APEA Predictor NSG 6440 Week 4: Final Exam Questions & Solutions, Exams of Nursing

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APEA PREDICTOR NSG 6440 WEEK 4

ELABORATION ACTUAL FINAL EXAM WITH

ALL POSSIBLE QUESTIONS AND VERIFIED

CORRECT SOLUTIONS (EXPLANATIONS

PROVIDED)

A GRADE

SOURCED FROM CHAMBERLAIN UNIVERSITY NURSING EXPERTS

o A patient presents with pruritic lesions on both knees. There are visible silver scales. HowShould this condition be managed? a. Topical antifungal cream or ointment b. Oral antibiotics c. Topical corticosteroids cream d. Topical anti-fungal/ steroid cream Explanation: Psoriasis is characterized by erythematous papules, as well as itchy, red, preciselydefined plaques with silvery scales. Auspitz sings is another common finding. Topical agents containing tar and salicylic acid may be used. Topical steroids, such as betamethasone, may also be ordered. o Antidepressant discontinuation syndrome is less likely if the patient a. Is male b. Is less than 35 y/o c. Has taken an SSRI with a short half lifed. Gradually tapers SSRI use Explanation: Antidepressant discontinuation syndrome is most often seen in the primary care office in association with SSRI discontinuation, because SSRIs are the most commonly prescribed class of antidepressant medications. Interruption of treatment with an anti- depressant medication is sometimes associated with an antidepressant discontinuation syndrome; in early reports it was referred to as a “withdrawal reaction. Symptoms of antidepressant discontinuation syndrome can include flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal. Tapering is recommended by experts.

o Patient with benign prostatic hyperplasia (BPH) should be taught to avoid which one of thefollowing drug classes? a. Alpha adrenergic antagonist b. Anti-androgen agents c. Tricyclic antidepressant (TCA) d. Sulfonamides Explanation: tricyclic antidepressant should not be used by men with benign prostatic hyperplasia because of the increased risk of urinary retention secondary to the anticholigergiceffects of TCAs. o Which of the following is the best response to a woman who has just admitted she is a victim of spousal abuse? a. What was if you did to make him angry?

b. You must seek refuge immediatelyc. I am concerned about your safety d. I am going to call a shelter for you Explanation: The first step is to establish trust in the therapeutic relationship. without trust future collaboration, intervention and client outcome cannot be accomplished to facilitate appropriate and safe behavior. The experience of abuse is a traumatic psychological crisis that must be addressed as such. The healthcare providers must emphasize the fact that the victim has not done anything wrong and they must also emphasize the fact that the victim's life and the lives of their children can be in danger if the abuse is not addressed. It will not disappear with a lack of action. An order of protection against the perpetrator is often recommended. o For which patient group does the US Preventive Services Task Force recommend routinescreening for asymptomatic bacteriuria a. pregnant woman b. Children c. Patients with diabetes d. patients over the age of 70 Explanation: an increased incidence of bacteriuria is found in all the population listed. However, bacteriuria in pregnant women increases the mother…..Also increased is the risk of a pre-term delivery, which then increases perinatal and fetal morbidity and mortality. The recommended it…. o What diabetic complications result from hyperglycemia?

1. Retinopathy
2. Hypertension resistant to treatment
3. Peripheral neuropathy
4. Accelerated atherosclerosisa. 1,2, b. 2,3, c. 1,3, d. 1,2, explanation: Complications of untreated or uncontrolled hyperglycemia over a prolonged period of time include: Microvascular complications: Retinopathy, Nephropathy, Neuropathy Macrovascular complications: Coronary artery disease, Cerebrovascular disease, Peripheralvascular disease

o A 6 y/o presents w/ complaints of sore throat and fever for 2 days. He has multiple vesiculated ulcerations on his tonsils and uvula. There are no other remarkable findings. What isthe most likely diagnosis? a. Viral pharyngitisb. Herpangina c. Epiglottitis d. Tonsillitis

