Exam 3-3

Question 1

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 primary care pediatric nurse practitioner recommend?
Select one:
a. Getting fluoride varnish treatments prior to vacations
b. Giving the children fluoridated water after meals
c. Having the children use a chlorhexidine gluconate oral rinse
d. Offering gum containing xylitol after meals

Answer 1

d. Offering gum containing xylitol after meals

Question 2

The primary care pediatric nurse practitioner is evaluating an 11-month-old infant who has had three viral respiratory illnesses causing bronchiolitis. The child’s parents both have seasonal allergies and ask whether the infant may have asthma. What will the nurse practitioner tell the parents?
Select one:
a. “Although it is likely, based on family history, it is too soon to tell.”
b. “There is little reason to suspect that your infant has asthma.”
c. “With your infant’s history of bronchiolitis, asthma is very likely.”
d. “Your infant has definitive symptoms consistent with a diagnosis of asthma.”

Answer 2

a. “Although it is likely, based on family history, it is too soon to tell.”

Question 3

The primary care pediatric nurse practitioner is reviewing lab work and diabetes management with a school-age child whose HbA1C is 7.6% who reports usual blood sugars before meals as being 80 to 90 mg/dL. The nurse practitioner will consult with the child’s endocrinologist to consider which therapy?
Select one:
a. Continuous glucose monitoring
b. Continuous subcutaneous insulin infusion
c. Self-monitoring of blood glucose
d. Use of a long-acting insulin analogue

Answer 3

a. Continuous glucose monitoring

Question 4

The primary care pediatric nurse practitioner is considering use of a relatively new drug for a 15-month-old child. The drug is metabolized by the liver, so the nurse practitioner will consult a pharmacologist to discuss giving the drug:
Select one:
a. less often or at a lower dose.
b. more often or at a higher dose.
c. via a parenteral route.
d. via the oral route.

Answer 4

a. less often or at a lower dose.

Question 5

An infant is brought to clinic with bright erythema in the neck and flexural folds after recent treatment with antibiotics for otitis media. What is the treatment for this condition?
Select one:
a. 1% hydrocortisone cream to affected areas for 1 to 2 days
b. Oral fluconazole 6 mg/kg on day 1, then 3 mg/kg/dose for 14 days
c. Topical keratolytics and topical antibiotics for 7 to 10 days
d. Topical nystatin cream applied several times daily

Answer 5

d. Topical nystatin cream applied several times daily

Question 6

During a well child assessment of an African-American infant, the primary care pediatric nurse practitioner notes a dark red-brown light reflex in the left eye and a slightly brighter, red-orange light reflex in the right eye. The nurse practitioner will
Select one:
A. dilate the pupils and reassess the red reflex.
B. order auto-refractor screening of the eyes.
C. recheck the red reflex in 1 month.
D. refer the infant to an ophthalmologist.

Answer 6

D. refer the infant to an ophthalmologist.

Question 7

A preschool-age child is brought to clinic for evaluation of a rash. The primary care pediatric nurse practitioner notes an intense red eruption on the child’s cheeks and circumoral pallor. What will the nurse practitioner tell the parents about this rash?
Select one:
a. This rash may be a prodromal sign of rubella or roseola.
b. The child will need immunization boosters to prevent serious disease.
c. This is a benign rash with no known serious complications.
d. Expect a lacy, maculopapular rash to develop on the trunk and extremities.

Answer 7

d. Expect a lacy, maculopapular rash to develop on the trunk and extremities.

Question 8

The primary care pediatric nurse practitioner orders a pulmonology consult for a child who has severe asthma. The nurse practitioner writes “child with asthma refractory to conventional treatments needs suggestions for alternative treatments.” The nurse practitioner expects the pulmonologist to
Select one:
a. confirm the medical diagnosis for the child’s parents.
b. make recommendations for disease management.
c. stress the importance of adherence to the medication regimen.
d. take over management of this child’s chronic illness.

Answer 8

b. make recommendations for disease management.

Question 9

The primary care pediatric nurse practitioner performs a Hirschberg test to evaluate
Select one:
a. color vision.
b. ocular alignment.
c. peripheral vision.
d. visual acuity.

Answer 9

b. ocular alignment.

Question 10

A school-age child has fever of 104°F, sore throat, vomiting and malaise. The primary care pediatric nurse practitioner 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. A rapid strep test is positive. What will the nurse practitioner do to manage this child’s illness?
Select one:
a. Administer intramuscular ceftriaxone.
b. Hospitalize for further diagnostic tests.
c. Prescribe oral amoxicillin.
d. Refer to a pediatric infectious disease specialist.

Answer 10

c. Prescribe oral amoxicillin.

