NURS 6541 final Exam may 2020

NURS 6541 final may 2020 Question 1 1 out of 1 points A small-for-gestational-age, dysmorphic newborn infant has microcephaly and sloping forehead, cutis aplasia (missing portion of the skin and hair) of the scalp, p ...

NURS 6541 final may 2020 Question 1 1 out of 1 points A small-for-gestational-age, dysmorphic newborn infant has microcephaly and sloping forehead, cutis aplasia (missing portion of the skin and hair) of the scalp, polydactyly, microphthalmia, and omphalocele. Which of these is the most likely diagnosis? Selected Answer: a. Patau syndrome (trisomy 13) • Question 2 • 1 out of 1 points A 16-year-old girl has enuresis, frequent urination, a white vaginal discharge, and a dark rash around her neck. Her serum glucose level is 250 mg/dL, and her urinalysis is positive for 2+ glucose but is otherwise negative. Which of the following is the most likely diagnosis? Selected Answer: c. Type II diabetes • Question 3 • 1 out of 1 points Mark, age 15, is 5 feet tall andn weighs 85 pounds. You suspect anorexia and know that the best initial approach is to Selected Answer: d. Confront Mark with the fact that you suspect an eating disorder. • Question 4 • 1 out of 1 points Which of the following is not a sign or symptom of congenital hypothyroidism? Selected Answer: d. Frequent stooling • Question 5 • 0 out of 1 points While doing a 5-year-old well child exam, you notice two small patches of hair loss. Broken hair is present, as is erythema and scaling. On the basis of this information, which of these is the likely diagnosis? Selected Answer: c. Alopecia areata • Question 6 • 1 out of 1 points Hope is a 7-month-old who presents in January with a 1-day history of cough, yellow nasal discharge,and low-grade temp (T max 100°F). She was previously healthy. She does have 2+ edema of the nasal turbinates and cloudy rhinorrhea. She is afebrile in the office. Her chest, mouth, and ears are clear. You prescribe: Selected Answer: d. Saline drops, bulb suction, humidified air, and increased PO fluids • Question 7 • 1 out of 1 points The parents of an 8-year-old Down Syndrome boy arrive for his annual well-child visit. He wants to participate in sports, including the Special Olympics. Until further examination can be completed, which of the following sports would you suggest as being safe? Selected Answer: a. Tennis • Question 8 • 1 out of 1 points Jason, age 14, appears with tender discoid breast tissue enlargement (2-3 cm in diameter) beneath the areola. Your next action would be to Selected Answer: a. Perform watchful waiting for 1 year. • Question 9 • 1 out of 1 points You see a 7-year-old boy a day after he was bitten by his pet dog. According to the mother, the dog bit the child after he snuck up on the dog and grabbed his tail. The dog has had all its vaccinations, including rabies. The child has had no fever, has full movement of the injured limb, and has no sign of neurologic or vascular injury. The wound is on the child’s forearm, is not deep, and is not bleeding, but has developed about 2 cm of erythema surrounding the site. Which of the following is the most appropriate treatment? Selected Answer: c. Oral amoxicillin-clavulanate for 7-14 days • Question 10 • 1 out of 1 points A head injury in which bruising or tearing of the cerebral structures occurs is a Selected Answer: d. Contusion • Question 11 • 1 out of 1 pointsA 14-year-old has a 3-week history of fever, anorexia, and abdominal pain. What additional symptom would cause the NP to suspect Crohn's disease? Selected Answer: b. Blood, mucous diarrhea • Question 12 • 1 out of 1 points Which of the following should be done annually after 1 year of age in a child with Down syndrome? Selected Answer: a. Thyroid screenings • Question 13 • 1 out of 1 points A previously healthy male has a 3-month history of increasing headaches, blurred vision, and personality changes. Previously he admitted to marijuana experimentation more than 1 year ago. On examination he is a healthy, athletic-appearing 17-year-old with decreased extraocular range of motion and left eye visual acuity. Which of the following is the best next step in his management? Selected Answer: c. Neuroimaging • Question 14 • 1 out of 1 points Kelly, your 11-year-old well visit patient, presents to the office with weight loss, polyuria, and polydipsia. Which of the following do you need to rule out? Selected Answer: d. Diabetes mellitus • Question 15 • 1 out of 1 points A 3-week old presents to the office in January with a 1-week history of nasal congestion and