Exam 3-4

Question 1

A child is brought to the clinic with a generalized, annular rash characterized by raised wheals with pale centers. On physical examination, the child’s lungs are clear and there is no peripheral edema. A history reveals ingestion of strawberries earlier in the day. What is the initial treatment?
Select one:
a. Aqueous epinephrine 1:1000 subcutaneously
b. Cetirizine once in clinic and then once daily for 2 weeks
c. Diphenhydramine 0.5 to 1 mg/kg/dose every 4 to 6 hours
d. Prednisone 1 to 2 mg/kg/day for 1 week with rapid taper

Answer 1

c. Diphenhydramine 0.5 to 1 mg/kg/dose every 4 to 6 hours

Question 2

A child has a fever and arthralgia. The primary care pediatric nurse practitioner learns that the child had a sore throat 3 weeks prior and auscultates a murmur in the clinic. Which test will the nurse practitioner order?
Select one:
a. Anti-DNase B test
b. ASO titer
c. Rapid strep test
d. Throat culture

Answer 2

b. ASO titer

Question 3

A parent is concerned about vaccine adverse reactions. Based on an Institute of Medicine report, what will the primary care pediatric nurse practitioner tell the parent?
Select one:
a. Administering multiple vaccines may trigger the development of type 1 diabetes.
b. The MMR may be linked to febrile seizures in immunocompromised children.
c. There is some risk of CNS disorders associated with the hepatitis B vaccine.
d. Vaccines containing thimerosol are linked to pervasive developmental disorders.

Answer 3

b. The MMR may be linked to febrile seizures in immunocompromised children.

Question 4

A 4-year-old child has just been released from the hospital after orthopedic surgery on one leg following a bicycle accident. The child is sitting quietly on the exam table. When asked to rate pain, the child points to the “1” on a faces rating pain scale. What will the primary care pediatric nurse practitioner do next?
Select one:
a. Assess the child’s vital signs and ability to walk without pain.
b. Refill the prescription for a narcotic analgesic medication.
c. Suggest that the parents give acetaminophen for mild pain.
d. Teach the parent to give analgesics based on the child’s report of pain.

Answer 4

a. Assess the child’s vital signs and ability to walk without pain.

Question 5

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 primary care pediatric nurse practitioner notes induration and erythema of these nodes. What will the nurse practitioner do?
Select one:
a. Obtain a complete blood count and C-reactive protein.
b. Order an immunofluorescent assay (IFA) for serum antibodies.
c. Perform a needle aspiration of the affected lymph nodes.
d. Prescribe a 5-day course of azithromycin.

Answer 5

b. Order an immunofluorescent assay (IFA) for serum antibodies.

Question 6

An adolescent who had cradle cap as an infant is in the clinic with thick crusts of yellow, greasy scales on the forehead and behind the ears. What will the primary care pediatric nurse practitioner recommend?
Select one:
a. Daily application of ketoconazole 2% topical cream
b. High-potency topical corticosteroids applied daily
c. Mineral oil and shampoo on the affected areas
d. Selenium sulfide shampoo twice weekly to the face

Answer 6

a. Daily application of ketoconazole 2% topical cream

Question 7

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 primary care pediatric nurse practitioner tell this parent?
Select one:
a. Febrile seizures are more likely in younger infants with some vaccines.
b. Maternal antibodies neutralize some vaccines and are delayed until 12 months.
c. The risk of adverse effects is lower for some vaccines after the first year.
d. Too many vaccines at once can overwhelm the infant’s immune system.

Answer 7

b. Maternal antibodies neutralize some vaccines and are delayed until 12 months.

Question 8

A 5-year-old 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?
Select one:
a. Prescribe tetracycline 4.4 mg/kg twice daily for 7 to 10 days.
b. Refer the child to a dentist for reimplantation of the avulsed teeth.
c. Refer the child to a dentist immediately for further examination.
d. Remove the teeth, place them in saline, and refer the child to a dentist.

Answer 8

c. Refer the child to a dentist immediately for further examination.

Question 9

What will the primary care pediatric nurse practitioner teach the parent of an infant about cleaning the child’s teeth?
Select one:
a. To allow the child to control the amount of toothpaste used
b. To choose a toothpaste with a mint flavor
c. To use a smear of toothpaste and not to rinse the mouth
d. To use a toothpaste containing whitening agents

Answer 9

c. To use a smear of toothpaste and not to rinse the mouth

Question 10

The primary care pediatric nurse practitioner is prescribing ibuprofen for a 25 kg child with JIA who has oligoarthitis. If the child will take 4 doses per day, what is the maximum amount the child will receive per dose?
Select one:
a. 200 mg
b. 250 mg
c. 400 mg
d. 450 mg

Answer 10

b. 250 mg

Question 11

The primary care pediatric nurse practitioner is performing a well child examination on a 2-year-old child with a history of intrauterine growth retardation (IUGR) whose height remains less than the 3rd percentile on a WHO growth chart. What will the nurse practitioner do?
Select one:
a. Consider prescribing growth hormone therapy.
b. Reassure the parent that this is normal for this child.
c. Refer the child to a dietician for dietary supplementation.
d. Refer the child to a pediatric endocrinologist.

