NUR MN 580 MIDTERM EXAM QUESTIONS WITH CORRECT ANSWERS | LATEST UPDATE (GRADED A+)

The primary care pediatric nurse practitioner is preparing to perform a painful procedure on a 4monthold infant. Besides providing local anesthesia, what other pain control method provides analgesic effects? A. Providing toys B. Singing or music C. Sucrose solution Correct D. Swaddling or cuddling 12. An adolescent female reports moderate dysmenorrhea with periods and tells the primary care pediatric nurse practitioner that 400 mg ibuprofen every 6 to 8 completely control her pain. What will the nurse practitioner recommend? A. Increasing the ibuprofen dose to 600 to 800 mg every 6 to 8 hours B. Taking extra strength acetaminophen 1000 mg every 4 to 6 hours C. Taking naproxen 500 mg initially and then 250 mg every 6 to 8 hours correct D. Using extended release naproxen 500 mg every 12 hours 13. What is the most important dose limiting factor when prescribing acetaminophen with hydrocodone? A. Acetaminophen dose Correct B. Gastrointestinal side effects C. Pruritis symptoms D. Urinary retention 14. An adolescent takes ibuprofen, acetaminophen, and a tricyclic antidepressant (TCA) to treat phantom limb pain and reports that the medications are no longer effective. What will the primary care pediatric nurse practitioner do? A. Change the TCA to a selective serotonin reuptake inhibitor. B. Evaluate the adolescent for drug seeking behavior. C. Increase the TCA dose and reevaluate in 2 to 3 weeks. D. Refer the adolescent to a pain management specialist. Correct 15. The parent of a school age child with a chronic pain condition tells the primary care pediatric nurse practitioner that the child has requested to stay home from school more often in the past few months. The child’s exam does not reveal any significant change in pathology, and a review of the child’s medications indicates appropriate dosing of analgesic medications. What will the nurse practitioner recommend? A. Assessing the child’s pain every day to determine changes B. Ensuring the child stays quiet in bed with videos when having pain C. Having the child do homework when staying home from school Correct MN580 MIDTERM EXAM D. Requiring the child to go to school even during pain episodes 16. The parent of a 2weekold infant reports that the infant was diagnosed with transient tachypnea of the newborn shortly after birth. The primary care pediatric nurse practitioner understands that, in this condition, A. antibiotic therapy is generally necessary to prevent severe infection. B. home oxygen therapy is needed until the infant grows out of the condition. C. recovery is usually complete with minimal intervention and treatments. Correct D. treatment with exogenous surfactant and mechanical ventilation is needed. 17. A 2monthold infant has a staccato cough and fever. Which aspect of the history is most important in determining the diagnosis? A. Day care attendance B. Immunization history Correct C. Medication history D. Past medical history 18. According to recent research, which populations may have higher rates of under immunization than others? A. Those with higher rates of Asians B. Those with higher rates of graduate degrees Correct C. Those with lower rates of poverty D. Those with lower rates of primary providers 19. The parent of a 2monthold infant is reluctant to have the baby vaccinated. What is an initial step in responding to these concerns. A. Inform the parent that all vaccines may be given without thimerosol. B. Providing Vaccine Information Statements for the parent to review. C. Question the parent’s reasons for concern about immunizations. Correct D. Remind the parent that the infant is exposed to thousands of germs each day. MN580 MIDTERM EXAM 20. A parent is concerned about vaccine adverse reactions. Based on an Institute of Medicine report, what will the primary care pediatric nurse practitioner tell the parent? A. Administering multiple vaccines may trigger the development of type 1 diabetes. B. The MMR may be linked to febrile seizures in immunocompromised children. Correct C. There is some risk of CNS disorders associated with the hepatitis B vaccine. D. Vaccines containing thimerosol are linked to pervasive developmental disorders. 21. A 2monthold infant will receive initial immunizations, and the parent asks about giving medications to increase the infant’s comfort and minimize fever. What will the pediatric nurse practitioner recommend? A. Administering ibuprofen or acetaminophen as needed Correct B. Avoiding antipyretics if possible to attain better immunity C. Giving ibuprofen and acetaminophen only after the vaccines D. Pretreating the infant with both ibuprofen and acetaminophen 22. The primary care pediatric nurse practitioner reviews the immunization records of an 18monthold child and notes that the child received an MMR immunization 2 days prior to the first birthday. What will the nurse practitioner do? A. Administer a reduced dose of MMR to ensure adequate immunity. B. Obtain mumps, measles, and rubella titers to determine immunity. C. Recommend the next dose of MMR vaccine at 4 to 5 years of age. Correct D. Repeat the MMR vaccine since the first dose was given too soon 23. A 5yearold child who has a history of pertussis infection as an infant is in the clinic for immunizations prior to kindergarten. Which vaccine will be given? A. DTaP Correct B. DTP C. Td D. Tdap MN580 MIDTERM EXAM 24. Select the statement that best describes the thelarche stage of puberty in females. 