occastional cough. On the night prior to the visit in infant developed a fever 102ºF rectally, was difficult to breastfeed, and had paroxysmal coughing and noisy, labored breathing. On exam, you note an ill-appearing infant who is lethergic with wheezing, tachypnea, and intercostal retractions. The infant is home with the mom at this time; however, has a sibling who is 4-years-old and is in daycare and recently had cold symptoms. If the patient has been diagnosed with RSV bronchiolitis, which of the following would be the treatment of choice? Selected Answer: a. Fluids and nutritional support and close monitoring • Question 16 • 1 out of 1 points Chest pain in young children is usuallySelected Answer: a. Noncardiac in origin • Question 17 • 1 out of 1 points Maddie, age 2, had a complete blood count (CBC) drawn at her last visit. It indicates that she has a microcytic hypochromic anemia. What should you do now at this visit? Selected Answer: a. Obtain a lead level. • Question 18 • 1 out of 1 points Most children with Duchenne muscular dystrophy become wheelchair dependent by what age? Selected Answer: b. 4 to 6 years of age • Question 19 • 1 out of 1 points The following clinical description best matches which genetic disorder? A tall, thin 14-year-old boy has no signs of puberty. He was delayed in his speech development and always has done less well in school than his siblings. He is shy, and teachers report his activity is immature. Physical examination reveals breast development, and long limbs with a decreased upper segment/lower segment ration. He has small testes and phallus. Selected Answer: e. Klinefelter syndrome (XXY) • Question 20 • 1 out of 1 points Of the following patients, which child should not receive a tuberculin skin test? Selected Answer: d. A 2-year-old who was infected with RSV 2 months ago and is currently asymptomatic. • Question 21 • 1 out of 1 points A 10-year-old male presents with a fever of 102ºF and complaints of leg pains. His mother reports that he had an upper respiratory infecion with a sore throat about 2 weeks ago. No treatment was needed. On examination, he has tender and swollen knees bilaterally. His heart rate is 125 bpm and a blowing systolic murmur is heard at the apex. No murmur was noted at in the chart. The mostly diagnosis is:Selected Answer: a. Rheumatic fever • Question 22 • 1 out of 1 points When a neonate is initially protected against measles, mumps, and rubella because the mother is immune, this is an example of which type of immunity? Selected Answer: b. Natural passive • Question 23 • 1 out of 1 points Sarah, age 13, is markedly obese and has a poor self-image. How do you differentiate between compulsive eating and bulemia? Selected Answer: a. A compulsive eater does not induce vomiting. • Question 24 • 1 out of 1 points Seborrhea dermatitis is common for both infants and adolescents. Which is not correct for this condition? Selected Answer: b. The condition in adolescents is known as acne with comedones and popular and pustular lesions. • Question 25 • 1 out of 1 points Which chromosomal abnormality is associated with short stature in girls? Selected Answer: b. Turner syndrome • Question 26 • 1 out of 1 points You see a patient you believe has folliculitis. What medication would be the best to treat this patient? The patient has no allergies. Selected Answer: c. Dicloxacillin • Question 27 • 1 out of 1 points Antibiotic therapy is one of the mainstays of treatment for which of the following causes of wheezing?Selected Answer: b. Epiglottitis • Question 28 • 1 out of 1 points Which of the following symptoms are most suggestive of pneumonia in a young child? Selected Answer: a. Fever, tachypnea, coryza, cough, scattered rales • Question 29 • 1 out of 1 points An 11-year-old has been diagnosed with mild intermittent asthma. Which of the following is not a routine part of the clinical management? Selected Answer: a. School excuse to not participate in recess and/or physical education activities • Question 30 • 0 out of 1 points Generalized absence seizures usually occur in which age group? Selected Answer: a. Middle-aged adults • Question 31 • 1 out of 1 points Which test is routinely recommended for a preparticipation sports physical? Selected Answer: c. A Snellen test • Question 32 • 0 out of 1 points A healthy, thriving 4-year-old male has had sudden episodes of drawing his knees to his chest and crying like he is in acute pain for the last 5 hours. These episodes are separated by quiet times when he appears normal and comfortable. He is not vomiting