Practice Questions

Question 1

1. Which of the following is appropriate advice to give to a mother who is breastfeeding her 10-day-old infant?
   A. “Your milk will come in today.”
   B. “To minimize breast tenderness, the baby should not be kept on either breast for more than 5 to 10 minutes.”
   C. “A clicking sound made by the baby during feedings signifies a good latch and suck.”
   D. “The baby’s urine should be light or colorless.”

Answer 1

D. “The baby’s urine should be light or colorless.”

Question 2

2. Which of the following is appropriate advice to give to a mother who is breastfeeding her 12-hour-old infant?
   A. “You will likely have enough milk to feed the baby within a few hours of birth.”
   B. “The baby might need to be awakened to be fed.”
   C. “Supplemental feeding is needed unless the baby has at least four wet diapers in the first day of life.”
   D. “The baby will likely have a seedy yellow bowel movement today.”

Answer 2

B. “The baby might need to be awakened to be fed.”

Question 3

3. Compared with the use of infant formula, advantages for the baby of breastfeeding include all of the following except:
   A. lower incidence of diarrheal illness.
   B. greater weight gain in the first few weeks of life.
   C. reduced risk of allergic disorders.
   D. lower occurrence of constipation.

Answer 3

B. greater weight gain in the first few weeks of life.

Question 4

4. At 3 weeks of age, the average-weight, formula-fed infant should be expected to take: mL
   A. 2 to 3 oz, or 60 to 90 mL, every 2 to 3 hours.
   B. 2 to 3 oz, or 60 to 90 mL, every 3 to 4 hours.
   C. 3 to 4 oz, or 90 to 118 mL, every 2 to 3 hours.
   D. 3 to 4 oz, or 90 to 118 mL, every 3 to 4 hours.

Answer 4

A. 2 to 3 oz, or 60 to 90 mL, every 2 to 3 hours.

Question 5

6. Nursing infants generally maximally receive about which percentage of the maternal dose of a drug?
A. 1%
B. 3%
C. 5%
D. 10%

Answer 5

A. 1%

Question 6

7. Most drugs pass into breast milk through:
A. active transport.
B. facilitated transfer.
C. simple diffusion.
D. creation of a pH gradient.

Answer 6

C. simple diffusion.

Question 7

8. To remove a drug from breast milk through “pump and dump,” the nursing mother should refrain from taking the offending medication and the process must be continued for:
   A. two infant feeding cycles.
   B. approximately 8 hours.
   C. three to five half-lives of the drug.
   D. a period of time that is highly unpredictable.

Answer 7

C. three to five half-lives of the drug.

Question 8

9. When counseling a breastfeeding woman about alcohol use during lactation, you relate that:
   A. drinking a glass of wine or beer will enhance the let-down reflex.
   B. because of its high molecular weight, relatively little alcohol is passed into breast milk.
   C. maternal alcohol use causes a reduction in the amount of milk ingested by the infant.
   D. infant intoxication can be seen with mother’s having as few as one to two alcoholic drinks.

Answer 8

C. maternal alcohol use causes a reduction in the amount of milk ingested by the infant.

Question 9

10. A 23-year-old woman is breastfeeding her healthy newborn. She wishes to start using hormonal contraception. Which of the following represents the best regimen?
    A. combined oral contraception initiated at 2 weeks
    B. progesterone-only oral contraception initiated at 3 weeks
    C. medroxyprogesterone acetate (Depo-Provera) given day 1 postpartum
    D. use of all forms of hormonal contraception is discouraged during lactation

Answer 9

B. progesterone-only oral contraception initiated at 3 weeks

Question 10

11. Guidelines recommend that a breastfeeding mother waits until breastfeeding is well established for approximately 6 months before using combined oral contraceptives (COC) because:
    A. in early breastfeeding, the amount of hormone in COC could cause significant harm to the nursing infant.
    B. efficacy of COC could be compromised by breastfeeding.
    C. milk flow could be compromised by COC.
    D. COC oral contraceptive use could affect mother’s sleep patterns.

