Pediatric Nurse Practitioner Exam Practice Questions, Exams of Pediatrics

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Pediatric Nurse Practitioner Exam

Practice Questions

The concept of health promotion consists of efforts to prevent rather than to cure disease or disability. This description best describes: a. tertiary prevention b. secondary prevention c. primary prevention d. morbidity prevention - ANS c Standards for well child care and health promotion are set forth by the: a. Task Force on Preventative Services, US Department of Health and Human services b. American Academy of Family Physicians c. American Academy of pediatrics d. Healthy People 2010 and 2020 - ANS c A 15 yo female comes to the clinic for a health maintenance visit. The patient reports no complaints. She does well in school, has many friends, and gets along well with her parents and two siblings. She has recently become sexually active with her boyfriend of 6mo. The physical exam is normal for her age. What screening, lab tests, and/or immunizations should the PNP order? a. Vision, hearing, urinalysis, STD screen, pelvic exam, and immunizations as needed b. STD screen, pneumococcal vaccine, pelvic exam, and cholesterol screening as indicated c. vision, hearing, STD screen, pelvic exam, and hemoglobin if indicated. d. Measles vaccine, vision, hearing, STD screen, pelvic exam exam, and cholesterol screen if indicated. - ANS a Which of the following is the best written chief complaint? a. 5yo asian female with itchy red rash

b. 1 mo with difficulty feeding c. 15yo african american female complaining of lower abdominal pain for 3 days d. 12yo caucasian with itchy eye for 1 week - ANS c The past history should include a. family history b. social hx c. symptom analysis d. hospitalization - ANS d The family history should include: a. the health status of the paternal grandparents b. the living conditions of the family c. the work status of the parents d. school information - ANS a Which of the following statements would be considered subjective data obtained from the client during the review of systems for the skin? a. the skin appears dry & excoriated b. a lesion is noted on the lateral aspect of the right leg c. there is moderate acne on the forehead and back d. the patient denies changes in skin texture - ANS d The PNP is completing the ROS on a 4mo. What response from the mother might indicate a cardiac problem in the infant & require a more thorough history? a. the baby gets the hiccups often.

b. it takes the baby over 30min to complete a bottle c. the baby's heart seems to beat rapidly sometimes d. sometimes the baby sounds congested - ANS b The PNP is obtaining a review of systems on a healthy 8yo girl. It would be important to include: a. the date of last breast self-exam. b. any limitations related to sports participation. c. the last hematocrit and hemoglobin d. the last lead screen - ANS b The mother of a 3yo states that her son was completely toilet trained at 18mo. The PNP explores further, asking: a. how the mother did the toilet training b. if the child is dry at night and fully trained for urine and stool day and night c. at what age did the mother begin toilet training the other child. d. if the child gets up at night to use the bathroom - ANS b Jasmine, a 5-month-old infant is in the clinic for a well child visit and is sleeping in her mother's arms. What should the PNP do first? a. Examine the ears, since this is uncomfortable for the infant. b. Quickly give any needed immunizations. c. Begin with assessment of the head and proceed from head to toe. d. auscultate the heart & lungs while the infant is sleeping. - ANS d 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." - ANS 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 - ANS 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 - ANS 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 - ANS a The parents of a child with cystic fibrosis are considering another pregnancy. They want to know what their chances are of having another child with cystic fibrosis. The PNP explains that cystic fibrosis is an autosomal recessive disorder and that each conception of carrier parents has a:

a. 25% chance of being affected b. 50% chance of being affected c. 75% chance of being affected d. 100% chance of being affected - ANS 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 - ANS d A male with Vitamin D-resistant rickets asks what his chances are of passing his disease to his parents. The PNP answers: a. all sons will be affected by only 25% daughters b. all daughters are affected by only 25% sons c. 50% of all offspring will have the disease d. all daughters will be affected but no sons. - ANS d The PNP is following a 15-year-old male adolescent with consistent blood pressure readings of 132 to 138/84 to 86 mm Hg, which is classified as significant hypertension. After performing a workup, the PNP determines that the adolescent has primary hypertension. The most judicious recommendation for therapy is: A) Diet and exercise counseling and referral to a specialist B) A diuretic, low-salt diet, exercise, and counseling by a dietician C) Perform an extensive family history to determine other risk factors D) A vasodilator, restricted activity, and a low-fat diet - ANS a

