Pediatric Medical Conditions and Management, Exams of Pediatrics

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PNP Pediatric Nurse Practitioner 2024

Exam 3 Practice Test 1 Questions and

Answers 100% Pass

The mother of a newborn brings the baby to the clinic because she is afraid something is wrong with her baby ("his head is so big"). The PNP responds that: a. "this is normal. The head of a newborn is proportionately large to the rest of the body" b. "Yes, this does appear abnormal. I will make an appointment for the baby to be seen by a neurologist." d. "your head appears large so it is probably genetic." - Answer>> a A healthy 12yo female is at the clinic for a well checkup. On physical examination, a marked elevation of the right scapula and right thoracic hump and spinal curve abnormally are noted. Spinal films indicate 20 degree curve. The PNP should: a. refer the patient to an orthopedist b. monitor the patient every 3 mo until menarche c. refer the patient for physical therapy d. recommend bedrest and back brace - Answer>> a What is the % of risk an autosomal dominant gene is being passed on to each offspring? a. 25 b. 50 c. 100 d. none - Answer>> b A 13yo female is at the clinic for a routine check up. What presenting symptoms might alert the PNP to the presence of a possible genetic disorder? a. <10% on growth chart, Tanner I, and learning difficulties

b. Precocious puberty, developmental delays, gifted piano player c. Lactose intolerance, frequent ear infections, speech delays d. Peanut allergy, right-sided weakness, and exhibits bullying behavior - Answer>> a The parents of a son with hemophilia are considering another pregnancy. The mother has been identified as a carrier of the hemophilia gene. What chance does each female offspring have of having hemophilia. a. 100% b. 50% c. 25% d. none - Answer>> d An adolescent is being seen at a community health center because of recurrent respiratory tract infections. The complete blood cell count (CBC) with differential shows a white blood cell count of 20,500 with 35% blast cells. The next step in managing the adolescent's care is to: A) Repeat the CBC with differential in 1 week B) Refer to a specialist in pediatric hematology C) Perform bone marrow aspiration D) Hospitalize the adolescent immediately - Answer>> b A 9-month-old infant was diagnosed with sickle cell disease shortly after birth. The mother telephones the PNP to report that the infant has a fever of 103.2°F. The best response to the mother is: A) "Take the infant to the emergency room immediately." B) "Administer a dose of ibuprofen, and call back in 6 hours if the fever continues." C) "Give extra fluids and acetaminophen, and call back tomorrow if the fever continues." D) "Give extra fluids and acetaminophen, and bring the infant to the clinic tomorrow morning." - Answer>> a

A 5-year-old child has sudden onset of nonblanching purpuric lesions scattered over the body and petechiae scattered over the neck and shoulders. The mother reports that the child has been healthy, except for a cold a few weeks ago. The child is not taking any medications. Physical examination reveals a healthy, afebrile child with no other significant findings. The laboratory data show a hemoglobin level of 12.5 g/dL, white blood cell count of 6500/mm3, and platelet count of 20,000/mm3. Based on this information, what should the PNP do next? A) Reassure the parents that these findings are consistent with acute idiopathic thrombocytopenia purpura (ITP), and advise a hematology consultation for confirmation B) Refer the child immediately to the pediatric hematology/oncology department of the nearest tertiary care center C) Report the family to the local protective services department as soon as possible because of the - Answer>> a A 4-year-old child is scheduled for a tonsillectomy and adenoidectomy. The preoperative laboratory tests indicate a prolonged active partial thromboplastin time (aPTT). The PNP should suggest that they: A) Continue with the surgery, and monitor the child closely for bleeding complications B) Cancel the surgery, and recheck the aPTT in 1 week C) Cancel the surgery, and refer the child to a hematologist D) Obtain a family history, and determine whether there are other relatives with a bleeding disorder - Answer>> c A 13-year-old adolescent complains of having difficulty walking and the arms feeling weak. The adolescent had a cold 2 weeks ago. On examination, the PNP is not able to elicit deep tendon reflexes. The PNP knows that the most appropriate course of action is to:

