PC-PNCB Exam Topics (Answered) 2022/2023

PC-PNCB Exam Topics BACKGROUND: - 3yo boy - abnormal stools x6mo (greasy, floating) - Freq sinus infxn (tx = amox) QUESTION: Which DX test? A) Anti-transglutaminase IgA B) Ciliary biopsy + molecular genetic testing C) Pulm Fxn Testing D) Sweat Chloride Testing CORRECT ANSWER(S): D) Sweat Chloride Test for CF (>60mEq/L) WRONG ANSWERS: A) Dx's celiac disease B) Dx's primary ciliary dyskinesia C) Dx asthma & determines lung fxn in CF BACKGROUND: - IOM recommendations of NP as part of a team QUESTION: Which is true? A) Regulatory construct that mandates autonomy of NP B) Leader appointed by statute C) Laws allow full participation of team to potential of training and skill D) NP role varies CORRECT ANSWER(S): D) NP role varies WRONG ANSWERS: A) Team-based care is not a regulatory construct B) Should be flexible C) Current laws prohibit this BACKGROUND: - 1 wk old infant - "Clunk" with adducting legs while applying downward and lateral pressure on knees QUESTION: What sign is this? A) Barlow B) Psoas C) Ortolani D) Galeazzi CORRECT ANSWER(S): A) Barlow --> DDH WRONG ANSWERS: B) Pain elicited by passively extending thigh of pt lying on side --> appendicitis C) Hip relocation and "clunk" w/abduction of legs and lifting up on trochanters -->DDH D) Discrepancy in height of flexed thighs (affected limb is shortened) -->DDH BACKGROUND: - 25-OH Vitamin D Level of 19ng/mL - Normal Xrays QUESTION: What is the diagnosis? A) Vitamin D Deficiency B) Rickets C) Vitamin D Insufficiency D) Nothing, this child is normal CORRECT ANSWER(S): A) Vit D Deficiency levels are <20 WRONG ANSWERS: B) Can't be this because normal Xray C) Vit D Insuff levels are 20-30 D) Incorrect BACKGROUND: - Screening test of 100 subjects - 20 screening tests are positive (18 actually have it) - 80 screening tests are negative (10 actually have it) QUESTION: What probability that pt has it when test is positive? A) 0.28 B) 0.64 C) 0.87 D) 0.90 CORRECT ANSWER(S): D) Positive Predictive Value: 18 correct positives / 20 total positives = 0.90 % are correct positives WRONG ANSWERS: A) This is the Prevalence (total number of those that actually have it / total number of subjects) B) This is the Sensitivity (# positive tests/#people with disease) C) Negative Predictive Value (probability that person will not have the disease if the test is negative = 70/80) BACKGROUND: - Avoidance QUESTION: What is true when using avoidance as a method of conflict resolution? A) Results in pursuing one's own goals at expense of another B) Results in meeting the goal's of the other person C) It does not address the conflict D) Effective when individuals are of equal power CORRECT ANSWER(S): C) It does not address the conflict, only postpones it WRONG ANSWERS: A) This is Competition B) This is Accommodation D) This is Compromise BACKGROUND: - Pt in alcohol withdrawal QUESTION: How do you communicate with this pt? A) Cheerful tone & humor B) Short sentences & matter of fact manner C) Loud voice to ensure pt can hear D) Full explanations in a soft voice CORRECT ANSWER(S): B) Pt may be disoriented & anxious WRONG ANSWERS: A) Leads pt to feeling like the staff member is laughing at him, which may lead to withdrawal C) Loud tone of voice makes pt feel as though he's being yelled at or chastised D) Typically these pts can't follow extensive explanations, so keep sentences short & to the point BACKGROUND: - 10yo male w/Constitutional Growth Delay QUESTION: Kid asks, "When will I be as tall as my Dad?" A) Eventually, you'll hit a growth spurt B) Little chance you'll be as tall as your dad C) Unsure what final height will be, but should be less than Dad D) Eat well, otherwise you'll always be short CORRECT ANSWER(S): A QUESTION: What % of adolescents who commit suicide suffered from associated psychiatric disorder at the time of their death? A) 90% B) 75% C) 50% D) 30% CORRECT