NR602-Final Exam Questions with complete solutions., Exams of Nursing

Download NR602-Final Exam Questions with complete solutions. and more Exams Nursing in PDF only on Docsity! NR602-Final Exam Questions with complete solutions Chapter 40 - GI Disorders - correct answer- The parent of a colicky infant asks about using a probiotic medication. What will you tell them? - correct answer-There is no conclusive evidence about using probiotics to treat colic. A toddler who was born prematurely refuses most solid foods and has poor weight gain. A barium swallow study reveals a normal esophagus. What will the primary care pediatric nurse practitioner consider next to manage this child's nutritional needs? - correct answer-Video fluoroscopy swallowing study A toddler is seen in the clinic after a 2 day history of intermittent vomiting and diarrhea. An assessment reveals an irritable child with dry mucous membranes, 3 second capillary refill, 2 second recoil of skin, mild tachycardia and tachypnea, and cool hands and feet. The child has had two wet diapers in the past 24 hours. What will the primary care pediatric nurse practitioner recommend? - correct answer-Oral rehydration solution with follow-up in 24 hours. A 9-year-old girl has a history of frequent vomiting, and her mother has frequent migraine headaches. The child has recently begun having more frequent and prolonged episodes accompanied by headaches. An exam reveals abnormal eye movements and mild ataxia. What is the correct action? - correct answer-Refer to a pediatric gastroenterologist for further workup. The parent of a 3-month-old reports that the infant arches and gags while feeding and spits up undigested formula frequently. The infant's weight gain has dropped to the 5th percentile from the 12 th percentile. What is the best course of treatment for this infant? - correct answer-Begin a trial of extensively hydrolyzed protein formula for 2-4 weeks. A school age child has a 3-month history of dull, aching epigastric pain that worsens with eating and awakens the child from sleep. A complete blood count shows a hemoglobin of 8 mg/dL. What is the next step in management? - correct answer-Refer for EGD. A 2-month-old infant cries up to 4 hours each day and, according to the parents, is inconsolable during crying episodes with fists and legs noted to be tense and stiff. The infant is breastfeeding frequently but is often fussy during feedings. The physical exam is normal, and the infant is gaining weight normally. What will the primary care pediatric nurse practitioner recommend? - correct answer-Eliminating certain foods from the mother's diet. A child is in the clinic after swallowing a metal bead. A radiograph of the GI tract shows a 6 mm cylindrical object in the child's stomach. The child is able to swallow without difficulty and is not experiencing pain. What is the correct course of treatment? - correct answer-Have the parents watch for the object in the child's stool. A 10-year-old child has had abdominal pain for 2 days, which began in the periumbilical area and then localized to the right lower quadrant. The child vomited once today and then experienced relief from pain followed by an increased fever. What is the likely diagnosis? - correct answer-Appendicitis with perforation Bactrim = 1st line treatment in children w/ no prior h/o UTIs A preschool age child with no previous history has mild flank pain and fever but no abdominal pain or vomiting. A urinalysis is positive for leukocyte esterase and nitrites. A culture is pending. Which is the correct course of treatment for this child? - correct answer-Order Augmentin (Amoxicillin / Clavulanate). A 3 year old child has just completed a 7day course of amoxicillin for a second febrile urinary tract infection and currently has a negative urine culture. What is the next course of action? - correct answer-Obtain a renal and bladder ultrasound. A 9 month old infant with a history of three urinary tract infections is diagnosed with grade II vesicoureteral reflux (abnormal flow of urine back up the tubes). Which medication will be prescribed? - correct answer-TMPSMX; TMP (Bactrim) 2mg/kg as a single daily dose. The parent of a toddler diagnosed with grade V vesicoureteral reflux asks the primary care pediatric nurse practitioner how the disease will be treated. What will the nurse practitioner tell this parent? - correct answer-That surgery to correct the condition is possible. A healthy 14 year old female has a dipstick urinalysis that is positive for 56 RBCs per hpf but otherwise normal. What is the first question the primary care pediatric nurse practitioner will ask this patient? - correct answer-When was your last menstrual period. A child has gross hematuria, abdominal pain, and arthralgia as well as a rash. What diagnosis is most likely? - correct answer-Henoch Schonlein Purpura (HSP) An adolescent has 2+ proteinuria in a random dipstick urinalysis. A subsequent first morning voided specimen is negative. What will the primary care pediatric nurse practitioner do to manage this condition? - correct answer- Monitor for proteinuria at each annual well child examination. A child is diagnosed with nephrotic syndrome, and the pediatric nurse practitioner provides primary care in consultation with a pediatric nephrologist. The child was treated with steroids and responded well to this treatment. What will the nurse practitioner tell the child's parents about this disease? - correct answer-Steroids will be used when relapses occur. A child who has nephrotic syndrome is on a steroid and a salt restricted diet for a relapse of symptoms. A dipstick urinalysis shows 1+ protein, down from 3+ at the beginning of the episode. In consultation with the child's nephrologist, what is the correct course of treatment considering this finding? - correct answer-Continue with steroids and salt restrictions until the urine is negative for protein. A child who had GABHS 2 weeks prior is in the clinic with periorbital edema, dyspnea, and elevated blood pressure. A urinalysis reveals tea colored urine with hematuria and mild proteinuria. What will the primary care pediatric nurse practitioner do to manage this condition? - correct answer- Refer the child to a pediatric nephrologist for hospitalization. An adolescent has right sided flank pain without fever. A dipstick urinalysis reveals gross hematuria without signs of infection or bacteriuria, and the primary care pediatric nurse practitioner diagnoses possible nephrolithiasis (kidney stones). What is the initial treatment for this condition? - correct answer-Increasing fluid intake up to 2L daily. During a well child examination of a 2 year old child, the primary care pediatric nurse practitioner palpates a unilateral, smooth, firm abdominal mass which does not cross the midline. What is the next course of action that? - correct answer-Refer the child to an oncologist immediately. A 6 month old infant has a retractile testis that was noted at the 2month well baby exam. What will the primary care pediatric nurse practitioner do to manage this condition? - correct answer- Refer the infant to a pediatric urologist or surgeon for possible orchiopexy. A 9 month old infant is brought to the clinic with scrotal swelling and fussiness. The primary care pediatric nurse practitioner notes a tender mass in the affected scrotum that is difficult to reduce. What is the correct action? - correct answer-Refer immediately to a pediatric surgeon. The mother of a 12 month old uncircumcised male infant reports that the child seems to have pain associated with voiding. A physical examination reveals a tight, pinpoint opening of the foreskin, which thickened and inflamed. What will the primary care pediatric nurse practitioner do? - correct answer-Refer the child to pediatric urologist. An adolescent male comes to the clinic reporting unilateral scrotal pain, nausea, and vomiting that began that morning. The primary care pediatric nurse practitioner palpates a painful, swollen testis and elicits increased pain with slight elevation of the testis (a negative Phren's sign). The primary care pediatric nurse practitioner diagnoses an 8-year-old child with type 1 diabetes after a routine urine screen is positive for glucose and negative for ketones and plasma glucose is 350 mg/dL. The child's weight is normal and the parents report a mild increase in thirst and urine output in the past few days. Which course of action is correct? - correct answer-Begin insulin and refer the child to a children's diabetes center. The primary care pediatric nurse practitioner is reviewing lab work and diabetes management with a school-age child whose HbA1C is 7.6% who reports usual blood sugars before meals as being 80 to 90 mg/dL. The nurse practitioner will consult with the child's endocrinologist to consider which therapy? - correct answer-Continuous glucose monitoring. The primary care pediatric nurse practitioner is performing a well child examination on a 12yearold child who was diagnosed with type 1 diabetes at age 9. The child had a lipid screen at age 10 with an LDL cholesterol < 100 mg/dL. What will the nurse practitioner recommend as part of ongoing management for this child? - correct answer-Comprehensive ophthalmologic exam. A 13 year old Native American female has a BMI at the 90th percentile for age. The primary care pediatric nurse practitioner notes the presence of a hyperpigmented velvetlike rash in skin folds (Acanthosis Nigricans). The child denies polydipsia, polyphagia, and polyuria. The nurse practitioner will - - correct answer-Order a fasting blood sample for a metabolic screen for type 2 diabetes. The primary care pediatric nurse practitioner prescribes metformin for a 15 year old adolescent newly diagnosed with type 2 diabetes. What will the nurse practitioner include when teaching the adolescent about this drug? - correct answer- The importance of checking blood glucose 3 or 4 times daily A 16yearold adolescent female whose BMI is at the 90th percentile reports irregular periods. The primary care pediatric nurse practitioner notes widespread acne on her face and back and an abnormal distribution of facial hair. The nurse practitioner will evaluate her further based on a suspicion of which diagnosis? - correct answer-Polycystic ovarian syndrome (PCOS) The primary care pediatric nurse practitioner is providing nutritional counseling for a 9 year old female whose weight is at the 95th percentile for her age. What is the goal for this patient? - correct answer-Maintenance of her current weight. The primary care pediatric nurse practitioner notes a musty odor when examining a newborn at a 2- week checkup. What will the nurse practitioner suspect? - correct answer-PKU (phenylketonuria) An initial key part of management for a child suspected of having an inborn error of metabolism is - - correct answer-Consulting a metabolic specialist. Chapter 30 - Mental Health Disorders - correct answer- A child diagnosed with attention-deficit/hyperactivity disorder (ADHD) has difficulty stopping activities to begin other activities at school. The primary care pediatric nurse practitioner understands that this is due to difficulty with what self- regulation ability? - correct answer-Flexibility PNP cares for a preschool-age child who was exposed to drugs prenatally. The child bites other children and has tantrums when asked to stop, but is able to state later why this behavior is wrong. This child most likely has a disorder r/t what process? - correct answer-Executive function The parent of a child diagnosed with ADHD tells the PNP that the child gets overwhelmed by homework assignments, doesn't seem to know which ones to do first, and then doesn't do any assignments. The NP tells the parent that this represents impairment in which executive function? - correct answer- Activation The PNP is examining a 3 year old who speaks loudly, in a monotone voice, does not make eye contact, and prefers to sit on the exam room floor moving a toy truck back and forth in a repetitive manner. Which disorder does the NP expect? - correct answer-Autism spectrum disorder During a well child examination on a 4-month-old infant, the primary care pediatric nurse practitioner evaluates mental health issues. Which statement by the parent indicates a potential problem with the parent/infant relationship? - correct answer-I let my baby cry a while to learn to be patient. A child has a difficult temperament. What will the primary care pediatric nurse practitioner tell the parent about managing this child's behavior? - correct answer-It is important for the parent to learn to manage criticism and power struggles. During a well child assessment of a preschool age child, the parent voices concerns that, because the child has behavior problems at school, the child may have a mental health disorder. An adolescent has recently begun doing poorly in school and has stopped participating in sports and other extracurricular activities. During the history interview, the adolescent reports feeling tired, having difficulty concentrating, and experiencing a loss of appetite for the past few weeks but cannot attribute these changes to any major life event. Which is an important next step in managing this patient? - correct answer-Determining suicidal ideation and risk of suicide. An adolescent is diagnosed with major depression, and the mental health specialist has prescribed SSRI fluoxetine (Prozac). What other treatment is important to protect against suicide risk? - correct answer-Cognitive behavioral therapy. A 13-year-old child has exhibited symptoms of mild depression for several weeks. The parent reports feeling relieved that the symptoms have passed but concerned that the child now seems to have boundless energy and an inability to sit still. What will the primary care pediatric nurse practitioner do? - correct answer-Refer the child to a child psychiatrist for evaluation of bipolar disorder. A toddler has begun hitting and biting other children at a day care center and is exhibiting temper tantrums and bad language at home. The parent reports that these behaviors began shortly after a sibling was born. What will the NP do? - correct answer-Engage the parent in positive parenting strategies to facilitate appropriate child coping. A 14-year-old female comes to the clinic with amenorrhea for 3 months. A pregnancy test is negative. The adolescent's body weight is at 82% of expected for height and age. The mother reports her daughter often throws up and refuses to eat most foods. Which condition does the NP suspect? - correct answer-Anorexia nervosa. What is the hallmark sign of bipolar disorder in adolescents? - correct answer-Episodes of highs and lows with periods of stability What is considered a 1st line treatment for ADHD? - correct answer-Methylphenidate (Quillivant) - stimulant Behavioral therapy for ages 4-5 PNP is conducting a f/u exam on a child who recently began taking low-dose stimulant medication to treat ADHD. School performance and home behavior have improved, but parents report noticing a few "tics" (i.e. twitching of eyelids). The child, however, appears unaware these "tics" & is not bothered by them. What will the NP recommend? - correct answer-Continue the medication as prescribed PNP is performing an exam on a 5 year old who exhibits ritualistic behaviors, avoids contact with other children, and has limited speech. Parents report having concerns > 2 years ago about Autism, but were told it was too early to diagnose. What will the NP do first? - correct answer-Ask the parents to describe the child's behaviors from infancy through preschool Chapter 6 - GYN A&P - correct answer- A major contributor to pelvic stability is: - correct answer-The ilium and its ligaments The sheet made up of dense fibrous tissue that spans the opening of the anterior pelvic outlet is/are the: - correct answer-A sphincter muscles. How many different fiber sections subdivide the levator ani muscular sheet? - correct answer-4 What is the function of the Bartholin gland? - correct answer-Stimulated during sexual arousal Secrete lubricating mucous in to the introitus Which arteries supply blood to the clitoris? - correct answer-dorsal and clitoral cavernosal arteries What is the approximate number of follicles at the initiation of puberty? - correct answer-400,000 The four segments of a fallopian tube are the: -pars interstitialis -isthus -ampulla - - correct answer-Infundibulum What causes the epithelium to thicken, differentiate, and accumulate glycogen? - correct answer- Estrogen About how many openings are in the nipple? - correct answer-15-20 What is one of the most frequent reasons women visit their clinician? - correct answer-Changes in menstruation What is the objective of the endometrial cycle? - correct answer-To prepare a site to nourish and maintain the ovum Ovulation is dependent on an increased level of? - correct answer-Estrogen and the LH surge What initiates contractions of the uterine muscle leading to menstruation? - correct answer- Prostaglandins Why does the cervical mucus become thick, viscous, and opaque after ovulation? - correct answer-To reduce the risk of ascending infection at the time of implantation Which organism causes 90% of vulvovaginal candidiasis (yeast infection) episodes in women? - correct answer-Candida albicans What is the most common symptom of vulvovaginal candidiasis? - correct answer-Vulvar pruritis (itching) What percentage of Toxic Shock Syndrome cases are related to menses? - correct answer-50% Women who have had TSS should be instructed to not use tampons or? - correct answer-Barrier contraception methods What is generally the cause of Bartholin's cyst? - correct answer-Obstruction of a duct in Bartholin's gland Chapter 25 - Menstrual Cycle Pain and Premenstrual Conditions - correct answer- What term refers to the period from about 7 to 10 days before menstrual flow begins, until the first or second day of menstrual flow? - correct answer-Premenstrual Approximately what percentage of women experience severe recurring symptoms associated with their menstrual cycle? - correct answer-10% Why shouldn't symptoms such as bloating, and breast tenderness be considered disordered premenstrual symptoms? - correct answer-Because these symptoms affect the majority of women Of the four symptom clusters of perimenstrual symptoms identified by Woods, Mitchell, Lentz (1999), which was the dominant one in terms of explaining variance in premenstrual symptoms? - correct answer-Turmoil How is secondary dysmenorrhea defined? - correct answer-An underlying pathology causing pain symptoms during menstrual flow. What is the term for the exacerbation of somatic or mood symptoms in the late luteal or menstrual phase of the cycle? - correct answer-Premenstrual magnification Which of the following is a diagnostic label that is listed in the Diagnostic and Statistical Manual IV-TR? - correct answer-Premenstrual dysphoric disorder Women who report experiencing the most severe symptoms of PMS tend to be : - correct answer-In their late 30s. Which of the following is one of the key criteria for a diagnosis of PMS? - correct answer-Exclusion of other diagnoses that may better explain the symptoms. All menstruating women report that which type of symptoms is highest during menses? - correct answer-Gastrointestinal What hormone has been shown to help with relieving the mood discomfort cluster of symptoms of PMS? - correct answer-Progesterone Which dietary supplement has been shown to help treat PMS? - correct answer-Calcium The only botanical treatment with Level I evidence to support its use in PMS is: - correct answer-Chaste tree berry. Research suggests a link between PMS and: - correct answer-Seasonal affective disorder Chapter 26 - Normal and Abnormal Uterine Bleeding - correct answer- What are the 4 types of AUB? - correct answer-P: polyps A: adenomyosis (presence of endometrial tissue in uterus) L: leiomyomas (aka uterine fibroids) M: malignancy & hyperplasia What is the best definition of abnormal uterine bleeding (AUB)? - correct answer-Uterine bleeding that is irregular in amount of frequency. What is a good first question to ask women who presents with a concern about abnormal bleeding? - correct answer-What is a normal pattern for you? In women of reproductive age, the most common cause of a bleeding pattern that is suddenly different is a: - correct answer-Complication of a pregnancy. Progesterone breakthrough bleeding is sometimes seen in women who: - correct answer-Use progesterone-only contraception. The least variation in menses occurs during the ages of: - correct answer-20-40 years old. How can liver and renal disease result in abnormal uterine bleeding? - correct answer-They result in an inability to adequately clear estrogen from the body. Signs of endometrial or cervical cancer may present abnormal uterine bleeding, often