PNP Board Certification Review (fall)- Health Promotion and Well-Child Care for Infants, Children, and Adolescents

1. Sixteen-year-old Sarah makes the following state-ments to you during a health visit. Which of the fol-lowing pieces of information should not be kept confidential? a. "I have been sexually active with three of my boyfriends." b. "I sometimes smoke marijuana. "c. "I want to get pregnant." d. "Sometimes I feel like ending my life." - ANSWER-1. D: Any statements a patient makes that entail harm of self or others are not covered by patient confidential-ity guidelines. 2. In performing a physical examination of a 9-month-old infant, which of the following developmental fears would not be appropriate for you to consider? a. Stranger anxiety b. Pain c. Separation from parents d. Bodily harm - ANSWER-2. D: A 9-month-old infant is not capable of such higher-order thinking. 3. When performing a physical examination of a toddler, which of the following body parts would you examine last? a. Heart and lungs b. Abdomen and genitals c. Ears and throat d. Hips and extremities - ANSWER-3. C: Ears and throat examination is most threatening to the toddler and likely to produce resistance during the examination. 4. Role-play with equipment during the course of a physical examination would be most beneficial with which of the following age groups? a. Toddlers b. Preschoolers c. Young school-age children d. Older school-age children - ANSWER-4. B: Preschoolers engage in imaginative play and are more easily engaged in this activity. 5. Providing reassurance of "normalcy" during the course of an examination would be most important for: a. Preschool children b. Young school-age children c. Older school-age children d. Adolescents - ANSWER-5. D: Adolescents have heightened concerns regarding body image. They fear that they are abnormal and would be reassured by this behavior. 6. Which of the following would not elevate the pulse of a child? a. Fever b. Anemia c. Hypothyroidism d. Exercise - ANSWER-6. C: Hypothyroidism decreases body metabolism, and the others cause an increase in body metabolism and subsequent pulse rate. 7. The PNP recognizes which of the following signs as indicators that a baby is not receiving sufficient breastmilk? a. Sleepiness, jaundice, and decreased urine and stool b. Diarrhea, nausea, and vomiting c. Bulging fontanel and irritability d. Sleeplessness and excitability - ANSWER-7. A: Decreased intake would cause decreased alertness and decreased excretion of bilirubin due to decreased urine and stool output. 8. Blood pressure should be measured at well-child vis-its beginning at age: a. 2 years b. 3 years c. 4 years d. 5 years - ANSWER-8. B: At age 3 years, per AAP recommendations for pre-ventive pediatric health care. 9. A wide pulse pressure that results from a high sys-tolic blood pressure is usually not due to which of the following? a. Fever b. Exercise c. Excitement d. A patent ductus arteriosus - ANSWER-9. D: Pulse pressure is the difference between systolic and diastolic blood pressures (normal is 20 to 50 mm Hg). A wide pulse pressure from high systolic pressure is usually due to fever, exercise, or excitement. A wide pulse pressure from low diastolic pressure is usually due to patent ductus arteriosus, aortic regurgitation, or other serious heart disease. 10. Head and chest circumferences should be equal at: a. 6 months of age b. 1 year of age c. 2 years of age d. 3 years of age - ANSWER-10. B: Head circumference is approximately 2 cm larger than chest during the first year of life; head and chest circumferences should be equal at 1 year of age; dur-ing childhood, chest is usually 5 to 7 cm larger than head. 11. The anterior fontanel usually closes by: a. 2 months of age b. 6 months of age c. 18 months of age d. 24 months of age - ANSWER-11. C: The posterior fontanel closes at 2 months, and the anterior fontanel closes at 18 months. 12. Diffuse edema of the soft tissue of the scalp that usu-ally crosses suture lines in the newborn is: a. Bossing b. Caput succedaneum c. Cephalohematoma d. Macrocephaly - ANSWER-12. B: Caput succedaneum crosses the suture lines, whereas a cephalohematoma does not. Macrocephaly is enlarged head circumference, and bossing is full-ness of the frontal area. 13. An infant should no longer have a head lag when pulled from the supine to sitting position at what age? a. 2 months b. 4 months c. 6 months d. 9 months - ANSWER-13. C: By 6 months of age, there should be no head lag when infant is pulled from supine to sitting position; if present, it may indicate neuromuscular disorder; may be the first sign of cerebral palsy. 