Exam 1: Quizzes/Test Bank Flashcards
Which of the following procedures is least likely to improve vaccination rates over several years?
Providing posters in the waiting room about vaccinations in general
Which of the following is false?
Regarding vaccines
Missed vaccination opportunities are a minor contributor to low vaccination rates in many practices.
Which administration route is incorrect?
For immunizations
Hep B, IM, in the outer quadrants of the buttock of a child
Which of the follow is incorrect?
Hep B is an attenuated live viral vaccine
Which is not a valid contraindication?
For MMR, allergy to eggs
Which of the following DTaP immunization records, although late at times, is otherwise entirely within the recommended guidelines?
3, 4, 6, and 15 months
Which of the following is false?
The Vaccine Injury Compensation Program provides compensation for permanent and non-permanent injuries temporaily associated with any recommended vaccination.
Which of the following is a contraindication to further doses of DTaP vaccine?
Anaphylaxis after DTaP
Which statement about the routine schedule is false?
The first dose of MMR is ideally given from 15-19 months of age
A single mother of an infant worries that living in a household with only one parent will cause her child to be maladjusted. To help address the mother’s concerns the PCP NP will suggest:
Developing consistent daily routines for the child
During a well child exam, the PCP learns that the parents of a young child fight frequently about finances. The parents state that they do not fight in front of the child and feel that the situation is temporary and related to the father’s job layoff. What will the NP do?
Suggest counseling to learn ways to handle stress.
During a well child assessment of an 18 month old child, the PCP observes the child becoming irritable and uncooperative. The parent tells the child to stop fussing. What will the NP do?
Offer the child a book or a toy to look at
Which recommendation will a PCP make when parents ask about ways to discipline their 3 y/o child who draws on the walls with crayons?
Provide a roll of paper for drawing and teach the child to use this.
The PCP conducts a well baby exam on an infant and notes mild gross motor delays, but no delays in other areas. Which initial course of action will the NP recommend?
Teach the parents to provided exercises to encourage motor development
The PCP is examining a newborn infant recently discharged from the NICU after a premature birth. The parent is upset and expresses worry about whether the infant will be normal. What will the NP do in this situation?
Point out the tasks that the infant can preform while conducting the assessment
The PCP sees a developmentally delayed toddler for an initial visit. The family has just moved to the area and asks the NP about community services and resources for their child. What should the NP do initally?
Ask the parents if they have an individualized family service plan (IFSP)
The PCP has a cohort of patients who have special health care needs. Which is an important role of the NP when caring for these children?
Care coordination and collaboration
The PCP preforms a physical examination on a 9 month old infant and notes two central incisors on the lower gums. The parent states that the infant nurses, takes solid foods 3x/day, and occasionally takes water from a cup. What will the PCP counsel the parent to promote optimum dental health?
To make an appointment for an initial dental examination
The PCP enters an exam room and finds a 2 month old infant in a car seat on the exam table. The infant’s mother is playing a game on her smart phon. The NP interprets this behavior as:
Moderate concern for parenting problems
A mother brings her 9 month infant in for a routine visit. What milestone would be appropriate for the NP to ask if the infant is meeting?
Rolls back to stomach and stomach to back
A 5 day old infant comes in for a newborn check up. On assessment of the newborn you note that the skin is jaundice in color. The anterior fontanel is slightly sunken. Per mom, the infant have only had 2 diapers today. The infant is strictly breastfed and this is the moms 1st child. She states baby is having trouble latching on. A bili level is sent and comes back at 18. You identify this newborn to be dehydrated and is most likely to have breast milk jaundice. Which nursing intervention(s) will be required for this baby?
All of the above: phototherapy, providing support and education for the lactating mom, strict monitoring of I/O
Apgar scores measure heart rate, RR, reflex irritability, color, and:
Muscle tone
A mother on the postpartum unit asked to have her infant back from the nursery so that she can breastfeed. The nurse brings the newborn to the room and hands the baby to the mother. She asks the mother to let her know how long the baby feeds. What vital step did the nurse forget to take before giving the baby to the mother?
The nurse should have identified the baby’s ID band the the mother’s
Excessive heat loss results in which of these?
Depletion of glucose levels
A mother has just delivered her new baby a few hours ago. She asks the nurse if she can bathe the baby because he has blood on him. The best response from the nurse would be:
Its important that we not bathe the baby too soon after birth. Lets wait until later in the day.
A 4-week old infant is brought to the ED. Mom states the baby hasn’t been eating well and has had decreased diapers for 2 days. The baby has been sleeping more and has been hard to wake up. On assessment, you find that the baby is difficult to arouse, is hypotonic and temperature is 35.4 rectally. What is an important lab value to check?
Blood glucose
A pregnant woman with a history of a clotting disorder is required to self-administer heparin during her pregnancy. After delivery, the infant will be at greater risk for:
Decreased Vitamin K
A part of injury prevention is making and keeping infant appointments. The required checkups and vaccinations are at:
2, 3, 6, 9 months and 1 year
Your are taking care of an infant who was admitted with dehydration. His weight is 6kg. You have been monitoring his I/O’s. What would you expect the infants urinary output to be in order to maintain adequate hydration?