as heavy, prolonged bleeding or: - correct answer-Menometrorrhagia. Products from which of the following herbs have been associated with alterations in estrogen levels, resulting in AUB? - correct answer-Gingko Exercise-induced amenorrhea is probably due to the combination of low body fat and decreased secretion of: - correct answer-GnRH When is a pelvic examination unnecessary for a woman who is experiencing AUG? - correct answer-If she has recently begun menstruation. What test should be ordered for a woman who is experiencing AUB as well as headaches and peripheral vision changes? - correct answer-Prolactin level test A pregnant client has come to the emergency department with complaints of nasal congestion and epistaxis. Which is the correct interpretation of these symptoms by the health care provider? - correct answer- Estrogen causes increased blood supply to the mucous membranes, and can result in congestion and nosebleeds. While providing education to a primiparous (1st pregnancy) client, regarding the normal changes of pregnancy, What is important for the nurse to explain about Braxton Hicks contractions? - correct answer-These occur throughout pregnancy, but you may not feel them until the third trimester. Why should a woman in her third trimester of pregnancy expect to visit her health care provider every 4 weeks? - correct answer-The conditions of the expectant mother and fetus can be monitored. A client in her third trimester complains of nausea and vomiting. She asks, Why does this happen? What is the nurse's best response? - correct answer-It may be due to changes in hormones. Which advice to the client is one of the most effective methods for preventing venous statis? - correct answer-Rest often with the feet elevated. To relieve a leg cramp, what should the client be instructed to perform? - correct answer-Dorsiflexion of the foot. Which complaint made by a client at 35 weeks gestation requires additional assessment? - correct answer-Abdominal pain Which laboratory result would be a cause for concern if exhibited by a client at her first prenatal visit during the second month of her pregnancy? - correct answer-Rubella titer 1:6 A client in her third trimester is asking about safe travel. Which statement should the nurse give about safe travel during pregnancy? - correct answer-If you are traveling by car, stop to walk every 1-2 hours. The client has just learned she is pregnant and overhears the gynecologist saying that she has a positive Chadwick's sign. When the client asks the nurse what this means, how should the nurse respond? - correct answer-Occurs normally in pregnancy, when estrogen causes increased blood flow in the area of the cervix. Bluish discoloration of cervix, vagina, & vulva and can be seen as early as 6-8 weeks s/p conception Chapter 33 - Diagnoses of Pregnancy and Overview of Prenatal Care - correct answer- A pregnant clients biophysical profile score is 8. She asks the nurse to explain the results. What is the nurses best response? - correct answer-The test results are within normal limits. A score of 8 points with good amniotic fluid volume is considered reassuring (A score of 6 points could indicate a problem & warrants further testing) The primary reason for evaluating alpha-fetoprotein (AFP) levels in maternal serum, is to determine whether the fetus has: - correct answer-A neural tube defect. Which should be considered a contraindication for transcervical chorionic villus sampling? - correct answer-Positive for group B streptococcus Which nursing intervention is necessary prior to a second-trimester transabdominal ultrasound? - correct answer-Instruct the client to drink 1-2 quarts of water. What is the term for a nonstress test, in which there are two or more fetal heart rate accelerations with fetal movement, of 15BPM or more, in a 20-minute period? - correct answer-Reactive In preparing a pregnant client for a nonstress test (NST), which of the following should be included in the plan of care? - correct answer-Position the client in comfort, adjusting the tocotransducer belt to locate fetal heart rate. The results of a contraction stress test (CST) are positive. Which intervention is necessary based on the test results? - correct answer-Contact the health care provider to discuss birth options for the client. A pregnant client has received the results of her triple-screen testing (measures AFP, HCG, and unconjugated Estriol), and it is positive. She provides you with a copy of the test results that she obtained from the lab. What would the nurse anticipate as being implemented in the clients plan of care? - correct answer- Refer to the physician for additional testing A newly pregnant patient tells the nurse that she has irregular periods and is unsure of when she got pregnant. Scheduling an ultrasound is a standing prescription for the patients' health care provider. When is the best time for the nurse to schedule the patient's ultrasound? - correct answer-Immediately. Chapter 35 - Overview of Postpartum Care - correct answer- A multiparous client is admitted to the postpartum unit after a rapid labor and birth of a 4000-g (8lbs 13oz) infant. Her fundus is boggy, lochia is heavy, and vital signs are unchanged.