Module 2A (Ch 30, 32, 29, 12, 37, 31, 35)

Question 1

The parent of a 4-­month-­old infant is concerned that the infant cannot hear. Which test will the primary care pediatric nurse practitioner order to evaluate potential hearing loss in this infant?

Answer 1

Auditory brainstem response (ABR)

Question 2

The primary care pediatric nurse practitioner obtains a tympanogram on a child that reveals a sharp peak of ­180 mm H2O. What does this value indicate

Answer 2

Negative ear pressure

Question 3

An 18­-month-­old child with no previous history of otitis media awoke during the night with right ear pain. The primary care pediatric nurse practitioner notes an axillary temperature of 100.5°F and an erythematous, bulging tympanic membrane. A tympanogram reveals of peak of +150 mm H2O. What is the recommended treatment for this child?

Answer 3

An analgesic medication and watchful waiting

Question 4

A 7-­month-­old infant has had two prior acute ear infections and is currently on the 10th day of therapy with amoxicillin­clavulanate after a failed course of amoxicillin. The primary care pediatric nurse practitioner notes marked middle ear effusion and erythema of the TM. The child is irritable and has a temperature of 99.8°F. What is the next step in management of this child’s ear infection

Answer 4

Refer the child to an otolaryngologist

Question 5

. A 3-­year-­old child with pressure-­equalizing tubes (PET) in both ears has otalgia in one ear. The primary care pediatric nurse practitioner is able to visualize the tube and does not see exudate in the ear canal and obtains a type A tympanogram. What will the nurse practitioner do

Answer 5

Order ototopical antibiotic/corticosteroid drops

Question 6

What will the primary care pediatric nurse practitioner teach the parents of a child who has new pressure-­equalizing tubes (PET) in both ears?

Answer 6

Parents should notice improved hearing in their child.

Question 7

A child with a history of otitis externa asks about ways to prevent this condition. What will the primary care pediatric nurse practitioner recommend

Answer 7

Drying the ear canal with a hair dryer

Question 8

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?

Answer 8

Order ototopical antibiotic/corticosteroid drops.

Question 9

A child who has otitis externa has severe swelling of the external auditory canal that persists after 2 days of therapy with ototopical antibiotic/corticosteroid drops. What is the next step in treatment for this child

Answer 9

Insert a wick into the external auditory canal.

Question 10

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?

Answer 10

Refer the child to an otolaryngologist for removal

Question 11

A 3-­year-­old child has had one episode of acute otitis media 3 weeks prior with a normal tympanogram just after treatment with amoxicillin. In the clinic today, the child has a type B tympanogram, a temperature of 102.5°F, and a bulging tympanic membrane. What will the primary care pediatric nurse practitioner order

Answer 11

Amoxicillin­clavulanate twice daily

Question 12

The primary care pediatric nurse practitioner diagnoses acute otitis media in a 2­-year-­old child who has a history of three ear infections in the first 6 months of life. The child’s tympanic membrane is intact and the child has a temperature of 101.5°F. What will the nurse practitioner prescribe for this child

Answer 12

id treat but An analgesic medication and watchful waiting

Question 13

A child who was treated with amoxicillin and then amoxicillin­clavulanate for acute otitis media is seen for follow­up. The primary care pediatric nurse practitioner notes dull­gray tympanic membranes with a visible air­fluid level. The child is afebrile and without pain. What is the next course of action

Answer 13

Monitoring ear fluid levels for 3 months

Question 14

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

Answer 14

Cholesteatoma

Question 15

In a respiratory disorder causing a check­valve obstruction, which symptoms will be present

Answer 15

Air entry on inspiration with expiratory occlusion

Question 16

A child has an acute infection causing lower airway obstruction. Which initial symptom is expected in this child

Answer 16

Wheezing

Question 17

A 4-­year-­old child with an upper respiratory tract infection has cloudy nasal discharge and moderate nasal congestion interfering with sleep. The parent asks what product to use to help with symptoms. What will the primary care pediatric nurse practitioner recommend

