NURSING 602 pediatric midterm study set exam with questions and answers
(100% solved)
A 10-year-old child has had abdominal pain for 2 days, which began in the periumbilical area
and then localized to the right lower quadrant. The child vomited once today and then
experienced relief from pain followed by an increased fever. What is the likely diagnosis?
Appendicitis with perforation
Gastroenteritis
Pelvic inflammatory disease (PID)
Urinary tract infection (UTI) - ✔✔✔-ANS: A
The child has the progression of symptoms typical of appendicitis with perforation - pain before
vomiting that localizes to the RLQ and then relief of pain with onset of fever upon perforation.
With gastroenteritis, vomiting precedes pain. PID symptomology includes increasing pain over
time. The symptoms of an UTI include fever, chills, and urinary symptoms.
A 10-year-old is hit in the head with a baseball during practice and is diagnosed with
concussion, even though no loss of consciousness occurred. The primary care pediatric nurse
practitioner is evaluating the child 2 weeks after the injury and learns that the child is still
experiencing some sleepiness every day. The neurological exam is normal. The child and the
parent are adamant that the child be allowed to return to play baseball. What will the nurse
practitioner recommend?
Continuation of cognitive rest only
Continuation of physical and cognitive rest
Continuation of physical rest only
Returning to play - ✔✔✔-ANS: B
Both physical and cognitive rest is indicated after diagnosis of concussion in youth, particularly if
symptoms continue following injury. Cognitive recovery may lag behind physical recovery and is
a key factor in return-to-play decisions. Only after all symptoms resolve may athletes progress
through steps to gradually return to play.
A 12-month-old infant exhibits poor weight gain after previously normal growth patterns. There
is no history of vomiting, diarrhea, or irregular bowel movements, and the physical exam is
normal. What is the next step in evaluating these findings?
,NURSING 602 pediatric midterm study set exam with questions and answers
(100% solved)
Complete blood count and electrolytes
Feeding and stooling history and 3-day diet history
Stool cultures for ova and parasites
Swallow study with videofluoroscopy - ✔✔✔-ANS: B
Vomiting, diarrhea, and bowel irregularities are more predictive of organic causes of FTT, which
are not present in this infant. A careful history and physical examination and limited laboratory
evaluation are the first steps unless there is reason to think that an organic cause is present. The
fact that the infant was previously gaining weight appropriately makes a swallowing disorder
less likely.
A 12-month-old infant who had cardiopulmonary bypass with RBC and plasma infusions during
surgery at 8 months is seen for a well child examination. Which vaccine may be administered at
this visit?
MMR
OPV
PCV-13
Varivax - ✔✔✔-ANS: C
Live vaccines should be delayed until 6 months after cardiopulmonary bypass and exposure to
RBCs and plasma. The PCV-13 is not a live-virus vaccine and the others are.
A 12-year-old child has a recent history of increased thirst and frequent urination. The child's
weight has been in the 95th percentile for several years. A dipstick UA is positive for glucose,
and random plasma glucose is 350 mg/dL. Which test will the primary care pediatric nurse
practitioner order to determine the type of diabetes in this child?
Fasting plasma glucose
Hemoglobin A1C levels
Pancreatic antibodies
Thyroid function tests - ✔✔✔-ANS: C
,NURSING 602 pediatric midterm study set exam with questions and answers
(100% solved)
If the type of diabetes is uncertain, screening for pancreatic antibodies should be considered to
confirm the diagnosis of type 1 diabetes. Fasting plasma glucose may be elevated in both types.
Hemoglobin A1C does not distinguish among types. Thyroid function tests are not indicated
unless there is a suspicion of concomitant associated autoimmune conditions.
A 12-year-old child who plays soccer is diagnosed with vocal cord dysfunction. What will the
primary care nurse practitioner say when the child's parents ask about continued sports
participation?
The child may continue to participate in soccer.
The child should limit activity to non-aerobic sports.
This condition is a contraindication for all sports.
This condition predisposes the child to sudden cardiac death. - ✔✔✔-ANS: A
Vocal cord dysfunction causes shortness of breath and must be managed but does not prevent
children from participation in sports. It does not indicate underlying cardiac problems and does
not mean children should avoid any sport that may increase heart or respiratory rates.
A 12-year-old child whose BMI is greater than the 95th percentile has a blood pressure at the
98th percentile for age, sex, and height. After lifestyle changes that include diet and exercise,
the child's BMI drops to the 90th percentile, but the blood pressure remains the same. What is
the primary care pediatric nurse practitioner's next step in treating this child?