Answer 10

C. milk flow could be compromised by COC.

Question 11

12. At what point after childbirth can a combined oral contraceptive be started without other risk factors for venous thrombosis in a woman who is not breastfeeding?
A. 1 day
B. 1 week
C. 3 weeks
D. 6 weeks

Answer 11

C. 3 weeks

Question 12

13. The anticipated average daily weight gain during the first 3 months of life is approximately:
A. 15 g or 0.53 oz.
B. 20 g or 0.7 oz.
C. 25 g or 0.88 oz.
D. 30 g or 1 oz.

Answer 12

D. 30 g or 1 oz.

Question 13

14. The average required caloric intake in an infant from age 0 to 3 months is usually:
A. 40 to 60 kcal/kg/d.
B. 60 to 80 kcal/kg/d.
C. 80 to 100 kcal/kg/d.
D. 100 to 120 kcal/kg/d.

Answer 13

C. 80 to 100 kcal/kg/d.

Question 14

15. Regarding physiologic jaundice in the newborn, select all that are correct:
    A. It occurs between the first 12 and 24 hours of life.
    B. It progresses from the abdomen toward the head of the infant.
    C. Unconjugated bilirubin is elevated.
    D. Risk of development of hyperbilirubinemia can be reduced in a breastfed infant with frequent breastfeeding every 2 to 3 hours per 24 hours.
    E. It can be avoided by supplemental water and dextrose feedings between breastfeeding in the first 3 to 4 days of life to increase infant hydration while awaiting mother’s milk to come in.

Answer 14

C. Unconjugated bilirubin is elevated.
D. Risk of development of hyperbilirubinemia can be reduced in a breastfed infant with frequent breastfeeding every 2 to 3 hours per 24 hours.

Question 15

26. Which of the following would not be found in newborns?
    A. best vision at a range of 8 to 12 inches
    B. presence of red reflex
    C. light-sensitive eyes
    D. lack of defensive blink

Answer 15

D. lack of defensive blink

Question 16

27. Which of the following do you expect to find in an examination of a 2-week-old infant?
    A. a visual preference for the human face
    B. a preference for low-pitched voices
    C. indifference to the cry of other neonates
    D. poorly developed sense of smell

Answer 16

A. a visual preference for the human face

Question 17

33. The presumptive diagnosis of fragile X syndrome can be confirmed by a blood test.
    A. true
    B. false

Answer 17

A. true

Question 18

34. The following chromosomal syndrome is a common etiology of social and verbal developmental delays in boys:
A. Tay-Sachs disease.
B. cystic fibrosis.
C. fragile X.
D. trisomy 18.

Answer 18

C. fragile X.

Question 19

35. One physical sign of fragile X syndrome in males includes:
A. large eyes.
B. large forehead.
C. small head.
D. recessive jaw.

Answer 19

B. large forehead.

Question 20

36. Klinefelter syndrome is most commonly marked by:
A. language impairment in males.
B. fine motor delay in males.
C. hip and breast enlargement in women.
D. attention deficit disorder in males.

Answer 20

A. language impairment in males.

Question 21

37. Klinefelter syndrome and risk for having a child with this condition can be accurately identified by (choose all that apply):
A. urine test.
B. literacy assessment.
C. amniocentesis.
D. blood testing for carrier state.

Answer 21

C. amniocentesis.

D. blood testing for carrier state.

Question 22

41. At which of the following ages in a young child’s life is parental anticipatory guidance about protection from falls most helpful?
A. birth
B. 2 months
C. 4 months
D. 6 months

Answer 22

A. birth

Question 23

43. At which of the following ages in a young child’s life is parental anticipatory guidance about infant sleep position most helpful?
A. birth
B. 2 weeks
C. 2 months
D. 4 months

Answer 23

A. birth

Question 24

22. Fetal TORCH infections can cause microcephaly, mental retardation, hepatosplenomegaly, and intrauterine growth retardation. The acronym TORCH stands for:
    A) Toxoplasma gondii, other infections, rubella, cytomegalovirus, and herpes
    B) Toxic shock syndrome, ocular infections, rubella, cytomegalovirus, and herpes zoster
    C) Tetanus, ophthalmic infections, roseola, cancer, and head abnormalities
    D) Toxins, other infections, roseola, candidiasis, and head abnormalities

Answer 24

A) Toxoplasma gondii, other infections, rubella, cytomegalovirus, and herpes
The acronym TORCH stands for Toxoplasma gondii, other infections, rubella, cytomegalovirus, and herpes. Although several of the conditions listed in the other answer options can also cause fetal problems, they are not included in the TORCH acronym.