Answer 17

Saline rinses

Question 18

A 5-­year-­old child has enlarged tonsils and a history of four throat infections in the previous year with fever, cervical lymphadenopathy, and positive Group A Streptococcus pyogenes (GABHS) cultures. The parent reports that the child snores at night and expresses concerns about the child’s quality of sleep. The next step in managing this child’s condition is to

Answer 18

refer to a pulmonologist for polysomnography evaluation

Question 19

A school-­age child has an abrupt onset of sore throat, nausea, headache, and a temperature of 102.3°F. An examination reveals petechiae on the soft palate, beefy­red tonsils with yellow exudate, and a scarlatiniform rash. A Rapid Antigen Detection Test (RADT) is negative. What is the next step in management for this child?

Answer 19

Perform a follow-­up throat culture.

Question 20

An adolescent has suspected infectious mononucleosis after exposure to the virus in the past week. The primary care pediatric nurse practitioner examines the adolescent and notes exudate on the tonsils, soft palate petechiae, and diffuse adenopathy. Which test will the primary care pediatric nurse practitioner perform to confirm the diagnosis

Answer 20

EBV­ specific antibody testing

Question 21

A school-­age child has had nasal discharge and daytime cough but no fever for 12 days without improvement in symptoms. The child has not had antibiotics recently and there is no significant antibiotic resistance in the local community. What is the appropriate treatment for this child

Answer 21

Amoxicillin 45 mg/kg/day

Question 22

After 14 days of treatment with amoxicillin 45 mg/kg/day for acute rhinosinusitis, a child continues to have mucopurulent nasal discharge along with induration, swelling, and erythema of both eyelids. What is the next course of treatment

Answer 22

Referral to a pediatric otolaryngologist

Question 23

The parent of a toddler and a 4­-week­-old infant tells the primary care pediatric nurse practitioner that the toddler has just been diagnosed with pertussis. What will the nurse practitioner do to prevent disease transmission to the infant?

Answer 23

Order azithromycin 10 mg/kg/day in a single dose daily for 5 days.

Question 24

A schoo-l­age child has frequent nosebleeds. Nasal visualization reveals fresh clots and excoriated nasal mucosa but no visible site of bleeding. Coagulation studies are normal. In spite of symptomatic measures, the child continues to have nosebleeds. What is the next course of action

Answer 24

Refer to an otolaryngologist for further evaluation

Question 25

A child is in the clinic because of symptoms of purulent, foul ­smelling nasal discharge from the right nostril. Nasal visualization reveals something shiny in a mass of mucous in the nasal cavity. What will the primary care pediatric nurse practitioner do

Answer 25

Attempt to remove the mass gently using alligator forceps

Question 26

A 2­-year-­old child is brought to the clinic after developing a hoarse, bark-­like cough during the night with “trouble catching his breath” according to the parent. The history reveals a 2 day history of low ­grade fever and upper respiratory symptoms. On exam, the child has a respiratory rate of 40 breaths per minute, occasional stridor when crying, and a temperature of 101.3°F. What is the next step in treatment for this child

Answer 26

Prescribe oral dexamethasone for 2 days

Question 27

The primary care pediatric nurse practitioner evaluates a child who awoke with a sore throat and high fever after a nap. The child appears anxious and is sitting on the parent’s lap with the neck hyperextended. The physical exam reveals stridor, drooling, nasal flaring, and retractions. What will the nurse practitioner do next

Answer 27

Transport the child to the hospital via emergency medical services.

Question 28

A 5-­month-­old infant who has a 3 ­day history of cough and rhinorrhea has developed symptoms of respiratory distress with audible expiratory wheezes and increased coughing. The infant’s immunizations are up­ to ­date. The physical exam reveals a respiratory rate of 50 breaths per minute, coarse expiratory wheezing, and prolonged expiration. An oxygen saturation is 96% on room air. What is the recommended treatment for this infant

Answer 28

Recommend increased fluids and close follow­up

Question 29

A previously healthy school-­age child develops a cough and a low-­grade fever. The primary care pediatric nurse practitioner auscultates wheezes in all lung fields. Which diagnosis will the nurse practitioner suspect

