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BURNS PEDIATRIC FINAL EXAM STUDY. (5).pdf, Exams of Nursing

University of West London (UWL)Nursing

BURNS PEDIATRIC FINAL EXAM STUDY. (5).pdf

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BURNS PEDIATRIC FINAL EXAM STUDY GUIDE

QUESTION AND ANSWERS LATEST VERSION

VERIFIED RATIONALE GRADED A+

- ans

1. 1. A child has a 1-cm laceration on the forehead proximal to the hairline after

running into a pole while playing sports. To minimize the risk of infection, the primary care

pediatric nurse practitioner will irrigate the wound and

a. a. allow the wound to heal by secondary intention.

b. b. delay closure of the wound for several days.

c. c. refer the child to a plastic surgeon for wound closure.

d. d. suture the wound within 6 hours. - ansANS: D

Children are less likely than adults to get wound infections, with an infection rate from sutured

lacerations at 2%. The PNP should clean and suture the wound. Wounds from animal bites are

often left to heal by secondary intention to prevent infection. Referral to a plastic surgeon is

necessary for cosmetic reasons. Delaying closure for several days is recommended for heavily

contaminated wounds and those caused by high-velocity missile injuries, crush injuries, and

explosion injuries.

1. 1. According to the 2007 NHIS analysis of the use of CAM therapy, use was higher

among :

a. a. families whose parent or parents had a college education.

b. b. Hispanic and African-American populations.

c. c. persons who had not recently taken prescription medications.

d. d. those living in households earning less than $65,000. - ansANS: A

The NHIS review showed that CAM use was higher in households with at least one college-

educated parent. CAM use was also higher in non-Hispanic Caucasians, persons who had

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QUESTION AND ANSWERS LATEST VERSION

VERIFIED RATIONALE GRADED A+

ans

1. A child has a 1-cm laceration on the forehead proximal to the hairline after running into a pole while playing sports. To minimize the risk of infection, the primary care pediatric nurse practitioner will irrigate the wound and a. a. allow the wound to heal by secondary intention. b. b. delay closure of the wound for several days. c. c. refer the child to a plastic surgeon for wound closure. d. d. suture the wound within 6 hours. - ansANS: D Children are less likely than adults to get wound infections, with an infection rate from sutured lacerations at 2%. The PNP should clean and suture the wound. Wounds from animal bites are often left to heal by secondary intention to prevent infection. Referral to a plastic surgeon is necessary for cosmetic reasons. Delaying closure for several days is recommended for heavily contaminated wounds and those caused by high-velocity missile injuries, crush injuries, and explosion injuries.
1. According to the 2007 NHIS analysis of the use of CAM therapy, use was higher among : a. a. families whose parent or parents had a college education. b. b. Hispanic and African-American populations. c. c. persons who had not recently taken prescription medications. d. d. those living in households earning less than $65,000. - ansANS: A The NHIS review showed that CAM use was higher in households with at least one college- educated parent. CAM use was also higher in non-Hispanic Caucasians, persons who had

QUESTION AND ANSWERS LATEST VERSION

VERIFIED RATIONALE GRADED A+

taken prescription drugs within the past 3 months, and those living in households with incomes higher than $65,000.

1. The mother of a 15-year-old female expresses concerns that her daughter may be sexually active because she's had a steady boyfriend for over a year. The primary care pediatric nurse practitioner learns that the family is Catholic and that the mother had an abortion when she was 16 years old. What will the nurse practitioner do initially? a. a. Explore the mother's feelings about her own past experience. b. b. Offer to prescribe contraception to prevent pregnancy. c. c. Recommend that the mother discuss this with her daughter. d. d. Suggest that the mother talk to a priest about her daughter. - ansANS: A An initial step when assisting families to manage ethical and behavioral issues is to assist parents and children in values clarification. Before offering other suggestions, the PNP should help the mother to clarify her own feelings. The other options may be necessary after values are clarified.
1. The parent of a 4-year-old points to a picture and says, "That's your sister." The child responds by saying, "No! It's my baby!" This is an example of which type of thinking in preschool-age children? a. a. Animism b. b. Artificialism c. c. Egocentrism d. d. Realism - ansANS: D Children at this age are developing their ability to establish causality. Nominal realism occurs

QUESTION AND ANSWERS LATEST VERSION

VERIFIED RATIONALE GRADED A+

c. c. Suggesting an after-school exercise program to help with weight loss d. d. Using a food diary to track all calories and food intake - ansANS: B Children with brain dysfunction affecting hypothalamic control may need rigid restrictions of access to all foods in refrigerators, cupboards, and even garbage cans

