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CPN STUDY QUESTIONS WITH
COMPLETE AND ACCURATE
SOLUTIONS.
A 6-week-old male infant is brought into the ED by his mother. He has a weeklong history of progressively worsening emesis that is projectile in nature. What is his most likely diagnosis? A. Intussusception. B. Appendicitis. C. Pyloric stenosis. D. Pancreatitis. -- Answer ✔✔ C: Projectile vomiting in a 6 week-old male is the classic presentation for pyloric stenosis, obstruction of the pyloric sphincter between the gastric pylorus and the small intestine, caused by hypertrophy and hyperplasia of the circular muscle of the pylorus, which obstructs the sphincter. An 8-year-old male has contracted chicken pox (varicella virus). With which of the following family members can the child have contact? A. 20-year-old aunt on chemotherapy. B. 35-year-old uncle with HIV. C. 95-year-old grandfather on long-term steroid therapy. D. 2-year-old brother who has never had varicella but has had the vaccine -- Answer ✔✔ D: The 2-year-old brother, who has had the vaccine, is likely immune to varicella, so contact is safe. All of the other relatives have some form of immunosuppression from infection (HIV) or medications (chemotherapy and steroids) and should avoid contact with the patient
A 5-year-old girl has a fever, headache, and complaints of a stiff neck. The physician suspects bacterial meningitis. What is the best test culture site to detect the bacteria? A. Lumbar puncture. B. Clean catch urine. C. Blood culture. D. Nasal swab. -- Answer ✔✔ A: Lumbar puncture is the method of choice for detecting the bacteria causing bacterial meningitis and sending a sample for culture, as meningitis infects the meninges and bacteria is present in the cerebrospinal fluid. A 2-year-old child has severe dental caries in the upper and lower front teeth, posterior aspects. What is the most likely cause for this type of caries? A. Lack of fluoridation in the water. B. Sleeping with water in a nighttime bottle. C. Low carbohydrate diet. D. Sleeping with sugared liquid in nighttime bottle -- Answer ✔✔ D: Caries in the posterior front teeth is a sign of sleeping with sugared drinks in the nighttime bottle (such as juice) because fluid pools in the mouth when the child falls to sleep. Which of the following patients will likely need surgical correction of his/her fracture? A. 10-year-old with humeral head fracture. B. 5-year-old with tuft fracture of the distal phalanx. C. 4-year-old with tuft fracture of the toe. D. 16-year-old with radial head fracture. -- Answer ✔✔ A: Humeral head fractures usually need open reduction and internal fixation to maintain proper future functioning. Distal phalanx and toe fractures are treated with splints and fracture of the radial head with a sling.
may result from poor oxygenation but alone it is not a reliable indicator of worsening asthma. A patient is experiencing dizziness, shortness of breath, lightheadedness, and nausea caused by encephalitis. Which of the following descriptions most accurately describes the patient's condition? A. metabolic acidosis B. respiratory alkalosis C. metabolic alkalosis D. respiratory acidosis -- Answer ✔✔ B: Respiratory alkalosis results from hyperventilation, during which extra CO2 is excreted, causing a decrease in carbonic acid (H2CO3) concentration in the plasma. Symptoms include tachycardia, arrhythmias, lightheadedness, nausea, and vomiting. 10-year-old male with sickle cell disease comes into the ED complaining of pain in his legs due to a vaso-occlusive crisis. In addition to IV fluids, what is the other initial treatment for this client? A. Elevate legs. B. Ace wrap to legs. C. Nitroglycerine paste. D. Pain medication. -- Answer ✔✔ D: In addition to IV fluids, the other primary initial treatment for sickle cell crisis resulting in vascular occlusion is pain medication because pain is often severe. Other treatments include oxygen, hydroxyurea (anti-sickling medication), blood transfusions if anemia is pronounced, and antibiotics if the crisis was triggered by an infection. 14-year-old male with renal failure is given an arteriovenous fistula (shunt) for future dialysis. How does the nurse assess the shunt post-operatively for patency? A. Assess for bruit and thrill. B. Monitor blood pressure on that arm.