Continued close monitoring of blood pressure
Ordering an echocardiogram or MRI
Prescribing an ACE inhibitor medication
Referral to a nephrologist or cardiologist - ✔✔✔-ANS: D
Children who have persistent BP elevation after lifestyle changes are made should be referred to
a nephrologist or cardiologist who has experience using antihypertensive agents in children. The
specialist orders necessary tests and medications, not the primary care provider.
, NURSING 602 pediatric midterm study set exam with questions and answers
(100% solved)
A 12-year-old child whose weight and BMI are in the 75th percentile has a diastolic blood
pressure that is between the 95th and 99th percentiles for age, sex, and height on three
separate occasions. Initial tests for this child will include
complete blood count.
erythrocyte sedimentation rate.
renal function and plasma renin tests.
urinalysis and electrolytes. - ✔✔✔-ANS: C
Since the majority of children with stage 1 or 2 hypertension have renal or renovascular causes
for elevated BP, renal function and plasma renin tests should be performed. Children under 10
years of age with stage 2 hypertension should have more aggressive laboratory evaluation,
including CBC, ESR, UA, and electrolytes.
A 13-year-old Native American female has a BMI at the 90th percentile for age. The primary
care pediatric nurse practitioner notes the presence of a hyperpigmented velvet-like rash in skin
folds. The child denies polydipsia, polyphagia, and polyuria. The nurse practitioner will
counsel the child to lose weight to prevent type 2 diabetes.
diagnose type 2 diabetes if the child has a random glucose of 180 mg/dL.
order a fasting blood sample for a metabolic screen for type 2 diabetes.
refer the child to a pediatric endocrinologist. - ✔✔✔-ANS: C
This child has three risk factors for type 2 diabetes: Native American ethnicity, overweight, and
acanthosis nigricans. The PNP should perform metabolic screening on a fasting blood sample to
diagnose this. Lifestyle changes may be necessary to control the disease if diagnosed, but this
child may already have the disease, and management options aren't clear until the diagnosis is
made. Diagnosis is based on a random glucose >200 mg/dL. It is not necessary to refer this child
until a diagnosis is made.
A 14-year-old boy who is overweight develops a unilateral limp with pain in the hip and knee on
the affected side. An exam reveals external rotation of the hip when flexed and pain associated
with attempts to internally rotate the hip. What is most important initially when managing this
child's condition?
(100% solved)
A 10-year-old child has had abdominal pain for 2 days, which began in the periumbilical area
and then localized to the right lower quadrant. The child vomited once today and then
experienced relief from pain followed by an increased fever. What is the likely diagnosis?
Appendicitis with perforation
Gastroenteritis
Pelvic inflammatory disease (PID)
Urinary tract infection (UTI) - ✔✔✔-ANS: A
The child has the progression of symptoms typical of appendicitis with perforation - pain before
vomiting that localizes to the RLQ and then relief of pain with onset of fever upon perforation.
With gastroenteritis, vomiting precedes pain. PID symptomology includes increasing pain over
time. The symptoms of an UTI include fever, chills, and urinary symptoms.
A 10-year-old is hit in the head with a baseball during practice and is diagnosed with
concussion, even though no loss of consciousness occurred. The primary care pediatric nurse
practitioner is evaluating the child 2 weeks after the injury and learns that the child is still
experiencing some sleepiness every day. The neurological exam is normal. The child and the
parent are adamant that the child be allowed to return to play baseball. What will the nurse
practitioner recommend?
Continuation of cognitive rest only
Continuation of physical and cognitive rest
Continuation of physical rest only
Returning to play - ✔✔✔-ANS: B
Both physical and cognitive rest is indicated after diagnosis of concussion in youth, particularly if
symptoms continue following injury. Cognitive recovery may lag behind physical recovery and is
a key factor in return-to-play decisions. Only after all symptoms resolve may athletes progress
through steps to gradually return to play.
A 12-month-old infant exhibits poor weight gain after previously normal growth patterns. There
is no history of vomiting, diarrhea, or irregular bowel movements, and the physical exam is
normal. What is the next step in evaluating these findings?
,NURSING 602 pediatric midterm study set exam with questions and answers
(100% solved)
Complete blood count and electrolytes
Feeding and stooling history and 3-day diet history
Stool cultures for ova and parasites
Swallow study with videofluoroscopy - ✔✔✔-ANS: B
Vomiting, diarrhea, and bowel irregularities are more predictive of organic causes of FTT, which
are not present in this infant. A careful history and physical examination and limited laboratory
evaluation are the first steps unless there is reason to think that an organic cause is present. The
fact that the infant was previously gaining weight appropriately makes a swallowing disorder
less likely.
