NUR 646 FINAL EXAM STUDY GUIDE – WITH COMPLETE SOLUTIONS 2024, Exams of Nursing

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NUR 646 FINAL EXAM STUDY GUIDE – WITH

COMPLETE SOLUTIONS 2024

Airway obstruction A child has an acute infection causing lower airway obstruction. Which initial symptom is expected in this child? a. Atelectasis b. Barrel chest c. Over-inflation d. Wheezing Wheezing is the principal sound patients make if the obstruction allows enough air to pass through the narrowed lumen when lower airway obstruction occurs. Eventually, over-inflation and atelectasis occur. Barrel chest is the result of chronic over- inflation. Altered elimination patterns – bowel and bladder The primary care pediatric nurse practitioner sees a 3-year-old child who chronically withholds stools, in spite of the parents' attempts to stop the behavior, requiring frequent treatments with laxative medications. Which diagnosis will the nurse practitioner use to facilitate third-party reimbursement? a. Altered elimination pattern b. Elimination disorder c. Encopresis d. Parenting alteration The primary care pediatric nurse practitioner is managing a 6-year-old child who has chronic constipation and encopresis. The nurse practitioner has ruled out neurogenic etiology. The parents report that the child was difficult to toilet train as a toddler. What is key to managing this child's condition? a. Encouraging use of maintenance medications for at least 2 months after resolution of constipation b. Referral to a mental health consultant to manage problems in the parent-child dyad c. Spending time with the parents to uncover their feelings about their child's condition d. Teaching the parents that the symptom of stool retention is often voluntary for the child The primary care pediatric nurse practitioner is performing a well child exam on a 12- month-old infant. The parent tells the nurse practitioner that the infant has predictable bowel and bladder habits and asks about toilet training. What will the nurse practitioner tell this parent? a. It is too early to begin introducing the child to the toilet, and the parent should wait until the child is at least 2 years old. b. Placing the child on a "potty" chair helps the child associate elimination cues with the toilet. c. Predictability of elimination patterns indicates readiness for toilet

training, and the parent can begin this process.

d. The parent should wait until other signs of toilet training readiness occur before introducing the child to the toilet. The parent of a 5-year-old child tells the primary care pediatric nurse practitioner that the child has been using the toilet to urinate for since age 3 but continues to defecate in "pull-ups." The nurse practitioner learns that the child has predictable bowel movements and a physical examination is normal. What will the nurse practitioner recommend? a. Providing a reward system to offer incentives when the child uses the toilet b. Put the child back in diapers and resume toilet training in a few months. c. Putting the child on the toilet for 5 to 10 minutes at the usual time of defecation d. Use of polyethylene glycol until the child is able to use the toilet regularly The primary care pediatric nurse practitioner evaluates a 4-year-old girl whose parent reports frequent urination in the evenings on weekdays, incontinence after voiding. The parent reports that the child has soft formed stools 5 or 6 times weekly. Which assessment will the nurse practitioner make initially? a. Examination for labial adhesions b. Palpation for abdominal masses c. Screening for potential child abuse d. Urine culture and sensitivity The primary care pediatric nurse practitioner is counseling the parent of an 8- year-old child who has primary nocturnal enuresis. The nurse practitioner recommends an enuresis alarm, but the parent wishes to use medication. What will the nurse practitioner tell the parent? a. Anticholinergic medications are most commonly used for enuresis. b. Drug therapy is an effective way to achieve long-term control. c. Drug therapy is safest when the nasal spray form is used. d. The combination of alarm therapy and intermittent drug therapy is best. The primary care pediatric nurse practitioner is evaluating a 5-year-old child who has frequent soiling of stool associated with stomach aches and decreased appetite for the past 2 months. The parent states that the child has two or fewer formed bowel movements each week and has been toilet trained for about 2 years. Which initial assessment will the nurse practitioner make? a. History of neurogenic conditions b. Recent adjustments in the family c. Recent illnesses, fluid intake, changes in diet d. Toilet training history Appendicitis 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? a. Appendicitis with perforation b. Gastroenteritis c. Pelvic inflammatory disease (PID) d. Urinary tract infection (UTI) The child has the progression of symptoms typical of appendicitis with perforation -pain before vomiting that localizes to the RLQ and then relief of pain with onset of fever upon perforation. Asthma The mother of a newborn tells the primary care pediatric nurse practitioner that she is worried that her child will develop allergies and asthma. Which tool will the nurse practitioner use to evaluate this risk? a. Three-generation pedigree b. Review of systems c. Genogram d. Ecomap A child is in the clinic for evaluation of an asthma action plan. The primary care pediatric nurse practitioner notes that the child's last visit was for a pre-kindergarten physical and observes that the child is extremely anxious. What will the nurse practitioner do initially? a. Ask the child's parent why the child is so anxious. b. Perform a physical assessment to rule out shortness of breath. c. Reassure the child that there is nothing to be afraid of. d. Review the purpose of this visit and any anticipated procedures. The primary care pediatric nurse practitioner prescribes a twice daily inhaled corticosteroid for a 12-year-old child. At a well child visit, the child reports not using the medication on a regular basis. Which response by the pediatric nurse practitioner demonstrates an understanding of client-centered care? a. Asking the child to describe usual daily routines and schedules b. Referring the family to a social worker to help with medication compliance c. Reviewing the asthma action plan with the parent and the child d. Teaching the child how the medication will help to control asthma symptoms The primary care pediatric nurse practitioner is performing a focused problem assessment on a child who has asthma and learns that one of the child's parents smokes around the child in spite of being advised against this. The nurse practitioner recognizes this as a possible alteration in which functional health pattern? a. Cognitive- perceptual b. Health perception c. Role-relationship d. Values-beliefs