C. Ease of venipuncture at shunt site. D. Rate of flow during dialysis. -- Answer ✔✔ A: The patency of an AV shunt is assured by assessing for bruit and thrill. Continuous wave Doppler ultrasound can also assess patency. Venipuncture and blood pressure measurements should never be done on the arm with an AV shunt. nurse is admitting a 16-year-old female to the mental health unit with a diagnosis of bulimia and anorexia. What OTC medications should the client's belongings be screened for as they may interfere with treatment? A. Imodium. B. Acetaminophen (Tylenol). C. Laxatives. D. Ibuprofen (Motrin). -- Answer ✔✔ C: People with eating disorders, such as bulimia and anorexia, often use laxatives as well as diuretics to control weight. New patients should be checked for these items. Bulimics may purge by vomiting after eating. 10-year-old is accidentally shot in the forearm by a small caliber firearm. The wound enters the dorsum of the forearm and exits on the ventral side. The patient is ambulatory and has minor pain at the site. What test is likely needed for evaluation of the injury? A. Arteriogram. B. CT of arm. C. MRI of arm. D. Ultrasound of arm -- Answer ✔✔ A: An arteriogram is needed to assess the vascular supply in the arm after a gunshot wound to ensure that no injury to the ulnar and radial artery has occurred. A 17-year-old female with severe acne wants treatment for her condition. What form of treatment requires the patient use 2 forms of contraception and sign a consent form?
after sterilizing with iodine and wearing sterile gloves. Alcohol cleansing does not sterilize, and shaving can break the skin, increasing the chance of contamination. Samples are not routinely drawn from the femoral site. The child of a celebrity client is admitted to a nursing floor, and the nurse taking care of this patient notices a medical assistant not involved in the care of the patient looking at her chart. What would be the most appropriate course of action? A. Confront medical assistant and make her apologize. B. Notify nursing supervisor of HIPAA violation. C. Place chart in locked cabinet. D. Place chart at end of client's bed. -- Answer ✔✔ B: An unauthorized person's looking at any patient's chart is a clear HIPAA violation and must be reported to the supervisor in charge so that appropriate disciplinary action can be taken. A 7-year-old female is newly diagnosed with celiac disease. What is the best choice for a carbohydrate food source for this patient? A. Baked potato. B. Pasta. C. Bread. D. Saltine crackers. -- Answer ✔✔ A: Only the potato is a suitable source of carbohydrate for a person with celiac disease. Celiac disease is an allergic sensitivity to gluten in wheat products. Pasta, bread, and saltine crackers are all made with flour, which contains gluten. The parents of a newborn male ask you about the benefits of circumcision. It is appropriate to inform them that circumcision seems to decrease the risk of transmission of which of the following sexually transmitted diseases? A. Human papillomavirus (HPV).
B. Syphilis. C. HIV. D. Hepatitis C. -- Answer ✔✔ C: Circumcision has been shown to decrease the rates of transmission of HIV but does not affect rates of syphilis, HPV, or hepatitis C. A 15-year-old female is diagnosed with a newly-acquired infectious disease. Which of the following is NOT a mandatory reportable disease to the health department? A. TB. B. Varicella. C. Syphilis. D. Rabies. -- Answer ✔✔ B: Varicella (chickenpox) is not a reportable disease, and most children are vaccinated for varicella; however, the CDC requires reporting of TB, syphilis, and rabies as these are public health concerns. Following an exposure to a TB-infected family member, a twelve-year- old male is screened for TB with a PPD (Mantoux) test. After administration of the test, when should he be brought back for reading of the result? A. 24 to 36 hours. B. 36 to 48 hours. C. 48 to 72 hours. D. 72 to 96 hours. -- Answer ✔✔ C: PPD tests should be read 48 to 72 hours after administration. Any sign of induration is measured. Induration of 15 mm or blistering is a positive finding for general screening, but if the person has been exposed to someone with active TB, then 10 mm induration is considered positive. A newborn is scheduled for a chloride sweat test. For which genetic disorder does this test screen?
B. Umbilical hernia. C. Inguinal hernia. D. Hiatal hernia. -- Answer ✔✔ A: An undescended testis increases the risk of testicular cancer in adulthood in the affected testis as well as the contralateral testis. Hernias are unrelated to incidence of testicular cancer. A 2-year-old client with a corneal abrasion needs to be examined. What is the best positioning for this client? A. Restrained on papoose board. B. Restrained by parent on gurney. C. Under sedation in an operative room. D. Held on a parent's lap -- Answer ✔✔ D: Difficult examinations should be initially attempted while the child is sitting on a parent's lap. This will allow examination while under the calming care of the parent. Restraints are psychologically traumatic and should be used as a last resort only. Sedation in the operating room is not necessary Following a diagnosis of cystic fibrosis in their infant child, the parents should be educated in all of the following EXCEPT: A. Genetic counseling. B. Sign language. C. Home chest percussions. D. Dietary modifications. -- Answer ✔✔ B: CF is not directly associated with deafness, so education in sign language is not indicated although repeated treatment with antibiotics (aminoglycosides) can cause sensorineural hearing deficit. Cystic fibrosis is an autosomal recessive disease and the parents should receive genetic counseling about the risk of the disease in future offspring. CF has both pulmonary and pancreatic manifestations so chest percussions and dietary modifications would be appropriate.