Explanation: Herpangina is a viral infection common in toddlers and young children caused byCoxsackie virus. The clinical findings of numerous, small (1-2 mm) ulcerations on the tonsils and uvula are typical of herpangina. The ulcerations can be very painful but usually resolve in 7 to 10 days. Treatment is symptomatic. o A patient has Kawasaki syndrome. Which characteristics would be UNUSUAL? a. Age > 15 years b. Fever > 101 F (38.3 C) c. Exudative pharyngitis d. Painful rash explanation: Kawasaki disease is an acute febrile vasculitis syndrome that evolves inflammation of the blood vessels. This condition often causes cardiac complication in children by damaging the coronary arteries is most prevalent in children of Asian ethnicity. Diagnosis of Kawasaki disease requires presentation of fever and 4 of the following criteria: bilateral bulbar conjunctival injection, oral mucous membrane changes, peripheral extremity changes, polymorphous rash, and cervical lymphadenopathy. o According to the JNC 8 guideline hypertension in a 40 y/o can be diagnosed when blood pressure exceeds a. 140/ 0 b. 130/ 0 c. 125/ d. 150/ Explanation: According to JNC 8 guidelines, hypertension is a sustained elevation of systolic BP greater than or equal to 140 mmHg or diastolic BP greater or equal than 90mmHg, taken from 2 or more readings on 2 different occasions after an initial screening. o A 48 y/o female complains of pain and stiffness in her right hip and knee that is mild on awakening in the morning, get worse as the day progresses and is relived with hot baths and ibuprofen. Crepitus is palpated on range of motion of the knee. Signs of inflammation are notably absent. What is the most likely diagnosis? a. Rheumatoid arthritis (RA) b. Gout c. Osteoarthritis (OA) d. Osteoporosis

Explanation: Rheumatoid arthritis is characterized by several joint deformities, usually bilaterally symmetrical. RA is characterized by inflammatory processes, while OA is not. RA and OA are chronic conditions. Gout is characterized by acute exacerbations related to a defect in purine metabolism, increased uric acid production, or decreased uric acid excretion. o A 7-year old female patient presents with severe injuries that are inconsistent with the explanation given for them. The nurse practitioner questions the mother about abuse. She admits that her husband, the child’s father, beat the child. How should the nurse practitioner proceed? a. Inform the mother that the abuse must be reported to child protection authorities. b. Counsel the mother that if it happens again it will be reported to child protection service. c. Ask the child what she did to cause the punishment

d. Refer the family to the National Domestic Violence hotline. Explanation: An awareness of all the unique presentations of child abuse, subjective or objective, physical, sexual, or neglect, is essential for NPs. Objective findings, such as broken bones, burns, and bruises, may be as a result of an intentional injury from physical abuse or from an unintentional injury as a result of neglect. Both must be considered. Repeated visits to the emergency department, frequent or suspicious injuries, or bilateral or multiple healing fractures are often indicators of physical abuse. Once the diagnosis of child abuse has been made, the primary role of the NP is to ensure the child is safe. If the NP suspect that a child is undergoing abuse, it’s critical to report it—and to continue reporting each separate incidence if it continues to recur. o A 1 - month-old presents with reported recurrent diarrhea, screaming, and drawing up of thelegs followed by periods of lethargy. On physical examination, a “sausage-like” mass in the upper right quadrant of the distended abdomen. Which of the following is the most likely diagnosis? a. Intussusception b. Volvulus c. Crohn’s disease d. Foreign body in the GI tract explanation: Intussusception is one of the most common causes of abdominal obstruction in children prior 2 years of age; is best described as a portion of the intestine which telescopes into a more distal intestinal segment. The classic triad of intussusception include crampy (intermittent, also known as colicky) abdominal pain, vomiting, and bloody stools. The patient may pull up his knees with crying. The patient may develop vomiting with bilious emesis. Progressive lethargy/altered level of consciousness and pallor is common. The etiology of this lethargic presentation is not known, but it tends to occur in younger infants. As intussusception progresses, a palpable, sausage-shape mass may develop. Some hypothesize that this is due to release of endogenous opioids or endotoxins released from ischemic bowel. Intussusception in a child presenting with lethargy is often difficult to diagnose since other causes of lethargy such as dehydration, hypoglycemia, sepsis, toxic ingestion, post-ictal state, etc., must also be considered. Ultrasound is the preferred diagnostic test. Enemas is considered the first line of treatment prior surgery. Volvulus occurs more frequently in middle-aged and elderly men. Cronos’s is most often diagnosed between 13 – 30 years of age. o A middle-aged female complains of insomnia, night sweats, feeling intensely hot, emotional lability, extreme nervousness and impatience. The LEAST likely cause of her symptoms is