13 ml/kg/hr
A mother brings her newborn daughter to the ED with concerns that she is having vaginal bleeding. You know this is normal and called what?
Pseudomenstruation
While interviewing a mother of an infant, you note that the mother gets frustrated as she explains that her baby has been up all night crying at least 3x a week for the last 2 weeks. She states that she has tried everything and feels hopeless. What would be the BEST response for you as the NP?
You are doing nothing wrong. This can be a common occurrence in infants and you should not feel guilty
The parent of a newborn infant asks the PCP when to intervene to help the infant’s future intellectual growth. What will the NP tell the parent?
Language and literacy skill begin at birth
The PCP preforms a well baby examination on a 7 day/old infant who is nursing well, according to mother. The NP notes the infant weighted 3250g at birth and 2990g when discharge on the second DOL. The infant weights 3080g at this visit. Which action is correct?
Schedule a weight check in 1 week
During an assessment of a 4 week old infant, the PCP learns that a breastfed infant nurses every 2 hours during the day but is able to sleep for a 4 hour period during the night. the infant has gained 20g per day in the interval since last seen in clinic. What will the NP recommend?
Continuing to nurse the infant using the current pattern
The PCP is preforming a well baby examination on a 2 month old infant who has gained 25g per day in the last interval. The mother is nursing and tell the NP that her infant seems fussy and wants to nurse more often. What will the NP tell her?
The infant may be going through an expected growth spurt
The mother of a 6 week old breastfeeding infants tells the PCP that her baby, who previously had BM’s with each feeding, now has a BM once every 3rd day. What will the NP tell her?
This may be a normal for breastfed babies
The mother of a 3 month old child tells the PCP that it is “so much fun” now that her infant coos and smiles and wants to play. What is the important for the NP to teach this mother?
How to read the infant’s cues for overstimulation
The parent of a 5 month old is worried because the infant becomes fussy but doesn’t always seem interested in nursing. What will the NP tell this parent?
The infant may be expressing a desire to play or to rest
The mother of a 6 month old infant is distressed because the infant can say “dada” but not “mama” and asks the PCP why this is when she is the one who spends more time with the infant. How will the NP respond?
At this age, you baby does not understand the meaning of sounds
The PCP is preforming a well child examination on a 9 month old infant whose hearing is normal but who responds to verbal cues with only single syllable vocalizations. What will the NP recommend to the parents to improve speech and language skills in this infant?
Read simple board books to the infant at bedtime
The PCP is examining a 12 month old infant who was 6 weeks premature and observes the infant uses a raking motion to pick up small objects. The PEDS questionnaire completed by the parent did not show significant developmental delays. What will the NP do first?
Perform an in-depth developmental assessment
The PCP is evaluating a 2 y/o with a documented speech delay. Screening at assess motor skills and cognition are normal, and the child passed a recent hearing test. What will the NP do next?
Ask the child’s parents whether they read to the child
The PCP preforms a developmental assessment on a 32 month old child. The child’s parent reports that about 70% of the child’s speech is intelligible. The NP observes the the child has difficulty pronouncing “t”, “d”, “k”, and “g” sounds. Which action is correct?
Reassure the parent that this is normal
During a well child assessment of an 18 month old child, the PCP observes the child point to a picture of a dog and say “want puppy!” The NP recognizes this as an example of:
Telegraphic speech
The PCP is offering anticipatory guidance to the parents of an 12 month old child. The parents are bilingual in Spanish and English and have many Spanish speaking relatives nearby. They are resisting exposing the child to Spanish out of concern that the child will not learn English well. What will the NP tell the parents?
Most bilingual children are able to shift from one language to another when appropriate
The PCP is counseling the parents of a toddler about appropriate discipline. The parents report that the child is very active and curious, and they are worried about the potential for injury. What will the NP recommend?
Allow the child to explore and experiment while providing appropriate limits
The mother of a 3 y/o child takes the child to a play group once a week. She expresses concern that the child plays with toys but does not interact with other toddlers. What will the NP counsel the mother on?
Toddler may be interested in other children, but usually do not engage in interactive play
The parent of a 4 y/o points to a picture and says “that’s you sister.” The child responds by saying, “No! It’s my baby!” This is an example of which type of thinking in preschool age?
Realism
The parent of a 24 month old child asks the PCP when toilet training should begin. How will the NP respond?
“Tell em about your child’s daily habits”
The parents of a 3 y/o child are concerned that the child has begun refusing usual foods and wants to eat mashed potatoes and chicken strips at every meal and snack. The child’s rate of weight has slowed, but the child remains at the same percentile for weight on a growth chart. What will the NP tell the parents to do?
Place a variety of nutritious foods on the child’s plate at each meal
The PCP is examining a 6 y/o child who attends first grade. The child reports “hating” school. The parent states that the child pretends to be sick frequently in order to stay home from school. To further assess this situations, the NP will first ask the child:
to name one or two friends
The parent of a 10 y/o boy tells the PCP that the child doesn’t appear to have any interest in girls and spends most of his time with a couple of other boys. The parent is worried about the child’s sexual identity. The NP will tell the parent:
This attachment to other same gender children is how the child learns to interact with others
The parents of a 12 y/o child are concerned that some the child’s other classmates may be a bad influence on their child, who, they say, has been raised to believe in right and wrong. What will the NP tell the parent?
