NR602 APPB MIDTERM EXAM QUESTIONS AND ANSWERS LATEST UPDATE 2023/2024 ALL ANSWERS 100% COR, Exams of Nursing

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Who should receive the 2-dose HPV vaccine - CORRECT ANSWERS children who get the 1st dose BEFORE 15 yo. When should the second dose of HPV vaccine take place? - CORRECT ANSWERS 6- months after the first dose What is GABHS? - CORRECT ANSWERS group a beta-hemolytic streptococcus (Strep throat) What is the first line ABX for dog and cat bites? - CORRECT ANSWERS Amoxicillin clavulanate for 7-10 days Treatment of GABHS pharyngitis - CORRECT ANSWERS Penicillin V or Amoxicillin for 10 days. Amoxicillin 500mg PO BID X 10 days What are characteristics of fetal alcohol spectrum disorder? - CORRECT ANSWERS Poor prenatal and postnatal growth Hypotonia, poor coordination Cardiac defects (e.g., VSD, ASD) Narrow eyes, microphthalmia, large epicanthal folds, microcephaly, small upper jaw, smooth groove in the upper lip, thin upper lip Simian creases common Tertiary Care - CORRECT ANSWERS intensive care, subacute care highly complex care and therapy services from practitioners in a hospital or overnight facility quaternary care - CORRECT ANSWERS ● extension of tertiary care, extremely specialized services (e.g. burn units and transplant surgery) available typically only on a regional basis. Port-Wine Stain (Nevus Flammeus) present as - CORRECT ANSWERS pink-to-red, flat, stain- like lesions blanches to pressure irregular size/shape,usually, unilateral

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When should Port-Wine Stain be referred to a pediatric ophthalmologist? - CORRECT ANSWERS If the birthmark is present on the upper AND lower eyelids or on the V1 and V2 branches of the Trigeminal Nerve (CN V). Why should a pt. with a Port-Wine Stain be referred to an ophthalmologist? - CORRECT ANSWERS to rule out congenital glaucoma or Sturge-Weber syndrome treatment for Port-Wine Stain - CORRECT ANSWERS pulsed dye laser The child who has one eye or best-corrected vision in one eye worse than 20/40 and a small face to fit should be required to wear - CORRECT ANSWERS molded polycarbonate sport frames (American National Standards Institute [ANSI] Z87.1 frames). Symptoms of Kawasaki disease - CORRECT ANSWERS Fever x5 days and one of the following: enlarged lymph in the neck bright-red rash b/L conjunctivitis dry cracked lips/strawberry tongue diagnostics of Kawasaki disease - CORRECT ANSWERS monitor ECG immediately. CBC w/ diff, platelet count, CMP, ESR, and CRP Requires echocardiogram & cardiologist. Treatment of Kawasaki Disease - CORRECT ANSWERS ● IV immunoglobulin - a single dose of 2 g/kg over 8 to 12 hours, ideally in the first 10 days of the illness ● high-dose aspirin (80 to 100mg/kg/day in four divided doses, every 6 hours initially) until afebrile for at least 48 to 72 hours, then lowering the aspirin dose to 3 to 5 mg/kg/day for 6 to 8 weeks with discontinuation if the echocardiogram is normal How long should a child f/u w/ cardiology after Kawasaki disease? - CORRECT ANSWERS 1 year

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Live virus vaccines should be delayed for how long after administration of IV immunoglobulin. - CORRECT ANSWERS 11 months An 8-year-old has a painful limp. He reports that his knee hurts medially. On exam he has pain with internal rotation of the hip. How should the NP manage this situation? - CORRECT ANSWERS He should be immediately referred to orthopedic The NP should order a hip and knee x-ray, CBC and ESR. He should be referred for synovial fluid aspiration. congenital cataracts. ddx? - CORRECT ANSWERS TORCH (birth), galactase def (need surgery) What is the number-one bacteria that causes Cystic Fibrosis? - CORRECT ANSWERS Pseudomonas aeruginosa symptoms of cystic fibrosis - CORRECT ANSWERS thick mucus builds up in the lungs Wheeziness of breathing Salty tasting skin pathophysiology of cystic fibrosis - CORRECT ANSWERS ● Defective Cl channel ● Secretion of abnormaly thick mucus that plugs lungs, pancreas and liver ● Recurrent pulmonary infections (pseudomonas spp, s. aureus), chronic bronchitis, bronchiectasis, pancreatic insufficiency (malabsorption, and steatorrhea), nasal polyp and meconium ileus in newborn ● Mutation often causes abnormal protein folding resulting in degradation of channel before reaching cell surface diet recommendation for cystic fibrosis. - CORRECT ANSWERS High protein and low fat complications of cystic fibrosis - CORRECT ANSWERS atelectasis, recurrent infections, cor pulmonale, respiratory failure, malabsorption, malnutrition, electrolyte imbalances, sterility, and infertility Diagnosis of Cystic Fibrosis - CORRECT ANSWERS pilocarpine iontophoresis Sweat chloride test