The primary care pediatric nurse practitioner is counseling a school-age child about asthma management strategies. The child states that it is "too much trouble" to remember to use an inhaled corticosteroid medication twice daily and reports feeling fine, in spite of exhibiting expiratory wheezes. Which action uses the health belief and self-efficacy model to teach this child about asthma management? a. Asking the child to try to use the inhaler at least once daily b. Discussing whether the child wants to participate in athletics c. Obtaining pre- and post-treatment spirometry testing d. Providing written information about inhaled corticosteroids The parent of a child who has asthma asks the primary care pediatric nurse practitioner about whether the child may engage in strenuous exercise. What will the nurse practitioner tell the parent? a. Children with asthma should be excluded from vigorous exercise and most strenuous sports. b. Children with asthma show improved aerobic and anaerobic fitness with moderate to vigorous/physical activity. c. Physical activity has been shown to improve overall pulmonary function in children with asthma. d. Vigorous exercise helps improve symptoms in children with poorly controlled asthma. The primary care pediatric nurse practitioner is counseling an adolescent who was recently hospitalized for an asthma exacerbation and learns that the child usually forgets to use twice- daily inhaled corticosteroid medications that are supposed to be given at 0800 and 2000 each day. Which strategy may be useful in this case to improve adherence? a. Ask the adolescent to identify two times each day that may work better. b. Consider having the school nurse supervise medication administration. c. Prescribing a daily oral corticosteroid medication instead. d. Suggest that the parent enforce the medication regimen each day. Bell Palsy A child with a recent history of URI reports tingling and pain in one ear followed by sagging of one side of the face. The primary care pediatric nurse practitioner observes that the child cannot close the eye or mouth on the affected side but does not elicit limb weakness on that side. What will the nurse practitioner do? a. Initiate a short course of antibiotic therapy. b. Perform diagnostic testing to rule out serious causes. c. Prepare the parents for lifelong complications. d. Prescribe oral prednisone 1 mg/kg/day initially. This child has symptoms and a history consistent with Bell's palsy. Oral prednisone is given to reduce inflammation causing paralysis for 1 week with a 1 week taper