The pressures from outside influences may superseded parental teachings and should be confronted
During a well child exam of a schoolage child, the PCP learns that the child has been having angry episodes at school. The NP observes the child to appear withdrawn and sad. Which action is appropriate?
Ask the child and the parent about stressor at home
The PCP is preparing to conduct a well child assessment of an 8 y/o child. How will the NP being the exam?
Ask the child about school, friends, home activities, and sports
The parent of a 6 y/o child expresses concern that the child may have ADHD. Which screening tool will the PCP use to evaluate this possibilty?
Conner’s 3 Parent and Teacher Rating Scale
The parent of a 5 y/o child who has just begun kindergarten expresses concern that the child will have difficulty adjusting to the birth of a sibling. What will the NP recommend?
Having snack time with the child each day to discuss the school day
A school-age child has begun refusing all cooked vegetables. What will the PCP recommend to the parent?
Ensure that the child has 3 nutritious meals and 2 nutritious snacks each day
The PCP preforms a physical exam on a 12 y/o child and notes poor hygiene and inappropriate clothes for the weather. The child’s mother appears clean and well dressed. The child reports getting 6-7 hours of sleep each night because of texting with friends late each evening. What action by the NP will help promote healthy practices?
Discuss setting clear exceptions about self-care with the mother
During a well-child exam of a 5 y/o child, the PCP assesses the child for school readiness. Which finding may be a factor limiting school readiness for this child?
Parental concerns about bullying in the school
The PCP is examining a school age child who complain of frequent stomach pain and headaches. The parent reports that the child misses several days of school each month. The child has a normal exam. Before proceeding with further diagnostic tests, what will the NP initially ask the parent?
About the timing of the symptoms each day and during the week
The PCP is evaluating recurrent stomach pain in a school age child. The child’s exam is normal. The NP learns that the child reports pain most evenings after school and refuses to participate in sports, but does not have N/V. The child’s grandmother recently had gallbladder surgery. Which action is correct?
Encourage the child to keep a log of pain, stool patterns, and dietary intake
The PCP is preforming a well child assessment on a 13 y/o F whose mother asks when her daughter’s periods may start. Which information will the NP use to help estimate the onset of periods?
The patient’s age at thelarche (breast budding)
The PCP is examining a 15 y/o F who reports having her first period at age 13. She states that she has had five periods in the last year, with the last on 2 months prior. She participates in basketball at school. What action is correct?
Perform biometric screening to determine lean body mass
During a well child assessment of a 13 y/o M the PCP notes small testicles, pubic and axillary hair. To further evaluate these findings, the NP will ask the patient about:
Participation in sports
The mother of a 16 y/o M was recently divorced after several years of an abusive relationship and tells the PCP that the adolescent has begun skipping school and hanging out with friends at the local shopping mall. When she confronts her child, he responds by saying that her hates her. What will the NP tell this mother?
Adolescents often need counseling to help them cope with life events
The PCP is performing a well child exam on a 12 y/o F who has achieved early sexual maturation. The mother reports that she spends more time with her older sister’s friends instead of her own classmates. What will the NP tell this parent?
Girl who join an older group of peers may become sexually active at an earlier age
The mother of a 15 y/o adolescent female tells the PCP that her daughter has extreme mood swings prior to her periods, which the adolescent vehemently denies. When asked if she notices anything different just before her periods, the adolescent point to her mother and says “she gets really hard to live with.” This demonstrates which characteristic of adolescent thinking?
Apparent hypocrisy
The PCP is preforming an exam on an adolescent male who asks about sexual identity because of concern that a friend is worried about being gay. Which response will the NP make in this situation?
Tell the adolescent that, unless he is at risk, what he says will be confidential
The parent of a 14 y/o child tells the PCP that the child skips classes frequently in spite of various disciplinary measures, such as grounding and extra homework and is earning C/D’s in most classes. What will the NP recommend?
Evaluation for possible learning disorders
The parent of a 14 y/o child tells the PCP that the adolescent has expressed a desire to be a vegetarian, is refusing all meat served at home, and wants the family to eat vegetarian meals. What will the NP tell the parent?
Suggest that the adolescent prepare appropriate vegetarian dishes to complement the family meals
The PCP is preforming a well child exam on a 17 y/o F whose mother is present during the history. The mother expressed concern that her daughters wishes to have an eyebrow piercing and states that she is opposed to the idea. What will the NP do?
Provide information about piercings and encourage continued discussion
The parent of a 16 /o tells the PCP that the teen was recently caught smoking an e-cigarette. What will the NP tell this parent?
E-Cigarette use may be a risk factor for later substance abuse
The parent of an adolescent reports noting cutting marks on the teen’s arms and asks the PCP what it means. What will the NP tell this parent?
Cutting is a way of dealing with emotional distress
The PCP is preforming a focused problem assessment on a child who has asthma and learns that one of the child’s parents smokes around the child in spite of being advised against this. The NP recognizes this as a possible alteration in which functional health pattern?