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asthma diagnostics - CORRECT ANSWERS ● Pulmonary function tests - Spirometry (PEFR or FEV1) ● chest x-ray PA and lateral ● Oxygen saturation (SaO2) ● CBC if anemia is suspected first line treatment for allergic rhinitis - CORRECT ANSWERS ● Avoid triggers ● nasal steroid sprays ● Fluticasone 50mcg (Flonase) 2 times aday Triamcinolone 55mcg (Nasacort 24HR) 1-2x daily ● topical antihistamine spray ● Azelastine (Astelin) 1-2x daily ● Comolyn sodium nasal spray 3x daily (less effective than steroids) second line treatment for allergic rhinitis - CORRECT ANSWERS ● decongestants (pseudoephedrine or Sudafed) PRN do NOT give to pregnant/infants/young children ● oral antihistamines Benadryl (causes sedation) 2nd gen: Zyrtec/Claritin PO daily Enterovirus - CORRECT ANSWERS Poliovirus and coxsackievirus How is enterovirus transmitted? - CORRECT ANSWERS fecal-oral route what group is at risk for enterovirus - CORRECT ANSWERS <10 yrs. A nurse conducting a meeting on prevention of eye injuries. Which statements by the group members indicate that the group needs additional teaching? Select all that apply - CORRECT ANSWERS -"If you get hit in the eye with something, apply direct pressure with an ice pack." "If your eyes feel gritty while you are wearing contact lenses, put rewetting drops in them."

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The school nurse is teaching a group of parents about strategies to prevent eye injuries. Which statement by a parent indicates understanding of the teaching session? - CORRECT ANSWERS "My son wears a face shield when he plays hockey. if dark-red brown light reflex is on eye exam, what should the NP do - CORRECT ANSWERS ● Refer to an ophthalmologist, risk of retinoblastoma Best sports to play if you have asthma - CORRECT ANSWERS ● those physical activities of short duration—golf, volleyball, gymnastics, baseball, wrestling, football, and short-term track and field events. While some swimming can be a high-endurance event, the warmth and humidity around the pool make breathing easier down syndrome is caused by. - CORRECT ANSWERS Trisomy 21 clinical findings of down syndrome - CORRECT ANSWERS ● round flat face ● upward slanting eyes ● low set ears ● chronic open mouth d/t enlarged tongue ● simian crease ● cataracts ● heart defects ● congenital hearing loss people w/ down syndrome are at higher risk for congenital cataracts and should receive - CORRECT ANSWERS Ongoing ophthalmologic exam for cataracts tx for cataracts - CORRECT ANSWERS surgery parent education for down syndrome - CORRECT ANSWERS ● cervical spine positioning - avoid contact sports ● monitor for myelopathy (disease of the spinal cord) signs of otitis media - CORRECT ANSWERS ● Fever, TM erythema, TM bulging, TM dullness

