NURS 6541 MIDTERM EXAM

NURS 6541 MIDTERM EXAM   Question 1 1 out of 1 points What is the most common form of child abuse seen in pediatric primary care? Selected Answer: c. Shaken baby syndrome  Question 2 1 out of 1 points Which of the following conditions requires urgent inpatient admission? Selected Answer: b. Cervical adenitis  Question 3 1 out of 1 points An eye that deviates in when covered but that returns to midline when uncovered is an Selected Answer: b. esophoria  Question 4 1 out of 1 points All of the following are consistent with peritonsillar abscess except: Selected Answer: c. Trismus  Question 5 1 out of 1 points Which adolescent would be at greatest risk for developing anorexia nervosa? Selected Answer: d. 14-year-old female gymnast  Question 6 1 out of 1 points A mother states that her 4-year-old son constantly grinds his teeth at night. You document this as: Selected Answer: b. Bruxism  Question 7 1 out of 1 points FIRST-LINE therapy for preschoolers (4-5 years of age) diagnosed with attention-deficit hyperactive disorder is: Selected Answer: c. Behavior therapy  Question 8 1 out of 1 points A 7-year-old has just been diagnosed with attention deficit hyperactivity disorder (ADHD). Her parents report that she is doing poorly in school and is disruptive in the classroom. They ask you what they can do. Your best response is: Selected Answer: c. "Use a consistent approach with behavioral cues both at home and at school."  Question 9 1 out of 1 points The most common substance used in middle school is Selected Answer: b. Alcohol  Question 10 1 out of 1 points The most likely weight of a 1-year-old whose birth weight was 6-1/2 pounds would be: Selected Answer: b. 19 to 20 pounds  Question 11 0 out of 1 points Which of the following characterizes middle adolescence (14 to 16 years old)? Selected Answer: c. Concrete thinking, present orientation, intense preoccupation with body image  Question 12 1 out of 1 points Mark, a 10-year-old, has a lot of ear pain. He does not want anyone to touch it and is crying in pain. The ear canal is swollen and exudate is present. The TM is normal. Mark should be instructed to do which of the following? Selected Answer: a. Keep ear dry until symptoms improve.  Question 13 1 out of 1 points A 2-year-old child weighs 34 lb. What type of car seat should the child use? Selected Answer: d. A forward-facing car seat in the back of the vehicle.  Question 14 1 out of 1 points An expected milestone of a 4-year-old is the ability to Selected Answer: b. Copy a cross  Question 15 0 out of 1 points A child's central visual acuity is 20/30 by age Selected Answer: b. 4 years  Question 16 0 out of 1 points Early reflexive responses that are not related to survival include all but: Selected Answer: c. Swimming  Question 17 1 out of 1 points Sam has an otitis media. He also presents with conjunctivitis. This is due to which organism? Selected Answer: d. Haemophilus influenza  Question 18 1 out of 1 points Which of the following children has abnormal language development? Selected Answer: b. Speech is 50% understandable at 36 months of age  Question 19 1 out of 1 points Appropriate advice for a mother of a 2-week-old child here for a “well child” visit includes which of the following? Selected Answer: b. Sleep in the supine position is recommended  Question 20 0 out of 1 points A 14-year-old female comes into the office for an urgent visit after taking 10 valium tablets. Following the initial emergent care and stailization, the most important part of the management is: Selected Answer: d. Obtaining a psychiatric consultation.  Question 21 1 out of 1 points Miguel, age 14, was hit in the eye with a baseball and developed eye pain, decreased visual acuity, and injection of the globe. Upon exam you note blood in the anterior chamber and confirm diagnosis of hyphema. What treatment do you recommend while Miguel is waiting to see the ophthalmologist Selected Answer: b. Apply bilateral eye patches.  Question 22 1 out of 1 points A 4-month-old presents with both eyes turning inward. What is this called? Selected Answer: c. Esotropia  Question 23 1 out of 1 points Sarah, age 15, presents with pain and pressure over her cheeks and discolored nasal discharge. You cannot transilluminate the sinuses. You suspect which common sinus to be affected? Selected Answer: d. Maxillary sinus  Question 24 1 out of 1 points You see a 30-month-old who speaks in mixed Spanish and English. The child’s vocabulary is normal but at the low end of the normal language spectrum. The parent is worried the child’s development will not be normal because she mixes up the two languages. You respond: Selected Answer: a. "Your child's speech is normal and bilingual children commonly intermix the words from both languages until about 3 years of age."  