NURS-6541D-3/NURS-6541N-3/NURS-6541C-3 Midterm Exam Spring 2020 (100/100)

1. Tammy, age 3, is at the o?ce for her well-child visit. She has trouble removing her own shirt as requested. Her mother yanks o? her shirt after smacking her wrist and saying, "you must do as you're told quickly." Whic ...

1. Tammy, age 3, is at the o?ce for her well-child visit. She has trouble removing her own shirt as requested. Her mother yanks o? her shirt after smacking her wrist and saying, "you must do as you're told quickly." Which action is indicated? 2. Epiglottitis has decreased due to which immunization? 3. While assessing the skin of an infant, you note cafe-au-lait spots. Which disease should be ruled out? 4. You are doing a kindergarten physical on a 5-year-old girl. Which of the following scenarios would suggest the child is not ready to start kindergarten in the fall? 5. Mark is in the exam room. You are concerned he may have epiglottitis. In what position do these patients prefer to sit? 6. A typically developing 8-year-old girl will have which of the following genital development? 7. An expected milestone of a 4-year-old is the ability to 8. Appropriate advice for a mother of a 2-week-old child here for a “well child” visit includes which of the following? 9. A common feature of 2-year-old behavior is: 10. The ?rst sign of the onset of female puberty is usually: 11. Sam has an otitis media. He also presents with conjunctivitis. This is due to which organism? 12. You receive a phone call from the mother of a 2-year-old. She states her child has sleep refusal. You suggest the child should be able to: 13. Which of the following complication of strep pharyngitis cannot be prevented with antibiotics? 14. A 13-month-old child is noted to be at the 25th percentile for weight, the 10th percentile for height, and less than the 5th percentile for head circumference. She was born at term. She was noted to have a small head at birth, to be developmentally delayed throughout her life, and to have required cataract surgery shortly after birth. She currently takes phenobarbital for seizures. Which of the following would most likely explain this child’s small size? 15. Which of the following strategies would not be appropriate to include as part of your treatment plan of an 8-year-old boy who is obese? 16. Which of the following children has abnormal language development? 17. Josh, age 13, has some enlargement of the scrotum and testes, a reddened scrotal sac, and some hair texture alteration. His penis is not enlarged. He is in Tanner stage 18. Which of the following substances is associated with pupillary constriction? 19. Which of the following is a priority nurse practitioner role to help children and adolescents to have healthy sexual development? 20. You assess a 15-year-old's visual acuity and note her vision to be 20/50 in the right eye. She asks you what that means and you respond 21. A 7-month-old male is found to have a spiral fracture of the femur that his father says he got by climbing onto a chair and then jumping off. Which of the following statements is true regarding this situation? 22. Which of the following statements is true regarding lying and stealing by the school- age child? 23. A mother of a 6-month-old asks you about normal sleep patterns for an infant this age. The best response is: 24. Appropriate anticipatory guidance for the parents of an 8-year-old girl includes 25. The most likely weight of a 1-year-old whose birth weight was 6-1/2 pounds would be: 26. You see a healthy 18-month-old for a well-child visit. At the 12-month visit he received the diphtheria, tetanus, and acellular pertussis (DTaP) third dose; hepatitis B second dose; measles, mumps, and rubella (MMR) first dose; injected poliovirus (IPV) second dose; pneumococcal conjugate (PCV13) fourth dose; and Haemophilus influenzae type B (Hib) fourth dose. Which of the following do you order today? 27. Upon eye examination of a newborn, you note inner canthal folds and Brush?eld spots. What do you suspect? 28. Sarah, age 15, presents with pain and pressure over her cheeks and discolored nasal discharge. You cannot transilluminate the sinuses. You suspect which common sinus to be a?ected? 29. Max, a 9-year-old boy, is a very active child with limited self-control. He is easily distracted and has di?culty staying on task. You determine that he should have a neurodevelopmental evaluation because he is showing signs of 30. Miguel, age 14, was hit in the eye with a baseball and developed eye pain, decreased visual acuity, and injection of the globe. Upon exam you note blood in the anterior chamber and confirm diagnosis of hyphema. What treatment do you recommend while Miguel is waiting to see the ophthalmologist 31. A teenage female who is overweight has moderate acne on the face and chest, and irregular menses. Elevation of which laboratory test provides the test evidence of polycystic ovarian syndrome? 32. You see a 5-month-old who is fussy, has interrupted sleep, and is drooling. You note large lower lateral incisor bulges. You recommend: 33. Hannah, age 4, is brought into the office by her father. She complains of a sore throat, difficulty swallowing, copious oral secretions, stridor, and a temperature of 102F. She does not have pharyngeal erythema or cough. What do you suspect? 34. Which is the correct order for introduction of solid foods to an infant? 