1. The primary care pediatric nurse practitioner is examining a newborn who is breastfeeding and notes the presence of an ankyloglossia. What will the nurse practitioner do next? a. a. Ask the mother if the infant has any feeding difficulties. b. b. Refer the infant for a possible frenulectomy. c. c. Schedule an appointment with a lactation consultant. d. d. Suggest that the mother feed breast milk by bottle. - ansANS: A Infants with ankyloglossia may have difficulty feeding if the tongue does not extend well. The PNP should first assess feeding difficulties and then may refer for a lactation consultant or consider a frenulectomy.
1. The mother of a 3-year-old child takes the child to a play group once a week. She expresses concern that the child plays with toys but does not interact with the other toddlers. What will the primary care pediatric nurse practitioner counsel the mother? a. a. The child probably is very shy but will outgrow this tendency with repeated exposure to other children. b. b. The toddler may have a language delay that interferes with socialization with other children. c. c. Toddlers may be interested in other children but usually do not engage in interactive play.

QUESTION AND ANSWERS LATEST VERSION

VERIFIED RATIONALE GRADED A+

d. d. Toddlers need more structured play to encourage interaction and socialization with others. - ansANS: C Parallel play is common among toddlers who, although they may be fascinated by other children, generally do not engage with peers in an interactive manner. This does not mean that the child is shy or has a language delay, although in preschool years, the development of symbolic language increases interactive play. Children need both structured and free play, but structured play will not increase interaction during this normally parallel period.

1. The primary care pediatric nurse practitioner is counseling the mother of a newborn about breastfeeding her infant. Which supplements will the nurse practitioner recommend? a. a. Fat-soluble vitamins b. b. Iron c. c. Multivitamins with iron d. d. Vitamin D - ansANS: D The level of vitamin D in breast milk may not be adequate for breastfed infants, so it should be given as a supplement. Human milk has more than adequate amounts of other vitamins. Iron is not present, but this is generally added at 6 months of age, when solid foods are added to the diet.
1. The primary care pediatric nurse practitioner is examining a school-age child who has had several hospitalizations for bronchitis and wheezing. The parent reports that the child has several coughing episodes associated with chest tightness each week and gets relief with an albuterol metered-dose inhaler. What will the nurse practitioner order? a. a. Allergy testing

QUESTION AND ANSWERS LATEST VERSION

VERIFIED RATIONALE GRADED A+

1. The primary care pediatric nurse practitioner examines a child who has had stiffness and warmth in the right knee and left ankle for 7 or 8 months but no back pain. The nurse practitioner will refer the child to a rheumatology specialist to evaluate for a. a. enthesitis-related JIA. b. b. oligoarticular JIA. c. c. polyarticular JIA. d. d. systemic JIA. - ansANS: B Oligoarticular JIA is characterized by mild, painless asymmetric joint involvement without systemic symptoms. Enthesitis-related JIA involves arthritis of the lower limbs, especially the hips, intertarsal joints, and sacroiliac joints, with swelling, tenderness, and warmth. Polyarticular JIA involves 5 or more joints. Systemic JIA presents with systemic symptoms, such as fever.
1. The primary care pediatric nurse practitioner learns that the mother of a newborn infant is being tested for tuberculosis after a positive TB skin test. What will the nurse practitioner tell the mother who states a desire to breastfeed her baby? a. a. Breast milk is contraindicated if the mother has tuberculosis. b. b. She may continue to nurse her baby since the risk of transmission is low. c. c. That she can express breast milk and feed that to her infant d. d. To give formula until results of tuberculosis testing are known - ansANS: C A maternal diagnosis of active, untreated TB is a contraindication to nursing, but expressed breast milk may be fed to the infant. The mother may feed expressed breast milk
1. The primary care pediatric nurse practitioner sees a 3-year-old child whose parents report is a picky eater in spite of their continued efforts to provide nutritious meals. The parents ask whether a multivitamin is necessary. How will the nurse practitioner

QUESTION AND ANSWERS LATEST VERSION

VERIFIED RATIONALE GRADED A+

respond? a. a. Ask the parents to provide a 3-day food diary. b. b. Prescribe a daily multivitamin with iron. c. c. Reinforce the need to meet DRIs each day. d. d. Tell them that supplements are unnecessary - ansANS: A Although most children who are "picky eaters" eat a balanced diet over time, it is worth assessing the situation using a 3-day diet history to determine whether key nutrients are being missed and if the child needs an MV supplement. MVs are not usually necessary and iron is not given unless there is a deficiency. It is not necessary to meet DRIs every day. Supplements may be necessary after data is collected.

