorder does the nurse practitioner suspect? A. Attention­deficit/hyperactivity disorder B. Autism spectrum disorder Correct C. Executive function disorder D. Sensory processing disorder 11. The primary care pediatric nurse practitioner is selecting a medication for a ID: 36 12­year­old child who is newly diagnosed with ADHD. The child is overweight, has a history of an atrial septal defect at birth, and reports mild shortness of breath during exercise. What will the nurse practitioner prescribe? A. A low­dose stimulant medication B. A non­stimulant medication C. Behavioral therapy only D. Cardiovascular pre­screening Correct 12. The primary care pediatric nurse practitioner is conducting a follow­up ID: 40 examination on a child who has recently begun taking a low­dose stimulant medication to treat ADHD. The child’s school performance and home behaviors have improved. The child’s parent reports noticing a few tics, such a twitching of the eyelids, but the child is unaware of them and isn’t bothered by them. What will the nurse practitioner recommend? A. Adding an alpha­agonist medication B. Changing to a non­stimulant medication C. Continuing the medication as prescribed Correct D. Stopping the medication immediately Questions 1. The primary care pediatric nurse practitioner uses a shared decision­making ID: 86 (SDM) model when working with families of children with chronic health conditions. When using this model, the nurse practitioner can expect A. considerably more time in each encounter. B. improved patient health outcomes. Correct C. less PNP involvement in health care decisions. D. lower provider and higher patient satisfaction. 2. The primary care pediatric nurse practitioner diagnoses a 5­year­old child with ID: 82 asthma and prescribes an oral steroid and a short­acting beta­adrenergic medication via a metered­dose inhaler to manage acute symptoms. Along with education about the prescribed medications, what information is important to give the child’s family at this visit? A. An asthma action plan B. Effects and side effects of current medications C. Information about spirometry testing D. Instructions for medications at school 3. The parent of a child with complex health care needs tells the primary care ID: 64 pediatric nurse practitioner that the child has had difficulty breathing the past two nights but can’t articulate specific symptoms. The child has normal oxygen saturations and a normal respiratory rate with clear breath sounds. What will the nurse practitioner do? A. Admit the child to the hospital for close observation and monitoring of respiratory status. B. Encourage the parent to call when concerned and schedule a follow­up appointment the next day. Correct C. Perform a complete blood count, blood cultures, and a chest radiograph to evaluate symptoms. D. Reassure the parent that the child has a normal exam and is most likely not ill. 4. Which characteristic is the key criterion that identifies a child has having special ID: 80 needs? A. Cognitive function B. Emotional health C. Health service requirements Correct D. Medical diagnosis 5. The primary care pediatric nurse practitioner is performing a well baby ID: 74 examination on a 2­week­old infant who was recently discharged home from the neonatal intensive care unit. The mother reports that the infant was born at 26 weeks’ gestation and states she was told that her baby will probably have developmental delays. What is the most important aspect of long­term management for this infant? A. Careful monitoring of attainment of developmental milestones Correct B. Familiarizing the parent with laws that mandate educational support C. Providing genetic counseling to the infant’s parents D. Referral to social services for assistance with resources 6. The primary care pediatric nurse practitioner is preparing to perform a well child ID: 90 examination on a 5­year­old child who has multiple developmental and cognitive delays. The child’s mother is angry and tells the nurse practitioner that her friends’ children are all preparing for kindergarten. The nurse practitioner will A. allow the mother to express her feelings, understanding that she is experiencing grief. Correct B. reassure the mother that special educational opportunities are available for her child. C. suggest that the mother find a support group with other children with special needs. D. tell her that most schools provide services for children with special health care needs. 7. The parent of a toddler who has special health care needs is resistant to a ID: 66 suggestion that her child needs a gastrostomy tube for nutrition. The toddler has fallen from the 10th percentile to the 5th percentile in the past few months and resists taking in appropriate amounts of food by mouth even with assistance from occupational therapy. What will the primary care pediatric nurse practitioner do? A. Inform the mother that, since other options have failed, the gastrostomy tube is the only option. B. Refer the child to a dietician to teach the mother the importance of adequate nutrition. C. Set weight gain and food intake goals with the mother and schedule regular visits to monitor weight. Correct D. Suggest that the gastrostomy tube may be tried temporarily and removed once the child gains weight. 8. What is the most important role of the primary care pediatric nurse practitioner ID: 92 who provides care for a child with special health care needs who sees several specialists and receives community and school­based services? A. Assessing the parent’s ability to perform home care tasks B. Coordinating services to ensure continuity of care Correct C. Monitoring the family’s adherence to the health care plan D. Ordering medications and other prescribed treatments 9. A toddler swallowed a coin several days prior. The child’s parent has not found ID: 76 the coin in the child’s stool. Which imaging test will the primary care pediatric nurse practitioner employ to evaluate this ingestion? A. Abdominal ultrasound B. Computed tomography C. Conventional radiograph Correct D. Magnetic resonance imaging 10. The primary care pediatric nurse practitioner is assessing an ill 2­month­old infant ID: 72 who is febrile and refusing most fluids. The preliminary blood work indicates a viral infection and shows that the infant is hydrated. The infant is alert. The infant’s parents are attentive and live close by. What will the nurse practitioner do? A. Administer a parenteral antibiotic and antipyretic and send the infant home. B. Admit the infant to an inpatient hospital unit for overnight monitoring. C. Give the parents sick care instructions and follow up in the clinic in the morning. Correct D. Send the infant to the urgent care center for intravenous fluids. 11. A toddler is prescribed a liquid oral medication. The parent tells the primary care ID: 84 pediatric nurse practitioner that the child refuses to take medications and usually spits them out. What will the nurse practitioner do? A. Demonstrate oral medication administration with the toddler in the office. rrect B. Instruct the parent to hide the medication in a favorite food or beverage. C. Order the medication to be given via another route if possible. D. Tell the parent to offer the child a reward each time the medication is taken. 