1. Appearance of pubic hair 2. Appearance of breast tissue maturation 3. Onset of first menstrual period 4. All the above ANS 4 25. Congenital Hypothyroidism is common in infants with Downs syndrome. Newborn screening for Congenital Hypothyroidism is required in all 50 states. Thyroid studies should be performed several times during the first years of life, and then a minimum of: 1. Every two months. 2. Every month. 3. Every six months. 4. Yearly. ANS: 4 26. Malignancies are common in children with Downs syndrome. The incidence is 18 times that of the general population for developing: 1. Colon cancer. 2. Leukemia. 3. Pancreatic cancer. 4. Bladder cancer. ANS: 2 27. Downs syndrome children often have instability of the neck at the first and second cervical vertebrae. As a nurse, you explain to the caregiver that he/she should look for signs and symptoms of spinal cord changes, such as: 1. Changes in reflexes. 2. Changes in bowel function. 3. All of the above. MN580 MIDTERM EXAM 4. None of the above. ANS: 3 28. An 18monthold child with no previous history of otitis media awoke during the night with right ear pain. The primary care pediatric nurse practitioner notes an axillary temperature of 100.5°F and an erythematous, bulging tympanic membrane. A tympanogram reveals of peak of +150 mm H2O. What is the recommended treatment for this child? A. Amoxicillin 80 to 90 mg/kg/day in two divided doses B. An analgesic medication and watchful waiting Correct C. Ceftriaxone 50 to 75 mg/kg/dose IM given once D. Ototopical antibiotic drops twice daily for 5 days 29. A 7monthold infant has had two prior acute ear infections and is currently on the 10th day of therapy with amoxicillin clavulanate after a failed course of amoxicillin. The primary care pediatric nurse practitioner notes marked middle ear effusion and erythema of the TM. The child is irritable and has a temperature of 99.8°F. What is the next step in management of this child’s ear infection? A. Order a second course of amoxicillin clavulanate. B. Perform tympanocentesis for culture. C. Prescribe clindamycin twice daily. D. Refer the child to an otolaryngologist. Correct 30. A 3yearold child with pressure equalizing tubes (PET) in both ears has otalgia in one ear. The primary care pediatric nurse practitioner is able to visualize the tube and does not see exudate in the ear canal and obtains a type A tympanogram. What will the nurse practitioner do? A. Order ototopical antibiotic/corticosteroid drops. Correct B. Prescribe a prophylactic antibiotic medication. C. Reassure the parent that this is a normal exam. D. Refer the child to an otolaryngologist for follow up 31. What will the primary care pediatric nurse practitioner teach the parents of a child who has new pressure equalizing tubes (PET) in both ears? MN580 MIDTERM EXAM A. Parents should notice improved hearing in their child. Correct B. PET will help by reducing the number of ear infections the child has. C. The child should use earplugs when showering or bathing. D. The tubes will most likely remain in place for 3 to 4 years. 32. A child with a history of otitis externa asks about ways to prevent this condition. What will the primary care pediatric nurse practitioner recommend? A. Cleaning ear canals well after swimming B. Drying the ear canal with a hair dryer Correct C. Swimming only in chlorinated pools D. Using cerumenolytic agents daily 33. A child complains of itching in both ears and is having trouble hearing. The primary care pediatric nurse practitioner notes periauricular edema and marked swelling of the external auditory canal and elicits severe pain when manipulating the external ear structures. Which is an appropriate intervention? A. Obtain a culture of the external auditory canal. B. Order ototopical antibiotic/corticosteroid drops. Correct C. Prescribe oral amoxicillin clavulanate. D. Refer the child to an otolaryngologist. 34. A child who has otitis externa has severe swelling of the external auditory canal that persists after 2 days of therapy with ototopical antibiotic/corticosteroid drops. What is the next step in treatment for this child? A. Insert a wick into the external auditory canal. Correct B. Irrigate the external auditory canal with saline. C. Order systemic corticosteroids. D. Prescribe an oral antibiotic medication. MN580 MIDTERM EXAM 35. The primary care pediatric nurse practitioner notes a small, round object in a child’s external auditory canal, near the tympanic membrane. The child’s parent thinks it is probably a dried pea. What will the nurse practitioner do to remove this object? A. Irrigate the external auditory canal to flush out the object. B. Refer the child to an otolaryngologist for removal. Correct C. Remove the object with a wire loop curette. D. Use a bayonet forceps to grasp and remove the object. 36. A 3yearold child has had one episode of acute otitis media 3 weeks prior with a normal tympanogram just after treatment with amoxicillin. In the clinic today, the child has a type B tympanogram, a temperature of 102.5°F, and a bulging tympanic membrane. What will the primary care pediatric nurse practitioner order? A. A referral for tympanocentesis B. Amoxicillin twice daily C. Amoxicillin clavulanate twice daily Correct D. Intramuscular ceftriaxone 37. The primary care pediatric nurse practitioner diagnoses acute otitis media in a 2yearold child who has a history of three ear infections in the first 6 months of life. The child’s tympanic membrane is intact, and the child has a temperature of 101.5°F. What will the nurse practitioner prescribe for this child? A. Amoxicillin twice daily for 10 days B. An analgesic medication and watchful waiting Correct C. Antibiotic ear drops and ibuprofen D. Ceftriaxone given once intramuscularly