Question 25

53. A toddler with congenital heart disease is seen for a 1-week history of facial and lower-extremity edema accompanied by shortness of breath. The child’s mother reports that the child’s appetite has been poor. The chest x-ray reveals that the child has congestive heart failure (CHF). Which of the following heart sounds are found in these patients?
A) S1 and S2
B) S1, S2, and S3
C) S1, S2, and S4
D) Still’s murmur and S4

Answer 25

B) S1, S2, and S3
Congestive heart failure is the inability of the heart to pump a sufficient amount of blood to the organs to meet the body’s requirements. It is common to hear S1, S2, and S3 heart sounds on exam. Common signs and symptoms include fatigue, shortness of breath with activity, and edema of lower extremities.

Question 26

125. A faun tail nevus is a sign of which of the following?
A) Down syndrome
B) Infantile scoliosis
C) Congenital heart disease
D) Spina bifida

Answer 26

D) Spina bifida

A faun tail nevus is an abnormal tuft of hair in the lumbosacral area, which can be a sign of spina bifida.

Question 27

127. Café-au-lait spots look like tan-to-light brown stains that have irregular borders. They can be located anywhere on the body. Which of the following is a correct statement?
     A) They are associated with neurofibromatosis or von Recklinghausen’s disease
     B) They may be considered as precancerous after a biopsy
     C) They are more common in darker-skinned children
     D) They are associated with Wilson’s disease

Answer 27

A) They are associated with neurofibromatosis or von Recklinghausen’s disease
Café-au-lait spots are caused by an increase in melanin content, often with the presence of giant melanosomes. They have irregular borders and vary in color from light to dark brown. Neurofibromatosis causes tumors to grow in the nervous system, and these tumors commonly cause skin changes that are seen as café-au-lait spots.

Question 28

130. The red reflex is elicited by shining a light in the eyes of the infant at an angle with the light about 15 in. away. The nurse practitioner is screening for?
A) Cataracts
B) Strabismus
C) Blindness
D) The blinking response

Answer 28

A) Cataracts
Screening for cataracts is performed by shining a light into the eyes at an angle, approximately 15 inches away. If the red reflex is not elicited, then cataracts are present.

Question 29

131. A 44-year-old patient with Down syndrome starts to develop impaired memory and difficulty with his usual daily life routines. He is having problems functioning
     at the job that he has done for the past 10 years. The physical exam and routine labs are all negative. The vital signs are normal. His appetite is normal. The most
     likely diagnosis is:
     A) Tic douloureux
     B) A stroke
     C) Alzheimer’s disease
     D) Delirium

Answer 29

C) Alzheimer’s disease
Delirium is an acute decline in mental status and is
temporary. Common causes are fever, shock, drugs, alcohol, and dehydration. Alzheimer’s disease is a permanent change to the brain that causes short-term
memory loss, agnosia, apraxia, and aphasia. In this case, the patient’s physical exam is normal; however, he is having memory loss and difficulty working and
carrying out his normal tasks.

Question 30

150. The cover/uncover test is a screening tool for:
A) Color blindness
B) Strabismus
C) Visual acuity
D) Cataracts

Answer 30

B) Strabismus
The cover/uncover test screens for strabismus. Color blindness is evaluated by using the Ishihara tool. Visual acuity is evaluated using the Snellen chart. Cataracts are screened by using the ophthalmoscope and shining a light into the eyes at an angle, approximately 15 inches away. If the red reflex is not elicited, then cataracts are present.

