Exam 3-10

Question 1

A 3-year-old child who attends day care has had a fever, nausea, and vomiting several weeks prior and now has darkened urine and constipation along with hepatomegaly and right upper quadrant tenderness. What treatment is warranted for this child?
Select one:
a. HAV vaccine
b. Immunoglobulin G
c. Interferon-alfa
d. Supportive care

Answer 1

d. Supportive care

Question 2

A complete blood count on a 12-month-old infant reveals microcytic, hypochromic anemia with a hemoglobin of 9.5 g/dL. The infant has mild pallor with no hepatosplenomegaly. The primary care pediatric nurse practitioner suspects
Select one:
a. hereditary spherocytosis.
b. iron-deficiency anemia.
c. lead intoxication.
d. sickle-cell anemia.

Answer 2

b. iron-deficiency anemia.

Question 3

A 7-year-old female has recently developed pubic and axillary hair without breast development. Her bone age is consistent with her chronological age, and a pediatric endocrinologist has diagnosed idiopathic premature adrenarche. The primary care pediatric nurse practitioner will monitor this child for which condition?
Select one:
a. Adrenal tumor
b. Congenital adrenal hyperplasia
c. Polycystic ovary syndrome
d. Type 1 diabetes mellitus

Answer 3

c. Polycystic ovary syndrome

Question 4

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 verify the type or the length of time the ticks were attached. The child is asymptomatic. What is the best course of action?
Select one:
a. Administer a prophylactic single dose of doxycycline.
b. Perform serologic testing for IgG or IgM antibodies.
c. Prescribe amoxicillin three times daily for 14 to 21 days.
d. Teach the parents which signs and symptoms to report.

Answer 4

d. Teach the parents which signs and symptoms to report.

Question 5

A 3-year-old 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?
Select one:
a. Administer the MMR vaccine to help prevent disease.
b. Give antiviral medications at the first sign of symptoms.
c. Give the child a dose of immune globulin to mitigate the response.
d. Reassure the parent that most exposed children will not get measles.

Answer 5

a. Administer the MMR vaccine to help prevent disease.

Question 6

A 10-year-old child has a 1-week history of fever of 104°C that is unresponsive to antipyretics. The primary care pediatric nurse practitioner examines the child and notes bilateral conjunctival injection and a polymorphous exanthema, with no other symptoms. Lab tests show elevated ESR, CRP, and platelets. Cultures are all negative. What will the nurse practitioner do?
Select one:
a. Begin treatment with intravenous methyl prednisone.
b. Consider IVIG therapy if symptoms persist one more week.
c. Order a baseline echocardiogram today and another in 2 weeks.
d. Reassure the child’s parents that this is a self-limiting disorder.

Answer 6

c. Order a baseline echocardiogram today and another in 2 weeks.

Question 7

The parent of a school-age child reports that the child usually has allergic rhinitis symptoms beginning each fall and that non-sedating antihistamines are only marginally effective, especially for nasal obstruction symptoms. What will the primary care pediatric nurse practitioner do?
Select one:
a. Order an intranasal corticosteroid to begin 1 to 2 weeks prior to pollen season.
b. Prescribe a decongestant medication as adjunct therapy during pollen season.
c. Recommend adding diphenhydramine to the child’s regimen for additional relief.
d. Suggest using an over-the-counter intranasal decongestant.

Answer 7

a. Order an intranasal corticosteroid to begin 1 to 2 weeks prior to pollen season.

Question 8

The primary care pediatric nurse practitioner diagnoses an 8-year-old child with type 1 diabetes after a routine urine screen is positive for glucose and negative for ketones and plasma glucose is 350 mg/dL. The child’s weight is normal and the parents report a mild increase in thirst and urine output in the past few days. Which course of action is correct?
Select one:
a. Admit the child to the hospital for initial insulin management.
b. Begin insulin and refer the child to a children’s diabetes center.
c. Order a fasting serum glucose and a dipstick UA in the morning.
d. Send the child to the emergency department for fluids and IV insulin.

Answer 8

b. Begin insulin and refer the child to a children’s diabetes center.