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treatment for otitis media - CORRECT ANSWERS ● only those with purulent otitis media, otherwise ● 1st line: Amoxicillin x10 days 80-90 mg/kg/day divided twice a day (maximum dose 2 to 3 gm daily) ● 2nd line: Amoxicillin-clavulanate or Azithromycin x5 days or Benzocaine otic drops can be used for children older than 5 years old When to just "watch and wait" instead of treating acute otitis media - CORRECT ANSWERS ● Young children with unilateral AOM without severe symptoms and fever <102.2°F [39°C] ● Children ≥24 months old without severe symptoms Watchful waiting (48-72 hours) recommended inchildren 6 months to 2-years of age Is tenderness of the mastoid area a complication of otitis externa - CORRECT ANSWERS no signs of otitis externa (swimmers ear) - CORRECT ANSWERS ● After swimming ● inflammation of the ear canal ● pain, itching, redness, swelling, hearing loss painful to touch tragus! treatment of otitis externa - CORRECT ANSWERS ● Otopical ABX/steroid drops: Ciprodex (Alcon) - Ciprofloxacin/Dexamethasone Use ≥6 months old What are the two locations of adolescent migraines - CORRECT ANSWERS ● Usually frontal/temporal ● Occipital location is unusual and should be carefully evaluated (occipital headache in children whether unilateral or bilateral is rare and calls for diagnostic caution; many cases are attributable to structural lesions) Clinical findings of an ACL sprain? - CORRECT ANSWERS ● Swelling/effusion and pain. ● Instability with lateral movement. ● POSITIVE Lachman test.

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What is the drug of choice in treating Scabies - CORRECT ANSWERS ● Begins with applying a thin layer of scabicide to the entire body, excluding the eyes. Reapplied in 7 days on all symptomatic patients. ● Permethrin 5% applied to face, neck, and body. Rinsed off in 8-14 hrs Rotavirus - CORRECT ANSWERS ● cause of diarrhea globally (teach diaper care). ● Rotavirus vaccine for infants between 6-32 weeks old (2 or 3 series orally) RV1 &RV ● Risk for intussusception usually occurs within 7 days following the first or second dose. ● The primary mode of transmission is the fecal-oral route, usually through direct contact between people. Scabies - CORRECT ANSWERS ● itching, worse at night. curving burrows under the skin, especially in webs of fingers ● Red-Brown vesiculopustular lesions tend to be found in infant on palms, soles, scalp, face, posterior auricular, and axillae, concentrated in the folds ● Treat with permethrin 5% Nevi - CORRECT ANSWERS ● found in up to 90% of African Americans (most common) ● Follow ABCDE mnemonic for melanoma Nevi, refer if.... - CORRECT ANSWERS Rapidly growing or changing nevus

• More than 50 nevi
• One or more atypical nevi
• History of one or more first-degree relatives with melanoma
• Presence of a giant or large congenital nevus
• Signs of excessive sun exposure (increased nevi and freckles in exposed areas)
• History of immunosuppression and multiple nevi on examination Primary care PNPs - CORRECT ANSWERS well-child care and the prevention and/or management of both common pediatric acute illnesses and chronic conditions

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Acute care PNPs - CORRECT ANSWERS ● provide care for acutely, critically, and chronically ill children who are unstable, experiencing life-threatening illness, are medically fragile and/or technologically dependent. ● is not the site where they practice, but the acuity of the patient for whom they are caring Tertiary Care - CORRECT ANSWERS ● requires both specialized expertise and equipment Quaternary Care - CORRECT ANSWERS ● requires highly specialized expertise and highly unusual or specialized equipment SIDS: - CORRECT ANSWERS ● Bedsharing with infants greatly increases the risk of SIDS. Meningococcal - CORRECT ANSWERS ● MenACYWY-D: at 12 months and 16 yrs old booster ● MenB-4C, MenB-FHbp 11-12 yrs and booster at 16 years Cath up immunizations - CORRECT ANSWERS ?? Abrasions - CORRECT ANSWERS ● red streaking. Assess circulation, sensation, motion, ****function of surrounding area Puncture wound - CORRECT ANSWERS Ultrasound is best for evaluation of radiolucent foreign objects including wood and plastic. Lacerations - CORRECT ANSWERS ● PE: neurovascular (pulses, motor function, sensation to distal laceration), ROM, do edges approximate Poison - CORRECT ANSWERS ● management: Basic life support focuses on airway, breathing, and circulation• Ocular: copious saline lavage• Skin: copious water rinse or gentle soap and water• Gastrointestinal: dilution; gastric emptying; activated charcoal administration; catharsis; whole bowel irrigation (after consulting poison control) Infant Development 1-3 Months Old: - CORRECT ANSWERS Digestive system fully functional at age of 3 months

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MIgraine HA - CORRECT ANSWERS ● include at least 2 of the following: unilateral location, pulsating quality, moderate to severe pain with an increase during exertion, nausea/vomiting, photophobia, or phonophobia. HA lasts 4-72hrs Infant Development 4-5 Months Old - CORRECT ANSWERS ● Roll from back to side first, then prone to supine ● visually follow their parent by turning their head ● squeals, coo and add vowel and consonant sound. Start to laugh. Locate sounds ● seek out environmental objects like mirrors, their hands. smile, mouth objects, eye-to- hand control Infant Development 6-8 Months Old - CORRECT ANSWERS ● roll back to abd., sit erect, crawl, bounce. , reach for items and transfer objects from hand to hand ● like to feed themselves Infant Development 9-12 Months Old - CORRECT ANSWERS ● pull to stand, walking while holding furniture or held ● wave bye-bye Precocious puberty: - CORRECT ANSWERS ● occurs when signs of puberty emerge earlier than 8-years-old for girls and 9-years-old for boys Hepatoviruses--> Hepatitis A - CORRECT ANSWERS ● Preicteric phase: Malaise, nausea, anorexia, vomiting, digestive complaints, fever rarely higher than 102 Icteric phase:Jaundice appears shortly after symptom onset, Urine darkens, and stools become clay colored.posterior cervical adenopathy, Mild hepatomegaly Roseola Infantum (Exanthem Subitum) or sixth disease: HHV-6 and HHV-7 - CORRECT ANSWERS rose-colored maculopapular rash, 2 to 3 mm in diameter, appears. fades on pressure. Varicella - CORRECT ANSWERS ● Scarlet fever: begins after flu like sx caused by GAS ● 1st day rash: papular rash, similar in appearance to sandpaper, associated w/ throat pain/pharingitis, flushed cheeks, increased density of neck,transverse lines /pastia sign, increased density in groin

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● day 3: strawberry tongue, +blanching test Non-Group A or B Streptococci - CORRECT ANSWERS Penicillin G is the drug of choice with modification based on culture sensitivities ● Penicillin G is the drug of choice with modification based on culture sensitivities - CORRECT ANSWERS ● Scarlet fever: begins after flu like sx caused by GAS ● 1st day rash: papular rash, similar in appearance to sandpaper, associated w/ throat pain/pharingitis, flushed cheeks, increased density of neck,transverse lines /pastia sign, increased density in the groin ● day 3: strawberry tongue, +blanching test Non-Group A or B Streptococci - CORRECT ANSWERS ● Penicillin G is the drug of choice with modification based on culture sensitivities ● 75: Penicillin G is the drug of choice with modification based on culture sensitivities ● DX: Spirometry Interpretation of percentage predicted is: >75%: Normal ● 60% to 75%: Mild obstruction ● 40% to 69%: Moderate Pityriasis Rosea - CORRECT ANSWERS ● Herald spot or patch" to trunk, upper arm, neck, or thigh. OR Christmas tree pattern ● Reassure the child's parents that the rash is benign and self-limited Port wine Stain (Vascular Nevi) - CORRECT ANSWERS ● port-wine stain purple-red macules permanent that grows with child. if forehead or eyelid involved and neuro/optho f/u is needed). Cataract - CORRECT ANSWERS Must see ophthalmologist if amblyopia may develop. Ear screening - CORRECT ANSWERS ● before 1 month of age w/ Evoked otoacoustic emission (EOAE) testing