and has not had a bowel movement today. What is the most likely diagnosis. Selected Answer: d. Hirschprung disease • Question 33 • 1 out of 1 pointsA 15-day-old infant has respiratory distress. A quick observation suggests she has slight cyanosis, hepatosplenomegaly, and features consistent with Down Syndrome. The cardiac examination demonstrates a loud first heart sound, a low-pitched, mid-diastolic murmur at the lower left sternal border, and a harsh apical holosystolic murmur in the mitral area. Which of the following cardiac conditions most likely explains her heart findings? Selected Answer: b. Complete atrioventricular canal (endocardial cushion defect) • Question 34 • 0 out of 1 points An ex-preemie with bronchopulmonary dysplasia has been discharged to home from the NICU. One potential problem area that requires close monitoring is Selected Answer: a. Temperature control. • Question 35 • 1 out of 1 points A 16-year-old presents with pharyngitis, cough, and high fever. Her chest x-ray reveals bilateral pulmonary infiltrates. Her white blood cell count is normal and the neutrophil count is normal. The most likely etiology is Selected Answer: b. Chlamydia pneumonia • Question 36 • 1 out of 1 points Which of the following vaccines provides protection against a common type of sepsis/meningitis? Selected Answer: b. Haemophius influenzae vaccine • Question 37 • 1 out of 1 points A mother brings a 2-year-old to your office with the complaint that she passes 5 to 10 watery stools per day that often contain undigested food. The child appears healthy and has no other GI symptoms. She is acting, eating, and voiding normally. Weight gain is normal and the mother states she often drinks (her favorite drink is Kool-Aid) instead of eating. The best management for this condition is: Selected Answer: c. Counsel to decrease fluid intake, increase dietary fiber, and increase fats to 40% of calories. • Question 38 • 1 out of 1 points Six months after being diagnosed with what appears to be insulin-dependent diabetes, the 5-year-old in the case presentation has a significant decrease in his insulin requirement. Which of the following is the most likely explanation?Selected Answer: b. He has entered the "honeymoon phase" of his diabetes. • Question 39 • 1 out of 1 points Grace, age 15, has been diagnosed with acne. Which of the following is not true with this condition? Selected Answer: a. Poor hygiene is the primary cause of acne. • Question 40 • 1 out of 1 points All of the following is treatment for a child with phimosis except Selected Answer: a. Ice packs • Question 41 • 1 out of 1 points Primary dysmenorrhea is due to Selected Answer: b. Elevated prostaglandin level • Question 42 • 1 out of 1 points Children in child care facilities are at greater risk of being exposed to which of the following infections? Selected Answer: d. HAV • Question 43 • 1 out of 1 points A 14-month-old child has lower extremity bowing, a waddling gait, genu varum, and is at the 5th percentile for height. Laboratory data include low-normal serum calcium, moderately low serum phosphate, and elevated serum alkaline phosphatase levels, hyperphosphaturia, and normal parathyroid levels. Which of the following is the most likely diagnosis? Selected Answer: a. Genetic primary hypophosphatemia • Question 44 • 1 out of 1 pointsA child has developed her second perirectal abscess in 6 months. She should be evaluated for which of the following conditions? Selected Answer: d. Crohn's disease • Question 45 • 1 out of 1 points The classic radiographic finding of croup is Selected Answer: b. Steeple sign • Question 46 • 1 out of 1 points What is the primary treatment for testicular torsion? Selected Answer: a. Immediate surgical referral • Question 47 • 1 out of 1 points You see a 7-year-old with a positive stool culture for Salmonella enteriditis. The appropriate therapy for a non-dehydrated child is Selected Answer: d. Bland diet with focus on maintaining hydration • Question 48 • 1 out of 1 points Riley, a 12-year-old girl, has scaly, hyperpigmented lesions in a "Christmas tree" distribution. It is predominantly on her trunk. One lesion is on her buttock that is larger than the other, at about 4 cm in diameter. What is your diagnosis? Selected Answer: a. Pityriasis rosea • Question 49 • 1 out of 1 points You are on call and receive a phone call from the parents of a 13-year-old known asthmatic. She has been having chest tightness and a worsening cough for 48 hours. She has significant nasal discharge that began 14 days ago and intermittent complaint of headache. She is now running a low-grade fever. Her peak flow the last 48 hours is 70–80% of personal best. Her temperature right now is 101.7°F. She is on salmeterol with corticosteroid (Advair) and PRN albuterol. Which of the following is most appropriate? Selected Answer: d. See her in the office in the morning and prescribe a 14-day course of amoxicillin plus the addition of a short course of oral steroids.• Question 50 • 1 out of 1 points Which of the following therapeutic options is common for the treatment of both bee stings and bite wounds? Selected Answer: b. Tetanus vaccination • Question 51 • 1 out of 1 points A common presenting symptom of inflammatory bowel disease is Selected Answer: d. Unexplained fever • Question 52 • 1 out of 1 points Newborn R.T. has a vascular lesion that will not fade as she gets older. What is your diagnosis? Selected Answer: a. Port-wine stain (nervus flammeus) • Question 53 • 0 out of 1 points Ana is a 14-year-old female and has not yet started her menstrual cycle. The history is noncontributory and the physical is normal. Mom started her menstrual cycle at 14-years of age. Ana's breast development and pubic hair began about a year ago. Mom is very concerned. The most appropriate initial step would be to Selected Answer: a. Do a pregnancy test • Question 54 • 1 out of 1 points The diet of a 3-year-old with cystic fibrosis should be supplemented with which of the following? Selected Answer: e. Vitamin D • Question 55 • 1 out of 1 points Which of the following objective data are associated with significantly better long-term outcomes in children born with open spina bifida? Selected Answer: c. Perineal sensation• Question 56 • 1 out of 1 points Individuals with chronic adrenal insufficiency often have Selected Answer: b. A craving for salt • Question 57 • 1 out of 1 points A healthy 8-month-old infant presents with diarrhea but no dehydration. What is the best advice to give to the parents? Selected Answer: b. Give bananas, cereal, vegetables, and full-strength formula as tolerated. • Question 58 • 1 out of 1 points An essential test in the evaluation of a 2-year-old being managed for Kawasaki disease is Selected Answer: b. an echocardiogram • Question 59 • 1 out of 1 points In mild to moderate attacks of acute asthma, Albuterol should be given every 4-6 hours prn and routine medication should be Selected Answer: c. Continued as usual • Question 60 • 1 out of 1 points Which fo the following foods would be most appropriate for a child with celiac disease? Selected Answer: a. Rice with butter • Question 61 • 1 out of 1 points John is 4 years old and in today for a well child visit. He is due for his 4-year-old immunizations. He was recently diagnosed with ALL and is being treated with chemotherapy and radiation. Which statement is true about immunizations during treatments during childhood cancer? Selected Answer: d. Immunizations are not given during active chemotherapy.• Question 62 • 1 out of 1 points The most useful test for evaluation of suspected acute rheumatic fever is Selected Answer: c. Antistreptolysin-O (ASO) titer • Question 63 • 1 out of 1 points A 15-year-old girl has a 1-month history of urinary frequency without dysuria and recent onset of an itchy rash beneath both breasts. She has been gaining weight over the past year and regularly complains of fatigue. She is afebrile, with a weight greater than the 99th percentile and has an erythematous, macular rash beneath both breasts characterized by satellite lesions. Urinalysis is significant for 2+ glucosuria but no pyuria. Which of the following is the most likely diagnosis? Selected Answer: a. Diabetes mellitus • Question 64 • 1 out of 1 points Tommy has bloody diarrhea. His family eats fast-food four to five times each week. Which organism may have caused the diarrhea? Selected Answer: a. E. Coli • Question 65 • 1 out of 1 points A 6-year-old male is brought in for evaluation of a painful hip. He has been limping and not wanting to walk for the past 2 days. He has no obvious injury. He feels a little better if he is given ibuprofen. He has not had a fever and does not have any other current symptoms, although he had "the flu" last week. On examination, his vital signs are normal. His right hip has some pain with internal rotation. He walks with a pronounced limp. Which of the following statements is most accurate? Selected Answer: a. He should have a complete blood count (CBC) and ESR. • Question 66 • 1 out of 1 points Which of the following conditions is most responsible for developmental delays