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191 Cards in this Set
- Front
- Back
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Which of the following is NOT considered primary prevention?
A) Injury prevention B) Assess growth & development C) Dental hygiene D) Immunizations |
B) Assess growth & development
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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) morbidity prevention D) primary prevention |
D) primary prevention
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The concept of health promotion consists of screening or providing education to promote early detection of diseases. This description best describes:
A) tertiary prevention B) secondary prevention C) morbidity prevention D) primary prevention |
B) secondary prevention
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The concept of health promotion consists of limiting residual disability resulting from disease and helping individuals lead productive lives despite limitations. This description best describes:
A) tertiary prevention B) secondary prevention C) morbidity prevention D) primary prevention |
A) tertiary prevention
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Which of the following is the best written chief complaint?
A) 5-year-old Asian female with itchy red rash B) 1-month-old with difficulty feeding C) 15-year-old African-American female complaining of lower abdominal pain for 3 days D) 12-year-old-Caucasian with itchy eye for 1 week |
C) 15-year-old African-American female complaining of lower abdominal pain for 3 days
chief complaint should contain the age, sex, and race of client; the reason for the visit; and if a complaint, how long the symptom has been present |
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The PNP is completing the review of systems on a 4-month-old. What response from the mother might indicate a cardiac problem in the infant and require a more thorough history?
A) The baby's heart seems to beat rapidly sometimes B) Sometimes the baby sounds congested C) It takes the baby over 30 minutes to complete a bottle D) The baby gets the hiccups often |
C) It takes the baby over 30 minutes to complete a bottle
this may indicate that the baby tires easily and may have a cardiac problem warranting further investigation. Hiccups are not indicative of a problem. |
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The mother of a 3-year-old states that her son was completely toilet trained at 18 months of age. The PNP explores further, asking:
A) If the child is dry at night and fully trained for urine and stool day and night B) At what age did the mother begin toilet training the other child C) If the child gets up at night to use the bathroom D) How the mother did the toilet training |
A) If the child is dry at night and fully trained for urine and stool day and night
A child is usually not completely toilet trained until 3 years of age or later |
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The original nurse practitioner program was institutionalized as a(n):
A. Geriatric program B. Adult program C. Pediatric program D. Women’s health program |
C. Pediatric program
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The initial rationales for the creation of the expanded nursing role included all of the following EXCEPT that:
A. An increased need existed for child health services B. Nurses could assume a role in extending child health services C. Nurses could be taught to do physical exams and counsel D. Nurses could work in inpatient settings providing acute care management |
D. Nurses could work in inpatient settings providing acute care management
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Which of the following are examples of marketing to increase pediatric nurse practitioner recognition?
A. “The PNP Advantage” B. “Why a PNP Is Right for Your Child” C. Both of the above D. Neither “a” nor “b” |
C. Both of the above
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The mother of a newborn brings the baby to the clinic because she is afraid something is wrong with her baby ("his head is so big"). The PNP responds that:
A. "This is normal. The head of a newborn is proportionately large to the rest of the body." B. "Yes, this does appear abnormal. I will make an appointment for the baby to be seen by a neurologist." C. "Your baby has hydrocephalus and needs to see a neurologist." D. "Your head appears large so it is probably a genetic trait." |
A. "This is normal. The head of a newborn is proportionately large to the rest of the body."
head growth predominates during the fetal period. head size is greater than chest size at birth. the head continues to grow until approximately 6 years of age. |
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The legislative listserv was created for all of the following purposes EXCEPT to:
A. Inform about legislative issues B. Alert pediatric nurse practitioners on issues in the legislature affecting their practice C. Allow rapid dissemination of legislative information D. Allow for members of Congress to get in touch with their constituents |
D. Allow for members of Congress to get in touch with their constituents
The listserv does not allow members of Congress to contact their constituents. |
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Two levels of ANCC credentialing and their acronyms are:
A. Board Certified (BC) and Certified (RN,C). B. Certified (CPNP) and Board Certified (BC, PNP). C. Board Certified (C, PNP) and Certified (RN,C). D. Certified (NC) and Board Certified (NCB). |
A. Board Certified (BC) and Certified (RN,C).
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Pediatric nurse practitioners who are certified through the PNCB use the credential:
A. PNP B. PNPC C. CPNP D. PNCB |
C. CPNP
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Presently, in the majority of states, a pediatric nurse practitioner may do all the following EXCEPT:
A. Receive third-party reimbursement B. Prescribe medications C. Receive Medicaid and Medicare reimbursement D. Work completely independently |
D. Work completely independently
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Seatbelt laws, bicycle safety helmet laws, and child safety restraint laws present a conflict between which ethical principles?
A. Veracity and beneficence B. Autonomy and fidelity C. Justice and veracity D. Nonmaleficence and autonomy |
D. Nonmaleficence and autonomy
- Autonomy = the right of an individual to self-determination, where an individual freely governs his or her own actions. - Nonmaleficence = to do no harm. The act of nonmaleficence is violated by omission and putting others at risk. An individual can decide not to use a child safety restraint and thus place the child at risk for harm. |
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Agencies like the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) have an established process for assessing quality of care or services in which an organization demonstrates that it meets a set of minimum standards. What is this process called?
A. Certification B. Licensure C. Accreditation D. Quality assurance/quality improvement |
C. Accreditation
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Which ethical principle supports the public health system of the United States?
A. Beneficence B. Justice C. Fidelity D. Veracity |
B. Justice
Justice is the fair distribution of rights and resources. Allocation of resources is fair and of greatest good to the most people. |
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The process performed by a health care institution which grants the nurse practitioner specific authority to perform designated clinical activities in their facility is termed:
A. Credentialing B. Accrediting C. Privileging D. Certification |
C. Privileging
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Levels of prescriptive authority for a pediatric nurse practitioner vary from state to state. Which of the following statements is correct?
A. Prescription authority (including controlled substances) for a pediatric nurse practitioner is independent of physician involvement in approximately half of the states B. Prescription authority (including controlled substances) for a pediatric nurse practitioner has some degree of physician involvement or delegation of prescription writing in more than half of the states. C. Prescription authority (excluding controlled substances) for a pediatric nurse practitioner is independent of physician involvement in approximately half of the states. D. Prescription authority (excluding controlled substances) for a pediatric nurse practitioner is not independent of physician involvement in all of the states. |
B. Prescription authority (including controlled substances) for a pediatric nurse practitioner has some degree of physician involvement or delegation of prescription writing in more than half of the states.
Prescriptive authority for the pediatric nurse practitioner, which includes controlled substances, has some degree of physician involvement or delegation of prescription writing with written documentation in 39 states, and without written documentation in one state. |
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The American Medical Association (AMA) publishes current procedural terminology (CPT) codes yearly. Guidelines for evaluation and management (E/M) services use descriptors for these services. These descriptors recognize seven components. These are history, examination, medical decision making, counseling, coordination of care, nature of presenting problem, and time. Key components identified by AMA for use when selecting a level of E/M service are:
A. Counseling, coordination of care, and nature of presenting problem B. Examination, medical decision making, and counseling C. Medical decision making, coordination of care, and time D. History, examination, and medical decision making |
D. History, examination, and medical decision making
These components must be present in every patient encounter. |
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The American Medical Association (AMA) publishes current procedural terminology (CPT) codes yearly. Guidelines for evaluation and management (E/M) services use descriptors for these services. These descriptors recognize seven components. These are history, examination, medical decision making, counseling, coordination of care, nature of presenting problem, and time. Contributory factors identified by the AMA important to E/M services but are NOT required to be provided in every patient encounter are:
A. Counseling, coordination of care, and nature of presenting problem B. Examination, medical decision making, and counseling C. Medical decision making, coordination of care, and time D. History, examination, and medical decision making |
A. Counseling, coordination of care, and nature of presenting problem
These components are not required at every visit. |
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Which governing agency grants pediatric nurse practitioners a Medicare personal identification number (PIN)?
A. Health Care Financing Administration B. State Department of Health C. Joint Commission Accreditation of Health Care Organization D. National Association of Pediatric Nurse Practitioners |
A. Health Care Financing Administration
Nurse practitioners can bill directly for their services or reassign payments to an employer with Medicare personal identification number (PIN). Health Care Financing Administration (HCFA) is a federal agency of the U.S. Department of Health and Human Services. HCFA administers the Medicare and Medicaid programs. |
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A pediatric nurse practitioner is offered a position in the pediatric outpatient clinic at a health maintenance organization. The human resources manager asks where she went to nurse practitioner school and what organization granted her national certification. The pediatric nurse practitioner asks why she needs this information. The HRM replies, "We need this information for:
A. Credentialing B. Privileging C. Security validation D. Licensure |
A. Credentialing
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What is the Advanced Practice Registered Nurse Compact (APRN)?
A. An agreement between selected states for mutual recognition of RN and APRN licenses to practice. B. An agreement between the government for mutual recognition of RN and APRN licenses to practice. C. An agreement between the local governing agencies to keep RN and APRN licenses in practice. D. An agreement between schools of nursing for mutual recognition of RN and APRN licenses to practice. |
A. An agreement between selected states for mutual recognition of RN and APRN licenses to practice.
Currently 18 states participate in the Nurse Licensure Compact Agreement. This agreement allows nurses to practice in participating member states without relicensure. Nurses may be licensed in more than one state either by examination or by the endorsement of a license issued by another state. |
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Which of the following theories used by pediatric nurse practitioners proceeds from the simple to the complex?
A. Structural functional theory. B. Communication theory. C. General systems theory. D. Developmental theory. |
D. Developmental theory
Developmental theory explains human growth and development. This model outlines the eight consecutive stages in the family life cycle that offer a predictive overview of the activities that occur in families over time. |
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Which of the following pediatric nurse practitioners is best demonstrating critical thinking?
A. Mary, who uses the approaches her collaborating physician uses in all practice situations. B. Joanne, who collaborates with peers in difficult situations to determine the best approach to care. C. Susan, who always uses drug and protocol books on her PDA to determine needed care. D. Terry, who bases care on the most common approaches which work in his practice. |
B. Joanne, who collaborates with peers in difficult situations to determine the best approach to care.
Collaboration helps the PNP validate findings and decision making. Collaboration also helps the PNP avail him- or herself of the knowledge and insights of peers. Protocols are useful, but basing care totally on protocols can result in care that does not meet the needs of an individual child or fails to consider an unusual presentation or treatment approach. |
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Clinical reasoning and decision-making skills are difficult to develop because:
A. Everyday problems are messy and ill-defined B. Pediatrics is such an old specialization C. Patients change over time D. Books become outdated quickly |
A. Everyday problems are messy and ill-defined
While some texts and other resources present content (e.g., pathophysiology, relevant assessments, and recommended care) becomes outdated, the real world of the child and his or her family makes the assessment, planning, implementation, and evaluation of care more difficult because each child is different and certain situations are unique, |
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Which of the following activities would be most effective to help a pediatric nurse practitioner identify errors in her clinical reasoning process?
A. Reading of case studies B. Development of a personal portfolio C. Use of simulated patient encounters D. Completion of web-based learning modules |
C. Use of simulated patient encounters
A simulated patient encounter is a setting where they can get feedback about therapeutic communication, questioning skills, and physical examination techniques as well as their therapeutic conclusions and plan of care. |
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Of the following, the best way an interdisciplinary care team can promote clinical reasoning among team members is through the use of:
A. Grand rounds B. Practice-based quality assurance initiatives C. Having team members do online case studies D. Paying costs for continuing education programs |
A. Grand rounds
Grand rounds provide an opportunity for professionals from a wide range of disciplines to review and discuss care. |
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The learning of the diagnostic process and clinical decision making is best supported by the:
A. Study of algorithms B. Engaging in debate C. Reading case studies D. Keeping a personal journal with reflections on practice. |
A. Study of algorithms
Algorithms guide the clinician through the steps of the decision-making process for a particular problem. Engaging in debate, reading case studies, and keeping a personal journal are ways to promote knowledge, but they do not directly teach or refine clinical reasoning. |
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Which of the following is a standard for nursing ethics?
A. ANA Standards for Nursing Practice. B. The Nurse Practice Act. C. The Nightingale Pledge. D. ANA Code for Nurses. |
D. ANA Code for Nurses.
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Which one of the following statements is NOT true regarding the updated CDC growth charts?
A. BMI-for-age charts are currently used for all age groups. B. The 85th percentile to identify children at risk for becoming overweight was added to the BMI-for-age and weight-for-stature charts. C. The 3rd and 97th percentiles were added to the growth charts. D. The lower limits of length and height were extended. |
A. BMI-for-age charts are currently used for all age groups.
The BMI-for-age charts are for children and adolescents aged 2 to 20, not for infants and children younger than 2 years of age. |
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What is the formula for calculating BMI?