35. Parents bring their 16-year-old daughter for a “well-child” checkup. She looks normal on examination. As part of your routine care you plan a urinalysis. The father pulls you aside and asks you to secretly run a UDS on his daughter. Which of the following is the most appropriate course of action? 36. You see a young child who has tripled her birth weight and looks for hidden objects. When given blocks, she places one in each hand. She has a fine pincer grasp. On the floor, she walks around holding objects and is trying to take independent steps. This child is most likely how old? 37. Head and chest circumferences should be equal at: 38. A healthy, well-developed 6-year-old child arrives as a new patient to your clinic. His immunization card reveals that he received an immunization at birth and some when he was 2 months old, but none sense. Which of the following statements about him is correct? 39. Mark, a 10-year-old, has a lot of ear pain. He does not want anyone to touch it and is crying in pain. The ear canal is swollen and exudate is preswent. The TM is normal. What is the proper management for his patient? 40. The father of a 3-year-old is concerned because the child stutters. What should your approach be? 41. Which of the following statements about bullying is true? 42. You are performing an examination of a 3-year-old who is new to your o?ce. Which ending requires immediate further evaluation? 43. For adolescent girls, peak height velocity should occur by Tanner Stage (SMR): 44. A 6-month-old infant has been growing poorly. His parents have changed his formula three times without success. His examination is remarkable for a pale, emaciated child with little subcutaneous fat and anterior fontanelle fullness. His laboratory test results are notable for a hemolytic anemia and prolonged bleeding times. Which of the following is the most appropriate next step? 45. During a “well-child” visit, the parents of a healthy 5-month-old offer a great amount of information. Which of the following bits of information is of most concern? 46. Sandy, age 18 months, crosses her legs when lifted from behind rather than pulling them up. Her legs are also hard to separate, making diaper changing di?cult. She persistently uses only one hand. What condition do you suspect? 47. By what age should most children be able to sit well without support? 48. Which of the following screenings should adolescents have done annually? 49. Which of the following issues or concepts is relevant to the school-age child? 50. An eye that deviates in when covered but that returns to midline when uncovered is an 51. Luke, a 17-month-old, failed treatment with amoxicillin for otitis media. At the two-week recheck, his TM was still erythematous and you cannot see the landmarks. He has persistent nasal congestion, he is not sleeping at night, and he has a 101°F fever. What is the next best step for Luke? 52. I like to use my pincer grasp that involves the ablitily to pick up a small object such as a raisin or piece of cereal with the thumb and fore?nger, and that is mastered around what age? 53. A ?fteen-year-old female makes a statement to you during a well visit. Which of the following statements should not be kept con?dential? 54. The appropriate lab tests in assessment of cervical adenitis include all of the following except: 55. Sally, age 4, presents to the o?ce with her mother for a well-child visit. To assess for age-appropriate ?ne motor skills, what activity would you ask her to perform? 56. Improve access to care and partially solve physician shortage. 57. You see a 4-year-old for a well-child visit. He has received four diphtheria, tetanus, and acellular pertussis vaccines (DTaP); three injected polio vaccines (IPV); one measles, mumps, and rubella vaccine (MMR); one varicella vaccine; and two hepatitis B (Hep B) vaccines. What do you order today? 58. At what age would a child be expected to remember a string of numbers and repeat them backwards? 59. A child's head circumference is routinely measured on each well visit until what age? 60. Which of the following vaccines is routinely recommended at 4 months of age? 61. A 2-year-old boy has been slightly less than the 50th percentile for weight, height and head circumference, but in the last 6 months he has fallen to slightly less than the 25th percentile for weight. The pregnancy was normal, his development is as expected, and the family reports no psychosocial problems. The mother says that he is now a finicky eater (wants only macaroni and cheese at all meals), but she insists that he eat a variety of foods. The meals are marked by much frustration for everyone. His examination is normal. Which of the following is the best next step in his care? 62. The mother of a 5-year-old informs you that her daughter cheats when playing board games. What is the best response? 63. Parents bring their 6-month-old son to see you. He is symmetrically less than the 5th percentile for height, weight and head circumference. He was born at 30 weeks’ gestation and weighed 1000g. He was a planned pregnancy, and his mother’s prenatal course was uneventful until an automobile accident initiated the labor. He was ventilated for 3 days in the intensive care unit but otherwise did well without ongoing problems. He was discharged at 8 weeks of life. Which of the following is the most likely explanation for his small size? 64. A 9-year-old who weighs 70 pounds asks why she can't sit in the front passenger seat of the family car. Your best response is 65. A 7-year-old has just been diagnosed with attention deficit hyperactivity disorder (ADHD). Her parents report that she is doing poorly in school and is disruptive in the classroom. They ask you what they can do. Your best response is: 66. The parent of a 2-year-old tells you her daughter recently started having breath-holding spells. She tells you the older sibling “did the same thing” and asks you for help. You advise her that after a breath-holding event: 67. A breastfed infant is expected to have a lower incidence of which of the following? 68. Which of the following injuries is most likely to be caused by abuse of a toddler? 69. FIRST-LINE therapy for preschoolers (4-5 years of age) diagnosed with attention- de?cit hyperactive disorder is: 70. Chelsea, age 8, complains that she feels as if something is stuck in her ear. What action is contraindicated? 71. An 8-year-old female is brought into the office by her mother. She has complaints of fever and sore throat for the past 2 days. She denies difficulty swallowing but has loss of appetite and mild diarrhea. A few classmates have similar symptoms. A review of systems reveals clear nasal drainage, dry cough, and hoarseness. On exam she has a 101.5 temperature, 3+ erythematous tonsils, and anterior cervical lymphadenopathy. What is the likely diagnosis? 72. Which of the following characterizes middle adolescence (14 to 16 years old)? 73. You see a 6-month-old for a well-child visit and the mother tells you the child’s grandmother recommends that she give the infant whole milk and eggs when he starts solids. What should you tell the mother? 74. Which of the following is a true contraindication of vaccinating a child? 75. A 12-year-old male states he noticed an enlargement of his testes and scrotum. When counseling him about the next step in pubertal development, you state: 76. Medicaid provides health insurance coverage to 77. Mark, a 10-year-old, has a lot of ear pain. He does not want anyone to touch it and is crying in pain. The ear canal is swollen and exudate is present. The TM is normal. Mark should be instructed to do which of the following? 78. Which of the following eye ?ndings would be considered an ophthalmic emergency? 79. You see a 30-month-old who speaks in mixed Spanish and English. The child’s vocabulary is normal but at the low end of the normal language spectrum. The parent is worried the child’s development will not be normal because she mixes up the two languages. You respond: 80. Which of the following represents normal sequencing of development in a toddler? 81. All of the following are consistent with peritonsillar abscess except: 82. A Mantoux test in a child with no risk factors is considered positive with a reaction of: 83. A mother states that her 4-year-old son constantly grinds his teeth at night. You document this as: 84. A 4-year-old believes there is more juice in a tall, thin glass than a shorter, wider one. The child has not yet achieved which of the principles of Piaget? 85. Please interpret the following labs for an adolescent. The adolescent has a history of obesity and acanthosis nigricans. 86. A 2-day-old infant has significant nasal and rectal bleeding. He was delivered by a midwife at home; the pregnancy was without complications. His Apgar scores were 9 at 1 minute and 9 at 5 minutes. He has breastfed well and has not required a health care professional visit since birth. Which of the following vitamin deficiencies might explain his condition? 87. A 14-year-old female comes into the office for an urgent visit after taking 10 valium tablets. Following the initial emergent care and stailization, the most important part of the management is: 88. A di?erential diagnosis for child abuse would include all of the following except. 89. What method can be safely used to remove cerumen in a 15-month-old child's ear? 90. A mother brings her 4-week-old infant into the o?ce because she noticed small yellow-white glistening bumps on her infant's gums. She says they look like teeth but is concerned that they may be cancer. You diagnose these bumps as 91. Which of the following foreign body in the nose requires immediate removal? 92. An 11-year-old girl has dizziness, pupillary dilation, nausea, fever, techycardia, and facial ?ushing. She says she can "see" sound and "hear" colors. The agent likely to be responsible is which of the following? 93. A 2-day-old newbornwith conjunctivitis is likely due to 94. Conductive hearing loss can be caused by 95. A 4-month-old presents with both eyes turning inward. What is this called? 96. All of the following may predispose a patient to thrush except: 97. The mother of a 4-year-old tells you he likes to "play with himself" while playing and watching television. You advise the mother to 98. Blood pressure should be measured at well-child visits starting at age: 99. I can walk well on tiptoes, my speech is 50% understandable, I know six body parts, but I cannot balance on one foot for 1 second. I am: 100. You see a 13-year-old who reports she is learning some basic geometry (areas, volume etc.). The ability to successfully master these concepts occurs during which Piaget developmental stage?