in children? Selected Answer: c. Fetal Alcohol Syndrome • Question 67• 1 out of 1 points Which of the following is not a feature of DiGeorge syndrome? Selected Answer: c. Frontal bossing • Question 68 • 1 out of 1 points The peak incidence for adolescent gynecomastia occurs at age Selected Answer: a. 13 to 14 years of age • Question 69 • 1 out of 1 points The most common trigger for an acute asthma episode in the very young child is Selected Answer: d. Respiratory infections • Question 70 • 1 out of 1 points The following clinical description best matches which genetic disorder? A 15-year-old girl with primary amenorrhea is noted to be well below the 5th percentile for height. She has hypertension, a low posterior hairline, prominent and low-set ears, and excessive nuchal skin. Selected Answer: e. Turner syndrome (XO) • Question 71 • 1 out of 1 points Kawasaki disease is most common in Selected Answer: c. Children younger than 5 years of age • Question 72 • 1 out of 1 points What does a low level of thyroid stimulating hormone (TSH) indicate? Selected Answer: a. Hyperthyroidism • Question 73• 1 out of 1 points John, age 12, injured his spinal cord by diving into a shallow lake. He is in a wheelchair but can self-transfer. He can use his shoulder and extend his wrist, but has no finger control. At what level of the spinal cord was the damage? Selected Answer: a. C6 • Question 74 • 1 out of 1 points Drew is a 6-month-old with newly diagnosed sickle cell disease. His mother brings him to the office for a well-baby visit. Which of the following should you do on this visit? Selected Answer: a. Immunize Drew with diphtheria, tetanus, and pertussis: Haemophilus influenzae type B (HIB), hepatitis B (HBV), and polio vaccines. • Question 75 • 1 out of 1 points The most common central nervous system side effect of mumps in children is Selected Answer: c. Ataxia • Question 76 • 1 out of 1 points Whitney is a 2-year-old female with dysuria. She has a fever of 102.4 and is nontoxic. She has no prior history of UTI. Urine dipstick reveals 1+ leukocyte esterase, 2+ nitrates, 1+ non-hemolyzed blood, pH of 6.0, and specific gravity 1.025. Her vulvovaginal area is slightly red with no discharge. Which of the following treatments is recommended. Selected Answer: a. Start sulfamethoxazole/trimethoprim (Bactrim) for 10 days and send culture and sensitivity • Question 77 • 1 out of 1 points One of the most appropriate agents used to treat influenza A is Selected Answer: d. Oseltamivir • Question 78 • 1 out of 1 points Robert, your 15-year-old male patient, is here today for a well visit. He is tall in stature and has increased arm span, laxity of joints, pectus excavatum, and an abnormal echocardiogram. Which of the following diagnosis would you suspect Robert as having? Selected Answer: b.Marfan syndrome • Question 79 • 0 out of 1 points A 7-week-old male with three episodes of severe abdominal pain and vomiting in the last month, previously diagnosed with failure to thrive. Which of the following is the most likely etiology? Selected Answer: b. Volvulus • Question 80 • 1 out of 1 points Which of the following is a characteristic physical sign of fragile X syndrome in adolescent males? Selected Answer: c. Macro-orchidism • Question 81 • 0 out of 1 points A small-for-gestational-age infant is born to a 35-year-old woman. He has low-set and malformed ears, microcephaly, rockerbottom feet, inguinal hernias, cleft lip/palate, and micrognathia. Chromosomal analysis is likely to reveal which of the following? Selected Answer: d. Patau syndrome (trisomy 13) • Question 82 • 0 out of 1 points Sam is a healthy 17-year-old student. He is thinking about having sex and asks for more information about condoms. You give him all of the following information except Selected Answer: a. It is only safe to use water-based lubricant with latex condoms. • Question 83 • 1 out of 1 points During the 2-year-old well-child visit, the child's mother shows you a picture from the birthday party. You notice only one eye has a red reflex on the picture. When you do the exam, in the right eye, you notice leukocoria. What is your diagnosis? Selected Answer: c. Retinoblastoma • Question 84 • 0 out of 1 pointsWhich of the following is true regarding the diagnosis of epiglottitis? Selected Answer: d. Diagnosis is decreasing in incidence. • Question 85 • 1 out of 1 points Dave, age 17, has gynecomastia. You should also assess him for Selected Answer: b. Testicular cancer • Question 86 • 0 out of 1 points In children who have not received antibiotics in the