Pediatric Nurse Practitioner Q&A, Exams of Nursing

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1. 14. A schoolage child has a history of chronic otitis media and is seen in the clinicmwith vertigo. The primary care pediatric nurse practitioner notes profuse purulent otorrhea from both pressureequalizing tubes and a pearlywhite lesion on one tympanic membrane. Which condition is most likely?: Ans- Cholesteatoma
2. 3. A dipstick urinalysis is positive for leukocyte esterase and nitrites in a schoolage child with dysuria and foulsmelling urine but no fever who has not had previous urinary tract infections. A culture is pending. What will the pediatric nurse practitioner do to treat this child?: Ans- Prescribe trimethoprimsulfamethoxazole (TMP) twice daily for 3 to 5 days
3. the parent of a 4monthold infant is concerned that the infant cannot hear. Which test will the primary care pediatric nurse practitioner order to evaluate potential hearing loss in this infant?: Ans- Auditory brainstem response (ABR)
4. 4. The primary care pediatric nurse practitioner attempts to learn more about the ID: Ans- 13348419842 emotional health of an 18monthold child through which assessment strate- gy?: Ans- Observation of the child with caretakers in structured and unstructured situations
5. 6. What will the primary care pediatric nurse practitioner teach the parents of a child who has new pressureequalizing tubes (PET) in both ears?: Ans- Parents should notice improved hearing in their child.
6. 4. A preschoolage child with no previous history has mild flank pain and fever but no abdominal pain or vomiting. A urinalysis is positive for leukocyte esterase and nitrites. A culture is pending. Which is the correct course of treatment for this child?: Ans- Order amoxicillin clavulanate
7. 7. A child with a history of otitis externa asks about ways to prevent this condition. What will the primary care pediatric nurse practitioner recommend?: Ans- Drying the ear canal with a hair dryer
8. 12. The primary care pediatric nurse practitioner is evaluating recurrent stomach pain in a schoolage child. The child's exam is normal. The nurse practitioner learns that the child reports

pain most evenings after school and refuses to participate in sports but does not have nausea or vomiting. The child's grandmother recently had gallbladder surgery. Which action is correct?: Ans- Encourage the child to keep a log of pain, stool patterns, and dietary intake

9. 9. A child who has otitis externa has severe swelling of the external audi- tory canal that persists after 2 days of therapy with ototopical antibiotic/cor- ticosteroid drops. What is the next step in treatment for this child?: Ans- Insert a wick into the external auditory canal.
10. 5. A 3yearold child has just completed a 7day course of amoxicillin for a secondfebrile urinary tract infection and currently has a negative urine cul- ture. What is the next course of action?: Ans- Obtain a renal and bladder ultrasound.
11. 8. 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?: Ans- Order ototopical antibiot- ic/corticosteroid drops.
12. 5. A middleschoolage child is skipping school frequently and getting poor grades since the child's father was killed while deployed in the military. How will the primary care pediatric nurse practitioner manage this situation?: Ans- Refer the child to a mental health specialist for evaluation and treatment.
13. The primary care pediatric nurse practitioner is examining a 2weekold infant and auscultates a wide splitting of S 2 during expiration. What condition may this finding represent?: Ans- Atrial septal defect
14. A 9monthold infant with a history of three urinary tract infections is diagnosed with grade II vesicoureteral reflux. Which medication will be pre- scribed?: Ans- TMPSMX~ TMP 2 mg/kg as a single daily dose
15. 2. The primary care pediatric nurse practitioner auscultates a new grade II vibratory, midsystolic murmur at the mid sternal border in a 4yearold child that is

louder when the child is supine. What type of murmur is most likely?: Ans- Still's murmur