Question 31

151. The mother of a 4-week-old infant is concerned that her infant’s eyes are crossed for a few seconds occasionally. The nurse practitioner would:
     A) Recommend referral to a pediatric ophthalmologist
     B) Advise the mother that this is a normal finding in infants up to 2 months of age
     C) Recommend that multivitamin supplements be given to the infant daily
     D) Educate her on how to patch the infant’s eye every 4 hours

Answer 31

B) Advise the mother that this is a normal finding in infants up to 2 months of age
Infants’ eyes commonly cross over at times, and this is a normal finding up to 2 months of age.

Question 32

159. While checking for the red reflex on a 3-year-old boy during a well child visit, a white reflection is seen on the child’s left pupil. Which of the following conditions
should be ruled out?
A) Unilateral strabismus
B) Unilateral cataracts
C) Retinoblastoma of the left eye
D) Color blindness of the left eye

Answer 32

C) Retinoblastoma of the left eye
Retinoblastoma is a rare type of cancer in which a cancerous tumor of the retina is present. This is diagnosed by noting a pupil that appears white or has white spots on it. One or both eyes may be affected. It is often seen in photographs, where there will be a white glow in the eye instead of the usual “red eye” noted in pictures from the flash.

Question 33

167. You are reviewing the bilirubin level on a 3-day-old full-term neonate. You note that it is 10 mg/dL. The infant has a slight yellow color to his skin, mucous membranes, and sclera. The infant is feeding well, is not irritable, and has 8 to 10 wet diapers per day. Which of the following is a true statement?
     A) Keep on monitoring the infant’s bilirubin level until it returns back to normal in about 1 week
     B) Recommend that the infant be treated with phototherapy 10 minutes a day until the bilirubin level is back down to a normal range
     C) Refer the infant to a neonatologist as soon as possible
     D) Refer the infant to the neonatal intensive care unit

Answer 33

A) Keep on monitoring the infant’s bilirubin level until it returns back to normal in about 1 week
Bilirubin is excreted through the urine and feces. Increased fluids and wetting 8–10 diapers a day is sufficient fluid intake/excretion to help bring down the bilirubin level. Levels should continue to be monitored and should improve in approximately 1 week.

Question 34

174. The apex of the heart is located at:
     A) Second ICS (intercostal space) to the right of the sternal border
     B) Second ICS to the left of the sternal border
     C) The left lower sternal border
     D) The left side of the sternum at the fifth ICS by the midclavicular line

Answer 34

D) The left side of the sternum at the fifth ICS by the midclavicular line

Question 35

178. All of the following are correct statements regarding the S3 component of the heart sound except:
     A) It occurs very early in diastole and is sometimes called an opening snap
     B) It is a normal finding in some children, healthy young adults, and athletes
     C) It can be a normal variant if heard in a person age 40 or older
     D) It signifies CHF (congestive heart failure)

Answer 35

C) It can be a normal variant if heard in a person age 40 or older
S3 heart sounds occur early in diastole and are sometimes referred to as an “opening snap.” It is a
normal variant in children, healthy young adults, and athletes. Bibasilar crackles in lung bases and the presence of S3 heart sounds are classic findings of CHF.

Question 36

185. You notice a medium-pitched harsh systolic murmur during an episodic exam. It is best heard at the right upper border of the sternum. What is most likely?
A) Mitral stenosis
B) Aortic stenosis
C) Pulmonic stenosis
D) Tricuspid regurgitation

Answer 36

B) Aortic stenosis
Aortic stenosis is best heard at the right upper border of the sternum, radiating to the neck with a medium-pitched systolic murmur. Mitral stenosis is heard at the apex of the heart and sounds like a low-pitched diastolic rumbling murmur. It is suggested that this murmur is heard best with the bell side of the stethoscope.

Question 37

191. A new mother is breastfeeding her full-term 4-week-old infant. She wants to know whether she should give the infant vitamin supplements. The best advice is:
     A) Since she is breastfeeding, the infant does not need any vitamin supplements until he is at least 6 months of age
     B) Breast milk gives the infant all the vitamins he needs until 12 months of age
     C) Breastfed infants require iron and Vitamin D supplementation right away
     D) Breastfed infants require iron and Vitamin E supplementation at 3 months of age

Answer 37

C) Breastfed infants require iron and Vitamin D supplementation right away
While infants do receive Vitamin D through human milk, the AAP recommends a daily supplement of 200 IU Vitamin D for all breastfed infants.