The PNP is examining a neonate with a heart murmur. The S2 sound is loudest at the apex. The respiratory rate is 65 breaths per minute, and the heart rate is 180 beats per minute. Which of the following would be an appropriate action by the PNP? A) Reevaluate the neonate in 24 hours B) Increase the number of oral feedings C) Order cardiac catheterization D) Refer the neonate to a cardiologist - ANS d A 2-week-old neonate is brought to the clinic with excessive lacrimation of both eyes. The eyes are clear, with no areas of redness, but the corneas appear hazy. The PNP explains to the parents the possible diagnosis and treatment as follows: A) Congenital glaucoma requiring an ophthalmology referral B) Corneal foreign body requiring fluorescein staining and removal C) Chalazion requiring treatment with antibiotic eyedrops D) Allergic conjunctivitis requiring treatment with Benadryl eyedrops - ANS a On examination of a 3-month-old infant the PNP is unable to elicit a red reflex in the right eye. Previous examinations failed to note the presence or absence of a red reflex. The PNP's response is to: A) Reassure the parents that this is not a problem because the infant has dark eyes B) Note this finding in the infant's chart and check again in a few months C) Refer the infant to an ophthalmologist to rule out retinal trauma D) Immediately refer the infant to a pediatric ophthalmologist to rule out a congenital cataract or retinoblastoma - ANS d A 4-year-old child with chickenpox has vesicles on the skin of the right eyelid. The child complains of eye pain and blurred vision. The PNP should treat the condition by: A) Applying cool compresses to the eye and lesions

B) Prescribing eyedrops containing steroids to decrease inflammation and pain C) Prescribing polyspoium ophthalmic ointment for the secondary bacterial infection D) Immediately referring the child to an ophthalmologist - ANS 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 - ANS 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." - ANS 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 - ANS 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 - ANS c A 14-year-old adolescent, who appears to be in acute distress and is anxious, is brought to the clinic with symptoms of high fever, chills, malaise, pharyngitis, vomiting, peripheral cyanosis, tachypnea, tachycardia, low blood pressure, and erythroderma. The PNP recognizes this as toxic shock syndrome and: A) Orders a CBC and blood culture immediately B) Orders a CBC and blood culture, and sends the adolescent to an emergency room for a lumbar puncture C) Sends the adolescent to the emergency room by ambulance immediately without providing any treatment in the clinic D) Collaborates with the clinic physician to determine appropriate antibiotic use in this patient - ANS c 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) Wait for the next well visit to see if the situation has changed D) Order an MRI - ANS b

A 9-year-old child is brought to the clinic for the evaluation and treatment of a rash. While examining the child, the PNP detects a speech dysfluency. The most appropriate plan of treatment should include: A) Treating the rash and scheduling a well-child visit to address the speech problem B) Treating the rash and making a referral for speech, language, and hearing evaluation with a speech pathologist C) Treating the rash and making no referral because it is too late for speech therapy to be beneficial D) Using a clinical screening tool to determine whether a language disorder exists - ANS b 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 - ANS 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 - ANS b A neonate is diagnosed with trisomy 21 based on karyotyping. What type of follow-up will the infant need? A) Echocardiography; thyroid function tests at birth, 3 months, and yearly thereafter; a CBC; and an audiology consult

