Exam 3-1

Question 1

The primary care pediatric nurse practitioner reviews the immunization records of an 18-month-old child and notes that the child received an MMR immunization 2 days prior to the first birthday. What will the nurse practitioner do?
Select one:
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.
d. Repeat the MMR vaccine since the first dose was given too soon

Answer 1

c. Recommend the next dose of MMR vaccine at 4 to 5 years of age.

Question 2

The primary care pediatric nurse practitioner cares for several families with chronically ill children who text status updates about their children to a mobile device that has an encryption- protection platform installed. If the nurse practitioner misplaces the mobile device, it is important to
Select one:
a. disconnect the user from the system to avoid a data breach.
b. notify the families that their messages may be read by others.
c. obtain a new device as soon as possible to resume communication.
d. upload the messages from another remote device.

Answer 2

a. disconnect the user from the system to avoid a data breach.

Question 3

The primary care pediatric nurse practitioner sees a child for follow-up care after hospitalization for ARF. The child has polyarthritis but no cardiac involvement. What will the nurse practitioner teach the family about ongoing care for this child?
Select one:
a. Aspirin is given for 2 weeks and then tapered to discontinue the medication.
b. Prophylactic amoxicillin will need to be given for 5 years.
c. Steroids will be necessary to prevent development of heart disease.
d. The child will need complete bedrest until all symptoms subside.

Answer 3

Aspirin is given for 2 weeks and then tapered to discontinue the medication.

Question 4

The primary care pediatric nurse practitioner performs a well child examination on a 1-month-old. The infant was recently discharged from the neonatal intensive care unit after treatment with parenteral acyclovir for a neonatal herpetic infection and is currently taking oral acyclovir. What will the nurse practitioner do to manage this infant’s care?
Select one:
a. Obtain regular absolute neutrophil counts.
b. Perform routine skin cultures for herpes simplex virus.
c. Reinforce the need to give acyclovir indefinitely.
d. Stop the oral acyclovir at 2 months of age.

Answer 4

a. Obtain regular absolute neutrophil counts.

Question 5

A 3-year-old child has head lice. What will the initial treatment recommendation be to treat this child?
Select one:
a. Lindane
b. Permethrin 
c. Pyrethrin
d. Spinosad

Answer 5

b. Permethrin

Question 6

The primary care pediatric nurse practitioner is considering using a drug for an “off-label” use in a child. The nurse practitioner has used the drug in a similar situation previously, has consulted a pharmacology resource and the FDA website, and has determined that there are no significant contraindications and warnings for this child. What else must the nurse practitioner do when prescribing this drug?
Select one:
a. Discuss recommendations with the parents and document their consent.
b. Document anecdotal reports of previous use of the drug by other providers.
c. Follow up daily with the parents to determine safe administration of the drug.
d. Report this use to the FDA Medwatch website for tracking purposes.

Answer 6

a. Discuss recommendations with the parents and document their consent.

Question 7

The primary care pediatric nurse practitioner is managing care for a child diagnosed with iron-deficiency anemia who had an initial hemoglobin of 8.8 g/dL and hematocrit of 32% who has been receiving ferrous sulfate as 3 mg/kg/day of elemental iron for 4 weeks. The child’s current lab work reveals elevations in Hgb/Hct and reticulocytes with a hemoglobin of 10.5 g/dL and a hematocrit of 36%. What is the next step in management of this patient?
Select one:
a. Continue the current dose of ferrous sulfate and recheck labs in 1 to 2 months.
b. Discontinue the supplemental iron and encourage an iron-enriched diet.
c. Increase the ferrous sulfate dose to 4 to 6 mg/kg/day of elemental iron.
d. Refer the child to a pediatric hematologist to further evaluate the anemia.

Answer 7

a. Continue the current dose of ferrous sulfate and recheck labs in 1 to 2 months.

Question 8

A child who was treated with amoxicillin and then amoxicillin-clavulanate for acute otitis media is seen for follow-up. The primary care pediatric nurse practitioner notes dull-gray tympanic membranes with a visible air-fluid level. The child is afebrile and without pain. What is the next course of action?
Select one:
a. Administering ceftriaxone IM
b. Giving clindamycin orally
c. Monitoring ear fluid levels for 3 months
d. Watchful waiting for 48 to 72 hours

Answer 8

c. Monitoring ear fluid levels for 3 months

Question 9

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
Select one:
a. counsel the child to lose weight to prevent type 2 diabetes.
b. diagnose type 2 diabetes if the child has a random glucose of 180 mg/dL.
c. order a fasting blood sample for a metabolic screen for type 2 diabetes.
d. refer the child to a pediatric endocrinologist.

Answer 9

c. order a fasting blood sample for a metabolic screen for type 2 diabetes.

Question 10

An African-American child has recurrent tinea capitis and has just developed a new area of alopecia after successful treatment several months prior. When prescribing treatment with griseofulvin and selenium shampoo, what else will the primary care pediatric nurse practitioner do?
Select one:
a. Monitor CBC, LFT, and renal function during therapy. Incorrect
b. Order oral prednisone daily for 5 to 14 days.
c. Perform fungal cultures on family members and pets.
d. Prescribe oral itraconazole or terbinafine.