Answer 29

Atypical pneumonia

Question 30

A child is diagnosed with community­ acquired pneumonia and will be treated as an outpatient. Which antibiotic will the primary care pediatric nurse practitioner prescribe

Answer 30

Amoxicillin

Question 31

The primary care pediatric nurse practitioner manages care in conjunction with a pediatric pulmonologist for a child with cystic fibrosis. Which medication regimen is used to facilitate airway clearance for this child

Answer 31

Inhaled dornase alfa

Question 32

The primary care pediatric nurse practitioner performs a vision screen on a 4­-month-old infant and notes the presence of convergence and accommodation with mild esotropia of the left eye. What will the nurse practitioner do

Answer 32

Refer the infant to a pediatric ophthalmologist.

Question 33

During a well child exam on a 4-­year-­old child, the primary care pediatric nurse practitioner notes that the clinic nurse recorded “20/50” for the child’s vision and noted that the child had difficulty cooperating with the exam. What will the nurse practitioner recommend

Answer 33

Test the child’s vision in 1 month.

Question 34

During a well child assessment of an African ­American infant, the primary care pediatric nurse practitioner notes a dark red­brown light reflex in the left eye and a slightly brighter, red­orange light reflex in the right eye. The nurse practitioner will

Answer 34

refer the infant to an ophthalmologist.

Question 35

The primary care pediatric nurse practitioner performs a Hirschberg test to evaluate

Answer 35

ocular alignment.

Question 36

The primary care pediatric nurse practitioner applies fluorescein stain to a child’s eye. When examining the eye with a cobalt blue filter light, the entire cornea appears cloudy. What does this indicate

Answer 36

There is too much stain on the cornea

Question 37

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

Answer 37

Patching of the unaffected eye for 2 hours each day

Question 38

The primary care pediatric nurse practitioner performs a well child examination on a 9-­month-­old infant who has a history of prematurity at 28 weeks’ gestation. The infant was treated for retinopathy of prematurity (ROP) and all symptoms have resolved. When will the infant need an ophthalmologic exam

Answer 38

At 12 months of age

Question 39

During a well-­baby assessment on a 1-­week-­old infant who had a normal exam when discharged from the newborn nursery 2 days prior, the primary care pediatric nurse practitioner notes moderate eyelid swelling, bulbar conjunctival injections, and moderate amounts of thick, purulent discharge. What is the likely diagnosis

Answer 39

Chlamydia trachomatis conjunctivitis

Question 40

The primary care pediatric nurse practitioner performs a well baby assessment of a 5-­day-­old infant and notes mild conjunctivitis, corneal opacity, and serosanguinous discharge in the right eye. Which course of action is correct

Answer 40

Admit the infant to the hospital immediately.

Question 41

A preschool-­age child who attends day care has a 2 ­day history of matted eyelids in the morning and burning and itching of the eyes. The primary care pediatric nurse practitioner notes yellow-­green purulent discharge from both eyes, conjunctival erythema, and mild URI symptoms. Which action is correct?

Answer 41

Prescribe topical antibiotic drops

Question 42

A 14-­year-­old child has a 2 ­week history of severe itching and tearing of both eyes. The primary care pediatric nurse practitioner notes redness and swelling of the eyelids along with stringy, mucoid discharge. What will the nurse practitioner prescribe

Answer 42

Topical NSAID drops

Question 43

The primary care pediatric nurse practitioner observes a tender, swollen red furuncle on the upper lid margin of a child’s eye. What treatment will the nurse practitioner recommend

Answer 43

Warm, moist compresses 3 to 4 times daily

Question 44

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

Answer 44

Refer to an ophthalmologist

Question 45

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

Answer 45

Admit to the hospital for intravenous antibiotics.

Question 46

A school-­age child is seen in the clinic after a fragment from a glass bottle flew into the eye. What will the primary care pediatric nurse practitioner do?

Answer 46

Refer immediately to an ophthalmologist

Question 47

A school­-age child is hit in the face with a baseball bat and reports pain in one eye. The primary care pediatric nurse practitioner is able to see a dark red fluid level between the cornea and iris on gross examination, but the child resists any exam with a light. Which action is correct?

