MN580 MIDTERM EXAM REVIEW, Exams of Health sciences

Download MN580 MIDTERM EXAM REVIEW and more Exams Health sciences in PDF only on Docsity!

MN580 MIDTERM

EXAM REVIEW

1. Cyclic vomiting may:
2. Last for days.
3. Require SSRIs to stop hurting.
4. Not be associated with a headache.
5. Requires pain medication and Zofran. ANS: 3
6. A 5-day old infant comes in for a newborn checkup. On assessment of the newborn, you note that the skin is jaundice in color. The anterior fontanel is slightly sunken. Per mom, the infant has only had 2 diapers today. The infant is strictly breastfed, and this is moms first child. She states baby is having trouble latching on. A bilirubin level is sent and comes back at 18. You identify this newborn to be dehydrated and is most likely to have breast milk jaundice. Which nursing intervention(s) will be required for this baby?
7. Phototherapy
8. Providing support and education for the lactating mother
9. Strict monitoring of intake and output
10. All of the above ANS 4
11. You are taking care of an infant who was admitted with dehydration. His weight is 6kg. You have been watching his I & Os. What would you expect the infants urinary output to be in order to maintain adequate hydration?
12. 0.52 ml/kg/hr
13. 0.52.5 ml/kg/hr
14. 13 ml/kg/hr
15. As long as he is having wet diapers it does not matter ANS: 3
16. The primary care pediatric nurse practitioner diagnoses a 5yearold child with asthma and prescribes an oral steroid and a short acting beta-adrenergic medication via a metered dose inhaler to manage acute symptoms. Along with education about the prescribed medications, what information is important to give the child’s family at this visit? A. An asthma action plan B. Effects and side effects of current medications Correct C. Information about spirometry testing

B. Have the child describe any pain as “no pain, a little pain, or a lot of pain.” Correct C. Question the child about the intensity and specific location of any pain. D. Rely on nonverbal responses such as facial expressions and limb movements.

9. A 4yearold child has just been released from the hospital after orthopedic surgery on one leg following a bicycle accident. The child is sitting quietly on the exam table. When asked to rate pain, the child points to the “1” on a faces rating pain scale. What will the primary care pediatric nurse practitioner do next? A. Assess the child’s vital signs and ability to walk without pain. Correct B. Refill the prescription for a narcotic analgesic medication. C. Suggest that the parents give acetaminophen for mild pain. D. Teach the parent to give analgesics based on the child’s report of pain.
10. A developmentally and cognitively disabled 10yearold child who is unable to communicate must undergo a series of surgeries, and the child’s parent asks how to know if the child is in pain and when to give pain medication. What will the primary care pediatric nurse practitioner teach this parent to use to assess this child’s pain? A. Comfort scale B. FLACC scale C. NCCPCR Correct D. Nonverbal observations
11. The primary care pediatric nurse practitioner is preparing to perform a painful procedure on a 4monthold infant. Besides providing local anesthesia, what other pain control method provides analgesic effects? A. Providing toys B. Singing or music C. Sucrose solution Correct D. Swaddling or cuddling

12. An adolescent female reports moderate dysmenorrhea with periods and tells the primary care pediatric nurse practitioner that 400 mg ibuprofen every 6 to 8 completely control her pain. What will the nurse practitioner recommend? A. Increasing the ibuprofen dose to 600 to 800 mg every 6 to 8 hours B. Taking extra strength acetaminophen 1000 mg every 4 to 6 hours C. Taking naproxen 500 mg initially and then 250 mg every 6 to 8 hours correct D. Using extended release naproxen 500 mg every 12 hours
13. What is the most important dose limiting factor when prescribing acetaminophen with hydrocodone? A. Acetaminophen dose Correct B. Gastrointestinal side effects C. Pruritis symptoms D. Urinary retention
14. An adolescent takes ibuprofen, acetaminophen, and a tricyclic antidepressant (TCA) to treat phantom limb pain and reports that the medications are no longer effective. What will the primary care pediatric nurse practitioner do? A. Change the TCA to a selective serotonin reuptake inhibitor. B. Evaluate the adolescent for drug seeking behavior. C. Increase the TCA dose and reevaluate in 2 to 3 weeks. D. Refer the adolescent to a pain management specialist. Correct
15. The parent of a school age child with a chronic pain condition tells the primary care pediatric nurse practitioner that the child has requested to stay home from school more often in the past few months. The child’s exam does not reveal any significant change in pathology, and a review of the child’s medications indicates appropriate dosing of analgesic medications. What will the nurse practitioner recommend? A. Assessing the child’s pain every day to determine changes B. Ensuring the child stays quiet in bed with videos when having pain C. Having the child do homework when staying home from school Correct

20. A parent is concerned about vaccine adverse reactions. Based on an Institute of Medicine report, what will the primary care pediatric nurse practitioner tell the parent? A. Administering multiple vaccines may trigger the development of type 1 diabetes. B. The MMR may be linked to febrile seizures in immunocompromised children. Correct C. There is some risk of CNS disorders associated with the hepatitis B vaccine. D. Vaccines containing thimerosol are linked to pervasive developmental disorders.
21. A 2monthold infant will receive initial immunizations, and the parent asks about giving medications to increase the infant’s comfort and minimize fever. What will the pediatric nurse practitioner recommend? A. Administering ibuprofen or acetaminophen as needed Correct B. Avoiding antipyretics if possible to attain better immunity C. Giving ibuprofen and acetaminophen only after the vaccines D. Pretreating the infant with both ibuprofen and acetaminophen
22. The primary care pediatric nurse practitioner reviews the immunization records of an 18monthold child and notes that the child received an MMR immunization 2 days prior to the first birthday. What will the nurse practitioner do? A. Administer a reduced dose of MMR to ensure adequate immunity. B. Obtain mumps, measles, and rubella titers to determine immunity. C. Recommend the next dose of MMR vaccine at 4 to 5 years of age. Correct D. Repeat the MMR vaccine since the first dose was given too soon
23. A 5yearold child who has a history of pertussis infection as an infant is in the clinic for immunizations prior to kindergarten. Which vaccine will be given? A. DTaP Correct B. DTP C. Td D. Tdap

