NURS 6541 FINAL EXAM Primary Care & Child Exam bank

NURS 6541 FINAL EXAM Primary Care Adolescent & Child.  Question 1 0 out of 0 points When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integri ...

NURS 6541 FINAL EXAM Primary Care Adolescent & Child.  Question 1 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  Question 2 1 out of 1 points Antibiotic therapy is one of the mainstays of treatment for which of the following causes of wheezing? Selected Answer: c. Epiglottitis  Question 3 1 out of 1 points Dave, age 17, has gynecomastia. You should also assess him for Selected Answer: c. Testicular cancer  Question 4 1 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, rocker-bottom feet, inguinal hernias, cleft lip/palate, and micrognathia. Chromosomal analysis is likely to reveal which of the following? Selected Answer: e.Edwards syndrome (trisomy 18)  Question 5 1 out of 1 points Primary dysmenorrhea is due to Selected Answer: a. Elevated prostaglandin level  Question 6 1 out of 1 points A 3-week-old male infant with 2 days of projectile, nonbilious vomiting and constant feeding. Which of the following is the most likely etiology? Selected Answer: f. Pyloric stenosis  Question 7 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 8 0 out of 1 points Which of the following is a measure of childhood intelligence? Selected Answer: a. Bayley scales Question 9 1 out of 1 points An 8-month-old baby arrives to the office with his mother with a complaint of decreased left arm movement. He is a product of a normal term pregnancy, has had no medical problems, and was in good health when his mother dropped him off at the daycare center. Upper arm radiographs show a left humerus spiral fracture. Which of the following is the most appropriate next step in management? Selected Answer: b. Send the child to the hospital for admission and call child protective services.  Question 10 1 out of 1 points A 4-year-old female with profuse vomiting, sweating, lacrimation, and diarrhea, who seizes in the emergency room. Which of the following is the most likely etiology? Selected Answer: f. Insecticide ingestion  Question 11 1 out of 1 points A 9-year-old is diagnosed with dyspepsia without hematemesis, melena, or occult blood. The most appropriate next step is Selected Answer: d. Trial of ranitidine (Zantac)  Question 12 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: d.Tetanus vaccination  Question 13 1 out of 1 points You are examining Beth, age 9 months, and note a palpable right supraclavicular node. You know that this finding is suspicious for Selected Answer: d. Lymphoma of the mediastinum  Question 14 1 out of 1 points When examining a child with abdominal pain, what symptom would lead to a likely organic etiology? Selected Answer: c. Night waking  Question 15 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: b. Perineal sensation  Question 16 1 out of 1 points A 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 17 1 out of 1 points A 3-year-old presents with macrocephaly, developmental delay, coarse facial features, large tounge, kyphosis, hip dislocation, tonsillar and adenoidal hypertrophy, and hepatomegaly. She is receiving early intervention services without improvement. What is the best next step? Selected Answer: a. Refer to genetics for further evaluations  Question 18 1 out of 1 points Ben has been diagnosed with folliculitis, an inflammatory condition involving the pilosebaceous follicle. What is the most common cause of this condition? Selected Answer: d. Staphylococcus aureus  Question 19 1 out of 1 points Which of the following is not true of insect stings from bees, wasps, and fire ants? Selected Answer: b. Greater reaction of hypersensitivity occurs most often with the initial exposure than with subsequent exposures.  Question 20 1 out of 1 points Unilateral wheezing is a finding suggestive ofSelected Answer: c. Foreign body aspiration  Question 21 1 out of 1 points A 16-year-old is brought in as a walk-in by his parents. His parents state that he acutely developed a fever, chills and rash. He has been confused and not answering their questions. On examination he is toxically ill appearing, and is febrile, tachycardia and hypotensive. He is noted to have a diffuse petechial rash. What is the most likely diagnosis? Selected Answer: d. Meningococcemia  Question 22 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: c. Incision and drainage of the abscess  Question 23 1 out of 1 points A 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, middiastolic 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: c. Complete atrioventricular canal (endocardial cushion defect)  Question 24 1 out of 1 points The organism that causes hand, foot, mouth syndrome is what virus? Selected Answer: d. Coxsackie  Question 25 1 out of 1 points Your patient has inflammatory bowel disease. Which of the following finding is most consistent with ulcerative colitis? Selected Answer: a. Left-sided abdominal pain  Question 26 1 out of 1 points Jesse, age 5, has a diagnosis of encopresis. After the diagnosis, what would be your next action? Selected Answer: b. Rule out a neurologic disorder.  Question 27 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: e. Tennis  Question 28 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: a. He has entered the "honeymoon phase" of his diabetes.  Question 29 1 out of 1 points The classic radiographic finding of croup is Selected Answer: d. Steeple sign  Question 30 1 out of 1 points A common cause of in-toeing in childhood is Selected Answer: a. Internal tibial torsion  Question 31 1 out of 1 points Mrs. 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: d. He drinks 7 to 8 ounces every 3 hours.  Question 32 0 out of 1 points Which of the following is true regarding the diagnosis of epiglottitis? Selected Answer: a. Every effort should be made to visualize the epiglottitis in the office and confirm the diagnosis  Question 33 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 34 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: b. Saline drops, bulb suction, humidified air, and increased PO fluids  Question 35 1 out of 1 points An ex-preemie with bronchopulmonary dysplasia has been discharged to home from theNICU. One potential problem area that requires close monitoring is Selected Answer: d. Insufficient caloric intake.  Question 36 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 37 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: c. Genetic primary hypophosphatemia  Question 38 0 out of 1 points Lisa has Cushing's syndrome. You would suspect her to have or to develop Selected Answer: b. Generalized increased pigmentations of the skin  Question 39 1 out of 1 points You have a patient that you think may have intussusception. Which of the following findingmay you see? Selected Answer: b. Inconsolable screaming  Question 40 1 out of 1 points An 11-month-old male with intermittent bouts of crying and nonbilious vomiting, has a history of Meckel diverticulum. A small elongated mass is felt on the right side of his abdomen. Which of the following is the most likely etiology? Selected Answer: e. Intussusception  Question 41 1 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: d. Toe walking is considered normal until age 3.  Question 42 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: b. Confront Mark with the fact that you suspect an eating disorder.  Question 43 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: c. Klinefelter syndrome (XXY)  Question 44 1 out of 1 points Which test is routinely recommended for a preparticipation sports physical? Selected Answer: d. A Snellen test  Question 45 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 46 1 out of 1 points Which of the following statements is not true with slipped capital femoral epiphysis? Selected Answer: b. It is thought to be caused by repetitive stresses in young athletes prior to growth spurts.  Question 47 1 out of 1 pointsFifth disease is usually Selected Answer: d. Seen in children ages 5 to 14 years of age  Question 48 1 out of 1 points A head injury in which bruising or tearing of the cerebral structures occurs is a Selected Answer: b. Contusion  Question 49 1 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: b. Latex condoms are the most recommended and are heat tolerant.  Question 50 1 out of 1 points A 15-year-old girl has experienced abdominal pain, vomiting, and lethargy for 3 days. Her chest and throat examinations are clear, but her abdominal examination is significant for right lower quadrant pain. Rectal examination is equivocal for pain, and her pelvic examination is remarkable for pain upon movement of her cervix. Laboratory data include elevated white blood cell count, serum glucose level of 145 mg/dL, and serum bicarbonate level of 21mEq/dL. Her urinalysis is remarkable for 1+ white blood cells, 1+ glucose, and 1+ ketones. Which of the following is the most likely diagnosis? Selected Answer: b. Pelvic inflammatory disease (PID)  Question 511 out of 1 points A common presenting symptom of inflammatory bowel disease is Selected Answer: c. Unexplained fever  Question 52 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: b. E. Coli  Question 53 1 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: b. Tinea corporis  Question 54 1 out of 1 points A 14-year-old girl from another state was followed for 7 years for a history of insulindependent diabetes mellitus. Her hemoglobin A1C is 14.9%. This laboratory test indicates which of the following? Selected Answer: a. Her glucose control is poor.  Question 551 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 the following is the most likely etiology? Selected Answer: e. Esophageal foreign body  Question 56 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: a. XYY male  Question 57 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: b. Pityriasis rosea  Question 58 1 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.Intussusception  Question 59 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: c. Amoxicillin plus clavulanic acid (Augmentin)  Question 60 1 out of 1 points Which of the following is not a feature of DiGeorge syndrome? Selected Answer: b. Frontal bossing  Question 61 1 out of 1 points What is the appropriate management of a child with asthma who presents with acute wheezing and/or coughing? Selected Answer: b. Administer a short-acting beta agonist  Question 62 1 out of 1 points Jennifer, age 16, is an active cheerleader who just developed type 1 diabetes. She is worried that she will not fit in with her friends anymore because she does not think she can have all the same snacks they have. How do you respond?Selected Answer: d. Any snacks that are sufficient in calories to maintain your normal weight are okay.  Question 63 1 out of 1 points Shelby is a healthy 4-week-old who presents to your office in mid-January with a 3- day history of nasal congestion with occasional cough. She started running a lowgrade fever last night (T max 101.5°F). Now she is refusing to nurse and has paroxysmal coughing and noisy/labored breathing. Physical exam reveals an illappearing infant with lethargy and tachypnea, intercostal retractions, expiratory wheezes, and occasional rales. She does not attend day care but has a 3-year-old sibling who does and who recently had a “cold.” What is the MOST LIKELY cause of Shelby’s illness? Selected Answer: b. RSV bronchiolitis  Question 64 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: d. Vitamin D  Question 65 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 66 1 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: b. Amylase and lipase  Question 67 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 68 1 out of 1 points Which of the following is not associated with congenital adrenal hyperplasia? Selected Answer: c. Hypernatremia  Question 69 1 out of 1 points Which of the following is not a sign or symptom of congenital hypothyroidism? Selected Answer: a. Frequent stooling  Question 70 1 out of 1 pointsA 2-year-old girl has increased work of breathing. Her father notes she had cough and subjective fever over the past 3 days. She has been complaining that her “belly hurts” and has experienced one episode of post-tussive emesis but no diarrhea. Her immunizations are current, and she is otherwise healthy. Her temperature is 102°F. She is somnolent but easily aroused. Respirations are 28 breaths/min, and her examination is remarkable for decreased breath sounds at the left base posteriorly with prominent crackles. Which of the following acute interventions is the LEAST likely to assist in the diagnosis? Selected Answer: a. Sputum culture  Question 71 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: b. Testicular torsion  Question 72 0 out of 1 points A 5-year-old girl is somewhat short and has mild leg bowing. Her medical history is significant only for well-controlled seizure disorder. Serum calcium, phosphorus, and alkaline phosphatase levels and urinary amino acid concentration are normal. A bone age is notable for abnormal distal radius and ulna mineralization. Which of the following is the most likely diagnosis? Selected Answer: b. Genetic primary hypophosphatemia  Question 73 1 out of 1 points Screening infants for anemia should occur at what age?Selected Answer: a. 9 months  Question 74 1 out of 1 points When Jason, age 12, slid into homeplate while playing baseball, he injured his ankle. You are trying to differentiate between a strain and a sprain. You know that a sprain Selected Answer: c. Is an injury to the ligaments that attach to the bones in a joint.  Question 75 1 out of 1 points Which of the following is not found in an adolescent with untreated Graves' disease? Selected Answer: c. Tendency to gain weight easily  Question 76 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 77 1 out of 1 points The most common congenital heart defect in children asSelected Answer: c. Ventricular septal defect  Question 78 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: c. 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 79 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 80 1 out of 1 points Chest pain in young children is usually Selected Answer: b. Noncardiac in origin  Question 811 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 82 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: e. Chlamydia trachomatis  Question 83 1 out of 1 points The most common central nervous system side effect of mumps in children is Selected Answer: a. Ataxia  Question 84 1 out of 1 points Which malignancy is associated with genitourinary anomalies? Selected Answer: a. Wilms' tumor Question 85 0 out of 1 points In evaluating Tommy, a child with bloody diarrhea, which of the following would not be an appropriate first action? Selected Answer: d. Check growth chart  Question 86 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: d. Natural passive  Question 87 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: c. School excuse to not participate in recess and/or physical education activities  Question 88 1 out of 1 points Anthony is a known asthmatic. He has symptoms three times a week but never more than once a day. Exacerbations affect his normal activities occasionally. He awakens with cough three to four times a month. You classify his asthma as Selected Answer: c. Mild persistent Question 89 1 out of 1 points Hypercholesterolemia in children older than 2 is defined as a total cholesterol at or above Selected Answer: d. 200 mg/dL  Question 90 0 out of 1 points A 2-year-old presents with a history of wheezing and persistent cough. The father reports the child had a coughing/choking episode about a week ago that was spontaneously resolved. A few days later she began to cough and wheeze. This scenario is most consistent with Selected Answer: b. Bronchiolitis  Question 91 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: c. Marfan syndrome  Question 92 1 out of 1 points The most common trigger for an acute asthma episode in the very young child is Selected Answer: c. Respiratory infections  Question 931 out of 1 points All of the following is treatment for a child with phimosis except Selected Answer: a. Ice packs  Question 94 1 out of 1 points An adolescent who has tall stature, increased arm span, laxity of joints, pectus excavatum, and abnormal echocardiogram woudl be expected to have Selected Answer: a. Marfan syndrome  Question 95 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 96 1 out of 1 points Vomiting in infancy has a long list of differential diagnoses. Which of the following other symptoms would mostly likely point to pyloric stenosis? Selected Answer: b. Sausage-shaped mass in abdomen  Question 97 1 out of 1 pointsA 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: a. Neuroimaging  Question 98 1 out of 1 points Which of the following conditions is most responsible for developmental delays in children? Selected Answer: a. Fetal Alcohol Syndrome  Question 99 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: d. Turner syndrome (XO)  Question 100 1 out of 1 points An adolescent female presents with a 2-day history of increasing lower abdominal pain. She has mild vomiting and anorexia and fevers to 101F. She is unable to defecate but has an urge to do so. CBC reveals a slightly elevated WBC of 14,000, but is otherwise normal. Serum electrolytes are normal. The next step is Selected Answer: b. Refer to surgery for evaluation for appendicitis. Question 101 1 out of 1 points A 7-year-old presents with abrupt fever, stridor, drooling, and hyperextension of the neck. You examine the nose and throat and notice one tonsil is enlarged and there is marked erythema of the pharynx with uvular deviation. Which is most appropriate? Selected Answer: a. Refer to otolaryngology for management of a peritonsillar abscess and possible hospital admission Friday, May 8, 2020 3:48:09 AM EDT