Question 11

A 4-year-old child has clusters of small, clear, tense vesicles with an erythematous base on one side of the mouth along the vermillion border, which are causing discomfort and difficulty eating. What will the primary care pediatric nurse practitioner recommend as treatment?
Select one:
a. Mupirocin ointment applied to lesions 3 times daily
b. Oral acyclovir 20 to 40 mg/kg/dose for 7 to 10 days
c. Topical acyclovir applied to lesions 4 times daily
d. Topical diphenhydramine and magnesium hydroxide

Answer 11

d. Topical diphenhydramine and magnesium hydroxide

Question 12

An adolescent who recently spent time in a hot tub while on vacation has discrete, erythematous 1- to 2-mm papules that are centered around hair follicles on the thighs, upper arms, and buttocks. How will the primary care pediatric nurse practitioner manage this condition?
Select one:
a. Culture the lesions and treat with appropriate IM antibiotics.
b. Hospitalize for incision and drainage and intravenous antibiotics.
c. Order an antistaphylococcal beta-lactamase-resistant antibiotic.
d. Prescribe topical keratolytics and topical antibiotics.

Answer 12

d. Prescribe topical keratolytics and topical antibiotics.

Question 13

A 16-year-old adolescent female whose BMI is at the 90th percentile reports irregular periods. The primary care pediatric nurse practitioner notes widespread acne on her face and back and an abnormal distribution of facial hair. The nurse practitioner will evaluate her further based on a suspicion of which diagnosis?
Select one:
a. Dyslipidemia
b. Hypothyroidism
c. Nonalcoholic steatohepatitis
d. Polycystic ovary syndrome

Answer 13

d. Polycystic ovary syndrome

Question 14

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 primary care pediatric nurse practitioner recommend?
Select one:
a. Chlorhexidine gluconate
b. Diphenhydramine and Maalox
c. Oral acyclovir
d. Topical antiviral medication

Answer 14

a. Chlorhexidine gluconate

Question 15

An adolescent takes ibuprofen, acetaminophen, and a tricyclic antidepressant (TCA) to treat phantom limb pain and reports that the medications are no longer effective. What will the primary care pediatric nurse practitioner do?
Select one:
a. Change the TCA to a selective serotonin reuptake inhibitor.
b. Evaluate the adolescent for drug-seeking behavior.
c. Increase the TCA dose and reevaluate in 2 to 3 weeks.
d. Refer the adolescent to a pain management specialist.

Answer 15

d. Refer the adolescent to a pain management specialist.

Question 16

The primary care pediatric nurse practitioner evaluates a 5-year-old child who presents with pallor and obtains labs revealing a hemoglobin of 8.5 g/dL and a hematocrit of 31%. How will the nurse practitioner manage this patient?
Select one:
a. Prescribe elemental iron and recheck labs in 1 month.
b. Reassure the parent that this represents mild anemia.
c. Recommend a diet high in iron-rich foods.
d. Refer to a hematologist for further evaluation.

Answer 16

a. Prescribe elemental iron and recheck labs in 1 month.

Question 17

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?
Select one:
a. Inform the parent that all vaccines may be given without thimerosol.
b. Providing Vaccine Information Statements for the parent to review.
c. Question the parent’s reasons for concern about immunizations.
d. Remind the parent that the infant is exposed to thousands of germs each day.

Answer 17

c. Question the parent’s reasons for concern about immunizations.

Question 18

An adolescent who has exercise-induced asthma (EIA) is on the high school track team and has recently begun to practice daily during the school week. The adolescent uses 2 puffs of albuterol via a metered-dose inhaler 20 minutes before exercise but reports decreased effectiveness since beginning daily practice. What will the primary care pediatric nurse practitioner do?
Select one:
a. Counsel the adolescent to decrease the number of practices each week.
b. Increase the albuterol to 4 puffs 20 minutes prior to exercise.
c. Order a daily inhaled corticosteroid medication.
d. Prescribe cromolyn sodium in addition to the albuterol.

Answer 18

c. Order a daily inhaled corticosteroid medication.

Question 19

The parent of an 18-month-old child calls the clinic to report that the child has a rectal temperature of 100.4°F (38°C). The child is playing normally, taking fluids well, and has a slightly reduced appetite. What will the primary care pediatric nurse practitioner recommend?
Select one:
a. Administering an antipyretic medication
b. Bringing the child to the clinic for evaluation
c. Offering extra fluids and calling if symptoms change
d. Ordering outpatient lab work such as a CBC

Answer 19

c. Offering extra fluids and calling if symptoms change

Question 20

A school-age child has a history of chronic otitis media and is seen in the clinic with vertigo. The primary care pediatric nurse practitioner notes profuse purulent otorrhea from both pressure-equalizing tubes and a pearly-white lesion on one tympanic membrane. Which condition is most likely?
Select one:
a. Cholesteatoma
b. Mastoiditis
c. Otitis externa
d. Otitis media with effusion

Answer 20

a. Cholesteatoma