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PNP Pediatric Nurse Practitioner 2024
Exam Review Questions and
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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 - Answer>> 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 - Answer>> 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. - Answer>> 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 - Answer>> c The past history should include a. family history b. social hx c. symptom analysis d. hospitalization - Answer>> 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 - Answer>> 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 - Answer>> 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 - Answer>> b
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 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 - 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 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. - Answer>> 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 - Answer>> a A 2-week-old neonate is brought to the clinic with excessive lacrimation of both eyes. The eyes are clear, with no areas of
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 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 - Answer>> 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 - Answer>> 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 - Answer>> d
C) Applies a sterile dressing D) Administers tetanus vaccine and educates family regarding signs of wound infection - Answer>> d 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 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 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 - Answer>> 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 - Answer>> d 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 - Answer>> 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 - Answer>> b
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 - Answer>> a 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: A) Spastic diplegia B) Spastic quadriplegia C) Athetoid cerebral palsy D) Spastic hemiplegia - Answer>> a A mother brings a 1-year-old child with Down's syndrome to the clinic. She is concerned that the child has been congested for 10 days. The child was born at home and has never been seen in this practice. The mother reports that the child is doing well, has no problems, and is still being breastfed. The child has never been examined by a doctor. The PNP's initial plan of care for the child is: A) Treat the congestion, and start immunizations B) Start immunizations, and refer the parents for genetic counseling C) Rule out an ear infection, and refer the child to a physician for a hearing evaluation D) Rule out a heart defect, and refer the child to a physician - Answer>> a
The PNP has completed vision screens on the children who attend a day care and preschool center. Which of the following children should be referred for further testing? A) A 3-year-old child (tested with a Sjögren hand chart) with the following results: right eye, 20/40; left eye, 20/ B) A 4-year-old child (tested with an HOTV chart) with the following results: right eye, 20/40; left eye, 20/ C) A 4-year-old child (tested with a Snellen E chart) with the following results: right eye, 20/20; left eye, 20/ D) A 3-year-old child (tested with an Allen chart) with the following results: right eye, 20/30; left eye, 20/30 - Answer>> a 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
C) Fears that interfere with social development resolve as the child develops D) Parents should not allow the child to withdraw from a fearful situation - Answer>> a The mother of a 2-year-old child is concerned about the child's thumb sucking during the day when not playing and at night while sleeping. The PNP suggests that: A) This is not a problem unless the thumb sucking continues past age 3 years B) The mother should obtain an orthodontic device for the child's mouth to discourage the sucking behavior C) The parents should send the child to time-out when caught thumb sucking during the day D) The parents should ignore the behavior because it is not harmful at this age - Answer>> d A 3-year-old child is brought to the clinic for a well-child visit. The mother requests help with toilet training. The child refuses to use the toilet to have a bowel movement and squats, wearing a diaper, in a secluded corner to pass a stool. The parents offer encouragement through rewards and the "big kid" approach to using the toilet, but nothing seems to help. The PNP should respond that: A) Refusal to use the toilet after age 2.5 years is the result of caregivers (parents, day care workers, etc.) putting too much emphasis on toilet training B) The child should be forced to sit on the toilet every 2 hours for 5 to 10 minutes during the day C) All responsibilities, including clean up (with appropriate assistance), should be turned over to the child after wetting or soiling pants D) Autonomy struggles are common at this age; most children eventually train themselves - Answer>> d
The mother of a 2-year-old child requests information regarding toilet training readiness. The PNP tells the mother that the most important factor in determining readiness to toilet train is that the child: A) Is not bothered by wet or soiled pants B) Is strong willed and shows an interest in the potty C) Is able to communicate needs and follow directions D) Wakes up from naps with soaked diapers - Answer>> c The PNP counsels the mother of an infant about possible sibling rivalry a 2-year-old sibling may exhibit. To decrease sibling rivalry the PNP suggests that the parents should: A) Tell the older child that he or she is no longer a baby and can wait until his or her needs can be met B) Not allow the older child to touch the infant under any circumstances C) Not tolerate any regression on the part of the older child D) Set aside extra time to spend with the older child - Answer>> d A mother brings her 2-year-old child to the clinic for a well-child visit. The mother's chief complaint is the child's rebellious behavior. The mother says that she has tried time-out, yelling, and spanking but nothing has worked. The child has never slept through the night and still gets a bottle in the middle of the night. In the examination room the PNP observes as the child repeatedly gets into the mother's purse when she is not paying attention, despite the mother telling the child "no." Based on the history and observation, the PNP suggests that: A) The child needs to have limits and boundaries set consistently and the mother could benefit from parenting classes B) The child is normal; this rebelliousness is only a phase and will improve with time C) The child exhibits behavior atypical of 2-year-old children and immediate referral to a child psychologist is necessary
B) Have speech that is 100% intelligible to strangers C) Speak in sentences of three to four words D) Not have problems with dysfluency (stuttering) - Answer>> a 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 The 19-year-old mother of an infant in the PNP's care has just found out that she is expecting her second child. The mother's first prenatal visit is scheduled soon. The mother smokes two packs of cigarettes a day. What action should the PNP take? A) Inform the mother about the risks to herself and to her children from secondhand smoke B) Sign the mother up for smoking cessation classes C) Let the obstetrician/gynecologist assess and manage this issue D) Write the mother a prescription for nicotine replacement therapy - Answer>> a 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 A 12-year-old child is brought to the office for a yearly physical. The child states that he has recently noticed an enlargement of his testes and scrotum. When counseling the boy as to what to expect next in pubertal development the PNP tells him: A) The penis will grow in length B) The penis will grow in width C) Facial hair will appear D) Changes in voice will occur - Answer>> a 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 PNP has prescribed salmeterol (Serevent) by inhalation for an asthmatic. The family should be warned about which of the following side effects that occur with this medication? A) Tachycardia and headache B) Weight gain and acne C) Nausea and vomiting D) Dysrhythmia and dry mouth - Answer>> a
