NURS 612 COMPREHENSIVE AND EXAM-FOCUSED MEDICAL QUESTIONS AND VERIFIED ANSWERS| GRADED A+

A 15-year-old with a diagnosis of epilepsy had a seizure in your office lasting 12 minutes requiring rectal diazepam (Valium). He is stable in a postictal state. His parents express concern as his last seizure was 2 years ago and he wanted to be weaned off his phenytoin (Dilantin).Which of the following may have contributed to this seizure? Experimentation with alcohol consumption which lowers seizure threshold. Recent growth spurt resulting in decreased kg/mg dosage Adolescent may be challenging diagnosis and non-compliant with phenytoin regimen All choices are correct - Answer D. All choices are correct What question in an adolescent's history is the MOST important to ask concerning new onset of headaches? Alcohol use Caffeine use History of headache most severe when arising from sleep Positive family history for headaches - Answer C. History of headache most severe when arising from sleep A 17-year-old arrives for evaluation of a headache. He states it is worse in the morning and does not respond to ibuprofen. His caffeine intake has not changed, he has no known head trauma. On exam you note he is slow to respond to questions and your fundoscopic exam the optic disc borders are blurred (papilledema). You explain your next action He exhibits a focal neurological sign, order a CT He exhibits a focal neurological sign, discharge the patient home prescribing bedrest, acetaminophen and recommend sunglasses He exhibits no focal neurological signs, discharge the patient home on bedrest, teaching family members signs warning signs of increased ICP He exhibits no focal neurological signs. discharge the patient home recommending return to school, but no contact sports until headache resolved - Answer A. He exhibits a focal neurological sign, order a CT A 17-year-old gymnast presents following her competition with a resolving headache rated 3/10, after her spotter missed her and she fell 4 feet and struck her head. Although she did not lose consciousness and seems fine now, her parents are concerned because she does not remember how she got off the gym floor. Which of the following would NOT be indicated. Prescribe bedrest, acetaminophen and recommend sunglasses if light sensitive Teach warning signs of head injuryand send home on bedrest Order a CT of the Head Recommend return to school, but no contact sports until headache resolved. - Answer C. Order a CT of the Head Your 12-year-old male patient has a history of cord compression and anoxia at birth presents with spasticity and partial paralysis. His likely diagnosis is: erb's palsy brachial plexus palsy cerebral palsy muscular dystrophy - Answer C. cerebral palsy A 3 year-old-femaie presents with loss of the use of her left arm since her forcep delivery birth. Which of the following is her most likely diagnosis? brachial plexus palsy cerebral palsy Bell's palsy none are likely diagnoses - Answer A. brachial plexus palsy 9-year-old Sarah presents with her normal-height parents who are concerned about her short stature. Physical exam is unremarkable except for height and weight are in the 3rd percentile, you note she is Tanner Stage 1, her endocrine work-up is normal except for a delayed bone age (8 years). The treatment for Sarah's suspected diagnosis: Reassurance, close observation, with anticipated growth acceleration Urgent endocrine referral for growth hormone, with anticipated growth acceleration Urgent endocrine referral for Turner syndrome Reassurance, close observation, with anticipated short stature - Answer A. Reassurance, close observation, with anticipated growth acceleration 16-year-old Michael presents with his 60-year-old father with a concern about delayed puberty, physical exam is remarkable for scant body hair, tall stature, mild gynecomastia and hypogonadism. The treatment for Michael's suspected diagnosis is: Reassurance, close observation, with anticipated catch up sexual maturity Endocrine referral for growth hormone, with anticipated catch up sexual maturity Endocrine referral for likely Klinefelter syndrome and consideration of testosterone therapy Endocrine referral for likely Klinefelter syndrome for consideration of growth hormone therapy - Answer C. Endocrine referral for likely Klinefelter syndrome and consideration of testosterone therapy 15-year-old Dana presents with her 60-year-old mother w a concern about delayed puberty with amenorrhea, physical exam is remarkable noting short stature, low set ears and hair line, cubitus valgus and web necked. The treatment for Dana's suspected diagnosis is: Reassurance, close observation, with anticipated catch up sexual maturity Endocrine referral for likely Turner's syndrome and consideration of estrogen, progesterone AND growth hormone therapy Endocrine referral for likely Turner's syndrome and consideration of estrogen, and progesterone hormone therapy Endocrine referral for growth hormone, with anticipated catch up sexual maturity - Answer B. Endocrine referral for likely Turner's syndrome and consideration