NRNP 6541 Midterm Exam (3 Versions, Latest-20232024, 300 Q & A) NRNP6541 Midterm Exam NR, Exams of Nursing

Download NRNP 6541 Midterm Exam (3 Versions, Latest-20232024, 300 Q & A) NRNP6541 Midterm Exam NR and more Exams Nursing in PDF only on Docsity! NURS 6541 MIDTERM EXAM PREP TEST SOLUTION CONTAINING 100 QUETSIONS WITH ALL CORRECT ANSWERS UPDATED SOLUTION   Question 1 What is the most common form of child abuse seen in pediatric primary care?  Question 2 Which of the following conditions requires urgent inpatient admission?  Question 3 An eye that deviates in when covered but that returns to midline when uncovered is an  Question 4 All of the following are consistent with peritonsillar abscess except:  Question 5 Which adolescent would be at greatest risk for developing anorexia nervosa?  Question 6 A mother states that her 4-year-old son constantly grinds his teeth at night. You document this as:  Question 7 FIRST-LINE therapy for preschoolers (4-5 years of age) diagnosed with attention-deficit hyperactive disorder is:  Question 8 A 7-year-old has just been diagnosed with attention deficit hyperactivity disorder (ADHD). Her parents report that she is doing poorly in school and is disruptive in the classroom. They ask you what they can do. Your best response is:  Question 9 The most common substance used in middle school is  Question 10 The most likely weight of a 1-year-old whose birth weight was 6-1/2 pounds would be:  Question 11 Which of the following characterizes middle adolescence (14 to 16 years old)?  Question 12 Mark, a 10-year-old, has a lot of ear pain. He does not want anyone to touch it and is crying in pain. The ear canal is swollen and exudate is present. The TM is normal. Mark should be instructed to do which of the following?  Question 13 A 2-year-old child weighs 34 lb. What type of car seat should the child use?  Question 14 An expected milestone of a 4-year-old is the ability to  Question 15 A child's central visual acuity is 20/30 by age  Question 16 Early reflexive responses that are not related to survival include all but:  Question 32 A healthy, well-developed 6-year-old child arrives as a new patient to your clinic. His immunization card reveals that he received an immunization at birth and some when he was 2 months old, but none sense. Which of the following statements about him is correct?  Question 33 Conductive hearing loss can be caused by  Question 34 A fifteen-year-old female makes a statement to you during a well visit. Which of the following statements should not be kept confidential?  Question 35 Which of the following eye findings would be considered an ophthalmic emergency?  Question 36 You see a 7-year-old with complaints of "having accidents at night." Physical exam and history are unremarkable. Urinalysis, urine culture, and specific gravity are normal. His parents ask about the best treatment for this problem. The best response is  Question 37 During a domestic health assessment, the CDC recommends screening every refugee child for which of the following diseases?  Question 38 The diagnostic criteria for autism spectrum disorder include all of the following except  Question 39 A 19-month-old says “mama” and “dada,” points and gestures if he wants things, and follows simple one-step commands. Your best response is which of the following?  Question 40 While assessing the skin of an infant, you note cafe-au-lait spots. Which disease should be ruled out?  Question 41 A differential diagnosis for child abuse would include all of the following except.  Question 42 Which of the following screenings should adolescents have done annually?  Question 43 The nurse practitioner role was initially established to  Question 44 An 8-year-old female is brought into the office by her mother. She has complaints of fever and sore throat for the past 2 days. She denies difficulty swallowing but has loss of appetite and mild diarrhea. A few classmates have similar symptoms. A review of systems reveals clear nasal drainage, dry cough, and hoarseness. On exam she has a 101.5 temperature, 3+ erythematous tonsils, and anterior cervical lymphadenopathy. What is the likely diagnosis?  Question 45 Josh, age 13, has some enlargement of the scrotum and testes, a reddened scrotal sac, and some hair texture alteration. His penis is not enlarged. He is in Tanner stage  Question 46 Mark is in the exam room. You are concerned he may have epiglottitis. In what position do these patients prefer to sit?  Question 47 Hannah, age 4, is brought into the office by her father. She complains of a sore throat, difficulty swallowing, copious oral secretions, stridor, and a temperature of 102F. She does not have pharyngeal erythema or cough. What do you suspect?  Question 48 John is diagnosed with allergic conjunctivitis. What type of discharge do you expect to see upon exam?  