12. The primary care pediatric nurse practitioner orders a pulmonology consult for a ID: 88 child who has severe asthma. The nurse practitioner writes “child with asthma refractory to conventional treatments needs suggestions for alternative treatments.” The nurse practitioner expects the pulmonologist to A. confirm the medical diagnosis for the child’s parents. B. make recommendations for disease management. Correct C. stress the importance of adherence to the medication regimen. D. take over management of this child’s chronic illness. 13. The primary care pediatric nurse practitioner cares for several families with K. L. ID: chronically ill children who text status updates about their children to a mobile device that has an encryption­ protection platform installed. If the nurse practitioner misplaces the mobile device, it is important to A. disconnect the user from the system to avoid a data breach. Correct B. notify the families that their messages may be read by others. C. obtain a new device as soon as possible to resume communication. D. upload the messages from another remote device. 14. The parent of an 18­month­old child calls the clinic to report that the child has a I. J. ID: rectal temperature of 100.4°F (38°C). The child is playing normally, taking fluids well, and has a slightly reduced appetite. What will the primary care pediatric nurse practitioner recommend? G. A. Administering an antipyretic medication B. Bringing the child to the clinic for evaluation C. Offering extra fluids and calling if symptoms change orrect D. Ordering outpatient lab work such as a CBC 15. The parent of a preschool­age child calls the clinic to report that the child has H. ID: clear, watery drainage from both eyes, mild erythema of the conjunctiva, and no fever or other symptoms. What will the primary care pediatric nurse practitioner recommend? A. Allow the child to go to preschool. Correct B. Bring the child to the clinic for a culture. C. Keep the child home for 2 days. D. Use antibiotic eyedrops for 3 days.. 16. A parent brings a 4­month­old infant to the clinic who has had a low­grade fever E. F. ID: for 24 hours. The primary care nurse practitioner notes that the infant has a weak cry, slightly dry oral mucosa, mottled skin, and a respiratory rate of 65 breaths per minute and sleeps unless stimulated by the examiner,. What will the nurse practitioner do? A. Administer oral fluids in the clinic. B. Admit the infant to the hospital. Correct C. Order outpatient laboratory tests. D. Send the infant home with close follow­up. Questions 1. A pharmaceutical company has developed a new drug that was tested only ID: 05 on adults. The FDA has declared this drug to have potential benefits for ill children. According to the Pediatric Research Equity Act (PREA), what may the pharmaceutical company be required to do? A. Conduct pediatric drug studies to determine whether the drug is safe and effective in children. Correct B. Provide labeling stating that the safety and efficacy of the drug is not established for children. C. Receive a patent extension for conducting pediatric studies to determine use in children. D. Survey existing data about the drug to determine potential use in the pediatric population. 2. The primary care pediatric nurse practitioner prescribes a new medication for ID: 09 a child who develops a previously unknown adverse reaction. To report this, the nurse practitioner will A. access the BPCA website. B. call the PREA hotline. C. log onto the FDA Medwatch website. Correct D. use the AAP online PediaLink program. 3. The primary care pediatric nurse practitioner is considering use of a relatively ID: 01 new drug for a 15­month­old child. The drug is metabolized by the liver, so the nurse practitioner will consult a pharmacologist to discuss giving the drug: A. less often or at a lower dose. Correct B. more often or at a higher dose. C. via a parenteral route. D. via the oral route. 4. The primary care pediatric nurse practitioner is considering using a drug for ID: 07 an “off­label” use in a child. The nurse practitioner has used the drug in a similar situation previously, has consulted a pharmacology resource and the FDA website, and has determined that there are no significant contraindications and warnings for this child. What else must the nurse practitioner do when prescribing this drug? A. Discuss recommendations with the parents and document their consent. Correct B. Document anecdotal reports of previous use of the drug by other providers. C. Follow up daily with the parents to determine safe administration of the drug. I. D. Report this use to the FDA Medwatch website for tracking purposes. 5. The primary care pediatric nurse practitioner is counseling an adolescent J. ID: who was recently hospitalized for an asthma exacerbation and learns that the child usually forgets to use twice­ daily inhaled corticosteroid medications that are supposed to be given at 0800 and 2000 each day. Which strategy may be useful in this case to improve adherence? A. Ask the adolescent to identify two times each day that may work better. Correct B. Consider having the school nurse supervise medication administration. G. C. Prescribing a daily oral corticosteroid medication instead. D. Suggest that the parent enforce the medication regimen each day. 6. The primary care pediatric nurse practitioner is treating a toddler who has a H. ID: lower respiratory tract illness with a low­grade fever. The child is eating and taking fluids well and has normal oxygen saturations in the clinic. The nurse practitioner suspects that the child has a viral pneumonia and will A. order an anti­viral medication and schedule a follow­up appointment. B. prescribe a broad­spectrum antibiotic until the lab results are received. C. teach the parents symptomatic care and order labs to help with the diagnosis. Correct D. write a prescription for an antibiotic to be given if the child’s condition worsens. E. 7. The single mother of a 4­year­old who attends day care tells the primary care F. ID: pediatric nurse practitioner that she had difficulty giving her child a twice­daily amoxicillin for 10 days to treat otitis media during a previous episode several months earlier because she works two jobs and is too busy. The child has an ear infection in the clinic today. What will the nurse practitioner do? C. A. Administer an intramuscular antibiotic. B. Order twice­daily amoxicillin for 5 days. C. Prescribe azithromycin once daily for 5 days. Correct D. Reinforce the need to adhere to the plan of care. 8. The parent of a school­age child who has asthma tells the primary care D. ID: pediatric nurse practitioner that the child often comes home from school with severe wheezing after gym class and needs to use his metered­dose inhaler right away. What will the nurse practitioner do? A. Recommend