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PNP Boards > Health Promotion and Well Child Care Questions > Flashcards

Health Promotion and Well Child Care Questions Flashcards

1
Q

A 16 yo girl makes the following statements to you during her health visit. Which of the following pieces of information should not be kept confidential?

a) I have been sexually active with three of my boyfriends
b) I sometimes smoke marijuana
c) I want to get pregnant
d) Sometimes I feel like ending my life

A

d) Sometimes I feel like ending my life

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2
Q

In performing a physical examination on a nine month old infant, which of the following developmental fears would not be appropriate for you to consider?

a) Stranger anxiety
b) Pain
c) Separation from parents
d) Bodily harm

A

d) Bodily harm

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3
Q

When performing a physical examination on a toddler, which of the following body parts would you examine last:

a) Heart and lungs
b) abdomen and genitals
c) Ears and throat
d) Hips and extremities

A

c) Ears and throat

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4
Q

Role play with equipment during the course of a physical examination would be most beneficial with which of the following age groups:

a) Toddlers
b) Preschoolers
c) Young school-age children
d) Older school-age children

A

b) Preschoolers

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5
Q

Providing reassurance of “normalcy” during the course of an examination would be most important for:

a) Preschool children
b) Young school-age children
c) Older school-age children
d) Adolescents

A

d) Adolescents

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6
Q

Which of the following would not elevate the pulse of a child:

a) Fever
b) Anemia
c) Hypothyroidism
d) Exercise

A

c) Hypothyroidism

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7
Q

The PNP recognizes which of the following signs as indicators that baby is not receiving sufficient breastmilk?

a) Sleepiness, jaundice, decreased urine and stool
b) Diarrhea, nausea, and vomiting
c) Bulging fontanel and irritability
d) Sleeplessness and excitability

A

a) Sleepiness, jaundice, decreased urine and stool

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8
Q

Blood pressure should be measured at WCC beginning at age:

a) 2
b) 3
c) 4
d) 5

A

b) 3

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9
Q

A wide pulse pressure that results from a high systolic blood pressure is usually not due to which of the following:

a) Fever
b) Exercise
c) Excitement
d) A patent ductus arteriosus

A

d) A patent ductus arteriosus

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10
Q

Head and chest circumferences should be equal at:

a) 6 months
b) 1 year
c) 2 years
d) 3 years

A

b) 1 year

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11
Q

The anterior fontanel usually closes by:

a) 2 months
b) 6 months
c) 18 months
d) 24 months

A

c) 18 months

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12
Q

Diffuse edema of the soft tissue of the scalp which usually crosses suture lines in the newborn is:

a) Bossing
b) Caput seccedaneum
c) Cephalohematoma
d) Macrocephaly

A

b) Caput seccedaneum

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13
Q

An infant should no longer have head lag when pulled from the supine to sitting position at what age?

a) 2 months
b) 4 months
c) 6 months
d) 9 months

A

c) 6 months

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14
Q

“Boggy” nasal mucous membranes with serous drainage upon examination usually suggests:

a) Sinusitis
b) Polyps
c) URI
d) Allergic rhinitis

A

d) Allergic rhinitis

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15
Q

A white instead of red reflex upon eye examination of a 1 yo child would suggest:

a) An accommodative error
b) Retinoblastoma
c) Papilledema
d) Retinal detachment

A

b) Retinoblastoma

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16
Q

A cobblestone appearance of the palpebral conjunctiva usually indicates:

a) Bacterial infection
b) Chemical irritation
c) Viral infection
d) Severe allergy

A

d) Severe allergy

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17
Q

An eye that deviates in when covered but returns to midline when uncovered is an:

a) Esophoria
b) Exophoria
c) Esotropia
d) Exotropia

A

a) Esophoria

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18
Q

Pain produced by manipulation of the auricle or pressure on the tragus suggests:

a) Acute otitis media
b) Otitis externa
c) Otitis media with effusion
d) Mastoiditis