Health perception
The PCP examines an infant whose weight is below the 3rd percentile and whose mother does not comply with the feeding regiment. When attempting to enlist the help of the infant’s grandmother, the grandmother says “my daughter was like this when she was a baby and she turned out all right.” Which approach will the NP take to improve the outcome for this infant?
Ask the grandmother about her daughter’s health during childhood
The PCP provides patient teaching for children newly diagnosed with IBS. At which stage of development will children be able to understand the link between stress and the symptoms of the disease?
Formal operational stage
The PCP is counseling an obese adolescent whose parents both have Type 2 Diabetes. Which health behavior prediction model is useful when the NP discusses lifestyle changes with this client?
Health belief model
The PCP is counseling a school-age child about asthma management strategies. The child states that it is “too much trouble” to remember to use an ICS medication 2x daily and reports feeling fine inspite of exhibiting expiratory wheezes. Which action uses the health belief and self-efficacy model to teach this child about asthma management?
Obtaining pre and post-treatment spirometry testing
An adolescent who is overweight expresses a desire to lose weight in order to participate in sports but tell the PCP he doesn’t want to give up sweets and soft drinks because he enjoys them too much. Which stage of change does this represent?
Contemplation
The PCP sees a 17 y/o client who quit smoking almost 1 year ago, but how reports having renewed cravings when around friends who smoke. Using knowledge of the maintenance stage of change, the PCP will:
Suggest the teen consider taking up a sport or other physical activity
The PCP is working with a 12 y/o F who has poor diabetes control. The child tells the NP that the parent forgets to remind her to check the blood sugars. Which action is correct?
Help the child develop a strategy to remember without parental prompts
The PCP is counseling an obese 16 y/o client about weight management. The adolescent says “I know I need to lose weight, but I don’t want to give up all my favorite foods.” When using motivational interviewing techniques, how will the NP respond?
“Do you think there are any food you could limit or do without for a while?”
The parent of a newborn has quit smoking cigarettes within the past month and reports feeling fidgety. Using a “reframing” technique, how will the PCP respond?
Explore ways that the parent can use this extra energy to do things for the baby
The PCP is assessing the health literacy of the parent of a toddler. Which tool will the NP use to estimate reading level?
SMOG
The pediatric NP provides primary care for a special needs infant whose parent takes an active role in the infant’s care. The parent has a high school diploma and asks many questions about her infant’s treatments. Which approach will the NP take to ensure health literacy for this parent?
Ask the parent to read back all information given
The PCP is counseling the parent of an overweight school-age child about improving overall fitness. What will the NP include?
Encourage the child to begin by engaging in swimming or cycling
The parent of a child who has asthma asks the PCP about whether the child may engage in strenuous exercise. What will the NP tell the parent?
Children with asthma show improved aerobic and anaerobic fitness with moderate to vigorous/physical activity
The PCP is discussing lifestyle changes with an adolescent who has HTN. What will the NP recommend about exercise for this client?
Regular vigorous activity initially with combination of resistance and aerobic exercise to maintain lower BP
The PCP is offering anticipatory guidance to the parents of a 6 yo child who has Down Syndrome. What will the NP tell the parents about physical activity and sports in school?
Their child should have cervical spine evaluation before participation in sports
The PCP is discussing fitness and exercise with the parents of a 5 y/o child who asks what kinds of activities are developmentally appropriate for their child. What will the NP recommend?
Bike riding
The parents of a prepubertal female who is on the local swim team tell the PCP that their daughter wants to begin a strength training program to help improve her swimming ability. What will the NP recommend?
Enrolling their daughter in a program that uses fixed weight machines or resistance bands
The parent of a 14 y/o child asks the PCP how to help the child prevent injuries when basketball tryouts being later in the school year. Which recommendation will be of most benefit?
Preseason conditioning
The PCP is counseling a parent about bicycle helmet use. The parent reports having a helmet used a year previously by an older child and wonders about using if for a younger child since they are so expensive. What will the NP tell the parent?
If the helmet is free from marks, you may use it
The PCP is preforming a well child examination on a high school age adolescent who plays football who has hypercalciuria. Which dietary supplement will the NP question the adolescent about?
Protein supplements
The PCP is preforming a pre-participation sports physical exam on a 14 y/o M who will be on the wrestling team at school. What will the NP include when discussing healthy practices with this adolescent?
Risks associated with repeatedly losing and gaining weight
The PCP is evaluating a heart murmur during a pre-participation examination of a high school athlete. Which finding would be a concern requiring referral to a cardiologist?
A murmur that is quieter when squatting and louder with a Valsalva maneuver
The parent of a 12 y/o child with sickle cell trait asks the PCP whether the child may play football. What will the NP tell this parent?
Child with SCT should follow heat acclimatization guidelines
The parent of a child newly diagnoses with epilepsy asks the PCP if the will ever be able to participate in gym and sports. What will the NP recommend?
Direct supervision of some activities is necessary
The PCP diagnoses a high school basketball player with mono. The adolescent asks when she may resume play. What will the NP tell her?
A 4 weeks, she must have an exam to determine fitness for play.
A 12 y/o child who plays soccer is diagnoses with vocal cord dysfunction. What will the PCP say when the child’s parents ask about continued sports participation?