ANSWER(S): A) 90% Preceding stressful events include romantic breakups, school/legal probs, & death in the family BACKGROUND: GI = N/V/Ab Pain Renal = Diabetes Insipidus Neuro = tremor, ataxia, coma QUESTION: Most effective tx for this type of poisoning? A) Activated Charcoal B) Sodium Bicar C) Glucagon D) Hemodialysis CORRECT ANSWER(S): D) Hemodialysis bc this is lithium toxicity -- other mgmt includes whole bowel irrigation w/polyethylene glycol & IV saline rehydration. WRONG ANSWERS: A) Used for ______ overdose B) Used for TCA overdose C) Used for Bblocker overdose QUESTION: Which feature is characteristic of Prader-Willi Syndrome? A) Genetic abnormality on chromosome 7 B) Pts w/short stature, hypogonadism, hyperphagia, and obesity C) Generalized Anx DO = most common associated psych DO D) Level of insight w/regard to obsessions & compulsions is low CORRECT ANSWER(S): B) Short stature, hypogonadism, hyperphagia, and obesity WRONG ANSWERS: A) Prader-Willi abnormality is a deletion on chromosome 15 C) OCD = most associated psych DO D) Level of insight varies QUESTION: Which of the following is true of advocacy within the nursing profession? A) Most rules that control advanced practice are shaped by nurses B) NPs have high comfort level w/advocacy C) Professional nursing orgs do not facilitate opportunities for NPs to branch out on their own with advocacy D) Broader representation from the NP community is necessary for NPs to have impact on healthcare legislation CORRECT ANSWER(S): D) Not enough NPs are engaged in healthcare policy process WRONG ANSWERS: A) B) C) BACKGROUND: - 8 yo white male - 3wk hx of diarrhea, explosive for the first 4 days progressing to greasy loose stools w/out blood or mucus - Occasional cramping/bloating w/belching - Afebrile - UO = normal, but 4 lb weight loss since onset - Exam = hyperactive bowel sounds, moderate abdominal bloating without tenderness, no tenderness on rectal exam QUESTION: What is the etiology of his diarrhea? A) Norwalk Virus B) Shigella C) Giardia Intestinalis D) Enteroinvasive E. coli CORRECT ANSWER(S): C) Giardia Intestinalis --> Most common intestinal parasite in US & UK --> Explosive watery diarrhea progressing to subacute greasy/malodorous stools w/foul flatulence, abdominal bloating, and sulphurous eructation --> Weight loss is common --> Acquired from contaminated water sources or from oral-fecal contamination WRONG ANSWERS: These all present a more acute picture with dehydration. A) Norwalk Virus B) Shigella D) Enteroinvasive E. coli QUESTION: Which is true of the appropriations bill? A) Usually originate in Senate B) Provide spending for the life of the bill C) Establish laws or programs and contain recommended dollar amounts D) Provide for spending authority of a single fiscal year CORRECT ANSWER(S): D) Authorization vs. Appropriations --- Authorizations: establish laws or programs & can recommend dollar amounts, but do not allocate funds or guarantee funding --- Appropriations: provide spending authority for a single fiscal year from Oct 1 through Sept 30 WRONG ANSWERS: A) These originate in the House of Reps B) There are different types of appropriations bills that extend for different amounts of time C) This describes authorization bills, which must be funded by appropriations bills BACKGROUND: - 4yo male - Progressive periorbital edema, wt gain, anorexia, & nausea for several weeks - PE = HTN - UA = 4+ Protein QUESTION: What is also most likely? A) Hyperalbuminemia B) Thrombophilia C) Hypotriglyceridemia D) Urinary bacteria CORRECT ANSWER(S): B) This is Nephrotic Syndrome -- May have microscopic hematuria -- Acute mgmt = fluid restriction, systemic corticosteroid therapy, and admission for possible renal biopsy WRONG ANSWERS: A) Should be HYPOalbuminemia C) Should be HYPOlipidemia D) UTI usually not assoc'd QUESTION: Which of the following has demostrated to have the single