B) An ophthalmologic evaluation, neck x-ray films by age 3 years, and referral to early intervention and parent education C) Karyotyping, echocardiography, audiologic and ophthalmologic evaluation, and referral to early intervention and parent education D) Karyotyping; echocardiography; renal ultrasonography; thyroid function tests at birth, age 3 months, and yearly thereafter; and referral to early intervention and parent education - ANS a The parents of a 9-year-old with primary enuresis request information regarding treatment options. When discussing alternative treatments for enuresis, the PNP offers pertinent information to help the child and parents make an appropriate decision about which treatment would be best. The family should be told: A) The alarm is the safest therapy, but the relapse rate is about 10% B) Pharmacologic therapy has the lowest relapse rate C) Motivational therapy should be used after pharmacologic treatment D) Treatment should begin with bladder awareness training - ANS d A parent asks for suggestions in helping a 6-year-old child who wets the bed. What intervention would the PNP recommend for this child diagnosed with primary nocturnal enuresis? A) Use a "wet night" calendar to mark the dates of wetting accidents B) Allow the child to take care of changing wet clothes and linens C) Criticize the child when a wetting accident has occurred D) Praise any progress made by the child - ANS d 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 - ANS 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 - ANS c A 15-year-old adolescent has pallor and fatigue. The CBC results are consistent with iron-deficiency anemia. What would be appropriate information to give this adolescent? A) Antacids increase the absorption of iron B) Dairy foods are good sources of dietary iron C) Juices fortified with vitamin C inhibit the absorption of nonheme iron D) Tannin-containing products, such as tea, inhibit the absorption of nonheme iron - ANS d When discussing the cause of impetigo with the parents of a child just diagnosed, the PNP tells them it is caused by: A) Klebsiella species or group A beta-hemolytic streptococci (GABHS) B) Proteus species or anaerobes C) Staphylococcus aureus or GABHS D) Escherichia coli or candidal organisms - ANS c The PNP examines a 4-year-old child who is home-schooled and immunization-delayed. The child has pain when chewing; a fever; and enlarged, tender salivary nodes. The PNP diagnoses mumps and informs the mother that mumps is contagious for: A) 7 days before the onset of symptoms

B) 10 days before the onset of symptoms C) 1 to 2 days before and 5 days after D) As long as 3 days after the onset of symptoms - ANS a A 10-year-old child is brought to the clinic after jumping over a rusty fence and receiving a puncture wound to the buttocks. Immunizations are up to date with last tetanus given when child was 4 years old. The PNP cleanses the wound and: A) Administers a tetanus vaccine and prescribes penicillin for 14 days B) Starts prophylactic antibiotics C) Applies a sterile dressing D) Administers tetanus vaccine and educates family regarding signs of wound infection - ANS d A 17-year-old adolescent comes to the office to ask about a self-medication regimen for monthly menstrual cramps. The adolescent reports routinely taking 1200 mg of ibuprofen every 4 to 6 hours for the first 3 days of menses each month to relieve cramps. The PNP tells her: A) "The dose is okay because it is only a few days a month." B) "Discontinue the medication because it may impair renal or liver function." C) "The dose should be decreased because of the risk of gastrointestinal ulceration." D) "Aspirin is a better medication for relieving menstrual cramps." - ANS 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 - ANS 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." - ANS 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 - ANS a A grandfather tells the PNP that with winter coming he is planning to buy several bottles of cough syrup and treat his family members when they get colds and coughs. Although the PNP discourages this practice, the guidelines the PNP provides should include a warning that cough suppressants should be used only for: A) Coughs that occur in the morning B) Coughs that occur during exercise C) Harsh, "brassy" coughs D) Temporary dry coughs - ANS d A father asks the PNP if an opioid cough suppressant, such as promethazine hydrochloride with codeine (Phenergan with codeine), would help his school-aged child who is recovering from a cold and complaining of a "nagging cough." The PNP explains that possible problems of opioid cough suppressants include: A) Potential for abuse and diarrhea

B) Respiratory depression and diarrhea C) Dependency and constipation D) Respiratory stimulation and constipation - ANS c 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." - ANS c A parent has questions regarding the use of over-the-counter fever medications for a 2-year-old. The child has had a temperature of 101.2°F with no other symptoms of illness for the past day. The mother has been treating the fever by alternating doses of acetaminophen and ibuprofen every 3 to 4 hours. The child is playful and has a normal appetite. Appropriate counseling for this mother should include: A) Continue giving the medicines every 3 to 4 hours at the appropriate dosage for the child's weight until the fever subsides B) Increase the interval of the medications to every 6 hours C) This amount and frequency of antipyretics may be inappropriate and harmful in a child whose only symptom is a low-grade fever D) Stop the medications, because a temperature of 101.2°F in a child with no other symptoms does not necessitate the use of antipyretics - ANS c A 14-month-old is brought to the clinic with a cough and yellow-green nasal discharge for the past 7 days. The father has been giving the child over-the-counter cold medications every 6 hours. The child has no fever. Appetite, activity, and elimination are unchanged. The father states he had the same symptoms and was put on an antibiotic for a sinus infection. He is concerned that the child has the same infection. The most appropriate action by the PNP is to: A) Order a Water's view sinus x-ray film to rule out acute sinusitis B) Prescribe an appropriate antibiotic to treat the sinus infection