Question 25 1 out of 1 points Sarah, 7 years old, is in the office today. All of the following are acceptable management options for allergic rhinitis, except Selected Answer: d. Nasal neosynephrine  Question 26 1 out of 1 points The mother of a 4-year-old tells you he likes to "play with himself" while playing and watching television. You advise the mother to Selected Answer: d. Explain to the child that masturbation is something that should be done in private.  Question 27 1 out of 1 points Which of the following would not suggest an eating disorder with a purging component? Selected Answer: d. Diarrhea  Question 28 1 out of 1 points I can roll over, grasp a rattle, and reach for things and have begun feeding myself finger foods, but I can’t wave bye-bye yet. How old am I? Selected Answer: b. 6 months  Question 29 1 out of 1 points You see a 13-year-old who reports she is learning some basic geometry (areas, volume etc.). The ability to successfully master these concepts occurs during which Piaget developmental stage? Selected Answer: d. Formal operational  Question 30 0 out of 1 points A 7-year-old boy with mental retardation was born at home at 26 weeks gestation to a 28- year-old mother who had received no prenatal care. An evaluation is likely to suggest his MR is related to which of the following? Selected Answer: b. Congenital infection with cytomegalovirus  Question 31 1 out of 1 points You are doing a kindergarten physical on a 5-year-old girl. Which of the following scenarios would suggest the child is not ready to start kindergarten in the fall? Selected Answer: c. Counts to 4 and draws a person with three parts.  Question 32 1 out of 1 points A healthy, well-developed 6-year-old child arrives as a new patient to your clinic. His immunization card reveals that he received an immunization at birth and some when he was 2 months old, but none sense. Which of the following statements about him is correct? Selected Answer: a. He is too old to receive the Haemophilus influenzae Type B vaccine.  Question 33 1 out of 1 points Conductive hearing loss can be caused by Selected Answer: a. Serous otitis  Question 34 1 out of 1 points A fifteen-year-old female makes a statement to you during a well visit. Which of the following statements should not be kept confidential? Selected Answer: d. "Sometimes I feel like ending my life."  Question 35 1 out of 1 points Which of the following eye findings would be considered an ophthalmic emergency? Selected Answer: a. Unilateral vesicular lesions on the upper eyelid in a 3-week old.  Question 36 1 out of 1 points You see a 7-year-old with complaints of "having accidents at night." Physical exam and history are unremarkable. Urinalysis, urine culture, and specific gravity are normal. His parents ask about the best treatment for this problem. The best response is Selected Answer: c. Fluid restriction and voiding prior to the night may be effective.  Question 37 1 out of 1 points During a domestic health assessment, the CDC recommends screening every refugee child for which of the following diseases? Selected Answer: b. tuberculosis  Question 38 1 out of 1 points The diagnostic criteria for autism spectrum disorder include all of the following except Selected Answer: c. Tolerance of flexibility with routines  Question 39 0 out of 1 points A 19-month-old says “mama” and “dada,” points and gestures if he wants things, and follows simple one-step commands. Your best response is which of the following? Selected Answer: c. Encourage early intervention services for speech.  Question 40 1 out of 1 points While assessing the skin of an infant, you note cafe-au-lait spots. Which disease should be ruled out? Selected Answer: a. Neurofibromatosis  Question 41 1 out of 1 points A differential diagnosis for child abuse would include all of the following except. Selected Answer: c. Prader-Wlli syndrome  Question 42 1 out of 1 points Which of the following screenings should adolescents have done annually? Selected Answer: d. Psychosocial screening, blood pressure, body mass index  Question 43 1 out of 1 points The nurse practitioner role was initially established to Selected Answer: c. Improve access to care and partially solve physician shortage.  