The child may continue to participate in soccer.
The parents of a high school basketball player tells the PCP that the adolescent becomes SOB only when exercising. What will the NP recommend?
Evaluation for underlying cardiac causes of this symptom
A 10 y/o is hit in the head with a baseball during practice and is diagnosed with a concussion, even though no LOC occurred. The PCP 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 NP recommend?
Continuation of physical and cognitive rest
A 15 y/o female basketball player who has secondary amenorrhea is evaluated by the PCP who notes a BMI in the 3rd percentile. What will the NP counsel this patient?
To work with a dietician to improve healthy weight gain
The PCP is examining a 17 y/o M who is on his high school swim team. The adolescent is concerned about “lumps” on his chest. The NP notes a marked increase in weight since the last visit along with worsening of the adolescent’s acne. Given this set of symptoms, which performance enhancing substance will the NP be concerned about and ask about?
DHEA (Dehydroepiandrosterone)
A 2 month old infant has a staccato cough and fever. Which aspect of the history is MOST important in determining the diagnosis?
Immunization history
When reviewing a WBC count, the PCP suspects a viral infection when which WBC element is elevated?
Lymphocytes
Which lab value is most concerning in an infant with fever and a suspected bacterial infection?
C-Reactive protein of 11.5mg/L
A toddler is receiving long-term antibiotics to treat osteomyelitis. Which laboratory test will the PCP order to monitor response to therapy in this child?
ESR
According to recent research, which populations may have higher rates of under immunization than others?
Those with higher rates of graduate degrees
The parent of a 2 month old infant is reluctant to have the baby vaccinated. What is an initial step in responding to these concerns?
Question the parent’s reasons for concern about immunizations
A parent is concerned about vaccine adverse reactions. Based on an IOM report, what will the PCP tell the parent?
The MMR may be linked to febrile seizures in immunocompromised children
A 2 month old infant will receive initial immunizations, and the parent asks about giving medications to increase the infants comfort and minimize fever. What will the NP recommend?
Administering Ibuprofen or Acetaminophen as needed
The parent of an infant asks why some vaccines, such as MMR, are not given along with the other series of immunizations at 2, 4, and 6 months of age. What will the PCP tell this parents?
Maternal antibodies neutralize some vaccines and are delayed until 12 months
The PCP is performing an initial well child exam on a 3 y/o child recently adopted from Africa. The adoptive parent has a record of immunizations indicating that the child is fully vaccinated. What will the NP?
Perform antibody titers and reimmunize the child
The PCP reviews the immunization records of an 18 month old child and notes that the child received an MMR immunization 2 days prior to the 1st birthday. What will the NP do?
Recommend the next dose of MMR vaccine at 4-5 y/o
A 5 y/o 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?
DTaP
An adolescent female who is sexually active and what has not had the HPV vaccine asks if she may have it. What will the PCP tell her?
The vaccine will no protect her from and HPV oncogenic types acquired previously
An 18 month old child has bronchopulmonary dysplasia. To help prevent pneumococcal disease, which vaccine will be ordered?
PCV13
A 5 y/o child who received VariZIG after exposure to varicella while immunocompromised during chemotherapy is in the clinic 5 months after stopping chemotherapy for kindergarten vaccines. What will the PCP order for this child?
MMR, Varivax, Tdap
A 3 y/o child who attends day care has had a fever, N/V several weeks prior and now has darkened urine and constipation along with hepatomegaly and RUQ tenderness. What treatment is warranted for this child?
Supportive care
A 10 month old infant who is new to the clinic has chronic Hep B infection. What will the PCP do to manage this infant’s disease?
Consult a pediatric infectious disease specialist
The PCP performs a well child examination on 1 month old. The infant was recently discharged from the NICU after treatment with parenteral acyclovir for a neonatal herpetic infection and is currently taking oral acyclovir. What will the NP do to manage this infant’s care?
Obtain regular absolute neutrophil counts
A 19 month old infant has had a fever of 103 for 2 days and now has a diffuse, maculopapular rash that blanches on pressure. The infant’s immunizations are up to date. What will the NP do?
Reassure the parent that this is a mild, self-limiting disease
A child who is immunocompromised has a fever and a rash consisting of macules, papules, and pustules. What will the PCP do?
Hospitalize the child for IV acyclovir
A child whose parents have refused vaccines has been exposed to chickenpox and the parents ask whether the child may attend day care. What will the NP tell them?
The child should stay home if any symptoms occur and may return in 1 week if no rash develops
An 18 month old who developed URI symptoms 1 day prior is brought to the clinic with a high fever, chills, muscle pains, and a dry hacking cough. A rapid flu is negative and a viral culture is pending. What will the NP do?
Prescribe oseltamivir and follow closely
The PCP is reviewing medical records for a newborn that is new to the clinic. The toddler’s mom was found to be HIV positive during her pregnancy with this child and received antiretroviral therapy during pregnancy. The child was born by C-section, begun an antiretroviral prophylaxis, and did not breastfeed. What is the correct management for this child?