A) Refer the adolescent to an orthopedic surgeon B) Schedule a follow-up visit in 1 week C) Refer the adolescent to a neurologist D) Refer the adolescent to an emergency room - Answer>> d A 1-year-old child is brought to the clinic with a temperature of 102°F and left flank pain. The urine dipstick test indicates nitrates and leukocyte esterase. The presenting signs and symptoms suggest left pyelonephritis. Based on the data, the most appropriate action for the PNP is to: A) Refer the child to a urologist for diagnosis and treatment B) Consult with a physician C) Provide symptomatic treatment for 24 hours, and repeat the urine dipstick test D) Send urine for culture and sensitivity testing - Answer>> b A 10-year-old child is examined because of recurrent UTIs. A urologic workup is performed. No abnormalities are found. To help prevent future UTIs, the PNP should suggest which of the following interventions? A) Taking a 30-minute bath daily B) Avoiding showering C) Using a voiding schedule to expand the bladder D) Practicing good perineal hygiene - Answer>> d A PNP responsible for neonatal discharge rounds at the hospital examines a male infant and notes that the urethral opening appears displaced ventrally along the glans. A closer assessment reveals an undiagnosed mild hypospadias. What should the parents be told? A) Hypospadias occurs in approximately 1 in 500 neonates B) The infant should be evaluated for other anomalies of the upper urinary tract C) The infant should be assessed for undescended testes and inguinal hernia

D) Routine circumcision should be performed by 6 weeks of age - Answer>> c A 2-month-old infant is brought to clinic with a stuffy, runny nose of 3 days' duration. The infant is afebrile and has no cough or respiratory difficulty but is not nursing or sleeping well. The tympanic membranes are within normal limits. What advice would the PNP give? A) Administer amoxicillin suspension 125 mg/5 mL, 1 tsp three times a day for 10 days B) Elevate the head of the bed, administer saline nose drops, and use a room humidifier C) Investigate allergic overload in the home; administer amoxicillin and Neosynephrine nose drops D) Change the infant's formula to a soy-based formula - Answer>> b A 2-year-old child is brought to the clinic with a 2-day history of a harsh, predominantly nocturnal cough, fever of 100°F, and clear rhinorrhea. The child is diagnosed with croup. Which of the following would the PNP tell the parent? A) "The cold symptoms should be gone in 3 days." B) "If the child is unable to swallow and begins to drool, call the office." C) "A high fever is normal for the first 2 days of a cold." D) "An antibiotic needs to be prescribed." - Answer>> b A mother calls the office and asks what she can do to decrease the discomfort her 9-year-old child is experiencing with an upper respiratory tract infection. The mother should be instructed to: A) Administer pseudoephedrine and normal saline nose drops B) Administer normal saline nose drops and benzonatate C) Place a cool-mist humidifier in the child's room, and administer benzonatate

D) Administer dextromethorphan and normal saline nose drops - Answer>> a The mother of a 10-week-old calls the office because the infant is passing hard stools. What suggestions would the PNP offer a mother? A) "Do nothing. Time will take care of the problem." B) "Hold the infant upright so gravity can help the stool pass." C) "Give a little extra water with added pasteurized apple or prune juice." D) "Add honey to a 4-oz bottle of water." - Answer>> c The PNP returns a phone call to the mother of a 2-week-old infant. The infant is breastfed exclusively and at the 1-week checkup weighed 4 oz more than at birth. The infant has not had a bowel movement in 4 days but has had more than eight wet diapers each day, is nursing vigorously, and has no signs or symptoms of illness. Appropriate counseling for this mother should include: A) Because there has been no bowel movement in 4 days, a glycerin suppository should be administered B) Rectal stimulation should be performed every hour until a bowel movement is produced C) No treatment is necessary; the mother should be reassured only D) The infant should be evaluated in the gastroenterology clinic - Answer>> c While examining a 3-year-old child for a well-child visit, labial adhesions are noted. The PNP discusses with the mother: A) Concern of sexual abuse B) Proper hygiene C) Causes of UTI D) Surgical treatment of the adhesions - Answer>> b