Question 38

201. What is the primary carbohydrate found in breast milk and commercial infant formulas?
A) Fructose
B) Lactose
C) Glucose
D) Sucrose

Answer 38

B) Lactose

Question 39

220. A newborn’s mother is discovered to be HBsAg (hepatitis B surface antigen) positive. Which of the following would you recommend for this infant?
     A) Give the baby hepatitis B immunoglobulin
     B) Give the baby both hepatitis B vaccine and hepatitis B immunoglobulin
     C) Give the baby hepatitis B vaccine only
     D) Send the baby home because he is not infected

Answer 39

B) Give the baby both hepatitis B vaccine and hepatitis B immunoglobulin
For a mother who tests positive for HBsAg, the newborn infant should be given hepatitis B vaccine and hepatitis B immunoglobulin for protection.

Question 40

223. The following are acceptable methods of birth control for breastfeeding mothers except:
     A) Diaphragm with spermicidal gel
     B) Progesterone-only pills (Micronor)
     C) Condoms
     D) Low-dose oral contraceptives with at least 20 mcg of estradiol (Alesse, Lo-estrin)

Answer 40

D) Low-dose oral contraceptives with at least 20 mcg of estradiol (Alesse, Lo-estrin)
Low-dose oral contraceptives that contain estradiol are contraindicated for breastfeeding mothers.

Question 41

230. A medium-pitched harsh mid-systolic murmur is best heard at the right second ICS of the chest. It radiates into the neck. Which of the following is the correct
diagnosis?
A) Aortic stenosis
B) Pulmonic stenosis
C) Aortic regurgitation
D) Mitral stenosis

Answer 41

A) Aortic stenosis
The murmur associated with aortic stenosis can be auscultated as harsh and high pitched in the right second intercostal space; it typically radiates to the carotid arteries and apex.

Question 42

232. What is the caloric content of infant formula and breast milk?
A) 10 kcal/30 mL
B) 15 kcal/30 mL
C) 20 kcal/30 mL
D) 25 kcal/30 mL

Answer 42

C) 20 kcal/30 mL

Question 43

236. An infant who does not have a history of reactive airway disease and allergy has both inspiratory and expiratory wheezing accompanied by fever and profuse clear nasal discharge. Which of the following is most likely?
     A) Tracheobronchitis
     B) Bronchiolitis
     C) Croup
     D) A small foreign body that is lodged on the left main bronchus

Answer 43

B) Bronchiolitis
Symptoms of tracheo bronchitis include prominent dry, nonproductive cough; later, coughing up phlegm is common. Bronchiolitis is a viral infection caused by RSV that is commonly seen during the winter/spring months in infants and young children. Typical signs/symptoms include fever, inspiratory/expiratory wheezing, with clear drainage. Croup is a viral infection with the classic “barking” cough; the patient may have a runny nose, but typically no fever. When a child swallows a foreign object, choking, wheezing, and shortness of breath may occur, but no fever or clear drainage is present.

Question 44

251. A new mother who is on her fourth day of breastfeeding complains to the nurse practitioner of very sore breasts. The nurse practitioner would:
     A) Recommend a decrease in the number of times she breastfeeds her infant per day
     B) Recommend that she stop breastfeeding and use infant formula for the next 48 hours
     C) Educate the mother that this is normal during the first week or 2 of breastfeeding and the soreness will eventually go away
     D) Recommend that she purchase plastic nipple pads for her nursing bra and use them daily

Answer 44

C) Educate the mother that this is normal during the first week or 2 of breastfeeding and the soreness will eventually go away
Nursing during the first 2 weeks after delivery may cause tenderness and soreness of the nipples and usually
resolves after this. The mother should continue to breastfeed as she has been advised, and she should make sure the infant is latching on appropriately.