16. 4. The primary care pediatric nurse practitioner is performing a well baby examination on a 2monthold infant who has gained 25 grams per day in the last interval. The mother is nursing and tells the nurse practitioner that her infant seems fussy and wants to nurse more often. What will the nurse practitioner tell her?: Ans- The infant may be going through an expected growth spurt.
17. 3. During a well child assessment, the primary care pediatric nurse prac- titioner auscultates a harsh, blowing grade IV/VI murmur in a 6monthold infant. What will the nurse practitioner do next?: Ans- Refer to a pediatric cardiologist for further evaluation
18. 12. A child who has nephrotic syndrome is on a steroids and a saltrestrict- ed diet for a relapse of symptoms. A dipstick urinalysis shows 1+ protein, down from 3+ at the beginning of the episode. In consultation with the child's nephrologist, what is the correct course of treatment considering this finding?: Ans- Continue with steroids and salt restrictions until the urine is negative for protein
19. 4. The primary care pediatric nurse practitioner provides primary care for a 4month old infant who has a ventricular septal defect. The infant has been breast- feeding well but in the past month has dropped from the 20th percentile to the 5th for weight. What will the nurse practitioner recommend?: Ans- Fortifying breast milk to increase the number of calories per ounce
20. 6. The parent of a 4yearold child reports that the child seems to be having trouble adjusting to a new day care and reportedly is always engaging in solitary play when the parent arrives to pick up the child. What will the primary care pediatric nurse practitioner do?: Ans- Ask the parent if the child is slow to warm up to other new situations
21. 5. A 12monthold infant who had cardiopulmonary bypass with RBC and plasma

infusions during surgery at 8 months is seen for a well child examination. Which vaccine may be administered at this visit?: Ans- PCV

22. 13. A child who had GABHS 2 weeks prior is in the clinic with periorbital edema, dyspnea, and elevated blood pressure. A urinalysis reveals teacolored urine with hematuria and mild proteinuria. What will the primary care pediatric nurse practitioner do to manage this condition?: Ans- Refer the child to a pediatric nephrologist for hospital- ization.
23. The primary care pediatric nurse practitioner performs a well child exam- ination on a 12monthold 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?: Ans- Amoxicillin
24. 7. The primary care pediatric nurse practitioner sees a developmentally delayed toddler for an initial visit. The family has just moved to the area and asks the nurse practitioner about community services and resources for their child. What should the nurse practitioner do initially?: Ans- Ask the parents if they have an individualized family service plan (IFSP).
25. 20. A 7yearold child who has a history of a repaired congenital heart defect has many dental caries along with gingival erythema and irritation and a temper- ature of 102.5°F. What will the primary care pediatric nurse practitioner do next?: Ans- Ad- mit to the hospital with a pediatric cardiology consult.
26. 16. A 6monthold infant has a retractile testis that was noted at the 2month well baby exam. What will the primary care pediatric nurse practitioner do to manage this condition?: Ans- Refer the infant to a pediatric urologist or surgeon for possible orchiopexy

27. 21. A 15yearold female reports fainting at school in class on two occa- sions. The adolescent's orthostatic blood pressures are normal. The primary care pedi- atric nurse practitioner suspects a cardiac cause for these episodes and will order which tests before referring her to a pediatric cardiologist?: Ans- 12lead electrocardiogram
28. 7. The parent of a schoolage child is concerned because the child has started to express anger about a grandparent's death even though this occurred when the child was a toddler. What will the primary care pediatric nurse practitioner tell the par- ent?: Ans- The significance of this loss must be reworked at each developmental level
29. 7. During a well baby examination of a 6weekold infant, the primary care pediatric 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?: Ans- Refer the infant to a pediatric cardiologist
30. 14. An adolescent has rightsided flank pain without fever. A dipstick urinalysis reveals gross hematuria without signs of infection or bacteriuria, and the primary care pediatric nurse practitioner diagnoses possible nephrolithiasis. What is the initial treatment for this condition?: Ans- Increasing fluid intake up to 2 L daily
31. 8. A 3monthold infant who was previously healthy now has a persistent cough, bilateral lung crackles, and poor appetite. The primary care pediatric nurse practitioner auscultates a grade III/VI, lowpitched, holosystolic murmur over the left lower sternal border and palpates the liver at one centimeter below the ribs. What diagno- sis is likely?: Ans- Ventricular septal defect
32. 6. The mother of a 15yearold adolescent female tells the primary care pediatric nurse practitioner that her daughter has extreme mood swings prior to her periods, which the adolescent vehemently denies. When asked if she notices anything different

just before her periods, the adolescent points to her mother and says, "She

gets really hard to live with." This demonstrates which characteristic of adolescent thinking?: Ans- Apparent hypocrisy