14. "Boggy" nasal mucous membranes with serous drain-age upon examination usually suggest: a. Sinusitis b. Polyps c. URI d. Allergic rhinitis - ANSWER-14. D: Boggy nasal mucous membranes (bluish, pale, edematous) with serous drainage indicates allergic rhinitis. 15. A white instead of red reflex upon eye examination of a 1-year-old child would suggest: a. An accommodative error b. Retinoblastoma c. Papilledema d. Retinal detachment - ANSWER-15. B: White spots (leukokoria) within the area of either or both red reflexes is an abnormal red reflex and should be immediately referred to an ophthalmolo-gist for a more complete examination to rule out a retinoblastoma. 16. A cobblestone appearance of the palpebral conjunc-tiva usually indicates: a. Bacterial infection b. Chemical irritation c. Viral infection d. Severe allergy - ANSWER-16. D: A cobblestone appearance of the conjunctiva is consistent with allergic conjunctivitis. 17. An eye that deviates in when covered but that returns to midline when uncovered is an: a. Esophoria b. Exophoria c. Esotropia d. Exotropia - ANSWER-17. A: Esophoria is inward (eso) as opposed to outward (exo) movement of the eye when covered (phoria, as opposed to tropia, which is a movement of the eye without coverage). 18. Pain produced by manipulation of the auricle or pres-sure on the tragus suggests: a. Acute otitis media b. Otitis externa c. Otitis media with effusion d. Mastoiditis - ANSWER-18. B: Otitis externa is inflammation of the external audi-tory canal and is painful with movement of the ear structure. 19. A hypernasal voice and snoring in a child is suggestive of: a. Polyps of the larynx b. Nasopharyngeal tumor c. Hypertrophied adenoids d. Cleft palate - ANSWER-19. C: A hypernasal voice and/or snoring is characteristic of hypertrophied adenoids. 20. Physiologic splitting of the second heart sound during inspiration in a child: a. Is normal b. Should be evaluated with an EKG c. Suggests an ASD d. Should be referred to a cardiologist - ANSWER-20. A: Physiologic splitting of the second heart sound dur-ing inspiration in a child is normal (refer to cardiac section in this chapter). 21. Which of the following is not characteristic of inno-cent heart murmurs in children? a. Systolic in timing b. Varies in loudness with positioning c. Usually transmitted to the neck d. Usually loudest at lower left sternal border or at second or third intercostal space2 - ANSWER-21. C: Innocent murmurs rarely transmit to other areas of the body. 22. A Grade II musical or vibratory murmur heard best at the lower left sternal border that changes with posi-tioning is suggestive of a: a. Pulmonary ejection murmur b. Ventricular septal defect c. Venous hum d. Vibratory or Still's murmur - ANSWER-22. D: The description is that of an innocent murmur, which is termed vibratory or Still's murmur based on its grade, location, and sound. 23. Wheezing in a child may not be found in which of the following conditions? a. Asthma b. Bronchiolitis c. Pleural friction rub d. Cystic fibrosis - ANSWER-23. C: A pleural friction rub causes grating or squeaking sounds as the pleural lining rubs together. It does not cause wheezing. 24. Gynecomastia in a male may not be a finding in which of the following? a. Normal pubertal development b. Steroid usage c. Hypothyroidism d. Testicular tumor - ANSWER-24. C: Hypothyroidism produces less thyroxine and would not be a risk factor for increasing male estrogen levels, which are responsible for gynecomastia. 25. Which of the following would usually not be con-sidered a sign of a pituitary tumor in an adolescent female? a. Dysfunctional uterine bleeding b. Galactorrhea c. Loss of peripheral vision d. Increase in headaches - ANSWER-25. A: Less frequent or no menstrual periods are a sign of a pituitary tumor, so dysfunctional uterine bleeding would not occur in that disorder. The other symptoms can occur with a pituitary tumor. 