Practice Exam Questions for Primary Care Pediatric Nurse Practitioners, Exams of Nursing

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NURS 629 Practice Exam Questions With

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 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. Correct  During a well child exam on a 4-year-old child, the primary care pediatric nurse ID: 13348411168 practitioner notes that the clinic nurse recorded “20/50” for the child’s vision and noted that the child had difficulty cooperating with the exam. What will the nurse practitioner recommend? A. Follow up with a visual acuity screen in 6 months. B. Refer to a pediatric ophthalmologist. C. Re-test the child in 1 year. D. Test the child’s vision in 1 montohrr.ect  During a well child assessment of an African-American infant, the primary care ID: 13348411148 pediatric nurse practitioner notes a dark red-brown light reflex in the left eye and a slightly brighter, red-orange light reflex in the right eye. The nurse practitioner will A. dilate the pupils and reassess the red reflex. B. order auto-refractor screening of the eyes. C. recheck the red reflex in 1 month. D. refer the infant to an ophthalmologist. Correct

 The primary care pediatric nurse practitioner performs a Hirschberg test to evaluate A. color vision. B. ocular alignment. Correct C. peripheral vision. D. visual acuity.  The primary care pediatric nurse practitioner applies fluorescein stain to a child’s eye. When examining the eye with a cobalt blue filter light, the entire cornea appears cloudy. What does this indicate? A. The cornea has not been damaged.

B. There is too little stain on the cornea.

C. There is damage to the cornea. D. There is too much stain on the cornea. Correct  A toddler exhibits exotropia of the right eye during a cover- uncover screen. The ID: 13348411156 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 dCaoyrrect  The primary care pediatric nurse practitioner performs a well child examination on ID: 13348411140

a 9-month-old infant who has a history of prematurity at 28 weeks’ gestation. The infant was treated for retinopathy of prematurity (ROP) and all symptoms have resolved. When will the infant need an ophthalmologic exam? A. At 12 months of age Correct B. At 24 months of age C. At 48 months of age D. At 60 months of age  During a well-baby assessment on a 1-week-old infant who had a normal exam ID: 13348411144 when discharged from the newborn nursery 2 days prior, the primary care pediatric nurse practitioner notes moderate eyelid swelling, bulbar conjunctival injections, and moderate amounts of thick, purulent discharge. What is the likely diagnosis? A. Chemical-induced conjunctivitis B. Chlamydia trachomatis conjunctivitis Correct C. Herpes simplex virus (HSV) conjunctivitis D. Neisseria gonorrhea conjunctivitis

Correct  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. Correc C. Give oral erythromycin 30 to 50 mg/kg/day for 2 weeks. D. Teach the parent how to perform tear duct massage.  A preschool-age child who attends day care has a 2-day history of matted eyelids K. (^) L. ID: 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? I. A. Culture the conjunctival discharge. B. Observe the child for several days. C. Order an oral antibiotic medication. D. Prescribe topical antibiotic drops. Correc  A 14-year-old child has a 2-week history of severe itching and tearing of both J. ID: 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? G. A. Saline solution or artificial tears B. Topical mast cell stabilizer C. Topical NSAID drops D. Topical vasoconstrictor drops H. ID:  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 daiClyorrect E. F. I:

 The primary care pediatric nurse practitioner is treating an infant with lacrimal duct obstruction who has developed bacterial conjunctivitis. After 2 weeks of treatment with topical antibiotics along with massage and frequent cleansing of secretions, the infant’s symptoms have not improved. Which action is correct? A. Perform massage more frequently. B. Prescribe an oral antibiotic. C. Recommend hot compresses. D. Refer to an ophthalmologist. Correc  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. Correc 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 school-age child is seen in the clinic after a fragment from a glass bottle flew into the eye. What will the primary care pediatric nurse practitioner do? A. Refer immediately to an ophthalmologist. Correc B. Attempt to visualize the glass fragment. C. Irrigate the eye with sterile saline. D. Instill a topical anesthetic.  A school-age child is hit in the face with a baseball bat and reports pain in one ID: 13348411164 ID: 13348411142

eye. The primary care pediatric nurse practitioner is able to see a dark red fluid level between the cornea and iris on gross examination, but the child resists any exam with a light. Which action is correct? A. Administer an oral analgesic medication. B. Apply a Fox shield and reevaluate the eye in 24 hours. C. Instill anesthetic eyedrops into the affected eye. D. Refer the child immediately to an ophthalmologist. Correc Questions  The parent of a 4-month-old infant is concerned that the infant cannot hear. ID: 13348431621 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) Correc D. Evoked otooacoustic emission (EOAE) testing  The primary care pediatric nurse practitioner obtains a tympanogram on a child that^ reveals^ a^ sharp^ peak^ of^ - mm H 2 O. What does this value indicate? A. A normal tympanic membrane B. Middle ear effusion C. Negative ear pressure Correct D. Tympanic membrane perforation  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 ID: 13348431629 ID: 13348431617 temperature of 100.5°F and an erythematous, bulging tympanic membrane. A tympanogram reveals of peak of +150 mm H 2 O. 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 Correct C. Ceftriaxone 50 to 75 mg/kg/dose IM given once D. Ototopical antibiotic drops twice daily for 5 days