33. 9. An infant with trisomy 21 has a complete AV canal defect. Which finding, associated with having both of these conditions, will the primary care pediatric nurse practitioner expect?: Ans- Oxygen desaturation
34. 15. During a well child examination of a 2yearold child, the primary care pediatric nurse practitioner palpates a unilateral, smooth, firm abdominal mass which does not cross the midline. What is the next course of action that?: Ans- Refer the child to an oncologist immediately.
35. 10. A 9monthold infant has a grade III/VI, harsh, rumbling, continuous murmur in the left infraclavicular fossa and pulmonic area. A chest radiograph reveals cardiac enlargement. The primary care pediatric nurse practitioner will refer the infant to a pedi- atric cardiologist and prepare the parents for which intervention to repair this defect?: Ans- Coil insertion in the catheterization laboratory
36. 8. The parent of a schoolage child reports that the child doesn't like being alone in rooms because of a fear of aliens hiding in closets. What will the primary care pediatric nurse practitioner tell the parent?: Ans- "Fear of imaginary creatures does not usually occur at this age."
37. A 5yearold child who had a repair for transposition of the great arteries shortly 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?: Ans- Refer the child to the cardiologist immediately
38. 17. A 9monthold infant is brought to the clinic with scrotal swelling and fussiness. The primary care pediatric nurse practitioner notes a tender mass in the affected scrotum that is

difficult to reduce. What is the correct action?: Ans- Refer immediately to a pediatric surgeon

39. 7. A 6yearold child has a systolic blood pressure between the 95th and 99th 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: Ans- stage 1 hypertensive
40. 8. The primary care pediatric nurse practitioner is counseling a parent about bicycle helmet use.The parent reports having a helmet used a year previous- ly by an older child and wonders about using it for a younger child since they are so expensive. What will the nurse practitioner tell the parent?: Ans- "If the helmet is free from marks, you may use it."
41. 12. The primary care pediatric nurse practitioner is performing a well child examination on a schoolage child who had complete repair of a tetralogy of Fallot defect in infancy. What is important in this child's health maintenance regime?: Ans- Cardi- ology clearance for sports participation
42. 18. The mother of a 12monthold uncircumcised male infant reports that the child seems to have pain associated with voiding. A physical examina- tion reveals a tight, pinpoint opening of the foreskin, which thickened and inflamed. What will the primary care pediatric nurse practitioner do?: Ans- Refer the child to a pediatric urologist.
43. 19. A 12yearold child whose BMI is greater than the 95th percentile has a blood 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?: Ans- Referral to a nephrologist or cardiologist
44. 9. The parent of a preschoolage child reports that the child often appears anxious and nervous and that this is associated occasionally with a rapid heart rate and tremors. What is the best type of referral that the primary care pediatric nurse practitioner could recommend?: Ans- Play therapy

45. 13. 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?: Ans- Evaluation by a cardiologist prior to participation
46. 19. An adolescent male comes to the clinic reporting unilateral scrotal pain, nausea, and vomiting that began that morning. The primary care pediatric nurse practitioner palpates a painful, swollen testis and elicits increased pain with slight eleva- tion of the testis (a negative Phren's sign). What will the nurse practitioner do?: Ans- Refer the adolescent immediately to a pediatric urologist or surgeon
47. 18. A 12yearold 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 include: Ans- renal function and plasma renin tests
48. 8. The parent of a 14yearold child tells the primary care pediatric nurse practitioner that the child skips classes frequently in spite of various disci- plinary measures, such as grounding and extra homework and is earning Cs and Ds in most classes. What will the nurse practitioner recommend?: Ans- Evaluation for possible learning disorders
49. 16. An adolescent female has a history of repaired tetralogy of Fallot. Which long term complication is a concern for this patient?: Ans- Mitral valve prolapse
50. 11. A child is diagnosed with nephrotic syndrome, and the pediatric nurse practitioner provides primary care in consultation with a pediatric nephrologist. The child was treated with steroids and responded well to this treatment. What will the nurse practitioner tell the child's parents about this disease?: Ans- "Steroids will be used when relapses occur."
51. 15. A 5yearold child has an elevated blood pressure during a well child exam. The 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?: Ans- Coarcta- tion of the aorta