Question 44 0 out of 1 points An 8-year-old female is brought into the office by her mother. She has complaints of fever and sore throat for the past 2 days. She denies difficulty swallowing but has loss of appetite and mild diarrhea. A few classmates have similar symptoms. A review of systems reveals clear nasal drainage, dry cough, and hoarseness. On exam she has a 101.5 temperature, 3+ erythematous tonsils, and anterior cervical lymphadenopathy. What is the likely diagnosis? Selected Answer: b. Strep pharyngitis  Question 45 1 out of 1 points Josh, age 13, has some enlargement of the scrotum and testes, a reddened scrotal sac, and some hair texture alteration. His penis is not enlarged. He is in Tanner stage Selected Answer: d. II  Question 46 1 out of 1 points Mark is in the exam room. You are concerned he may have epiglottitis. In what position do these patients prefer to sit? Selected Answer: c. Sitting up and leaning forward  Question 47 1 out of 1 points Hannah, age 4, is brought into the office by her father. She complains of a sore throat, difficulty swallowing, copious oral secretions, stridor, and a temperature of 102F. She does not have pharyngeal erythema or cough. What do you suspect? Selected Answer: c. Epiglottitis  Question 48 1 out of 1 points John is diagnosed with allergic conjunctivitis. What type of discharge do you expect to see upon exam? Selected Answer: a. Stringy and white  Question 49 1 out of 1 points The first sign of the onset of female puberty is usually: Selected Answer: c. Breast buds  Question 50 1 out of 1 points A 6-month-old infant has been growing poorly. His parents have changed his formula three times without success. His examination is remarkable for a pale, emaciated child with little subcutaneous fat and anterior fontanelle fullness. His laboratory test results are notable for a hemolytic anemia and prolonged bleeding times. Which of the following is the most appropriate next step? Selected Answer: d. Obtain a sweat chloride concentration  Question 51 0 out of 1 points Which of the following statements about "routine" screening tests is true? Selected Answer: d. Lead testing is obtained on all 12- and 14-month-old children.  Question 52 1 out of 1 points A mother of a 6-month-old asks you about normal sleep patterns for an infant this age. The best response is: Selected Answer: a. 10 hours at night and 3-4 hours during the day  Question 53 1 out of 1 points A Mantoux test in a child with no risk factors is considered positive with a reaction of: Selected Answer: a. at least 15 mm induration  Question 54 1 out of 1 points Which is the correct order for introduction of solid foods to an infant? Selected Answer: c. Cereal, vegetables, fruits, and meats  Question 55 0 out of 1 points Initial screening tests for an 11-year-old with a family history of hyperlipidemia and weight at the 97th percentile include: Selected Answer: a. fasting glucose, postprandial glucose, fasting lipid profile  Question 56 0 out of 1 points Luke, a 17-month-old, failed treatment with amoxicillin for otitis media. At the twoweek recheck, his TM was still erythematous and you cannot see the landmarks. He has persistent nasal congestion, he is not sleeping at night, and he has a 101°F fever. What is the next best step for Luke? Selected Answer: c. Ceftriaxone and an antihistamine  Question 57 0 out of 1 points A 2-year-old boy has been slightly less than the 50th percentile for weight, height and head circumference, but in the last 6 months he has fallen to slightly less than the 25th percentile for weight. The pregnancy was normal, his development is as expected, and the family reports no psychosocial problems. The mother says that he is now a finicky eater (wants only macaroni and cheese at all meals), but she insists that he eat a variety of foods. The meals are marked by much frustration for everyone. His examination is normal. Which of the following is the best next step in his care? Selected Answer: a. Sweat chloride testing  Question 58 1 out of 1 points The parent of a 2-year-old tells you her daughter recently started having breathholding spells. She tells you the older sibling “did the same thing” and asks you for help. You advise her that after a breath-holding event: Selected Answer: c. Act as if nothing abnormal happened.  Question 59 1 out of 1 points Which of the following represents normal sequencing of development in a toddler? Selected Answer: d. Feeds self, can undress self with help, washes hands, imitates housework.  Question 60 1 out of 1 points You diagnose a 16-year-old with acute otitis media and need to prescribe an antibiotic with beta-lactamase coverage. What do you choose? Selected Answer: d. amoxicillin and potassium clavulanate (Augmentin)  Question 61 0 out of 1 points A 14-year old has ataxia. He is brought to the local emergency department, where he appears euphoric, emotionally labile, and a bit disoriented. He has nystagmus and hypersalivation. Many notice his abusive language. Which of the following agents is most likely responsible for his condition? Selected Answer: d. Phencyclidine (PCP)  Question 62 0 out of 1 points Medicaid provides health insurance coverage to Selected Answer: d. Anyone whose personal income falls below federal poverty level.  Question 63 1 out of 1 points Which of the following vaccines is routinely recommended at 4 months of age? Selected Answer: b. Diphtheria, tetanus, acellular pertussis (DTaP)  Question 64 1 out of 1 points A 13-month-old child is noted to be at the 25th percentile for weight, the 10th percentile for height, and less than the 5 th percentile for head circumference. She was born at term. She was noted to have a small head at birth, to be developmentally delayed throughout her life, and to have required cataract surgery shortly after birth. She currently takes phenobarbital for seizures. Which of the following would most likely explain this child’s small size? Selected Answer: a. Congenital cytomegalovirus infection  Question 65 1 out of 1 points A 3-year-old (37 months) refuses to have bowel movements on the toilet. He is bladder trained. He goes and hides and squats when having bowel movements. Positive encouragement and praise is not working. You advise: Selected Answer: a. Toilet refusal in 3-year-olds is largely due to caregivers overemphasizing toilet training.  Question 66 0 out of 1 points Which of the following children should be referred for a comprehensive developmental evaluation? Selected Answer: d. A 3-year-old who consistently tracks at the 5th percentile for height and weight since birth.  Question 67 0 out of 1 points Which of the following injuries is most likely to be caused by abuse of a toddler? Selected Answer: b. Spiral fracture of the tibia.  Question 68 0 out of 1 points You would be concerned about the language development of a child who: Selected Answer: b. Pronounces words that are not understandable at 2 years of age  Question 69 1 out of 1 points A 7-month-old male is found to have a spiral fracture of the femur that his father says he got by climbing onto a chair and then jumping off. Which of the following statements is true regarding this situation? Selected Answer: c. You can be held legally liable for failing to report child abuse.  Question 70 1 out of 1 points A new mom calls the NP on postpartum day 5. She reports her newborn wants to nurse for 30 minutes every 1- 1/2 to 2 hours. Which of these is the best response? Selected Answer: c. "This is a very healthy breastfeeding pattern. Be sure to rest when you can. You are doing a great job."  Question 71 1 out of 1 points Upon eye examination of a newborn, you note inner canthal folds and Brushfield spots. What do you suspect? Selected Answer: d. Down syndrome  Question 72 0 out of 1 points Acute otitis media can be diagnosed when there is Selected Answer: c. Fluid in the middle ear without signs or symptoms of an ear infection.  Question 73 0 out of 1 points Which of the following are important considerations when screening child refugees for tuberculosis? SELECT TWO (2) Selected Answers: b. Mantoux TST should not be used in a child who has received a Bacille Calmette-Guerin vaccination. c. IGRA may be falsely positive in children who have autoimmune disorders.  Question 74 1 out of 1 points Which of the following statements is true regarding lying and stealing by the school-age child? Selected Answer: c. They represent a common, transient problem.  Question 75 1 out of 1 points Which of the following foreign body in the nose requires immediate removal? Selected Answer: c. battery  Question 76 1 out of 1 points During a “well-child” visit, the parents of a healthy 5-month-old offer a great amount of information. Which of the following bits of information is of most concern? Selected Answer: d. Limited eye contact with parents.  Question 77 1 out of 1 points You assess a 15-year-old's visual acuity and note her vision to be 20/50 in the right eye. She asks you what that means and you respond Selected Answer: b. "You can see at 20 feet with your right eye what most people can see at 50 feet."  Question 78 1 out of 1 points An 11-year-old girl has dizziness, pupillary dilation, nausea, fever, tachycardia, and facial flushing. She says she can "see" sound and "hear" colors. The agent likely to be responsible is which of the following? Selected Answer: e. Lysergic acid diethylamide (LSD)  Question 79 0 out of 1 points Which of the following signs may indicate a baby is not receiving sufficient breastmilk? Selected Answer: b. Sleepiness and excitability  Question 80 1 out of 1 points Which of the following strategies would not be appropriate to include as part of your treatment plan of an 8-yearold boy who is obese? Selected Answer: b. Referral to nutritionist for weight reduction plan.  Question 81 1 out of 1 points Which of the following complication of strep pharyngitis cannot be prevented with antibiotics? Selected Answer: d. Glomerulonephritis  Question 82 0 out of 1 points You see a 4-year-old for a well-child visit. He has received four diphtheria, tetanus, and acellular pertussis vaccines (DTaP); three injected polio vaccines (IPV); one measles, mumps, and rubella vaccine (MMR); one varicella vaccine; and two hepatitis B (Hep B) vaccines. What do you order today? Selected Answer: b. PVC 13, DTaP, IPV, MMR, and Varivax  Question 83 1 out of 1 points You see a 6-month-old for a well-child visit and the mother tells you the child’s grandmother recommends that she give the infant whole milk and eggs when he starts solids. What should you tell the mother? Selected Answer: b. The baby should remain on infant formula and stage 2 and 3 baby foods for now.  