A 12-month-old infant who had cardiopulmonary bypass with RBC and plasma infusions during
surgery at 8 months is seen for a well child examination. Which vaccine may be administered at
this visit?
MMR
OPV
PCV-13
Varivax - ✔✔✔-ANS: C
Live vaccines should be delayed until 6 months after cardiopulmonary bypass and exposure to
RBCs and plasma. The PCV-13 is not a live-virus vaccine and the others are.
A 12-year-old child has a recent history of increased thirst and frequent urination. The child's
weight has been in the 95th percentile for several years. A dipstick UA is positive for glucose,
and random plasma glucose is 350 mg/dL. Which test will the primary care pediatric nurse
practitioner order to determine the type of diabetes in this child?
Fasting plasma glucose
Hemoglobin A1C levels
Pancreatic antibodies
Thyroid function tests - ✔✔✔-ANS: C
,NURSING 602 pediatric midterm study set exam with questions and answers
(100% solved)
If the type of diabetes is uncertain, screening for pancreatic antibodies should be considered to
confirm the diagnosis of type 1 diabetes. Fasting plasma glucose may be elevated in both types.
Hemoglobin A1C does not distinguish among types. Thyroid function tests are not indicated
unless there is a suspicion of concomitant associated autoimmune conditions.
A 12-year-old child who plays soccer is diagnosed with vocal cord dysfunction. What will the
primary care nurse practitioner say when the child's parents ask about continued sports
participation?
The child may continue to participate in soccer.
The child should limit activity to non-aerobic sports.
This condition is a contraindication for all sports.
This condition predisposes the child to sudden cardiac death. - ✔✔✔-ANS: A
Vocal cord dysfunction causes shortness of breath and must be managed but does not prevent
children from participation in sports. It does not indicate underlying cardiac problems and does
not mean children should avoid any sport that may increase heart or respiratory rates.
A 12-year-old child whose BMI is greater than the 95th percentile has a blood pressure at the
98th percentile for age, sex, and height. After lifestyle changes that include diet and exercise,
the child's BMI drops to the 90th percentile, but the blood pressure remains the same. What is
the primary care pediatric nurse practitioner's next step in treating this child?
Continued close monitoring of blood pressure
Ordering an echocardiogram or MRI
Prescribing an ACE inhibitor medication
Referral to a nephrologist or cardiologist - ✔✔✔-ANS: D
Children who have persistent BP elevation after lifestyle changes are made should be referred to
a nephrologist or cardiologist who has experience using antihypertensive agents in children. The
specialist orders necessary tests and medications, not the primary care provider.
, NURSING 602 pediatric midterm study set exam with questions and answers
(100% solved)
A 12-year-old child whose weight and BMI are in the 75th percentile has a diastolic blood
pressure that is between the 95th and 99th percentiles for age, sex, and height on three
separate occasions. Initial tests for this child will include
complete blood count.
erythrocyte sedimentation rate.
renal function and plasma renin tests.
urinalysis and electrolytes. - ✔✔✔-ANS: C
Since the majority of children with stage 1 or 2 hypertension have renal or renovascular causes
for elevated BP, renal function and plasma renin tests should be performed. Children under 10
years of age with stage 2 hypertension should have more aggressive laboratory evaluation,
including CBC, ESR, UA, and electrolytes.
A 13-year-old Native American female has a BMI at the 90th percentile for age. The primary
care pediatric nurse practitioner notes the presence of a hyperpigmented velvet-like rash in skin
folds. The child denies polydipsia, polyphagia, and polyuria. The nurse practitioner will
counsel the child to lose weight to prevent type 2 diabetes.
diagnose type 2 diabetes if the child has a random glucose of 180 mg/dL.
order a fasting blood sample for a metabolic screen for type 2 diabetes.
refer the child to a pediatric endocrinologist. - ✔✔✔-ANS: C
This child has three risk factors for type 2 diabetes: Native American ethnicity, overweight, and
acanthosis nigricans. The PNP should perform metabolic screening on a fasting blood sample to
diagnose this. Lifestyle changes may be necessary to control the disease if diagnosed, but this
child may already have the disease, and management options aren't clear until the diagnosis is
made. Diagnosis is based on a random glucose >200 mg/dL. It is not necessary to refer this child
until a diagnosis is made.
A 14-year-old boy who is overweight develops a unilateral limp with pain in the hip and knee on
the affected side. An exam reveals external rotation of the hip when flexed and pain associated
with attempts to internally rotate the hip. What is most important initially when managing this
child's condition?