The primary care pediatric nurse practitioner is examining a young child who has cerebral palsy. Which part of the family history raises concerns about potential child maltreatment? a. Child attends day care b. Limited financial resources c. Mother works outside the home d. No membership in a church During a well-baby exam on a 9-month-old infant, the parent reports that the baby always uses the left hand to pick up objects and asks if the baby will be left-handed. What will the primary care pediatric nurse practitioner do? a. Explain that it is too soon to tell which hand the infant will prefer later. b. Perform a careful assessment of fine and gross motor skills. c. Teach the parent to encourage the infant to use both hands. d. Tell the parent that a hand preference usually develops between 6 and 12 months. Hand preference before 1 year of age is usually suspect for cerebral palsy and may indicate a lack of motor skills in the other hand. The PNP should perform a careful assessment of fine and gross motor skills. Because of their inability to ambulate, children with cerebral palsy should be evaluated for which nutrients? a. Calcium and vitamin D b. Fat-soluble vitamins c. Iron and zinc d. Sodium and potassium Cardiac murmurs A 3-month-old infant who was previously healthy now has a persistent cough, bilateral lung crackles, and poor appetite. The primary care pediatric nurse practitioner auscultates a grade III/VI, low-pitched, holosystolic murmur over the left lower sternal border and palpates the liver at one centimeter below the ribs. What diagnosis is likely? a. Atrial septal defect b. Coarctation of the aorta c. Patent ductus arteriosis d. Ventricular septal defect VSD and may not present at birth but appear later as CHF becomes more pronounced. An ASD typically does not have a murmur until the child is 2 or 3 years old, but the provider can often hear a split S2 sound. Coarctation of the aorta may cause a systolic ejection murmur. A PDA has a characteristic machinery-like murmur. During a well child assessment, the primary care pediatric nurse practitioner auscultates a harsh, blowing grade IV/VI murmur in a 6-month-old infant.

What will the nurse practitioner do next? a. Get a complete blood count to rule out severe anemia.

b. Obtain an electrocardiogram to assess for arrhythmia. c. Order a chest radiograph to evaluate for cardiomegaly. d. Refer to a pediatric cardiologist for further evaluation. A harsh, blowing murmur is suspicious for pathology, so a cardiology referral is warranted. The cardiologist will determine which tests and procedures should be performed. During a routine well child exam on a 5-year-old child, the primary care pediatric nurse practitioner auscultates a grade II/VI, harsh, late systolic ejection murmur at the upper left sternal border that transmits to both lung fields. The child has normal growth and development. What will the nurse practitioner suspect? a. Aortic stenosis b. Patent ductus arteriosus c. Pulmonic stenosis d. Tricuspid atresia The primary care pediatric nurse practitioner is examining a 2-week-old infant and auscultates a wide splitting of S2 during expiration. What condition may this finding represent? a. Atrial septal defect b. Coarctation of the aorta c. Patent ductus arteriosis d. Ventricular septal defect A wide splitting of S2 without becoming a single sound on expiration may indicate increased pulmonary flow, typical of atrial septal defect. The primary care pediatric nurse practitioner auscultates a new grade II vibratory, mid- systolic murmur at the mid sternal border in a 4-year-old child that is louder when the child is supine. What type of murmur is most likely? a. Pathologic murmur b. Pulmonary flow murmur c. Still's murmur d. Venous hum A 9-month-old infant has a grade III/VI, harsh, rumbling, continuous murmur in the left infraclavicular fossa and pulmonic area. A chest radiograph reveals cardiac enlargement. The primary care pediatric nurse practitioner will refer the infant to a pediatric cardiologist and prepare the parents for which intervention to repair this defect? a. Cardiopulmonary bypass surgery b. Coil insertion in the catheterization laboratory c. Indomethacin administration d. Observation for spontaneous closure Common ear disorders

A child who has otitis externa has severe swelling of the external auditory canal that persists after 2 days of therapy with ototopical antibiotic/corticosteroid drops. What is the next step in treatment for this child? a. Insert a wick into the external auditory canal. b. Irrigate the external auditory canal with saline. c. Order systemic corticosteroids. d. Prescribe an oral antibiotic medication. A 7-month-old infant has had two prior acute ear infections and is currently on the 10th day of therapy with amoxicillin-clavulanate after a failed course of amoxicillin. The primary care pediatric nurse practitioner notes marked middle ear effusion and erythema of the TM. The child is irritable and has a temperature of 99.8°F. What is the next step in management of this child's ear infection? a. Order a second course of amoxicillin-clavulanate. b. Perform tympanocentesis for culture. c. Prescribe clindamycin twice daily. d. Refer the child to an otolaryngologist. A school-age child has a history of chronic otitis media and is seen in the clinic with vertigo. The primary care pediatric nurse practitioner notes profuse purulent otorrhea from both pressure-equalizing tubes and a pearly- white lesion on one tympanic membrane. Which condition is most likely? a. Cholesteatoma b. Mastoiditis c. Otitis externa d. Otitis media with effusion An 18-month-old child with no previous history of otitis media awoke during the night with right ear pain. The primary care pediatric nurse practitioner notes an axillary temperature of 100.5°F and an erythematous, bulging tympanic membrane. A tympanogram reveals of peak of +150 mm H2O. What is the recommended treatment for this child? a. Amoxicillin 80 to 90 mg/kg/day in two divided doses b. An analgesic medication and watchful waiting c. Ceftriaxone 50 to 75 mg/kg/dose IM given once d. Ototopical antibiotic drops twice daily for 5 days The parent of a 4-month-old infant is concerned that the infant cannot hear. Which test will the primary care pediatric nurse practitioner order to evaluate potential hearing loss in this infant? a. Acoustic reflectometry b. Audiometry c. Auditory brainstem response (ABR) d. Evoked otooacoustic emission (EOAE) testing