that the child go to the school nurse when symptoms start. B. Review the child’s asthma action plan and possibly increase his steroid dose. C. Suggest asking the school to excuse the child from gym class. D. Write the prescription for two metered­dose inhalers with spacers. Correct Questions 1. The primary care pediatric nurse practitioner is evaluating a 10­year­old child ID: 17 who is describing shooting pain in both legs associated with aching, tingling, and burning. The child is unable to pinpoint specific locations for this pain. Which type of pain does the nurse practitioner suspect? A. Chronic pain B. Neuropathic pain Correct C. Somatic pain D. Visceral pain 2. A 3­year­old child is recovering from injuries sustained in a motor vehicle ID: 21 accident. How will the primary care pediatric nurse practitioner evaluate this child’s pain? A. Ask the child to rate pain intensity on a 4­ to 5­item pain discrimination scale. B. Have the child describe any pain as “no pain, a little pain, or a lot of pain.” Correct C. Question the child about the intensity and specific location of any pain. D. Rely on nonverbal responses such as facial expressions and limb movements. 3. A 4­year­old child has just been released from the hospital after orthopedic ID: 25 surgery on one leg following a bicycle accident. The child is sitting quietly on the exam table. When asked to rate pain, the child points to the “1” on a faces rating pain scale. What will the primary care pediatric nurse practitioner do next? A. Assess the child’s vital signs and ability to walk without pain. Correct B. Refill the prescription for a narcotic analgesic medication. C. Suggest that the parents give acetaminophen for mild pain. D. Teach the parent to give analgesics based on the child’s report of pain. 4. A developmentally and cognitively disabled 10­year­old child who is unable to ID: 27 communicate must undergo a series of surgeries, and the child’s parent asks how to know if the child is in pain and when to give pain medication. What will the primary care pediatric nurse practitioner teach this parent to use to assess this child’s pain? A. Comfort scale B. FLACC scale C. NCCPC­R Correct D. Non­verbal observations 5. The primary care pediatric nurse practitioner is preparing to perform a painful ID: 23 procedure on a 4­month­old infant. Besides providing local anesthesia, what other pain control method provides analgesic effects? A. Providing toys B. Singing or music C. Sucrose solution Correct D. Swaddling or cuddling 6. An adolescent female reports moderate dysmenorrhea with periods and tells the primary care pediatric nurse practitioner that 400 mg ibuprofen every 6 to 8 completely control her pain. What will the nurse practitioner recommend? A. Increasing the ibuprofen dose to 600 to 800 mg every 6 to 8 hours B. Taking extra­strength acetaminophen 1000 mg every 4 to 6 hours C. Taking naproxen 500 mg initially and then 250 mg every 6 to 8 hours D. Using extended­release naproxen 500 mg every 12 hours 7. What is the most important dose­limiting factor when prescribing acetaminophen with hydrocodone? A. Acetaminophen dose Correct B. Gastrointestinal side effects C. Pruritis symptoms D. Urinary retention 8. An adolescent takes ibuprofen, acetaminophen, and a tricyclic antidepressant ID: 33 hours doesn’t ID: 31 ID: 19 (TCA) to treat phantom limb pain and reports that the medications are no longer effective. What will the primary care pediatric nurse practitioner do? A. Change the TCA to a selective serotonin reuptake inhibitor. B. Evaluate the adolescent for drug­seeking behavior. C. Increase the TCA dose and reevaluate in 2 to 3 weeks. D. Refer the adolescent to a pain management specialist. Correct 9. The parent of a school­age child with a chronic pain condition tells the ID: 29 primary care pediatric nurse practitioner that the child has requested to stay home from school more often in the past few months. The child’s exam does not reveal any significant change in pathology, and a review of the child’s medications indicates appropriate dosing of analgesic medications. What will the nurse practitioner recommend? A. Assessing the child’s pain every day to determine changes B. Ensuring the child stays quiet in bed with videos when having pain C. Having the child do homework when staying home from school Correct D. Requiring the child to go to school even during pain episodes Questions 1. A 2­month­old infant has a staccato cough and fever. Which aspect of the history is most important in determining the diagnosis? A. Day care attendance B. Immunization history Correct C. Medication history D. Past medical history 2. When reviewing a white blood cell (WBC) count, the primary care pediatric nurse practitioner suspects a viral infection when which WBC element is elevated? A. Bands B. Leukocytes C. Lymphocytes D. Neutrophils 3. Which lab value is most concerning in an infant with fever and a suspected bacterial infection? A. C­reactive protein of 11.5 mg/L Correct B. Lymphocyte count of 8.7 C. Platelet count of 475 D. White blood cell count of 14 4. A toddler is receiving long­term antibiotics to treat osteomyelitis. Which laboratory ID: 47 ID: 99 ID: 51 ID: 93 test will the primary care pediatric nurse practitioner order to monitor response to therapy in this child? A. Blood cultures B. Erythrocyte sedimentation rate (ESR) Correct C. Serum procalcitonin (Pro­CT) D. White blood count (WBC) 5. According to recent research, which populations may have higher rates of under­ ID: 79 immunization than others? A. Those with higher rates of Asians B. Those with higher rates of graduate degrees Correct C. Those with lower rates of poverty D. Those with lower rates of primary providers 6. The parent of a 2­month­old infant is reluctant to have the baby vaccinated. What ID: 49 is an initial step in responding to these concerns? A. Inform the parent that all vaccines may be given without thimerosol. B. Providing Vaccine Information Statements for the parent to review. C. Question the parent’s reasons for concern about immunizations. D. Remind the parent that the infant is exposed to thousands of germs each day. 7. A parent is concerned about vaccine adverse reactions. Based on an Institute of Medicine report, what will the primary care pediatric nurse practitioner tell the parent? ID: 55 A. Administering multiple vaccines may trigger the development of type 1 diabetes. B. The MMR may be linked to febrile seizures in immunocompromised children. Correct C. There is some risk of CNS disorders associated with the hepatitis B vaccine. D. Vaccines containing thimerosol are linked to pervasive developmental disorders. 