C) Reassure the father that the child probably has a viral infection and suggest supportive care; if symptoms don't improve in 7 days, return for evaluation D) Inform the father that no treatment is necessary but suggest she bring the child in if symptoms do not improve within 4 weeks - ANS 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 - ANS 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 - ANS b A 10-month-old infant is brought to the clinic for a rash. The rash is circumscribed, dry, pruritic, slightly flaky, and located on the cheeks and flexor surface of the arms. What treatment should the PNP prescribe? A) Bathe the infant frequently, and apply Vaseline to the rash B) Bathe the infant once a week with Dial soap and apply Gold Bond cream to the lesions C) Bathe the infant daily with mild soap, such as Dove, and apply Eucerin cream daily D) Bathe the infant daily or every other day with Dove soap and apply a high potency corticosteroid cream, paying particular attention to the cheeks - ANS c

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 - ANS c An 18-month-old child is brought to the office for irritability, nightmares, and generally being tired for the past few nights. The child has had an upper respiratory tract infection for which the grandmother has administered an over-the-counter medication for rhinorrhea. The child is afebrile and alert, with obvious clear rhinorrhea. The PNP: A) Orders sinus radiologic studies B) Prescribes amoxicillin C) Discusses side effects of decongestants and antihistamines D) Suggests that the grandmother administer acetaminophen - ANS c A 16-year-old presents with pallor and fatigue for the past several weeks. The complete blood count (CBC) results are consistent with iron deficiency anemia. What should the PNP tell this teen? A) Antacids increase the absorption of iron B) Dairy foods are good sources of dietary iron C) Juices fortified with vitamin C inhibit the absorption of nonheme iron D) Tannin-containing products, such as tea, inhibit the absorption of nonheme iron - ANS d 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 - ANS a The murmur heard when a child has rheumatic heart disease is the result of: A) Myocarditis B) Pericarditis C) Valvulitis D) Coronary artery involvement - ANS c 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 - ANS 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 - ANS a Which of the following findings suggests a need for further evaluation for glomerular disease? A) Blood pressure of 135/

B) +1 protein and red blood cell (RBC) casts in the urine C) Bright red urine D) A urine culture of 100,000 bacteria/mL - ANS b An 8-year-old child is brought to the urgent care clinic. No chart is available for the history. The child's symptoms include tea-colored urine and periorbital edema, and the blood pressure is 142/90. There is no dysuria or frequency. Poststreptococcal acute glomerulonephritis (PSAGN) is suspected. Which of the following statements is correct? A) PSAGN typically begins 28 days after a streptococcal infection B) Appropriate antibiotic treatment prevents nephritogenic group A beta-hemolytic streptococcal (GABHS) infection C) The urine test reveals no RBC casts or proteinuria D) Treatment in the acute phase may require salt restriction, diuretics, and antipyretics; the expected outcome is good - ANS d 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?" - ANS c A 12-year-old child is seen in the school-based clinic because of a red, swollen, tender area on the upper eyelid. The PNP prescribes: A) A topical steroid to be applied to the inflamed eyelid B) Warm compresses to be applied two to three times a day and a topical antibiotic

C) A systemic antibiotic for 2 weeks D) A systemic antihistamine and a steroid cream - ANS b A 14-year-old adolescent has an annular rash (erythema migrans) on the legs with some clearing in the center of the lesions. The rash has appeared and disappeared over the last few weeks. The adolescent also complains of fever, myalgia, and headache. Which of the following subjective data would be most helpful in making a diagnosis for this condition? A) The rash is pruritic and feels warm B) The adolescent recently went backpacking in wooded area C) A sore throat developed 3 days ago D) The adolescent went on a hiking trip 3 days ago in Southern California - ANS b 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 - ANS a A 15-year-old adolescent is brought to the clinic with jaundice, anorexia, and nausea. The adolescent is concerned that she may be pregnant because she has nausea and has had unprotected sex. The PNP suspects that the diagnosis may be: A) Infectious mononucleosis B) Hepatitis B C) Chronic fatigue syndrome D) Viral gastritis - ANS b

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 - ANS 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 - ANS 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 - ANS a A child is brought to the office with irritability, agitation, muscle pain, and cramping in the large leg muscles. On examination a target lesion consisting of an erythematous ring around a pale center is noted. The child has been playing in the garage and does not recall seeing or being bitten by an insect. The child's face is flushed, and there is some diaphoresis. The PNP suspects: A) An allergic reaction to flea bites B) A black widow spider bite