52. 10. A 9yearold child exhibits school refusal and a reluctance to attend sleepovers with classmates. The parent is concerned because the child has recently begun sleeping in the parents' bed. Which initial action by the primary care pediatric nurse practitioner is appropriate?: Ans- Assess for environmental stress, parental dysfunction, and mater- nal depression
53. 14. During a routine well child exam on a 5yearold 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?: Ans- Pulmonic stenosis
54. 7. The parent of a toddler diagnosed with grade V vesicoureteral reflux asks the primary care pediatric nurse practitioner how the disease will be treated. What will the nurse practitioner tell this parent?: Ans- That surgery to correct the condition is possible
55. In a respiratory disorder causing a checkvalve obstruction, which symp- toms will be present?: Ans- Air entry on inspiration with expiratory occlusion
56. 7. The parent of a 5monthold is worried because the infant becomes fussy but doesn't always seem interested in nursing. What will the nurse practitioner tell this parent?: Ans- The infant may be expressing a desire to play or to rest.
57. 5. A schoolage child has an abrupt onset of sore throat, nausea, headache, and a temperature of 102.3°F. An examination reveals petechiae on the soft palate, beefyred tonsils with yellow exudate, and a scarlatiniform rash. A Rapid Antigen Detection Test (RADT) is negative. What is the next step in management for this child?: Ans- Perform a followup throat

culture

58. 9. A child has gross hematuria, abdominal pain, and arthralgia as well as a rash. What diagnosis is most likely?: Ans- HenochSchönlein purpura
59. 2. A child has an acute infection causing lower airway obstruction. Which initial symptom is expected in this child?: Ans- Wheezing
60. 11. The parent of a schoolage child reports that the child becomes frustrated when unable to perform tasks well and often has temper tantrums and difficulty sleeping. Which disorder may be considered in this child?: Ans- Generalized anxiety disorder (GAD)
61. 3. A 4yearold child with an upper respiratory tract infection has cloudy nasaldischarge and moderate nasal congestion interfering with sleep. The parent asks what product to use to help with symptoms. What will the primary care pediatric nurse practitioner recommend?: Ans- Saline rinses
62. 10. An adolescent has 2+ proteinuria in a random dipstick urinalysis. A subsequent first morning voided specimen is negative. What will the primary care pediatric nurse practitioner do to manage this condition?: Ans- Monitor for proteinuria at each annual well child examination.
63. 4. A 5yearold child has enlarged tonsils and a history of four throat infections in the previous year with fever, cervical lymphadenopathy, and positive Group AStreptococcus pyogenes (GABHS) cultures.The parent reports that the child snores at night and expresses concerns about the child's quality of sleep. The next step in managing this child's condition is to: Ans- refer to a pulmonologist for polysomnography evaluation
64. A positive anterior or positive drawer test would be indicative of which injured ligament?: Ans- Cruciate ligament
65. An adolescent has suspected infectious mononucleosis after exposure to the virus in the past week. The primary care pediatric nurse practitioner examines the adolescent and notes exudate on the tonsils, soft palate pe- techiae, and diffuse adenopathy. Which test will the primary care pediatric nurse practitioner perform to confirm the diagnosis?: Ans- EBVspecific antibody testing
66. 8. A healthy 14yearold female has a dipstick urinalysis that is positive for

56 RBCs per hpf but otherwise normal. What is the first question the primary

care pediatric nurse practitioner will ask this patient?: Ans- "When was your last menstrual period (LMP)?"