8. A 2­month­old infant will receive initial immunizations, and the parent asks about giving ID: 77 medications to increase the infant’s comfort and minimize fever. What will the pediatric primary care nurse practitioner recommend? A. Administering ibuprofen or acetaminophen as needed Correct B. Avoiding antipyretics if possible to attain better immunity C. Giving ibuprofen and acetaminophen only after the vaccines D. Pre­treating the infant with both ibuprofen and acetaminophen 9. The parent of an infant asks why some vaccines, such as MMR, are not given ID: 87 along with the other series of immunizations at 2, 4, and 6 months of age. What will the primary care pediatric nurse practitioner tell this parent? A. Febrile seizures are more likely in younger infants with some vaccines. B. Maternal antibodies neutralize some vaccines and are delayed until 12 months. Correct C. The risk of adverse effects is lower for some vaccines after the first year. D. Too many vaccines at once can overwhelm the infant’s immune system. 10. The primary care pediatric nurse practitioner is performing an initial well child ID: 39 exam on a 3­year­old child recently adopted from Africa. The adoptive parent has a record of immunizations indicating that the child is fully vaccinated. What will the nurse practitioner do? A. Administer a booster dose of each vaccine to ensure immunity. B. Find out whether the vaccines were provided by reliable suppliers. C. Perform antibody titers and reimmunize the child. Correct D. Record the vaccines in the child’s electronic medical record. 11. The primary care pediatric nurse practitioner reviews the immunization records of ID: 65 an 18­month­old child and notes that the child received an MMR immunization 2 days prior to the first birthday. What will the nurse practitioner do? A. Administer a reduced dose of MMR to ensure adequate immunity. B. Obtain mumps, measles, and rubella titers to determine immunity. C. Recommend the next dose of MMR vaccine at 4 to 5 years of age. Correct D. Repeat the MMR vaccine since the first dose was given too soon 12. A 5­year­old child who has a history of pertussis infection as an infant is in the clinic for immunizations prior to kindergarten. Which vaccine will be given? A. DTaP B. DTP C. Td D. Tdap 13. An adolescent female who is sexually active and who has not had the HPV ID: 91 ID: 57 vaccine asks if she may have it. What will the primary care pediatric nurse practitioner tell her? A. Getting the vaccine now will still protect her from HPV oncogenic types even if already exposed B. Receiving the HPV vaccine series will replace the need for regular cervical cancer screening C. She will need to have Papanicolaou and pregnancy screening prior to receiving the vaccine D. The vaccine will not protect her from any HPV oncogenic types acquired previously Correct 14. An 18­month­old child has bronchopulmonary dysplasia. To help prevent ID: 61 pneumococcal disease, which vaccine will be ordered? A. PCV7 B. PCV13 Correct C. PCV23 D. PCV33 15. A 5­year­old child who received VariZIG after exposure to varicella while M. N. ID: immunocompromised during chemotherapy is in the clinic 5 months after stopping chemotherapy for kindergarten vaccines. What will the primary care pediatric nurse practitioner order for this child? K. A. MMR and Tdap B. MMR, Varivax, Tdap Correct C. Tdap only D. Varivax and Tdap 16. A 3­year­old child who attends day care has had a fever, nausea, and vomiting L. ID: several weeks prior and now has darkened urine and constipation along with hepatomegaly and right upper quadrant tenderness. What treatment is warranted for this child? I. A. HAV vaccine B. Immunoglobulin G C. Interferon­alfa D. Supportive care Correct 17. A 10­month­old infant who is new to the clinic has chronic hepatitis B infection. J. ID: What will the primary care pediatric nurse practitioner do to manage this infant’s disease? G. A. Consult a pediatric infectious disease specialist. Correct B. Prescribe interferon­alfa. C. Provide supportive care. D. Consider use of lamivudine. 18. The primary care pediatric nurse practitioner performs a well child examination on H. ID: a 1­month­old. The infant was recently discharged from the neonatal intensive care unit after treatment with parenteral acyclovir for a neonatal herpetic infection and is currently taking oral acyclovir. What will the nurse practitioner do to manage this infant’s care? A. Obtain regular absolute neutrophil counts. Correct B. Perform routine skin cultures for herpes simplex virus. C. Reinforce the need to give acyclovir indefinitely. D. Stop the oral acyclovir at 2 months of age. 19. A 9­month­old infant has had a fever of 103°F for 2 days and now has a diffuse, E. F. ID: maculopapular rash that blanches on pressure. The infant’s immunizations are up­to­date. What will the primary care pediatric nurse practitioner do? A. Administer immunoglobulin G to prevent fulminant illness. B. Perform serologic testing for human herpes virus ­6 and human herpes virus ­7. C. Reassure the parent that this is a mild, self­limiting disease. Correct D. Recommend avoiding contact with pregnant women. 20. A child who is immunocompromised has a fever and a rash consisting of macules, papules, and pustules. What will the primary care pediatric nurse practitioner do? A. Administer varicella immune globulin (VariZIG). B. Hospitalize the child for intravenous acyclovir. Correct C. Order intravenous immunoglobulin as an outpatient. D. Prescribe oral acyclovir for the duration of the illness. 21. A child whose parents have refused vaccines has been exposed to chickenpox, ID: 71 ID: 63 and the parents ask whether the child may attend day care. What will the primary care pediatric nurse practitioner tell them? A. The child may attend day care as long as no rash is present even with mild fever or other symptoms. B. The child should remain home and receive oral acyclovir for 5 days to prevent onset of symptoms. C. The child should stay home until the 21­day incubation period has passed even if symptom free. D. The child should stay home if any symptoms occur and may return in 1 week if no rash develops. Correct 22. An 18­month­old child who developed upper respiratory symptoms 1 day prior is ID: 97 brought to the clinic with a high fever, chills, muscle pains, and a dry, hacking cough. A rapid influenza test is negative and a viral culture is pending. What will the primary care pediatric nurse practitioner do? A. Consider therapy with rimantadine. B. Hospitalize for supportive treatment. C. Prescribe oseltamivir and follow closely Correct D. Wait for cultures to determine treatment. 23. The primary care pediatric nurse practitioner is reviewing medical records for a ID: 81 newborn that is new to the clinic. The toddler’s mother was found to be HIV positive during her pregnancy with this child and received antiretroviral therapy during pregnancy. The child was born by cesarean section, begun on anti­retroviral prophylaxis, and did not breastfeed. What is the correct management for this child? A. Consult with a pediatric HIV specialist. Correct B. Discontinue cART after 4 weeks of age. C. Obtain a CD4+ cell count and HIV RNA levels. D. Reinforce the need to give cART for life. 24. A 3­year­old child whose immunizations are up­to­date has been exposed to ID: 95 measles because of a localized outbreak among unvaccinated children. The parent reports that contact with infected children occurred within the last 2 days at a birthday party. What is the best course of action? A. Administer the MMR vaccine to help prevent disease. Correct B. Give antiviral medications at the first sign of symptoms. C. Give the child a dose of immune globulin to mitigate the response. D. Reassure the parent that most exposed children will not get measles. 