Answer 10

c. Perform fungal cultures on family members and pets.

Question 11

he primary care pediatric nurse practitioner performs a vision screen on a 4-month-old infant and notes the presence of convergence and accommodation with mild esotropia of the left eye. What will the nurse practitioner do?
Select one:
A. Patch the right eye to improve coordination of the left eye.
B. Reassure the parents that the infant will outgrow this.
C. Recheck the infant’s eyes in 2 to 4 weeks.
D. Refer the infant to a pediatric ophthalmologist.

Answer 11

D. Refer the infant to a pediatric ophthalmologist.

Question 12

A child will need an occlusive dressing to treat lichen simplex chronicus. What will the primary care pediatric nurse practitioner tell the parents about applying this treatment?
Select one:
a. Apply ointment before the dressing.
b. Plastic wrap should not be used.
c. The dressing should be applied to dry skin.
d. Change the dressing twice daily.

Answer 12

a. Apply ointment before the dressing.

Question 13

The primary care pediatric nurse practitioner is performing a well-baby checkup on a 6-month-old infant and notes a candida diaper rash and oral thrush. The infant has had two ear infections in the past 2 months and is in the 3rd percentile for weight. What will the nurse practitioner do?
Select one:
a. Order a CBC with differential and platelets and quantitative immunoglobulins.
b. Order candida and pneumococcal skin tests and lymphocyte surface markers.
c. Refer the infant to an immunologist for evaluation of immunodeficiency. Incorrect
d. Refer the infant to an otolaryngologist to evaluate recurrent otitis media.

Answer 13

a. Order a CBC with differential and platelets and quantitative immunoglobulins.

Question 14

The primary care pediatric nurse practitioner evaluates children’s growth to screen for endocrine and metabolic disorders. Which is a critical component of this screening?
Select one:
a. Measuring supine length in children over the age of 2 years
b. Obtaining serial measurements to assess patterns over time
c. Using the CDC growth chart for children under age 2 years Incorrect
d. Using the WHO growth chart for children over age 2 years

Answer 14

b. Obtaining serial measurements to assess patterns over time

Question 15

A 9-month-old infant has had a fever of 103°F 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 primary care pediatric nurse practitioner do?
Select one:
a. Administer immunoglobulin G to prevent fulminant illness.
b. Perform serologic testing for human herpes virus -6 and human herpes virus -7.
c. Reassure the parent that this is a mild, self-limiting disease.
d. Recommend avoiding contact with pregnant women.

Answer 15

c. Reassure the parent that this is a mild, self-limiting disease.

Question 16

During a well-baby assessment on a 1-week-old infant who had a normal exam when discharged from the newborn nursery 2 days prior, the primary care pediatric nurse practitioner notes moderate eyelid swelling, bulbar conjunctival injections, and moderate amounts of thick, purulent discharge. What is the likely diagnosis?
Select one:
a. Chemical-induced conjunctivitis
b. Chlamydia trachomatis conjunctivitis
c. Herpes simplex virus (HSV) conjunctivitis
d. Neisseria gonorrhea conjunctivi

Answer 16

b. Chlamydia trachomatis conjunctivitis

Question 17

A toddler swallowed a coin several days prior. The child’s parent has not found the coin in the child’s stool. Which imaging test will the primary care pediatric nurse practitioner employ to evaluate this ingestion?
Select one:
a. Abdominal ultrasound 
b. Computed tomography
c. Conventional radiograph
d. Magnetic resonance imaging

Answer 17

c. Conventional radiograph

Question 18

A 4-year-old child who has asthma has teeth with smooth, cupped-out teeth on the chewing surfaces. Which is the most likely explanation for this finding?
Select one:
a. Bruxism 
b. Bulimia
c. Decreased saliva
d. Gastroesophageal reflux

Answer 18

d. Gastroesophageal reflux

Question 19

An adolescent female reports moderate dysmenorrhea with periods and tells the primary care pediatric nurse practitioner that 400 mg ibuprofen every 6 to 8 hours doesn’t completely control her pain. What will the nurse practitioner recommend?
Select one:
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
d. Using extended-release naproxen 500 mg every 12 hours

Answer 19

c. Taking naproxen 500 mg initially and then 250 mg every 6 to 8 hours

Question 20

A 9-month-old infant has developed two teeth since the 6-month checkup. The local water supply contains fluoride. What will the primary care pediatric nurse practitioner do to promote healthy dentition at this visit?
Select one:
a. Apply sodium fluoride varnish to the infant’s teeth.
b. Encourage the parents to make an initial dental appointment. Incorrect
c. Prescribe oral fluoride supplementation.
d. Teach the parents how to brush the infant’s teeth with fluoride toothpaste.

Answer 20

a. Apply sodium fluoride varnish to the infant’s teeth.