greatest impact on incident reduction? A) Quality of professional education B) Years of personnel experience C) Development of safety culture D) Penalties for violation of safety rules CORRECT ANSWER(S): C) WRONG ANSWERS: A) B) D) QUESTION: In which scenario is breastfeeding contraindicated? A) Mom + for Hep C Virus Antibody B) Baby + for Galactose 1-Phosphate Uridyltransferase Deficiency on NS C) Hyperbilirubinemia admitted for phototherapy D) Mom + for CMV CORRECT ANSWER(S): B) WRONG ANSWERS: A) C) D) BACKGROUND: - 2yo male - eyes moving rapidly/randomly/erratically in all directions - yesterday, arms/legs jerk sporadically and involuntarily - today, difficulty walking - 2 months ago, had strep pharyngitis treated with 10days of amox QUESTION: What is the next best step? A) Measure urinary vanillylmandelic acid B) Obtain an ASO titer C) Perform EEG D) Reassurance CORRECT ANSWER(S): A) This is opsoclonus-myoclonus syndrome ("dancing eyes, dancing feet") -- presents prior to 3yo -- 40-50% have neuroblastoma, which secretes vanillylmandelic acid (excreted in urine) -- get a 24-hr measurement of catecholamine levels -- can also get CT/MRI, US, or PET WRONG ANSWERS: B) Pt will have +ASO titer due to recent strep (w/in last 6 mo) C) D) BACKGROUND: - 2 Groups, each of 100 pts w/cervical cancer - Group A = New Drug, Q = 96/100 go into remission - Group B = Std Tx = 80/100 go into remission QUESTION: What is the odds ratio for improved treatment with Q? A) 0.1 B) 0.17 C) 0.36 D) 6.0 CORRECT ANSWER(S): D) Odds Ratio = (RemissionGroupA x NoRemissionGroupB) / (NoRemissionGroupA x RemissionGroupB) WRONG ANSWERS: A) B) C) BACKGROUND: - Term Male weighing 3000g - APGAR 7, 9 - Hypoplastic nasal alae, thin upper lip, mild micrognathia, & submucosal cleft palate - Vibratory holosystolic murmur (no cyanosis) - US --> VSD - Tolerating formula & passed meconium - Day 2 of life, jerky movements in all four extremities QUESTION: What treatment does this child need? A) IV Calcium Gluconate B) IV Phenobarb C) IV 10% Dextrose Soln D) IV Pyridoxine CORRECT ANSWER(S): A) This is DiGeorge with a sz due to low calcium (from hypoparathyroidism) WRONG ANSWERS: B) DOC for neonatal sz caused by brain disorders C) DOC for when sz caused by hypoglycemia D) Pyridoxine dependency is rare cause of neonatal sz BACKGROUND: - 15mo boy - Met all developmental milestones - Eye Exam = white reflex w/strabismus QUESTION: Next step in mgmt? A) Antibiotics B) Oph referral C) Cover affected eye D) Cover the normal eye CORRECT ANSWER(S): B) This is retinoblastoma (most common malignant eye tumor in children) WRONG ANSWERS: A) C) D) In amblyopia, patch dominant eye to allow weak eye to get stronger QUESTION: Nonmaleficence is a principle ethic in nursing. It is best described as: A) Compassion, desire to do good B) Dedication, fairness, honesty, agreement to keep promises C) Avoidance of harm D) Equal and fair distribution of resources based on impartial analysis of benefits CORRECT ANSWER(S): C) WRONG ANSWERS: A) This is Beneficence B) This is Fidelity D) This is justice QUESTION: Researcher believes DASH diet will reduce systolic BP in a population to <140mmHg. Which of the following tests should the researcher use to analyze data? A) One-tailed test B) Two-tailed test C) Correlation D) Standard Deviation CORRECT ANSWER(S): A) Used where "region of rejection" of the null hypothesis is only on one side of the sampling distribution (2 options = below 140, above 140) WRONG ANSWERS: B) "Region of rejection" is on both sides of the sampling distribution (3 options = below 120, 120-140, and above 140) C) Determines relationship b/t 2 variables, but does not distinguish b/t dep and indep variables D) Measure of how much scores deviate from the mean QUESTION: Which common electrolyte & BP abnormalities would be expected in a 4wk male w/severe congenital adrenal hyperplasia? A) Hyper