25. A preschool­age child is brought to clinic for evaluation of a rash. The primary ID: 73 care pediatric nurse practitioner notes an intense red eruption on the child’s cheeks and circumoral pallor. What will the nurse practitioner tell the parents about this rash? A. This rash may be a prodromal sign of rubella or roseola. B. The child will need immunization boosters to prevent serious disease. C. This is a benign rash with no known serious complications. D. Expect a lacy, maculopapular rash to develop on the trunk and extremities. Correct 26. An unimmunized school­age child whose mother is in her first trimester of ID: 45 pregnancy is diagnosed with rubella after a local outbreak. What will the primary care pediatric nurse practitioner recommend? A. Assessment of maternal rubella titers Correct B. Intravenous immunoglobulin for the child C. MMR vaccine for the mother and child D. Possible termination of the pregnancy 27. A child is brought to the clinic with a fever, headache, malaise, and a red, annular ID: 83 macule surrounded by an area of clearing and a larger, erythematous annular ring. The child complains of itching at the site. What will the primary care pediatric nurse practitioner do to determine the diagnosis? A. Ask about recent tick bites Correct B. Obtain a skin culture C. Order blood cultures D. Perform serologic testing 28. A child whose family has been camping in a region with endemic Lyme disease suffered several tick bites. The parents report removing the ticks but are not able to or the length of time the ticks were attached. The child is asymptomatic. What is the action? A. Administer a prophylactic single dose of doxycycline. B. Perform serologic testing for IgG or IgM antibodies. C. Prescribe amoxicillin three times daily for 14 to 21 days. D. Teach the parents which signs and symptoms to report. Correct 29. A 10­month­old infant has an erythematous, fluctuant, non­draining abscess on FH.. I. ID: 69 verify the type G. ID: the right buttock after 10 days of treatment with amoxicillin for impetigo. What is the next step in managing this infant’s care? A. Consultation with a pediatric infectious disease specialist B. Culture of any superficial open surface wounds C. Empiric treatment with clindamycin D. Incision and drainage of the abscess with culture 30. A child with a history of a pustular rash at the site of a cat scratch on one arm now D. E. ID: has warm, tender, swollen axillary lymph nodes on the affected side. The primary care pediatric nurse practitioner notes induration and erythema of these nodes. What will the nurse practitioner do? A. Obtain a complete blood count and C­reactive protein. B. Order an immunofluorescent assay (IFA) for serum antibodies. orrect C. Perform a needle aspiration of the affected lymph nodes. D. Prescribe a 5­day course of azithromycin. 31. A 7­year­old child whose immunizations are up­to­date has a fever, headache, ID: 03 stiff neck, and photophobia. What course of treatment is indicated? A. Empiric treatment with oral antibiotics or intramuscular ceftriaxone B. Hospitalization for diagnosis and treatment with antibiotics C. Immediate vaccination with meningococcal vaccine D. Outpatient lab work, including a CBC and blood and CSF cultures 32. A school­age child has fever of 104°F, sore throat, vomiting and malaise. The ID: 89 primary care pediatric nurse practitioner observes that the tonsils, oropharynx, and palate are erythematous and covered with exudate; the tongue is coated and red; and there is a red, sandpaper­like rash on the child’s neck, trunk, and extremities. A rapid strep test is positive. What will the nurse practitioner do to manage this child’s illness? A. Administer intramuscular ceftriaxone. B. Hospitalize for further diagnostic tests. C. Prescribe oral amoxicillin. Correct D. Refer to a pediatric infectious disease specialist. 33. An adolescent has a TB skin test prior to working as a volunteer in a hospital. The ID: 53 adolescent is healthy and has not travelled to or from a TB­endemic area or had close contact with anyone who has TB. The Mantoux skin test shows 10 mm of induration after 48 hours. What will the primary care pediatric nurse practitioner do? A. Ask the adolescent about exposure to homeless persons. B. Order a chest radiograph to rule out active TB. C. Reassure the adolescent that this is a negative screen. Correct D. Refer the adolescent to an infectious disease specialist. 34. The primary care pediatric nurse practitioner is examining a 2­month­old infant ID: 75 with fever and cough. A WBC is 14,000/mm3 and a chest radiograph is normal. The infant is nursing well and having normal stools. What would be an appropriate next step? A. Admitting the infant to the hospital for LP and IV antibiotics B. Obtaining a blood culture, erythrocyte sedimentation rate, and C­reactive protein C. Performing a catheterized urinalysis to screen for leukocytes and nitrites Correct D. Prescribing empiric, broad­spectrum antibiotics with close follow­up Questions 1. An 8­year­old child is diagnosed with systemic lupus erythematosus (SLE), and ID: 68 the child’s parent asks if there is a cure. What will the primary care pediatric nurse practitioner tell the parent? A. Complete remission occurs in some children at the age of puberty. B. Periods of remission may occur but there is no permanent cure. Correct C. SLE can be cured with effective medication and treatment. D. The disease is always progressive with no cure and no remissions. 2. The primary care pediatric nurse practitioner examines a child who has had ID: 72 stiffness and warmth in the right knee and left ankle for 7 or 8 months but no back pain. The nurse practitioner will refer the child to a rheumatology specialist to evaluate for A. enthesitis­related JIA. B. oligoarticular JIA. Correct C. polyarticular JIA. D. systemic JIA. 3. The primary care pediatric nurse practitioner is managing care for a child who has JIA who has a positive ANA. Which specialty referral is critical for this child? A. Cardiology B. Ophthalmology Correct C. Orthopedics D. Pain management 4. The primary care pediatric nurse practitioner is prescribing ibuprofen for a 25 kg ID: 92 ID: 60 child with JIA who has oligoarthitis. If the child will take 4 doses per day, what is the maximum amount the child will receive per dose? A. 200 mg B. 250 mg Correct C. 400 mg D. 450 mg 5. The parent of a school­age child who is diagnosed with oligoarticular JIA asks the ID: 94 primary care pediatric nurse practitioner what exercises the child may do to help reduce symptoms. What will the nurse practitioner recommend? A. Running B. Swimming Correct C. Weights D. Yoga 6. A 12­year­old child is brought to the clinic with joint pain, a 3­week