26. Which of the following is not a specific examination test for a dislocated hip? a. Barlow's test b. Ortolani's test c. Trendelenburg test d. Gower's test - ANSWER-26. D: Gower's test is a sign described when a child has to use his hand to "walk" up his own body from a squat-ting position due to a weakness of the proximal mus-cles of the lower legs. 27. In addition to the knee, which of the following should be examined in a child complaining of knee pain? a. Foot b. Ankle c. Hip d. Spine - ANSWER-27. C: Disorders of the hip often present as knee pain, so hip deformities should be ruled out with a complaint of knee pain. 28. Which of the following infant reflexes should not dis-appear by 6 months of age? a. Moro b. Rooting c. Tonic neck d. Plantar grasp - ANSWER-28. D: Moro reflex is present from birth to 4-6 months, rooting reflex is present from birth to 3-4 months, tonic neck reflex is present from birth (or at 6 weeks) to 4-6 months, and plantar grasp reflex is present from birth to 10-12 months. 29. Spasticity in an infant may be an early sign of :a. Neurofibromatosis b. Hydrocephalus c. Cerebral palsy d. Muscular dystrophy - ANSWER-29. C: Spasticity is the most common symptom of cere-bral palsy. It results from damage to the motor cor-tex of the brain before, during, or after birth. This part of the brain is responsible for the control of body movements. 30. A shift to the left is present when which of the follow-ing are elevated? a. Neutrophils b. Bands or stabs c. Lymphocytes d. Eosinophils - ANSWER-30. B: Bands, which are immature WBCs, are elevated with bacterial infections. 31. Which of the following is usually elevated with viral infections? a. Neutrophils b. Eosinophils c. Lymphocytes d. Basophils - ANSWER-31. C: Lymphocytes are WBCs that are elevated with viral infections. 32. Decreased platelets may not be found in which of the following? a. Leukemia b. Anemia c. ITP d. Medication usage (e.g., ampicillin, cephalothin) - ANSWER-32. B: Anemia is indicated by a decreased hemoglobin/hematocrit and is not a platelet disorder. 33. Which of the following does not suggest a urinary tract infection? a. Increased protein b. Increased WBCs c. Increased RBCs d. Increased nitrites - ANSWER-33. A: Increased protein may be an indication of a kidney disorder and is not an indication of a urinary tract infection. 34. A Mantoux test in a child with no risk factors is con-sidered positive with a reaction of: a. At least 5 mm induration b. At least 8 mm induration c. At least 10 mm induration d. At least 15 mm induration - ANSWER-34. D: At least 15 mm induration is a positive screen, per the AAP. 35. The PNP teaches new parents that when breastfeed-ing is well established they can expect baby to have: a. As many as 4 wet diapers each day b. A stool every 2-3 days c. One wet diaper an hour d. Five to 6 wet diapers and 2-3 stools each day - ANSWER-35. D: Five to 6 wet diapers and 2-3 stools each day are expected by age 5 or 6 months and beyond. 36. Cholesterol screening should be done: a. On children 2 years of age and older who have a parent with a total cholesterol level of 240 mg/dL or greater b. Once for all children at 6 years of age c. On overweight children with a family history of premature cardiovascular disease d. Once for all children at 12 years of age - ANSWER-36. A: Children 2 years of age and older who have a parent with a total cholesterol level of 240 mg/dL or greater are at risk for elevated cholesterol level. It is a recom-mended screening test for children between 9 and 11 years of age. 37. For which of the following screening tests should chil-dren fast for 12 hours before the test is administered? a. Total cholesterol b. Serum chemistry profile c. Serum lipid profile d. Hematocrit - ANSWER-37. C: A lipid profile requires fasting to ensure fats ingested prior to the test have been metabolized. 38. Which of the following is the most important history-taking question for a sports evaluation? a. Has the child ever had a head injury? b. Has the child ever fainted or lost consciousness during exercise? c. Does the child ever get short of breath with exercise? d. Has the child ever undergone surgery? - ANSWER-38. B: Fainting or lost consciousness during exercise may indicate an underlying cardiac condition. 39. Which of the following conditions would not exclude a child from participating in contact collision sports? a. Fever b. Absence of a paired organ c. Atlantoaxial instability