 A 7-month-old infant has had two prior acute ear infections and is currently on the ID: 1334843 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. Correct  A 3-year-old child with pressure-equalizing tubes (PET) in both ears has otalgia in ID: 13348431627 one ear. The primary care pediatric nurse practitioner is able to visualize the tube and does not see exudate in the ear canal and obtains a type A tympanogram. What will the nurse practitioner do? A. Order ototopical antibiotic/corticosteroid drops. B. Prescribe a prophylactic antibiotic medication. C. Reassure the parent that this is a normal exam. D. Refer the child to an otolaryngologist for follow-up  What will the primary care pediatric nurse practitioner teach the parents of a child who has new pressure-equalizing tubes (PET) in both ears? A. Parents should notice improved hearing in their child. B. PET will help by reducing the number of ear infections the child has. C. The child should use earplugs when showering or bathing. D. The tubes will most likely remain in place for 3 to 4 years.  A child with a history of otitis externa asks about ways to preve nt this condi tion. What will the prima ry care pedia tric

nurse practitioner recommend? (^) A. Cleaning ear canals well after swimmin g B. Drying the ear canal with a hair dryer C. Swimmin g only in chlorinat e d pools

D. Using cerumenolytic agents daily  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. Correc C. Prescribe oral amoxicillin-clavulanate. D. Refer the child to an otolaryngologist.  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. J. K. ID:  The primary care pediatric nurse practitioner notes a small, round object in a child’s external auditory canal, near the tympanic membrane. The child’s parent thinks it is probably a dried pea. What will the nurse practitioner do to remove this object? A. Irrigate the external auditory canal to flush out the object. B. Refer the child to an otolaryngologist for removal. C. Remove the object with a wire loop curette. D. Use a bayonet forceps to grasp and remove the object.  A 3-year-old child has had one episode of acute otitis media 3 weeks prior Corr with a Corr

H. I. ID: normal tympanogram just after treatment with amoxicillin. In the clinic today, the child has a type B tympanogram, a temperature of 102.5°F, and a bulging tympanic membrane. What will the primary care pediatric nurse practitioner order? F. A. A referral for tympanocentesis B. Amoxicillin twice daily C. Amoxicillin-clavulanate twice daily Correct D. Intramuscular ceftriaxone

 The primary care pediatric nurse practitioner diagnoses acute otitis media in a 2- G. ID: year-old child who has a history of three ear infections in the first 6 months of life. The child’s tympanic membrane is intact and the child has a temperature of 101.5°F. What will the nurse practitioner prescribe for this child? A. Amoxicillin twice daily for 10 days B. An analgesic medication and watchful waiting (^) Correct C. Antibiotic ear drops and ibuprofen D. Ceftriaxone given once intramuscularly  A child who was treated with amoxicillin and then amoxicillin- clavulanate for acute otitis media is seen for follow-up. The primary care pediatric nurse practitioner notes dull-gray tympanic membranes with a visible air-fluid level. The child is afebrile and without pain. What is the next course of action? A. Administering ceftriaxone IM B. Giving clindamycin orally C. Monitoring ear fluid levels for 3 months Correct D. Watchful waiting for 48 to 72 hours  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 Correct B. Mastoiditis C. Otitis externa D. Otitis media with effusion Questions  The primary care pediatric nurse practitioner is examining a 2- week-old infant and auscultates a wide splitting of S 2 during expiration. What condition may this finding

Correct represent? A. Atrial septal defect Correct B. Coarctation of the aorta C. Patent ductus arteriosis D. Ventricular 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  During a well child assessment, the primary care pediatric nurse practitioner ID: 13348441107 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. Correc  The primary care pediatric nurse practitioner provides primary care for a 4-month- ID: 13348441105 old infant who has a ventricular septal defect. The infant has been breastfeeding well but in the past month has dropped from the 20th percentile to the 5th for weight. What will the nurse practitioner recommend? A. Adding solid foods to the infant’s diet to increase caloric intake B. Fortifying breast milk to increase the number of calories per ounce Correct C. Stopping breastfeeding and giving 30 kcal/ounce formula D. Supplementing breastfeeding with 24 kcal/ounce formula

 A 12-month-old infant who had cardiopulmonary bypass with RBC and plasma ID: 13348441117 infusions during surgery at 8 months is seen for a well child examination. Which vaccine may be administered at this visit?

Correct

A. MMR

B. OPV

C. PCV-

D. Varivax  The primary care pediatric nurse practitioner performs a well child examination on ID: 13348437999 a 12-month-old child who had repair of a congenital heart defect at 8 months of age. The child has a normal exam. The parent reports that the child is not taking any medications. The nurse practitioner will contact the child’s cardiologist to discuss whether the child needs which medication? A. Amoxicillin Correct B. Capoten C. Digoxin D. Furosemide  During a well baby examination of a 6-week-old infant, the primary care pediatric ID: 13348437995 nurse practitioner notes poor weight gain, acrocyanosis of the hands and feet, and a respiratory rate of 60 breaths per minute. Oxygen saturation on room air is 93%. The remainder of the exam is unremarkable. Which action is correct? A. Follow-up in 1 week to assess the infant’s weight. B. Order a chest radiograph and an electrocardiogram. C. Reassure the parents that the exam is within normal limits. D. Refer the infant to a pediatric cardiologist. Correct  A 3-month-old infant who was previously healthy now has a persistent cough, ID: 13348441103 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 defectCorrect

 An infant with trisomy 21 has a complete AV canal defect. Which finding, 133441101 ssociated with having both of these conditions, will the primary care pediatric nurse practitioner expect? A. Crackles in both lungs B. Hepatomegaly C. Oxygen desaturation Correct D. Peripheral edema  A 9-month-old infant has a grade III/VI, harsh, rumbling, continuous murmur in the ID: 13348441131 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 (^) Correct C. Indomethacin administration D. Observation for spontaneous closure  A 5-year-old child who had a repair for transposition of the great arteries shortly ID: 13348437991 after birth is growing normally and has been asymptomatic since the surgery. The primary care nurse practitioner notes mild shortness of breath with exertion and, upon questioning, learns that the child has recently complained of dizziness. What will the nurse practitioner do? A. Order an echocardiogram and chest radiograph. B. Perform pulmonary function testing. C. Reassure the parent that these symptoms are common. D. Refer the child to the cardiologist immediately. Correc  The primary care pediatric nurse practitioner is performing a well child examination on a school-age child who had complete repair of a tetralogy of Fallot defect in infancy. What is important in this child’s health maintenance regime? A. Cardiology cleara nce for sports partic ipatio n

Correct ID: 13348437997

B. Restriction of physical activity to avoid pulmonary complications C. Sub-acute bacterial endocarditis prophylaxis precautions D. Teaching about management of hypercyanotic episodes  The primary care pediatric nurse practitioner is performing a sports physical on an adolescent whose history reveals mild aortic stenosis. What will the nurse practitioner recommend? A. Avoidance of all sports to prevent sudden death B. Clearance for any sports since this is mild C. Evaluation by a cardiologist prior to participation Correct D. Low-intensity sports, such as golf or bowling ID: 13348441113  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 Correct D. Tricuspid atresia  A 5-year-old child has an elevated blood pressure during a well child exam. The ID: 13348441123 primary care pediatric nurse practitioner notes mottling and pallor of the child’s feet and lower legs and auscultates a systolic ejection murmur in the left infraclavicular region radiating to the child’s back. The nurse practitioner will suspect which condition? A. Aortic stenosis B. Coarctation of the aorta (^) Correct C. Patent ductus arteriosus D. Pulmonic stenosis

 An adolescent female has a history of repaired tetralogy of Fallot. Which long- term complication is a concern for this patient? A. Aortic stenosis B. Chronic cyanosis

C.

Mitral valve prolapse D.

Ventricular failure  A 6-year-old child has a systolic blood pressure between the 95th and 99th ID: 13348441109 percentile for age, sex, and height and a diastolic blood pressure between the 90th and the 95th percentile on three separate clinic visits. This child’s blood pressure is classified as A. normotensive. B. pre-hypertensive. C. stage 1 hypertensive. Correc D. stage 2 hypertensive.  A 12-year-old child whose weight and BMI are in the 75th percentile has a diastolic blood pressure that is between the 95th and 99th percentiles for age, sex, and height on three separate occasions. Initial tests for this child will includeA. complete blood count. B. erythrocyte sedimentation rate. C. renal function and plasma renin tests. Correc D. urinalysis and electrolytes.  A 12-year-old child whose BMI is greater than the 95th percentile has a blood ID: 13348441115 pressure at the 98th percentile for age, sex, and height. After lifestyle changes that include diet and exercise, the child’s BMI drops to the 90th percentile, but the blood pressure remains the same. What is the primary care pediatric nurse practitioner’s next step in treating this child? A. Continued close monitoring of blood pressure B. Ordering an echocardiogram or MRI C. Prescribing an ACE inhibitor medication

D. Referral to a nephrologist or cardiologist Correct  A 7-year-old child who has a history of a repaired congenital heart defect has ID: 13348441125 many dental caries along with gingival erythema and irritation and a temperature of 102.5°F. What will the primary care pediatric nurse practitioner do next? A. Admit to the hospital with a pediatric cardiology consult. Correc B. Obtain blood cultures and a CBC and consult a pediatric cardiologist. C. Refer the child to a pediatric dental surgeon immediately. D. Start prophylactic antibiotics such as penicillin twice daily for 2 weeks.  A 15-year-old female reports fainting at school in class on two occasions. The ID: 13348441111