history of low­ ID: 80 grade fever, and a facial rash. The primary care pediatric nurse practitioner palpates an enlarged liver 2 cm below the subcostal margin along with diffuse lymphadenopathy. An ANA test is positive. Which test may be ordered to confirm a diagnosis of SLE? A. Anti­double­strand DNA antibodies Correct B. Anti­La antibodies C. Anti­Ro antibodies D. Anti­Sm antibodies 7. The primary care pediatric nurse practitioner is reviewing the rheumatology plan ID: 84 of care for a child who is diagnosed with SLE. Besides reinforcing information about prescribed medications, what will the nurse practitioner teach the family to help minimize flaring of episodes? A. Have the child rest between activities. B. Obtain regular ophthalmology exams. C. Participate in low­impact exercises. D. Use UVA and UVB sunscreen daily. Correct 8. An adolescent female reports poor sleep, fatigue, muscle and joint paint, and ID: 90 anxiety lasting for several months. The primary care pediatric nurse practitioner notes point tenderness at several sites. What will the nurse practitioner do next? A. Evaluate the adolescent’s pain using a numeric pain scale. B. Obtain ANA, CBC, liver function, and muscle enzymes tests. C. Reassure the adolescent that this condition is not life­threatening. D. Refer the adolescent to a rheumatologist for further evaluation. Correct 9. A child has a fever and arthralgia. The primary care pediatric nurse practitioner ID: 58 learns that the child had a sore throat 3 weeks prior and auscultates a murmur in the clinic. Which test will the nurse practitioner order? A. Anti­DNase B test B. ASO titer Correct C. Rapid strep test D. Throat culture 10. The primary care pediatric nurse practitioner sees a child for follow­up care after K. L. ID: hospitalization for ARF. The child has polyarthritis but no cardiac involvement. What will the nurse practitioner teach the family about ongoing care for this child? A. Aspirin is given for 2 weeks and then tapered to discontinue the medication. Correct I. B. Prophylactic amoxicillin will need to be given for 5 years. C. Steroids will be necessary to prevent development of heart disease. D. The child will need complete bedrest until all symptoms subside. 11. An 8­year­old boy has a recent history of an upper respiratory infection and J. ID: comes to the clinic with a maculopapular rash on his lower extremities and swelling and tenderness in both ankles. The pediatric nurse practitioner performs a UA, which shows proteinuria and hematuria and diagnoses HSP. What ongoing evaluation will the nurse practitioner perform during the course of this disease? A. ANA titers B. Blood pressure measurement Correct C. Chest radiographs D. Liver function studies 12. A 10­year­old child has a 1­week history of fever of 104°C that is unresponsive to G. H. ID: antipyretics. The primary care pediatric nurse practitioner examines the child and notes bilateral conjunctival injection and a polymorphous exanthema, with no other symptoms. Lab tests show elevated ESR, CRP, and platelets. Cultures are all negative. What will the nurse practitioner do? A. Begin treatment with intravenous methyl prednisone. B. Consider IVIG therapy if symptoms persist one more week. C. Order a baseline echocardiogram today and another in 2 weeks. Correct D. Reassure the child’s parents that this is a self­limiting disorder. 13. The primary care pediatric nurse practitioner is evaluating an 11­month­old infant E. F. ID: who has had three viral respiratory illnesses causing bronchiolitis. The child’s parents both have seasonal allergies and ask whether the infant may have asthma. What will the nurse practitioner tell the parents? A. “Although it is likely, based on family history, it is too soon to tell.” B. “There is little reason to suspect that your infant has asthma.” C. “With your infant’s history of bronchiolitis, asthma is very likely.” D. “Your infant has definitive symptoms consistent with a diagnosis of asthma.” 14. The primary care pediatric nurse practitioner is examining a school­age child who ID: 70 has had several hospitalizations for bronchitis and wheezing. The parent reports that the child has several coughing episodes associated with chest tightness each week and gets relief with an albuterol metered­dose inhaler. What will the nurse practitioner order? A. Allergy testing B. Chest radiography C. Spirometry testing Correct D. Sweat chloride test 15. A school­age child who uses a SABA and an inhaled corticosteroid medication is ID: 62 seen in the clinic for an acute asthma exacerbation. After 4 puffs of an inhaled short­acting B2­ agonist (SABA) every 20 minutes for three treatments, spirometry testing shows an FEV1 of 60% of the child’s personal best. What will the primary care pediatric nurse practitioner do next? A. Administer an oral corticosteroid and repeat the three treatments of the inhaled SABA. B. Admit the child to the hospital for every 2 hour inhaled SABA and intravenous steroids. C. Give the child 2 mg/kg of an oral corticosteroid and have the child taken to the emergency department. D. Order an oral corticosteroid, continue the SABA every 3 to 4 hours, and follow closely. Correct 16. A child who has been diagnosed with asthma for several years has been using a ID: 74 short­acting B2­agonist (SABA) to control symptoms. The primary care pediatric nurse practitioner learns that the child has recently begun using the SABA two or three times each week to treat wheezing and shortness of breath. The child currently has clear breath sounds and an FEV1 of 75% of personal best. What will the nurse practitioner do next? A. Add a daily inhaled corticosteroid. Correct B. Administer 3 SABA treatments. C. Continue the current treatment. D. Order an oral corticosteroid. 17. An adolescent who has asthma and severe perennial allergies has poor asthma ID: 64 control in spite of appropriate use of a SABA and a daily high­dose inhaled corticosteroid. What will the primary care pediatric nurse practitioner do next to manage this child’s asthma? A. Consider daily oral corticosteroid administration. B. Order an anticholinergic medication in conjunction with the current regimen. C. Prescribe a LABA/inhaled corticosteroid combination medication. D. Refer to a pulmonologist for omalizumab therapy. Correct 18. An adolescent who has exercise­induced asthma (EIA) is on the high school track ID: 88 team and has recently begun to practice daily during the school week. The adolescent uses 2 puffs of albuterol via a metered­dose inhaler 20 minutes before exercise but reports decreased effectiveness since beginning daily practice. What will the primary care pediatric nurse practitioner do? A. Counsel the adolescent to decrease the number of practices each week. B. Increase the albuterol to 4 puffs 20 minutes prior to exercise. C. Order a daily inhaled corticosteroid medication. Correct D. Prescribe cromolyn sodium in addition to the albuterol. 