Answer 47

Refer the child immediately to an ophthalmologist

Question 48

The primary care pediatric nurse practitioner is performing a well child exam on a 4­month-­old infant who is nursing exclusively. The mother reports that the infant has had a marked decrease in the number of stools each day, from 3 to 5 stools each day to only one stool every other day. How will the nurse practitioner respond?

Answer 48

Ask the mother to describe the color and consistency of the stools.

Question 49

The primary care pediatric nurse practitioner is performing a well child exam on a 12­-month-­old infant. The parent tells the nurse practitioner that the infant has predictable bowel and bladder habits and asks about toilet training. What will the nurse practitioner tell this parent

Answer 49

Placing the child on a “potty” chair helps the child associate elimination cues with the toilet.

Question 50

The primary care pediatric nurse practitioner is performing a well child exam on a 24-­month-­old child. The parent tells the nurse practitioner that the child is being toilet trained and expresses frustration that on some days the child uses the toilet every time and on other days not at all. What will the nurse practitioner do

Answer 50

Ask the parent about the child’s toilet habits and understanding of toilet training.

Question 51

The primary care pediatric nurse practitioner is discussing toileting issues with the parent of a 3­-year-­old toddler who reports that the child has been toilet trained for several months but has recently been refusing to have bowel movements and is becoming constipated. What will the nurse practitioner do?

Answer 51

Ask the parent about bathroom facilities in the child’s day care.

Question 52

The primary care pediatric nurse practitioner is evaluating a 5­-year-­old child who has frequent soiling of stool associated with stomach aches and decreased appetite for the past 2 months. The parent states that the child has two or fewer formed bowel movements each week and has been toilet trained for about 2 years. Which initial assessment will the nurse practitioner make

Answer 52

Recent illnesses, fluid intake, changes in diet

Question 53

The primary care pediatric nurse practitioner is managing a 6-­year-­old child who has chronic constipation and encopresis. The nurse practitioner has ruled out neurogenic etiology. The parents report that the child was difficult to toilet train as a toddler. What is key to managing this child’s condition

Answer 53

Encouraging use of maintenance medications for at least 2 months after resolution of constipation

Question 54

The parent of a 5-­year-­old child tells the primary care pediatric nurse practitioner that the child has been using the toilet to urinate for since age 3 but continues to defecate in “pull­ups.” The nurse practitioner learns that the child has predictable bowel movements and a physical examination is normal. What will the nurse practitioner recommend

Answer 54

Putting the child on the toilet for 5 to 10 minutes at the usual time of defecation

Question 55

The primary care pediatric nurse practitioner evaluates a 4-­year-­old girl whose parent reports frequent urination in the evenings on weekdays, incontinence after voiding. The parent reports that the child has soft formed stools 5 or 6 times weekly. Which assessment will the nurse practitioner make initially?

Answer 55

Examination for labial adhesions

Question 56

The primary care pediatric nurse practitioner is concerned that a toddler may have vesicoureteral reflux based on a history of dysfunctional voiding patterns and a series of urinary tract infections. Which intervention is appropriate

Answer 56

Referral to a urologist for evaluation

Question 57

The primary care pediatric nurse practitioner is evaluating a 4-­year-­old female child for enuresis. The parents reports that the child has never been dry at night and has recently begun having daytime incontinence, usually when at preschool. The nurse practitioner learns that the child does not appear to have an abnormal urine stream. What will the nurse practitioner do next

Answer 57

Examine the urethral meatus and labia and obtain a dipstick clean catch urinalysis

Question 58

The primary care pediatric nurse practitioner is counseling the parent of an 8­-year­old child who has primary nocturnal enuresis. The nurse practitioner recommends an enuresis alarm, but the parent wishes to use medication. What will the nurse practitioner tell the parent

Answer 58

The combination of alarm therapy and intermittent drug therapy is best.