A

b) Otitis externa

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19
Q

A hypernasal voice and snoring in a child is suggestive of:

a) Polyps of the larynx
b) Nasopharyngeal tumor
c) Hypertrophied adenoids
d) Cleft palate

A

c) Hypertrophied adenoids

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20
Q

Physiological splitting of the second heart sound during inspiration in a child:

a) is normal
b) should be evaluated with an EKG
c) Suggests ASD
d) Should be referred to a cardiologist

A

a) is normal

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21
Q

Which of the following is not characteristic of innocent heart murmurs in children?

a) Systolic in timing
b) Varies in loudness with positioning
c) Usually transmitted to the neck
d) Usually loudest at lower left sternal border or at second or third intercostal space

A

c) Usually transmitted to the neck

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22
Q

A grade II musical or vibratory murmur heard best at the lower left sternal border that changes with positioning is suggestive of a:

a) Pulmonary ejection murmur
b) Ventricular septal defect
c) Venous hum
d) Vibratory or Still’s murmur

A

d) Vibratory or Still’s murmur

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23
Q

Wheezing in a child may not be found in which of the following conditions:

a) Asthma
b) Bronchiolitis
c) Pleural friction rub
d) Cystic fibrosis

A

c) Pleural friction rub

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24
Q

Gynecomastia in a male may not be a finding in which of the following:

a) Normal pubertal development
b) Steroid usage
c) Hyperthyroidism
d) Testicular tumor

A

c) Hyperthyroidism

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25
Q

Which of the following would usually not be considered a sign of a pituitary tumor in an adolescent female?

a) Dysfunctional uterine bleeding
b) Galactorrhea
c) Loss of peripheral vision
d) Increase in headaches

A

a) Dysfunctional uterine bleeding

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26
Q

Which of the following is not a specific examination test for a dislocated hip?

a) Barlow’s test
b) Ortolani’s test
c) Trendelenburg test
d) Gower’s test

A

d) Gower’s test

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27
Q

In addition to the knee, which of the following should be examined in a child complaining of knee pain?

a) Foot
b) Ankle
c) Hip
d) Spine

A

c) Hip

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28
Q

Which of the following infant reflexes should not disappear by 6 months of age?

a) Moro
b) rooting
c) tonic neck
d) plantar grasp

A

d) plantar grasp

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29
Q

Spasticity in an infant may be an early sign of:

a) Neurofibromatosis
b) Hydrocephalus
c) Cerebral palsy
d) Muscular dystrophy

A

c) Cerebral palsy

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30
Q

A shift to the left is present when which of the following are elevated?

a) Neutrophils
b) Bands or stabs
c) Lymphocytes
d) Eosinophils

A

b) Bands or stabs

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31
Q

Which of the following is usually elevated with viral infections?

a) Neutrophils
b) Eosinophils
c) Lymphocytes
d) Basophils

A

c) Lymphocytes

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32
Q

Decreased platelets may not be found in which of the following:

a) Leukemia
b) Anemia
c) Idiopathic thrombocytopenic purpura
d) Medication usage (e.g. ampicillin, cephalothin)

A

b) Anemia

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33
Q

Which of the following does not suggest a urinary tract infection?

a) Increased protein
b) Increased WBCs
c) Increased RBCs
d) Increased nitrites

A

a) Increased protein

34
Q

A Mantoux test in a child with no risk factors is considered positive with a reaction of:

a) At least 5 mm induration
b) At least 8 mm induration
c) At least 10 mm induration
d) At least 15 mm induration

A

d) At least 15 mm induration

35
Q

The PNP teaches new parents that when breast feeding is well established they can expect baby to have:

a) as many as 4 wet diapers each day
b) a stool every 2-3 days
c) 1 wet diaper an hour
d) 5-6 wet diapers and 2-3 stools each day