19. A school­age child with asthma is seen for a well child checkup and, in spite of ID: 56 “feeling fine,” has pronounced expiratory wheezes, decreased breath sounds, and an FEV1less than 70% of personal best. The primary care pediatric nurse practitioner learns that the child’s parent administers the daily medium­dose ICS but that the child is responsible for using the SABA. A treatment of 4 puffs of a SABA in clinic results in marked improvement in the child’s status. What will the nurse practitioner do? A. Have the parent administer all of the child’s medications. B. Increase the ICS medication to a high­dose preparation. C. Reinforce teaching about the importance of using the SABA. D. Teach the child and parent how to use home PEF monitoring. orrect 20. The parent of a school­age child reports that the child usually has allergic rhinitis ID: 52 symptoms beginning each fall and that non­sedating antihistamines are only marginally effective, especially for nasal obstruction symptoms. What will the primary care pediatric nurse practitioner do? A. Order an intranasal corticosteroid to begin 1 to 2 weeks prior to pollen season. Correct B. Prescribe a decongestant medication as adjunct therapy during pollen season. C. Recommend adding diphenhydramine to the child’s regimen for additional relief. D. Suggest using an over­the­counter intranasal decongestant. 21. A 4­month­old infant has a history of reddened, dry, itchy skin. The primary care ID: 66 pediatric nurse practitioner notes fine papules on the extensor aspect of the infant’s arms, anterior thighs, and lateral aspects of the cheeks. What is the initial treatment? A. Moisturizers Correct B. Oral antihistamines C. Topical corticosteroids D. Wet wrap therapy 22. The primary care pediatric nurse practitioner is performing a well­baby checkup ID: 86 on a 6­month­old infant and notes a candida diaper rash and oral thrush. The infant has had two ear infections in the past 2 months and is in the 3rd percentile for weight. What will the nurse practitioner do? A. Order a CBC with differential and platelets and quantitative immunoglobulins. Correct B. Order candida and pneumococcal skin tests and lymphocyte surface markers. C. Refer the infant to an immunologist for evaluation of immunodeficiency. D. Refer the infant to an otolaryngologist to evaluate recurrent otitis media. Questions 1. The primary care pediatric nurse practitioner evaluates children’s growth to ID: 92 screen for endocrine and metabolic disorders. Which is a critical component of this screening? A. Measuring supine length in children over the age of 2 years B. Obtaining serial measurements to assess patterns over time ID: 53 C. Using the CDC growth chart for children under age 2 years D. Using the WHO growth chart for children over age 2 years 2. The primary care pediatric nurse practitioner is performing a well child examination on a 5­year­old girl. The parents ask if the child s adult height can be predicted. The nurse practitioner learns that the mother is 5'8" tall and the father is 5'11" tall. The nurse practitioner will estimate which expected adult height for this child? A. 5'11" tall B. 5'7" tall Correct C. 5'8" tall D. 6' tall Correct ID: 00 3. The primary care pediatric nurse practitioner is performing a well child examination on a 2­year­old child with a history of intrauterine growth retardation (IUGR) whose height remains less than the 3rd percentile on a WHO growth chart. What will the nurse practitioner do? A. Consider prescribing growth hormone therapy. B. Reassure the parent that this is normal for this child. C. Refer the child to a dietician for dietary supplementation. D. Refer the child to a pediatric endocrinologist. Correct ID: 82 4. The primary care pediatric nurse practitioner is evaluating a child who has short stature. Although bone age studies reveal a delay in bone age, the child’s growth is consistent with bone age. Which diagnosis is most likely? A. Constitutional growth delay Correct B. Growth hormone deficiency C. Idiopathic short stature D. Klinefelter syndrome 5. The mother of a female infant is concerned that her daughter is developing ID: 06 breasts. The primary care pediatric nurse practitioner notes mild breast development but no pubic or axillary hair. What is the likely diagnosis? A. Congenital adrenal hyperplasia causing breast development B. Precocious puberty needing endocrinology management C. Premature adrenarche which will lead to pubic hair onset D. Premature thelarche which will resolve over time Correct 6. A 7­year­old female has recently developed pubic and axillary hair without breast ID: 96 development. Her bone age is consistent with her chronological age, and a pediatric endocrinologist has diagnosed idiopathic premature adrenarche. The primary care pediatric nurse practitioner will monitor this child for which condition? A. Adrenal tumor B. Congenital adrenal hyperplasia C. Polycystic ovary syndrome Correct D. Type 1 diabetes mellitus 7. A 6­year­old female has had a recent growth spurt and an exam reveals breast ID: 90 and pubic hair development. Her bone age is determined to be 8 years. What will the primary care pediatric nurse practitioner do next? A. Order LH and FSH levels and a long­acting GnRH agonist. B. Order thyroid function tests to exclude primary hypothyroidism. C. Reassure the parent that this is most likely idiopathic. D. Refer the child to a pediatric endocrinologist for management. Correct 8. An infant has congenital adrenal hyperplasia. At a routine well baby checkup, the primary care pediatric nurse practitioner notes vomiting, poor feeding, lethargy, and dehydration. Which action is correct? A. Administer an intramuscular stress dose of hydrocortisone succinate. B. Administer intravenous fluids in the clinic and reassess hydration status. C. Prescribe an oral hydrocortisone in a replacement dose of 8 to 10 mg/M2. D. Refer the infant to the emergency department for fluids, dextrose, and steroids. Correct 9. The primary care pediatric nurse practitioner performs a physical examination on ID: 04 mild ID: 78 a 9­month­old infant with congenital hypothyroidism who takes daily levothyroxine sodium and notes a recent slowing of the infant’s growth rate. What will the nurse practitioner order? A. Free serum T4 and TSH levels Correct B. Serum levothyroxine level C. Total T4 and free T4 levels D. TSH and total T4 levels 10. A 12­year­old child has a recent history of increased thirst and frequent urination. ID: 88 The child’s weight has been in the 95th percentile for several years. A dipstick UA is positive for glucose, and random plasma glucose is 350 mg/dL. Which test will the primary care pediatric nurse practitioner order to determine the type of diabetes in this child? A. Fasting plasma glucose B. Hemoglobin A1C levels C. Pancreatic antibodies Correct D. Thyroid function tests 11. The primary care pediatric nurse practitioner diagnoses an 8­year­old child with ID: 94 type 1 diabetes after a routine urine screen is positive for glucose and negative for ketones and plasma glucose is 350 mg/dL. The child’s weight is normal and the parents report a mild increase in thirst and urine output in the past few days. Which course of action is correct? A. Admit the child to the hospital for initial insulin management. B. Begin insulin and refer the child to a children’s diabetes center. Correct C. Order a fasting serum glucose and a dipstick UA in the morning. D. Send the child to the emergency department for fluids and IV insulin. 