Which of the following medications has been linked to the development of Reye's syndrome when given to febrile children? A. Acetaminophen (Tylenol). B. Naprosyn (Aleve). C. Aspirin. D. Ibuprofen (Motrin). -- Answer ✔✔ C: Use of aspirin in febrile children has been linked to the development of Reye's syndrome, a severe respiratory condition. Therefore, aspirin is not recommended for use in children. Fever in children is usually treated with acetaminophen or ibuprofen. A newborn with jaundice is treated with outpatient ultraviolet light therapy. What blood test is tested to ensure that the jaundice is clearing? A. Bilirubin. B. CBC. C. AST. D. Amylase. -- Answer ✔✔ A: Jaundice is caused by an elevation of bilirubin, which is monitored to ensure treatment success. As red blood cells break down, bilirubin forms and is excreted through the liver, but the infant's liver may be immature and unable to remove bilirubin fast enough, so bilirubin levels in the blood rise. Ultraviolet light helps to break down bilirubin. A 2-month-old male is being evaluated for gastroesophageal reflux. What is the best test to confirm this diagnosis? A. CT scan. B. Barium enema. C. Upper GI barium series D. Night-time Ph probe -- Answer ✔✔ D: A nighttime Ph probe requires a special monitoring device be inserted through the nose and down the esophagus to assess for acid reflux into the esophagus, confirming the diagnosis.
5 years old for rapid infusion of fluids and medications if another IV site is not accessible. The medial malleolus is used for older children and adults. Other possible sites include the distal femur, clavicle, humerus, and ileum. A 5-year-old is diagnosed with probable "Fifth's disease" caused by Parvovirus B19 although she does not yet have a rash. Which of the following should the child avoid? A. Contact sports. B. Tylenol. C. Pregnant women. D. Spicy food -- Answer ✔✔ C: Parvovirus B19 can cause birth defects if contracted by a pregnant mother, so the child should be counseled to avoid anyone pregnant until the disease resolves. Parvovirus B19 is contagious in the time from onset until the bright red rash occurs on the cheeks and a lacy rash on the body. Once the rash appears, the child is probably no longer contagious and can resume normal contacts and activity A 13-year-old female is diagnosed with Clostridium difficile colitis. What is the most probable cause of this infection? A. Recent antibiotic use. B. Travel to Central America. C. Drinking from a stream. D. Eating undercooked pork -- Answer ✔✔ A: The most common cause for C. difficile colitis is recent antibiotic use that disrupts the normal colonic flora, allowing overgrowth of the offending bacteria. C. difficile produces a lethal cytotoxin (Toxin B) and an endotoxin with cytotoxic action (Toxin A), which cause fluid to accumulate in the colon and severe damage to mucous membranes.
A 14-year-old male is suspected of having infectious mononucleosis. What Point of Care Testing (POCT) device can be used to confirm this diagnosis? A. Urine dip. B. Monospot. C. Rapid strep test. D. Rapid influenza test -- Answer ✔✔ B: A Monospot test for Epstein- Barr virus is used to confirm infectious mononucleosis. The test requires one drop of serum mixed with a special solution. The test can confirm mononucleosis between 2 and 9 weeks after infection. It is not accurate during the incubation period. A 12-year-old female immigrant from the Philippines has a positive PPD (Mantoux) skin test. What vaccine given routinely in her native country can cause false positive PPD tests? A. Varicella. B. Yellow fever. C. Influenza. D. BCG. -- Answer ✔✔ D: BCG (Bacille Calmette-Guérin) is a tuberculosis vaccine routinely administered to children in countries with high incidences of childhood tuberculous meningitis. PPD can show false positive although PPD may still be used. QuantiFERON-TB®-TB Gold test is not affected by prior BCG vaccination Which of the following congenital hernias is more commonly seen in African-American children? A. Umbilical hernia. B. Inguinal hernia. C. Hiatal hernia. D. Femoral hernia. -- Answer ✔✔ A: Umbilical hernias are more common in African-American children. They usually resolve with growth of the child by age 4 and do not require surgical correction
frequency hearing loss at the 4000-Hertz level, making it hard for the child to hear high-pitched voices and certain sounds, such as consonants. Digital hearing aids may be programmed to compensate for high frequency hearing loss Which of the following would NOT be considered a pediatric patient at high risk for dehydration? A. 4-year-old male with 30% body surface area burn. B. 7-year-old female with diabetic ketoacidosis C. 12-year-old male with hyperventilation due to anxiety D. 8-year-old male with cellulitis in the right arm. -- Answer ✔✔ D: Cellulitis, a bacterial skin infection, is not associated with dehydration. Burns, diabetic ketoacidosis, and hyperventilation may all contribute to dehydration in children. A 15-year-old female is evaluated for an intentional overdose of aspirin. The excessive ingestion of this medication puts the patient at risk for what acid-base disorder? A. Metabolic acidosis. B. Metabolic alkalosis. C. Respiratory acidosis. D. Respiratory alkalosis. -- Answer ✔✔ A: The ingestion of aspirin (salicylic acid) puts the patient at risk for a metabolic acidosis due to the acidic medication. Symptoms include drowsiness, confusion, headache, decreased blood pressure, flushed skin, nausea, vomiting, diarrhea and tachypnea. Symptoms consistent with a diagnosis of dehydration in children would include all of the following EXCEPT: A. Thirst. B. Bradycardia. C. Dry mucous membranes.