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preventing AOM - CORRECT ANSWERS ● Exclusive breastfeeding until at least 6 MAvoid bottle propping, feeding infants lying down, and passive smoke exposurePneumococcal vaccine; specifically, PCV13, which contains subtype 19AAnnual influenza vaccine helps prevent otitis mediaXylitol liquid or chewing gum as toleratedlicensed day care facilities with fewer children Bronchitis - CORRECT ANSWERS ● Management: pain med. hydration. bronchodilator if obstruction/wheezing ● SABA, atrovent, short term course of corticosteroids Pertussis (whooping cough) - CORRECT ANSWERS ● Tx: azithromycin, clarithromycin, and erythromycin is recommended for all ages. EXPECT risk for pyloric stenosis and erythromycin in infants younger than 1 month Atrial septal defect - CORRECT ANSWERS ● Left to right shunting (Acyanotic)↑ Pulmonary blood flow ● Opening in septum between atria ● Signs: widely split S2, right ventricle heave, systolic murmur at pulmonic or diastolic murmur at tricuspid ● Symptoms: asymptomatic; older children may have fatigue or exercise intolerance Ventricular sepal defect - CORRECT ANSWERS ● Opening in septum between ventricles; most common congenital defect; most close spontaneously ● Signs: systolic murmur at Erb's point or tricuspid; larger openings positive for heaves and thrill ● Symptoms: asymptomatic with small to moderate openings; infants with large openings exhibit symptoms (dyspnea, respiratory infections, diaphoresis, fatigue) Meningitis (bacterial, viral, fungal, or parasitic infection) - CORRECT ANSWERS ● S&S: fever, headache, neck stiffness, and nausea, vomiting and Altered mental status, phonophobia, photophobia, and a rash. Cerebral palsy - CORRECT ANSWERS ● 75% of CP cases are spastic or characterized by muscular rigidity, difficulty lifting his head and stiff legs that cross when picked up.

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Seizures - CORRECT ANSWERS ● Epilepsy is defined as a chronic condition of two or more unprovoked seizures that are greater than 24 hours apart or one seizure with a "high risk" of recurrent seizures Status epilepticus- must not miss Diagnosis - CORRECT ANSWERS ● A medical emergency Headache red flag - CORRECT ANSWERS ● Red flags: sudden onset, worsening patterns, systemic illness, and focal neurologic signs. MIgraine HA - CORRECT ANSWERS ● include at least 2 of the following: unilateral location, pulsating quality, moderate to severe pain with an increase during exertion, nausea/vomiting, photophobia, or phonophobia. HA lasts 4-72hrs scoliosis - CORRECT ANSWERS Asymmetry related to scoliosis is noted in the posterior thoracic region. Asymmetry of the shoulders, scapula, and iliac crests is indicative of scoliosis What does the vaccines for children (VFC) program offer? - CORRECT ANSWERS enables PCPs to obtain ACIP-rec- ommended vaccines without cost. These vaccines are provided free to children < than 19 years old who are Medicaid-eligible, are uninsured, or who are Native American or Alaska Native. The VFC program pays for 50% of all vaccines administered to children in the United States younger than 6 years old What is the difference between a well child exam and a sports physical? - CORRECT ANSWERS ● The history is like the well-child check, but the physical assessment focuses on cardiovas- cular, neurological, and orthopedic wellness when is Chelation therapy, a medication that binds to lead to excrete via urine, recom in mended for lead poisoning? - CORRECT ANSWERS ● levels greater than 45 μg/dL When is lead screening recommended? - CORRECT ANSWERS ● 12 and 24 months, if elevated then repeat in 2-4 wks Lead levels greater than ___________ g1⁄4/dl are associated with anemia and decreased iron absorption - CORRECT ANSWERS ● 10 μg/dL

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How long should asthma be con- trolled for before stepping down? - CORRECT ANSWERS 3 months

. the most common type of headache with onset in adolescence is: - CORRECT ANSWERS tension headache best way to differentiate severity of asthma - CORRECT ANSWERS ● intermittent: less than 2 days a week ● mild: greater than 2 days a week ● moderate: daily ● severe: several times per day treatment of intermittent asthma? - CORRECT ANSWERS SABA PRN treatment of mild persistent asthma? - CORRECT ANSWERS low dose ICS (formoterol) + SABA prn Treatment of moderate persistent asthma - CORRECT ANSWERS ● low dose ICS + LABA combo (Ad- vair/Symbicort)+ SABA prn treatment of mild persistent asthma? - CORRECT ANSWERS low dose ICS (formoterol) + SABA prn Treatment of moderate persistent asthma - CORRECT ANSWERS ● low dose ICS + LABA combo (Ad- vair/Symbicort)+ SABA prn scoliosis - CORRECT ANSWERS Asymmetry related to scoliosis is noted in the posterior thoracic region. Asymmetry of the shoulders, scapula, and iliac crests is indicative of scoliosis