12. The primary care pediatric nurse practitioner is reviewing lab work and diabetes ID: 98 management with a school­age child whose HbA1C is 7.6% who reports usual blood sugars before meals as being 80 to 90 mg/dL. The nurse practitioner will consult with the child’s endocrinologist to consider which therapy? A. Continuous glucose monitoring Correct B. Continuous subcutaneous insulin infusion C. Self­monitoring of blood glucose D. Use of a long­acting insulin analogue 13. The primary care pediatric nurse practitioner is performing a well child ID: 80 examination on a 12­year­old child who was diagnosed with type 1 diabetes at age 9. The child had a lipid screen at age 10 with an LDL cholesterol <100 mg/dL. What will the nurse practitioner recommend as part of ongoing management for this child? A. Annual lipid profile evaluation B. Annual screening for microalbuminuria C. Comprehensive ophthalmologic exam Correct D. Hypothyroidism screening every 5 years 14. A 13­year­old Native American female has a BMI at the 90th percentile for age. ID: 86 The primary care pediatric nurse practitioner notes the presence of a hyperpigmented velvet­like rash in skin folds. The child denies polydipsia, polyphagia, and polyuria. The nurse practitioner will A. counsel the child to lose weight to prevent type 2 diabetes. B. diagnose type 2 diabetes if the child has a random glucose of 180 mg/dL. C. order a fasting blood sample for a metabolic screen for type 2 diabetes. Correct D. refer the child to a pediatric endocrinologist. 15. The primary care pediatric nurse practitioner prescribes metformin for a 15­year­ ID: 12 old adolescent newly diagnosed with type 2 diabetes. What will the nurse practitioner include when teaching the adolescent about this drug? A. That insulin therapy will be necessary in the future B. The importance of checking blood glucose 3 or 4 times daily ID: 84 Correct C. To consume a diet with foods that are high in vitamin B12 D. To use a stool softener to prevent gastrointestinal side effects 16. A 16­year­old adolescent female whose BMI is at the 90th percentile reports irregular periods. The primary care pediatric nurse practitioner notes widespread acne on her face and back and an abnormal distribution of facial hair. The nurse practitioner will evaluate her further based on a suspicion of which diagnosis? A. Dyslipidemia B. Hypothyroidism C. Nonalcoholic steatohepatitis D. Polycystic ovary syndrome Correct ID: 10 17. The primary care pediatric nurse practitioner is providing nutritional counseling for a 9­year­old female whose weight is at the 95th percentile for her age. What is the goal for this patient? A. A loss of 10 to 15 pounds in 6 months B. An average weight loss of 2 pounds per month C. Maintenance of her current weight Correct D. Weight loss of 5% of her current body weight 18. The primary care pediatric nurse practitioner notes a musty odor when examining ID: 02 a newborn at a 2­week checkup. What will the nurse practitioner suspect? A. Galactosemia B. Glucose­6­phosphatase deficiency C. Phenylketonuria Correct D. Urea cycle disorder 19. An initial key part of management of a child suspected of having an inborn error ID: 76 of metabolism is A. consulting a metabolic specialist. Correct B. obtaining a complete family history. C. ordering metabolic screening tests. D. referring the family to a dietician. Questions 1. The primary care pediatric nurse practitioner reviews a child’s complete blood count with differential white blood cell values and recognizes a “left shift” because of A. a decreased eosinophil count. B. a decreased lymphocyte count. C. an elevated monocyte count. D. an elevated neutrophil count. Correct 2. A complete blood count on a 12­month­old infant reveals microcytic, hypochromic ID: 12 ID: 08 anemia with a hemoglobin of 9.5 g/dL. The infant has mild pallor with no hepatosplenomegaly. The primary care pediatric nurse practitioner suspects A. hereditary spherocytosis. B. iron­deficiency anemia. Correct C. lead intoxication. D. sickle­cell anemia. 3. The primary care pediatric nurse practitioner evaluates a 5­year­old child who ID: 92 presents with pallor and obtains labs revealing a hemoglobin of 8.5 g/dL and a hematocrit of 31%. How will the nurse practitioner manage this patient? A. Prescribe elemental iron and recheck labs in 1 month. Correct B. Reassure the parent that this represents mild anemia. C. Recommend a diet high in iron­rich foods. D. Refer to a hematologist for further evaluation. 4. The primary care pediatric nurse practitioner is managing care for a child ID: 04 diagnosed with iron­deficiency anemia who had an initial hemoglobin of 8.8 g/dL and hematocrit of 32% who has been receiving ferrous sulfate as 3 mg/kg/day of elemental iron for 4 weeks. The child’s current lab work reveals elevations in Hgb/Hct and reticulocytes with a hemoglobin of 10.5 g/dL and a hematocrit of 36%. What is the next step in management of this patient? A. Continue the current dose of ferrous sulfate and recheck labs in 1 to 2 months. Correct B. Discontinue the supplemental iron and encourage an iron­enriched diet. C. Increase the ferrous sulfate dose to 4 to 6 mg/kg/day of elemental iron. D. Refer the child to a pediatric hematologist to further evaluate the anemia. 5. The primary care pediatric nurse practitioner performs a well baby examination ID: 10 on a 4­month­old infant who is exclusively breastfed and whose mother plans to introduce only small amounts of fruits and vegetables in addition to breastfeeding. To ensure that the infant gets adequate amounts of iron, what will the nurse practitioner recommend? A. Elemental iron supplementation of 1 mg/kg/day until cereals are added Correct B. Elemental iron supplementation of 3 mg/kg/day for the duration of breastfeeding C. Monitoring the infant’s hemoglobin and hematocrit at every well­baby checkup D. Offering iron­fortified formula to ensure adequate iron intake 6. The primary care pediatric nurse practitioner reviews hematology reports on a ID: 98 child with beta­thalassemia minor and notes an Hgb level of 8 g/dL. What will the nurse practitioner do? A. Evaluate serum ferritin. Correct B. Order Hgb electrophoresis. C. Prescribe supplemental iron. D. Refer for RBC transfusions. 7. The primary care pediatric nurse practitioner sees a 12­month­old infant who is ID: 88 being fed goat’s milk and a vegetarian diet. The child is pale and has a beefy­red, sore tongue and oral mucous membranes. Which tests will the nurse practitioner order to evaluate this child’s condition? A. Hemoglobin electrophoresis B. RBC folate, iron, and B12 levels Correct C. Reticulocyte levels D. Serum lead levels 8. A toddler who presents with anemia and reticulocytopenia has a history of a ID: 02