of estrogen, progesterone AND growth hormone therapy A 4-year-old girl presents with her mother with concerned about her breast development. Her family history is negative for endocrine disorders. Physical exam is unremarkable except for stage 1 breast development, no pubic with no signs of axillary or pubic hair . Her height and weight are above the 95th percentile. Which of the following BEST describes this child's physical findings? Normal variant Precocious puberty Premature thelarche Premature adrenarche - Answer C. Premature thelarche Identified risk factors for nonorganic failure to thrive include all of the following EXCEPT Diabetes Type I Parental neglect Underfeeding Inadequate caloric intake - Answer A. Diabetes Type I You are seeing a 2-month-old infant girl that you suspect has Turner's syndrome. Based on your knowledge of the physical manifestations of Turner's syndrome, what would you expect to see at this 2-month exam? Webbed neck, cubitus valgus Hypertelorism, low-set ears Micrognathia, hip dysplasia Microcephaly, cubitus valgus - Answer A. Webbed neck, cubitus valgus A 5-year-old presents with lethargy, on exam you note a1-kg weight loss since her WCC 8 months ago. Your differential diagnosis includes diabetes. Which of the following is THE MOST common presenting complaint of Type 1 diabetes in children? Polyphagia and BMI >85% Ketoacidosis Arrested growth Polyuria, polydipsia or nighttime enuresis - Answer D. Polyuria, polydipsia or nighttime enuresis A 12-year-old female has a recent history of recurrent vaginal yeast infection effectively treated with miconazole vaginal cream. The child's weight has been in the 95th percentile for several years, but height has only been in the 50th percentile. A dipstick UA is positive for glucose, and random plasma glucose is 250 mg/dL. Considering the likely diagnosis, what will be the most appropriate plan of care? Metformin prescription, urine dipsticks for urine glucose monitoring, healthy diet and exercise regimen Insulin prescription, home glucometer for blood glucose monitoring, healthy diet and exercise regimen Metformin prescription, home glucometer for blood glucose monitoring, healthy diet and exercise Insulin prescription, urine dipsticks for urine glucose monitoring, healthy diet and exercise - Answer C. Metformin prescription, home glucometer for blood glucose monitoring, healthy diet and exercise A newborn JT in your care tests positive for PKU. His parents ask if switching his formula will improve his musty odor. They understand this disorder may impact his brain development and are requesting an MRI of his brain. As the FNP, you offer the following explanation of JT's PKU is due to: missing a hormone needed to synthesize important brain chemicals like norepinephrine, his new formula and supplements will help his brain development. This is monitored with PKU blood levels and not measurable with the MRI missing a hormone needed to synthesize important brain chemicals like melanin, his new formula and supplements will help his brain development. This is monitored with PKU blood levels and not measurable with the MRIRI missing a hormone needed to synthesize important brain chemicals, his new formula and supplements will help his brain development. This is monitored with an MRI. D. missing a hormone ne - Answer A. missing a hormone needed to synthesize important brain chemicals like norepinephrine, his new formula and supplements will help his brain development. This is monitored with PKU blood levels and not measurable with the MRI A 7-year-old male has a recent history of viral infection and now presents with polyuria, polydipsia and a 1.5- kg weight loss. A dipstick UA is positive for glucose, and random plasma glucose is 350 mg/dL. Considering the likely diagnosis, what will included in the most appropriate plan of care? Metformin prescription, home glucometer for blood glucose monitoring, healthy diet and exercise regimen Insulin prescription (sq. infusion via pump or injection), home glucometer for blood glucose monitoring, healthy diet and exercise regimen Metformin prescription, urine dipsticks for urine glucose monitoring, healthy diet and exercise regimen Insulin prescription (sq. infusion via pump or injection), urine dipsticks for urine glucose monitoring, healthy diet and exercise regimen - Answer B. Insulin prescription (sq. infusion via pump or injection), home glucometer for blood glucose monitoring, healthy diet and exercise regimen On your patient schedule see a diagnosis of plagiocephaly on your patient schedule. You vaguely recall learning something about this in Nurs 612 so you check UpToDate and are able to explain the etiology of this head growth disturbance is to the parents of this 4-month-old : Your child's head appears small. His head size is 2 SD below the mean, this can result abnormal brain development from a genetic or teratogenic exposure Your child's head appears flat. This form of craniostenosis can result from premature fusion of lambdoidal or coronal skull sutures and often results in brain injury....