Question 59

The primary care pediatric nurse practitioner is teaching a parent of a child with dry skin about hydrating the skin with bathing. What will the nurse practitioner include in teaching

Answer 59

Have the child soak in a lukewarm water bath

Question 60

A child will need an occlusive dressing to treat lichen simplex chronicus. What will the primary care pediatric nurse practitioner tell the parents about applying this treatment

Answer 60

Apply ointment before the dressing.

Question 61

When prescribing topical glucocorticoids to treat inflammatory skin conditions, the primary care pediatric nurse practitioner will

Answer 61

prescribe brand­name preparations for consistent effects.

Question 62

A pre­school age child has honey­crusted 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

Answer 62

Amoxicillin­clavulanate 90 mg/kg/day for 10 days

Question 63

A child is brought to clinic with several bright red lesions on the buttocks. The primary care pediatric nurse practitioner examines the lesions and notes sharp margins and an “orange peel” look and feel. The child is afebrile and does not appear toxic. What is the course of treatment for these lesions

Answer 63

Initiate empiric antibiotic therapy and follow up in 24 hours to assess response.

Question 64

An adolescent who recently spent time in a hot tub while on vacation has discrete, erythematous 1­ to 2­mm 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

Answer 64

Prescribe topical keratolytics and topical antibiotics.

Question 65

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

Answer 65

Topical nystatin cream applied several times daily

Question 66

A school­age 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

Answer 66

Treat empirically with antifungal cream.

Question 67

A child has several circular, scaly lesions on the arms and abdomen, some of which have central clearing. The primary care pediatric nurse practitioner notes a smaller, scaly lesion on the child’s scalp. How will the nurse practitioner treat this child?

Answer 67

Prescribe oral griseofulvin for 2 to 4 weeks.

Question 68

A child is diagnosed with tinea versicolor. What is the correct management of ID: 13348425718 this disorder?

Answer 68

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

Question 69

An adolescent female has grouped vesicles on her oral mucosa. To determine whether these are caused by HSV­1 or HSV­2, the primary care pediatric nurse practitioner will order which test

Answer 69

Viral culture

Question 70

A 4­year­old 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

Answer 70

Topical diphenhydramine and magnesium hydroxide

Question 71

A previously healthy school­age child develops herpes zoster on the lower back. What will the primary care pediatric nurse practitioner do to manage this condition?

Answer 71

Order Burow solution and warm soothing baths as comfort measures.

Question 72

A child has small, firm, flesh­colored papules in both axillae which are mildly pruritic. What is an acceptable initial approach to managing this condition?

Answer 72

Reassuring the parents that these are benign and may disappear spontaneously

Question 73

A school­age 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?

Answer 73

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

Question 74

A 3­year­old child has head lice. What will the initial treatment recommendation be to treat this child

Answer 74

Permethrin

Question 75

A 9­month­old infant has vesiculopustular lesions on the palms and soles, on the face and neck, and in skin folds of the extremities. The primary care pediatric nurse practitioner notes linear and S­shaped burrow lesions on the parent’s hands and wrists. What is the treatment for this rash for this infant?

Answer 75

Permethrin 5% cream applied to face, neck, and body and rinsed off in 8 to 14 hours

Question 76

An adolescent has acne with lesions on the cheeks and under the chin. Which distribution is this?

Answer 76

Topical erythromycin with benzoyl peroxide Correct

Question 77

A child has an area of inflammation on the neck that began after wearing a hand­knot woolen sweater. On examination, the skin appears chafed with mild erythematous patches. The lesions are not pruritic. What is an appropriate initial treatment?

Answer 77

Topical corticosteroids applied 2 to 3 times daily

Question 78

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

Answer 78

Daily application of ketoconazole 2% topical cream

Question 79

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

Answer 79

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

Question 80

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

Answer 80

Consult with a pediatric intensivist for admission to a pediatric intensive care unit

Question 81

A school­age child has a rash without fever or preceding symptoms. Physical examination reveals a 3­cm ovoid, erythematous lesion on the trunk with a finely scaled elevated border, along with generalized macular, ovoid lesions appearing in a “Christmas tree” pattern on the child’s back. What is the initial action