a. Thyrotoxicosis b. Menopausal vasomotor instability c. Alcohol or another drug withdrawald. New onset type 2 diabetes mellitus Explanation: New onset diabetes produces elevated serum glucose levels less than 200 mg/dL (7.0 mmol/L) and usually no clinical signs or symptoms. At higher levels, the patient may report lethargy, fatigue, weakness, weight loss, and polydipsia, polyuria, and/or polyphagia. Complaintsof insomnia, night sweats, feeling intensely hot, emotional lability, and extreme nervousness may

be caused by thyroxine excess, menopausal instability, or withdrawal from alcohol or other drugsof addiction. o Which of the following indicated need for further evaluation? a. A 7 y/o girl with vaginal bleeding b. A 7 years old girl with no true pubic hair c. A 12 years old boy with sparse, slightly pigmented pubic hair d. A 12 - year-old girl with breast buds explanation: In newborn girls, withdrawal bleeding may occur as a normal response to maternalestrogen leaving the infant’s uterine lining. Vaginal bleeding after the first few weeks of life and before puberty is considered abnormal. Early vaginal bleeding can indicate trauma, foreign bodies (toilet paper is the most common), vulvovaginitis, hemangiomas, benign polyps, precocious puberty, or sexual abuse. o A young couple is being seen by the NP for preconception counseling. They express a wish for pregnancy within the next 3 month and are very eager to know what they can do now to “make the baby as healthy as possible”. Which of the following should the NP encourage to decrease the chance of neural tube defect in the fetus? a. Maternal alpha-fetoprotein levelb. Folic acid 0.4 mg daily c. Rubella vaccine today d. Vitamin E 400 IU daily Explanation: Supplementation with folic acid decreases the development of neural tube defects, such as spina bifida and anencephaly. Folic acid plays an essential role in neural tube closure. Neural tube development/closure takes place in the fist 4 weeks of embryonic life ( weeks’ gestation). U.S. Public Health Service and the CDC recommend that all women of childbearing age consume 0.4 mg of folic acid daily to prevent tube defects. o A patient with a past history of documented coronary arterial blockage less than 70% complains of chest pain several time p…. which is relived with nitroglycerin. Which is the most appropriate initial action for the NP? a. Refer to a cardiologist as soon as possible b. Prescribe long-acting nitroglycerin c. Order treadmill stress test d. Prescribe an ACE inhibitor and re-evaluate in 24 to 48 hours Explanation: The patient has at least a 70% occlusion of a major coronary artery. For a patient to be considered for CABG, the coronary arteries to be bypassed must have approximately a 70% occlusion (60% if in the left main coronary artery).

o A 3 y/o has enlarged, warm, tender cervical lymph nodes, indicating: a. Infection proximal to the nodes b. A possible cancer diagnosis c. Shorty nodes, a common normal variant in children d. An infectious process distal to the nodes explanation: size of lymph nodes is important. Nodes > 1 cm are significant and should be assescarefully. Nodes > 5 cm are almost always neoplastic. Tenderness of a node usually suggest