C) A brown recluse spider bite D) Ingestion of weed pods - ANS b 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 - ANS b A 10-year-old child is brought to the office with coughing, abdominal pain, splinting on the right side, fever, headache, and chills. The child appears to be in severe distress. There are decreased breath sounds, crackles, and dullness to percussion in the area of the right middle and right lower lobe. The diagnosis of pneumonia is made. The PNP orders an anteroposterior and lateral view of the chest and: A) Sputum stain B) Blood culture C) Complete blood cell count and blood culture D) Blood gases and pulse oximetry - ANS c 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 - ANS 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 - ANS c A 15-year-old adolescent who has joint pain related to juvenile rheumatoid arthritis has been taking NSAIDs to relieve the pain. The adolescent came to the school-based clinic with epigastric and abdominal pain. The PNP suspects that the pain is related to the NSAIDs and manages the symptoms by: A) Modifying the adolescent's diet B) Substituting salicylates for NSAIDs C) Treating for H. pylori D) Administering a H2 receptor antagonist - ANS d A 9-year-old child has circumscribed, coalescent, generalized, erythematous raised lesions of various sizes. The PNP recognizes that the most common cause of hives is: A) Sun exposure B) Cold exposure C) Ingestion of foods and food additives D) Insect bites - ANS 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 - ANS b A 2.5-year-old child has anal itching and has been awakening at night. The PNP diagnoses: A) Sexual abuse B) Pinworms C) Hemorrhoids D) Rectal fistula - ANS b The PNP is evaluating an 8-year-old child with an eye injury. About 1 hour ago the child was hit in the eye with a foreign body. When the eye is stained with fluorescein, a vertical linear abrasion is visible. The pupils are equal in size and reactive, and a positive red reflex is noted bilaterally. There are no abnormal extraocular movements. No foreign body is visible. An appropriate plan of care for this patient would include the following: A) Close both eyes, and apply eye patches B) Instill ophthalmic steroid drops three times a day, but do not apply an eye patch C) Apply antibiotic ointment, but do not apply an eye patch D) Instill antibiotic drops, and apply patches over both eyes - ANS c A 4-year-old child is brought to the clinic with ulcers on the tongue and oral mucosa. There are vesicles on the palms, soles, and interdigital areas. The PNP diagnoses: A) Rubeola B) Infectious mononucleosis C) Herpangina D) Hand-foot-and-mouth disease - ANS d The PNP discusses the use of trimethoprim/sulfamethoxazole (Bactrim) in infants 2 months old and younger with the PNP student. The antibiotic should not be prescribed in the infant because:

A) The infant has low renal clearance B) The infant has rapid renal clearance C) The drug causes decreased gastric emptying D) The infant has an immature liver and protein binding ability - ANS d A 16-year-old adolescent comes to the school-based clinic with chest pain. The most common cause of cardiac pain in children and adolescents is: A) Myocarditis B) Tachycardia C) Mitral valve prolapse D) Preventricular contractions - ANS c 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 - ANS 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 - ANS 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 - ANS b In evaluating a 7-year-old child for ADHD, the PNP questions the parents about reported behavior at school. Of the following symptoms, which would be most descriptive of ADHD? A) The child will not listen to direction or when spoken to, submits messy papers with careless mistakes, runs about or climbs excessively, has difficulty sustaining attention, and exhibits intrusive behavior B) The child has a short attention span, has difficulty listening, has difficulty organizing tasks, and interrupts others who are talking C) The child seems to want attention, has a short attention span for schoolwork, talks out of turn, fidgets a lot, and interrupts others D) The child wants attention, makes careless mistakes in schoolwork, has difficulty taking turns, and fidgets a lot - ANS a A 6-year-old child with asthma is brought to the clinic because the parents have noticed daily wheezing for the past week, especially during the night. The PNP recognizes that this may indicate the child has: A) Intermittent asthma B) Mild persistent asthma C) Moderate persistent asthma D) Severe persistent asthma - ANS c A 7-year-old child with cerebral palsy is brought to the clinic. The child is unable to walk but is able to use a wheelchair. The child uses the arms and hands to eat and perform self-care tasks. The PNP diagnoses this child with: