CMN 577 Final Exam | Questions And Answers With
Rationale| With Complete Solutions
. A 15-month-old child who attends day care 3 times a week
comes to the clinic. The patient's mother states that the patient
had an episode earlier today where she "shook" for almost three
minutes and would not respond during that time. The patient's
temperature is 102o F and the patient's mom says her daughter
has had a severe cough for the last four days. The nurse
practitioner would suspect that which type of seizure has
occurred?
A. Neonatal Seizure
B. Childhood Absence Epilepsy
C. Febrile Seizure
Focal Seizure Correct Answers Febrile Seizure
Rationale: Criteria for febrile seizures are 1) age 3mo-6yr, 2)
fever greater than 101.8oF and 3) non-CNS infection. Febrile
seizures are generalized and last less than 5 minutes. Acute
respiratory illnesses are most commonly associated with febrile
seizures (Hay, Levin, Deterding & Abzug, 2018, p. 772). Risk
factors include day care attendance, family history of febrile
seizures and prolonged neonatal hospitalization (Hay, Levin,
Deterding & Abzug, 2018, p. 762). Neonatal seizures occur in
children aged birth-2weeks old (Hay, Levin, Deterding &
Abzug, 2018, p. 762). Childhood absence epilepsy occur in
children aged 3-12 years old and will have a vacant stare and
loss of consciousness (Hay, Levin, Deterding & Abzug, 2018, p.
764). Focal seizures can occur in any age but are not associated
with fevers and may involve any part of the body and may
spread in a fixed pattern (Hay, Levin, Deterding & Abzug, 2018,
p. 764).
,. A 4-week-old male accompanied by his mother was brought in
today to be seen for vomiting. The first- time mother is
extremely concerned that something is terribly wrong with her
baby because "for 2 days now, he has been projectile vomiting
after he takes a bottle." She describes the vomitus as "looking
just like the formula he drank." The mother also states, "he
hasn't had very many wet diapers the past 2 days and his belly
seems really tight after each bottle." As the provider caring for
the child, you know the most likely diagnosis based upon the
mother's history and concerns is
A. Gastroesophageal Reflux
B. Pyloric Stenosis
C. Acute Viral Gastroenteritis
D. Intussusception Correct Answers Pyloric Stenosis
Rationale: Pyloric stenosis is defined as projectile postprandial
vomiting that usually begins between 2 and 4 weeks of age but
may start as late as 12 weeks. Vomitus is rarely bilious but may
be blood streaked. The upper abdomen may be distended after
feeding. Treatment of dehydration and electrolyte imbalance is
mandatory before surgical intervention. The incidence of pyloric
stenosis is 1-8 per 1000 births with a 4:1 male predominance.
. An APRN is performing a well visit for a 6-month-old child.
The child has one tooth and another tooth bud on the lower
gums. The parents ask when they should take the child to the
dentist. Your best response would be:
A. By 12 months of age a child should establish a dental home
B. When the first tooth erupts an initial visit by a pediatric
dentist is recommended
,C. Clean the teeth with a washcloth and use non-fluoride tooth
paste and visit the dentist by 24 months.
D. Between the ages of 6 to 12 when all their baby teeth are
replaced by permanent teeth. Correct Answers By 12 months of
age a child should establish a dental home
Rational: Establishment of a dental home for a child by 12
months of age is an essential foundation for the prevention of
dental disease, such as early childhood caries.
. If a 7-year-old presents with oppositional behaviors,
nightmares, or withdrawal, which intervention would not be
helpful?
a. acknowledging their fear, sadness
b. maintaining as much normalcy as possible & keeping routine
c. bribing child to talk about stressor / loss
d. allowing control when age appropriate Correct Answers
bribing child to talk about stressor / loss
Rationale: school age children begin to apply logic and accept
others points of view, while a loss can be traumatic, providing
an open environment for the child to ask questions, have
feelings acknowledged, allowing them to make decisions while
age appropriate and safe and maintaining routines is important.
Forcing the child to talk when they are not comfortable does not
support their understanding.
1. A 25-year-old male presents to clinic complaining of a severe,
throbbing headache for the past 2 days. The pain increases when
exposed to bright lights and is accompanied by nausea. He states
the headache started after working a 16-hour shift without
resting. What type of headache is the patient suffering from and
what medication is appropriate for immediate relief?
, A. Migraine headache - Zolmitriptan 5mg PO one dose now,
repeat after 2 hours if no relief
B. Migraine headache - Topiramate 50mg BID
C. Tension - Type Headache - Zolmitriptan 5mg PO one dose
now, repeat after 2 hours if no relief
D. Cluster headache - Sumatriptan 6mg SQ single dose Correct
Answers Migraine headache - Zolmitriptan 5mg PO one dose
now, repeat after 2 hours if no relief
Migraine headaches can be unilateral and are often accompanied
by nausea, vomiting, and photophobia. These headaches can be
triggered by lack of sleep and stress. Zolmitriptan is often
effective for immediate relief of migraines. Topiramate is used
as a prophylaxis for migraines. The patient's symptoms are not
characteristic of a tension type or cluster headache. Triptans are
not recommended for tension type headaches.
1. A 36-year-old female is being seen in your clinic for left sided
facial weakness. In your review of systems, the patient reports
that "certain sounds really bother her and taste buds seem off".
She also reports temporal pain which had subsided. Your
physical exam revealed no other neurological deficits. Which of
the following intervention would be most appropriate?
A. Call 911 to activate emergency stroke protocols
B. Refer the patient to neurology
C. Order an MRI
D. Prescribe a course of oral corticosteroids Correct Answers
Prescribe a course of oral corticosteroids
Bell's Palsy commonly causes alterations in taste and
hyperacusis. This contrasts with stroke. Corticosteroids increase
Rationale| With Complete Solutions
. A 15-month-old child who attends day care 3 times a week
comes to the clinic. The patient's mother states that the patient
had an episode earlier today where she "shook" for almost three
minutes and would not respond during that time. The patient's
temperature is 102o F and the patient's mom says her daughter
has had a severe cough for the last four days. The nurse
practitioner would suspect that which type of seizure has
occurred?
A. Neonatal Seizure
B. Childhood Absence Epilepsy
C. Febrile Seizure
Focal Seizure Correct Answers Febrile Seizure
Rationale: Criteria for febrile seizures are 1) age 3mo-6yr, 2)
fever greater than 101.8oF and 3) non-CNS infection. Febrile
seizures are generalized and last less than 5 minutes. Acute
respiratory illnesses are most commonly associated with febrile
seizures (Hay, Levin, Deterding & Abzug, 2018, p. 772). Risk
factors include day care attendance, family history of febrile
seizures and prolonged neonatal hospitalization (Hay, Levin,
Deterding & Abzug, 2018, p. 762). Neonatal seizures occur in
children aged birth-2weeks old (Hay, Levin, Deterding &
Abzug, 2018, p. 762). Childhood absence epilepsy occur in
children aged 3-12 years old and will have a vacant stare and
loss of consciousness (Hay, Levin, Deterding & Abzug, 2018, p.
764). Focal seizures can occur in any age but are not associated
with fevers and may involve any part of the body and may
spread in a fixed pattern (Hay, Levin, Deterding & Abzug, 2018,
p. 764).
,. A 4-week-old male accompanied by his mother was brought in
today to be seen for vomiting. The first- time mother is
extremely concerned that something is terribly wrong with her
baby because "for 2 days now, he has been projectile vomiting
after he takes a bottle." She describes the vomitus as "looking
just like the formula he drank." The mother also states, "he
hasn't had very many wet diapers the past 2 days and his belly
seems really tight after each bottle." As the provider caring for
the child, you know the most likely diagnosis based upon the
mother's history and concerns is
A. Gastroesophageal Reflux
B. Pyloric Stenosis
C. Acute Viral Gastroenteritis
D. Intussusception Correct Answers Pyloric Stenosis
Rationale: Pyloric stenosis is defined as projectile postprandial
vomiting that usually begins between 2 and 4 weeks of age but
may start as late as 12 weeks. Vomitus is rarely bilious but may
be blood streaked. The upper abdomen may be distended after
feeding. Treatment of dehydration and electrolyte imbalance is
mandatory before surgical intervention. The incidence of pyloric
stenosis is 1-8 per 1000 births with a 4:1 male predominance.
. An APRN is performing a well visit for a 6-month-old child.
The child has one tooth and another tooth bud on the lower
gums. The parents ask when they should take the child to the
dentist. Your best response would be:
A. By 12 months of age a child should establish a dental home
B. When the first tooth erupts an initial visit by a pediatric
dentist is recommended
,C. Clean the teeth with a washcloth and use non-fluoride tooth
paste and visit the dentist by 24 months.
D. Between the ages of 6 to 12 when all their baby teeth are
replaced by permanent teeth. Correct Answers By 12 months of
age a child should establish a dental home
Rational: Establishment of a dental home for a child by 12
months of age is an essential foundation for the prevention of
dental disease, such as early childhood caries.
. If a 7-year-old presents with oppositional behaviors,
nightmares, or withdrawal, which intervention would not be
helpful?
a. acknowledging their fear, sadness
b. maintaining as much normalcy as possible & keeping routine
c. bribing child to talk about stressor / loss
d. allowing control when age appropriate Correct Answers
bribing child to talk about stressor / loss
Rationale: school age children begin to apply logic and accept
others points of view, while a loss can be traumatic, providing
an open environment for the child to ask questions, have
feelings acknowledged, allowing them to make decisions while
age appropriate and safe and maintaining routines is important.
Forcing the child to talk when they are not comfortable does not
support their understanding.
1. A 25-year-old male presents to clinic complaining of a severe,
throbbing headache for the past 2 days. The pain increases when
exposed to bright lights and is accompanied by nausea. He states
the headache started after working a 16-hour shift without
resting. What type of headache is the patient suffering from and
what medication is appropriate for immediate relief?
, A. Migraine headache - Zolmitriptan 5mg PO one dose now,
repeat after 2 hours if no relief
B. Migraine headache - Topiramate 50mg BID
C. Tension - Type Headache - Zolmitriptan 5mg PO one dose
now, repeat after 2 hours if no relief
D. Cluster headache - Sumatriptan 6mg SQ single dose Correct
Answers Migraine headache - Zolmitriptan 5mg PO one dose
now, repeat after 2 hours if no relief
Migraine headaches can be unilateral and are often accompanied
by nausea, vomiting, and photophobia. These headaches can be
triggered by lack of sleep and stress. Zolmitriptan is often
effective for immediate relief of migraines. Topiramate is used
as a prophylaxis for migraines. The patient's symptoms are not
characteristic of a tension type or cluster headache. Triptans are
not recommended for tension type headaches.
1. A 36-year-old female is being seen in your clinic for left sided
facial weakness. In your review of systems, the patient reports
that "certain sounds really bother her and taste buds seem off".
She also reports temporal pain which had subsided. Your
physical exam revealed no other neurological deficits. Which of
the following intervention would be most appropriate?
A. Call 911 to activate emergency stroke protocols
B. Refer the patient to neurology
C. Order an MRI
D. Prescribe a course of oral corticosteroids Correct Answers
Prescribe a course of oral corticosteroids
Bell's Palsy commonly causes alterations in taste and
hyperacusis. This contrasts with stroke. Corticosteroids increase