Question 45

256. All of the following statements reflect inadequate breast milk production except:
     A) Full-term infant is at birth weight by the second week of life
     B) Less than 6 wet diapers per day or less than 4 stools per day
     C) Infant is nursing fewer than 8 times per 24-hour period
     D) Weight loss of > 10% of birth weight

Answer 45

A) Full-term infant is at birth weight by the second week of life
The full-term infant should be back to birth weight at 2 weeks of age. The infant should be nursing every 2–4 hours and should wet 6–10 diapers a day (24 h).

Question 46

257. The best screening test for detecting and monitoring both hyperthyroidism and hypothyroidism is:
A) The total T3–4
B) Thyroid-stimulating hormone (TSH)
C) Thyroid profile
D) Palpation of the thyroid gland

Answer 46

B) Thyroid-stimulating hormone (TSH)
The best “screening” test of hypothyroidism and hyperthyroidism is the TSH. If this result is abnormal, then further diagnostic tests should be performed.

Question 47

267. The nurse practitioner examines a 4-week-old boy whose mother reports that he has cried for at least 3 hours a day at the same time of day since birth. What is the main goal in the clinical evaluation of this infant?
     A) Rule out any physiologic cause for the crying spells
     B) Make sure that the infant is well clothed
     C) Evaluate the environment
     D) Order laboratory and diagnostic testing

Answer 47

A) Rule out any physiologic cause for the crying spells
For infants that cry for several hours during the day, ruling out a physiological problem that may be causing the distress is recommended.

Question 48

274. The S1 heart sound is caused by:
     A) Closure of the atrioventricular valves
     B) Closure of the semilunar valves
     C) Opening of the atrioventricular valves
     D) Opening of the semilunar valves

Answer 48

A) Closure of the atrioventricular valves

Question 49

275. Patients with Down syndrome are at higher risk for all of the following except:
A) Atlantoaxial instability
B) Congenital heart disease
C) Early onset of Alzheimer’s disease
D) Melanoma

Answer 49

D) Melanoma
Patients with the diagnosis of Down syndrome are at higher risk for atlantoaxial instability, congenital heart defects, and early onset of Alzheimer’s disease. Children with Down syndrome who participate in sport activities must be carefully examined for these conditions prior to participation to prevent injury.

Question 50

283. The mother of a 13-year-old male with Down syndrome is in the family nurse practitioner’s office and wants a sports physical done for her son. She reports that he wants to join the football team in his school. You would tell the mother that her son:
     A) Can play a regular football game as long as he wears maximum protective football gear
     B) Cannot play some contact sports because of an increased risk of cervical spine injury
     C) Can play certain contact sports after he has been checked for cervical instability
     D) None of the above

Answer 50

B) Cannot play some contact sports because of an increased risk of cervical spine injury
Children with the diagnosis of Down syndrome are at higher risk for atlantoaxial instability, congenital heart defects, and early onset of Alzheimer’s disease. Therefore, due to the risk of cervical spine injury, some contact sports are not advised.

Question 51

295. A newborn infant who is small for gestational age is noted to have shortened palpebral fissures and microcephaly with a small jaw. This infant is most likely to be diagnosed with:
A) Down syndrome
B) Fetal alcohol syndrome
C) Growth retardation
D) Hydrocephalus

Answer 51

B) Fetal alcohol syndrome

Classic symptoms of fetal alcohol syndrome include small palpebral fissures and microcephaly with a small jaw.

Question 52

307. A major risk factor for a Down syndrome infant is:
     A) Maternal age younger than 16 years
     B) Maternal age older than 35 years
     C) A positive family history of Down syndrome
     D) A positive family history of genetic disease

Answer 52

B) Maternal age older than 35 years

Maternal age greater than 35 years during pregnancy is a risk factor for infant Down syndrome.

Question 53

320. The posterior fontanel should be completely closed by:
A) 3 months
B) 4 months
C) 5 months
D) 6 months

Answer 53

A) 3 months
The posterior fontanelle normally closes by 3 months of age. The anterior fontanelle closes between 12 and 18 months of age.