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weight (kg) / height squared (m^2)
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Jacob comes into the clinic for his 9-month well baby exam. Jacob's parents want to know if there is an alternate developmental screening test that can be given to him. He is asleep at the time of his well child exam. Your best response is:
A. He will be documented as being asleep during the screening. B. Jacob will be referred for further diagnostic testing because it is unusual that a 9-month-old child would be sleepy during the daytime. C. Have parents keep him awake. D. The parents can complete the Ages and Stages Questionnaire and mail it into the clinic. |
D. The parents can complete the Ages and Stages Questionnaire and mail it into the clinic.
The Ages and Stages Questionnaire (ASQ) is a parent report covering ages 4 months through 60 months. It includes six questions in each of the five domains: communication, gross motor, fine motor, problem solving, and personal-social, and the parents note whether the child can perform the skill identified. |
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Carissa's parents report that she is a fussy child and is a very picky eater. You note on the growth chart she is at the less than 3rd percentile for weight and stature for a 10-month-old child. Which of the following assessment tools would be the most appropriate to use to assess the caregiver-infant interaction?
A. Denver II. B. Clinical Linguistic and Auditory Milestone Scale (CLAMS). C. Nursing Child Assessment Satellite Training (NCAST). D. Mullen Scales. |
C. Nursing Child Assessment Satellite Training (NCAST).
The NCAST is an assessment technique that provides observable behaviors that describe the parent-child interaction, infant behavior, and parental behavior. The provider must complete a training course before using this tool. |
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Which of the following is NOT a test for infants and toddlers for speech and language evaluation?
A. ELM (Early Language Milestone scale). B. Fluharty-2. C. Clinical Linguistic and Auditory Milestone test (CLAMS/CAT). D. REEL (Receptive and Expressive Emergent Language). |
B. Fluharty-2.
Fluharty-2 tests articulation and language performance in children 3 to 6 years of age. |
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Which of the following is not a common cause of gross motor delay?
A. Normal variation. B. Mental retardation. C. Autism spectrum disorder. D. Cerebral palsy. |
C. Autism spectrum disorder.
Normal variation is the most common cause of motor delay, followed by mental retardation and then cerebral palsy. The three essential features of autism are: impaired social interaction, absent or abnormal speech/language development, a narrow range of interest, and stereotyped or repetitive response to objects. |
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The average size for a newborn anterior fontanelle is:
A. 0.5 cm. B. 1.0 cm. C. 1.5 cm. D. 2.1 cm. |
D. 2.1 cm.
Although the range of size of the newborn fontanelle is wide, the mean newborn anterior fontanelle size is 2.1 cm. The posterior fontanelle size is 0.5 to 0.7 cm. |
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Besides the cover-uncover test, what is another test that can be used to screen for strabismus?
A. The Bruckner test or red reflex. B. Fundoscopy. C. Corneal light reflex. D. Cardinal fields of gaze. |
C. Corneal light reflex.
This demonstrates binocular fixation. If the corneal light reflex occurs equally, then strabismus is unlikely. The red reflex test demonstrates the absence of retinoblastoma or congenital cataracts. Fundoscopic exam evaluates the fundus, which is not related to visual fixation. Cardinal fields of gaze demonstrate extraocular movement. |
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Grace's mother brings her to the office. She says that her left ear is draining. On exam you see that the external canal has an orange-colored runny substance in it but the tympanic membrane appears normal. The ear canal is not inflamed. This is consistent with:
A. Otitis externa. B. Otitis media. C. Otitis media with effusion. D. Excessive cerumen. |
D. Excessive cerumen.
Cerumen can be copious and orange to yellow color is common. A normal tympanic membrane and no inflammation of the external canal rules out the other diagnoses. |
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One way to assess for increased intracranial pressure is palpation of the fontanelle in infants. The best position for the infant during this assessment is:
A. The supine position. B. The prone position. C. In a sitting position. D. While crying in a sitting position. |
C. In a sitting position.
The sitting position decreases the effect of gravity or crying and gives the most accurate assessment. |
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At what age should the anterior fontanelle no longer be palpable?
A. 26 months. B. 2 months. C. 18 months. D. 6 months. |
A. 26 months.
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At 10 months of age, you can assess receptive language ability by asking the:
A. Parent if the child says "mama" or "dada". B. Child to perform one action with a verbal command. C. Child to point to objects according to their use. D. Parent if the child can speak at least 20 words. |
B. Child to perform one action with a verbal command.
At 10 months, a child should be able to understand (receive) language enough to comply with a one-action command like "wave bye-bye". Speech is considered part of expressive language. Identifying objects and their function is a more complex skill, developed in the second year of life. |
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When taking the neonatal history of a 6-month-old patient new to your office, which of the following factors will have an effect on current lung function?
A. Low gestational age at birth. B. Low Apgar scores. C. IUGR. D. SGA. |
A. Low gestational age at birth.
Prematurity is the greatest risk factor for chronic lung disease, which can continue to cause problems in a 6-month-old. |
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Peak flow meter measurements are based on the child’s:
A. Age. B. Height. C. Weight. D. BMI. |
B. Height
Height is most closely correlated with lung volume. |
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Auscultation is important in the evaluation of the respiratory system; however, what other assessment can give you a lot of information about how well the respiratory system is functioning?
A. Heart rate. B. Skin color. C. Bowel sounds. D. Reflexes. |
B. Skin color.
Any change in skin color toward blue or gray, whether circumoral or generalized, is a sign of poor gas exchange and respiratory or cardiorespiratory compromise. |
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Audrey is 8 years old. Her father brings her in because she has been saying that “it hurts to breathe deep”. On auscultation, you hear a harsh grating sound with respirations. This is indicative of a:
A. Friction rub. B. Crackles. C. Wheezing. D. Stridor. |
A. Friction rub.
Friction rubs are present when there is inflammation and two surfaces are moving across each other. Crackles are caused by consolidation or fluid accumulation. Wheezes and stridor are caused by airway narrowing. |
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Dylan presents with a complaint of abrupt onset of fever and cough for 24 hours. One exam, you find decreased breath sounds in the right lower lobe. With percussion, you believe you hear dullness. The last test you could do to confirm your suspicion of pneumonia is whispered pectoriloquy. You expect to find:
A. Increased quality of loudness of whispered sounds. B. Decreased quality of loudness of whispered sounds. C. Abnormal voice sounds. D. Normal voice sounds. |
A. Increased quality of loudness of whispered sounds.
When there is consolidation of a lung field, whipered sounds will be clearer and louder but not normal over the area of auscultation. |
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All of the following syndromes are associated with congenital heart conditions EXCEPT:
A. Turner's syndrome. B. Fecal alcohol syndrome. C. Noonan's syndrome. D. Marfan syndrome. |
A. Turner's syndrome.
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Maternal rubella infection during the first trimester has been associated with:
A. Venous hum. B. Patent ductus arteriosus. C. Mitral stenosis. D. Tetralogy of Fallot. |
B. Patent ductus arteriosus.
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Vickie, a pediatric nurse practitioner, is doing a cardiac assessment on an 18-month-old. Where would she expect to find the point of maximal impulse (PMI)?
A. Second intercostal space at the mid-clavicular line. B. Second intercostal space at the right sternal border. C. Fourth intercostal space at the mid-clavicular line. D. Fourth intercostal space at the right sternal border. |
C. Fourth intercostal space at the mid-clavicular line.
The PMI in infants and children under 4 years of age is located at the mid-clavicular line, fourth intercostal space. |
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Which of the following characteristics of a heart murmur in a child would cause the GREATEST concern?
A. Changes with position. B. Vibratory in nature. C. Grade II/VI. D. Occurs during diastole. |
D. Occurs during diastole.
Murmurs that occur during diastole are never innocent murmurs; therefore, this finding should raise concern and indicate further investigation. Murmurs that change with position, are not loud (grade I-II), and are vibratory in nature are characteristic of innocent murmurs. |
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At what age should all well children get a blood pressure screening?
A. 12 months. B. 18 months. C. 24 months. D. 36 months. |
D. 36 months.
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The clinic medical assistant obtained a blood pressure on a 4-year-old using an automated machine. The pediatric nurse practitioner noted the measurement was less than the 90th percentile. What would be the BEST initial action to take?
A. Repeat the test using the other automated machine at the clinic. B. Refer to the pediatric cardiologist. C. Repeat the test using the manual auscultation method. D. Schedule a repeat test in 24 to 48 hours. |
C. Repeat the test using the manual auscultation method.
National guidelines recommend that blood pressure readings of less than the 90th percentile be confirmed using the manual auscultation method. |
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While making newborn rounds on a 12-hour-old nweborn, which finding would NOT be considered normal?
A. Soft, grade III systolic murmur. B. Blood pressure reading of 70/40. C. Apical heart rate of 62. D. Capillary refill rate of 2 seconds. |
C. Apical heart rate of 62.
The normal apical heart rate in a newborn is 80 to 180 beats per minute. A soft, grade III/IV systolic murmur found in the first 24 hours after birth is normal because the ductus arteriosus may not be closed. A normal newborn systolic blood pressure is between 65 and 95 mm Hg and the normal diastolic blood pressure is between 30 and 60 mm Hg. Capillary refill of 1 to 2 seconds is a normal finding. |
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Jana is a 16-year-old who comes into the clinic for a sports physical examination. Her blood pressure, measured twice, is 130/88 and 128/90, respectively. Based on her blood pressure readings, she is considered:
A. Antihypertensive. B. Normotensive. C. Prehypertensive. D. Hypertensive. |
C. Prehypertensive.
Any adolescent with a blood pressure of greater than or equal to 120/80 mm Hg is considered prehypertensive. Elevated blood pressure readings should be repeated twice during a clinic visit and the two systolic readings and two diastolic reading should be averaged. |
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Blood pressure percentages are based on:
A. Age, gender, and percentage of height. B. Age, gender, and percentage of weight. C. Age, height, and weight. D. Age and weight. |
A. Age, gender, and percentage of height.
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A parent of a child diagnosed with an innocent heart murmur asks you to explain what causes this sound. The BEST response is:
A. There is an obstruction as the blood flows through the child's heart valves. B. The structures of your child's heart are different from a normal heart. C. The sound is caused by turbulent blood flow in the heart. D. The pressure in the heart is high in children. |
C. The sound is caused by turbulent blood flow in the heart.
Innocent heart murmurs are common in children and are caused by the turbulent blood flow at the origin of the great vessels. |
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If brown or black spots are noted on the lips of a 6-year-old child it would be important to ask if others in the family have which of the following disorders?
A. Celiac disease. B. Marfan syndrome. C. Inflammatory bowel disease. D. Peutz-Jeghers syndrome. |
D. Peutz-Jeghers syndrome.
Peutz-Jeghers syndrome is an autosomal dominant hereditary disorder characterized by small brown or black spots on the lips and/or in the mouth. There is an increased risk for cancer of the gut, breasts, or ovaries in people with this condition. |
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Umbilical hernias are often found in infants and premature infants because:
A. The abdominal pressure from birth causes the muscles to separate. B. The diastasis recti muscles entrap the umbilical cord during embryological development. C. The small intestines herniate into the umbilicus during embryological development. D. Infants perform a Valsalva's maneuver in response to birth, increasing abdominal pressure that creates a hernia. |
C. The small intestines herniate into the umbilicus during embryological development.
At the end of the fifth week of embryological development, the liver and the spleen are large. This decreases the intraabdominal space available for the small intestines. If the organs don't decrease in size by week 10, the intestine cannot return to the mid-gut, resulting in an umbilical hernia. |
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Can the absolute measure of body mass index (BMI) be accurately used to describe a child's adiposity or degree of overweight?
A. Yes, because this measure of body composition is arithmetically derived from a child's height and weight. B. Yes, because BMI correlates with doubly labeled water studies, which is the "gold standard" measure. C. No, because absolute BMI does not take into account the trate of growth based on a child's age and gender. D. No, because BMI has been determined to not take into account body mass that is muscle versus body mass that is adipose tissue. |
C. No, because absolute BMI does not take into account the trate of growth based on a child's age and gender.
BMI has been found to closely correspond with adipose measures in adults and has been accepted as a universal measure of body mass and adiposity; however, in children, BMI changes with the normal and expected growth that occurs in childhood. The rate of growth depends on the child's age and gender; therefore, BMI percentile is the most accurate accepted measure of childhood adiposity. |
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What is the normal liver size in a 3-year-old?
A. 2 cm. B. 4 cm. C. 6 cm. D. 8 cm. |
B. 4 cm.
The normal liver size in a 6-month-old is 2 cm, in a 3-year-old is 4 cm, in a 10-year-old is 6 cm, and in an adult is 8 cm. |
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The presence of rectal fistulas and skin tags suggest that the examiner may want to ask which of the following questions?
A. Does anyone in your immediate family have a history of peptic ulcer disease? B. Does anyone in your family have a history of inflammatory bowel disease? C. Does anyone in your family have a history of having duodenal polyps? D. Does anyone in your family have a history of gastroesophageal reflux? |
B. Does anyone in your family have a history of inflammatory bowel disease?
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Melissa is a 4-year-old child who has been brought to see you today for a 6-month history of constipation and intermittent rectal bleeding. Given this presentation, a thorough exam including a digital rectal exam is performed. What findings would NOT be considered normal on the digital rectal examination?
A. Stool in the rectal vault. B. Sphincter tone intact. C. Lubricated gloved finger easily inserted. D. Fecal occult blood test negative. |
A. Stool in the rectal vault.
While a 6-month history of rectal bleeding is very concerning, realizing that this occurred with constipation is less worrisome. Physical examination finding of a full rectal vault is not normal and may indicate that this child suffered from chronic constipation and withholding. This will likely need a long course of treatment to resolve. This is a common diagnosis in children during toilet-training years; however, it requires a full examination, a laboratory evaluation, and then a treatment trial. The other differential diagnosis to consider is Hirschprung's disease; however, this condition is much less common. |
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When lightly palpating the abdomen of a 14-year-old female, you note that she responds with tensing of her abdominal muscles. This persists when you distract her and when you hold her hand, techniques that can be used to reduce the patient's sensitivity during abdominal palpation. The technical term for her response to your palpation is:
A. Rigidity. B. Preparing. C. Guarding. D. Abdominal tension. |
C. Guarding.
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A complete physical examination should include checking for an anal wink. This is done to check:
A. That cranial nerve X is intact and properly functioning. B. If the superficial reflexes are intact. C. If the patient has suffered from sexual abuse. D. If the patient has normal sensory neurological function. |
B. If the superficial reflexes are intact.
The anal wink is a reflex that occurs in response to slight stimulation of the anus (i.e., stroking, light touch) during which the external anal sphincter tenses or puckers. Testing the anal wink is an important component of superficial reflex testing and evaluation of the intact functioning of the neurological system originating from the lowest sacral segments of the spinal cord. |
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One method used to auscultate the liver and approximate its size is the scratch test. This is performed by:
A. Scratching the liver and listening with a stethoscope to the resultant bowel sounds. B. Placing the stethoscope over the liver and then scratching on the lower abdomen. Noise created while scratching on the abdomen is heard best over the liver. C. Listening with a stethoscope to the noise created when scratching in a counterclockwise pattern beginning over the gastric bubble. D. Scratching the skin overlying the liver and listening with a stethoscope to the loud sounds that change to quieter sounds when the scratching goes beyond the edge of the liver. |
D. Scratching the skin overlying the liver and listening with a stethoscope to the loud sounds that change to quieter sounds when the scratching goes beyond the edge of the liver.
When scratching the surface of the skint hat overlies solid organs, such as the liver in the abdominal cavity, the sound waves will be more readily conducted and thus will be louder than scratching the skin overlying the hollow structures or structures not in direct contact with the overlying skin. |
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A 17-year-old male comes to see you today for a complaint of fatigue and abdominal pain. Upon physical examination, you determine that his spleen is 2 cm below the lower left costal border. Which of the following would be the BEST comment that you could make following this examination finding of his spleen?
A. Some people have larger spleens than other people. Your spleen is larger than many people your age and given your symptoms we should do more testing. B. Your spleen is in a slightly different location than most teenagers' spleens and I will note this in your chart. C. Your spleen is normal in size and is unlikely to be the cause of your symptoms. D. Do you play football or other contact sports? |
A. Some people have larger spleens than other people. Your spleen is larger than many people your age and given your symptoms we should do more testing.
Only 3% of adolescents have palpable spleens. These findings warrant further investigation. |
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John, a healthy 13-year-old male, presents to the clinic for a sports physical. When determining sexual maturation, you note enlargement of scrotum and testes without enlargement of penis. Scrotum is reddened in color. You also note a few, long, light straight hairs at the base of the penis. What Tanner stage of development is Chris?
A. Tanner I. B. Tanner II. C. Tanner III. D. Tanner IV. |
B. Tanner II.
Typically in male sexual maturation, testicles and scrotum begin growing, then pubic hair develops, and finally the penis enlarges. Tanner Stage II notes the beginning of sexual maturation when the scrotum and testes enlarge, a few immature pubic hairs exist, and penile enlargement has not yet occurred. |
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To conduct an examination of the hymen on 10-year-old Debbie, you apply traction to visualize the opening. You are unable to visualize the hymenal opening so you release traction, then reapply traction, attempt to float opening with normal saline, and place Debbie in knee-chest position. Despite these maneuvers, the hymen opening is not visible. This exam is consistent with:
A. Imperforate hymen. B. Crescentic hymen. C. Cribriform hymen. D. Perforate hymen. |
A. Imperforate hymen.
An inability to visualize a hymenal opening after using various techniques to provide visualization of the opening may indicate an imperforate hymen. An imperforate hymen is defined as no hymenal opening. An imperforate hymen requires a referral to gynecology and a hymenotomy may be needed. Crescentic hymen is a normal anatomical variant and no referral is needed. |
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A pubertal hymen can best be described as:
A. Smooth and delicate hymenal edge. B. Typically very sensitive to touch. C. Thickened, redundant, moist, and pale. D. Thickened, redundant, and very sensitive to touch. |
C. Thickened, redundant, moist, and pale.
Due to the release of estrogen, the pubertal hymen becomes thickened, redundant, moist, and pale in color. The pubertal hymen is no longer sensitive to touch, |
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What type of hair is darkly pigmented and found primarily on the scalp and face of males?
A. Vellus. B. Terminal. C. Lanugo. D. Bulb. |
B. Terminal.
Types of hair are lanugo (thin, short hair shed before term), vellus hair (short, soft, distributed over the body, unpigmented), terminal hair (long, coarse, found on the scalp, beard, eyebrows, eyelashes, and axillary and pubic hair). Bulb matrix is new hair cells. |
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A 3-year-old boy was brought into clinic because his mother noticed a very distinct erythematous area with a defined border on his waistline. The area was slightly indurated but intact. Which factor would be key in your assessment?
A. Food allergies. B. Recent injury. C. Recent illness. D. Use of a belt. |
D. Use of a belt.
Contact dermatitis is an acute or chronic inflammation of the skin. A common type of contact dermatitis is nickel dermatitis caused by jewelry, belts, snaps, or eyeglasses. |
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What is the normal nail angle?
A. 90 degrees. B. 180 degrees. C. 160 degrees. D. 140 degrees. |
C. 160 degrees.
The normal nail angle is 160 degrees. This angle changes in conditions such as clubbing. |
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Capillary refill should occur within how many seconds?
A. One B. Two C. Three D. Four |
B. Two
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What are dimensions of a nodule?
A. Less than 1 cm. B. Greater than 1 cm but less than 2 cm. C. Less than or equal to 2 cm. D. Greater than 2 cm. |
C. Less than or equal to 2 cm.
A nodule is defined as a raised, firm, movable lesion with indistinct borders of 2 cm or smaller. |
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Which ethnicity has a bluish tinge on the lips?
A. Mediterranean B. Asian C. Black D. Hispanic |
A. Mediterranean
Inspection of the skin includes overall appearance, including color and skin tone. Note any racial or ethnic differences: Black people will have a bluish tinge on their gums, tongue, and nail borders; whereas people of Mediterranean descent have a bluish tinge on their lips. |
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How often does the strateum corneum or horny cell layer shed and have a complete turnover in cells?
A. Every 1 to 2 weeks. B. Every 2 to 3 weeks. C. Every 3 to 4 weeks. D. Every 4 to 5 weeks. |
C. Every 3 to 4 weeks.
The stratum corneum or horny cell layer begins to develop at the 21st week and sheds with a complete turnover in cells every 3 to 4 weeks. |
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The formation of erythrocytes is determined by:
A. Erythropoietin, which is produced by the renal system in response to tissue hypoxia. B. The amount of iron and iron-binding capacity. C. The amount of bilirubin that is excreted by the liver. D. The number of circulating reticulocytes in the serum. |
A. Erythropoietin, which is produced by the renal system in response to tissue hypoxia.
RBC production is regulated by erythropoietin that the kidney produces when there is tissue hypoxia. Bilirubin is a breakdown product of RBCs which is excreted into the bile. Iron stores are reused to produce new RBCs. |
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A type of immature neutrophil that proliferates in infection and inflammation is termed a:
A. Band. B. Seg. C. Mast cell. D. Reticulocyte. |
A. Band.
A mature neutrophil has a segmented nucleus and is termed a "seg." An immature neutrophil has a band-shaped nucleus and is termed a "band." Increased bands are associated with significant infection as the body attempts to produce more neutrophils to fight. Reticulocytes are immature RBCs. |
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Which of the following statements is FALSE regarding the extrinsic coagulation cascade?
A. Tissue injury promotes this response. B. The cascade is evaluated by the partial thromboplastin time (PTT). C. Tissue factor is released by exposure of collagen to a vessel surface. D. Factors II, VII, and X are required. |
B. The cascade is evaluated by the partial thromboplastin time (PTT).
The extrinsic cascade is evaluated by the prothrombin time (PT). The intrinsic cascade is evaluated by the partial thromboplastin time (PTT). All other answers are true for the extrinsic cascade. |
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All of the following medications may possibly prolong bleeding EXCEPT:
A. Oral contraceptives. B. Sulfonamides. C. Penicillins. D. Anticonvulsants. |
A. Oral contraceptives.
Sulfonamides, penicillins, and anticonvulsant drugs are among those that can intensify bleeding. Oral contraceptives actually can increase the risk of clotting. |
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The type of lymphocyte that makes IgM antibodies and eventually IgG, IgA, and IgE antibodies on reexposure to the antigen is:
A. B lymphocyte. B. T lymphocyte. C. Natural killer (NK) lymphocyte. D. Cytokines. |
A. B lymphocyte.
B lymphocytes are a type of WBC that matures in the bone marrow and helps to form IgM and other antibodies. T lymphocytes arise from the thymus and destroy virus and tumor cells. Natural killer lymphocytes assist B lymphocytes to destroy foreign substances, while cytokines are hormone-like proteins activated by T cells to modulate inflammation and hematopoiesis, |
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A pediatric nurse practitioner is examining a 15-year-old male with severe pharyngitis. She notes that one tonsil is more edematous and erythematous than the other and the uvula is deviating toward that tonsil. The teen is having difficulty swallowing, What is the MOST important action the pediatric nurse practitioner must take?
A. Send the teen home on amoxicillin 500 mg three times a day for 10 days. B. Send a confirmatory group A beta hemolytic strep test to the lab for a full culture. C. Refer the teen to an ENT physician immediately for emergency evaluation of peritonsillar abscess. D. Send the teen home on Zithromax Z-pack for 5 days with one refill. |
C. Refer the teen to an ENT physician immediately for emergency evaluation of peritonsillar abscess.
When one tonsil enlarges significantly more than the other, appears erythematous and edematous, and causes the uvula to tend to deviate toward the more enlarged tonsil, there is great risk for peritonsillar abscess. This is considered an emergency, and normally an ENT physician will drain the abscess then begin the patient on an antibiotic regimen. Antibiotics alone may not cure this disorder. The infection may or may not be caused by group A beta hemolytic strep, which will affect the choice of antibiotic but not the fact that this situation requires emergency consultation with a physician. |
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The pediatric nurse practitioner is aware that patients presenting with enlarged supraclavicular lymph nodes are at risk for:
A. Mediastinal lymphadenopathy. B. Tuberculosis. C. Pneumonia. D. Infectious mononucleosis. |
A. Mediastinal lymphadenopathy.
Supraclavicular adenopathy is never normal. It is highly suspicious for malignancy, particularly mediastinal lymphadenopathy-associated malignancy. Tuberculosis and pneumonia may not cause adenopathy, although infectious mononucelosis will usually cause cervical and occipital lymphadenopathy. |
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A pediatric nurse practitioner receives back a report on a 3-year-old girl revealing anemia, neutropenia, and blasts. What action must be taken immediately?
A. Repeat the lab test because it cannot be correct. B. Tell the child’s parents to start an iron supplement. C. Refer the child to a pediatric hematologist-oncologist promptly. D. Check RBC morphology for MCV, MCH, and MCHC. |
C. Refer the child to a pediatric hematologist-oncologist promptly.
These results suggest severe hematologic malignancy. Urgent referral is necessary. |
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The pediatric nurse practitioner is examining an infant during a well child exam. She questions whether the spleen is enlarged, but also knows that the:
A. Spleen may extend more than 2 cm in an infant. B. Spleen is normally 1 to 2 cm below the left costal margin in infants and children. C. Spleen might feel hard in some infants. D. Liver edge may extend beyond 2 cm in the right costal margin in infants. |
B. Spleen is normally 1 to 2 cm below the left costal margin in infants and children.
Anything below 2 cm is worrisome. Spleen should feel soft. Also, the liver border should never extend beyond 2 cm in infants / children. |
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A pediatric nurse practitioner is taking care of a pediatric oncology patient. This child is suffering from neutropenia due to the chemotherapy regimen. The pediatric nurse practitioner is aware that:
A. There is no treatment for the neutropenia. B. The child is at no risk for infection. C. The patient should have a reticulocyte count drawn. D. The child can be treated with recombinant growth factors to accelerate hematopoiesis. |
D. The child can be treated with recombinant growth factors to accelerate hematopoiesis.
The reticulocyte count is more significant for bleeding disorders and anemias. |
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Han is a 2-month-old infant with a positive bilateral Babinski reflex, a poor Moro reflex, frog-leg posture when supine, limp ventral suspension, and floppy extremities with poor tone. He has been experiencing respiratory problems. A referral to the pediatric specialist is made. Based on the above findings, you suspect a diagnosis of:
A. Generalized spasticity with possible cerebral palsy. B. Developmental delay with possible genetic syndrome. C. Generalized hypotonia with possible spinal muscular atrophy. D. General extremity weakness with possible muscular dystrophy. |
C. Generalized hypotonia with possible spinal muscular atrophy.
These findings point to spinal muscular atrophy, especially since the child is experiencing respiratory problems. There is no data to support that he has spasticity or syndromic presentation. While poor tone causes generalized weakness, muscular dystrophy initially presents with proximal muscle weakness. This infant has generalized weakness. |
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Kendrick is an 18-month-old Hispanic boy whose father is concerned his son has “cowboy legs” (bowed legs) and he falls a lot. What is the most likely diagnosis for these findings?
A. Genu valgum. B. Physiologic genu varum. C. Patellar lateral subluxation. D. Bilateral varus thrust when walking. |
B. Physiologic genu varum.
Physiologic genu varum is a common and normal finding in a toddler. Patellar subluxation is rarely seen in a toddler. Varus thrust is indicative of infantile Blount’s disease. Genu valgum, or knock knees, is a common finding in a child 3 to 6 years old. |
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What is one of the most common causes of a limp in a 3-year-old girl?
A. Developmental dysplasia of the hip. B. Legg-Calve-Perthes disease of the hip(s). C. Stress fracture of the foot or ankle. D. Slipped capital femoral epiphysis. |
A. Developmental dysplasia of the hip.
A young child who has not been treated for developmental dysplasia of the hips may have a length discrepancy. This can cause a limp. Legg-Calve-Perthes disease is caused by avascular necrosis of the femoral head. This would be seen in 5-9 year old children, more commonly boys. Slipped capital femoral epiphysis would be seen in ages 8-15, more common in boys than girls. Stress fracture of the foot or ankle is a problem more commonly seen in adolescent age, usually athletes due to overuse. |
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Leilani is a 2-year-old girl whose father reports that she isn’t learning as quickly as her older sister and brother did. She was born premature at 35 weeks gestation after a long labor. She started walking at 21 months and still is “a little wobbly.” What gait disturbance would be consistent with this history?
A. She falls down a lot. B. She has ataxia and disequilibrium. C. She walks on her toes with a stoppage gait. D. She walks on the lateral borders and heels of her feet. |
B. She has ataxia and disequilibrium.
All children first learning to walk fall down a lot. Her birth history points to cerebral palsy. Spasticity and muscle weakness will contribute to toe walking and stoppage gait. This gait produces the wobbly appearance. Walking on the lateral borders or heels of the feet is caused by other orthopedic problems such as congenital coalitions of the foot bones. |
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What are the consequences of inadequate calcium intake in a child?
A. Skeletal dysplasia. B. Vitamin D deficiency (rickets). C. Juvenile osteoporosis. D. Cognitive developmental delay. |
B. Vitamin D deficiency (rickets).
Older adults who as children did not obtain adequate calcium intake are at greater risk for osteoporosis. Inadequate nutrition in general may cause problems with learning; however, there is no evidence to conclude that inadequate calcium causes cognitive delays. Skeletal dysplasia is congenital, not a result of inadequate nutrition in the child. |
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Three-year-old Jimmy in-toes. Three common etiologies of in-towing are internal tibial torsion, metatarsus adductus, and:
A. Femoral anteversion. B. Infantile Blount’s disease. C. Muscle imbalance. D. Bilateral genu valgum. |
A. Femoral anteversion.
Increased internal rotation (femoral anteversion) of the hips is commonly the etiology of in-toeing in young children. Infantile Blount’s is a disease of the proximal tibias. Muscle imbalance would not be a common reason, and may be indicative of underlying neuromuscular disorder. Genu valgum would not cause in-toeing, but may cause out-toeing. |
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Amber is a 6-year-old girl who recently moved to your city and is new to your practice. Her parents report that she has a history of brittle bone disease but cannot give you the name(s) of the physicians or clinics where she has been diagnosed and treated for osteogenesis imperfect. They tell you she has had several arm fractures in the last few years but they always heal okay. Dad tells you he had several arm fractures when he was a child, but was never taken to a specialist for the breaks. His father would take him to their town doctor and he would “patch him up like new.” Before the family leaves your clinic today, what will be very important to accomplish on this initial visit?
A. Radiographs of all the bones in her extremities to look for new fractures. B. Recommend and offer to schedule Amber for a consultation with a pediatric orthopedic specialist in the very near future. C. A referral to Child Protection Services for ongoing child abuse. D. Have her parents complete a medial release of records for prior medical treatment before their move. |
B. Recommend and offer to schedule Amber for a consultation with a pediatric orthopedic specialist in the very near future.
It is never easy to make clinical decisions in a situation like this. Some parents can be poor historians for many different reasons. Although the history is sketchy, Amber could very well have a history of pathologic fractures due to osteogenesis imperfect, although you would expect to see bowing and marked angulation of the bones that were fractured. A consultation with a pediatric orthopedic specialist is the best and safest way to proceed. Ultimately acquiring previous medical records is necessary for continuity. You have no proof that Amber is abused; however, you should have a high index of suspicion and surveillance and should monitor her often with frequent clinic visits until you can acquire more information. |
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What foot fracture is commonly seen in school-age children?
A. Distal fibular fracture due to in-line skating. B. Jones’ fracture of the base of the 5th metatarsal due to playing football. C. Spondylolysis due to hyperextension of the spine during gymnastics. D. Pathological calcaneal fracture due to long-distance running. |
B. Jones’ fracture of the base of the 5th metatarsal due to playing football.
5th metatarsal – the base of the small toe |
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Gower sign is seen in children with:
A. Developmental dysplasia of the hip. B. Scoliosis. C. Duchenne’s muscular dystrophy. D. Asymmetrical knee height. |
C. Duchenne’s muscular dystrophy.
Gower sign is seen in children with Duchenne’s muscular dystrophy. It occurs when a child who is attempting to stand from the ground, begins with both hands and feet on the floor and works his way up the legs with his hands until standing because of proximal weakness. Infants with developmental dysplasia of the hip will have a positive Ortolani’s sign and Barlow test. A positive Galeazzi or Allis sign are related to knee height asymmetry. |
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The neurologic examination includes testing children for sensory function. A young verbal child can be assessed for normal cortical sensation by:
A. Identifying familiar faces. B. Identifying objects by handling them. C. Identifying shapes drawn on the palm when eyes are closed. D. Evaluating abstract reasoning skills. |
C. Identifying shapes drawn on the palm when eyes are closed.
Graphesthesia is the ability to identify shapes traced on the palm with eyes closed and tests children for normal cortical sensation. Children with spatial and proprioceptive dysfunction will be unable to discriminate shapes. |
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A 16-year-old male presents to the urgent care clinic for evaluation of high fever to 103.5 F, headache, and stiff neck. As the patient is lying on the exam table during the physical examination, you flex his leg at both the hip and the knee. As you straighten the legs, he experiences severe pain. What is the name of sign you are eliciting during the physical examination?
A. Lachman’s sign. B. Babinski’s sign. C. Kernig’s sign. D. Brudzinski’s sign. |
C. Kernig’s sign.
Kernig’s sign is elicited with the child lying with knees flexed in the supine position. A positive isgn is when the practitioner notes pain and resistance when extending / straightening the legs of the child. |
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A 6-month-old infant with Down syndrome presents for a routine primary care visit and immunizations. Over the past few months, mother has noticed rapid, intermittent movement of his eyes when he was gazing at her. The involuntary rapid eye movement in this 6-month-old infant is called:
A. Opsoclonus. B. Nystagmus. C. Abducens movement. D. Ptosis. |
B. Nystagmus.
“Nystagmus” is described as rapid involuntary eye movements when the infant is focusing on an object. Ptosis refers to a droopy eyelid. |
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Rhythmic tonic-clonic movements of the foot refers to:
A. Tremors. B. Stepping reflex. C. Plantar fasciculations. D. Clonus. |
D. Clonus.
“Clonus” is defined as a rhythmic, tonic-clonic movement of the foot elicited by a brisk dorsiflexion of the foot. The stepping reflex is elicited in the newborn when holding the infant upright over the exam table and allowing the feet to touch. |
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Myotomes are:
A. Named according to the spinal nerve that supplies the sensory fibers. B. A group of muscles primarily innervated by motor fibers from a single nerve root. C. Specific muscle groups associated with reflexes. D. Fibers that innervate the skin. |
B. A group of muscles primarily innervated by motor fibers from a single nerve root.
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Observing normal activities of a newborn infant such as feeding and crying tests:
A. Cranial nerves X and XII. B. Cranial nerve XI. C. Cranial nerves VII and X. D. Cranial nerve IX. |
A. Cranial nerves X and XII.
Cranial nerve X is the vagus, and cranial nerve XII is the hypoglossal. These nerves are accurately assessed by observing the infant crying and feeding. |
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Neuronal messages are transmitted through the cortex by:
A. Neurotransmitter chemicals. B. Synapses. C. Dermatomes. D. Cognitive activity. |
A. Neurotransmitter chemicals.
Neurotransmitter chemicals are released at the synapses and carry the neuronal messages to the next synapse. The result is normal cognitive function. |
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During the neurologic examination, school-aged children can be assessed for balance and coordination using tests that are fun and assist the practitioner in assessing cerebellar function. The tests include:
A. Romberg’s test. B. Stereognosis. C. Graphesthesia. D. Two-point discrimination. |
A. Romberg’s test.
Romberg’s test assesses for balance and equilibrium in the young child. The child must be able to stand erect with the eyes closed and hands touching the sides. Observe the balance for several seconds while monitoring the child closely. Lesions in the cerebellum can cause the child to stagger and fall. The other tests evaluate normal cortical function. |
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Tremors can occur in children:
A. In the facial muscles. B. When the child is at rest or active. C. When testing tandem walking. D. When eliciting rapid alternative movements of the hands. |
B. When the child is at rest or active.
Tremors can occur in any part of the body and are involuntary, generally not elicited by certain activities. |
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Which of the following statements is NOT true regarding mutation?
A. Occurs when an incorrect nucleotide base is inserted during DNA synthesis. B. May produce either a “gain of function” or a “loss of function.” C. Usually visually apparent or biochemically detectable. D. A permanent change in genetic material. |
C. Usually visually apparent or biochemically detectable.
A mutation is a permanent change in genetic material, occurs when an incorrect nucleotide base is inserted during DNA synthesis, and some produce a “gain of function” or a “loss of function.” “PHENOTYPE” is the observable expression of a genetically determined trait that is visibly apparent or biochemically detectable. |
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Which of the following statements is NOT true of recessive characteristics or traits?
A. Expressed when one copy of the gene is present at corresponding loci of homologous chromosomes. B. Usually remain undetected for generations. C. Estimated that each human carries from five to seven recessive rare deleterious alleles in the heterozygous state. D. If a carrier of a recessive allele mates with another individual with the same recessive allele, then they may have a child with a homozygous recessive disease. |
A. Expressed when one copy of the gene is present at corresponding loci of homologous chromosomes.
Recessive trait or characteristic is expressed only when TWO copies of the same gene are present at corresponding loci of homologous chromosomes. |
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Which of the following inherited conditions is NOT autosomal recessive?
A. Tay-Sachs disease. B. Mucopolysaccharide disorders such as Hurler’s syndrome. C. Adrenogenital syndrome. D. Glucose-6-phosphate dehydrogenase deficiency. |
D. Glucose-6-phosphate dehydrogenase deficiency.
Glucose-6-phosphate dehydrogenase deficiency is an X-linked (SEX-LINKED) recessive disorder. AUTOSOMAL recessive diseases include CF, Tay-Sachs, sickle cell, adrenogenital syndrome, and mucopolysaccharide disorders such as Hurler’s dynrome. |
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Prader-Willi syndrome and Angelman syndrome are examples of which inheritance pattern?
A. Autosomal dominant. B. Mutagenesis. C. Uniparental disomy. D. Germ line mosaicism. |
C. Uniparental disomy.
Uniparental disomy occurs when inheritance of both chromosomes in a pair is from the same parent rather than inheriting one from each parent, as normally occurs. There is variable phenotypic expression of an abnormal gene depending on whether the abnormal gene was inherited from the mother or father. An example of this inheritance pattern is with chromosome 15 when a specific deleted gene results in Prader-Willi syndrome if it was inherited from the father, or in Angelman syndrome if inherited from the mother. |
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A newborn has a cleft lip and palate. The parents ask the pediatric nurse practitioner what caused this deformity to occur. The pediatric nurse practitioner relates that the etiology of cleft lip and palate is attributed to which of the following inheritance patterns?
A. The etiology is unknown at this time. B. Multifactorial. C. Mutagenesis. D. Germ line mosaicism. |
B. Multifactorial.
Cleft lip and palate occurs due to multifactorial causes (hereditary-environmental interactions). Several factors contribute to the total effect. No one factor is sufficient to produce the particular abnormalities, and it probably occurs from the interaction of several genes with environmental factors. |
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Taking a patient history, the pediatric nurse practitioner learns that the patient has polydactylly, as does the patient’s mother, grandfather, and two of her children, a son and daughter. The pediatric nurse practitioner can determine that this inheritance pattern is which of the following?
A. X-linked. B. Autosomal recessive. C. Autosomal dominant. D. Multifactorial. |
C. Autosomal dominant.
An autosomal dominant pattern appears in every generation with little or no skipping, and is transmitted by an affected person to half of his or her children on average. Usually males and females are affected equally, but not always. |
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A newborn is diagnosed with Marfan syndrome. The parents want to know more about this condition. To aid in describing this condition to the parents, the pediatric nurse practitioner is aware that which of the following defines a “syndrome”?
A. An abnormal variation in form or structure without inferring a specific cause. B. A condition exhibiting an external feature usually seen in the head, hands, feet, or face which may indicate the presence of more serious problems. C. A condition associated with significant disability and serious functional problems. D. A condition affecting two or more body systems and having one underlying cause. |
D. A condition affecting two or more body systems and having one underlying cause.
Marfan syndrome affects connective tissue but also may have cardiac, skeletal, and ocular manifestations. |
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A newborn is suspected of having Fragile X syndrome. Which of the following diagnostic tests is indicated for evaluation of this condition?
A. Biochemical testing. B. Chromosome analysis. C. DNA analysis of blood. D. There is no genetic testing available for this condition. |
C. DNA analysis of blood.
In Fragile X syndrome, the fragile site located on the distal long arm of chromosome X at Xq27.3 may not always be visible in chromosome analysis. |
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What is the difference between whole cell pertussis and acelular pertussis?
A. There is no difference. B. whole cell pertussis is a live vaccine and acellular pertussis is a killed vaccine. C. Acellular pertussis vaccine contains detoxified pertussis toxin and is associated with a much lower incidence of side effects. D. Whole cell pertussis vaccine contains detoxified pertussis toxin. |
C. Acellular pertussis vaccine contains detoxified pertussis toxin and is associated with a much lower incidence of side effects.
The use of acellular pertussis as a componbent in DTaP has replaced DTP vaccine since the year 2000. Acellular pertussis vaccine contains detoxified pertussis toxin and has a much safer side-effect profile than vaccines containing whole cell pertussis. |
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Which of the following is NOT required in the documentation of vaccine administration?
A. Expiration date. B. Signature and title of the person who administered the vaccine. C. Vaccine name. D. The date the CDC Vaccine Information Statement (VIS) was provided and the VIS publication date. |
A. Expiration date.
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The Vaccine for Children Program (VFC) provides immunizations for which of the following groups?
A. Eligible for Medicaid or who have no health insurance. B. People older than 18 years of age. C. U.S. citizens. D. People with a documented history of a chronic illness. |
A. Eligible for Medicaid or who have no health insurance.
VFC programs provide vaccines at no cost for children 18 years and younger, Medicaid eligible, no health plan or are underinsured for vaccines, Native American or Alaskan Native. |
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Choose the correct statement regarding vaccination:
A. Active immunity can result from exposure to a strain of a virus or bacteria or from administration of a vaccine. B. A vaccine series should be restarted if the time that has elapsed between doses exceeds the recommended intervals. C. Tdap, licensed for use in 2005, is recommended as the primary series for infants at 2, 4, and 6 months of age. D. A precaution is a condition in the infant, child, or adolescent that significantly increases the chance of a serious adverse event. |
A. Active immunity can result from exposure to a strain of a virus or bacteria or from administration of a vaccine.
A “PRECAUTION” is a condition in the infant, child, or adolescent that may increase the LIKELIHOOD of a serious adverse event or may interfere with the immunization’s ability to produce immunity. |
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Tino, a healthy 4-year-old, comes into the clinic for a well child check. He has had four DTaPs, three IPVs, one MMR, one varicella, and two hepatitis B vaccines. What would you order today?
A. PCV7, IPV, varicella, DTaP. B. Tdap, MMR, hepatitis B, IPV. C. DTaP, IPV, MMR, hepatitis B D. PCV7, DTaP, IPV, MMR. |
C. DTaP, IPV, MMR, hepatitis B
Need 3rd Hep B; PCV7 is NOT recommended for healthy children over 23 months of age. |
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Which one of the following immunizations was associated with an increased incidence of intussusceptions in infants?
A. Rota Shield. B. Rubella. C. Rota Teq. D. Rabies. |
A. Rota Shield.
Rota Shield, an oral immunization given to infants to protect against rotavirus infections, was removed from the market soon after it was licensed for use due to an increase incidence of intussusceptions. In 2006, Rota Teq (Merck & Co, Inc.) was approved for the protection of infants against rotavirus infection, after no increased incidence of intussusception was found in studying over 70,000 children who received the immunization. |
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A Mantoux test (PPD skin test; tuberculin skin test) in a child with no risk factors is considered positive with a reaction of at least:
A. 5 mm of induration. B. 8 mm of induration. C. 20 mm of erythema. D. 15 mm of induration. |
D. 15 mm of induration.
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Corrine is an active 12-month-old female recently adopted from China. This is her first encounter at your clinic. The adopted parents were given an immunization record from China that has not been translated into English. Which of the following is NOT an appropriate management for Corrine?
A. Only written documentation should be accepted as evidence of immunization status. B. All live vaccine immunizations need to be repeated. C. Repeating the immunizations is an acceptable option if status is unknown. D. The majority of immunizations used internationally are produced with adequate quality control standards. Have the record translated into English and follow the recommended schedule. |
B. All live vaccine immunizations need to be repeated.
The majority of vaccines used worldwide is produced with adequate quality control standards and are potent. Each case should be individually reviewed for special considerations and potential. |
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An 8-year-old male will be considered overweight when his body mass index for his age is at or above the:
A. 95th percentile B. 90th percentile C. 85th percentile D. 75th percentile |
A. 95th percentile
According to the CDC (2005), children with BMI-for-age at or above the 95th percentile are overweight. |
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Jason, a 4-year-old male, is overweight. Being overweight puts Jason at risk to experience health consequences. Which of the following is NOT a health-related issue Jason would expect as he gets older due to his overweight status?
A. Infertility. B. Early sexual maturation. C. Hepatic steatosis. D. Sleep apnea. |
B. Early sexual maturation.
Consequences for overweight children compared with other children include cardiovascular disease, metabolic syndrome, dyslipidemia, glucose intolerance, type 2 diabetes, hypertension, coronary heart disease, hepatic steatosis, cholelithiasis, some cancers (endometrial, breast, and colon), osteoarthritis, infertility, obesity hypoventilation syndrome, sleep apnea, pseudotumor cerebri, and EARLY SEXUAL MATURATION OF FEMALES. |
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The U.S. Department of Agriculture and U.S. Food and Drug Administration establish guidelines for individual’s energy and nutrient needs. Which of the following describes “recommended daily allowance” or RDA?
A. Median usual intake value that should meet the requirements of half of all apparently healthy individuals. B. Amount that is adequate for nearly all healthy individuals. C. Highest level of intake that should pose no risk of adverse health effects. D. Four nutrient-based reference values based on age and sex. |
B. Amount that is adequate for nearly all healthy individuals.
Dietary reference intake (DRI) – a new set of four nutrient-based reference values based on age and sex. Estimated average requirement (EAR) – median usual intake value that should meet the requirements of half of all apparently healthy individuals. Recommended daily allowance (RDA) – amount that is adequate for nearly all healthy individuals. Upper intake level (UL) – highest level of intake that should pose no risk of adverse health effects. |
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Amy, a 5-year-old, presents to your office for a well child exam. Amy’s family members are vegans and eat no animal products. The pediatric nurse practitioner should consider supplementation of which of the following essential nutrients because it is at risk to be inadequate in Amy’s diet?
A. Magnesium B. Zinc C. Niacin D. Vitamin B6 |
B. Zinc
In vegetarian diets, supplementation of the following may be necessary to provide the following essential nutrients: B12, folic acid, iron, zinc, vitamin D, and occasionally calcium. |
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Sarah, a 9-year-old, developed anaphylactic shock 60 minutes after ingesting shrimp. This type of reaction is classified as which of the following?
A. Immediate. B. Delayed. C. Food hypersensitivity. D. Deferred. |
A. Immediate.
Immediate anaphylactic shock is a reaction which occurs within minutes to 2 hours after ingestion. Delayed reactions occur 2 to 48 hours after ingestion. |
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Kimberley, a 6-year-old, develops acute nausea and vomiting often after ingesting bananas. The pediatric nurse practitioner has decided to administer a food challenge. Kimberley has avoided bananas for the past 2 weeks. What is the first step in food challenge assessment?
A. Observe Kimberley for skin, GI, and respiratory changes. B. Obtain intravenous access. C. Administer graded doses of either bananas or a placebo (both are disguised or placed in capsules). D. Confirm negative challenges with a meal-sized portion of the bananas. |
B. Obtain intravenous access.
Food challenge can be done in the office with strict medical supervision as follows. Patient avoids the suspected food(s) for at least 2 weeks. After intravenous access is obtained, graded doses of either a challenge food or a placebo food are administered (both are disguised in capsules). Ensure access to emergency medications and CPR equipment. Assess patient frequently for skin, GI, and respiratory changes. Terminate challenge when a reaction becomes apparent. Observe for delayed reactions. Confirm negative challenges with a meal-sized portion of the food. |
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Marty, an 18-year-old pregnant female, asks the pediatric nurse practitioner about breastfeeding. Which of the following is NOT an advantage that the pediatric nurse practitioner should discuss with Marty?
A. Breastfeeding infants during painful procedures provides analgesia. B. Breastfeeding encourages mother-infant interaction. C. Breastfeeding decreases otitis media and upper respiratory infections. D. Breastfed infants are satisfied for at least 4 hours. |
D. Breastfed infants are satisfied for at least 4 hours.
Benefits of breastfeeding include: Human milk is specifically designed for human infants and cannot be duplicated, encourages mother-infant interaction, provides analgesia during painful procedures, decreases otitis media and upper respiratory infections, decreases gastrointestinal problems including gastroesophageal reflux, decreases allergies, anti-inflammatory agents in breast milk help decrease atopy, decreases overweight, and costs less than formula. Breastfed infants should be satisfied for at least 2 hours. |
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Katherine, the mother of a breastfed 3-month-old, is planning to return to work. She plans to pump her breast milk and has questions about safe storage of breast milk. Which of the following is correct regarding freshly expressed breast milk?
A. May be stored at room temperature (<78F) for up to 12 hours. B. May be refrigerated (<39F) for up to 7 days. C. Will keep for 2 weeks in the freezer located inside refrigerator. D. Will keep for 4 months in the freezer section of refrigerator with a separate door. |
C. Will keep for 2 weeks in the freezer located inside refrigerator.
Freshly expressed breast milk may be safely stored at room temperature (<78 F) for 6 – 8 HOURS, refrigerated (< 39 F) for 3 – 5 DAYS, freezer for 2 WEEKS inside a refrigerator, or freezer w/ separate door for 3 MONTHS, and 6 – 12 MONTHS in a deep freezer (< 0 F). |
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Jill, a 15-year-old, presents to the pediatric nurse practitioner for a sports physical for cheerleading. Her BMI is at the 85th percentile for age and sex and she is Tanner stage III. Jill wants to lose weight and suggests to the pediatric nurse practitioner that she begin a popular trendy diet. The pediatric nurse practitioner responds with which of the following?
A. “I’d like to review your current diet and activity history.” B. “Tell me about your family history including the incidence of obesity.” C. “Tell me about the diet you are suggesting.” D. “Cheerleading will take care of this issue for you, so don’t worry about your weight.” |
A. “I’d like to review your current diet and activity history.”
This adolescent is at risk for becoming overweight and because she has expressed that her weight is a concern, this should be addressed. The best approach for the pediatric nurse practitioner is to determine the adolescent’s current dietary intake and activity level in order to provide appropriate guidance. |
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Which of the following age groups historically has the highest prevalence of unsatisfactory nutritional status?
A. Toddlers (1 to 3 years) B. Preschoolers (4 to 6 years) C. School-aged (7 to 11 years) D. Adolescents (12 to 21 years) |
D. Adolescents (12 to 21 years)
According to National Health and Nutrition Examination Surveys between 1971 and 1991, the highest prevalence of unsatisfactory nutritional status was in the adolescent age group. |
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Women with each of the following disorders should take a minimum of 4 mg of folate each day EXCEPT for those with:
A. Hyperlipidemia B. Seizure disorder C. Spina bifida D. Mental retardation |
A. Hyperlipidemia
Mental retardation, seizure medications, and neural tube defects such as spina bifida markedly increase the risk for disorders of the fetus’ central nervous system and congenital anomalies. |
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During the discharge physical examination of David, a 36-hour-old infant born at 37 weeks gestation, you recommend that he be seen within 24 to 48 hours following discharge because he has slight yellow color to his face. He is being breastfed. His parents, who are first-time parents, question why they need to bring him back so soon. Your best response is based upon your understanding that infants at higher risk for developing hyperbilirubinemia are those:
A. Born at less than 38 weeks gestation and are breastfeeding. B. Born to first-time mothers. C. Demonstrating signs of jaundice within the first 36 hours of life. D. Who are discharged before 48 hours of age. |
A. Born at less than 38 weeks gestation and are breastfeeding.
Infants at higher risk for developing hyperbilirubinemia are particularly those who are breastfed and born at less than 38 weeks of gestation. Infants of this group require closer monitoring. Appropriate follow-up should be based upon time of discharge and risk assessment. Parents need to be provided with written and verbal information about newborn jaundice. |
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While examining an infant’s head, you notice an area of swelling that is well-demarcated and does not cross the suture lines. This finding is caused by the rupture of blood vessels that traverse the skull to the periosteum, commonly known as:
A. Craniosynostosis B. Fractured skull C. Cephalhematoma D. Caput succedaneum |
C. Cephalhematoma
Cephalhematomas are caused by rupture of blood vessels that traverse the skull to periosteum. This type of head trauma typically presents as well-demarcated swellings on the head and do not cross suture lines. Complications such as skull fracture, intracranial hemorrhage, and hyperbilirubinemia require close monitoring and additional treatment. It may take up to 3 months for reabsorption of the cephalhematoma. |
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Which of the following conditions places infants at risk for hypoglycemia resulting from inadequate glucose production?
A. Hypothermia, large for gestational age, polycythemia. B. Small for gestational age, infant of an insulin-dependent diabetic mother. C. Hypothyroidism, adrenal insufficiency, Rh incompatibility. D. Polycythemia, infant of an insulin-dependent diabetic mother, galactosemia. |
A. Hypothermia, large for gestational age, polycythemia.
Term infants at risk for hypoglycemia from inadequate glucose production include the following: large for gestational age, intrauterine growth-restricted, postmature, cold stress, perinatal asphyxia, polycythemia, and inborn errors of metabolism. |
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During a routine 2-week newborn follow-up examination, you notice that Kyle still has his umbilical cord. Upon further inspection, you note no odor, erythema, or purulent drainage, but rather clear fluid draining from the umbilical cord. What is the most likely cause of this drainage?
A. Bacterial infection. B. Patent urachus. C. Omphalocele. D. Umbilical cyst. |
B. Patent urachus.
The umbilical cord usually separates around 1 to 2 weeks of life. The persistent presence of the umbilical cord with clear fluid drainage could indicate a patent urachus, a canal connecting the fetal bladder with the allantois, a membranous sac that contributes to the formation of the umbilical cord. |
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Kelly, a 48-hour-old term newborn born via cesarean section for frank beech presentation, is ready for discharge. During the discharge physical examination of this newborn, you note positive Ortolani’s sign of her hips. Your next priority for this infant should include which of the following?
A. Ultrasound of the hips before discharge. B. Instruct the family how to triple-diaper their baby. C. Refer to the orthopedist. D. X-ray of the hips. |
C. Refer to the orthopedist.
According to the AAP’s recommendations for management of developmental dysplasia of the hip (DDH), all newborns with positive Ortolani’s or Barlow’s signs at birth or during the routine 2-week exam should be referred to an orthopedist. The recommendations do not include further radiologic studies or triple-diapering the newborn. |
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The nursery nurse asks you to examine Scott because he shows no interest in breastfeeding, has not had any stool, and now has a full abdomen. Scott is now 38 hours old. One examination, you note a respiratory rate of 65, a distended abdomen measuring 3 centimeters larger than at birth. He appears jaundiced and has had a bilious emesis. What condition is mostly likely causing Scott’s symptoms?
A. Feeding intolerance. B. Pyloric stenosis. C. Hirschprung’s disease. D. Malrotation. |
C. Hirschprung’s disease.
Hirschprung’s disease is a condition of absence of parasympathetic innervation to the distal intestine with absence of ganglionic cells in the submucosal and myenteric plexuses of the colon. Hirschprung’s disease should be suspected in the newborn who does not pass meconium within 24 to 48 hours of birth. An abdominal x-ray will typically show diffuse intestinal and bowel dilation with absence of air in the rectum. The diagnosis is confirmed by rectal biopsy, which demonstrates absence of ganglionic cells. Surgery is the treatment for Hirschprung’s disease. |
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During a discharge physical examination of a term newborn weighing 4.6 kg, now 30 hours old, you note that he nursed four times in the last 24 hours for 10 minutes on only one breast. On examination, he is noted to be a little jittery, has a respiratory rate ranging between 65 and 76, and his temperature has ranged between 97 F and 97.2 F. Prenatal history is significant for maternal insulin-dependent diabetes and no history of drug use. His blood glucose levels after delivery were as follows: 40 at 1 hour of age and 55 at 2 hours. His blood glucose is now 50. What information should you obtain at this time?
A. Another blood glucose immediately, because you suspect the blood glucose is lower than reported. B. Complete blood count, blood culture, electrolytes, and ammonia. C. Complete blood count, blood culture, and neonatal bilirubin. D. Complete blood count, blood culture, and serum calcium. |
D. Complete blood count, blood culture, and serum calcium.
Symptoms of hypoglycemia, such as poor feeding, jitteriness, and tachypnea, are also symptoms of sepsis, hypocalcemia, or drug withdrawal. In absence of a maternal history of drug use, the practitioner should evaluate the infant for sepsis and hypocalcemia. |
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Blood pressures are not usually obtained as part of the routine newborn vital signs. When are blood pressure measurements indicated in the normal newborn?
A. Inability to palpate pulses in the lower extremities. B. Maternal history of chronic hypertension. C. Newborn heart rate less than 120. D. Hypoglycemia. |
A. Inability to palpate pulses in the lower extremities.
Strong arm pulses and weak or absent lower extremity pules suggest coarctation of the aorta (COA). Blood pressure measurements from all four extremities are recommended. A higher blood pressure of the upper extremities greater than 15 mm Hg is suggestive of COA. If COA is suspected, notify the pediatrician and/or cardiologist immediately. The infant will need an echocardiogram and possibly prostaglandin E1 to maintain patency of the ductus arteriosus. |
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During a routine discharge examination of a 36-hour-old term female infant, the parents ask you about the “rash” on their newborn’s skin. Upon examination, the “rash” appears as small, erythematous papules, some of which appear to be pustule-like, on the infant’s trunk. There is a distinctive, diffuse, blotchy erythematous halo surrounding the vesicles. The parents verbalize that they are concerned that their newborn has acquired a skin infection while in the hospital and would like to speak to the unit’s manager. The perinatal history is unremarkable and the newborn appears healthy and has been stable. What is the most likely cause of this “rash”?
A. Skin infection caused by Candida albicans. B. Milia. C. Herpes simplex. D. Erythema toxicum. |
D. Erythema toxicum.
Erythema toxicum is benign skin condition that occurs only during the neonatal period in approximately 48% of newborns. The condition is characterized by erythematous papules, pustules, and vesicles that are surrounded by a distinctive, diffuse, blotchy, and erythematous halo. |
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Which of the following newborn infants are at risk for hearing loss?
A. A 36-week gestation infant with a birth weight of 5 pounds 6 ounces. B. A term newborn with Apgars of 2 at 5 minutes and 5 at 5 minutes. C. A term infant born to a mother who took ampicillin for an ear infection 24 weeks into her pregnancy. D. A newborn with atrial septal defect. |
B. A term newborn with Apgars of 2 at 5 minutes and 5 at 5 minutes.
Low Apgar scores have been associated with newborn hearing loss. Infants are also at risk for hearing loss if they are born less than 1500 grams, have a family history of hearing loss, had intrauterine infections, have ear or craniofacial anomalies, have bacterial meningitis or respiratory distress, physical features of syndromes, or received ototoxic medications. |
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Iron deficiency anemia is a concern during infancy and is associated with anemia, growth problems, and cognitive delay. Heme iron is important because:
A. It is from ingested meat and poultry and is released in the intestinal lumen and enters the enterocyte as an intact protein (metalloporphyrin). B. It is made soluble by gastric acid in the stomach and is converted from ferric to ferrous form. C. It can be readily absorbed in a droplet form for easy absorption. D. Ferric reductase, a protein known Dctb, takes part in the process of reducing ferric iron to ferrous iron. |
A. It is from ingested meat and poultry and is released in the intestinal lumen and enters the enterocyte as an intact protein (metalloporphyrin).
Heme iron is about two to three times more absorbable than nonheme iron. In determining a patient’s iron nutrition, one needs to consider measuring hemoglobin level to determine the iron-containing protein in circulating red blood cells. Hemoglobin cannot be made without iron. Other iron-related proteins may also be ordered such as ferritin and total iron binding capacity. |
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A group of mothers are discussing their 8-month-old infants’ developmental milestones. All of the mothers except one say their infants are exhibiting signs of separation anxiety. What might be an appropriate question to ask the mother whose child is not showing signs of separation anxiety?
A. How many siblings does your infant have? B. Are you still breastfeeding? C. Does the child attend daycare? D. Where does the child sleep? |
C. Does the child attend daycare?
Children who attend daycare have less pronounced separation anxiety. |
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Sarah is brought in for her 4-month-old visit by her dad. When asked how she was doing, he said “Fine, she is such a quiet baby. She likes to be held but doesn’t really cry very much.” All of the following are appropriate actions EXCEPT:
A. Perform a Denver II Developmental Screening Test. B. Review the newborn screening examination results. C. Determine if there is a family history of hearing loss. D. Ask the father how many words Sarah verbalizes. |
D. Ask the father how many words Sarah verbalizes.
The 4-month-old infant is usually cooperative and interactive. At 4 months, an infant does not say words. Behaviors such as mimicry of the parents’ vocalizations and language stimulation are usually apparent. Babbling and cooing is present with turning to sounds or loud noises. The incidence of hearing loss is 3 per 1,000, 20 times greater than PKU. Universal newborn hearing screening is essential to confirm a diagnosis by 3 months of age because language development is significantly better when intervention begins before 6 months of age. Auditory brainstem response (ABR) or otoacoustic emissions (OAE) are both screening exams done on infants to determine hearing loss. |
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In infants, lead levels greater than ___ mcg/dl require follow-up.
A. 1 B. 2 C. 5 D. 10 |
D. 10
Lead levels higher than 10 mcg/dl are considered high and require follow-up. |
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Natasha is bringing her infant, Joey, into the clinic for a 5-month visit. Which of the following newborn reflexes may still be present?
A. Stepping. B. Plantar grasp. C. Rooting. D. Tonic neck. |
D. Tonic neck.
Stepping reflex disappears at 6 to 8 weeks and the plantar grasp disappears at 4 months. The rooting reflex disappears between 3 and 4 months. The tonic neck disappears between 4 and 6 months. |
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The most common cause of sepsis in the neonate is:
A. Escherichia coli. B. Streptococcus pneumoniae. C. Herpes simplex virus. D. Group B streptococcal (GBS) infection. |
D. Group B streptococcal (GBS) infection.
GBS infection is the leading cause of sepsis in neonates with an incidence of 1 to 8 cases per 100 live births. |
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The most reliable assessment tool for physical and neurologic maturity of the preterm, seriously ill, or fragile neonate is the:
A. Dubowitz Scale. B. Denver II. C. Ballard Gestational Aging Scale. D. Brazelton Neonatal Behavioral Assessment Scale. |
C. Ballard Gestational Aging Scale.
The Dubowitz Scale is used to estimate gestational age. The Denver II is a screening tool evaluating fine motor and gross motor development, and social and language skills in healthy infants and children. The Ballard Gestational Aging Scale is used to assess the physical and neurologic maturity of the infant. The Brazelton Assessment Scale assesses neonatal behavior. |
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Chronic lung disease (CLD)/bronchopulmonary dysplasia (BPD) in premature infants is caused by:
A. Respiratory distress and impaired gas exchange. B. Oxygen toxicity and barotraumas from pressure ventilation. C. Viral infections after birth. D. Bacterial infections after birth. |
B. Oxygen toxicity and barotraumas from pressure ventilation.
Chronic lung disease (CLD)/bronchopulmonary dysplasia (BPD) is caused by oxygen toxicity and barotraumas. This condition is characterized by the development of respiratory distress and impaired gas exchange. Treatment for this condition is long-term supplemental oxygen therapy. |
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The most common cardiac lesion in the premature infant is:
A. Patent ductus arteriosus. B. Truncus. C. Transposition of great vessels. D. Aortic stenosis. |
A. Patent ductus arteriosus.
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The most common cause of apnea of prematurity is:
A. Idiopathic. B. Gastroesophageal reflux. C. Tracheal malacia. D. Hypoxia. |
A. Idiopathic.
About 23% of preterm infants are highly susceptible to RSV and bronchitis in the first year of life and have catastrophic outcomes if this occurs. |
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A newborn is diagnosed with retinopathy of prematurity (ROP). The pediatric nurse practitioner should know that:
A. No treatment is currently available. B. Cryotherapy and laser therapy are effective treatments for preventing retinal detachment. C. Long-term sequelae result from the amount of oxygen toxicity to the optic nerve. D. Vitamins C and D are critical to the treatment of ROP. |
B. Cryotherapy and laser therapy are effective treatments for preventing retinal detachment.
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Factors that lead to anemia in premature infants include which of the following?
A. Higher iron stores and lower erythropoietin production. B. Higher erythropoietin production and gastrointestinal bleeding. C. Frequent blood sampling and poor weight gain. D. Frequent blood sampling and lower iron stores. |
D. Frequent blood sampling and lower iron stores.
Compared to term infants, premature infants also have a lower erythropoietin production, but lower iron stores. A preterm infant with anemia may show signs of tachycardia, poor feeding, low weight gain, and apnea with bradycardia. |
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The primary goal for families and infants in premature infant follow-up programs is:
A. Regimented medical follow-up to prevent complications. B. Normalization of the family. C. Education and developmental follow-up in a controlled environment. D. Reinforcement of hospital discharge programs. |
B. Normalization of the family.
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Preterm infants are predisposed to more frequent respiratory infections. What signs and symptoms would alert the pediatric nurse practitioner that a preterm infant is developing RSV?
A. Wheezing, rhinorrhea, cough, low-grade fever. B. Stridor, drooling, high fever. C. Wheezing, tachycardia, high fever. D. Cough, rhinorrhea, intermittent fever. |
A. Wheezing, rhinorrhea, cough, low-grade fever.
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Which of the following is true regarding hearing assessments for preterm infants?
A. A repeat of the brainstem auditory-evoked response test is indicated every 6 months. B. Brainstem auditory-evoked response should be repeated at 3 to 4 months of age. C. Tympanometry is not indicated in the preterm infant. D. An audiology visit is indicated every 6 months. |
B. Brainstem auditory-evoked response should be repeated at 3 to 4 months of age.
Tympanometry and acoustic reflex should be tested at every visit with a preterm infant to determine presence of serous otitis and hearing loss. |
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Gastroesophageal reflux (GER) often presents in the preterm infant with which of the following symptoms?
A. Apnea, bradycardia, pneumonia, and worsening respiratory illness. B. Decreased apnea and tachycardia. C. Worsening respiratory illness and projectile vomiting. D. Apnea, bradycardia, and intermittent diarrhea. |
A. Apnea, bradycardia, pneumonia, and worsening respiratory illness.
GER most commonly presents with increased apnea, bradycardia, pneumonia, or worsening BPD/CLD. |
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The incidence of intraventricular hemorrhage (IVH) in very low birth weight infants is:
A. 30% to 50%. B. less than 10%. C. over 50%. D. 17% to 59%. |
A. 30% to 50%.
IVH in very low birth weight infants ranges from 30% to 50% with sequelae in 17% to 23%. |
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Long-term neurologic sequelae of IVH include:
A. Seizures, hydrocephalus, cerebral palsy, and developmental delays. B. Developmental delays, increased photosensitivity, and apnea. C. Seizures and cardiac defects. D. GER and seizures. |
A. Seizures, hydrocephalus, cerebral palsy, and developmental delays.
Neurologic sequelae includes seizures, hydrocephalus, cerebral palsy, and mental retardation, as well as developmental delays. |
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The most prevalent form of child maltreatment in severe cases requiring child protective services’ attention is:
A. Sexual abuse. B. Neglect. C. Physical abuse. D. Emotional abuse. |
B. Neglect.
Neglect is the prevailing issue in the majority of case reports as well as child maltreatment fatalities. |
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A landmark case which set precedent for terminating parental rights of child abusers was the case of:
A. Oliver Twist in 1839. B. David Copperfield in 1851. C. Estella Havisham in 1861. D. Mary Ellen McCormick in 1874. |
D. Mary Ellen McCormick in 1874.
Twist, Copperfield, and Havisham are all fictional characters created by Charles Dickens whose themes often included overcoming childhood hardships. Mary Ellen McCormick was a real child in New York. Her stepmother’s beatings came to the attention of outsiders who sought to rescue the girl from this maltreatment. |
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The strategy by which this legal precedent was set to protect abused children was:
A. Intervention by the Society for the Prevention of Cruelty to Animals on the basis that a child could be considered an animal. B. Assistance by the Red Cross who championed the causes of people victimized by tragedy. C. Support from the American Civil Liberties Union who argued that the child’s rights were being violated. D. A decree issued by the World Council of Churches who decried all child-rearing practices which demeaned the dignity of children and/or their parents. |
A. Intervention by the Society for the Prevention of Cruelty to Animals on the basis that a child could be considered an animal.
The New York SPCA advocated for Mary Ellen McCormick because no laws existed to protect children at that time. Even today, children have relatively few legal rights compared with those of adults. The other answers are distracters. |
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In 20th century America, literature on “Battered Child Syndrome” was published and mandatory reporting laws were created in all 50 states in the:
A. 1920s B. 1940s C. 1960s D. 1980s |
C. 1960s
It happened in the 1960s, with the 1961 publication of an article in the Journal of the American Medical Association. Between 1963 and 1968, all of the American states had enacted laws regarding mandatory reporting by health care providers. |
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In comparison to parents and caregivers who do not abuse or neglect children, those with the following traits are more likely to be perpetrators of abuse or neglect:
A. Older, experienced, nondrinking, churchgoing adults who have strict behavioral expectations. B. Younger, experienced, nondrinking adults with significant stressors. C. Older, inexperienced, substance-abusing adults with low-stress lifestyles. D. Younger, inexperienced adults with substance abuse problems and high stress. |
D. Younger, inexperienced adults with substance abuse problems and high stress.
Perpetration of child maltreatment is correlated with youth and/or inexperience of parents, substance abuse, stress, depression, intimate partner violence, and experience of victimization in childhood. |
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According to the United States Department of Health and Human Services (2003) report, in confirmed cases of child abuse, what type of abuse is most frequently reported?
A. Neglect B. Physical C. Sexual D. Emotional |
A. Neglect
The United States Department of Health and Human Services (2003) reported that 61% of the cases of confirmed child abuse cases were neglect; physical abuse accounted for 19%, sexual abuse was 10%, and emotional abuse was 5%. |
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Guidelines for Adolescent Preventive Services (GAPS) recommend yearly screenings for all adolescents to include:
A. Psychosocial screening, blood pressure, and body mass index. B. Blood pressure, hemoglobin, complete physical examination. C. Complete physical examination, psychosocial screening, drug testing. D. Psychosocial screening, cholesterol screening, blood pressure. |
A. Psychosocial screening, blood pressure, and body mass index.
Guidelines for Adolescent Preventive Services (GAPS) recommends a physical examination three times during adolescence, but recommends screening for height, weight, blood pressure, BMI, and psychosocial concerns yearly. Screening for anemia using hemoglobin or hematocrit is recommended twice during adolescence, and cholesterol screening for teens at particular risk. While screening for drug use via interview or questionnaire is part o yearly psychosocial screening, testing for drug abuse is not recommended as part of routine preventive services. |
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You have recently seen Susanna, who is 15 years old, in your clinic, and have sent a confidential screen for sexually transmitted infections (STI). She has declined to share this information with her parents, but they are now requesting a complete copy of her medical records. Which response BEST describes your legal responsibilities?
A. Federal regulations do not give her parents the right to access medical records related to sexual activity and STI testing. B. Federal regulations give her parents the right to access all of Susanna’s medical records and override all state regulations. C. Federal regulations give her parents the right to access all of Susanna’s medical records, but state regulations take precedence if they are more restrictive. D. Federal regulations give the individual health care provider discretion in releasing medical records related to confidential services. |
C. Federal regulations give her parents the right to access all of Susanna’s medical records, but state regulations take precedence if they are more restrictive.
All 50 states allow adolescents to access some confidential services, although these vary widely from state to state. Current federal regulations do give parents the right to access all of a minor’s medical records, but states that have more restrictive privacy laws can override this federal mandate, and some states do allow provider discretion in withholding sensitive information. In this volatile and sensitive legal area, pediatric nurse practitioner should be aware of current legal limits of confidentiality in their respective states. |
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Sandra Jones is a PNP employed by a school district to work in a high school. What regulations cover the privacy and confidentiality rules of her practice?
A. Local regulations specific to the school district. B. Local regulations and HIPAA. C. FERPA and local regulations. D. FERPA, with HIPAA regulation of any third-party billing. |
D. FERPA, with HIPAA regulation of any third-party billing.
Health records in a school district are covered by the Family Educational Rights and Privacy Act (FEERPA), which allow school officials broader discretion in sharing information than HIPAA, and allows parents access to school-based health records. HIPAA applies to billing third parties, as in a school-based health center. Local regulations affect policies regarding the extent of confidential services offered in the school, but not rules about privacy and disclosure. Pediatric nurse practitioners who are covered by both HIPAA and FERPA regulations should seek guidance as to their intersection. |
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For most adolescent girls, menarche occurs between Tanner Stages (SMR):
A. 1 and 2. B. 2 and 3. C. 3 and 4. D. 4 and 5. |
C. 3 and 4.
Menarche begins between Tanner Stages 3 and 4, when the girl has reached 85% of her adult height, and generally within 4 years of thelarche (development of breast buds, a marker for Tanner 2). In general, the epiphyses close 2 years after menarche (Tanner 5). |
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Marta, 16 years old, has come in for a well adolescent exam, and reports that she is applying for a job in a large department store that requires a urine drug screen of prospective employees. She drinks alcohol and smokes marijuana at parties, reportedly about twice a month. In counseling her about her drug use, which of the following is the most accurate statement?
A. Marijuana can be detected in urine drug screens up to 2 to 3 weeks after use. B. Alcohol use has a profound effect on memory and motivation, even with occasional use. C. Marijuana has a short half-life in the body, and withdrawal effects can be felt within 1 week. D. Alcohol use among high-school students is rare. |
A. Marijuana can be detected in urine drug screens up to 2 to 3 weeks after use.
Marijuana has a long half-life, and withdrawal effects from regular use are often not felt until 6 weeks after cessation. While alcohol has many harmful effects, it is marijuana that most profoundly affects memory and motivation. According to the Youth Risk Behavior Surveys, about 80% of high-school students report some alcohol use. |
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You are screening David, 14 years old, for sexual activity. Of the following statements, what is the BEST way to initiate this discussion with him?
A. Ask him if any of his friends or acquaintances are starting to have sex. B. Ask him what he knows about sex. C. Ask him if he has a girlfriend. D. Ask him if he thinks he might have been exposed to a sexually transmitted infection. |
A. Ask him if any of his friends or acquaintances are starting to have sex.
About 1/3 of 9th graders report having had intercourse on the Youth Risk Behavior Surveys, which do not ask about other types of sexual activity. For younger teens, it is often effective to ease into sensitive questions by asking about friends and acquaintances. Asking David about a girlfriend both presumes that he is heterosexual and that any sexual exploration is in the context of an intimate relationship, while up to 4.5% of older teen boys report same-sex activity and many teens report that sexual activity can be part of a casual encounter. Asking teens what they know about a sensitive issue can be a conversation-stopper, while asking about exposure to STIs is an indirect and probably unproductive way of asking about sexual activity to a younger teen that is either still thinking concretely or else convinced that he is immune to risk. |
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A 17-year-old who is in your office for a checkup refuses to get undressed for the exam. Of all the possible explanations for this behavior, which one might require you to make an official report the day of the visit?
A. The teen is embarrassed about being overweight. B. The teen has been sexually abused in the past. C. The teen has just gotten a tattoo without parental permission. D. The teen has extensive acne scarring on the back. |
B. The teen has been sexually abused in the past.
All 50 states require child abuse reports for sexual abuse while the adolescent is still a minor, even if the abuse occurred in the past. Unless the PNP has documentation that a report has already been made, a report would have to be filed after this visit. While the tattoo was probably not obtained legally and might put the teen at risk for blood-borne infections, it is not reportable in itself. Infections such as HIV or hepatitis B or C might require a Health Department report in the PNP’s state, but definitive testing results would not be available the day of the visit. |
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Which of the following statements about bullying is the most accurate?
A. Girls are more likely to be bullied by physical contact than boys. B. African American children are most likely to be bullied. C. About 10% of sixth to tenth graders bully others “sometimes”. D. Bullying is more likely in urban settings than in suburban or rural settings. |
C. About 10% of sixth to tenth graders bully others “sometimes”.
The Health Behavior of School-aged Children Survey estimates that 10.6% of 6th to 10th graders bully “sometimes”. Girls are more likely to be bullied verbally than boys, and African American children are least likely to be bullied. No differences were found among urban, suburban, or rural settings. |
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Mark, 11 years old, is in your office with his father for a pre-camp physical exam. Mark’s father notes that Mark is getting “fresh” at home, seems bored at school, and is unsupervised between 3:30 PM and 6:00 PM, when the father gets home from work. The father asks your advice about the best way to keep Mark from “getting into trouble, like some of the other kids in the neighborhood.” Of the following, the best advice would be to:
A. Encourage supervised afterschool activities that will help Mark build some skills and follow any interests he might have, such as sports or music. B. Allow Mark some increased independence as an early adolescent. C. Accept Mark’s attitude to school and some rude behavior at home as a normal part of adolescence. D. Take away all of Mark’s privileges if he associates with neighborhood youth who are in trouble. |
A. Encourage supervised afterschool activities that will help Mark build some skills and follow any interests he might have, such as sports or music.
Early adolescents do not have developed impulse control, nor do they have the future orientation that might help them avoid risky behavior. After-school hours are the times that adolescents are most likely to get into trouble. The best approach for a parent in the same situation as Mark’s father is to keep Mark busy and supervised, and to help Mark develop some interests that may protect him from risky behavior in the future. While some rudeness is normal for early adolescents, there is no reason for Mark’s father to lower his standards of acceptable behavior in the home. Staying away from teens that are engaging in risky behavior is an excellent idea, but it is most effectively accomplished by keeping Mark busy and supervised, rather than putting the onus on Mark (restrictions for failure to stay away). |
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Jason is 18 years old and about to graduate from high school. Which of the following statements about Jason is most likely to be true?
A. Jason has less impulse control than younger adolescents. B. Jason may lose his health insurance if he does not attend college full-time. C. Jason does not have adult confidentiality rights as long as he lives with his parents. D. Jason does not have comparable reasoning abilities to an older adult. |
B. Jason may lose his health insurance if he does not attend college full-time.
Both public and private health insurance policies are variable with respect to young adults, and Jason may be able to either keep his parents’ health insurance or obtain insurance through his school if he attends college full-time; otherwise he is at risk of losing insurance support. At 18, Jason does have full confidentiality rights, although this may be more of a challenge to implement in a pediatric practice where his parents and the staff are used to fuller information-sharing than in an adult or family practice. Late adolescents generally have better impulse control than earlier adolescents. Cognitive development is not complete until age 20, but the main difference between the decision-making of late adolescents and older adults if life experience, not inherent reasoning ability. |
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Cherisse, 15 years old, is seeing her PNP because of menstrual irregularities. In reviewing her chart, the PNP notices that Cherisse’s weight has fluctuated widely over the last 2 years. Of the following topics, which are the most important for the PNP to cover in evaluating for a possible eating disorder?
A. Satisfaction with weight, drug use, sexual activity. B. Depression and suicidal ideation, sexual orientation, 24-hour diet recall. C. Drug use, history of sexual abuse, usual after-school activities. D. Satisfaction with weight, feeling that she should be dieting, number of diets in the past year. |
D. Satisfaction with weight, feeling that she should be dieting, number of diets in the past year.
As the major risk factor for an eating disorder, questions about dieting are paramount. A complete psychosocial screen is part of any evaluation for eating disorders, but questions about drug use, sexual activity, sexual orientation, and even sexual abuse are not specific for eating disorders. An eating disorder should be part of the differential for an adolescent with menstrual irregularities and weight fluctuation. |
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Which statement about puberty is the most accurate?
A. Girls are more likely than boys to reach full skeletal maturity in high school. B. In general, boys begin puberty earlier than girls. C. The growth spurt for girls begins earlier and lasts longer than for boys. D. Boys do not gain muscle mass after they have finished their skeletal growth. |
A. Girls are more likely than boys to reach full skeletal maturity in high school.
Girls begin puberty earlier than boys and have their growth spurt at earlier stage in puberty, in general completing their growth within 2 years of menarche. Boys begin their growth later, have increased growth over a longer period of time, and may not have completed their skeletal growth until ages 18 to 20. Young men have increased levels of testosterone as their epiphyses close, which accounts for an increase in muscle mass after skeletal growth is complete. |
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The physiologic process which results in the initiation of puberty is the release of:
A. FSH by the adrenal gland. B. LH by the ovaries and androgen by the testes. C. TRH, which stimulates TSH and prolactin. D. Estrogen and androgen by the testes and ovaries. |
C. TRH, which stimulates TSH and prolactin.
At the beginning of puberty, TRH causes the release of TSH and prolactin which stimulate the onset of sexual development. The release of sex hormones is regulated by the anterior pituitary, including the release of FSH and LH. The anterior pituitary causes the release of these hormones. Estrogen and the androgens are released later in the process after stimulation by TSH and prolactin. |
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What events in puberty are related to the development of adolescent acne?
A. The release of FSH. B. The release of TSH. C. Skin thickening and oil secretion. D. The production of inhibin B. |
C. Skin thickening and oil secretion.
Skin thickening and oil secretion can result in skin pore plugging and overproduction of oil that is associated with acne. FSH stimulates sperm production. TSH initiates pubertal development but is not associated with acne. Inhibin B is produced in the testicles and is associated with sperm production. |
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A female adolescent has the following characteristics: Breast buds with slight enlargement of the breast but no separation. Sparse, long, slightly pigmented, curly pubic hair along the labia. At what Sexual Maturity Rating (SMR, Tanner Stage) of development is this adolescent?
A. Stage 0 B. Stage 2 C. Stage 4 D. Stage 1 |
B. Stage 2
There is no Stage 0. When the characteristics differ (i.e. breasts in this case are closer to Stage 3 and genital development is closer to Stage 2), the lower stage is reported. Stage 4 characteristics are not present. Stage 1 characteristics are prepubertal. |
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Which of the following statement is TRUE regarding sexual activity in 9th to 12th grade adolescent?
A. About 45% of 9th to 12th grade adolescents have had sexual intercourse with four or more partners. B. About 25% used a condom during the last sexual intercourse. C. About 25% reported they got pregnant or got someone else pregnant. D. About 45% of 9th to 12th grade adolescents have had sexual intercourse. |
D. About 45% of 9th to 12th grade adolescents have had sexual intercourse.
According to the 2001 Youth Risk Behavioral Survey, 45.6% of 9th to 12th grade teens had sexual intercourse. 58% used a condom during their last sexual intercourse. About 5% reported they got pregnant or got someone else pregnant. |
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Appropriate management of gynecomastia is:
A. Refer to endocrinology for a work-up. B. Give testosterone supplements for a year. C. Refer to a pediatric surgeon for excision of excess tissue. D. Reassure that this is a temporary condition and will resolve without treatment. |
D. Reassure that this is a temporary condition and will resolve without treatment.
Gynecomastia is not a condition requiring an endocrinology consult and giving testosterone is not an appropriate treatment. Surgery is not necessary. Ordinarily the condition resolves in a year or less, and appropriate reassurance is the best action. |
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Which hormone(s) cause the adolescent growth spurt in females?
A. Estrogen. B. Androgens and thyroxin. C. TSH and ACTH. D. Gonadotropic hormones. |
B. Androgens and thyroxin.
Androgens and thyroxin cause the growth spurt and development of secondary sexual characteristics. Estrogen does not cause the growth spurt. TSH and ACTH are involved in egg production. The gonadotropic hormones cause ovarian maturation and production of progesterone and estrogen. |
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What stage of sexual maturation is associated with the skeletal growth spurt in females?
A. Stage 1 B. Stages 2 to 3 C. Stage 5 D. Stages 4 to 5 |
B. Stages 2 to 3
There is not growth spurt in Stage 1 and growth is slowed or complete by Stages 4 to 5. |
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A 6 year old child with mild mental retardation and cerebral palsy comes to the clinic for a well-child exam. Axillary hair and stage 2 pubic hair are present. What would be appropriate management for this child?
A. Explain to the parents that she needs sex education and that the school needs to be informed. B. Prescribe a low-dose oral contraceptive. C. Refer to endocrinology as soon as possible. D. Prescribe monthly testosterone injections and monitor closely. |
C. Refer to endocrinology as soon as possible.
Secondary sexual characteristics occurring in a 6 year old child are not normal and a referral should be made. Precocious puberty occurs when pubic and axillary hair occurs before 7 or 8 years in girls and before 9 years in boys. |
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Selection of a method of birth control should be made by:
A. The health care provider based on his/her experience. B. The parent of the adolescent since his/her insurance will pay for it. C. The adolescent, who is the patient. D. Jointly by the parent and child if possible. |
D. Jointly by the parent and child if possible.
The health care provider can offer advice but should not decide for the patient. Parental involvement is helpful but the parent shouldn’t make the final decision. The adolescent certainly should express his or her opinion and make the final decision in case of a conflict. But parental input would be helpful. The preferred method is a joint decision between parent and child. |
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Depo Provera is often preferred by providers and teens because:
A. It is easier to remember so pregnancy is less likely. B. It doesn’t cause weight gain. C. Periods are more regular. D. Risk of STDs is decreased. |
A. It is easier to remember so pregnancy is less likely.
The convenience of Depo Provera is a big advantage with teens. It is just as likely to cause weight gain as other methods. Amenorrhea is usual after a few months. STDs are not prevented by using Depo Provera. |
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An important part of family planning visits for sexually active teens is:
A. Ordering a pregnancy test prior to prescribing contraceptives. B. Suggesting that she try abstinence prior to prescribing contraceptives. C. Informing the parents about the teen’s decision. D. Explaining that as long as a pill is taken pregnancy is unlikely. |
A. Ordering a pregnancy test prior to prescribing contraceptives.
Ordering a pregnancy test is prudent for a sexually active teen. A Pap smear and cultures are also indicated at an initial visit. Suggesting abstinence may be counterproductive and result in pregnancy in the sexually active adolescent. Notifying parents is not appropriate unless the state law requires such action. It is likely to destroy rapport and trust in the teen. It is important for oral contraceptives to be taken at about the same time of day to avoid pregnancy. |