67. 7. A schoolage child has had nasal discharge and daytime cough but no fever for 12 days without improvement in symptoms. The child has not had antibiotics recently and there is no significant antibiotic resistance in the local community. What is the appropri- ate treatment for this child?: Ans- Amoxicillin 45 mg/kg/day
68. 12. The parent of a schoolage girl reports that the child has difficulty getting ready for school and is often late because of a need to check and recheck whether her teeth are clean and her room light has been turned off. What will the primary care pediatric nurse practitioner recommend to this parent?: Ans- Cognitivebehavioral therapy
69. 8. After 14 days of treatment with amoxicillin 45 mg/kg/day for acute rhi- nosinusitis, a child continues to have mucopurulent nasal discharge along with induration, swelling, and erythema of both eyelids. What is the next course of treatment?: Ans- Referral to a pediatric otolaryngologist
70. The primary care pediatric nurse practitioner is teaching a parent of a child with dry skin about hydrating the skin with bathing. What will the nurse practitioner include in teaching?: Ans- Have the child soak in a lukewarm water bath.
71. 9. The parent of a toddler and a 4weekold infant tells the primary care pediatric nurse practitioner that the toddler has just been diagnosed with pertussis. What will the nurse practitioner do to prevent disease transmis- sion to the infant?: Ans- Order azithromycin 10 mg/kg/day in a single dose daily for 5 days
72. 8. The primary care pediatric nurse practitioner evaluates a 4yearold girl ID: Ans- 13348417430whose parent reports frequent urination in the evenings on weekdays, incontinence after voiding. The parent reports that the child has soft formed stools 5 or 6 times weekly. Which assessment will the nurse practitioner make initially?: Ans- Examination for labial adhesions

73. 10. A schoolage child has frequent nosebleeds. Nasal visualization re- veals fresh clots and excoriated nasal mucosa but no visible site of bleeding. Coagulation studies are normal. In spite of symptomatic measures, the child continues to have nosebleeds. What is the next course of action?: Ans- Refer to an otolaryngologist for further evaluation
74. 15. A schoolage child is brought to clinic after a pediculosis capitis infestation is reported at the child's school. If this child is positive, what will the primary care pediatric nurse practitioner expect to find on physical examination, along with live lice near the scalp?: Ans- Itching of the scalp, with skin excoriation on the back of the head
75. 13. The primary care pediatric nurse practitioner evaluates a child who awoke with a sore throat and high fever after a nap.The child appears anxious and is sitting on the parent's lap with the neck hyperextended. The physical exam reveals stridor, drooling, nasal flaring, and retractions. What will the nurse practitioner do next?: Ans- Transport the child to the hospital via emergency medical services.
76. 13. The parents of a 4yearold boy are concerned because he has begun twisting and pulling out his hair, especially when he is tired or stressed. What will the primary care pediatric nurse practitioner recommend as part of an initial approach to treat this behavior?: Ans- Cutting his hair so that it is too short to pull
77. A child is in the clinic because of symptoms of purulent, foulsmelling nasal discharge from the right nostril. Nasal visualization reveals something shiny in a mass of mucous in the nasal cavity. What will the primary care pediatric nurse practitioner do?: Ans- Attempt to remove the mass gently using alligator forceps.
78. 16. A 3yearold child has head lice. What will the initial treatment recom- mendation be to treat this child?: Ans- Permethrin
79. 12. A 2yearold child is brought to the clinic after developing a hoarse, barklike cough during the night with "trouble catching his breath" according to the

parent. The history reveals a 2 day history of lowgrade fever and upper respiratory

symptoms. On exam, the child has a respiratory rate of 40 breaths per minute, occasional stridor when crying, and a temperature of 101.3°F. What is the next step in treatment for this child?: Ans- Prescribe oral dexamethasone for 2 days