Na, K, -tension B) Hypo Na, K, -tension C) Hypo Na, -tension, HyperK D) Hypo Na, Hyper K, -tension CORRECT ANSWER(S): C) Hyponatremia, Hyperkalemia, Hypotension - Salt-Wasting! - Could also have recurrent vomit, dehydration, and shock - Females have ambiguous genitalia at birth - 21-Hydroxylase Deficiency --> insufficient cortisone, aldosterone WRONG ANSWERS: A) B) D) BACKGROUND: - 4 day old male - ab pain w/sudden green/yellow vomiting - fussy all day, ill a few hours earlier - mildly distended abdomen - backwards L on ab XR QUESTION: What is the next best step in mgmt? A) Barium enema B) Emergency Surgery C) Broad Spectrum abx for presumed NEC D) Obtain US to r/o pyloric stenosis CORRECT ANSWER(S): B) Gastric and Duodenal dilation on XR = malrotation w/midgut volvulus - Double Bubble on XR - Surg reduces volvulus & relieves ischemia caused by constriction of the bowel's mesenteric blood supply - Necrosis can occur in as little as 3 hours BACKGROUND: - 3yo girl - short stature, macroceph, flat midface w/prominent forehead, rhizomelic shortening of limbs - signs of hydrocephalus - MRI = narrowing of foramen magnum & compression of brainstem --> neurosurgery QUESTION: Patient most likely has a mutation in which gene? A) FGFR3 B) FBN1 C) FMR1 D) MECP2 E) MTTL1 CORRECT ANSWER(S): A) These are characteristic of Achondroplasia, a result of mutation in FGFR3 WRONG ANSWERS: B) FBN1 Mutations = Marfans C) FMR1 Mutations = Fragile X D) MECP2 Mutations = Rett Syndrome E) MTTL1 Mutations = MELAS BACKGROUND: - 17yo F - Menarche at 11yo, very irregular since then - No menstruation in 4 months - Comedonal acne over forehead, cheeks, & chin + scattered pigmented hair on chin & upper lip - UPT is negative - LH, FSH, Estrogen, DHEA-S, TSH normal ranges - LH:FSH = >2:1 - Prolactin, Total Test, & Free Test slightly elevated QUESTION: ? A) Reassurance, irreg menses is norm until reg menses is established B) CT to eval for prolactinoma or pit tumor C) Start continuous progestin-only OCP D) Start combined OCP + Wt Loss + Exercise CORRECT ANSWER(S): D) This is Secondary Amenorrhea (caused by either pregnancy, anorexia, or PCOS). PCOS because obese, excessive androgens (acne, hirsutism), and LH:FHS >2:1 WRONG ANSWERS: A) Irreg menses is norm only in 1st 2 years after menarche + amenorrhea for >3mo is always uncommon B) Rare cause of amenorrhea, and only mildly elevated prolactin levels C) This may exacerbate symptoms QUESTION: Which of the following is true regarding acute salicylate toxicity? A) Tx w/Done nomogram B) Initial S/S = tinnitus & altered hearing C) Metab Alk = characteristic D) Significant GI bleeding in most pts E) Hyperkalemia CORRECT ANSWER(S): B) WRONG ANSWERS: A) C) Metab ACIDosis is characteristic D) For chronic use, not acute toxicity E) Should result in HYPOkalemia BACKGROUND: - 1wk term male in NICU for aortic stenosis & poor feeding - Cards waiting until older to correct heart since adequate systemic BP - PO feeds poor, requiring most feeds via NG - Labs show consistent hypercalcemia QUESTION: What diagnosis explains cardiac anomaly + hypercalcemia? A) Down Syndrome B) 22q11 deletion C) Prader Willi D) Williams Syndrome CORRECT ANSWER(S): D) Williams Syndrome - Elastin Gene Mutation --> hypercalcemia in neonates, supravalvular aortic stenosis, & intellectual disability WRONG ANSWERS: A) No hypercalcemia in Downs B) DiGeorge --> conotruncal cardiac anomalies, hypoplastic thymus, and HYPOcalcemia C) No hypercalcemia in PWS; Neonatal hypotonia --> asphyxia Feeding diff (poor suck) --> FTT Weak cry, genital hypoplasia, hypothalamic & pituitary dysfxn QUESTION: Which of the following statements is true regarding the oversight of the functions of the APN? A) National laws regulate scope of practice for NPs B) Nursing profession articulates the scope of professional nursing practice and defines its boundaries C) NPs licensed in one state are bound by