Question 84 1 out of 1 points Which of the following substances is associated with pupillary constriction? Selected Answer: c. Heroin  Question 85 0 out of 1 points A breastfed infant is expected to have a lower incidence of which of the following? Selected Answer: b. Asthma  Question 86 1 out of 1 points The results of the hemoglobin A1c test are LESS reliable in children with which of the following conditions? (Hint: select two) Selected Answers: d. Sickle Cell Disease e. Cystic Fibrosis  Question 87 1 out of 1 points Which of the following statements about bullying is true? Selected Answer: b. It occurs most commonly during unstructured times (lunch, recess, etc.).  Question 88 1 out of 1 points An 8-year-old female has an edematous, mildly erythematous right upper eyelid for 2 days with a fever of 102.9 (F). Which important eye assessment do you need to consider? Selected Answer: a. Ocular mobility  Question 89 1 out of 1 points What method can be safely used to remove cerumen in a 15-month-old child's ear? Selected Answer: d. Irrigation using warm water from a soft bulb syringe  Question 90 1 out of 1 points You see a 5-month-old who is fussy, has interrupted sleep, and is drooling. You note large lower lateral incisor bulges. You recommend: Selected Answer: e. A and D  Question 91 1 out of 1 points Sandy, age 18 months, crosses her legs when lifted from behind rather than pulling them up. Her legs are also hard to separate, making diaper changing difficult. She persistently uses only one hand. What condition do you suspect? Selected Answer: a. Cerebral palsy  Question 92 1 out of 1 points By what age should most children be able to sit well without support? Selected Answer: c. 9 months  Question 93 0 out of 1 points Chelsea, age 8, complains that she feels as if something is stuck in her ear. What action is contraindicated? Selected Answer: a. Using a small suction device to try and remove the object.  Question 94 1 out of 1 points A teenage female who is overweight has moderate acne on the face and chest, and irregular menses. Elevation of which laboratory test provides the test evidence of polycystic ovarian syndrome? Selected Answer: b. free testosterone  Question 95 0 out of 1 points Please interpret the following labs for an adolescent. The adolescent has a history of obesity and acanthosis nigricans. Test Results Fasting blood glucose 112 mg/dL 2 hour postprandial glucose 138 mg/dL Selected Answer: b. Impaired fasting glucose, impaired glucose tolerance  Question 96 1 out of 1 points You see a 3-year-old for a well-child visit. His mother informs you that potty training has been very easy because he “has an amazing internal clock. He falls asleep, gets hungry, and has bowel movements at the same time every day.” This describes which aspect of temperament? Selected Answer: d. Rhythmicity  Question 97 0 out of 1 points A 4-month-old child has poor weight gain. Her current weight is less than the 5th percentile, height about the 10th percentile, and head circumference at the 50th percentile. The planned pregnancy resulted in a normal, spontaneous, vaginal delivery; mother and child were discharged after a 48-hour hospitalization. Feeding is via breast and bottle; the quantity seems sufficient. The child has had no illness. The examination is unremarkable except for the child’s small size. Screening laboratory shows the hemoglobin and hematocrit are 11 mg/dL and 33% respectively, with a platelet count of 198,000/mm3. Serum electrolyte levels are sodium 140, chloride 105, potassium 3.5, bicarbonate 17, blood urea nitrogen 15, and creatinine 0.3. Liver function tests are normal. Urinalysis reveals a pH of 8 with occasional epithelial cells but no white blood cells, bacteria, protein, ketones, or reducing substances. Which of the following is the most appropriate therapy for this child? Selected Answer: a. Sweat chloride analysis  Question 98 0 out of 1 points Mark, a 10-year-old, has a lot of ear pain. He does not want anyone to touch it and is crying in pain. The ear canal is swollen and exudate is present. The TM is normal. What is the proper management for his patient? Selected Answer: a. Oral Amoxicillin and topical anesthetic  Question 99 1 out of 1 points A mother brings her 4-week-old infant into the office because she noticed small yellow-white glistening bumps on her infant's gums. She says they look like teeth but is concerned that they may be cancer. You diagnose these bumps as Selected Answer: a. Epstein's pearls  Question 100 0 out of 1 points A 2-day-old newbornwith conjunctivitis is likely due to Selected Answer: c. Gonorrhea