Answer 81

Reassure the child’s parents that the rash is benign and self­limited

Question 82

A child who has psoriasis, who has been using a moderate­potency topical steroid on thick plaques on the extremities and a high­potency topical steroid on more severe plaques on the elbows and knees, continues to have worsening of plaques. In consultation with a dermatologist, which treatment will be added

Answer 82

Anthralin ointment in high strength applied for 10 to 30 minutes daily

Question 83

During a well child examination of an infant, the primary care pediatric nurse practitioner notes 10 café au lait spots on the infant’s trunk. What is the potential concern associated with this finding

Answer 83

Neurofibromatosis

Question 84

The primary care pediatric nurse practitioner notes velvety, brown thickening of skin in the axillae, groin, and neck folds of an adolescent Hispanic female who is overweight. What is the initial step in managing this condition?

Answer 84

Performing metabolic laboratory tests

Question 85

An African­American child has recurrent tinea capitis and has just developed a new area of alopecia after successful treatment several months prior. When prescribing treatment with griseofulvin and selenium shampoo, what else will the primary care pediatric nurse practitioner do

Answer 85

Perform fungal cultures on family members and pets.

Question 86

The primary care pediatric nurse practitioner is examining a 2­week­old infant and auscultates a wide splitting of S2 during expiration. What condition may this finding represent?

Answer 86

Atrial septal defect

Question 87

The primary care pediatric nurse practitioner auscultates a new grade II vibratory, mid­systolic murmur at the mid sternal border in a 4­year­old child that is louder when the child is supine. What type of murmur is most likely

Answer 87

Still’s murmur

Question 88

During a well child assessment, the primary care pediatric nurse practitioner auscultates a harsh, blowing grade IV/VI murmur in a 6­month­old infant. What will the nurse practitioner do next

Answer 88

Refer to a pediatric cardiologist for further evaluation.

Question 89

The primary care pediatric nurse practitioner provides primary care for a 4­month­ old infant who has a ventricular septal defect. The infant has been breastfeeding well but in the past month has dropped from the 20th percentile to the 5th for weight. What will the nurse practitioner recommend

Answer 89

Fortifying breast milk to increase the number of calories per ounce

Question 90

A 12­month­old infant who had cardiopulmonary bypass with RBC and plasma infusions during surgery at 8 months is seen for a well child examination. Which vaccine may be administered at this visit

Answer 90

PCV­13

Question 91

The primary care pediatric nurse practitioner performs a well child examination on a 12­month­old child who had repair of a congenital heart defect at 8 months of age. The child has a normal exam. The parent reports that the child is not taking any medications. The nurse practitioner will contact the child’s cardiologist to discuss whether the child needs which medication

Answer 91

Amoxicillin

Question 92

During a well baby examination of a 6­week­old infant, the primary care pediatric nurse practitioner notes poor weight gain, acrocyanosis of the hands and feet, and a respiratory rate of 60 breaths per minute. Oxygen saturation on room air is 93%. The remainder of the exam is unremarkable. Which action is correct

Answer 92

Refer the infant to a pediatric cardiologist.

Question 93

A 3­month­old infant who was previously healthy now has a persistent cough, bilateral lung crackles, and poor appetite. The primary care pediatric nurse practitioner auscultates a grade III/VI, low­pitched, holosystolic murmur over the left lower sternal border and palpates the liver at one centimeter below the ribs. What diagnosis is likely?

Answer 93

Ventricular septal defect

Question 94

An infant with trisomy 21 has a complete AV canal defect. Which finding, associated with having both of these conditions, will the primary care pediatric nurse practitioner expect?

Answer 94

Oxygen desaturation

Question 95

A 9­month­old infant has a grade III/VI, harsh, rumbling, continuous murmur in the left infraclavicular fossa and pulmonic area. A chest radiograph reveals cardiac enlargement. The primary care pediatric nurse practitioner will refer the infant to a pediatric cardiologist and prepare the parents for which intervention to repair this defect?

Answer 95

Coil insertion in the catheterization laboratory

Question 96

A 5­year­old child who had a repair for transposition of the great arteries shortly after birth is growing normally and has been asymptomatic since the surgery. The primary care nurse practitioner notes mild shortness of breath with exertion and, upon questioning, learns that the child has recently complained of dizziness. What will the nurse practitioner do

Answer 96

Refer the child to the cardiologist immediately.