1. A child who has been diagnosed with asthma for several years has been using a short-acting B2-agonist (SABA) to control symptoms. The primary care pediatric nurse practitioner learns that the child has recently begun using the SABA two or three times each week to treat wheezing and shortness of breath. The child currently has clear breath sounds and an FEV1 of 75% of personal best. What will the nurse practitioner do next? a. a. Add a daily inhaled corticosteroid. b. b. Administer 3 SABA treatments. c. c. Continue the current treatment. d. d. Order an oral corticosteroid. - ansANS: A The child is showing a need to step up treatment based on the frequency of symptoms, greater than twice each week. The PNP should order an inhaled corticosteroid maintenance medication to control symptoms and reduce the need for a SABA. The child is not having an acute exacerbation, so does not need 3 SABA treatments. Oral corticosteroids are given for moderate obstruction, <70%.

QUESTION AND ANSWERS LATEST VERSION

VERIFIED RATIONALE GRADED A+

insulin production.

1. The primary care pediatric nurse practitioner is evaluating an 11-month-old infant who has had three viral respiratory illnesses causing bronchiolitis. The child's parents both have seasonal allergies and ask whether the infant may have asthma. What will the nurse practitioner tell the parents? a. a. "Although it is likely, based on family history, it is too soon to tell." b. b. "There is little reason to suspect that your infant has asthma." c. c. "With your infant's history of bronchiolitis, asthma is very likely." d. d. "Your infant has definitive symptoms consistent with a diagnosis of asthma." - ansANS: A A genetic predisposition for the development of an IgE-mediated response to aeroallergens is the strongest identifiable predisposing risk factor for asthma, but asthma is rarely diagnosed before age 12 months due to the high rate of viral-induced bronchiolitis. The PNP should be cautious about diagnosing asthma until wheezing without an association to viral illnesses occurs. This infant has clear risk factors for asthma
1. An 8-year-old boy has a recent history of an upper respiratory infection and comes to the clinic with a maculopapular rash on his lower extremities and swelling and tenderness in both ankles. The pediatric nurse practitioner performs a UA, which shows proteinuria and hematuria and diagnoses HSP. What ongoing evaluation will the nurse practitioner perform during the course of this disease? a. a. ANA titers b. b. Blood pressure measurement c. c. Chest radiographs

QUESTION AND ANSWERS LATEST VERSION

VERIFIED RATIONALE GRADED A+

d. d. Liver function studies - ansANS: B Hypertension is a serious risk of HSP, so repeated BP measurement is indicated. ANA titers are not measured with HSP. Chest radiographs are performed only if indicated. LFTs are not indicated

1. A 12-year-old child is brought to the clinic with joint pain, a 3-week history of low- grade fever, and a facial rash. The primary care pediatric nurse practitioner palpates an enlarged liver 2 cm below the subcostal margin along with diffuse lymphadenopathy. An ANA test is positive. Which test may be ordered to confirm a diagnosis of SLE? a. a. Anti-double-strand DNA antibodies b. b. Anti-La antibodies c. c. Anti-Ro antibodies d. d. Anti-Sm antibodies - ansANS: A Anti-double-strand DNA antibodies are present in most people with SLE and are generally exclusively seen in cases of SLE and not other diseases. Anti-SM antibodies are diagnostic of SLE but are only seen in 30% of patients with SLE.
1. A 10-year-old child has a 1-week history of fever of 104°C that is unresponsive to antipyretics. The primary care pediatric nurse practitioner examines the child and notes bilateral conjunctival injection and a polymorphous exanthema, with no other symptoms. Lab tests show elevated ESR, CRP, and platelets. Cultures are all negative. What will the nurse practitioner do? a. a. Begin treatment with intravenous methyl prednisone. b. b. Consider IVIG therapy if symptoms persist one more week.

