Exam 3-2

Question 1

The primary care pediatric nurse practitioner diagnoses a 5-year-old child with asthma and prescribes an oral steroid and a short-acting beta-adrenergic medication via a metered-dose inhaler to manage acute symptoms. Along with education about the prescribed medications, what information is important to give the child’s family at this visit?
Select one:
a. An asthma action plan
b. Effects and side effects of current medications
c. Information about spirometry testing
d. Instructions for medications at school

Answer 1

b. Effects and side effects of current medications

Question 2

An adolescent who has asthma and severe perennial allergies has poor asthma control in spite of appropriate use of a SABA and a daily high-dose inhaled corticosteroid. What will the primary care pediatric nurse practitioner do next to manage this child’s asthma?
Select one:
a. Consider daily oral corticosteroid administration.
b. Order an anticholinergic medication in conjunction with the current regimen.
c. Prescribe a LABA/inhaled corticosteroid combination medication.
d. Refer to a pulmonologist for omalizumab therapy.

Answer 2

d. Refer to a pulmonologist for omalizumab therapy.

Question 3

A child is diagnosed with tinea versicolor. What is the correct management of this disorder?
Select one:
a. Application of selenium sulfide 2.5% lotion twice weekly for 2 to 4 weeks
b. Oral antifungal treatment with fluconazole once weekly for 2 to 3 weeks
c. Sun exposure for up to an hour every day for 2 to 4 weeks
d. Using ketoconazole 2% shampoo on lesions twice daily for 2 to 4 weeks

Answer 3

a. Application of selenium sulfide 2.5% lotion twice weekly for 2 to 4 weeks

Question 4

The primary care pediatric nurse practitioner is examining a school-age child who has had several hospitalizations for bronchitis and wheezing. The parent reports that the child has several coughing episodes associated with chest tightness each week and gets relief with an albuterol metered-dose inhaler. What will the nurse practitioner order?
Select one:
a. Allergy testing
b. Chest radiography
c. Spirometry testing
d. Sweat chloride test

Answer 4

c. Spirometry testing

Question 5

he primary care pediatric nurse practitioner is assessing an ill 2-month-old infant who is febrile and refusing most fluids. The preliminary blood work indicates a viral infection and shows that the infant is hydrated. The infant is alert. The infant’s parents are attentive and live close by. What will the nurse practitioner do?
Select one:
a. Administer a parenteral antibiotic and antipyretic and send the infant home.
b. Admit the infant to an inpatient hospital unit for overnight monitoring.
c. Give the parents sick care instructions and follow up in the clinic in the morning.
d. Send the infant to the urgent care center for intravenous fluids.

Answer 5

c. Give the parents sick care instructions and follow up in the clinic in the morning.

Question 6

A child with cerebral palsy receives all nutrition via gastrostomy tube. What will the primary care pediatric nurse practitioner recommend to promote dental health in this child?
Select one:
a. Applying topical iodine every month
b. Daily chlorhexidine gluconate rinses
c. Ordering medications to prevent drooling
d. Prescribing prophylactic antibiotics

Answer 6

b. Daily chlorhexidine gluconate rinses

Question 7

n 18-month-old child has bronchopulmonary dysplasia. To help prevent pneumococcal disease, which vaccine will be ordered?
Select one:
a. PCV7
b. PCV13
c. PCV23
d. PCV33

Answer 7

b. PCV13

Question 8

An initial key part of management of a child suspected of having an inborn error of metabolism is
Select one:
a. consulting a metabolic specialist.
b. obtaining a complete family history.
c. ordering metabolic screening tests.
d. referring the family to a dietician.

Answer 8

a. consulting a metabolic specialist.

Question 9

The primary care pediatric nurse practitioner 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?
Select one:
a. Perform massage more frequently.
b. Prescribe an oral antibiotic.
c. Recommend hot compresses.
d. Refer to an ophthalmologist.

Answer 9

d. Refer to an ophthalmologist.

Question 10

When prescribing topical glucocorticoids to treat inflammatory skin conditions, the primary care pediatric nurse practitioner will
Select one:
a. initiate therapy with a high-potency glucocorticoid.
b. order lotions when higher potency is necessary.
c. prescribe brand-name preparations for consistent effects.
d. use fluorinated steroids to minimize adverse effects.