In providing anticipatory guidance to the parents of a 5-year-old child with diabetes, the PNP should teach them to recognize the symptoms of sweating, hunger, drowsiness, and confusion. These are all symptoms of: A) Diabetic ketoacidosis B) The dawn phenomenon C) Hypoglycemia D) The Somogyi phenomenon - Answer>> c A PNP has been asked by the emergency room physician to evaluate a child for costochondritis. The PNP would expect to find: A) Tenderness of the midsternal area B) Atelectasis on chest x-ray film C) Dullness on percussion D) Muffled heart sounds - Answer>> a A 16-year-old adolescent has evidence of weight loss. The PNP notes on the chart documentation of frequent loose stools for 2 weeks. The differential diagnosis includes hyperthyroidism. What additional clinical finding would suggest this diagnosis? A) Dry mouth B) Hypotension C) Coarse hair D) Heat intolerance - Answer>> d The PNP evaluates an infant born to a mother known to have autoimmune thyroid disease. Congenital hypothyroidism in infants is associated with which of the following? A) Excessive sleepiness B) Failure to thrive C) Tachycardia D) Diarrhea - Answer>> a

An 8-year-old child with spina bifida is examined in the clinic. The mother states that the child was doing well until attending a party at school today. Physical examination reveals a cooperative child with mild, clear rhinorrhea; red, watering eyes; generalized hives; edema of the face and eyes; and no acute respiratory symptoms. What would be the most appropriate question to ask when looking for the possible cause of an allergic reaction in this child? A) "What foods did you eat?" B) "Have you been exposed to anything new?" C) "Were there any balloons at the party?" D) "Did a bee or insect sting you?" - Answer>> c A 2-month-old infant has symptoms of a severe cough followed by vomiting. The infant had an upper respiratory tract infection 2 weeks before the onset of coughing. The PNP suspects pertussis and orders a chest x-ray film and culture of the nasopharynx. The PNP refers the infant for hospitalization and begins treatment with: A) Erythromycin B) Trimethoprim/sulfamethoxazole C) Corticosteroids and beta-agonist aerosol D) Amoxicillin - Answer>> a A complete blood count (CBC) is obtained for a 6-year-old child with a rash and systemic symptoms of fever and general malaise. The results are all within normal limits except the eosinophil count, which is elevated. This finding supports the diagnosis of: A) Allergic reaction B) Bacterial infection C) Viral exanthem D) Rheumatic fever - Answer>> a A child is brought to the clinic after being hit in the head with a hockey stick. The child now has profuse rhinorrhea but is in no

distress. The examination reveals a hemotympanum, which is indicative of: A) A foreign body in the canal B) Perforation of the tympanic membrane C) A basilar skull fracture D) Acute serosanguineous otitis media - Answer>> c A 2-year-old child who may have swallowed a watch battery is brought to the clinic. The child has no symptoms of ingestion of a foreign body. The initial action for the PNP is to: A) Obtain an x-ray film of the chest and abdomen to locate the battery B) Refer immediately for a surgery consult and possible removal of the battery C) Send the parents home with instructions to watch for the battery in the stool D) Send the parents home with instructions to return if the child experiences abdominal pain - Answer>> a A 3-year-old child is brought to the clinic with noisy respirations. Which of the following signs or symptoms would be an indication for immediate referral and hospitalization? A) Mild restlessness B) Stridor at rest C) Fever of 102°F D) Slightly elevated white blood cell count - Answer>> b A 12-year-old child comes to the school-based clinic complaining of unilateral chest pain that radiates to the back and abdomen. On physical examination, tenderness over the costochondral junction is noted. The chest pain is most likely caused by: A) A fractured rib B) Gastric reflux C) Costochondritis D) Pneumonia - Answer>> c