A child complains of itching in both ears and is having trouble hearing. The primary care pediatric nurse practitioner notes periauricular edema and marked swelling of the external auditory canal and elicits severe pain when manipulating the external ear structures. Which is an appropriate intervention? a. Obtain a culture of the external auditory canal. b. Order ototopical antibiotic/corticosteroid drops. c. Prescribe oral amoxicillin-clavulanate. d. Refer the child to an otolaryngologist. Common eye disorders The primary care pediatric nurse practitioner performs a well-baby assessment of a 5- day-old infant and notes mild conjunctivitis, corneal opacity, and serosanguinous discharge in the right eye. Which course of action is correct? a. Administer intramuscular ceftriaxone 50 mg/kg. b. Admit the infant to the hospital immediately. HPV conjunctiviitis c. Give oral erythromycin 30 to 50 mg/kg/day for 2 weeks. d. Teach the parent how to perform tear duct massage. The primary care pediatric nurse practitioner performs a vision screen on a 4-month-old infant and notes the presence of convergence and accommodation with mild esotropia of the left eye. What will the nurse practitioner do? a. Patch the right eye to improve coordination of the left eye. b. Reassure the parents that the infant will outgrow this. c. Recheck the infant's eyes in 2 to 4 weeks. d. Refer the infant to a pediatric ophthalmologist. A toddler exhibits exotropia of the right eye during a cover-uncover screen. The primary care pediatric nurse practitioner will refer to a pediatric ophthalmologist to initiate which treatment? a. Botulinum toxin injection b. Corrective lenses c. Occluding the affected eye for 6 hours per day d. Patching of the unaffected eye for 2 hours each day A preschool-age child is seen in the clinic after waking up a temperature of 102.2°F, swelling and erythema of the upper lid of one eye, and moderate pain when looking from side to side. Which course of treatment is correct? a. Admit to the hospital for intravenous antibiotics. Periorbital cellulitis b. Obtain a lumbar puncture and blood culture. c. Order warm compresses 4 times daily for 5 days. d. Prescribe a 10- to 14-day course of oral antibiotics. A preschool-age child who attends day care has a 2-day history of matted eyelids in the morning and burning and itching of the eyes. The primary care

pediatric nurse practitioner notes yellow-green purulent discharge from both eyes, conjunctival

erythema, and mild URI symptoms. Which action is correct? a. Culture the conjunctival discharge. b. Observe the child for several days. c. Order an oral antibiotic medication. d. Prescribe topical antibiotic drops. Bacterial conjuncitivitis The primary care pediatric nurse practitioner observes a tender, swollen red furuncle on the upper lid margin of a child's eye. What treatment will the nurse practitioner recommend? a. Culture of the lesion to determine causative organism b. Referral to ophthalmology for incision and drainage c. Topical steroid medication d. Warm, moist compresses 3 to 4 times daily hordeolum A 14-year-old child has a 2-week history of severe itching and tearing of both eyes. The primary care pediatric nurse practitioner notes redness and swelling of the eyelids along with stringy, mucoid discharge. What will the nurse practitioner prescribe? a. Saline solution or artificial tears b. Topical mast cell stabilizer c. Topical NSAID drops allergic conjunctivitis d. Topical vasoconstrictor drops Common fungal infections A school-age child has several annular lesions on the abdomen characterized by central clearing with scaly, red borders. What is the first step in managing this condition? a. Fluoresce the lesions with a Wood's lamp. b. Obtain fungal cultures of the lesions. c. Perform KOH-treated scrapings of the lesion borders. d. Treat empirically with antifungal cream.- tinea corporis A child has several circular, scaly lesions on the arms and abdomen, some of which have central clearing. The primary care pediatric nurse practitioner notes a smaller, scaly lesion on the child's scalp. How will the nurse practitioner treat this child? a. Obtain scrapings of the lesions for fungal cultures. b. Order prescription-strength antifungal creams. c. Prescribe oral griseofulvin for 2 to 4 weeks.-Tinea Capitis d. Recommend OTC antifungal creams and shampoos. Whenever tinea lesions occur on the scalp or nails, oral griseofulvin must be given for 2 to 4 weeks. Dental/Oral care A 4-year-old child who has had extensive dental surgery to treat dental caries has white spot lesions on the primary teeth. How often should this child receive fluoride varnish applications? a. Annually