A

d) 5-6 wet diapers and 2-3 stools each day

36
Q

Cholesterol screening should be done:

a) Children 2 years of age and older who have a parent with a total cholesterol level of 240 or greater
b) Once for all children at 6 years of age
c) Overweight children with a family history of premature cardiovascular disease
d) Once for all children at 12 years of age

A

a) Children 2 years of age and older who have a parent with a total cholesterol level of 240 or greater

37
Q

For which of the following screening tests should children fast for 12 hours before the test is done?

a) Total cholesterol
b) Serum chemistry profile
c) Serum lipid profile
d) Hematocrit

A

c) Serum lipid profile

38
Q

Which of the following is the most important history-taking question for a sports evaluation?

a) Has the child ever had a head injury?
b) Has the child ever fainted or lost consciousness during exercise?
c) does the child every get short of breath with exercise?
d) Has the child ever had prior surgeries?

A

b) Has the child ever fainted or lost consciousness during exercise?

39
Q

Which of the following conditions would not exclude a child from participating in contact collision sports?

a) Fever
b) Absence of a paired organ
c) Atlantoaxial instability
d) Prior head injury

A

a) Fever

40
Q

Which of the following topics would not be appropriate to include when providing anticipatory guidance to the parent of a 4-month-old infant?

a) Introduction of solid food
b) Teething
c) Negativism
d) Introduction of a cup

A

c) Negativism

41
Q

Which is the correct order for introduction of solid foods to an infant?

a) Fruits, cereal, vegetables, and meats
b) Cereal, meats, vegetables, and fruits
c) Fruits, cereal, meats, and vegetables
d) Cereal, vegetables, fruits, and meats

A

d) Cereal, vegetables, fruits, and meats

42
Q

Which of the following topics is not appropriate to include when providing anticipatory guidance to the parent of an 18 month old?

a) Temper tantrums
b) Toilet training
c) Dental care
d) Stranger anxiety

A

d) Stranger anxiety

43
Q

Appropriate anticipatory guidance for the parents of an 8 yo girl should not include:

a) Preparation for an increase in nervous mannerisms and restless activity
b) Preparation for pubertal changes
c) Information that friends begin to serve as allies against adults
d) Information that their daughter will take on idols and heros

A

a) Preparation for an increase in nervous mannerisms and restless activity

44
Q

A new mom calls te PNP on post partum day 5. She reports that her newborn wants to nurse for 30 minutes every 2 hours. Which of the following is your best response?

a) This is a very healthy breastfeeding pattern. Be sure to rest when you can. You are doing great
b) Yor baby is too demanding. If you continue to feed that often you will spoil your child
c) You are not making enough milk and your baby will need to go to the ED to be evaluated
d) Your baby has an oral fixation and you should offer a pacifier to relieve stress

A

a) This is a very healthy breastfeeding pattern. Be sure to rest when you can. You are doing great

45
Q

A pelvic exam should not be performed on which of the following adolescents?

a) A 14 yo who is sexually active
b) A 15 yo who has jest started menarche
c) A 17 yo who is having irregular menses
d) An 18 yo healthy female

A

b) A 15 yo who has jest started menarche

46
Q

Hip is flexed and thigh is adducted which causes displacement of femoral head from acetabulum with a palpable “clunk”:

A

Barlow’s test

47
Q

Hip is flexed at 90 degree angle and abducted with finger over greater trochanter which reduces dislocated hip; a “clunk” is heard and felt:

A

Ortolani’s test

48
Q

Child stands and raises one leg off the ground; lowering of iliac crest on side opposite weight-bearing leg indicates defect in weight-bearing hip:

A

Trendelenburg test

49
Q

Use of hands on legs to push self from sitting to standing position (shows generalized muscle weakness):

A

Gower’s sign

50
Q

Genu varum:

A

Bow legs. Common in toddlers.

51
Q

Genu valgum:

A

Knock knees. Common in preschool children.