D. Depressed fontanelles. -- Answer ✔✔ B: Tachycardia, not bradycardia, is a common sign of dehydration in pediatric patients. Children with dehydration typically are thirsty and have dry mucous membranes, reduced skin turgor, and depressed fontanelles (in infants). A 6-year-old female with dehydration due to vomiting is evaluated with a complete blood count (CBC). What lab finding is expected? A. Decreased mean corpuscular (cell) volume (MCV). B. Increased MCV. C. Increased hematocrit. D. Normal red cell distribution width (RDW). -- Answer ✔✔ C: Due to volume loss, the hematocrit will be elevated as red blood cells become more concentrated in the blood. The MCV test shows the average size of the red blood cells and helps to determine the type of anemia while RDW shows the variations in cell size, important for some types of anemia (such as pernicious anemia). What is the leading cause of death in children in developing countries? A. Accidental trauma. B. TB. C. AIDS. D. Infectious diarrhea. -- Answer ✔✔ D: Infectious diarrhea remains the leading cause of death in developing countries. Outbreaks of diarrhea are common in areas with poor sanitation that allows food and water to become contaminated with bacteria, such as E. coli or Shigella. What is the most common cause of viral (non-bacterial) diarrhea in pediatric patients? A. Rotavirus. B. Parainfluenza. C. Influenza.
A. First-degree burn. B. Second-degree burn. C. Third-degree burn. -- Answer ✔✔ B: A burn area that is red with blistering is consistent with a second: degree burn. A first-degree burn would have erythema but no blistering, and a third: degree burn would be dry and leathery. Burns are not classified as fourth-degree. Antibodies exist in the body to respond to allergens and protect the body against disease. Which antibodies act primarily against parasitic infections? -- Answer ✔✔ A: IgE is the primary antibody used in the defense of parasitic infections and is involved in allergic responses. IgM increases in response to infection, and IgG provides a secondary response to infection. IgA provides immune response in mucous membranes and decreases with immunosuppression and some infections (gonorrhea). A child presents with history of fever for 2 days at 102 degrees F. At what age would the child likely need a spinal tap and full work up for sepsis based on the fever only? -- Answer ✔✔ A: Children less than 6 months of age have immature immune systems, so a fever in a 3- month-old child would necessitate a full work up for sepsis. In caring for a child with a history of HIV infection, which of the following immunizations should NOT be given to the child? -- Answer ✔✔ D: As the varicella vaccine is live, it should not be given to anyone with a potentially suppressed immune system, such as a child with HIV, as it may cause infection even in such a small dose. MMR, influenza and tetanus are not live vaccines and may be administered. Due to sickle cell disease, a 7-year-old female is considered to be a splenic from repeated splenic
sequestration crises. What vaccine should she get to protect her from encapsulated bacteria? -- Answer ✔✔ C: Patients with no spleen function (either from removal after trauma or autoinfarction due to sickle cell disease) should have the pneumococcal vaccine to prevent infection with encapsulated bacteria Which of the following children over the age of 6 months should NOT be given the influenza vaccine? -- Answer ✔✔ D: A patient with streptococcal pharyngitis does not have a chronic medical condition for which influenza administration is recommended. Children with chronic diseases, such as renal disease, HIV, and type 1 diabetes, should receive the influenzae vaccine as influenza infection could be life threatening Which of the following patients would be most at risk from meningitis due to the severity of their current infection? -- Answer ✔✔ C: Peri-orbital cellulitis can spread to the central nervous system and lead to meningitis due to the venous drainage from this area. The infection can travel along vessels and nerve pathways into the lining of the brain. Peri-orbital cellulitis should be treated with antibiotics and the patient closely monitored. A 5-year-old with suspected meningitis is evaluated with a lumbar puncture. Which of the following lab results would NOT be consistent with a diagnosis of bacterial meningitis? -- Answer ✔✔ A: An elevated WBC, not a decreased level, is consistent with a diagnosis of bacterial meningitis along with elevated protein, decreased glucose, and cloudiness in the cerebrospinal fluid.