Consult with a pediatric HIV specialist
A 3 y/o child whose immunizations are up to date has been exposed to measles because of a localized outbreak among unvaccinated children. The parent reports that contact with infected children occurred within the last 2 days at a birthday party. What is the best course of action?
Administer the MMR vaccine to help prevent disease
A preschool-aged child is brought to the clinic for evaluation of a rash. The PCP notes an intense red eruption on the child’s cheeks and circumoral pallor. What will the NP tell the parents about this rash?
Expect a lacy, maculopapular rash to develop on the trunk and extremeties
An unimmunized school-aged child whose mother is in her first trimester of pregnancy is diagnoses with rubella after a local outbreak. What will the PCP recommend?
Assessment of maternal rubella titers
A child is brought to the clinic with a fever, headache, malaise, and a red annular macule surrounded by an area of clearing and a larger, erythematous annular ring. The child complains of itching at the site. What will the NP do to determine the diagnosis?
Ask about recent tick bites
A child whose family has been camping in a region with endemic Lyme disease suffered several tick bites. The parents report removing the ticks, but are not able to determine the length of time the ticks were attached. The child is asymptomatic. What is the action?
Teach the parents which signs and symptoms to report
A 10 month old has an erythematous, fluctuant, non-draining abscess on the R buttock after 10 days of treatment with amoxicillin for impetigo. What is the next step in managing this infant’s care?
Incision and drainage of the abscess with culture
A child with a history of a pustular rash at the site of a cat scratch on one arm now has warm, tender, swollen axillary lymph nodes on the affected side. The PCP notes induration and erythema of these nodes. What will the PCP do?
Order an immunofluorescent assay (IFA) for serum antibodies
A 7 y/o child whose immunizations are up to date has a fever, headache, stiff neck, and photophobia. What course of treatment is indicated?
Hospitalization for diagnosis and treatment with antibiotics
A school-age child has a fever of 104, sore throat, vomiting, and malaise. The PCP observes that the tonsils, oropharynx, and palate are erythematous and covered with exudate, the tongue is coated and red, and there is a red sandpaper-like rash on the child’s neck, trunk and extremities. Rapid strep is positive. What will the NP do to manage this child’s illness?
Prescribe oral amoxicillin.
An adolescent has a TB skin test prior to working as a volunteer in a hospital. The adolescent is healthy and has not travelled to or from a TB endemic area or had close contact with anyone who has TB. The skin test shows 10mm of induration at 48 hours. What will the PCP do?
Reassure the adolescent that this is a negative screen
The PCP is examining a 2 month old infant with fever and cough. WBCs are 14 and CXR is normal. The infant is nursing well and having normal stools. What would be an appropriate next step?
Preforming a catheterized UA to screen for leukocytes and nitrites
A 9 month old infant has developed 2 teeth since the 6 month checkup. The local water supply contains fluoride. What will the NP do to promote healthy dentition at this visit?
Apply sodium fluoride varnish to the infant’s teeth
What will the PCP recommend to the parent of an infant who is teething who asks about comfort measures?
Give the infant a cold teething ring or a wet washcloth to chew
An 18 month old child has horizontal, bright white lines along the upper gum line of the teeth. What is the most important question the NP will ask the child’s parents?
If the child is still drinking milk from a bottle
A 4 y/o child who has had extensive dental surgery to treat dental caries has white spot lesions on the primary teeth. How often should this child receive fluoride varnish applications?
Every 3-6 months
The parents of a formula fed newborn report that they get their drinking water from a well. What will the NP recommend to provide adequate fluoride for this infant?
Testing the fluoride level of their water source
What will the NP teach the parent of an infant about cleaning the child’s teeth?
To use a smear of toothpaste and not to rinse the mouth
A parent asks about ways to promote dental health in school-age children while on a family vacation that are convenient while camping and picnicking. What will the NP recommend?
Offering gum containing xylitol after meals
An adolescent has localized bleeding of the gums when brushing the teeth. An exam of the mouth reveals the presence of plaque and calculus on the teeth which are not loose. What will the NP recommend?
Consistently brushing and flossing the teeth twice daily
A school-age child has had herpes stomatitis for a week and continues to complain of pain. What will the NP recommend?
Topical application of diphenhydramine and Maalox
A child has several shallow mucosal lesions on the buccal mucosa and tongue that are surrounded with an erythematous halo and covered by yellow plaques. What will the NP recommend?
Chlorhexidine gluconate
During a well child exam, the PCP notes a yellowish-white serpentine bordered lesions on the anterior portion of a child’s tongue. What will the NP do?
Reassure the parent that these are benign lesions
A 4 y/o child who has asthma has teeth with smooth, cupped-out teeth on the chewing surfaces. What is the most likely explanation for this finding?
GERD
An adolescent female reports facial pain and frequent popping of her jaw. An exam reveals unilateral tender facial muscles and a deviation of the mandible to the affected side with opening of the mouth. What will the NP do?
Recommend ice packs, NSAIDS and a soft diet
A 5 y/o child is hit in the face with a baseball bat and is brought to the clinic by a parent. An exam reveals three avulsed front teeth. Radiologic studies are negative for facial fractures. What is the recommended treatment?
Refer the child to a dentist immediately for further examination
A child with CP receives all nutrition via G-tube. What will the NP recommend to promote dental health in this child?