52
Q

Diffuse edema of the soft tissue of the scalp which usually crosses suture lines; may be seen with bruising:

A

Caput succedaneum

53
Q

Subperiosteal collection of blood which does not cross suture lines; resolves over a few weeks to months:

A

Cephalohematoma

54
Q

Bulging of fontanel area that is associated with rickets and prematurity:

A

Bossing

55
Q

Eye that turns in or out:

A

Strabismus

56
Q

Exophthalmos:

A

Protruding eyeballs; seen in hyperthyroidism

57
Q

When eye is covered it deviates inward:

A

Esophoria

58
Q

When eye is covered it deviates outward:

A

Exophoria

59
Q

Eye deviates inward:

A

Esotropia

60
Q

Eye deviates outward:

A

Exotropia

61
Q

You detect a heart murmur while examining a 3 yo child. In determining whether or not a referral is necessary, you determine it is an “innocent” heart murmur for which of the following reasons:

a) It is best heard during diastole
b) It radiates to the axilla
c) The intensity is no greater than I or II/VI
d) There is no variation with change in position

A

c) The intensity is no greater than I or II/VI

62
Q

When providing anticipatory guidance about infant development, you might teach parents that a normal infant could first transfer an object from hand to hand at what age?

a) 2 months
b) 4 months
c) 7 months
d) 9 months

A

c) 7 months

63
Q

A 2 month old infant at your clinic received a combined DTaP/HepB/IPV vaccine and the parents are in need of teaching about possible side effects. Which of the following is not an adverse effect following administration of the DTaP vaccination?

a) Local reaction
b) Fever
c) Increased fussiness
d) Transient morbilliform rash

A

d) Transient morbilliform rash

64
Q

When reviewing immunization protocols at your clinic, you are aware that the varicella vaccine can be administered to susceptible children beginning at what age?

a) 4 months
b) 6 months
c) 12 months
d) 15 months

A

c) 12 months

65
Q

A 2 week old infant is in the clinic for a scheduled weight check. The best indication that a 2 week old infant is receiving adequate breastmilk is that the baby:

a) Passes at least 4 stools per day
b) Feeds every 3 hours
c) Voids 4 times per day
d) Has regained birthweight

A

d) Has regained birthweight

66
Q

A mother of an 8 month old infant asks you for advice about continued introduction of solids. Which of the following food groups do you recommend be introduced to the baby last?

a) Egg yolk
b) Egg white
c) Fruits
d) Vegetables

A

b) Egg white

67
Q

The mother of a 15 month old child informs you that she feeds the baby skim milk. You advise the mother to change to whole milk primarily because skim milk:

a) Is not as easily digested
b) Contains insufficient amounts of calcium
c) Contains too little protein
d) Provides an inadequate amount of essential fatty acids

A

d) Provides an inadequate amount of essential fatty acids

68
Q

An adolescent is being evaluated for childhood depression. Which behavior or sign is least likely to be evident?

a) Evidence of hallucinations and delusions
b) A history of recurrent “accidents”
c) A sense of guilt
d) the presence of eating disorders

A

a) Evidence of hallucinations and delusions

69
Q

A 12 yo boy is brought into the clinic for an urgent visit after having ingested 10 diazepam tablets. Following the initial emergent care and stabilization of the child, the most important aspect of your management is:

a) Referring the case to the social services
b) Assessing the family supports available to the child
c) Obtaining a psychiatric consultation
d) Reviewing the history for signs of depression

A

c) Obtaining a psychiatric consultation

70
Q

You are seeing a 15 month old boy with leukemia for a check up. If indicated, this child may receive all of the following vaccines except:

a) Inactivated polio vaccine (IPV)
b) H. influenzae type B (Hib)
c) Diptheria, tetanus, acellular pertussis (DTaP)
d) Varicella (VAR)

A

d) Varicella (VAR)