80. 10. The primary care pediatric nurse practitioner is evaluating a schoolage child who, after removal of a pituitary tumor, has altered hypothalamic control over hunger and satiety. The child is morbidly obese and expresses feeling depressed because of the obesity. What will the nurse practitioner recommend?: Ans- Restricting all access to food in the house and at school
81. The parent of an infant asks about using a probiotic medication. What will the primary care pediatric nurse practitioner tell this parent?: Ans- there is no conclusive evidence about using probiotics to treat colic.
82. 17. A 9monthold infant has vesiculopustular lesions on the palms and soles, on the face and neck, and in skin folds of the extremities. The primary care pediatric nurse practitioner notes linear and Sshaped burrow lesions on the parent's hands and wrists. What is the treatment for this rash for this infant?: Ans- Permethrin 5% cream applied to face, neck, and body and rinsed off in 8 to 14 hours
83. 2. A toddler who was born prematurely refuses most solid foods and has poor weight gain. A barium swallow study reveals a normal esophagus. What will the primary care pediatric nurse practitioner consider next to manage this child's nutritional needs?: Ans- Video fluoroscopy swallowing study
84. 14. A newly divorced mother of a toddler reports that the child began having difficulty sleeping and nightmares along with exhibiting angry outbursts and tantrums 2 months prior. The primary care pediatric nurse practitioner learns that the child refuses to play with usual playmates and often spends time sitting quietly. What will the nurse practitioner doini- tially?: Ans- Ask the mother about the child's relationship with the father.
85. 3. A toddler is seen in the clinic after a 2day history of intermittent vomiting and diarrhea. An assessment reveals an irritable child with dry mucous membranes, 3second capillary refill, 2 second recoil of skin, mild

tachycardia and tachypnea, and cool hands and feet. The child has had two wet diapers in the past 24 hours. What will the primary care pediatric nurse practitioner recommend?: Ans- Oral rehydration solution with followup in 24 hours

86. 18. An adolescent has acne with lesions on the cheeks and under the chin.Which distribution is this?: Ans- Hormonal
87. 4. A 9yearold girl has a history of frequent vomiting and her mother has frequent migraine headaches. The child has recently begun having more fre- quent and prolonged episodes accompanied by headaches. An exam reveals abnormal eye movements and mild ataxia. What is the correct action?: Ans- Refer to a pediatric gastroenterologist for further workup.
88. 8. The primary care pediatric nurse practitioner is providing anticipatory guidance to the mother of a breastfed 6monthold infant who asks about "babyled wean- ing." What will the nurse practitioner tell her about this practice?: Ans- "Infants are given soft, mash- able table foods when able to selffeed."
89. 5. The parent of a 3monthold reports that the infant arches and gags while feeding: Ans- Begin a trial of extensively hydrolyzed protein formula for 2 to 4 weeks.
90. 19. An adolescent has acne characterized by papules and pustules most- ly on the forehead and chin. What will the primary care pediatric nurse practitioner prescribe?: Ans- Topical erythromycin with benzoyl peroxide
91. A schoolage child has a 3month history of dull, aching epigastric pain that worsens with eating and awakens the child from sleep. A complete blood count shows a hemoglobin of 8 mg/dL. What is the next step in management?: Ans- Referral for esophagogastroduodenoscopy (EGD)
92. 15. An adolescent has recently begun doing poorly in school and has stopped participating in sports and other extracurricular activities. During the history interview, the adolescent reports feeling tired, having difficulty concentrating, and experiencing a loss of appetite for the past few weeks but cannot attribute these changes to any major life event. Which is an important next step in managing this patient?: Ans- Determining suicidal ideation and risk of suicide