A 10-month-old infant is noted to have cranial and facial asymmetry during a well-child visit. The PNP should: A) Observe the infant, and reevaluate cranial shape at the 1-year well visit B) Refer immediately to a neurologist C) Obtain a cranial radiologic film, CT scan of the skull, or both D) Perform a Denver Developmental Screening Test - Answer>> c A 10-month-old infant is brought to the clinic because of an acute illness. On examination the PNP notes a large, bulging umbilical mass. The mass is easily reducible although prominent when the child cries. The PNP: A) Refers the infant to a surgery clinic for evaluation of the hernia and treats the acute illness B) Treats the acute illness, comments on the hernia, and measures the abdominal opening C) Discusses with the parents the need to apply a bellyband to "hold in" the hernia D) Explains to the parents that surgical repair should be performed when the child is between age 2 and 3 years - Answer>> b The most sensitive physical finding for the diagnosis of testicular torsion is: A) The alleviation of pain when the testis is elevated B) Pain lasting for hours or days C) Abnormal results of urine culture D) Absence of the cremasteric reflex - Answer>> d A 14-year-old adolescent has pain in the knee. The pain increases with activity and is relieved with rest. The PNP diagnoses Osgood-Schlatter disease and orders:

A) An x-ray examination, application of hot packs to the knee, and rest B) Application of hot packs to the knee, aspirin, and rest C) A reduction in activity, application of ice to the knee, and ibuprofen D) Application of ice to the knee and continued participation in sports - Answer>> c The PNP in the Emergency Departmetnt is evaluating a 3-year- old child with a history of sudden onset of high fever and stridor. The child refuses to move and is sitting upright, leaning forward with the mouth open, and drooling. The safest and most helpful diagnostic test to order now would be: A) Urine culture B) A lateral neck x-ray film C) A chest x-ray film D) A throat culture - Answer>> b An infant brought to the clinic is diagnosed with failure to thrive (FTT), persistent growth deficiency of the head, and delayed development. Some unusual facial abnormalities are noted. The mother has a history of consuming large amounts of alcohol. The PNP suspects fetal alcohol syndrome (FAS) and refers the infant: A) To a First Steps Program or Birth to Three Program B) For consultation with a neurologist C) For a genetic workup D) For consultation with an endocrinologist - Answer>> a The PNP is assessing a neonate in the nursery. The cremasteric reflex is absent, and the right testicle cannot be palpated in the scrotum. The PNP should: A) Order a sonogram B) Consult with the physician C) Refer the neonate to the urology clinic

D) Not allow the neonate to be discharged from the hospital - Answer>> b The PNP is in the nursery to examine a neonate. The results of the neonatal screen are noted in the chart. The T4 level is low, and the TSH level is elevated. The PNP should: A) Consult with the physician, and repeat the tests B) Discharge the neonate, and schedule a follow-up visit in the office in 1 week C) Begin the neonate on thyroxine based on the test results D) Examine the neonate for signs of hypothyroidism - Answer>> a A 7.5-year-old Hispanic child has prepubertal pigmented pubic hair. No other secondary sex characteristics are noted. The mother is concerned that the child will soon begin menstruating. What advice would the PNP give the mother? A) "Premature sexual development is common in Hispanic girls, and no treatment is required." B) "Premature adrenarche can be a normal variant in Hispanic girls, and no treatment is required, but we will monitor the changes at each annual visit." C) "Central precocious puberty is a normal variant in 10% to 15% of girls." D) "Start talking to your daughter about the menstrual cycle because menarche will occur soon." - Answer>> b The mother of a 5-year-old child questions the PNP about precocious puberty. The PNP relates to the mother that complete or central precocious puberty: A) Is more common in boys B) Is usually idiopathic in girls C) Is often caused by central nervous system (CNS) tumors in girls

D) Affects one area of sexual development only - Answer>> b Three months ago, a 7-year-old child with type 1 diabetes was hospitalized for elevated blood glucose levels and thyroxine (T4) and ketones in the urine. The child's blood glucose level has been elevated for the past three mornings and within normal limits during the rest of the day. What advice would the PNP give the parents? A) "Increase the evening dose of regular insulin, which works from bedtime to the following morning." B) "Increase the evening dose of NPH, which works from bedtime to the following morning." C) "Decrease the evening dose of regular insulin, which works from bedtime to the following morning." D) "Decrease the evening dose of NPH, which works from bedtime to the following morning." - Answer>> b A 7-year-old child has a blood glucose level of 414 mg/dL. Ketones are present in the urine. The child is admitted to the hospital for treatment of type 1 diabetes. In the hospital a registered dietitian meets with the parents to explain how food influences blood glucose levels. The goal is a well-balanced diet that provides adequate nutrition for appropriate growth and development. The PNP reinforces the dietitian's advice by telling the parents that the child's diet should consist of: A) 10% to 15% fat, 30% to 35% protein, and 45% to 60% carbohydrates B) 10% to 20% fat, 10% to 20% protein, and 55% to 60% carbohydrates C) 5% to 10% fat, 25% to 30% carbohydrates, and 45% to 60% protein D) 30% to 35% fat, 10% to 15% carbohydrates, and 45% to 60% protein - Answer>> b

A 10-year-old diabetic has blurred vision, fruity breath odor, and a rapid pulse. The blood glucose level is 380 mg/dL, and the urine glucose level is 2%. A test strip was positive for ketones. The child complains of cough and a sore throat. The PNP reminds the child that ketoacidosis is a serious complication of diabetes and that ketone testing should be done: A) When the blood glucose test result is 180 mg/dL or more B) When the blood glucose level is 80 mg/dL or less C) Every day so that it is evident when the blood glucose level is elevated D) During any illness, even a cold - Answer>> d Hypothyroidism has just been diagnosed in a 5-year-old child, and thyroid replacement therapy has been initiated. Anticipatory guidance for the child and family should include: A) Emphasizing the importance of compliance and periodic monitoring of the child's response to therapy B) Initiating appropriate referrals for the child regarding possible mental retardation caused by hypothyroidism C) Helping the family accept the child's short stature, which cannot be prevented but can be coped with in a healthy manner D) Referring the child to a dermatologist for treatment of mixed edematous skin changes - Answer>> a An 11-year-old girl is brought to the office for an annual well-child visit. When discussing the onset of puberty with the preadolescent and the mother, which information would the PNP provide? A) "Pubic hair develops before breast buds." B) "Girls have their greatest linear growth after menses." C) "The average time from breast buds to menarche is 1.5 to 2. years." D) "The average age of onset for menarche is 10 to 12 years." - Answer>> c

An understanding of the pathophysiology of UTIs is essential when educating families about the prevention of recurrent infections. What should a family be told about decreasing the risk for UTI in their child? A) Encourage daily baths B) Prevent and monitor for constipation C) Encourage drinking grapefruit and orange juice D) Suggest the child use the bathroom three to four times a day - Answer>> b A father asks how his 10-year-old daughter could have developed pyelonephritis. The PNP explains that cystitis or pyelonephritis in childhood is most probably caused by: A) Catheterization or fecal soilage B) Hematogenous spread or bacteremia C) Drugs or foreign bodies D) Ascension of bacteria into the urinary tract - Answer>> d A 2-year-old child is screened for lead poisoning. The blood level is 16 mg/dL. The PNP discusses nutritional needs, including a diet high in: A) Protein and calcium B) Vitamin C and iron C) Fat and Zinc D) Calcium and iron - Answer>> d In counseling a parent regarding possible lead poisoning in the child, the PNP states that the most common source of lead is: A) Drinking water B) Soil C) Lead-based paint D) Batteries - Answer>> c A 17-year-old adolescent is anticipating marriage after completing high school. The adolescent does not have sickle cell disease and

is not a carrier of the trait, but the intended spouse has sickle cell trait. The adolescent asks if it is possible that any of their future children will have sickle cell disease. The adolescent is told that there is a 50% chance that: A) Their children will have sickle cell disease B) Their children will have sickle cell trait C) Only their sons will have sickle cell disease D) Only their sons will have sickle cell trait - Answer>> b An 11-year-old child is concerned about breast size. About 6 months ago when her breast development began, she noticed that her breasts were different sizes. The PNP responds: A) "This is abnormal and you need to see a specialist." B) "Menarche will appear soon." C) "A mammogram is needed." D) "The breasts will become closer to the same size within a few years." - Answer>> d The most appropriate advice the PNP can give the mother of a 10-month-old who weighs 21 lb concerning the use of car seats is: A) "A child weighing more than 20 pounds may face forward in the car seat." B) "A booster seat should be used when your child has outgrown a convertible car seat but is still too small to fit properly in a vehicle safety belt." C) "Keep using a rear-facing car seat until age 1 year." D) "It is safe to keep your child in a car seat in the front seat of the car as long as there is not a passenger-side airbag." - Answer>> c A 3-week-old infant is being breastfed by a new mother. The mother is unsure if the infant is getting enough breast milk. Besides documenting weight gain, what other signs can the

mother observe as an indication of adequate breast milk intake? The infant: A) Sleeps 4 to 5 hours between feedings B) Cries vigorously before feedings C) Has 4 stools and 6 wet diapers per day D) Sucks eagerly on a pacifier and chews on hands after feeding

• Answer>> c The PNP is performing a well-child examination on an 8-year-old child with a previous diagnosis of precocious puberty. The patient is Tanner stage III for breast development and pubic hair growth, with height and weight in the 95th percentiles. The patient has missed 6 months of her hormone therapy. The mother states that the child often complains of abdominal cramping, and the mother has noticed an increased vaginal discharge. The remainder of the examination is normal. Addressing the abdominal pain should include: A) Evaluation for a UTI B) Guidance regarding the appropriate dietary intake of fruits, fiber, and water to prevent constipation C) Anticipatory guidance regarding the importance of complying with drug therapy and the likelihood of the onset of menses D) A referral to a gastroenterologist for evaluation - Answer>> c A 15-year-old girl is being evaluated for possible delayed puberty. There is a documented history of Tanner stage 2 breast development and Tanner stage 1 pubic development at age 9. years. What current findings would support the diagnosis of delayed puberty? A) Family history of abnormal puberty B) Palpable breast buds with areolar enlargement C) Dark, coarse, curly pubic hair spreading over the mons D) Weight at 5th percentile - Answer>> b

An 8.5-year-old child is brought to the clinic for the first time. On physical examination a penile length of 6.2 cm is noted. The differential diagnosis includes precocious puberty. What additional clinical finding is associated with precocious puberty? A) A testicular length of 2.1 cm B) Multiple small café au lait spots (neurofibromatosis) C) A growth spurt of 5 cm/y D) A blood glucose level of 97 mg/dL - Answer>> b A 5-day-old neonate, diagnosed with trisomy 21, was noted to have an elevated thyroid-stimulating hormone (TSH) level. The neonatal screening was performed at age 3 days. What should the PNP do next? A) Reassure the mother that an elevated TSH at age 3 days is common and that no further treatment is necessary B) Repeat the test because it was not performed at the appropriate time C) Repeat the test when the child is age 3 weeks because this is the appropriate time D) Repeat the test and inform the mother that children with Down's syndrome have a high rate of hypothyroid disease - Answer>> d The PNP is meeting with the parents of a 7-year-old child with type 1 diabetes to discuss blood glucose levels. A suggested blood glucose level for a 7-year-old child with diabetes is between: A) 80 and 120 mg/dL B) 100 and 200 mg/dL C) 80 and 180 mg/dL D) 70 and 150 mg/dL - Answer>> c A 14-year-old Asian-American male is brought to the office for a well-child visit. The adolescent measures 145 cm (57 inches) in height and weighs 46 kg (102 lb). Physical examination reveals

underdeveloped genitalia (i.e., Tanner stage 1, testes down, no hernia). Which diagnostic tests would the PNP order initially? A) Thyroid function tests, a bone age determination, and a complete blood cell count B) Tests to determine plasma luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels and bone age C) Radiographic examination of the spine, tests to determine the plasma FSH level, and thyroid function studies D) Tests to determine the sedimentation rate, FSH, and bone age

• Answer>> b The PNP evaluates an infant born to a mother known to have autoimmune thyroid disease. Congenital hypothyroidism in infants is associated with which of the following? A) Excessive sleepiness B) Failure to thrive C) Tachycardia D) Diarrhea - Answer>> a In caring for a noncompliant 16-year-old adolescent with diabetes, the PNP can best assess the diabetic control by: A) Measuring the insulin level B) Obtaining a glucose tolerance test C) Monitoring serum glucose levels for 3 consecutive days D) Measuring the hemoglobin A1c level - Answer>> d The PNP is caring for a 10-day-old neonate who was born by vaginal delivery at a birthing center. The neonate was sent home at age 24 hours and received the initial thyroid function tests. The tests revealed a mildly low T4 and an elevated TSH level. The infant has been feeding without difficulty, has regained birth weight plus 3 oz, and appears alert during the examination. The PNP's management of the child should include: A) Beginning levothyroxine therapy and referring the family to an endocrinologist

B) Repeating the test, including serum T4, TSH, thyroxine-binding globulin, and T C) Referring the parents for genetic counseling D) Beginning fludrocortisone therapy and repeating the initial tests

• Answer>> b In the management of a child with a neurogenic bladder resulting from myelomeningocele, the most critical long-term goal is: A) Controlling incontinence B) Preventing kidney damage C) Preparing the child for bladder augmentation D) Preventing bladder spasms - Answer>> b A 4-year-old child is brought to the office for a preschool physical examination. The PNP asks the child to sit on the floor in a cross- legged position and then get up without using the hands. The child is unable to do so and rolls onto all four extremities before standing. The PNP is concerned that the child may have a: A) Neuromuscular disorder B) Developmental problem C) Cognitive deficit D) Neurologic deficit - Answer>> a A 6-month-old infant is brought to the clinic for a well-child visit. On physical examination, increased tone and lower leg scissoring are noted. The PNP recognizes this as a probable sign of: A) Muscular dystrophy B) Down's syndrome C) Cerebral palsy D) Fragile X syndrome - Answer>> c A previously healthy 10mo has vomiting, intermittent periods of intense crying, and the passage or red stool. Which would be considered FIRST in child? a. refer to emergency dept

b. obtain an abdominal x-ray c. obtain a complete blood count d. schedule surgical appointment for tomorrow. - Answer>> a. What is considered minimal weight gain in a normal newborn after discharge from the hospital? a. 10gms/day b. 20gms/day c. 30gms/day d. 40 gms.day - Answer>> c You would expect a school age child to: a. grow 1.5in per year b. grow 0.5in per year c. Gain about 6lb per year d. Gain about 3lb per year - Answer>> c Which of the following ongoing assessments have no specific indication for individuals which Turner's syndrome? a. Cardiac monitoring b. vision screening c. tanner staging d. thyroid screening - Answer>> b While examining a 2.5 week old infant, you notice irritability when you lift the infant and an asymmetrical Moro reflex. A spasm of the sternocleidomastoid on the left side is also present. These findings suggest: a. Torticollis b. Genu varum c. Fracture clavicle d. Pierre-Robin syndrome - Answer>> c Newborn screening for hypothyroidsm is done by measuring: a. thyroid stimulating hormone (TSH)