past month, which antibiotic is recommended by the Centers for Disease Control and Prevention for the management of acute bacterial respiratory infection? Selected Answer: d. Amoxicillin plus clavulanic acid (Augmentin) • Question 87 • 1 out of 1 points A 6-week-old boy, born by vaginal delivery after an uncomplicated term gestation, has experienced cough and “fast breathing” for 2 days. His mother relates that he has a 1-week history of nasal congestion and watery eye discharge, but no fever or change in appetite. He has a temperature of 99.4°F and a respiratory rate of 44 breaths/min. He has nasal congestion, clear rhinorrhea, erythematous conjunctivae bilaterally, and watery, right eye discharge. His lungs demonstrate scattered crackles without wheezes. Which of the following is the most likely pathogen? Selected Answer: a. Chlamydia trachomatis • Question 88 • 1 out of 1 points Screening infants for anemia should occur at what age? Selected Answer: a. 9 months • Question 89 • 0 out of 1 points Tracy, the mother of a 2-year-old, is concerned because her daughter walks on her toes all the time. What do you tell her? Selected Answer: a.Don't worry, she will outgrow it. • Question 90 • 1 out of 1 points Pinworms can cause which of the following? Selected Answer: b. Anal itching • Question 91 • 1 out of 1 points Which of the following is important to determine in the recent history of a child with suspected Clostridium difficile infection? Selected Answer: d. Antibiotic use • Question 92 • 1 out of 1 points The following clinical description best matches which genetic disorder? An institutionalized male juvenile delinquent upon close examination has severe nodulocystic acne, mild pectus excavatum, large teeth, prominent glabella, and relatively long face and fingers. His family says he has poor fine motor skills (such as penmanship), an explosive temper, and a low-normal IQ. Selected Answer: d. XYY male • Question 93 • 0 out of 1 points You are seeing a patient you think may have IBD. Which of the following tests would not be helpful? Selected Answer: c. Serum total protein and albumin • Question 94 • 1 out of 1 points What does shift to the left mean in a white blood count? Selected Answer: c. A rise in neutrophils • Question 95 • 1 out of 1 points A 6-year-old boy is left alone for 10 hours, now with hematemesis and pneumomediastinum on chest x-ray. Which of thefollowing is the most likely etiology? Selected Answer: a. Esophageal foreign body • Question 96 • 1 out of 1 points During a track and field meet, a 16-year-old male pole-vaulter falls to the ground screaming in pain. He complains of intense pain in his right scrotum. He vomits twice while waiting for the ambulance. He most likely has Selected Answer: d. Testicular torsion • Question 97 • 1 out of 1 points A 12-year-old girl was brought to the emergency department because of severe sore throat, muffled voice, drooling, and fatigue. She had been sick for the past 3 days and is unable to eat because of painful swallowing. The parents deny any history of recurrent pharyngitis. The patient still managed to open her mouth and you were able to see an abscess at the upper pole of the right tonsil with deviation of the uvula toward the midline. Examination of the neck reveals enlarged and tender lymph nodes. Which of the following is the most appropriate management? Selected Answer: d. Incision and drainage of the abscess • Question 98 • 1 out of 1 points Prophylactic penicillin should be started in children with sickle cell anemia by Selected Answer: d. 2 to 3 months of age • Question 99 • 1 out of 1 points An 18-month-old African American girl is brought to your office because she has been crying and stopped walking today. She will crawl, however. Her mom denies any injury to the child. On examination, she is crying but consolable in her mother’s arms. She has bruising and swelling just proximal to the left ankle. An x-ray reveals a spiral fracture of the tibia. At this time, you advise the mother that: Selected Answer: c. This is a common fracture resulting from twisting on a planted foot. • Question 100 • 1 out of 1 pointsMrs. Bay is upset. She is convinced something is seriously wrong with her son. He is a 2-month-old and frequently vomits after feeding. Which of the following is most suggestive of GERD (gastroesophageal reflux disease)? Selected Answer: a. He drinks 7 to 8 ounces every 3 hours. • Question 101 • 0 out of 0 points When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity? Selected Answer: Yes Friday, May 8, 2020 12:41:41 AM EDT