that state's scope of practice when practicing throughout the country D) Employers are responsible for ensuring that NPs practice w/in boundaries defined by state practice acts CORRECT ANSWER(S): B) WRONG ANSWERS: A) Each state develops own laws C) Must practice in licensed state D) Individual NPs are responsible QUESTION: Which of the following is a violation of patient confidentiality? Records released to A) Public Health Dept B) Insurance Company C) Referring physician D) Spouse CORRECT ANSWER(S): D) BACKGROUND: - 10mo w/hypotonia, alopecia, & sz - Labs = ketoacidosis, hyperammoniemia, elevated urine organic acid - Biotinidase deficiency is suspected QUESTION: What is true regarding Biotinidase deficiency? A) Biotin levels are elevated & should not be supplemented B) Hearing/Vision loss occur C) Biotin is a fat soluble B-complex vitamin D) Biotinidase does not participate in the processing of dietary protein-bound biotin CORRECT ANSWER(S): B) - Manifestations = sz, hypotonia, ataxia, dev delay, hearing/vision loss, spastic paraparesis, & cutaneous abnormalities (including alopecia) WRONG ANSWERS: A) Tx = biotin supp (prevents dev delay & reverses most symptoms) C) Biotin = water-soluble B-complex vit D) It is involved QUESTION: What is most significant risk factor in suicide in male adolescents? A) Prev suicide attempt B) Major Depressive Disorder C) Panic Disorder D) Substance Abuse CORRECT ANSWER(S): A) QUESTION: Law that improves access to transportation for older & Native Americans? A) Emergency Med Tx & Labor Act (EMTALA) B) Omnibus Budget Reconciliation Act (OBRA) C) Americans with Disabilities Act (ADA) D) Older Americans Act (OAA) CORRECT ANSWER(S): D) WRONG ANSWERS: A) EMTALA - prevents patient "dumping" from ERs, premature DC for economic reasons B) OBRA - Establishes guidelines for nursing facilities, such as long term care C) ADA - Provides physically & mentally disabled pts access to employment and the community QUESTION: Which of the following is true of evidence-based practice in medicine? A) Most evidence is rapidly integrated to clinical practice B) EBP refers only to use of current research evidence to formulate sound interventions C) National guidelines close gap b/t research outcomes & practice D) EBP is an approach that does not allow personalization of evidence to the pt CORRECT ANSWER(S): C) WRONG ANSWERS: A) May take 17 years to implement B) Uses current research, clinical expertise, and pt values to formulate interventions for pt care D) Should be personalized QUESTION: What % of child maltreatment is neglect (vs. physical, sexual, and emotional abuse)? A) 10% B) 25% C) 60% D) 90% CORRECT ANSWER(S): C) WRONG ANSWERS: Physical = 20% Sexual = 10% Emotional = 5% BACKGROUND: - 17yoF - Severe ab pain + n/v + fever + tachycardia - Previously eval'd for appendicitis, & other GYN causes - No cutaneous manifestations - Labs: increase aminolevulinic acid & PBG concentrations in urine; no increase in urinary/fecal coproporphyrin III. QUESTION: Which of the following is correct regarding this condition? A) Affected enzyme = PBG deaminase B) Affected enzyme = coproporphyrinogen oxidase C) Affected enzyme = protoporphyrinogen oxidase D) Sz can occur & should be tx'd w/phenobarb CORRECT ANSWER(S): A) This is acute intermittent porphyria (AIP) WRONG ANSWERS: B) C) D) BACKGROUND: - 3yo boy during WCC - Speech delay, but possible other delays QUESTION: What important screening test can you do on older kids with dev delays? A) TSH B) Metabolic Studies C) Venous Blood Lead Levels D) ECG CORRECT ANSWER(S): C) WRONG ANSWERS: A, B) Not indicated in child growing well w/normal NS D) Not indicated w/o hx of staring spells or other suspicious behav QUESTION: Current treatment for bulimia nervosa w/o bipolar d/o? A) SSRI B) Antipsychotic C) Mood Stabilizer D) CBT & SSRI CORRECT ANSWER(S): D) Specifically, Fluoxetine WRONG ANSWERS: A) B) C) QUESTION: Factitious vs. Conversion DOs? Factitious - Munchausen Syndrome Conversion - psuedoneuro syndrome; not caused by a physiologic disorder QUESTION: Which of the following statements regarding the cause of macrocephaly is correct? A) Can be d/t enlargement of subdural space B) Always associated w/increase in CSF production C) Never a benign finding D) Familial megalencephaly = most common cause CORRECT ANSWER(S): D) WRONG ANSWERS: A) *subarachnoid space, not subdural B) C) QUESTION: Which of the following statements about gender role behavior in children is correct? A) Boys less likely to engage in rough-and-tumble play than girls B) Girls more likely to express aggression through physical means C) Most children exhibit preference for same-sex playmates in middle childhood D) Gender role behavior generally correlates with erotic feelings CORRECT ANSWER(S): C) WRONG ANSWERS: A) Boys more likely to engage in rough-and-tumble play than girls B) Girls more likely to express aggression through verbal means D) Gender role behaviors (toy preferences, gesture, speech, social rules, and expression of aggression) are distinct from erotic feelings BACKGROUND: - Screening test to detect gonorrhea - 200 people studied - Positive test = 75 (25 false) - Negative test = 125 (50 false) QUESTION: Which of the following represents the negative predictive value of this test? A) 75/200 B) 50/125 C) 75/125 D) 25/100 CORRECT ANSWER(S): C) Negative Predictive Value = #TrueNegs / (#TrueNegs+#FalseNegs) QUESTION: Which of the following = std of care for primary stroke prevention in SCA w/abnormal transcranial dopplers? A) Chronic transfusion therapy B) Aspirin C) Warfarin D) Hydroxyurea CORRECT ANSWER(S): A) BACKGROUND: - Unexplained resp distress as newborn - Chronic bronchitis, sinusitis, & otitis w/age - Upper resp tract probs = year-round nasal drainage - Conductive hearing loss w/chronic middle ear effusion - Imaging = normal organ anatomy QUESTION: Exam of ciliary ultra-structure by transmission electron microscopy who lead to which of the following DX? A) Primary Ciliary Dyskinesia (PCD) B) Chronic Sinusitis C) Kartagener Syndrome D) Situ Abnormalities CORRECT ANSWER(S): A) defects causing inability of cilia to beat normally --> chronic cough, chronic rhinitis, chronic sinusitis WRONG ANSWERS: B) C) Chronic sinusitis, bronchiectasis, & situs inversus D) QUESTION: According to Piaget, when does object permanence happens at what age? A) 4mo B) 7mo C) 8mo D) 12mo CORRECT ANSWER(S): C) 8mo S/S of mono Bilateral cervical lymphadenopathy Mild fever & tachycardia Recent rash & sore throat x5 days Amox --> fine reticulated maculopapular rash QUESTION: Which of the following is a characteristic of qualitative research? A) Random Sampling B) Meta-Analysis of Data C) Research is Fundamentally Interpretive D) Use of a control group CORRECT ANSWER(S): C) - Broadly stated q's ab human experiences - Defines "how" instead of "how many" WRONG ANSWERS: A)Sampling techniques = purposive B) Data analysis is not statistical D) No control group BACKGROUND: - 5yo boy - bloody diarrhea x several days - fatigue, pallor, and malaise - several kids at school = similar complaints - Labs = severe anemia, thrombocytopenia, renal insuff QUESTION: Which of the following most likely cause of symptoms? A) Shigella B) Salmonella C) E. coli D) Rotavirus CORRECT ANSWER(S): C) E Coli - Triad of anemia, thrombocytopenia, and renal insuff = HUS or TTP (E. Coli is responsible for most HUS) - Tx = supportive & preventing complications of anemia + thrombocytopenia WRONG ANSWERS: A) Shigella (less common) B, D) Salmonella species & RV are not implicated BACKGROUND: - 9 day old neonate + seizures - remains afebrile - mom has been diluting formula QUESTION: What is most likely cause of seizures? A) Hypokalemia B) Hyponatremia C) Hypocalcemia D) Hypomagnesemia CORRECT ANSWER(S): B) In