93. 7. A 2monthold infant cries up to 4 hours each day and, according to the parents, is inconsolable during crying episodes with fists and legs noted to be tense and stiff. The infant is breastfeeding frequently but is often fussy during feedings. The physical exam is normal and the infant is gain- ing weight normally. What will the primary care pediatric nurse practitioner recommend?: Ans- Eliminating certain foods from the mother's diet
94. 20. A child has an area of inflammation on the neck that began after wear- ing a handknot woolen sweater. On examination, the skin appears chafed with mild erythematous patches. The lesions are not pruritic. What is an appropriate initial treatment?: Ans- Topical corticosteroids applied 2 to 3 times daily
95. 8. A child is in the clinic after swallowing a metal bead. A radiograph of the GI tract shows a 6 mm cylindrical object in the child's stomach. The child is able to swallow without difficulty and is not experiencing pain. What is the correct course of treatment?: Ans- Have the parents watch for the object in the child's stool
96. 7. The parent of a 5yearold child who has just begun kindergarten ex- presses concern that the child will have difficulty adjusting to the birth of a sibling. What will the primary care pediatric nurse practitioner recommend?: Ans- Having snack time with the child each day to discuss the school day
97. 9. A 10yearold child has had abdominal pain for 2 days, which began in the periumbilical area and then localized to the right lower quadrant. The child vomited once today and then experienced relief from pain followed by an increased fever. What is the likely diagnosis?: Ans- Appendicitis with perforation
98. 21. An adolescent who had cradle cap as an infant is in the clinic with thick crusts of yellow, greasy scales on the forehead and behind the ears. What will the primary care pediatric nurse practitioner recommend?: Ans- Daily application of ketoconazole 2% topical cream
99. An 18monthold child has a 1day history of intermittent, cramping abdom- inal pain with nonbilious vomiting. The child is observed to scream and draw up his legs during pain episodes and becomes lethargic in between. The primary care pediatric nurse practitioner notes a small amount of bloody, mucous stool in the diaper. What is the most likely diagnosis?: Ans- Intussuscep- tion

100. 16. An adolescent is diagnosed with major depression, and the mental health specialist has prescribed fluoxetine. What other treatment is impor- tant to protect against suicide risk?: Ans- Cognitivebehavioral therapy
101. 13. A schoolage child has recurrent diarrhea with foulsmelling stools, excessive flatus, abdominal distension, and failuretothrive. A 2week lactose- free trial failed to reduce symptoms. What is the next step in diagnosing this condition?: Ans- Serologic testing for celiac disease
102. 22. A child is brought to the clinic with a generalized, annular rash characterized by raised wheals with pale centers. On physical examination, the child's lungs are clear and there is no peripheral edema. A history reveals ingestion of strawberries earlier in the day. What is the initial treatment?: Ans- Diphenhydramine 0.5 to 1 mg/kg/dose every 4 to 6 hours
103. 12. An adolescent is diagnosed with functional abdominal pain (FAP). The child's symptoms worsen during stressful events, especially with school anxiety. What will be an important part of treatment for this child?: Ans- Teaching about the braingut interaction causing symptoms
104. 8. The parent of a 24monthold child asks the primary care pediatric nurse practitioner when toilet training should begin. How will the pediatric nurse practitioner respond?: Ans- "Tell me about your child's daily habits."
105. 11. A schoolage child has had abdominal pain for 3 months that occurs once or twice weekly and is associated with a headache and occasional difficulty sleeping, often causing the child to stay home from school. The child does not have vomiting or diarrhea and is gaining weight normally. The physical exam is normal. According to Bishop, what is included in the initial diagnostic workup for this child?: Ans- CBC, ESR, amylase, lipase, UA, and abdominal ultrasound
106. 23. A child who has been taking antibiotics is brought to the clinic with a rash. The parent reports that the child had a fever associated with what looked like sunburn and now has "blisters" all over. A physical examination shows coalescent

target lesions and widespread bullae and areas of peeled skin revealing

moist, red surfaces. What will the primary care pediatric nurse practitioner do?: Ans- Consult with a pediatric intensivist for admission to a pediatric intensive care unit.

107. A 30monthold girl who has been toilet trained for 6 months has daytime enuresis and dysuria and a lowgrade fever. A dipstick urinalysis is negative for leukocyte esterase and nitrites. What is the next step?: Ans- Send the urine to the lab for culture.
108. 17. A 13yearold child has exhibited symptoms of mild depression for several weeks. ID: Ans- 13348419846 The parent reports feeling relieved that the symptoms have passed but con- cerned that the child now seems to have boundless energy and an inability to sit still. What will the primary care pediatric nurse practitioner do?: Ans- Refer the child to a child psychiatrist for evaluation of bipolar disorder.
109. 2. The clean catch urine specimen of a child with dysuria, frequency, and fever has a colony count between 50,000 and 100,000 of E. coli. What is the treatment for this child?: Ans- Treat with antibiotics for urinary tract infection
110. 24. A schoolage child has a rash without fever or preceding symptoms. Physical examination reveals a 3cm ovoid, erythematous lesion on the trunk with a finely scaled elevated border, along with generalized macular, ovoid lesions appearing in a "Christmas tree" pattern on the child's back. What is the initial action?: Ans- Reassure the child's parents that the rash is benign and self limited.
111. 3. The primary care pediatric nurse practitioner is performing a well child exam on a 24monthold child. The parent tells the nurse practitioner that the child is being toilet trained and expresses frustration that on some days the child uses the toilet every time and on other days not at all. What will the nurse practitioner do?: Ans- Ask the parent about the child's toilet habits and understanding of toilet training
112. 25. A child who has psoriasis, who has been using a moderate potency topical steroid on thick plaques on the extremities and a highpotency topical steroid on more severe plaques on the elbows and knees, continues to have