Question 54

370. All of the following are true about strawberry hemangiomas found in infants except:
     A) Most will involute spontaneously by the age of 18 to 24 months
     B) Watchful waiting is the most useful strategy
     C) Hemangiomas should be treated with laser therapy if they have not resolved by the age of 12 months
     D) Strawberry hemangiomas are benign

Answer 54

C) Hemangiomas should be treated with laser therapy if they have not resolved by the age of 12 months
True strawberry hemangiomas will eventually resolve by the time the child goes to kindergarten. Most will reduce or disappear in the first 2 years. Laser treatment is rarely needed.

Question 55

377. Which of the following is correct regarding the best site to listen for mitral regurgitation?
A) The apical area during S2
B) It is best heard at the base at S1
C) It is best heard at the apex at S1
D) It is best heard at the base at S2

Answer 55

C) It is best heard at the apex at S1

Mitral regurgitation is best heard at the apical area; it is a high-pitched, blowing pansystolic murmur.

Question 56

454. An 18-year-old male is found to have a 47, XXY karyotype and is diagnosed with Klinefelter’s syndrome. The patient is most likely to have all of the following physical characteristics except:
     A) Gynecomastia
     B) Long limbs
     C) Lack of secondary sexual characteristics
     D) Large testes

Answer 56

D) Large testes
Signs/symptoms of Klinefelter’s syndrome include gynecomastia, long limbs, and lack of secondary sexual characteristics. Testes are usually small. Infertility is a major concern for these boys. If treated early, they may have a normal sexual/reproductive system in the future.

Question 57

470. A split S2 is best heard at which of the following areas?
A) The aortic area
B) The pulmonic area
C) The tricuspid area
D) The mitral area

Answer 57

B) The pulmonic area

Question 58

631. When does an infant triple its birth weight?
A) 3 months
B) 6 months
C) 12 months
D) 15 months

Answer 58

C) 12 months

By the age of 12 months, an infant is expected to have tripled its birth weight.

Question 59

632. A new mother is planning on breastfeeding her newborn infant for at least 6 months. She wants to know whether she should give the infant vitamins. Which of the following vitamin supplements is recommended by the American Academy of Pediatrics (APA) latest guideline during the first few days of life?
     A) Vitamin D drops
     B) Multi vitamin drops
     C) It is not necessary to give breastfed infants vitamin supplements because breast milk contains enough vitamins and minerals that are necessary for the infant’s growth and development
     D) Folic acid drops

Answer 59

A) Vitamin D drops
According to the APA, all infants should be given Vitamin D supplementation within the first few days of life. Mothers who plan to breastfeed their infants should be taught how to use Vitamin D drops. Infant formula is supplemented with Vitamin D (and many other vitamins, minerals, and omega-3 oil), so there is no need to give it separately.

Question 60

639. When an infant is found to have tufts of fine dark hair on the sacrum, which of the following tests is recommended?
     A) An ultrasound of the sacrum
     B) A plain radiograph of the lumbo sacral spine
     C) No imaging test is necessary
     D) Genetic testing

Answer 60

A) An ultrasound of the sacrum
An infant with tufts of fine dark hair on the sacrum should be evaluated for occult spina bifida. The first imaging test to order is an ultrasound of the lower spine.

Question 61

642. An adolescent male presents to the nurse practitioner for a wellness exam. The patient’s face is long and narrow with a prominent forehead and chin, and he has large ears. The mother reports that her son has intellectual disabilities and autistic disorder. Which of the following conditions is being described?
A) Fragile X disorder
B) Marfan’s syndrome
C) Turner’s syndrome
D) Down syndrome

Answer 61

A) Fragile X disorder
Fragile X syndrome is the most common form of inherited intellectual disability. The disorder is associated with a higher incidence of autism (especially boys). Males are affected more severely than females. The facial features can vary. The classic facie is a long, narrow face with a prominent forehead and chin and large ears. Other features include hyperlaxity of the joints, flat feet, high arched palate, and others. Definitive diagnosis is by genetic testing.