newborn w/o fever, hyponatremia = most common cause for seizure - Water intoxication is most common cause of hyponatremia during infancy (unable to concentrate urine adequately) WRONG ANSWERS: A) Uncommon in infancy & does not typically cause seizures C) Possible, but would be more likely if mom was diabetic, baby was preterm or had hx of anoxic enceph D) Possible, but even less likely than Hypocalcemia BACKGROUND: - 5 yo w/daily fevers q evening - Flat rash on trunk comes and goes, lasting a few hours - Child c/o jt pains & often limps - Less energy than normal - Mom says she looks ill QUESTION: What is this most consistent with? A) Polyarticular JIA B) Oligoarticular JIA C) Systemic JIA D) Psoriatic Arth CORRECT ANSWER(S): C) Often presents w/ill appearing child w/chronic daily fevers and a fleeting evanescent rash -- often arthralgias & myalgias, but may delayed years WRONG ANSWERS: A) Polyarticular JIA = 5+ jts w/in 1st 6 mo, wt bearing jts often affected w/some systemic involvement; ANA is positive B) Oligoarticular/Pauciarticular JIA = 4 or fewer jts, often large wt bearing jts --> flexion contractures; NO systemic involvement; ANA can be positive if uveitis present D) Psoriatic Arthritis - monoarticular & precedes rash; pitting nails, sacroilitis, and tenosynovitis BACKGROUND: - 5 yo boy weighing 50 lbs QUESTION: What are his safety restraints when riding in car? A) Rear-facing infant seat in back seat B) Rear-facing booster seat in back seat C) Booster seat in front seat D) Booster seat in back seat CORRECT ANSWER(S): D) Booster seat in back seat Two National Rules: - Rear facing until at least 1 yo - Must be in separate restraint (plus seatbelt) until 4 yo or 40lbs WRONG ANSWERS: A) B) C) D) BACKGROUND: - 2 hr old female in NICU - FT, 5180g via in vitro - Omphalocele prev eval'd by surg - Now jittery w/BG at 12 - PE = macroglossia, facial nevus flammeus, midface hypoplasia, & infraorbital creases QUESTION: Which of the following is she at risk for? A) Acute Lymphoid Leukemia B) Osteosarcoma C) Medullary Thyroid Cancer D) Hepatoblastoma CORRECT ANSWER(S): D) This is Beckwith-Wiedemann Syndrome (11p15) --> Wilms and Hepatoblastoma (do US and measure serum AFP) WRONG ANSWERS: A) B) C) BACKGROUND: - 14mo w/head injury after fall QUESTION: When assessing children with injuries, which of the following findings does the nurse consider most concerning for possible child abuse or neglect? A) Bruise in crawling, but not walking child B) Delay by parents in seeking care C) Bruising on legs D) Any scald injury in child under age of 5 CORRECT ANSWER(S): B) WRONG ANSWERS: A) 2 or more bruises in child not yet crawling = red flag C) Red Flag Bruising on torso, neck, ears, or buttocks; bite marks also D) Immersion scald injuries w/clear demarcation line (rather than splatter patter) are consistent w/abuse QUESTION: Which of the following statements regarding physiological peripheral pulm stenosis (PPPS) is true? A) May resolve spontaneously by 2-6 mo B) Majority of cases have an associated syndrome C) Detailed w/u to be done in neonatal period to find the etiology D) Usually associated w/mild cyanosis CORRECT ANSWER(S): A) PPPS d/t persistent fetal anatomy - soft, harsh systolic ejection murmur best heard at axilla WRONG ANSWERS: B) C) D) QUESTION: Which of the following is true of teamwork training for interprofessional collaborative practice in health professions education? A) Outcomes-based competency expectations required B) Includes training with other nurses only C) Has lagged behind practice changes D) Primary responsibility for developing core competencies = w/state Nursing Board CORRECT ANSWER(S): C) WRONG ANSWERS: A) Often not outcomes-based competencies expectations B) Includes all healthcare professions D) Primary responsibility for developing core competencies = health professions schools QUESTION: Which of the following is a legal