Answer 10

c. prescribe brand-name preparations for consistent effects.

Question 11

A 4-year-old 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?
Select one:
a. Annually
b. Twice yearly
c. Every 3 to 6 months
d. Every month

Answer 11

c. Every 3 to 6 months

Question 12

An unimmunized school-age child whose mother is in her first trimester of pregnancy is diagnosed with rubella after a local outbreak. What will the primary care pediatric nurse practitioner recommend?
Select one:
a. Assessment of maternal rubella titers
b. Intravenous immunoglobulin for the child
c. MMR vaccine for the mother and child
d. Possible termination of the pregnancy

Answer 12

a. Assessment of maternal rubella titers

Question 13

The single mother of a 4-year-old who attends day care tells the primary care pediatric nurse practitioner that she had difficulty giving her child a twice-daily amoxicillin for 10 days to treat otitis media during a previous episode several months earlier because she works two jobs and is too busy. The child has an ear infection in the clinic today. What will the nurse practitioner do?
Select one:
a. Administer an intramuscular antibiotic.
b. Order twice-daily amoxicillin for 5 days.
c. Prescribe azithromycin once daily for 5 days.
d. Reinforce the need to adhere to the plan of care.

Answer 13

c. Prescribe azithromycin once daily for 5 days.

Question 14

The primary care pediatric nurse practitioner is performing a well child examination on a school-age child who has a history of cancer treated with cranial irradiation. What will the nurse practitioner monitor in this child?
Select one:
a. Cardiomyopathy and arrhythmias
b. Leukoencephalopathy
c. Obesity and gonadal dysfunction
d. Peripheral neuropathy and hearing loss

Answer 14

b. Leukoencephalopathy

Question 15

A preschool-age child is seen in the clinic after waking up a temperature of 102.2°F, 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?

Select one:
A. Admit to the hospital for intravenous antibiotics.
B. Obtain a lumbar puncture and blood culture.
C. Order warm compresses 4 times daily for 5 days.
D. Prescribe a 10- to 14-day course of oral antibiotics.

Answer 15

A. Admit to the hospital for intravenous antibiotics.

Question 16

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?
Select one:
a. Obtain a culture of the external auditory canal.
b. Order ototopical antibiotic/corticosteroid drops.
c. Prescribe oral amoxicillin-clavulanate.
d. Refer the child to an otolaryngologist.

Answer 16

b. Order ototopical antibiotic/corticosteroid drops.

Question 17

A school-age child is brought to clinic after a pediculosis capitis infestation is reported at the child’s school. If this child is positive, what will the primary care pediatric nurse practitioner expect to find on physical examination, along with live lice near the scalp?
Select one:
a. Excoriated macules along the child’s collar and underwear lines
b. Inflammation and pustules on the face and neck
c. Itching of the scalp, with skin excoriation on the back of the head
d. Linear or S-shaped lesions in webs of fingers and sides of hands

Answer 17

c. Itching of the scalp, with skin excoriation on the back of the head

Question 18

What is the most important dose-limiting factor when prescribing acetaminophen with hydrocodone?
Select one:
a. Acetaminophen dose
b. Gastrointestinal side effects
c. Pruritis symptoms
d. Urinary retention

Answer 18

a. Acetaminophen dose

Question 19

The primary care pediatric nurse practitioner is performing a well child examination on a 5-year-old girl. The parents ask if the child s adult height can be predicted. The nurse practitioner learns that the mother is 5'8" tall and the father is 5'11" tall. The nurse practitioner will estimate which expected adult height for this child?
Select one:
a. 5'11" tall
b. 5'7" tall
c. 5'8" tall
d. 6' tall

Answer 19

b. 5’7” tall

Question 20

A 5-year-old 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 primary care pediatric nurse practitioner order for this child?
Select one:
a. MMR and Tdap
b. MMR, Varivax, Tdap
c. Tdap only
d. Varivax and Tdap

Answer 20

b. MMR, Varivax, Tdap