b. Twice yearly c. Every 3 to 6 months Patient is considered high risk d. Every month What will the primary care pediatric nurse practitioner recommend to the parent of an infant who is teething who asks about comfort measures? a. Administer oral ibuprofen or apply topical salicylates. b. Apply a topical anesthetic such a benzocaine to the gums. c. Give the infant a cold teething ring or wet washcloth to chew. d. Try Baby Orajel on the infant's gums several times daily. A parent asks about ways to promote dental health in school-age children while on a family vacation that are convenient while camping and picnicking. What will the primary care pediatric nurse practitioner recommend? a. Getting fluoride varnish treatments prior to vacations b. Giving the children fluoridated water after meals c. Having the children use a chlorhexidine gluconate oral rinse d. Offering gum containing xylitol after meals What will the primary care pediatric nurse practitioner teach the parent of an infant about cleaning the child's teeth? a. To allow the child to control the amount of toothpaste used b. To choose a toothpaste with a mint flavor c. To use a smear of toothpaste and not to rinse the mouth d. To use a toothpaste containing whitening agents The primary care pediatric nurse practitioner performs a physical examination on a 9- month-old infant and notes two central incisors on the lower gums. The parent states that the infant nurses, takes solid foods three times daily, and occasionally takes water from a cup. What will the pediatric nurse practitioner counsel the parent to promote optimum dental health? a. To begin brushing the infant's teeth with toothpaste b. To consider weaning the infant from breastfeeding c. To discontinue giving fluoride supplements d. To make an appointment for an initial dental examination Developmental assessments When providing well child care for an infant in the first year of life, the primary care pediatric nurse practitioner is adhering to the most recent American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care guidelines by : a. focusing less on development and more on illness prevention and nutrition. b. following guidelines established by the Bright Futures publication. c. scheduling well-baby visits to coincide with key developmental milestones. d. seeing the infant at ages 2, 4, 6, and 12 months when immunizations are due.

The primary care pediatric nurse practitioner performs a developmental assessment on a 3-year-old child and notes normal cognitive, fine-motor, and gross-motor abilities. The child responds appropriately to verbal commands during the assessment but refuses to speak when asked questions. The parent tells the nurse practitioner that the child talks at home and that most other adults can understand what the child says. The nurse practitioner will a. ask the parent to consider a possible speech delay and report any concerns. b. continue to evaluate the child's speech at subsequent visits. c. refer the child for a speech and hearing evaluation. d. tell the parent to spend more time in interactive conversations with the child. The primary care pediatric nurse practitioner learns that the mother of a 3- year-old child has been treated for depression for over 5 years. Which aspect of this child's development will be of the most concern to the nurse practitioner? a. Fine motor b. Gross motor c. Social/emotional d. Speech and language A female infant who was developing normally stops meeting developmental milestones at age 12 months and then begins losing previously acquired skills. What will the primary care pediatric nurse practitioner expect to tell the parents about this child's prognosis? a. Cognitive development will be normal but motor skills will be lost. b. Physical and speech therapy will help the infant regain lost skills. c. The child's intellectual development will not progress further. d. This is a temporary condition with full recovery expected. The parent of a newborn infant asks the primary care pediatric nurse practitioner when to intervene to help the infant's future intellectual growth. What will the nurse practitioner tell the parent? a. Cognitive learning begins during the toddler years. b. Intellectual growth begin when speech develops. c. Language and literacy skills begin at birth. d. Preschool is an optimal time to begin general learning. Emotional changes of adolescence The parent of an adolescent reports noting cutting marks on the teen's arms and asks the primary care pediatric nurse practitioner what it means. What will the nurse practitioner tell this parent? a. Cutting is a way of dealing with emotional distress. Coping strategy b. It is a method of fitting in with other adolescents.

c. The behavior is common and will usually stop. d. This type of behavior is a type of suicide attempt.