inflammation. Cancerous nodes frequently are larger, non-tender, and stone-like in consistency. Nodes are pea-sized, non-tender, mobile, discrete and reflect pre-existent infection. o The NP examines a 2 - month-old with unequal gluteal and thigh skin folds. What should theNP do next? a. Send the infant for x-ray of the hips b. Send the infant for ultrasound of the hipsc. Perform Ortolani and Barlow test d. Examine the infant for unequal arm length Explanation: Gluteal and thigh skin fold asymmetry may indicate congenital hip dysplasia. X- ray studies are not useful before 3 months-of-age because the femoral head has not completely ossified. o A very active 35 years old male has painful hemorrhoid, but he does not want hemorrhoidal surgery at this time. His diet has been indiscriminate as his job requires frequent travel. The most appropriate recommendation is for him to select food that are: a. Low in fiber such as milk and other dairy products b. High in simple carbohydrates such as white bread and mashed potatoesc. High in fiber such as bran, complex carbohydrates and fresh fruit d. High protein such a meat, poultry and fish Explanation: Hemorrhoid disease is the most common reason patients seek evaluation by a colon and rectal surgeon. The majority of hemorrhoids can be managed nonoperatively with medical management or office-based procedures. Patients should benefit from minimizing straining and avoiding constipation. Bulking of the stool facilitates this and can be accomplished by increasing dietary fiber and fluid intake. Stool softeners may also be used. o Correct instructions to give new parent who are transporting their newborn infant is a. A rear-facing infant car seat secured in the backseat is required until the infant weight 20 lbs. b. The infant car set may be secured in the back or front seat, but must rear-facing c. The infant car seat may be front facing when the infant is 1 year old d. A rear or front-facing infant car seat must be secured in the back seat until the infant weight 20 lbs. Explanation: The American Academy of Pediatrics (AAP) recommends that infants and toddlers ride in a rear-facing seat until they are 2 years old or until they have reached the maximum weight and height limits recommended by the manufacturer

o A 13 y/o pt. complains that he fell while running during football practice. Now his kneehurts and sometimes “lucks”. The NP conducts McMurrays test. Which of the following is TRUE about this test? a. An audible or palpated “click” is positive for a torn meniscus b. A various stress is applied to the flexed knee c. The straight leg is internally rotated with the patient supine and flat d. The knee is grasped with the examiner’s fingers placed laterally. Explanation: Mac Murray’s test is conducted while the patient is in the supine position. The NP places the distal hand on the foot and raises the knee slowly, keeping the foot and knee externally

rotated with the proximal hand resting on the join line. The knee is flexed and then quickly straightened. If an audible or palpable click occurs during the this test, the outcome is positive for medial meniscal injury. o A 20 y/o male patient complains of “scrotal swelling”. He states his scrotum feels heavy but denies pain. On examination, the NP notes transillumination of the scrotum. What is the most likely diagnosis? a. Hydrocele b. Orchitis c. Testicular torsion d. Indirect inguinal hernia Explanation: Hydrocele is common in newborns and usually disappears without treatment within the first year. Older men can develop hydroceles, sometimes due to inflammation or injury. Hydroceles are usually painless, but may become large and inconvenient. An ultrasound may be needed to diagnose the condition. o A 15 y/o male has a hx of cryptorchidism which was surgically repaired. Because of thisinformation, it is essential for the NP to teach him about a. Testicular self-examination b. Protection of the testes during sports activities c. Risk of testicular torsion d. Practicing safer sex Explanation: Cryptorchidism, even with surgical repair, is associated with increased risk for testicular cancer. o A pt. present with classic symptoms of gastroesophageal reflux diseases’ (GERD). He is instructed in lifestyle modification, and drug initialed. Two month later, he returns and report that he still has symptoms. The next steps are to. a) Refer for surgical interventions such as partial or complete fundoplication. b) Refer for endoscopy, namometry, and/or PH testing c) Repeat the 8*-week course of drug therapy while continuing lifestyles modifications. d) Review proper proton pump inhibitor dosing time and adherence with the patient. Explanation: poor adherence is an importance cause of inadequate acid suppression and refractory GERD. Determining adherence to proton pump inhibitor (PPI) therapy and superficially timing in relation to meals, should be sought first alarm features such as iron deficiency anemia, unexplained weight loss, and persistent vomiting would precipitate the need for further diagnostic testing. Diagnostic testing procedures should proceed any surgical intervention like fundoplication.

o A 51 – year- old post-menopausal female, request guidance regarding osteoporosis risk. The NP would be correct to recommend all of the following EXCEPT a. Moderate weight bearing exercise 3 times per week b. 1200 – 1500 mg calcium daily c. Avoidance of alcoholic beveragesd. Weight loss