Daily chlorhexidine gluconate rinses
The PCP performs a vision screen on a 4 month old infant and notes the presence of convergence and accommodation with mild esotropia of the L eye. What will the NP do?
Refer the infant to a pediatric ophthalmologist
During a well child exam of a 4 y/o child, the PCP notes the nurse recorded 20/50 for the child’s vision and noted that the child had difficulty cooperating with the exam. What will the NP recommend?
Test the child’s vision in 1 month
During a well child assessment of an African American infant, the PCP notes a dark red-brown light reflex on the L eye and a slightly brighter red-orange light reflex on the R eye. The NP will:
Refer the infant to an ophthalmologist
The PCP performs the Hirschberg test to evaluate:
Occular alignment
The PCP applies fluorescein stain to a child’s eye. When examining the eye with a cobalt blue filter light, the entire cornea appears cloudy. What does this indicate?
There is too much stain on the cornea
A toddler exhibits exotropia of the R eye during a cover/uncover screen. The NP will refer to a pediatric ophthalmologist to initiate which treatment?
Patching of the unaffected eye for 2 hours each day
The PCP performs a well child examination on a 9 month old infant who has a history of prematurity at 28 weeks gestation. The infant was treated with retinopathy of prematurity and all symptoms have resolved. When will the infant need an ophthalmologic exam?
At 12 months of age
During a well baby assessment on a 1 week old infant, who had a normal exam when discharge from the newborn nursery 2 days prior, the PCP notes moderate eyelid swelling, bulbar conjunctival injections and moderate amounts of thick, purulent discharge. What is the likely diagnosis?
Chlamydia trachomatis conjunctivitis
The PCP performs a well baby assessment of a 5 day old infant and notes mild conjunctivitis, corneal opacity, and serosanguinous discharge in the R eye. Which course of action is correct?
Admit the infant to the hospital immediately
A preschool-aged child who attends day care has a 2 day history of matted eyelids in the morning and burning, itching of the eyes. the PCP notes a yellow-green purulent discharge from both eyes, conjunctival erythema, and mild URI symptoms. Which action is correct?
Prescribe topical antibiotic drops
A 14 y/o child has a 2 week history of severe itching and tearing of both eyes. The PCP notes redness and swelling of the eyelids along with stringy, mucoid discharge. What will the NP prescribe?
Topical NSAID drops
The PCP observes a tender, swollen red furuncle on the upper lid margin of a child’s eye. What treatment will the NP recommend?
Warm, moist compresses 3-4x/day
The PCP is treating an infant with lacrimal duct obstruction who has developed bacterial conjunctivitis. After 2 weeks of treatment with topical antibiotics along with massage and frequent cleansing of secretions, the infant’s symptoms have not improved. Which action is correct?
Refer to an ophthalmologist
A preschool-age child is seen in the clinic after waking up with a temperature of 102.2, swelling and erythema of the upper lid of one eye and moderate pain when looking from side to side. Which course of treatment is correct?
Admit to hospital for IV antibiotics
A school-aged child is seen in the clinic after a fragment from a glass bottle flew into the eye. What will the NP do?
Refer immediately to an ophthalmologist.
A school-age child is hit in the face with a baseball bat and reports pain in one eye. the PCP is able to see a dark red fluid level between the cornea and the iris on gross examination, but the child resists any exam with a light. What is the correct action?
Refer the child immediately to an ophthalmologist
The parent of a 4 month old infant is concerned that the infant cannot hear. Which test will the PCP order to evaluate potential hearing loss in this infant?
Auditory brainstem response (ABR)
The PCP obtains a tympanogram on a child that reveals a sharp peak of 180mm H2O. What does this value indicate?
Negative ear pressure
An 18 month old child with no previous history of otitis media awoke during the with R ear pain. The NP notes an axillary temp of 100.5 and an erythematous, bulging tympanic membrane. A tympanogram reveals a peak of +150mm H2O. What is the recommended treatment for this child?
An analgesic medication and watchful waiting
A 7 month old infant has had 2 prior acute ear infections and is currently on the 10th day of therapy of amoxicillin-clavulanate after a failed course of amoxicillin. The PCP notes marked middle ear effusion and erythema of the TM. The child is irritable and has a temp of 99.8. What is the next step in management of this child’s ear infection?
Refer the child to an otolaryngologist
a 3 y/o child with pressure equalizing tubes (PET) in both ears has otalgia in one ear. The PCP is able to visualize the tube and does not see exudate in the ear canal and obtains a Type A tympanogram. What will the NP do?
Order ototopical antibiotic/corticosteroid drops
What will the PCP teach the parents of a child who has new pressure-equalizing tubes in both ears?
Parents should notice improved hearing in their child
A child with a history of otitis externa asks about ways to prevent this condition. What will the NP recommend?
Drying the ear canal with a hair dryer
A child complains of itching in both ears and having trouble hearing. The PCP notes periauricular edema and marked swelling of the external auditory canal and elicits sever pain when manipulating the external ear structures. Which is an appropriate intervention?
Order ototopical antibiotic/corticosteroid drops
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?
Insert a wick into the external auditory canal
The PCP 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 NP do to remove this object?
