(Test Bank) Pediatric Primary Care

Lee,Maaks,Burns,Dunn, 6

Medicine

Test Bank

6th Edition

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Description

Test Bank for Pediatric Primary Care, The downloadable file consists of 169 pages, and the total size of the file is 2.58 MB. Purchase now only for highly discounted price.

Author(s): Lee, Maaks, Burns, Dunn

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Study Note Preview

Questions 1. A child who has attention­deficit/hyperactivity disorder (ADHD) has difficulty ID: 13348413834 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 A. emotional control. B. flexibility. Correct C. inhibition. D. problem­solving. 2. The primary care pediatric nurse practitioner cares for a preschool­age child ID: 13348413832 who was exposed to drugs prenatally. The child bites other children and has tantrums when asked to stop but is able to state later why this behavior is wrong. This child most likely has a disorder of A. executive function. Correct B. information processing. C. sensory processing. D. social cognition. 3. The primary care pediatric nurse practitioner uses the Neurodevelopmental ID: 13348413842 Learning Framework to assess cognition and learning in an adolescent. When evaluating social cognition, the nurse practitioner will ask the adolescent A. about friends and activities at school. Correct B. if balancing sports and homework is difficult. C. to interpret material from a pie chart. D. to restate the content of something just read. 4. The primary care pediatric nurse practitioner is evaluating a school­age child ID: 13348413838 who has been diagnosed with ADHD. Which plan will the nurse practitioner recommend asking the child’s school about to help with academic performance? A. 504 Correct B. FAPE C. IDEA D. IEP 5. The parent of a child diagnosed with ADHD tells the primary care pediatric ID: 13348413844 nurse practitioner that the child gets overwhelmed by homework assignments, doesn’t seem to know which ones to do first, and then doesn’t do any assignments. The nurse practitioner tells the parent that this represents impairment in which executive function? A. Activation Correct B. Effort C. Emotion D. Focus 6. The primary care pediatric nurse practitioner is considering medication ID: 13348413826 options for a school­age child recently diagnosed with ADHD who has a primarily hyperactive presentation. Which medication will the nurse practitioner select initially? A. Low­dose stimulant B. Moderate­dose stimulant Correct C. Low­dose non­stimulant D. Moderate­dose non­stimulant 7. The parent of a 4­year­old child reports that the child gets upset when the ID: 13348413824 hall light is left on at night and won’t leave the house unless both shoes are tied equally tight. The primary care pediatric nurse practitioner recognizes that this child likely has which type of sensory processing disorder? A. Dyspraxia B. Over­responder Correct C. Sensory seeker D. Under­responder 8. The parent of a preschool­age child who is diagnosed with a sensory ID: 13348413828 processing disorder (SPD) asks the primary care pediatric nurse practitioner how to help the child manage the symptoms. What will the nurse practitioner recommend? A. Establishing a reward system for acceptable behaviors B. Introducing the child to a variety of new experiences C. Maintaining predictable routines as much as possible Correct D. Providing frequent contact, such as hugs and cuddling 9. The primary care pediatric nurse practitioner is performing an examination on ID: 13348413846 a 5­year­old child who exhibits ritualistic behaviors, avoids contact with other children, and has limited speech. The parent reports having had concerns more than 2 years ago about autism, but was told that it was too early to diagnose. What will the nurse practitioner do first? A. Administer an M­CHAT screen to screen the child for communication and socialization delays. B. Ask the parent to describe the child’s earlier behaviors from infancy through preschool. Correct C. Reassure the parent that if symptoms weren’t present earlier, the likelihood of autism is low. D. Refer the child to a pediatric behavioral specialist to develop a plan of treatment and management. 10. The primary care pediatric nurse practitioner is examining a 3­year­old child ID: 13348413830 who speaks loudly, in a monotone, does not make eye contact, and prefers to sit on the exam room floor moving a toy truck back and forth in a repetitive manner. Which disorder does the nurse practitioner suspect? A. Attention­deficit/hyperactivity disorder B. Autism spectrum disorder Correct C. Executive function disorder D. Sensory processing disorder 11. The primary care pediatric nurse practitioner is selecting a medication for a ID: 13348413836 12­year­old child who is newly diagnosed with ADHD. The child is overweight, has a history of an atrial septal defect at birth, and reports mild shortness of breath during exercise. What will the nurse practitioner prescribe? A. A low­dose stimulant medication B. A non­stimulant medication C. Behavioral therapy only D. Cardiovascular pre­screening Correct 12. The primary care pediatric nurse practitioner is conducting a follow­up ID: 13348413840 examination on a child who has recently begun taking a low­dose stimulant medication to treat ADHD. The child’s school performance and home behaviors have improved. The child’s parent reports noticing a few tics, such a twitching of the eyelids, but the ch ild is unaware of them and isn’t bothered by them. What will the nurse practitioner recommend? A. Adding an alpha­agonist medication B. Changing to a non­stimulant medication C. Continuing the medication as prescribed Correct D. Stopping the medication immediately Continue Questions 1. The primary care pediatric nurse practitioner uses a shared decision­making ID: 13348425786 (SDM) model when working with families of children with chronic health conditions. When using this model, the nurse practitioner can expect A. considerably more time in each encounter. B. improved patient health outcomes. Correct C. less PNP involvement in health care decisions. D. lower provider and higher patient satisfaction. 2. The primary care pediatric nurse practitioner diagnoses a 5­year­old child with ID: 13348425782 asthma and prescribes an oral steroid and a short­acting beta­adrenergic medication via a metered­dose inhaler to manage acute symptoms. Along with education about the prescribed medications, what information is important to give the child’s family at this visit? A. An asthma action plan B. Effects and side effects of current medications C. Information about spirometry testing D. Instructions for medications at school 3. The parent of a child with complex health care needs tells the primary care ID: 13348425764 pediatric nurse practitioner that the child has had difficulty breathing the past two nights but can’t articulate specific symptoms. The child has normal oxygen saturations and a normal respiratory rate with clear breath sounds. What will the nurse practitioner do? A. Admit the child to the hospital for close observation and monitoring of respiratory status. B. Encourage the parent to call when concerned and schedule a follow­up appointment the next day. Correct C. Perform a complete blood count, blood cultures, and a chest radiograph to evaluate symptoms. D. Reassure the parent that the child has a normal exam and is most likely not ill. 4. Which characteristic is the key criterion that identifies a child has having special ID: 13348425780 needs? A. Cognitive function B. Emotional health C. Health service requirements Correct D. Medical diagnosis Correct 5. The primary care pediatric nurse practitioner is performing a well baby ID: 13348425774 examination on a 2­week­old infant who was recently discharged home from the neonatal intensive care unit. The mother reports that the infant was born at 26 weeks’ gestation and states she was told that her baby will probably have developmental delays. What is the most important aspect of long­term management for this infant? A. Careful monitoring of attainment of developmental milestones Correct B. Familiarizing the parent with laws that mandate educational support C. Providing genetic counseling to the infant’s parents D. Referral to social services for assistance with resources 6. The primary care pediatric nurse practitioner is preparing to perform a well child ID: 13348425790 examination on a 5­year­old child who has multiple developmental and cognitive delays. The child’s mother is angry and tells the nurse practitioner that her friends’ children are all preparing for kindergarten. The nurse practit ioner will A. allow the mother to express her feelings, understanding that she is experiencing grief. Correct B. reassure the mother that special educational opportunities are available for her child. C. suggest that the mother find a support group with other children with special needs. D. tell her that most schools provide services for children with special health care needs. 7. The parent of a toddler who has special health care needs is resistant to a ID: 13348425766 suggestion that her child needs a gastrostomy tube for nutrition. The toddler has fallen from the 10th percentile to the 5th percentile in the past few months and resists taking in appropriate amounts of food by mouth even with assistance from occupational therapy. What will the primary care pediatric nurse practitioner do? A. Inform the mother that, since other options have failed, the gastrostomy tube is the only option. B. Refer the child to a dietician to teach the mother the importance of adequate nutrition. C. Set weight gain and food intake goals with the mother and schedule regular visits to monitor weight. Correct D. Suggest that the gastrostomy tube may be tried temporarily and removed once the child gains weight. 8. What is the most important role of the primary care pediatric nurse practitioner ID: 13348425792 who provides care for a child with special health care needs who sees several specialists and receives community and school­based services? A. Assessing the parent’s ability to perform home care tasks B. Coordinating services to ensure continuity of care Correct C. Monitoring the family’s adherence to the health care plan D. Ordering medications and other prescribed treatments 9. A toddler swallowed a coin several days prior. The child’s parent has not found ID: 13348425776 the coin in the child’s stool. Which imaging test will the primary care pediatric nurse practitioner employ to evaluate this ingestion? A. Abdominal ultrasound B. Computed tomography C. Conventional radiograph Correct D. Magnetic resonance imaging 10. The primary care pediatric nurse practitioner is assessing an ill 2­month­old infant ID: 13348425772 who is febrile and refusing most fluids. The preliminary blood work indicates a viral infection and shows that the infant is hydrated. The infant is alert. The infant’s parent s are attentive and live close by. What will the nurse practitioner do? A. Administer a parenteral antibiotic and antipyretic and send the infant home. B. Admit the infant to an inpatient hospital unit for overnight monitoring. C. Give the parents sick care instructions and follow up in the clinic in the morning. Correct D. Send the infant to the urgent care center for intravenous fluids. 11. A toddler is prescribed a liquid oral medication. The parent tells the primary care ID: 13348425784 pediatric nurse practitioner that the child refuses to take medications and usually spits them out. What will the nurse practitioner do? A. Demonstrate oral medication administration with the toddler in the office. rrect B. Instruct the parent to hide the medication in a favorite food or beverage. C. Order the medication to be given via another route if possible. D. Tell the parent to offer the child a reward each time the medication is taken. 12. The primary care pediatric nurse practitioner orders a pulmonology consult for a ID: 13348425788 child who has severe asthma. The nurse practitioner writes “child with asthma refractory to conventional treatments needs suggestions for alternative treatments.” The nurse practitioner expects the pulmonologist to A. confirm the medical diagnosis for the child’s parents. B. make recommendations for disease management. Correct C. stress the importance of adherence to the medication regimen. D. take over management of this child’s chronic illness. 13. The primary care pediatric nurse practitioner cares for several families with K. L. ID: chronically ill children who text status updates about their children to a mobile device that has an encryption­ protection platform installed. If the nurse practitioner misplaces the mobile device, it is important to A. disconnect the user from the system to avoid a data breach. Correct B. notify the families that their messages may be read by others. C. obtain a new device as soon as possible to resume communication. D. upload the messages from another remote device. 14. The parent of an 18­month­old child calls the clinic to report that the child has a I. J. ID: rectal temperature of 100.4°F (38°C). The child is playing normally, taking fluids well, and has a slightly reduced appetite. What will the primary care pediatric nurse practitioner recommend? G. A. Administering an antipyretic medication B. Bringing the child to the clinic for evaluation C. Offering extra fluids and calling if symptoms change orrect D. Ordering outpatient lab work such as a CBC 15. The parent of a preschool­age child calls the clinic to report that the child has H. ID: clear, watery drainage from both eyes, mild erythema of the conjunctiva, and no fever or other symptoms. What will the primary care pediatric nurse practitioner recommend? A. Allow the child to go to preschool. Correct B. Bring the child to the clinic for a culture. C. Keep the child home for 2 days. D. Use antibiotic eyedrops for 3 days.. 16. A parent brings a 4­month­old infant to the clinic who has had a low­grade fever E. F. ID: for 24 hours. The primary care nurse practitioner notes that the infant has a weak cry, slightly dry oral mucosa, mottled skin, and a respiratory rate of 65 breaths per minute and sleeps unless stimulated by the examiner,. What will the nurse practitioner do? A. Administer oral fluids in the clinic. B. Admit the infant to the hospital. Correct C. Order outpatient laboratory tests. D. Send the infant home with close follow­up. Questions 1. A pharmaceutical company has developed a new drug that was tested only ID: 13348428705 on adults. The FDA has declared this drug to have potential benefits for ill children. According to the Pediatric Research Equity Act (PREA), what may the pharmaceutical company be required to do? A. Conduct pediatric drug studies to determine whether the drug is safe and effective in children. Correct B. Provide labeling stating that the safety and efficacy of the drug is not established for children. C. Receive a patent extension for conducting pediatric studies to determine use in children. D. Survey existing data about the drug to determine potential use in the pediatric population. 2. The primary care pediatric nurse practitioner prescribes a new medication for ID: 13348428709 a child who develops a previously unknown adverse reaction. To report this, the nurse practitioner will A. access the BPCA website. B. call the PREA hotline. C. log onto the FDA Medwatch website. Correct D. use the AAP online PediaLink program. 3. The primary care pediatric nurse practitioner is considering use of a relatively ID: 13348428701 new drug for a 15­month­old child. The drug is metabolized by the liver, so the nurse practitioner will consult a pharmacologist to discuss giving the drug: A. less often or at a lower dose. Correct B. more often or at a higher dose. C. via a parenteral route. D. via the oral route. 4. The primary care pediatric nurse practitioner is considering using a drug for ID: 13348428707 an “off­label” use in a child. The nurse practitioner has used the drug in a similar situation previously, has consulted a pharmacology resource and the FDA website, and has determined that there are no significant contraindications and warnings for this child. What else must the nurse practitioner do when prescribing this drug? A. Discuss recommendations with the parents and document their consent. Correct B. Document anecdotal reports of previous use of the drug by other providers. C. Follow up daily with the parents to determine safe administration of the drug. I. D. Report this use to the FDA Medwatch website for tracking purposes. 5. The primary care pediatric nurse practitioner is counseling an adolescent J. ID: who was recently hospitalized for an asthma exacerbation and learns that the child usually forgets to use twice­ daily inhaled corticosteroid medications that are supposed to be given at 0800 and 2000 each day. Which strategy may be useful in this case to improve adherence? A. Ask the adolescent to identify two times each day that may work better. Correct B. Consider having the school nurse supervise medication administration. G. C. Prescribing a daily oral corticosteroid medication instead. D. Suggest that the parent enforce the medication regimen each day. 6. The primary care pediatric nurse practitioner is treating a toddler who has a H. ID: lower respiratory tract illness with a low­grade fever. The child is eating and taking fluids well and has normal oxygen saturations in the clinic. The nurse practitioner suspects that the child has a viral pneumonia and will A. order an anti­viral medication and schedule a follow­up appointment. B. prescribe a broad­spectrum antibiotic until the lab results are received. C. teach the parents symptomatic care and order labs to help with the diagnosis. Correct D. write a prescription for an antibiotic to be given if the child’s condition worsens. E. 7. The single mother of a 4­year­old who attends day care tells the primary care F. ID: pediatric nurse practitioner that she had difficulty giving her child a twice­daily amoxicillin for 10 days to treat otitis media during a previous episode several months earlier because she works two jobs and is too busy. The child has an ear infection in the clinic today. What will the nurse practitioner do? C. A. Administer an intramuscular antibiotic. B. Order twice­daily amoxicillin for 5 days. C. Prescribe azithromycin once daily for 5 days. Correct D. Reinforce the need to adhere to the plan of care. 8. The parent of a school­age child who has asthma tells the primary care D. ID: pediatric nurse practitioner that the child often comes home from school with severe wheezing after gym class and needs to use his metered­dose inhaler right away. What will the nurse practitioner do? A. Recommend that the child go to the school nurse when symptoms start. B. Review the child’s asthma action plan and possibly increase his steroid dose. C. Suggest asking the school to excuse the child from gym class. D. Write the prescription for two metered­dose inhalers with spacers. Correct Continue Questions 1. The primary care pediatric nurse practitioner is evaluating a 10­year­old child ID: 13348428717 who is describing shooting pain in both legs associated with aching, tingling, and burning. The child is unable to pinpoint specific locations for this pain. Which type of pain does the nurse practitioner suspect? A. Chronic pain B. Neuropathic pain Correct C. Somatic pain D. Visceral pain 2. A 3­year­old child is recovering from injuries sustained in a motor vehicle ID: 13348428721 accident. How will the primary care pediatric nurse practitioner evaluate this child’s pain? A. Ask the child to rate pain intensity on a 4­ to 5­item pain discrimination scale. B. Have the child describe any pain as “no pain, a little pain, or a lot of pain.” Correct C. Question the child about the intensity and specific location of any pain. D. Rely on nonverbal responses such as facial expressions and limb movements. 3. A 4­year­old child has just been released from the hospital after orthopedic ID: 13348428725 surgery on one leg following a bicycle accident. The child is sitting quietly on the exam table. When asked to rate pain, the child points to the “1” on a faces rating pain scale. What will the primary care pediatric nurse practitioner do next? A. Assess the child’s vital signs and ability to walk without pain. Correct B. Refill the prescription for a narcotic analgesic medication. C. Suggest that the parents give acetaminophen for mild pain. D. Teach the parent to give analgesics based on the child’s report of pain. 4. A developmentally and cognitively disabled 10­year­old child who is unable to ID: 13348428727 communicate must undergo a series of surgeries, and the child’s parent asks how to know if the child is in pain and when to give pain medication. What will the primary care pediatric nurse practitioner teach this parent to use to assess this child’s pain? A. Comfort scale B. FLACC scale C. NCCPC­R Correct D. Non­verbal observations 5. The primary care pediatric nurse practitioner is preparing to perform a painful ID: 13348428723 procedure on a 4­month­old infant. Besides providing local anesthesia, what other pain control method provides analgesic effects? A. Providing toys B. Singing or music C. Sucrose solution Correct D. Swaddling or cuddling 6. An adolescent female reports moderate dysmenorrhea with periods and tells the primary care pediatric nurse practitioner that 400 mg ibuprofen every 6 to 8 completely control her pain. What will the nurse practitioner recommend? A. Increasing the ibuprofen dose to 600 to 800 mg every 6 to 8 hours B. Taking extra­strength acetaminophen 1000 mg every 4 to 6 hours C. Taking naproxen 500 mg initially and then 250 mg every 6 to 8 hours D. Using extended­release naproxen 500 mg every 12 hours 7. What is the most important dose­limiting factor when prescribing acetaminophen with hydrocodone? A. Acetaminophen dose Correct B. Gastrointestinal side effects C. Pruritis symptoms D. Urinary retention 8. An adolescent takes ibuprofen, acetaminophen, and a tricyclic antidepressant ID: 13348428733 hours doesn’t ID: 13348428731 ID: 13348428719 (TCA) to treat phantom limb pain and reports that the medications are no longer effective. What will the primary care pediatric nurse practitioner do? A. Change the TCA to a selective serotonin reuptake inhibitor. B. Evaluate the adolescent for drug­seeking behavior. C. Increase the TCA dose and reevaluate in 2 to 3 weeks. D. Refer the adolescent to a pain management specialist. Correct 9. The parent of a school­age child with a chronic pain condition tells the ID: 13348428729 primary care pediatric nurse practitioner that the child has requested to stay home from school more often in the past few months. The child’s exam does not reveal any significant change in pathology, and a review of the child’s medications indicates appropriate dosing of analgesic medications. What will the nurse practitioner recommend? A. Assessing the child’s pain every day to determine changes Correct B. Ensuring the child stays quiet in bed with videos when having pain C. Having the child do homework when staying home from school Correct D. Requiring the child to go to school even during pain episodes Continue Questions 1. A 2­month­old infant has a staccato cough and fever. Which aspect of the history is most important in determining the diagnosis? A. Day care attendance B. Immunization history Correct C. Medication history D. Past medical history 2. When reviewing a white blood cell (WBC) count, the primary care pediatric nurse practitioner suspects a viral infection when which WBC element is elevated? A. Bands B. Leukocytes C. Lymphocytes D. Neutrophils 3. Which lab value is most concerning in an infant with fever and a suspected bacterial infection? A. C­reactive protein of 11.5 mg/L Correct B. Lymphocyte count of 8.7 C. Platelet count of 475 D. White blood cell count of 14 4. A toddler is receiving long­term antibiotics to treat osteomyelitis. Which laboratory ID: 13348428747 ID: 13348428799 ID: 13348428751 ID: 13348428793 test will the primary care pediatric nurse practitioner order to monitor response to therapy in this child? A. Blood cultures B. Erythrocyte sedimentation rate (ESR) Correct C. Serum procalcitonin (Pro­CT) D. White blood count (WBC) 5. According to recent research, which populations may have higher rates of under­ ID: 13348428779 immunization than others? A. Those with higher rates of Asians B. Those with higher rates of graduate degrees Correct C. Those with lower rates of poverty Correct D. Those with lower rates of primary providers 6. The parent of a 2­month­old infant is reluctant to have the baby vaccinated. What ID: 13348428749 is an initial step in responding to these concerns? A. Inform the parent that all vaccines may be given without thimerosol. B. Providing Vaccine Informati on Statements for the parent to review. C. Question the parent’s reasons for concern about immunizations. D. Remind the parent that the infant is exposed to thousands of germs each day. 7. A parent is concerned about vaccine adverse reactions. Based on an Institute of Medicine report, what will the primary care pediatric nurse practitioner tell the parent? ID: 13348428755 A. Administering multiple vaccines may trigger the development of type 1 diabetes. B. The MMR may be linked to febrile seizures in immunocompromised children. Correct C. There is some risk of CNS disorders associated with the hepatitis B vaccine. D. Vaccines containing thimerosol are linked to pervasive developmental disorders. 8. A 2­month­old infant will receive initial immunizations, and the parent asks about giving ID: 13348428777 medications to increase the infant’s comfort and minimize fever. What will the pediatric primary care nurse practitioner recommend? A. Administering ibuprofen or acetaminophen as needed Correct B. Avoiding antipyretics if possible to attain better immunity C. Giving ibuprofen and acetaminophen only after the vaccines D. Pre­treating the infant with both ibuprofen and acetaminophen 9. The parent of an infant asks why some vaccines, such as MMR, are not given ID: 13348428787 along with the other series of immunizations at 2, 4, and 6 months of age. What will the primary care pediatric nurse practitioner tell this parent? A. Febrile seizures are more likely in younger infants with some vaccines. B. Maternal antibodies neutralize some vaccines and are delayed until 12 months. Correct C. The risk of adverse effects is lower for some vaccines after the first year. D. Too many vaccines at once can overwhelm the infant’s immune system. 10. The primary care pediatric nurse practitioner is performing an initial well child ID: 13348428739 exam on a 3­year­old child recently adopted from Africa. The adoptive parent has a record of immunizations indicating that the child is fully vaccinated. What will the nurse practitioner do? rrect A. Administer a booster dose of each vaccine to ensure immunity. B. Find out whether the vaccines were provided by reliable suppliers. C. Perform antibody titers and reimmunize the child. Correct D. Record the vaccines in the child’s electronic medical record. 11. The primary care pediatric nurse practitioner reviews the immunization records of ID: 13348428765 an 18­month­old child and notes that the child received an MMR immunization 2 days prior to the first birthday. What will the nurse practitioner do? A. Administer a reduced dose of MMR to ensure adequate immunity. B. Obtain mumps, measles, and rubella titers to determine immunity. C. Recommend the next dose of MMR vaccine at 4 to 5 years of age. Correct D. Repeat the MMR vaccine since the first dose was given too soon 12. A 5­year­old child who has a history of pertussis infection as an infant is in the clinic for immunizations prior to kindergarten. Which vaccine will be given? A. DTaP B. DTP C. Td D. Tdap 13. An adolescent female who is sexually active and who has not had the HPV ID: 13348428791 ID: 13348428757 vaccine asks if she may have it. What will the primary care pediatric nurse practitioner tell her? A. Getting the vaccine now will still protect her from HPV oncogenic types even if already exposed B. Receiving the HPV vaccine series will replace the need for regular cervical cancer screening C. She will need to have Papanicolaou and pregnancy screening prior to receiving the vaccine D. The vaccine will not protect her from any HPV oncogenic types acquired previously Correct 14. An 18­month­old child has bronchopulmonary dysplasia. To help prevent ID: 13348428761 pneumococcal disease, which vaccine will be ordered? A. PCV7 B. PCV13 Correct C. PCV23 D. PCV33 Correct 15. A 5­year­old child who received VariZIG after exposure to varicella while M. N. ID: immunocompromised during chemotherapy is in the clinic 5 months after stopping chemotherapy for kindergarten vaccines. What will the primary care pediatric nurse practitioner order for this child? K. A. MMR and Tdap B. MMR, Varivax, Tdap Correct C. Tdap only D. Varivax and Tdap 16. A 3­year­old child who attends day care has had a fever, nausea, and vomiting L. ID: several weeks prior and now has darkened urine and constipation along with hepatomegaly and right upper quadrant tenderness. What treatment is warranted for this child? I. A. HAV vaccine B. Immunoglobulin G C. Interferon­alfa D. Supportive care Correct 17. A 10­month­old infant who is new to the clinic has chronic hepatitis B infection. J. ID: What will the primary care pediatric nurse practitioner do to manage this infant’s disease? G. A. Consult a pediatric infectious disease specialist. Correct B. Prescribe interferon­alfa. C. Provide supportive care. D. Consider use of lamivudine. 18. The primary care pediatric nurse practitioner performs a well child examination on H. ID: a 1­month­old. The infant was recently discharged from the neonatal intensive care unit after treatment with parenteral acyclovir for a neonatal herpetic infection and is currently taking oral acyclovir. What will the nurse practitioner do to manage this infant’s care? A. Obtain regular absolute neutrophil counts. Correct B. Perform routine skin cultures for herpes simplex virus. C. Reinforce the need to give acyclovir indefinitely. D. Stop the oral acyclovir at 2 months of age. 19. A 9­month­old infant has had a fever of 103°F for 2 days and now has a diffuse, E. F. ID: maculopapular rash that blanches on pressure. The infant’s immunizations are up­to­date. What will the primary care pediatric nurse practitioner do? A. Administer immunoglobulin G to prevent fulminant illness. B. Perform serologic testing for human herpes virus ­6 and human herpes virus ­7. C. Reassure the parent that this is a mild, self­limiting disease. Correct D. Recommend avoiding contact with pregnant women. 20. A child who is immunocompromised has a fever and a rash consisting of macules, papules, and pustules. What will the primary care pediatric nurse practitioner do? A. Administer varicella immune globulin (VariZIG). B. Hospitalize the child for intravenous acyclovir. Correct C. Order intravenous immunoglobulin as an outpatient. D. Prescribe oral acyclovir for the duration of the illness. 21. A child whose parents have refused vaccines has been exposed to chickenpox, ID: 13348428771 ID: 13348428763 and the parents ask whether the child may attend day care. What will the primary care pediatric nurse practitioner tell them? A. The child may attend day care as long as no rash is present even with mild fever or other symptoms. B. The child should remain home and receive oral acyclovir for 5 days to prevent onset of symptoms. C. The child should stay home until the 21­day incubation period has passed even if symptom free. D. The child should stay home if any symptoms occur and may return in 1 week if no rash develops. Correct 22. An 18­month­old child who developed upper respiratory symptoms 1 day prior is ID: 13348428797 brought to the clinic with a high fever, chills, muscle pains, and a dry, hacking cough. A rapid influenza test is negative and a viral culture is pending. What will the primary care pediatric nurse practitioner do? A. Consider therapy with rimantadine. B. Hospitalize for supportive treatment. C. Prescribe oseltamivir and follow closely Correct D. Wait for cultures to determine treatment. 23. The primary care pediatric nurse practitioner is reviewing medical records for a ID: 13348428781 newborn that is new to the clinic. The toddler’s mother was found to be HIV positive during her pregnancy with this child and received antiretroviral therapy during pregnancy. The child was born by cesarean section, begun on anti­retroviral prophylaxis, and did not breastfeed. What is the correct management for this child? A. Consult with a pediatric HIV specialist. Correct B. Discontinue cART after 4 weeks of age. C. Obtain a CD4+ cell count and HIV RNA levels. D. Reinforce the need to give cART for life. 24. A 3­year­old child whose immunizations are up­to­date has been exposed to ID: 13348428795 measles because of a localized outbreak among unvaccinated children. The parent reports that contact with infected children occurred within the last 2 days at a birthday party. What is the best course of action? A. Administer the MMR vaccine to help prevent disease. Correct B. Give antiviral medications at the first sign of symptoms. C. Give the child a dose of immune globulin to mitigate the response. D. Reassure the parent that most exposed children will not get measles. 25. A preschool­age child is brought to clinic for evaluation of a rash. The primary ID: 13348428773 care pediatric nurse practitioner notes an intense red eruption on the child’s cheeks and circumoral pallor. What will the nurse practitioner tell the parents about this rash? A. This rash may be a prodromal sign of rubella or roseola. B. The child will need immunization boosters to prevent serious disease. C. This is a benign rash with no known serious complications. D. Expect a lacy, maculopapular rash to develop on the trunk and extremities. Correct 26. An unimmunized school­age child whose mother is in her first trimester of ID: 13348428745 pregnancy is diagnosed with rubella after a local outbreak. What will the primary care pediatric nurse practitioner recommend? A. Assessment of maternal rubella titers Correct B. Intravenous immunoglobulin for the child C. MMR vaccine for the mother and child D. Possible termination of the pregnancy 27. A child is brought to the clinic with a fever, headache, malaise, and a red, annular ID: 13348428783 macule surrounded by an area of clearing and a larger, erythematous annular ring. The child complains of itching at the site. What will the primary care pediatric nurse practitioner do to determine the diagnosis? A. Ask about recent tick bites Correct B. Obtain a skin culture C. Order blood cultures D. Perform serologic testing 28. A child whose family has been camping in a region with endemic Lyme disease suffered several tick bites. The parents report removing the ticks but are not able to or the length of time the ticks were attached. The child is asymptomatic. What is the action? A. Administer a prophylactic single dose of doxycycline. B. Perform serologic testing for IgG or IgM antibodies. C. Prescribe amoxicillin three times daily for 14 to 21 days. D. Teach the parents which signs and symptoms to report. Correct 29. A 10­month­old infant has an erythematous, fluctuant, non­draining abscess on FH.. I. ID: 13348428769 verify the type G. ID: the right buttock after 10 days of treatment with amoxicillin for impetigo. What is the next step in managing this infant’s care? A. Consultation with a pediatric infectious disease specialist B. Culture of any superficial open surface wounds C. Empiric treatment with clindamycin D. Incision and drainage of the abscess with culture 30. A child with a history of a pustular rash at the site of a cat scratch on one arm now D. E. ID: has warm, tender, swollen axillary lymph nodes on the affected side. The primary care pediatric nurse practitioner notes induration and erythema of these nodes. What will the nurse practitioner do? A. Obtain a complete blood count and C­reactive protein. B. Order an immunofluorescent assay (IFA) for serum antibodies. orrect C. Perform a needle aspiration of the affected lymph nodes. D. Prescribe a 5­day course of azithromycin. 31. A 7­year­old child whose immunizations are up­to­date has a fever, headache, ID: 13348431603 stiff neck, and photophobia. What course of treatment is indicated? A. Empiric treatment with oral antibiotics or intramuscular ceftriaxone B. Hospitalization for diagnosis and treatment with antibiotics C. Immediate vaccination with meningococcal vaccine D. Outpatient lab work, including a CBC and blood and CSF cultures 32. A school­age child has fever of 104°F, sore throat, vomiting and malaise. The ID: 13348428789 primary care pediatric nurse practitioner observes that the tonsils, oropharynx, and palate are Correct Correct erythematous and covered with exudate; the tongue is coated and red; and there is a red, sandpaper­like rash on the child’s neck, trunk, and extremities. A rapid strep test is positive. What will the nurse practitioner do to manage this child’s illness? A. Administer intramuscular ceftriaxone. B. Hospitalize for further diagnostic tests. C. Prescribe oral amoxicillin. Correct D. Refer to a pediatric infectious disease specialist. 33. An adolescent has a TB skin test prior to working as a volunteer in a hospital. The ID: 13348428753 adolescent is healthy and has not travelled to or from a TB­endemic area or had close contact with anyone who has TB. The Mantoux skin test shows 10 mm of induration after 48 hours. What will the primary care pediatric nurse practitioner do? A. Ask the adolescent about exposure to homeless persons. B. Order a chest radiograph to rule out active TB. C. Reassure the adolescent that this is a negative screen. Correct D. Refer the adolescent to an infectious disease specialist. 34. The primary care pediatric nurse practitioner is examining a 2­month­old infant ID: 13348428775 with fever and cough. A WBC is 14,000/mm3 and a chest radiograph is normal. The infant is nursing well and having normal stools. What would be an appropriate next step? A. Admitting the infant to the hospital for LP and IV antibiotics B. Obtaining a blood culture, erythrocyte sedimentation rate, and C­reactive protein C. Performing a catheterized urinalysis to screen for leukocytes and nitrites Correct D. Prescribing empiric, broad­spectrum antibiotics with close follow­up Questions 1. An 8­year­old child is diagnosed with systemic lupus erythematosus (SLE), and ID: 13348419868 the child’s parent asks if there is a cure. What will the primary care pediatric nurse practitioner tell the parent? A. Complete remission occurs in some children at the age of puberty. B. Periods of remission may occur but there is no permanent cure. Correct C. SLE can be cured with effective medication and treatment. D. The disease is always progressive with no cure and no remissions. 2. The primary care pediatric nurse practitioner examines a child who has had ID: 13348419872 stiffness and warmth in the right knee and left ankle for 7 or 8 months but no back pain. The nurse practitioner will refer the child to a rheumatology specialist to evaluate for A. enthesitis­related JIA. B. oligoarticular JIA. Correct C. polyarticular JIA. D. systemic JIA. 3. The primary care pediatric nurse practitioner is managing care for a child who has JIA who has a positive ANA. Which specialty referral is critical for this child? A. Cardiology B. Ophthalmology Correct C. Orthopedics D. Pain management 4. The primary care pediatric nurse practitioner is prescribing ibuprofen for a 25 kg ID: 13348419892 ID: 13348419860 child with JIA who has oligoarthitis. If the child will take 4 doses per day, what is the maximum amount the child will receive per dose? A. 200 mg B. 250 mg Correct C. 400 mg D. 450 mg 5. The parent of a school­age child who is diagnosed with oligoarticular JIA asks the ID: 13348419894 primary care pediatric nurse practitioner what exercises the child may do to help reduce symptoms. What will the nurse practitioner recommend? A. Running B. Swimming Correct C. Weights D. Yoga 6. A 12­year­old child is brought to the clinic with joint pain, a 3­week history of low­ ID: 13348419880 grade fever, and a facial rash. The primary care pediatric nurse practitioner palpates an enlarged liver 2 cm below the subcostal margin along with diffuse lymphadenopathy. An ANA test is positive. Which test may be ordered to confirm a diagnosis of SLE? A. Anti­double­strand DNA antibodies Correct B. Anti­La antibodies C. Anti­Ro antibodies D. Anti­Sm antibodies 7. The primary care pediatric nurse practitioner is reviewing the rheumatology plan ID: 13348419884 of care for a child who is diagnosed with SLE. Besides reinforcing information about prescribed medications, what will the nurse practitioner teach the family to help minimize flaring of episodes? A. Have the child rest between activities. B. Obtain regular ophthalmology exams. C. Participate in low­impact exercises. D. Use UVA and UVB sunscreen daily. Correct 8. An adolescent female reports poor sleep, fatigue, muscle and joint paint, and ID: 13348419890 anxiety lasting for several months. The primary care pediatric nurse practitioner notes point tenderness at several sites. What will the nurse practitioner do next? A. Evaluate the adolescent’s pain using a numeric pain scale. B. Obtain ANA, CBC, liver function, and muscle enzymes tests. C. Reassure the adolescent that this condition is not life­threatening. D. Refer the adolescent to a rheumatologist for further evaluation. Correct 9. A child has a fever and arthralgia. The primary care pediatric nurse practitioner ID: 13348419858 learns that the child had a sore throat 3 weeks prior and auscultates a murmur in the clinic. Which test will the nurse practitioner order? A. Anti­DNase B test B. ASO titer Correct C. Rapid strep test D. Throat culture