GU tract disorders The primary care pediatric nurse practitioner is concerned that a toddler may have vesicoureteral reflux based on a history of dysfunctional voiding patterns and a series of urinary tract infections. Which intervention is appropriate? a. Initiating a bladder retraining program b. Ordering a voiding cystourethrogram c. Referral to a urologist for evaluation d. Treatment with prophylactic antibiotics If symptomatic vesicoureteral reflux is suspected, the PNP should refer the child to a urologist for diagnosis and initiation of treatment. A 9-month-old infant with a history of three urinary tract infections is diagnosed with grade II vesicoureteral reflux. Which medication will be prescribed? a. Amoxicillin 10 mg/kg as a single daily dose b. Ceftriaxone IM 50 mg/kg as a single daily dose c. Nitrofurantoin 1-2 mg/kg as a single daily dose d. TMP-SMX; TMP 2 mg/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? a. That long-term antibiotic prophylaxis will prevent scarring b. That surgery to correct the condition is possible c. that the child will most likely require kidney transplant d. that the condition will probably resolve spontaneously Immunizations : A parent is concerned about vaccine adverse reactions. Based on an Institute of Medicine report, what will the primary care pediatric nurse practitioner tell the parent? a. Administering multiple vaccines may trigger the development of type 1 diabetes. b. The MMR may be linked to febrile seizures in immunocompromised children. c. There is some risk of CNS disorders associated with the hepatitis B vaccine. d. Vaccines containing thimerosol are linked to pervasive developmental disorders. The primary care pediatric nurse practitioner reviews the immunization records of an 18- month-old child and notes that the child received an MMR immunization 2 days prior to the first birthday. What will the nurse practitioner do? a. Administer a reduced dose of MMR to ensure adequate immunity. b. Obtain mumps, measles, and rubella titers to determine

immunity. c. Recommend the next dose of MMR vaccine at 4 to 5 years of age. d. Repeat the MMR vaccine since the first dose was given too soon An 18-month-old child has bronchopulmonary dysplasia. To help prevent pneumococcal disease, which vaccine will be ordered?

a. PCV b. PCV c. PCV d. PCV An unimmunized school-age child whose mother is in her first trimester of pregnancy is diagnosed with rubella after a local outbreak. What will the primary care pediatric nurse practitioner recommend? a. Assessment of maternal rubella titers b. Intravenous immunoglobulin for the child c. MMR vaccine for the mother and child d. Possible termination of the pregnancy Management of rhinosinusitis : A school-age child has had nasal discharge and daytime cough but no fever for 12 days without improvement in symptoms. The child has not had antibiotics recently and there is no significant antibiotic resistance in the local community. What is the appropriate treatment for this child? a. Amoxicillin 45 mg/kg/day b. Amoxicillin 80-90 mg/kg/day c. Amoxicillin-clavulanate 80-90 mg/kg/day d. Saline irrigation for symptomatic relief This child meets criteria for treatment of acute rhinosinusitis (ARS) based on duration of symptoms without clinical improvement. acute bacterial rhinosinusitis treated with Amox-clav when no recent antibiotic use. Azithromycin if PCN allergy. Moxifloxacin if resistance to treatment or recent antibiotic use. After 14 days of treatment with amoxicillin 45 mg/kg/day for acute rhinosinusitis, a child continues to have mucopurulent nasal discharge along with induration, swelling, and erythema of both eyelids. What is the next course of treatment? a. Amoxicillin 80 mg/kg/day for 14 days b. Amoxicillin-clavulanate for 10 to 14 days c. Antibiotic ophthalmic drops for 5 to 7 days d. Referral to a pediatric otolaryngologist Possible periorbital cellulitis Mononucleosis : The primary care pediatric nurse practitioner diagnoses a high school basketball player with mononucleosis. The adolescent asks when she may resume play. What will the nurse practitioner tell her? a. After 3 weeks, she may begin lifting weights but not full sports. b. After 4 weeks, she may return to full play and practice. c. At 4 weeks, she must have an exam to determine fitness for play. d. She may engage in moderate exertion and practice after 3 weeks.