71
Q

While conducting the Denver II developmental screening test, the mother of an 18 month old child reports to you that the toddler does not imitate activities. You decide to assess the child’s development further by giving him tasks from which sector?

a) Personal-social
b) fine motor-adaptive
c) Language
d) Gross motor

A

a) Personal-social

72
Q

You have ordered routine blood screening for a 2 yo girl who, because of dietary habits, is at risk for iron deficiency anemia. Which of the following finding is not associated with iron deficiency anemia?

a) Hypochromic RBC
b) Microcytic RBC
c) Low reticulocyte count
d) Low free erythrocyte protoporphyrin (FEP) level

A

d) Low free erythrocyte protoporphyrin (FEP) level

Iron deficiency anemia is a microcytic, hypochromic anemia associated with low reticulocyte count and elevated FEP level.

73
Q

During a prenatal visit you review the mother’s record for routine prenatal screening results. While educating the mother you explain that the screening of maternal serum alph-fetoprotein (MSAFP) between the 15th and 21st weeks of pregnancy is done primarily to screen for:

a) Phenylketonuria
b) Galactosemia
c) Cystic fibrosis
d) Neural tube defects

A

d) Neural tube defects

74
Q

A tenderness is detected over the tibial tuberosity of a 10 yo boy during a routine examination at a school based clinic. The PNP knows this may be a sign of:

a) Osgood-Schlatter disease
b) Blount’s disease
c) Plantar fasciitis
d) Effusion in the joint space

A

a) Osgood-Schlatter disease

75
Q

The parents of a 1 week old infant are concerned about the unusual shape of their child’s head. In the physical exam of the infant, which of the following signs would not support a diagnosis of craniosynostosis?

a) Palpation of a ridge along a given suture line
b) Unusual skull configuration
c) A palpable lesion at the occipital region
d) Abnormal head circumference

A

c) A palpable lesion at the occipital region

76
Q

In the ED you encounter a toddler whose injuries are not consistent with the history that is given. Which of the following would be the best step a provider could take in order to foster communication with the abusive parents?

a) Realize that abusive parents have essentially different goals for their children than other caregivers do
b) Understand that parental hostility and resistance are potent symptoms of fear and inadequacy
c) Consider referring parents to a substance abuse program
d) Be cautious when sharing the results of medical findings

A

b) Understand that parental hostility and resistance are potent symptoms of fear and inadequacy

77
Q

You are preparing a drug prevention program for middle school students. Your educational approach is based on the knowledge that the most common substance of abuse in adolescence is:

a) Marijuana
b) Cocaine
c) Heroin
d) Alcohol

A

d) Alcohol

78
Q

During a check up of a 15 month old girl you note the child has dropped significantly in percentile for weight over the past few months. In evaluating a child with FTT, the most important part of your assessment involves:

a) The history
b) The physical exam
c) Laboratory studies
d) Observation of family interactions

A

a) The history

79
Q

A 7 yo child in your caseload has recently been placed on methylphenidate for behavioral concerns associated with ADHD. Which of the following side effects are not associated with this drug?

a) Decreased appetite
b) Weight loss
c) Irritability
d) Decreased heart rate

A

d) Decreased heart rate

80
Q

The parents of an 8 yo child are concerned that their son does not want to attend school. Which of the following historical findings are not usually associated with the diagnosis of school phobia?

a) Sporadic school absence
b) Chronic medical illness
c) Vague physical symptoms
d) Depression and anxiety

A

b) Chronic medical illness

81
Q

A 17 yo girl is referred to your clinic by the school nurse to be assessed for an eating disorder. Which of the following dynamics is not characteristic of anorexia nervosa?

a) Excessive eating followed by purging
b) A pervasive sense of helplessness and ineffectiveness
c) Weight loss that gives the patient a sense of mastery and controll
d) Low body temp, pulse rate, and blood pressure

A

a) Excessive eating followed by purging

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