b. Thyroxine (T4) and TSH c. Triiodothyronine (T3) d. T4 binding globulin (TBG) - Answer>> b Infants who have been identified as IUGR are prone to developing hypoglycemia due to: a. decreased metabolic rate b. low levels of glycogen stored c. become acidotic d. a prone to develop sepsis - Answer>> b Molly is a 12yo girl who has diffuse stomach pain and acute onset of diarrhea described as frequent urge to defecate. She is passing large amounts of flatus, small amounts of stool, and has rectal tenderness with digital exam. Which lab test will confirm your diagnosis? a. serum albumin & ESR b. abdominal ultrasound c. stool for ova & parasites d. Upper GI - Answer>> b Vomitus that is bilious suggest: a. obstruction proximal to the pylorus b. obstruction below the ampulla of Vater c. Pyloric stenosis d. peptic ulcer disease - Answer>> b An 18yo female college freshman, Bailey, presents to college health with an 8hr hx of abdominal pain that began in the periumbilical area and then localized to the RLQ. She has been on OCPs for teh past 6mo. Bailey denies a medical hx of UTIs, pregnancy, STDs, or chronic illness. Upon her physical exam, she is guarding on the RLQ with generalized tenderness and no masses. Her temp is 99.6 and her vitals are normal.

Based on this H&P, which of the following is the most likely diagnosis for Bailey? a. Mittelschmerz b. Ectopic pregnancy c. Appendicitis d. Gastroenteritis - Answer>> c An 18yo female college freshman, Bailey, presents to college health with an 8hr hx of abdominal pain that began in the periumbilical area and then localized to the RLQ. She has been on OCPs for teh past 6mo. Bailey denies a medical hx of UTIs, pregnancy, STDs, or chronic illness. Upon her physical exam, she is guarding on the RLQ with generalized tenderness and no masses. Her temp is 99.6 and her vitals are normal. Which of the following is the most suggestive of Bailey's diagnosis? a. Leukocytosis b. Hematemesis c. + psoas sign d. Vomiting before the onset of pain - Answer>> c You receive a call from a mother of a 2yo girl with a temp of 101F and diarrhea for 5 days with 6-8 liquid stools/day. How would you advise this mother? a. Go to ER now b. Come to the office tomorrow morning c. NPO d. Loperamide 10ml after each loose stool - Answer>> b An 18yo male comes to see you with a painless mass in the right side of his scrotum. The most likely diagnosis is: a. epididymitis b. testicular torsion c. incarcerated hernia d. hydrocele - Answer>> d

A mother of a 16mo old toddler announces that she is giving her child skim milk. You tell her she should switch to whole milk because: a. skim milk is not easily digested b. Skim milk does not have enough calcium c. Skim milk has too little protein d. Skim milk does not contain enough essential fatty acids - Answer>> d The time of ovulation is usually: a. about 14 days before onset of the next menstrual period b. about 14 days after the onset of the previous menstrual period c. during the menstrual period d. about 7 days after the onset of the menstrual period - Answer>> a Jess has recently noticed that a change in his voice, the shape of his body, and pubic and facial hair growth. What is he noticing is the development of: a. primary sexual characteristics b. secondary sexual characteristics c. deciduous sexual characteristics d. laten sexual characteristics - Answer>> b Which component of identity is likely to develop first? a. physical b. vocational c. moral d. ideological - Answer>> a Which of the following is responsible for sexual maturation of males? a. estrogen

b. testosterone c. progesterone d. adrogen - Answer>> b Which of the following is the correct sequence for adolescent female development? a. growth acceleration, breast development, pubic hair, menarche, axillary hair b. growth acceleration, pubic hair, breast development, axillary hair, menarche c. breast development, growth acceleration, axillary hair, pubic hair, menarche d. axillary hair, breast development, pubic hair development, menarche, growth acceleration - Answer>> a Which of the following drugs is important in symptom management and the prevention of complications in Kawasaki's disease? a. aspirin b. corticosteroids c. acetaminophen d. penicillin - Answer>> a During a visit to your clinic, Mitch, 2yo, presents large muscular calves & demonstrates difficulty rising from sitting position. Which lab test should you order below? a. serum calcium b. serum magnesium c. serum phosphorus d. serum creatine kinase - Answer>> d Which of the following tests is not an appropriate test for development dysplasia of the hip in an 18mo infant? a. allis sign b. skinfold symmetry