Full return to play should be determined on a case-by-case basis and is generally considered safe at 4 weeks after symptom onset, assuming physical stamina has returned, all symptoms have resolved, and the sport does not increase intraabdominal pressure during play. Athletes should avoid any form of exertion, including all sports during the first 3 weeks at a minimum and should avoid anything with a risk of chest or abdominal contact or anything that involves increased intra-abdominal pressure. Splenic rupture can occur spontaneously (rare), but the risk of rupture increases when participating in a contact or collision sport or a sport in which there is an increase in intraabdominal pressure. The nurse practitioner should recommend an exam at 4 weeks to determine fitness for play. Prebiotics/Probiotics: The parent of an infant asks about using a probiotic medication. What will the primary care pediatric nurse practitioner tell this parent? a. Probiotic medications have demonstrated efficacy in treating colic. b. Probiotics are not safe to use to treat infants who have colic. c. There are no studies showing usefulness of probiotics to manage colic. d. There is no conclusive evidence about using probiotics to treat colic. A 2-year-old child has an acute diarrheal illness. The child is afebrile and, with oral rehydration measures, has remained well hydrated. The parent asks what can be done to help shorten the course of this illness. What will the primary care pediatric nurse practitioner recommend? a. Clear liquids only b. Lactobacillus c. Loperamide d. Peppermint oil Respiratory tract infections: A 5-month-old infant who has a 3-day history of cough and rhinorrhea has developed symptoms of respiratory distress with audible expiratory wheezes and increased coughing. The infant's immunizations are up-to-date. The physical exam reveals a respiratory rate of 50 breaths per minute, coarse expiratory wheezing, and prolonged expiration. An oxygen saturation is 96% on room air. What is the recommended treatment for this infant? a. Administer a trial of bronchodilators. b. Obtain a viral culture of nasal washings. c. Order an oral corticosteroid medication. d. Recommend increased fluids and close follow-up. Bronchiolitis and is stable. Scoliosis, kyphosis, and lordosis:

A young adolescent female is observed to have mild unequal scapula prominences on gross examination while standing. In the Adams forward bending position, this inequality disappears. What will the primary care pediatric nurse practitioner do? a. Discuss posture and exercise and ask about backpacks and books. b. Obtain radiographic studies of the entire spine and neck. c. Reassure the child's parent that functional scoliosis will self-resolve. d. Refer to an orthopedic specialist for evaluation and possible bracing. A nine-year-old girl comes into the clinic for a wellness visit. The provider does an assessment on the patient. The patient has a AP curvature of the lumbar spine. Based off of your assessment what is your diagnosis? A. Scoliosis B. Pathologic lordosis C. Hyperlordosis or lumbar lordosis D. Kyphosis A 12-year-old boy was recently diagnosed with lumbar lordosis. The primary care provider instructs the child to bend forward. You observe that the lumbar spine flattened and the lordosis disappears in the forward bending position. This finding indicates that the spine : A. Is flexible and that the lordosis is only physiologic B. Does naturally have an AP curvature at the lumbar spine C. Is retractive and the lordosis is only pathologic D. Is a more severe case which means the child will need a back brace for treatment A mother brings in her 10-year-old daughter for a primary care visit. The daughter walks in and the nurse practitioner observes the child as she stands. Het abdomen and buttocks are protruding. The 10 year old girl appears like the photo what is your diagnosis? A. Kyphosis B. Scoliosis C. Femoral Anteversion D. Lumbar Lordosis A primary care provider received a 12-year-old boy who is being evaluated for lumbar lordosis. The provider asked the boy to bend forward. As the patient bends forward the provider notices that the AP curvature does not flatten. Based off of this finding what would be the next appropriate action by the Nurse Practitioner? A. Ask the patient if he experiences pain during this B. Note that this is a normal physiological finding in the chart C. Refer the patient to an orthopedist D. Send the patient for an X-ray to measure the curvature for accurate treatment. The parent of a female child is concerned that the child scoliosis will get worse if she sits around all the time and watches TV. The parent also states

that she tells the child to sit up straight to help with her posture and to prevent the disease from progressing.