QUESTION AND ANSWERS LATEST VERSION

VERIFIED RATIONALE GRADED A+

1. The primary care pediatric nurse practitioner is performing a well-baby checkup on a 6-month-old infant and notes a candida diaper rash and oral thrush. The infant has had two ear infections in the past 2 months and is in the 3rd percentile for weight. What will the nurse practitioner do? a. a. Order a CBC with differential and platelets and quantitative immunoglobulins. b. b. Order candida and pneumococcal skin tests and lymphocyte surface markers. c. c. Refer the infant to an immunologist for evaluation of immunodeficiency. d. d. Refer the infant to an otolaryngologist to evaluate recurrent otitis media. - ansANS: A Infants with warning signs of immunodeficiency, such as recurrent infections, skin infections, and oral thrush, should be evaluated. The initial step is to order a CBC with differential, platelets, and immunoglobulins. If this is not helpful, referral to an immunologist for further testing, such as candida and pneumococcal skin tests and lymphocyte surface markers, is warranted. Referral to an otolaryngologist is not indicated.
1. An adolescent who has exercise-induced asthma (EIA) is on the high school track team and has recently begun to practice daily during the school week. The adolescent uses 2 puffs of albuterol via a metered-dose inhaler 20 minutes before exercise but reports decreased effectiveness since beginning daily practice. What will the primary care pediatric nurse practitioner do? a. a. Counsel the adolescent to decrease the number of practices each week. b. b. Increase the albuterol to 4 puffs 20 minutes prior to exercise. c. c. Order a daily inhaled corticosteroid medication. d. d. Prescribe cromolyn sodium in addition to the albuterol. - ansANS: C Children with EIA should use 2 puffs of a B2-agonist and/or cromolyn MDI 15 to 30 minutes prior to exercise, but, since tolerance may develop if a B2-agonist is used more than a few times

QUESTION AND ANSWERS LATEST VERSION

VERIFIED RATIONALE GRADED A+

a week, it should not be used as a controller monotherapy. Those who exercise regularly should use an ICS as a controller medication. Patients with asthma should be encouraged to exercise to improve overall health. Increasing the albuterol dose will not overcome the tolerance. And ICS is a preferred controller medication.

1. A school-age child steps on a nail while wearing tennis shoes and develops cellulitis in that foot. The child's immunizations are up-to-date. What antibiotic will the pediatric nurse practitioner empirically prescribe? a. a. Amoxicillin-clavulanate b. b. Ciprofloxacin c. c. Clindamycin d. d. Trimethoprim-sulfamethoxazole - ansANS: B Plantar puncture wounds, particularly those wounds that occur following puncture of sneakers/shoes, require ciprofloxacin to cover potential Pseudomonas infection and to protect against an osteomyelitis. Amoxicillin-clavulanate is used in other puncture wounds with signs of infection. Clindamycin is used for similarly wounded children allergic to penicillins. TMP-SMX is used if MRSA is cultured.
1. The mother of a 2-month-old infant tells the primary care pediatric nurse practitioner that she is afraid her breast milk is "drying up" because her baby never seems satisfied and wants to nurse all the time. Which action is correct? a. a. Recommend pumping her breasts after feedings. b. b. Refer the mother to a lactation consultant. c. c. Suggest supplementation with formula. d. d. Weigh the infant to assess for a growth spurt. - ansANS: D

QUESTION AND ANSWERS LATEST VERSION

VERIFIED RATIONALE GRADED A+

they grasp rather than being spoon-fed, allowing the infant more control. Foods given either by spoon or finger-fed will meet the child's nutritional needs. More research is needed to determine if this method affords protection from obesity by improving self-regulation. Infants must be able to sit without support and to reach and grasp for objects.

1. The primary care pediatric nurse practitioner performs a developmental assessment on a 32-month-old child. The child's parent reports that about 70% of the child's speech is intelligible. The pediatric nurse practitioner observes that the child has difficulty pronouncing "t," "d," "k," and "g" sounds. Which action is correct? a. a. Evaluate the child's cognitive abilities. b. b. Obtain a hearing evaluation. c. c. Reassure the parent that this is normal. d. d. Refer the child to a speech therapist. - ansANS: C Intelligibility of speech reaches about 66% between the ages of 24 and 36 months. Tongue- contact sounds are more intelligible by age 5 years. This child exhibits normal speech for age. It is not necessary to perform a cognitive assessment based on these findings. Referrals for hearing and speech evaluations are not indicated, since these findings are within normal limits.
1. The primary care pediatric nurse practitioner sees a 6-year-old child after a hospitalization for injuries sustained in a motor vehicle accident (MVA) in which the child's grandfather was killed. The parent states that it is difficult to get the child to stop talking about the accident and is worried that the child will have permanent emotional scars. What will the nurse practitioner suggest?