worsening of plaques. In consultation with a dermatologist, which treatment will be added?: Ans- A. An- thralin ointment in high strength applied for 10 to 30 minutes daily B. Calcipotriol cream applied liberally each day to the entire body C. Oral steroids and methotrexate therapy until plaques resolve D. Wideband ultraviolet therapy for 15 minutes twice daily

113. 18. A toddler has begun hitting and biting other children at a day care center and is exhibiting temper tantrums and bad language at home. The parent reports that these behaviors began shortly after a sibling was born. What will the primary care pediatric nurse practitioner do?: Ans- Engage the parent in positive parenting strategies to facilitate appropriate child coping.
114. 26. During a well child examination of an infant, the primary care pedi- atric nurse practitioner notes 10 café au lait spots on the infant's trunk. What is the potential concern associated with this finding?: Ans- Neurofibromatosis
115. 3. The parent of a 12monthold infant asks the primary care pediatric nurse practitioner why 2% cow's milk is recommended instead of whole milk. What will the nurse practitioner tell this parent?: Ans- Younger children need a limited amount of fats.
116. 27. The primary care pediatric nurse practitioner notes velvety, brown thickening of skin in the axillae, groin, and neck folds of an adolescent Hispanic female who is overweight. What is the initial step in managing this condition?: Ans- Performing metabolic laboratory tests
117. 19. A 14yearold female comes to the clinic with amenorrhea for 3 months. A pregnancy test is negative.The adolescent's body weight is at 82% of expect- ed for height and age. The mother reports that her daughter often throws up and refuses to eat most foods. Which condition does the primary care pediatric nurse practitioner suspect?: Ans-

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Anorexia nervosa

118. 28. An AfricanAmerican child has recurrent tinea capitis and has just developed a new area of alopecia after successful treatment several months prior. When prescribing treatment with griseofulvin and selenium shampoo, what else will the primary care pediatric nurse practitioner do?: Ans- Perform fungal cultures on family members and pets
119. You are checking family hx for a teen that is in your clinic for a sports physical. What is crittically importan that you ask and why?: Ans- any history of hypertophic cardiomyopathy or sudden death. You ask this because HCM is famillal.
120. 14. A child has small, firm, fleshcolored papules in both axillae which are mildly pruritic. What is an acceptable initial approach to managing this condition?: Ans- Reassuring the parents that these are benign and may disappear spontaneously
121. A child who has attentiondeficit/hyperactivity disorder (ADHD) has dif- ficulty stopping activities to begin other activities at school. The primary care pediatric nurse practitioner understands that this is due to difficulty with the selfregulation component of: Ans- flexibility
122. 2. A child will need an occlusive dressing to treat lichen simplex chron- icus. What will the primary care pediatric nurse practitioner tell the parents about applying this treatment?: Ans- Apply ointment before the dressing
123. 3. The parents of a 12yearold child are concerned that some of the child's older classmates may be a bad influence on their child, who, they say, has been raised to believe in right and wrong. What will the primary care pediatric nurse practitioner tell the parent?: Ans- The pressures from outside influences may supersede parental teach- ings and should be confronted
124. 9. A child has several circular, scaly lesions on the arms and abdomen, some of which have central clearing. The primary care pediatric nurse practitioner notes a smaller, scaly lesion on the child's scalp. How will the nurse practitioner treat this