Question 97

The primary care pediatric nurse practitioner is performing a well child examination on a school­age child who had complete repair of a tetralogy of Fallot defect in infancy. What is important in this child’s health maintenance regime?

Answer 97

Cardiology clearance for sports participation

Question 98

The primary care pediatric nurse practitioner is performing a sports physical on an adolescent whose history reveals mild aortic stenosis. What will the nurse practitioner recommend

Answer 98

Evaluation by a cardiologist prior to participation

Question 99

During a routine well child exam on a 5­year­old child, the primary care pediatric nurse practitioner auscultates a grade II/VI, harsh, late systolic ejection murmur at the upper left sternal border that transmits to both lung fields. The child has normal growth and development. What will the nurse practitioner suspect?

Answer 99

Pulmonic stenosis

Question 100

A 5­year­old child has an elevated blood pressure during a well child exam. The primary care pediatric nurse practitioner notes mottling and pallor of the child’s feet and lower legs and auscultates a systolic ejection murmur in the left infraclavicular region radiating to the child’s back. The nurse practitioner will suspect which condition

Answer 100

Coarctation of the aorta

Question 101

An adolescent female has a history of repaired tetralogy of Fallot. Which long­ term complication is a concern for this patient

Answer 101

Mitral valve prolapse

Question 102

A 6­year­old child has a systolic blood pressure between the 95th and 99th percentile for age, sex, and height and a diastolic blood pressure between the 90th and the 95th percentile on three separate clinic visits. This child’s blood pressure is classified as

Answer 102

stage 1 hypertensive

Question 103

A 12­year­old child whose weight and BMI are in the 75th percentile has a diastolic blood pressure that is between the 95th and 99th percentiles for age, sex, and height on three separate occasions. Initial tests for this child will include

Answer 103

renal function and plasma renin tests

Question 104

A 12­year­old child whose BMI is greater than the 95th percentile has a blood pressure at the 98th percentile for age, sex, and height. After lifestyle changes that include diet and exercise, the child’s BMI drops to the 90th percentile, but the blood pressure remains the same. What is the primary care pediatric nurse practitioner’s next step in treating this child

Answer 104

Referral to a nephrologist or cardiologist

Question 105

A 7­year­old child who has a history of a repaired congenital heart defect has many dental caries along with gingival erythema and irritation and a temperature of 102.5°F. What will the primary care pediatric nurse practitioner do next

Answer 105

Admit to the hospital with a pediatric cardiology consult

Question 106

A 15­year­old female reports fainting at school in class on two occasions. The adolescent’s orthostatic blood pressures are normal. The primary care pediatric nurse practitioner suspects a cardiac cause for these episodes and will order which tests before referring her to a pediatric cardiologist

Answer 106

12­lead electrocardiogram

Question 107

A 30­month­old girl who has been toilet trained for 6 months has daytime enuresis and dysuria and a low­grade fever. A dipstick urinalysis is negative for leukocyte esterase and nitrites. What is the next step?

Answer 107

Send the urine to the lab for culture.

Question 108

The clean catch urine specimen of a child with dysuria, frequency, and fever has a colony count between 50,000 and 100,000 of E. coli. What is the treatment for this child?

Answer 108

Treat with antibiotics for urinary tract infection.

Question 109

A dipstick urinalysis is positive for leukocyte esterase and nitrites in a school­age child with dysuria and foul­smelling urine but no fever who has not had previous urinary tract infections. A culture is pending. What will the pediatric nurse practitioner do to treat this child

Answer 109

Prescribe trimethoprim­sulfamethoxazole (TMP) twice daily for 3 to 5 days.

Question 110

A preschool­age child with no previous history has mild flank pain and fever but no abdominal pain or vomiting. A urinalysis is positive for leukocyte esterase and nitrites. A culture is pending. Which is the correct course of treatment for this child

Answer 110

Order amoxicillin clavulanate

Question 111

A 3­year­old child has just completed a 7­day course of amoxicillin for a second febrile urinary tract infection and currently has a negative urine culture. What is the next course of action?