Explanation: the recommended calcium intake is 1,200 mg – 1500 mg a day. Regular weight- bearing and muscle-strengthening exercise reduce the risk of falls and fractures. Moderate alcohol intake has no known negative effect on bone and may even be associated with slightly higher bone density and lower risk of fracture in postmenopausal women. However, alcohol intake of more than two drinks per day for women or three drinks a day for men may be detrimental to bone health, increases the risk of falling and requires further evaluation for possible alcoholism. In addition, Risk factors for osteoporosis include age greater than 65, white or Asian ethnicity, cigarette smoking, inactive lifestyle, low weight and postmenopausal estrogen deficiency including premature menopause. o According to Erickson, the developmental task of the elderly adult is: a. Intimacy VS isolation b. Ego integrity VS despair c. Industry VS self-doubt d. Trust Vs mistrust explanation: o Moderate weight loss, particularly of visceral adipose tissue in patients with type 2 diabetesmellitus may have all of the following beneficial effects EXCEPT: a. Improved insulin sensitivity

b. Increased glucose uptake and utilization by the cells c. Increase lean muscle mass’ d. Improved lipid profile Explanation: Regular, consistent exercise is an essential part of diabetes and prediabetes management. The ADA recommends that people with diabetes perform at least 30 minutes, 5

days/wk of a moderate-intensity aerobic physical activity. The ADA also encourages people with type 2 diabetes to perform resistance training 3Xwk in the absence of contraindications. Exercise contributes to weight loss, which further decreases insulin resistance. The therapeutic benefits of regular physical activity may result in a decreased need for diabetes medications to reach target blood glucose goals. Regular exercise may also help reduce triglyceride and low-density lipoprotein (LDL) cholesterol levels, increase high-density lipoprotein (HDL), reduce BP, and improve circulation. Patients who use insulin, sulfonylureas, or meglitinides are at increased risk for hypoglycemia when they increase physical activity. o A 12 y/o presents with eat pain or 36 hours duration. The NP diagnoses acute otitis media because the a. Tympanic membrane is bulging and glossy with tiny bubbles visible posteriorly b. Tympanic membrane is retracted against boy landmarks c. Bony landmarks are obscured, and the tympanic membrane is mildly erythematous, dullsand immobile. d. Canal is narrowed, erythematous, and exquisitely tender with speculum contact Explanation: Serous otitis media typically presents with a flat or bulging and tympanic membrane with a fluid line and/or tiny bubbles visible posteriorly. The tympanic membrane may be immobile and retracted against the bony landmarks when the eustachian tube is swollen or congested as with the common cold or allergies. Narrowing of the external canal with erythema and extreme tenderness of the canal wall is indicative of otitis externa. o The NP should instruct the mother of an infant with thrush to: a. Take oral nystatin since she is breastfeeding b. Stop breast feeding until the thrush has resolved c. administer antifungal medication to the infant prior to feeding d. sterilized pacifiers and bottle nipples explanation: Most bouts of oral thrush occur for no apparent reason. However, regularly sterilization of pacifiers, bottles-feed and other mouth toys used by the baby may help to prevent some bouts. o A 26 y/o patient, 18 weeks pregnant with twins, has been healthy and has followed recommendations of her nurse midwife. She is in the office to discuss results of her maternal serum alpha-fetoprotein (MSAFP) test. which show elevation in this particular pregnancy? a. Elevated MSAFPO is an indicator of Down Syndrome

b. Low MSAFP is expected at 18 weeks’ gestation c. Neural tube defects are highly probabled. Elevated MSAFP is an expected finding Explanation: elevated maternal serum alfa Protein is expected when a woman is pregnant with twins. An elevation can also be an indication of a miscalculated due date. Low levels can indicateDown Syndrome

o The hallmark of neurofibromatosis (von Recklinghousen disease) present in almost 100% of patients is: a. Acoustic neuroma b. Astrocytoma of the retina c. Distinctive osseous lesion d. Café au lait spots Explanation: Von Recklinghausen disease is also known as neurofibromatosis. It is characterized by multiple neurofibromas, or tumors, forming that vary in shape, size, and location. Neurofibromatosis type 1 and neurofibromatosis are differentiated by clinical features. They both include benign tumors of the nerve tissue (neurofibromas). Only neurofibromatosis type 1 (90%) has prominent clinical features, such as cafe-au-lait pigmentation. Neurofibromatosis type 2 consists of neurofibromas only without clinical features. o The NP correctly teaches an elderly patient with pernicious anemia that food sources of B12 include a. Red meat, poultry, fish, eggs, dairy products b. Canned and frozen fruit c. Whole grain breads, cereals and pastas d. Fresh vegetables explanation: Pernicious anemia is a type of vitamin B12 anemia. VB12 can be found in foods such as meat, poultry, shellfish, eggs, and dairy products. A special protein, called intrinsic factor (IF), helps the intestines absorb vitamin B12. This protein is released by cells in the stomach. When the stomach does not make enough intrinsic factor, the intestine cannot properly absorb vitamin B12. o An 18 - year-old female applying for college admission present to the health clinic becauseevidence of rubella vaccination is required for admission. She says, “don’t remember ever getting that shot” She has negative serologic evidence of rubella antibody. The NP should: a. Tell her that her serologic evidence demonstrates that she is immune to the rubella and that she probably has the disease as a child b. Administer the vaccination after a negative pregnancy test and advise the patient that she must not get pregnant for 28 days c. Tell her that she needs the immunization and can get today if her pregnancy test is negative d. Administer the rubella vaccination after a negative pregnancy test and advise her

not to get pregnant for at least 6 months. Explanation: Due to this very small chance of illness, the Centers for Disease Control and Prevention (CDC) recommend waiting 28 days after getting the MMR vaccine before trying to get pregnant. o A 45 y/o obese pre-menopausal female complains of indigestion, flatulence, RUQ pain and epigastric “crampy pain”. Symptoms are exacerbated by high-fat meal. What is the most likelydiagnosis? a. Hepatitis

c. Acute pancreatitis d. Myocarditis Explanation: The “typical” patient with chronic cholecystitis is “female, fat, fertile, and (over) 40” years of age. Myocarditis produces retrosternal pain that is not related to diet. The pain of pancreatitis radiates to the back. The pain of hepatitis is non-specific upper quadrant pain. o A 16 y/o male presents w/ mild sore throat, fever, fatigue, posterior cervical adenopathy, and palatine petechia. With for this patient, what drug would be the LEAST appropriate to prescribe? a. Ibuprofen b. Erythromyci n c. Ampicillin d. Doxycycline Explanation: Mono can be managed with supportive care, including NSAIDs, and warmsailing gargles. patients with strep throat should be prescribed penny ceiling or every throw myosin instead of amoxicillin or ampicillin because amoxicillin and ampicillin often cause a rash in mono patients. o A characteristic of delirium that is typically absent in dementia is a. Acute onset of confusion in a previously alert and oriented patient b. Gradual loss of short-term memory c. Loss of language skills d. Long term memory gaps filled in with confabulation Explanation: Delirium is acute confusional state, is potentially a reversible cognitive impairment that often has a physiological cause; physiological causes include electrolyte imbalances, cerebral anoxia (an absence of oxygen); hypoglycemia; medication effects; tumors; subdural hematoma; and cerebral infection, infarction, or hemorrhage. Dementia is a generalized impairment of intellectual functioning that interferes with social and occupational functioning. It is an umbrella term that includes Alzheimer's disease, Lewy body disease, frontal-temporal dementia, and vascular dementia. o It is imperative that the NP teach patients taking oral contraceptives to report any of the danger signs of complications. Which of the following would be the LEAST concern to the NP? a. Lower leg pain b. Chronic cholecystitis

b. Upper abdominal pain c. Chest pain d. Weight gain Explanation: Common side effects of OCP includes: bleeding between periods, nausea, breast tenderness, headaches and weight gain. The symptoms often subside after a few months of use. Lower Leg pain can be indicative of- DVT. Other major complication can include the liver, gallbladder or the cardiac organ. o Which of the following oral medications should be avoided in a child under 8 years of age?

a. Cephalexin (Keflex) b. Tetracycline c. Rifampin d. Metronidazole (flaggyl) Explanation: Children younger than 8 years old should not take tetracycline. Deposition in thebone and primary dentition occurs during calcification in growing children. This causes discoloration and hypoplasia of the teeth and a temporary stunting of growth. o Which of the following descriptions of Denver II Developmental Screening Test is most accurate? a. Applicable to children from birth to 2 years; evaluates four major categories of development: motor, intellectual, emotional, and language to determine whether a child is within normal range for various behaviors or is developmentally delayed b. Applicable to children from birth to 5 years; evaluates four major categories of development: motor, vision, hearing and psychosocial to determine whether a child is normal or developmentally compromised c. Applicable to children from age 6 months to 6 years; evaluates 4 major categories ofdevelopment: intellectual, verbal, social and memory to determine IQ and aptitude d. Applicable to children from birth to 6 years; evaluates four major categories of development: gross motor, fine motor-adaptive, language, and personal social to determinewhether a child is within normal range for behaviors or is developmentally delayed. Explanation: The Denver Developmental Screening Test (DDST) is a screening test for cognitive and behavioral problems in children from birth until the age of 6 The purposes of the DDST and Denver II are to screen children or possible developmental problems and to verify suspected problems with an objective measure. The Denver II screens general development in four areas:

Social – Personal: Aspects of socialization inside and outside the home – eg, smiling.

Fine motor function – Adaptive: Eye/hand co-ordination, problem solving and

manipulation ofsmall objects – eg, grasping and drawing.

Language: Production of sounds, and ability to recognize, understand and use

language – eg, ability to combine words

Gross motor functions: Motor control, sitting, walking, jumping, and overall large muscle

movements. o A 12-month-old has conjunctivitis in his right eye with a mucopurulent discharge. The mother asks if the child can forego for antibiotic eye drops because he does not’s

like drops in his eyes. The NP replies that: a. If untreated, conjunctivitis may permanently damage the cornea b. Conjunctivitis is usually caused by a virus. Let’s wait a few days c. If no one else at the daycare has it, we can wait a few days. d. An oral antihistamine may be prescribed instead of eye drops. Explanation: Pink eye does not normally cause loss of vision, especially when treatment is administered in a timely manner. However, if bacterial conjunctivitis is serious and left untreated, it may damage the eye permanently, leading to loss of vision.

o which oral hypoglycemic agent would be safest for an elderly patient if hypoglycemia is a major concern? a. Tolbutamide (orinase) b. Glipizide (Glucotrol) c. Metformin (Glucophage) d. Chlorpropamide (diabinese) Explanation: When used alone, metformin typically does not cause hypoglycemia and is usually weight neutral or causes modest weight loss. Given the low risk of hypoglycemia, metformin has an important role in elderly patients with diabetes, as long as patients are selected appropriately to avoid the risk of lactic acidosis. o the components of the Denver II Developmental screening test are: a. Personal/social, fine motor, gross motor, language b. Intelligence, motor performance, language development c. Vocabulary, clarity of speech, abstract thinking d. Problem-solving, speech, gross motor, fine motor Explanation: The Denver II Developmental Screening Test is the most widely used tool to assess early childhood development and rates the categories of personal– social, fine motor– adaptive, language, and gross motor skills. The nurse should explain to the parent before administering the test that this test does not measure intelligence but of the child's level of development or ability to perform age- appropriate tasks. DDST II Assesses: Gross motor function Language development Fine motor-adaptive skills Personal-social skills o A patient has been taking fluoxetine (prozar) since being diagnosed with major depression 7 month ago. She reports considerable empowerment in her symptoms and her intention to discontinue the medication what should be the NP’s recommendation? a. Advice the patient to stop the antidepressant medication b. Question the patient to determine if the self-assessment is correct before advising her to discontinue the medication c. Recommend that the patient continue the antidepressant medication for at