QUESTION AND ANSWERS LATEST VERSION

VERIFIED RATIONALE GRADED A+

a. a. Assure the child that he is safe and this won't happen again. b. b. Encourage the child to express and examine feelings. c. c. Reassure the child that his grandfather is in heaven. d. d. Redirect these conversations to happier topics. - ansANS: B Management goals when health crises occur should focus on helping children and families make sense of the events and to better understand what is happening to help regain control. Helping the child to express and examine feelings will help him to put what happened in perspective. Assuring the child that accidents won't happen again is false and can lead to even more distress in the future. Telling the child that the grandparent is in heaven doesn't address all his fears about the accident. Redirecting the conversation to happier topics minimizes the child's concerns.

1. The primary care pediatric nurse practitioner sees a child for follow-up care after hospitalization for ARF. The child has polyarthritis but no cardiac involvement. What will the nurse practitioner teach the family about ongoing care for this child? a. a. Aspirin is given for 2 weeks and then tapered to discontinue the medication. b. b. Prophylactic amoxicillin will need to be given for 5 years. c. c. Steroids will be necessary to prevent development of heart disease. d. d. The child will need complete bedrest until all symptoms subside. - ansANS: A ASA is given for arthritis for 2 weeks and then will be tapered. Children with ARF will need penicillin prophylaxis, not amoxicillin. Steroids are sometimes used for symptomatic relief but do not prevent chronic heart disease. Bed rest is indicated only when cardiac symptoms occur.
1. An adolescent female reports poor sleep, fatigue, muscle and joint paint, and anxiety lasting for several months. The primary care pediatric nurse practitioner notes point

QUESTION AND ANSWERS LATEST VERSION

VERIFIED RATIONALE GRADED A+

b. b. Swimming c. c. Weights d. d. Yoga - ansANS: B Swimming is an excellent exercise for children with JIA because water therapy and the use of heat or cold reduce pain and stiffness, unless they have severe anemia or cardiac involvement.

1. A school-age child with asthma is seen for a well child checkup and, in spite of "feeling fine," has pronounced expiratory wheezes, decreased breath sounds, and an FEV less than 70% of personal best. The primary care pediatric nurse practitioner learns that the child's parent administers the daily medium-dose ICS but that the child is responsible for using the SABA. A treatment of 4 puffs of a SABA in clinic results in marked improvement in the child's status. What will the nurse practitioner do? a. a. Have the parent administer all of the child's medications. b. b. Increase the ICS medication to a high-dose preparation. c. c. Reinforce teaching about the importance of using the SABA. d. d. Teach the child and parent how to use home PEF monitoring. - ansANS: D Home PEF monitoring is useful for children to identify when symptoms are worsening. This child does not appear to notice the presence of airway tightness or wheezing and so might benefit from PEF monitoring to know when to use the SABA. School-age children should be learning how to manage their chronic disease, so having the parent administer all medications is not the best choice, especially since use of the SABA is still dependent on the child's report of symptoms. Since the child responded well to administration of the SABA, increasing the dose of ICS should not be done unless better management is not effective. Reinforcing the teaching is part of the plan but, unless the child is aware of symptoms, may not occur.

QUESTION AND ANSWERS LATEST VERSION

VERIFIED RATIONALE GRADED A+

1. A toddler is brought to the clinic after grabbing the hot end of his mother's curling iron. An examination reveals a pale, yellow burned area to the palm of one hand. What is true about this burn? a. a. It may take up to 3 weeks to heal with scarring likely. b. b. Scarring is unlikely, with healing expected in 3 to 7 days. c. c. Surgical intervention and skin grafting are usually required. d. d. This type of burn usually heals without scarring in 7 to 14 days. - ansANS: A A deep partial-thickness burn appears pale and yellow and scarring is more likely to occur, with complete healing taking up to 3 weeks. A superficial burn is erythematous without blisters and heals in 3 to 7 days without scarring. A full-thickness burn involves extensive destruction of underlying tissues and requires surgical intervention and skin grafts. A superficial partial- thickness burn is red, mottled, moist, and painful and may scar, with healing in 7 to 14 days.
1. The parent of a 12-month-old infant asks the primary care pediatric nurse practitioner why 2% cow's milk is recommended instead of whole milk. What will the nurse practitioner tell this parent? a. a. Whole milk is usually not fortified with vitamin D. b. b. 2% milk is higher in essential proteins and minerals. c. c. Young children don't need the extra calories found in whole milk. d. d. Younger children need a limited amount of fats. - ansANS: D The AAP recommends transitioning to unflavored 2% or fat-free cow's milk in the second year of life. Whole milk contains vitamin D and contains similar amounts of proteins and minerals. Children can get calories from other sources

BURNS PEDIATRIC FINAL EXAM STUDY. (5).pdf, Exams of Nursing

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