Answer 11

d. Refer the child to a pediatric endocrinologist.

Question 12

A 6-year-old female has had a recent growth spurt and an exam reveals breast and pubic hair development. Her bone age is determined to be 8 years. What will the primary care pediatric nurse practitioner do next?
Select one:
a. Order LH and FSH levels and a long-acting GnRH agonist.
b. Order thyroid function tests to exclude primary hypothyroidism.
c. Reassure the parent that this is most likely idiopathic.
d. Refer the child to a pediatric endocrinologist for management.

Answer 12

d. Refer the child to a pediatric endocrinologist for management.

Question 13

What will the primary care pediatric nurse practitioner teach the parents of a child who has new pressure-equalizing tubes (PET) in both ears?
Select one:
a. Parents should notice improved hearing in their child.
b. PET will help by reducing the number of ear infections the child has.
c. The child should use earplugs when showering or bathing.
d. The tubes will most likely remain in place for 3 to 4 years.

Answer 13

a. Parents should notice improved hearing in their child.

Question 14

The primary care pediatric nurse practitioner is preparing to perform a well child examination on a 5-year-old child who has multiple developmental and cognitive delays. The child’s mother is angry and tells the nurse practitioner that her friends’ children are all preparing for kindergarten. The nurse practitioner will
Select one:
a. allow the mother to express her feelings, understanding that she is experiencing grief.
b. reassure the mother that special educational opportunities are available for her child.
c. suggest that the mother find a support group with other children with special needs.
d. tell her that most schools provide services for children with special health care needs.

Answer 14

a. allow the mother to express her feelings, understanding that she is experiencing grief.

Question 15

The parent of a preschool-age child calls the clinic to report that the child has clear, watery drainage from both eyes, mild erythema of the conjunctiva, and no fever or other symptoms. What will the primary care pediatric nurse practitioner recommend?
Select one:
a. Allow the child to go to preschool.
b. Bring the child to the clinic for a culture.
c. Keep the child home for 2 days.
d. Use antibiotic eyedrops for 3 days.

Answer 15

a. Allow the child to go to preschool.

Question 16

A pharmaceutical company has developed a new drug that was tested only on adults. The FDA has declared this drug to have potential benefits for ill children. According to the Pediatric Research Equity Act (PREA), what may the pharmaceutical company be required to do?
Select one:
a. Conduct pediatric drug studies to determine whether the drug is safe and effective in children.
b. Provide labeling stating that the safety and efficacy of the drug is not established for children.
c. Receive a patent extension for conducting pediatric studies to determine use in children.
d. Survey existing data about the drug to determine potential use in the pediatric population.

Answer 16

a. Conduct pediatric drug studies to determine whether the drug is safe and effective in children.

Question 17

A toddler exhibits exotropia of the right eye during a cover-uncover screen. The primary care pediatric nurse practitioner will refer to a pediatric ophthalmologist to initiate which treatment?
Select one:
A. Botulinum toxin injection
B. Corrective lenses
C. Occluding the affected eye for 6 hours per day
D. Patching of the unaffected eye for 2 hours each day

Answer 17

D. Patching of the unaffected eye for 2 hours each day

Question 18

The primary care pediatric nurse practitioner is examining a 5-year-old child who has had recurrent fevers, bone pain, and a recent loss of weight. The physical exam reveals scattered petechiae, lymphadenopathy, and bruising. A complete blood count shows thrombocytopenia, anemia, and an elevated white cell blood count. The nurse practitioner will refer this child to a specialist for
Select one:
a. bone marrow biopsy.
b. corticosteroids and IVIG.
c. hemoglobin electrophoresis.
d. immunoglobulin testing.

Answer 18

a. bone marrow biopsy.

Question 19

A pre-school age child has honey-crusted lesions on erythematous, eroded skin around the nose and mouth, with satellite lesions on the arms and legs. The child’s parent has several similar lesions and reports that other children in the day care have a similar rash. How will this be treated?
Select one:
a. Amoxicillin 40 to 5 mg/kg/day for 7 to 10 days
b. Amoxicillin-clavulanate 90 mg/kg/day for 10 days
c. Bacitracin cream applied to lesions for 10 to 14 days
d. Mupirocin ointment applied to lesions until clear

Answer 19

b. Amoxicillin-clavulanate 90 mg/kg/day for 10 days