Question 49 The first sign of the onset of female puberty is usually:  Question 50 A 6-month-old infant has been growing poorly. His parents have changed his formula three times without success. His examination is remarkable for a pale, emaciated child with little subcutaneous fat and anterior fontanelle fullness. His laboratory test results are notable for a hemolytic anemia and prolonged bleeding times. Which of the following is the most appropriate next step?  Question 51 Which of the following statements about "routine" screening tests is true?  Question 52 A mother of a 6-month-old asks you about normal sleep patterns for an infant this age. The best response is:  Question 53 A Mantoux test in a child with no risk factors is considered positive with a reaction of:  Question 54 Which is the correct order for introduction of solid foods to an infant? You would be concerned about the language development of a child who:  Question 69 A 7-month-old male is found to have a spiral fracture of the femur that his father says he got by climbing onto a chair and then jumping off. Which of the following statements is true regarding this situation?  Question 70 A new mom calls the NP on postpartum day 5. She reports her newborn wants to nurse for 30 minutes every 1-1/2 to 2 hours. Which of these is the best response?  Question 71 Upon eye examination of a newborn, you note inner canthal folds and Brushfield spots. What do you suspect?  Question 72 Acute otitis media can be diagnosed when there is  Question 73 Which of the following are important considerations when screening child refugees for tuberculosis? SELECT TWO (2)  Question 74 Which of the following statements is true regarding lying and stealing by the school-age child?  Question 75 Which of the following foreign body in the nose requires immediate removal?  Question 76 During a “well-child” visit, the parents of a healthy 5-month-old offer a great amount of information. Which of the following bits of information is of most concern?  Question 77 You assess a 15-year-old's visual acuity and note her vision to be 20/50 in the right eye. She asks you what that means and you respond  Question 78 An 11-year-old girl has dizziness, pupillary dilation, nausea, fever, tachycardia, and facial flushing. She says she can "see" sound and "hear" colors. The agent likely to be responsible is which of the following?  Question 79 Which of the following signs may indicate a baby is not receiving sufficient breastmilk?  Question 80 Which of the following strategies would not be appropriate to include as part of your treatment plan of an 8-year-old boy who is obese?  Question 81 Which of the following complication of strep pharyngitis cannot be prevented with antibiotics?  Question 82 You see a 4-year-old for a well-child visit. He has received four diphtheria, tetanus, and acellular pertussis vaccines (DTaP); three injected polio vaccines (IPV); one measles, mumps, and rubella vaccine (MMR); one varicella vaccine; and two hepatitis B (Hep B) vaccines. What do you order today?  Question 83 You see a 6-month-old for a well-child visit and the mother tells you the child’s grandmother recommends that she give the infant whole milk and eggs when he starts solids. What should you tell the mother?  Question 84 Which of the following substances is associated with pupillary constriction?  Question 85 A breastfed infant is expected to have a lower incidence of which of the following?  Question 86 The results of the hemoglobin A1c test are LESS reliable in children with which of the following conditions? (Hint: select two)  Question 87 Which of the following statements about bullying is true?  Question 88 An 8-year-old female has an edematous, mildly erythematous right upper eyelid for 2 days with a fever of 102.9 (F). Which important eye assessment do you need to consider?  Question 89 What method can be safely used to remove cerumen in a 15-month-old child's ear?  Question 90 You see a 5-month-old who is fussy, has interrupted sleep, and is drooling. You note large lower lateral incisor bulges. You recommend:  Question 91 Sandy, age 18 months, crosses her legs when lifted from behind rather than pulling them up. Her legs are also hard to separate, making diaper changing difficult. She persistently uses only one hand. What condition do you suspect? NRNP 6541 Primary Care Of Adolescents And Children 2023 NRNP 6541 Week 6 Midterm Exam 2023 GENUINE EXAM (100% Correct PASS) NRNP 6541 Primary Care Of Adolescents And Children 2023 You see a 4-year-old for a well-child visit. He has received four diphtheria, tetanus, and acellular pertussis vaccines (DTaP); three injected polio vaccines (IPV); one measles, mumps, and rubella vaccine (MMR); one varicella vaccine; and two hepatitis B (Hep B) vaccines. What do you order today? CORREC T RESPON SE: c. Tetanus and diphtheria toxoid with acellular pertussis (TdaP), MMR, hepatitus B, and IPV • QUIZ 4 1 out of 1 points A 6-month-old infant has been growing poorly. His parents have changed his formula three times without success. His examination is remarkable for a pale, emaciated child with little subcutaneous fat and anterior fontanelle fullness. His laboratory test results are notable for a hemolytic anemia and prolonged bleeding times. Which of the following is the most appropriate next step? CORRECT RESPONSE: e. Perform a hemoglobin electrophoresis • QUIZ 5 2 out of 1 points Max, a 9-year-old boy, is a very active child with limited self-control. He is easily distracted and has difficulty staying on task. You determine that he should have a neurodevelopmental evaluation because he is showing signs of CORRECT RESPONSE: d. ADHD • QUIZ 6 1 out of 1 points You see a 3-year-old for a well-child visit. His mother informs you that potty training has been very easy because he “has an amazing internal clock. He falls asleep, gets hungry, and has bowel movements at the same time every day.” This describes which aspect of temperament? CORRECT RESPONSE: b. Rhythmicity • QUIZ 7 19 to 20 pounds • QUIZ 17 1 out of 1 points You are doing a kindergarten physical on a 5-year-old girl. Which of the following scenarios would suggest the child is not ready to start kindergarten in the fall? CORRECT RESPONSE: c. Counts to 4 and draws a person with three parts. • QUIZ 18 1 out of 1 points Sam has an otitis media. He also presents with conjunctivitis. This is due to which organism? CORRECT RESPONSE: d. Haemophilus influenza • QUIZ 19 1 out of 1 points Which of the following complication of strep pharyngitis cannot be prevented with antibiotics? CORRECT RESPONSE: a. Glomerulonephritis • QUIZ 20 1 out of 1 points During a “well-child” visit, the parents of a healthy 5-month-old offer a great amount of information. Which of the following bits of information is of most concern? CORRECT RESPONSE: c. Diet that includes baby cereal, five different baby vegetables, and one baby fruit. • QUIZ 21 2 out of 1 points Hannah, age 4, is brought into the office by her father. She complains of a sore throat, difficulty swallowing, copious oral secretions, stridor, and a temperature of 102F. She does not have pharyngeal erythema or cough. What do you suspect? CORRECT RESPONSE: c. Epiglottitis • QUIZ 22 1 out of 1 points Which of the following strategies would not be appropriate to include as part of your treatment plan of an 8-year-old boy who is obese? CORRECT RESPONSE: a. Referral to nutritionist for weight reduction plan. • QUIZ 23 1 out of 1 points Sally, age 4, presents to the office with her mother for a well-child visit. To assess for age-appropriate fine motor skills, what activity would you ask her to perform? CORRECT RESPONSE: b. Copy a circle. • QUIZ 24 2 out of 1 points A 4-month-old presents with both eyes turning inward. What is this called? CORRECT RESPONSE: d. Esotropia • QUIZ 25 1 out of 1 points You assess a 15-year-old's visual acuity and note her vision to be 20/50 in the right eye. She asks you what that means and you respond CORREC T RESPON SE: a. "You can see at 50 feet with your right eye what most people can see at 20 feet." • QUIZ 26 2 out of 1 points Upon eye examination of a newborn, you note inner canthal folds and Brushfield spots. What do you suspect? CORRECT RESPONSE: a. Down syndrome • QUIZ 27 1 out of 1 points The parent of a 2-year-old tells you her daughter recently started having breath-holding spells. She tells you the older sibling “did the same thing” and asks you for help. You advise her that after a breath-holding event: CORRECT RESPONSE: b. Act as if nothing abnormal happened. • QUIZ 28 0 out of 1 points Which of the following issues or concepts is relevant to the school-age child? CORRECT RESPONSE: a. Operational thinking • QUIZ 29 1 out of 1 points Mark, a 10-year-old, has a lot of ear pain. He does not want anyone to touch it and is crying in pain. The ear canal is swollen and exudate is preswent. The TM is normal. What is the proper management for his patient? CORRECT RESPONSE: d. Oral Amoxicillin and topical steroids • QUIZ 30 2 out of 1 points A new mom calls the NP on postpartum day 5. She reports her newborn wants to nurse for 30 minutes every 1-1/2 to 2 hours. Which of these is the best response? Most children can independently get dressed by themselves by age: CORRECT RESPONSE: a. 5 years • QUIZ 40 1 out of 1 points A 9-year-old who weighs 70 pounds asks why she can't sit in the front passenger seat of the family car. Your best response is CORREC T RESPON SE: c. The safest place for children under 12 years old and 100 pounds is in the backseat of the car. • QUIZ 41 1 out of 1 points A 12-year-old male states he noticed an enlargement of his testes and scrotum. When counseling him about the next step in pubertal development, you state: CORRECT RESPONSE: b. The penis will grow in length and width. • QUIZ 42 0 out of 1 points Which of the following screenings should adolescents have done annually? CORRECT RESPONSE: a. Blood pressure, hemoglobin, complete physical exam • QUIZ 43 0 out of 1 points A 19-month-old says “mama” and “dada,” points and gestures if he wants things, and follows simple one-step commands. Your best response is which of the following? CORRECT RESPONSE: d. Encourage early intervention services for speech. • QUIZ 44 0 out of 1 points What method can be safely used to remove cerumen in a 15-month-old child's ear? CORRECT RESPONSE: b. A size 2 curette • QUIZ 45 1 out of 1 points I can walk well on tiptoes, my speech is 50% understandable, I know six body parts, but I cannot balance on one foot for 1 second. I am: CORRECT RESPONSE: c. 2 years old (24 months) • QUIZ 46 2 out of 1 points Josh, age 13, has some enlargement of the scrotum and testes, a reddened scrotal sac, and some hair texture alteration. His penis is not enlarged. He is in Tanner stage CORRECT RESPONSE: a. II • QUIZ 47 1 out of 1 points Which of the following vaccines is routinely recommended at 4 months of age? CORRECT RESPONSE: a. Diphtheria, tetanus, acellular pertussis (DTaP) • QUIZ 48 1 out of 1 points I can roll over, grasp a rattle, and reach for things and have begun feeding myself finger foods, but I can’t wave bye-bye yet. How old am I? CORRECT RESPONSE: b. 6 months • QUIZ 49 0 out of 1 points A 2-day-old newbornwith conjunctivitis is likely due to CORRECT RESPONSE: b. Chlamydia • QUIZ 50 1 out of 1 points Which of the following conditions requires urgent inpatient admission? CORRECT RESPONSE: b. Orbital cellulitis • QUIZ 51 2 out of 1 points Mark, a 10-year-old, has a lot of ear pain. He does not want anyone to touch it and is crying in pain. The ear canal is swollen and exudate is present. The TM is normal. Mark should be instructed to do which of the following? CORRECT RESPONSE: c. Keep ear dry until symptoms improve. • QUIZ 52 1 out of 1 points The nurse practitioner role was initially established to CORRECT RESPONSE: a. Improve access to care and partially solve physician shortage. • QUIZ 53 1 out of 1 points Test Results Fasting blood glucose 112 mg/dL 2 hour postprandial glucose 138 mg/dL CORRECT RESPONSE: a. Impaired fasting glucose, impaired glucose tolerance • QUIZ 63 0 out of 1 points Which of the following statements is true regarding lying and stealing by the school-age child? CORREC T RESPON SE: b. They are more likely to happen with parents use consistent and firm behavior modeling. • QUIZ 64 0 out of 1 points Which of the following would not suggest an eating disorder with a purging component? CORRECT RESPONSE: b. Finger calluses • QUIZ 65 1 out of 1 points You see a 30-month-old who speaks in mixed Spanish and English. The child’s vocabulary is normal but at the low end of the normal language spectrum. The parent is worried the child’s development will not be normal because she mixes up the two languages. You respond: CORRECT RESPONSE: c. "The child may confuse the words now, but that will change by second grade." • QUIZ 66 2 out of 1 points An 11-year-old girl has dizziness, pupillary dilation, nausea, fever, techycardia, and facial flushing. She says she can "see" sound and "hear" colors. The agent likely to be responsible is which of the following? CORRECT RESPONSE: b. Lysergic acid diethylamide (LSD) • QUIZ 67 0 out of 1 points Chelsea, age 8, complains that she feels as if something is stuck in her ear. What action is contraindicated? CORRECT RESPONSE: a. Instilling several drops of mineral oil in the ear. • QUIZ 68 1 out of 1 points All of the following are consistent with peritonsillar abscess except: CORRECT RESPONSE: c. Unilateral enlargement of tonsil • QUIZ 69 2 out of 1 points The first sign of the onset of female puberty is usually: CORRECT RESPONSE: d. Breast buds • QUIZ 70 0 out of 1 points Which of the following are important considerations when screening child refugees for tuberculosis? SELECT TWO (2) CORREC T RESPON SEs: a. Interferon gamma release assay (IGRA) is not recommended for use in children younger than 5 years. c. Mantoux TST should not be used in a child who has received a Bacille Calmette- Guerin vaccination. • QUIZ 71 1 out of 1 points Which of the following represents normal sequencing of development in a toddler? CORREC T RESPON SE: d. Uses spoon without difficulty, uses parallel play, dresses and undresses self independently, washes hands. • QUIZ 72 2 out of 1 points An 8-year-old female has an edematous, mildly erythematous right upper eyelid for 2 days with a fever of 102.9 (F). Which important eye assessment do you need to consider? CORRECT RESPONSE: d. Ocular mobility • QUIZ 73 0 out of 1 points I like to use my pincer grasp that involves the ablitily to pick up a small object such as a raisin or piece of cereal with the thumb and forefinger, and that is mastered around what age? CORRECT RESPONSE: b. 6 months • QUIZ 74 0 out of 1 points You are performing an examination of a 3-year-old who is new to your office. Which finding requires immediate further evaluation? CORRECT RESPONSE: a. Heart rate increases during inspiration and decreases during expiration. • QUIZ 75 0 out of 1 points CORRECT RESPONSE: c. 9 months • QUIZ 85 1 out of 1 points A child's central visual acuity is 20/30 by age CORRECT RESPONSE: a. 4 years • QUIZ 86 2 out of 1 points A typically developing 8-year-old girl will have which of the following genital development? CORRECT RESPONSE: b. No pubic hair at all • QUIZ 87 1 out of 1 points A Mantoux test in a child with no risk factors is considered positive with a reaction of: CORRECT RESPONSE: a. at least 15 mm induration • QUIZ 88 1 out of 1 points You see a 5-month-old who is fussy, has interrupted sleep, and is drooling. You note large lower lateral incisor bulges. You recommend: CORRECT RESPONSE: e. A and D • QUIZ 89 0 out of 1 points You see a 13-year-old who reports she is learning some basic geometry (areas, volume etc.). The ability to successfully master these concepts occurs during which Piaget developmental stage? CORRECT RESPONSE: d. Concrete operational • QUIZ 90 1 out of 1 points Which of the following injuries is most likely to be caused by abuse of a toddler? CORRECT RESPONSE: a. Spiral fracture of the tibia. • QUIZ 91 2 out of 1 points FIRST-LINE therapy for preschoolers (4-5 years of age) diagnosed with attention-deficit hyperactive disorder is: CORRECT RESPONSE: a. Behavior therapy • QUIZ 92 1 out of 1 points A 4-month-old child has poor weight gain. Her current weight is less than the 5th percentile, height about the 10th percentile, and head circumference at the 50th percentile. The planned pregnancy resulted in a normal, spontaneous, vaginal delivery; mother and child were discharged after a 48- hour hospitalization. Feeding is via breast and bottle; the quantity seems sufficient. The child has had no illness. The examination is unremarkable except for the child’s small size. Screening laboratory shows the hemoglobin and hematocrit are 11 mg/dL and 33% respectively, with a platelet count of 198,000/mm3. Serum electrolyte levels are sodium 140, chloride 105, potassium 3.5, bicarbonate 17, blood urea nitrogen 15, and creatinine 0.3. Liver function tests are normal. Urinalysis reveals a pH of 8 with occasional epithelial cells but no white blood cells, bacteria, protein, ketones, or reducing substances. Which of the following is the most appropriate therapy for this child? CORRECT RESPONSE: b. Oral supplementation with bicarbonate • QUIZ 93 1 out of 1 points Epiglottitis has decreased due to which immunization? CORRECT RESPONSE: d. Hib • QUIZ 94 1 out of 1 points Tammy, age 3, is at the office for her well-child visit. She has trouble removing her own shirt as requested. Her mother yanks off her shirt after smacking her wrist and saying, "you must do as you're told quickly." Which action is indicated? CORRECT RESPONSE: c. Observe Tammy for signs of child abuse. • QUIZ 95 1 out of 1 points A mother states that her 4-year-old son constantly grinds his teeth at night. You document this as: CORRECT RESPONSE: b. Bruxism • QUIZ 96 1 out of 1 points Which of the following foreign body in the nose requires immediate removal? CORRECT RESPONSE: c. battery • QUIZ 97 1 out of 1 points A common feature of 2-year-old behavior is: CORRECT RESPONSE: b. Stranger anxiety • QUIZ 98 2 out of 1 points NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS Sandy, age 18 months, crosses her legs when lifed from behind rather than pulling them up. Her legs are also hard to separate, making diaper changing difficult. She persistently uses only one hand. What condition do you suspect? Selected Answer: a. Cerebral palsy Question 6 1 out of 1 points Which of the following represents normal sequencing of development in a toddler? Selected Answer: b. Feeds self, can undress self with help, washes hands, imitates housework. Question 7 1 out of 1 points Epiglottitis has decreased due to which immunization? Selected Answer: d. Hib Question 8 1 out of 1 points A 2-day-old infant has significant nasal and rectal bleeding. He was delivered by a midwife at home; the pregnancy was without complications. His Apgar scores were 9 at 1 minute and 9 at 5 minutes. He has breastfed well and has not required a health care professional visit since birth. Which of the following vitamin deficiencies might explain his condition? Selected Answer: b. P a g e 2 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS Vitamin K Question 9 1 out of 1 points I can roll over, grasp a rattle, and reach for things and have begun feeding myself finger foods, but I can’t wave bye-bye yet. How old am I? Selected Answer: a. 6 months Question 10 1 out of 1 points A 14-year old has ataxia. He is brought to the local emergency department, where he appears euphoric, emotionally labile, and disoriented. Many notice his abusive language. Which of the following agents is most likely responsible for his condition? Selected Answer: b. Barbituates Question 11 2 out of 1 points An 8-year-old female has an edematous, mildly erythematous right upper eyelid for 2 days with a fever of 102.9 (F). Which important eye assessment do you need to consider? Selected Answer: c. Ocular mobility Question 12 P a g e 3 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS 1 out of 1 points You see a 5-month-old who is fussy, has interrupted sleep, and is drooling. You note large lower lateral incisor bulges. You recommend: Selected Answer: e. A and D Question 13 1 out of 1 points You are doing a kindergarten physical on a 5-year-old girl. Which of the following scenarios would suggest the child is not ready to start kindergarten in the fall? Selected Answer: d. Counts to 4 and draws a person with three parts. Question 14 1 out of 1 points Miguel, age 14, was hit in the eye with a baseball and developed eye pain, decreased visual acuity, and injection of the globe. Upon exam you note blood in the anterior chamber and confirm diagnosis of hyphema. What treatment do you recommend while Miguel is waiting to see the ophthalmologist Selected Answer: b. Apply bilateral eye patches. Question 15 1 out of 1 points P a g e 4 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS Flourescein staining of the eye is used to detect a Selected Answer: d. Corneal abrasion Question 23 1 out of 1 points A 14-year-old female comes into the office for an urgent visit afer taking 10 valium tablets. Following the initial emergent care and stailization, the most important part of the management is: Selected Answer: a. Reviewing the history for signs of depression. Question 24 2 out of 1 points Which of the following children has abnormal language development? Selected Answer: c. Speech is 50% understandable at 36 months of age Question 25 1 out of 1 points P a g e 7 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS Please interpret the following labs for an adolescent. The adolescent has a history of obesity and acanthosis nigricans. Test Results Fasting blood glucose 112 mg/dL 2 hour postprandial glucose 138 mg/dL Selected Answer: d. Normal fasting glucose, postprandial glucose within normal limits Question 26 2 out of 1 points During a domestic health assessment, the CDC recommends screening every refugee child for which of the following diseases? Selected Answer: c. tuberculosis Question 27 1 out of 1 points Which of the following complication of strep pharyngitis cannot be prevented with antibiotics? Selected Answer: c. Glomerulonephritis Question 28 1 out of 1 points P a g e 8 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS Conductive hearing loss can be caused by Selected Answer: b. Serous otitis P a g e 9 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS Question 33 1 out of 1 points Which of the following is a priority nurse practitioner role to help children and adolescents to have healthy sexual development? Selected Answer: Question 34 1 out of 1 points c. Begin anticipatory guidance related to sexuality and normal pubertal development in the early school-age visits. You see a 7-year-old with complaints of "having accidents at night." Physical exam and history are unremarkable. Urinalysis, urine culture, and specific gravity are normal. His parents ask about the best treatment for this problem. The best response is Selected Answer: b. Fluid restriction and voiding prior to the night may be effective. Question 35 1 out of 1 points A 4-month-old presents with both eyes turning inward. What is this called? Selected Answer: d. Esotropia Question 36 1 out of 1 points P a g e 12 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS Role-play with equipment during the course of the physical exam would be the most beneficial with which age group? Selected Answer: a. P a g e 13 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS Preschoolers Question 37 1 out of 1 points A typically developing 8-year-old girl will have which of the following genital development? Selected Answer: b. No pubic hair at all Question 38 1 out of 1 points For adolescent girls, peak height velocity should occur by Tanner Stage (SMR): Selected Answer: b. 3 Question 39 1 out of 1 points Sally, age 4, presents to the office with her mother for a well-child visit. To assess for age- appropriate fine motor skills, what activity would you ask her to perform? Selected Answer: a. String beads. Question 40 2 out of 1 points P a g e 14 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS By what age should most children be able to sit well without support? Selected Answer: b. 9 months Question 45 P a g e 17 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS 1 out of 1 points You see a healthy 18-month-old for a well-child visit. At the 12-month visit he received the diphtheria, tetanus, and acellular pertussis (DTaP) third dose; hepatitis B second dose; measles, mumps, and rubella (MMR) first dose; injected poliovirus (IPV) second dose; pneumococcal conjugate (PCV13) fourth dose; and Haemophilus influenzae type B (Hib) fourth dose. Which of the following do you order today? Selected Answer: a. DTaP, varicella, hepatitis A, and hepatitis B Question 46 1 out of 1 points A 4-year-old believes there is more juice in a tall, thin glass than a shorter, wider one. The child has not yet achieved which of the principles of Piaget? Selected Answer: a. Conservation Question 47 1 out of 1 points A 2-day-old newbornwith conjunctivitis is likely due to Selected Answer: c. Chemical irritation from eye drops Question 48 1 out of 1 points P a g e 18 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS You see a 6-month-old for a well-child visit and the mother tells you the child’s grandmother recommends that she give the infant whole milk and eggs when he starts solids. What should you tell the mother? Selected a. P a g e 19 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS A Mantoux test in a child with no risk factors is considered positive with a reaction of: Selected Answer: c. at least 15 mm induration Question 53 1 out of 1 points The parent of a 2-year-old tells you her daughter recently started having breath-holding spells. She tells you the older sibling “did the same thing” and asks you for help. You advise her that afer a breath-holding event: Selected Answer: c. Act as if nothing abnormal happened. Question 54 1 out of 1 points A 2-year-old boy has been slightly less than the 50th percentile for weight, height and head circumference, but in the last 6 months he has fallen to slightly less than the 25th percentile for weight. The pregnancy was normal, his development is as expected, and the family reports no psychosocial problems. The mother says that he is now a finicky eater (wants only macaroni and cheese at all meals), but she insists that he eat a variety of foods. The meals are marked by much frustration for everyone. His examination is normal. Which of the following is the best next step in his care? Selected Answer: Question 55 1 out of 1 points P a g e 22 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS a. Reassurance and counseling for family about childhood normal developmental stage Head and chest circumferences should be equal at: P a g e 23 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS Selected Answer: c. 1 year of age Question 56 1 out of 1 points A 7-month-old male is found to have a spiral fracture of the femur that his father says he got by climbing onto a chair and then jumping off. Which of the following statements is true regarding this situation? Selected Answer: c. You can be held legally liable for failing to report child abuse. Question 57 1 out of 1 points A teenage female who is overweight has moderate acne on the face and chest, and irregular menses. Elevation of which laboratory test provides the test evidence of polycystic ovarian syndrome? Selected Answer: b. free testosterone Question 58 1 out of 1 points Sarah, 7 years old, is in the office today. All of the following are acceptable management options for allergic rhinitis, except Selected Answer: b. Nasal neosynephrine P a g e 24 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS Question 62 1 out of 1 points Sam has an otitis media. He also presents with conjunctivitis. This is due to which organism? P a g e 27 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS Selected Answer: a. Haemophilus influenza Question 63 1 out of 1 points A mother brings her 4-week-old infant into the office because she noticed small yellow-white glistening bumps on her infant's gums. She says they look like teeth but is concerned that they may be cancer. You diagnose these bumps as Selected Answer: a. Epstein's pearls Question 64 1 out of 1 points A common feature of 2-year-old behavior is: Selected Answer: a. Negativism Question 65 1 out of 1 points At what age would a child be expected to remember a string of numbers and repeat them backwards? Selected Answer: a. 12 years Question 66 P a g e 28 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS 0 out of 1 points Chelsea, age 8, complains that she feels as if something is stuck in her ear. What action is P a g e 29 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS You receive a phone call from the mother of a 2-year-old. She states her child has sleep refusal. You suggest the child should be able to: Selected Answer: Question 71 2 out of 1 points c. Protest when he goes to bed, but the parents should not pick him up or give him any attention. You see a young child who has tripled her birth weight and looks for hidden objects. When given blocks, she places one in each hand. She has a fine pincer grasp. On the floor, she walks around holding objects and is trying to take independent steps. This child is most likely how old? Selected Answer: c. 12 months Question 72 1 out of 1 points A 2-year-old child weighs 34 lb. What type of car seat should the child use? Selected Answer: b. A forward-facing car seat in the back of the vehicle. Question 73 1 out of 1 points A differential diagnosis for child abuse would include all of the following except. P a g e 32 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS Selected Answer: a. Prader-Wlli syndrome Question 74 1 out of 1 points P a g e 33 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS A 13-month-old child is noted to be at the 25th percentile for weight, the 10th percentile for height, and less than the 5th percentile for head circumference. She was born at term. She was noted to have a small head at birth, to be developmentally delayed throughout her life, and to have required cataract surgery shortly afer birth. She currently takes phenobarbital for seizures. Which of the following would most likely explain this child’s small size? Selected Answer: b. Congenital cytomegalovirus infection Question 75 1 out of 1 points All of the following are consistent with peritonsillar abscess except: Selected Answer: a. Trismus Question 76 1 out of 1 points You diagnose a 16-year-old with acute otitis media and need to prescribe an antibiotic with beta- lactamase coverage. What do you choose? Selected Answer: c. amoxicillin and potassium clavulanate (Augmentin) Question 77 1 out of 1 points P a g e 34 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS Appropriate advice for a mother of a 2-week-old child here for a “well child” visit includes which of the following? Selected Answer: b. Sleep in the supine position is recommended Question 82 1 out of 1 points I can walk well on tiptoes, my speech is 50% understandable, I know six body parts, but I cannot balance on one foot for 1 second. I am: Selected Answer: a. 2-1/2 years old (30 months) Question 83 1 out of 1 points Which of the following vaccines is routinely recommended at 4 months of age? Selected Answer: d. Diphtheria, tetanus, acellular pertussis (DTaP) Question 84 1 out of 1 points Which of the following characterizes middle adolescence (14 to 16 years old)? Selected Answer: Question 85 1 out of 1 points P a g e 37 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS b. Intense peer group involvement, feelings of immortality, sexual experimentation P a g e 38 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS The parents of a 7-year-old are concerned their son does not want to attend school. Which of the historical findings are not usually associated with the diagnosis of school phobia? Selected Answer: c. Chronic medical illness Question 86 1 out of 1 points You are performing an examination of a 3-year-old who is new to your office. Which finding requires immediate further evaluation? Selected Answer: d. Can stand briefly on one fit but cannot skip and hop. Question 87 2 out of 1 points A mother of a 6-month-old asks you about normal sleep patterns for an infant this age. The best response is: Selected Answer: b. 10 hours at night and 3-4 hours during the day Question 88 1 out of 1 points The results of the hemoglobin A1c test are LESS reliable in children with which of the following conditions? (Hint: select two) Selected Answers: d. P a g e 39 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS Question 92 1 out of 1 points Sarah, age 15, presents with pain and pressure over her cheeks and discolored nasal discharge. You cannot transilluminate the sinuses. You suspect which common sinus to be affected? P a g e 42 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS Selected Answer: a. Maxillary sinus Question 93 1 out of 1 points Which adolescent would be at greatest risk for developing anorexia nervosa? Selected Answer: a. 14-year-old female gymnast Question 94 1 out of 1 points A mother states that her 4-year-old son constantly grinds his teeth at night. You document this as: Selected Answer: d. Bruxism Question 95 1 out of 1 points An expected milestone of a 4-year-old is the ability to Selected Answer: c. Copy a cross Question 96 1 out of 1 points P a g e 43 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS Mark, a 10-year-old, has a lot of ear pain. He does not want anyone to touch it and is crying in pain. The ear canal is swollen and exudate is preswent. The TM is normal. What is the proper management for his patient? P a g e 44 | 47 NRNP 6541 MIDTERM EXAM 1 – QUESTION AND ANSWERS