Refer the child to an otolaryngologist for removal
A 3 y/o child has had on episode of acute otitis media 3 weeks prior with a normal tympanogram just after treatment with amoxicillin. In the clinic today, that child has a Type B tympanogram, a temperature of 102.5, and a bulging TM. What will the NP order?
Amoxicillin-clavulanate BID
The PCP diagnoses acute otitis media in a 2 y/o child who has a history of 3 ear infections in the first 6 months of life. The child’s TM is intact and the child’s temperature is 101.5. What will the NP prescribe for this child?
An analgesic medication and watchful waiting
A child who was treated with amoxicillin and then amoxicillin/clavulanate for acute otitis media is seen for follow-up. The PCP notes dull-gray TM with a visible airfluid level. The child is afebrile and denies pain. What is the next course of action?
Monitoring ear fluid levels for 3 months
A school age child has a history of chronic otitis media and is seen in the clinic with vertigo. The PCP notes profuse purulent otorrhea form both pressure-equalizing tubes and a pearly-white lesion on one TM. Which condition is most likely?
Cholesteatoma
In a respiratory disorder causing a check-valve obstruction, which symptoms will be present?
Air entry on inspiration with expiratory occlusion
A child has an acute infection causing lower airway obstruction. Which initial symptom is expected in this child?
Wheezing cough
A 4 y/o with URI has cloudy nasal discharge and moderate nasal congestion interfering with sleep. The parent asks what product to use to help with symptoms. What will the NP recommend?
Saline rinses
A 5 y/o has enlarged tonsils and a history of four throat infections in the previous year with fever, cervical lymphadenopathy, and Group A strep cultures. The parent reports that the child snores at night and expresses concerns about the child’s quality of sleep. The next step in managing this child’s conditions is to:
Refer to a pulmonologist for polysomnography evaluation (sleep study)
A school-aged child has an abrupt onset of sore throat, nausea, headache, and a temperature of 102.3. An examination reveals petechiae on the soft palate, beefy-red tonsils with yellow exudate, and a scarlatiniform rash. A rapid antigen detection test is negative. What is the next step in management for this child?
Throat culture
An adolescent has suspected infectious mono after exposure to the virus in the past week. The PCP examines the adolescent and notes exudates on the tonsils, soft palate petechiae, and diffuse adenopathy. Which test will the PCP perform to confirm diagnosis?
EBV specific antibody testing
A school-age child has had nasal discharge and daytime cough with no fever for 12 days without improvement in symptoms. The child has not had antibiotics recently and there is no significant antibiotic resistance in the local community. What is the appropriate treatment for this child?
Amoxicillin 45mg/kg/day
After 14 days of treatment with amoxicillin 45 mg/kg/day for acute rhinosinusititis, the child continues to have mucopurulent nasal discharge along with induration, swelling, and erythema of both eyelids. What is the next course of treatment?
Referral to a pediatric otolaryngologist
The parent of a toddler and a 4 week old infant tells the PCP that the toddler has just been diagnosed with pertussis. What will the NP do to prevent disease transmission to the infant?
Order azithromycin 10 mg/kg/day in a single dose daily for 5 days
A school age child has frequent nosebleeds. Nasal visualization reveals fresh clots and excoriated nasal mucosa, but no visible site of bleeding. Coag studies are normal. In spite of symptomatic measures, the child continues to have nosebleeds. What is the next course of action?
Refer to an otolaryngologist for further evaluation
A child is in the clinic because of symptoms of purulent, foul-smelling nasal discharge from the R nostril. Nasal visualization reveals something shiny in a mass of the mucous in the nasal cavity. What will the NP do?
Attempt to remove the mass gently using alligator forceps
A 2 y/o child is brought to the clinic after developing a hoarse, bark-like cough during the night with “trouble catching his breath” according to the parent. The history reveals a 2 day low grade fever and upper respiratory symptoms. On exam, the child has RR of 40 bpm, occasional stridor when crying, and a temp of 101.3. What is the next step in treatment for this child?
Prescribe oral dexamethasone for 2 days
The PCP evaluates a child who awoke with a sore throat and high fever after a nap. The child appears anxious and is sitting on the parent’s lap with the neck hyperextended. The physical exam reveals stridor, drooling, nasal flaring, and retractions. What will the NP do next?
Transport child to the hospital via EMS
A 5 month old infant who has a 3-day history of cough and rhinorrhea has developed symptoms of respiratory distress with audible expiratory wheezes and increased coughing. The infant’s immunizations are up to date. The physical exam reveals a respiratory rate of 50 bpm, coarse expiratory wheezes and prolonged expiration. SpO2 is 96% on RA. What is recommended treatment for this infant?
Recommend increased fluids and close follow-up
The PCP auscultates wheezes in all lung fields. Which diagnosis will the NP suspect?
Atypical PNA
A child is diagnosed with community acquired PNA (CAP) and will be treated as an outpatient. Which antibiotic will the NP prescribe?
Amoxicillin
The PCP manages care in conjunction with a pediatric pulmonologist for a child with CF. Which mediation regimen is used to facilitate airway clearance for this child?
Inhaled dornase alfa