Based on this statement the nurse practitioner would know that this statement is false because: A. The progression is likely due to the child's lack of using walking aids B. The progression is likely due to lack of calcium supplementation C. The progression is likely due to Hormonal changes, sexual maturity, and rapid growth D. The progression is likely due to rapid growth and the diet of the child and calcium The mother of an eight-year-old boy who was recently diagnosed with scoliosis asks the provider what the management plan is. The nurse practitioner explains that the primary aim of scoliosis management is to: A. Find out the root cause of the scoliosis B. Stop the progression of curvature and improve pulmonary function C. Reinforce good posture D. Refer to an orthopedist Sexual maturation The primary care pediatric nurse practitioner is performing a well child exam on a 12- year-old female who has achieved early sexual maturation. The mother reports that she spends more time with her older sister's friends instead of her own classmates. What will the nurse practitioner tell this parent? a. Early-maturing girls need to identify with older adolescents to feel a sense of belonging. b. Girls who join an older group of peers may become sexually active at an earlier age. c. Spending time with older adolescents indicates a healthy adjustment to her maturing body. d. The association with older adolescents will help her daughter to gain social maturity. During a well child assessment of a 13-year-old male, the primary care pediatric nurse practitioner notes small testicles and pubic and axillary hair. To further evaluate these findings, the nurse practitioner will ask the patient about a. alcohol and tobacco use. b. changes in voice. c. increase in height and weight. d. participation in sports. The initial sign of puberty in males is testicular enlargement. If this does not precede other changes, the PNP should consider whether the boy is taking exogenous anabolic steroids, common among those who wish to improve athletic ability. During a well child exam on a 13yearold female, the primary care pediatric nurse practitioner notes that the child is at Tanner Stage 3. During the exam, when the nurse practitioner initiates a conversation about healthy sexuality

education, the parent states that this topic is "off limits." What will the nurse practitioner do? A. Ask the adolescent whether she wishes to discuss these matters since she is becoming an adult.

B. Separate the parent from the adolescent to discuss the adolescent's concerns in private. C. Spend private time with the parent to discuss how sexuality education reduces the risk of early sexual intercourse and risky sexual behaviors. D. Tell the parent that this information is a routine part of adolescent well child examinations and must be included. Skin infections/disorders A 4-month-old infant has a history of reddened, dry, itchy skin. The primary care pediatric nurse practitioner notes fine papules on the extensor aspect of the infant's arms, anterior thighs, and lateral aspects of the cheeks. What is the initial treatment? a. Moisturizers b. Oral antihistamines c. Topical corticosteroids d. Wet wrap therapy A child is diagnosed with tinea versicolor. What is the correct management of this disorder? a. Application of selenium sulfide 2.5% lotion twice weekly for 2 to 4 weeks b. Oral antifungal treatment with fluconazole once weekly for 2 to 3 weeks c. Sun exposure for up to an hour every day for 2 to 4 weeks d. Using ketoconazole 2% shampoo on lesions twice daily for 2 to 4 weeks A child is brought to clinic with several bright red lesions on the buttocks. The primary care pediatric nurse practitioner examines the lesions and notes sharp margins and an "orange peel" look and feel. The child is afebrile and does not appear toxic. What is the course of treatment for these lesions? a. Hospitalize the child for intravenous antibiotics and possible I&D of the lesions. b. Initiate empiric antibiotic therapy and follow up in 24 hours to assess response. c. Obtain blood cultures prior to beginning antibiotic treatment. d. Perform gram stain and culture of the lesions before initiating antibiotics. A 9-month-old infant has vesiculopustular lesions on the palms and soles, on the face and neck, and in skin folds of the extremities. The primary care pediatric nurse practitioner notes linear and S-shaped burrow lesions on the parent's hands and wrists. What is the treatment for this rash for this infant? a. Ivermectin 200 mcg/kg for 7 to 14 days, along with symptomatic treatment for itching b. Permethrin 5% cream applied to face, neck, and body and rinsed off in 8 to 14 hours Scabies c. Treatment of all family members except the infant with permethrin 5% cream and ivermectin d. Treatment with permethrin 5% cream for 7 days in conjunction with ivermectin 200 mcg/kg Sports participation and injuries :