Answer 111

Obtain a renal and bladder ultrasound.

Question 112

A 9­month­old infant with a history of three urinary tract infections is diagnosed with grade II vesicoureteral reflux. Which medication will be prescribed

Answer 112

TMP­SMX; TMP 2 mg/kg as a single daily dose

Question 113

The parent of a toddler diagnosed with grade V vesicoureteral reflux asks the primary care pediatric nurse practitioner how the disease will be treated. What will the nurse practitioner tell this parent

Answer 113

That surgery to correct the condition is possible

Question 114

A healthy 14­year­old female has a dipstick urinalysis that is positive for 5­6 RBCs per hpf but otherwise normal. What is the first question the primary care pediatric nurse practitioner will ask this patient

Answer 114

“When was your last menstrual period (LMP)?”

Question 115

A child has gross hematuria, abdominal pain, and arthralgia as well as a rash. What diagnosis is most likely?

Answer 115

Henoch­Schönlein purpura

Question 116

10. An adolescent has 2+ proteinuria in a random dipstick urinalysis. A subsequent first­ morning voided specimen is negative. What will the primary care pediatric nurse practitioner do to manage this condition

Answer 116

Monitor for proteinuria at each annual well child examination.

Question 117

A child is diagnosed with nephrotic syndrome, and the pediatric nurse practitioner provides primary care in consultation with a pediatric nephrologist. The child was treated with steroids and responded well to this treatment. What will the nurse practitioner tell the child’s parents about this disease?

Answer 117

“Steroids will be used when relapses occur.”

Question 118

A child who has nephrotic syndrome is on a steroids and a salt­restricted diet for a relapse of symptoms. A dipstick urinalysis shows 1+ protein, down from 3+ at the beginning of the episode. In consultation with the child’s nephrologist, what is the correct course of treatment considering this finding?

Answer 118

Continue with steroids and salt restrictions until the urine is negative for protein

Question 119

A child who had GABHS 2 weeks prior is in the clinic with periorbital edema, dyspnea, and elevated blood pressure. A urinalysis reveals tea­colored urine with hematuria and mild proteinuria. What will the primary care pediatric nurse practitioner do to manage this condition

Answer 119

Refer the child to a pediatric nephrologist for hospitalization.

Question 120

An adolescent has right­sided flank pain without fever. A dipstick urinalysis reveals gross hematuria without signs of infection or bacteriuria, and the primary care pediatric nurse practitioner diagnoses possible nephrolithiasis. What is the initial treatment for this condition

Answer 120

Increasing fluid intake up to 2 L daily

Question 121

During a well child examination of a 2­year­old child, the primary care pediatric nurse practitioner palpates a unilateral, smooth, firm abdominal mass which does not cross the midline. What is the next course of action that

Answer 121

Refer the child to an oncologist immediately.

Question 122

A 6­month­old infant has a retractile testis that was noted at the 2­month well baby exam. What will the primary care pediatric nurse practitioner do to manage this condition?

Answer 122

Refer the infant to a pediatric urologist or surgeon for possible orchiopexy

Question 123

A 9­month­old infant is brought to the clinic with scrotal swelling and fussiness. The primary care pediatric nurse practitioner notes a tender mass in the affected scrotum that is difficult to reduce. What is the correct action

Answer 123

Refer immediately to a pediatric surgeon.

Question 124

The mother of a 12­month­old uncircumcised male infant reports that the child seems to have pain associated with voiding. A physical examination reveals a tight, pinpoint opening of the foreskin, which thickened and inflamed. What will the primary care pediatric nurse practitioner do

Answer 124

Refer the child to a pediatric urologist.

Question 125

An adolescent male comes to the clinic reporting unilateral scrotal pain, nausea, and vomiting that began that morning. The primary care pediatric nurse practitioner palpates a painful, swollen testis and elicits increased pain with slight elevation of the testis (a negative Phren’s sign). What will the nurse practitioner do

Answer 125

Refer the adolescent immediately to a pediatric urologist or surgeon.