requirement to practice as an NP? A) Certification B) Licensure C) Collaborative Agreement D) NPI CORRECT ANSWER(S): B) Licensure = legal requirement WRONG ANSWERS: A) "Voluntary" process granted by nongov agency (but now mandated in most states as a condition of licensure) C) Written agreement b/t supervising physician & NP D) Required for billing QUESTION: Which of the following is correct re: dx of intellectual disability? A) Assess via developmental hx B) Neuropsych = gold std for dx'ing intellectual disability C) Dx using lab findings D) There are correctable causes of cognitive impairment and behavioral disturbance CORRECT ANSWER(S): D) Vision/Hearing impairments, seizure DOs, and recent head injury are some causes that can be corrected that can cause cognitive & behavioral disturbances WRONG ANSWERS: A) Dev Hx alone is inadequate (should be used w/school perf, social adaptations) B) Neuropsych helps confirm dx & quantifies pt's strengths & deficits C) No single lab test to dx for intellectual disability and many kiddos w/dev delay do not have abnormal labs BACKGROUND: - 9 yo fever x2 days, peaking at 103.6F + occasional productive cough & rhinorrhea - somewhat lethargic, eating poorly, drinking well - Pulse ox at 89%, appears moderately ill, bibasilar rales w/scattered rhonchi - Bacterial PNA suspected --> pt hospitalized - CXR = discrete infiltrate in right middle lobe w/air bronchograms QUESTION: What is this pattern termed? A) Lobar PNA B) Pneumatocele C) Miliary PNA D) Interstitial PNA CORRECT ANSWER(S): A) Lobar = discrete, unilateral infiltrate in single lobe (usually bacterial) WRONG ANSWERS: B) Pneumatocele = gas-filled cavity in lung parenchyma C) MIliary PNA = MULTIPLE discrete lesions d/t hematogenous spread of pathogen to lungs D) Interstitial PNA = patchy or diffuse infiltrates of the interstitium in preference to the parenchyma (usually viral) QUESTION: What do the following symbols mean in a familial pedigree? A) Filled Square or Circle B) Empty Square or Circle C) Dot in middle of empty shape D) Triangle E) Diagonal Dash ANSWERS A) Diseased M (sq) or F (circ) B) Healthy M (sq) or F (circ) C) Carrier D) Sex unknown E) Death BACKGROUND: - 21mo fell on playground from 1-foot elevated platform, scraping his head, no LOC - PE = small abrasions on L temple, L palm, and bilat knees; small bruises in various stages of healing on arms/legs, as well as posterior and lateral chest and back of neck at base of hairline - Mom says "plays rough, he is a boy after all" and "is extremely accident-prone) - No previous ED visits QUESTION: What do you order next? A) MRI of brain B) CT scan of head C) Skeletal survey D) Neurology consult CORRECT ANSWER(S): C) Skeletal Survey for kids <2yo d/t concerns regarding placement of older bruising (abuse = bruises on chest, back, butt, neck, ear, cheeks, & genitals); also r/o bleeding DOs WRONG ANSWERS: A) B) D) BACKGROUND: - 9yo returned from India 1 wk ago - 2 day hx of progressive fever, H/A, malaise, N without V, and generalized ab pain w/minimal loose stools (no frank diarrhea) - UTD on immunizations + Hep A & Yellow Fever prior to trip - Took Mefloquine for malaria prophylaxis throughout her visit - PE = dehydrated, HR in 50s, faint/blanching/erythematous rash over chest & upper ab - Labs = mild high WBC and mod high LFTs QUESTION: Which of the following is true? A) Req admission for likely dengue fever, start IV clinda B) Relative bradycardia + high fever may indicated typhoid fever C) Contracted strain of malaria resistant to mefloquine D) WBC diff most likely reveals a high eosinophils CORRECT ANSWER(S): B) Typhoid Fever WRONG ANSWERS: A) Dengue = viral, not tx'd with abx (mosquito-borne infxn); usually present w/fever, malaise, and severe myalgias/arthralgias C) Unlikely since prophylaxis (mefloquine is very effective) D) Traveler's w/fever and elevated eosinophils = helminth infxn (as