Exam 3-7 Flashcards
A school-age child with asthma is seen for a well child checkup and, in spite of “feeling fine,” has pronounced expiratory wheezes, decreased breath sounds, and an FEV1 less than 70% of personal best. The primary care pediatric nurse practitioner learns that the child’s parent administers the daily medium-dose ICS but that the child is responsible for using the SABA. A treatment of 4 puffs of a SABA in clinic results in marked improvement in the child’s status. What will the nurse practitioner do?
Select one:
a. Have the parent administer all of the child’s medications.
b. Increase the ICS medication to a high-dose preparation.
c. Reinforce teaching about the importance of using the SABA.
d. Teach the child and parent how to use home PEF monitoring.
d. Teach the child and parent how to use home PEF monitoring.
The primary care pediatric nurse practitioner is providing nutritional counseling for a 9-year-old female whose weight is at the 95th percentile for her age. What is the goal for this patient?
Select one:
a. A loss of 10 to 15 pounds in 6 months
b. An average weight loss of 2 pounds per month
c. Maintenance of her current weight
d. Weight loss of 5% of her current body weight
c. Maintenance of her current weight
The primary care pediatric nurse practitioner is performing a well baby examination on a 2-week-old infant who was recently discharged home from the neonatal intensive care unit. The mother reports that the infant was born at 26 weeks’ gestation and states she was told that her baby will probably have developmental delays. What is the most important aspect of long-term management for this infant?
Select one:
a. Careful monitoring of attainment of developmental milestones
b. Familiarizing the parent with laws that mandate educational support
c. Providing genetic counseling to the infant’s parents
d. Referral to social services for assistance with resources
a. Careful monitoring of attainment of developmental milestones
What will the primary care pediatric nurse practitioner recommend to the parent of an infant who is teething who asks about comfort measures?
Select one:
a. Administer oral ibuprofen or apply topical salicylates.
b. Apply a topical anesthetic such a benzocaine to the gums.
c. Give the infant a cold teething ring or wet washcloth to chew.
d. Try Baby Orajel on the infant’s gums several times daily.
c. Give the infant a cold teething ring or wet washcloth to chew.
A 4-month-old infant has a history of reddened, dry, itchy skin. The primary care pediatric nurse practitioner notes fine papules on the extensor aspect of the infant’s arms, anterior thighs, and lateral aspects of the cheeks. What is the initial treatment? Select one: a. Moisturizers b. Oral antihistamines c. Topical corticosteroids d. Wet wrap therapy
a. Moisturizers
A 10-month-old infant who is new to the clinic has chronic hepatitis B infection. What will the primary care pediatric nurse practitioner do to manage this infant’s disease?
Select one:
a. Consult a pediatric infectious disease specialist.
b. Prescribe interferon-alfa.
c. Provide supportive care.
d. Consider use of lamivudine.
a. Consult a pediatric infectious disease specialist.
A toddler is prescribed a liquid oral medication. The parent tells the primary care pediatric nurse practitioner that the child refuses to take medications and usually spits them out. What will the nurse practitioner do?
Select one:
a. Demonstrate oral medication administration with the toddler in the office.
b. Instruct the parent to hide the medication in a favorite food or beverage.
c. Order the medication to be given via another route if possible.
d. Tell the parent to offer the child a reward each time the medication is taken.
d. Tell the parent to offer the child a reward each time the medication is taken.
A child who has been taking antibiotics is brought to the clinic with a rash. The parent reports that the child had a fever associated with what looked like sunburn and now has “blisters” all over. A physical examination shows coalescent target lesions and widespread bullae and areas of peeled skin revealing moist, red surfaces. What will the primary care pediatric nurse practitioner do?
Select one:
a. Consult with a pediatric intensivist for admission to a pediatric intensive care unit.
b. Order oral acyclovir 20 mg/kg/day in two doses for 6 to 12 months.
c. Prescribe systemic antihistamines and antimicrobial medications as prophylaxis.
d. Recommend analgesics, cool compresses, and oral antihistamines for comfort.
a. Consult with a pediatric intensivist for admission to a pediatric intensive care unit.
The primary care pediatric nurse practitioner prescribes metformin for a 15-year-old adolescent newly diagnosed with type 2 diabetes. What will the nurse practitioner include when teaching the adolescent about this drug?
Select one:
a. That insulin therapy will be necessary in the future
b. The importance of checking blood glucose 3 or 4 times daily
c. To consume a diet with foods that are high in vitamin B12
d. To use a stool softener to prevent gastrointestinal side effects
b. The importance of checking blood glucose 3 or 4 times daily
A school-age child has several annular lesions on the abdomen characterized by central clearing with scaly, red borders. What is the first step in managing this condition?
Select one:
a. Fluoresce the lesions with a Wood’s lamp.
b. Obtain fungal cultures of the lesions. Incorrect
c. Perform KOH-treated scrapings of the lesion borders.
d. Treat empirically with antifungal cream.
d. Treat empirically with antifungal cream.
The primary care pediatric nurse practitioner is reviewing medical records for a newborn that is new to the clinic. The toddler’s mother was found to be HIV positive during her pregnancy with this child and received antiretroviral therapy during pregnancy. The child was born by cesarean section, begun on anti-retroviral prophylaxis, and did not breastfeed. What is the correct management for this child?
Select one:
a. Consult with a pediatric HIV specialist.
b. Discontinue cART after 4 weeks of age.
c. Obtain a CD4+ cell count and HIV RNA levels.
d. Reinforce the need to give cART for life.
a. Consult with a pediatric HIV specialist.
The primary care pediatric nurse practitioner notes a small, round object in a child’s external auditory canal, near the tympanic membrane. The child’s parent thinks it is probably a dried pea. What will the nurse practitioner do to remove this object?
Select one:
a. Irrigate the external auditory canal to flush out the object.
b. Refer the child to an otolaryngologist for removal.
c. Remove the object with a wire loop curette.
d. Use a bayonet forceps to grasp and remove the object.
b. Refer the child to an otolaryngologist for removal
An adolescent has acne characterized by papules and pustules mostly on the forehead and chin. What will the primary care pediatric nurse practitioner prescribe?
Select one:
a. Azelaic acid applied daily at nighttime
b. Benzoyl peroxide applied twice daily
c. Topical erythromycin with benzoyl peroxide
d. Tretinoin applied nightly after washing the face
c. Topical erythromycin with benzoyl peroxide
A school-age child has had herpes stomatitis for a week and continues to complain of pain. What will the primary care pediatric nurse practitioner recommend?
Select one:
a. Administration of a topical antiviral medication
b. Taking oral acyclovir for 5 to 7 days
c. Topical application of diphenhydramine and Maalox
d. Using a chlorhexidine gluconate rinse
c. Topical application of diphenhydramine and Maalox
A toddler who presents with anemia and reticulocytopenia has a history of a gradual decrease in energy and increase in pallor beginning after a recent viral infection. How will the primary care pediatric nurse practitioner treat this child?
Select one:
a. Closely observe the child’s symptoms and lab values.
b. Consult with a pediatric hematologist.
c. Prescribe supplemental iron for 4 to 6 months.
d. Refer for transfusions to correct the anemia.
a. Closely observe the child’s symptoms and lab values.