24. Select the statement that best describes the thelarche stage of puberty in females.
25. Appearance of pubic hair
26. Appearance of breast tissue maturation
27. Onset of first menstrual period
28. All the above ANS 4
29. Congenital Hypothyroidism is common in infants with Downs syndrome. Newborn screening for Congenital Hypothyroidism is required in all 50 states. Thyroid studies should be performed several times during the first years of life, and then a minimum of:
30. Every two months.
31. Every month.
32. Every six months.
33. Yearly. ANS: 4
34. Malignancies are common in children with Downs syndrome. The incidence is 18 times that of the general population for developing:
35. Colon cancer.
36. Leukemia.
37. Pancreatic cancer.
38. Bladder cancer. ANS: 2
39. Downs syndrome children often have instability of the neck at the first and second cervical vertebrae. As a nurse, you explain to the caregiver that he/she should look for signs and symptoms of spinal cord changes, such as:
40. Changes in reflexes.
41. Changes in bowel function.
42. All of the above.

A. Parents should notice improved hearing in their child. Correct B. PET will help by reducing the number of ear infections the child has. C. The child should use earplugs when showering or bathing. D. The tubes will most likely remain in place for 3 to 4 years.

32. A child with a history of otitis externa asks about ways to prevent this condition. What will the primary care pediatric nurse practitioner recommend? A. Cleaning ear canals well after swimming B. Drying the ear canal with a hair dryer Correct C. Swimming only in chlorinated pools D. Using cerumenolytic agents daily
33. A child complains of itching in both ears and is having trouble hearing. The primary care pediatric nurse practitioner notes periauricular edema and marked swelling of the external auditory canal and elicits severe pain when manipulating the external ear structures. Which is an appropriate intervention? A. Obtain a culture of the external auditory canal. B. Order ototopical antibiotic/corticosteroid drops. Correct C. Prescribe oral amoxicillin clavulanate. D. Refer the child to an otolaryngologist.
34. A child who has otitis externa has severe swelling of the external auditory canal that persists after 2 days of therapy with ototopical antibiotic/corticosteroid drops. What is the next step in treatment for this child? A. Insert a wick into the external auditory canal. Correct B. Irrigate the external auditory canal with saline. C. Order systemic corticosteroids. D. Prescribe an oral antibiotic medication.

35. The primary care pediatric nurse practitioner notes a small, round object in a child’s external auditory canal, near the tympanic membrane. The child’s parent thinks it is probably a dried pea. What will the nurse practitioner do to remove this object? A. Irrigate the external auditory canal to flush out the object. B. Refer the child to an otolaryngologist for removal. Correct C. Remove the object with a wire loop curette. D. Use a bayonet forceps to grasp and remove the object.
36. A 3yearold child has had one episode of acute otitis media 3 weeks prior with a normal tympanogram just after treatment with amoxicillin. In the clinic today, the child has a type B tympanogram, a temperature of 102.5°F, and a bulging tympanic membrane. What will the primary care pediatric nurse practitioner order? A. A referral for tympanocentesis B. Amoxicillin twice daily C. Amoxicillin clavulanate twice daily Correct D. Intramuscular ceftriaxone
37. The primary care pediatric nurse practitioner diagnoses acute otitis media in a 2yearold child who has a history of three ear infections in the first 6 months of life. The child’s tympanic membrane is intact, and the child has a temperature of 101.5°F. What will the nurse practitioner prescribe for this child? A. Amoxicillin twice daily for 10 days B. An analgesic medication and watchful waiting Correct C. Antibiotic ear drops and ibuprofen D. Ceftriaxone given once intramuscularly
38. A child who was treated with amoxicillin and then amoxicillin clavulanate for acute otitis media is seen for follow up. The primary care pediatric nurse practitioner notes dull gray tympanic membranes with a visible air fluid level. The child is afebrile and without pain. What is the next course of action? A. Administering ceftriaxone IM B. Giving clindamycin orally

B. Obtain an electrocardiogram to assess for arrhythmia. C. Order a chest radiograph to evaluate for cardiomegaly. D. Refer to a pediatric cardiologist for further evaluation. Correct

43. The primary care pediatric nurse practitioner performs a well child examination on a 12monthold child who had repair of a congenital heart defect at 8 months of age. The child has a normal exam. The parent reports that the child is not taking any medications. The nurse practitioner will contact the child’s cardiologist to discuss whether the child needs which medication? A. Amoxicillin Correct B Capoten C. Digoxin D. Furosemide
44. A 3monthold infant who was previously healthy now has a persistent cough, bilateral lung crackles, and poor appetite. The primary care pediatric nurse practitioner auscultates a grade III/VI, low pitched, holosystolic murmur over the left lower sternal border and palpates the liver at one centimeter below the ribs. What diagnosis is likely? A. Atrial septal defect B. Coarctation of the aorta C. Patent ductus arteriosis D. Ventricular septal defect Correct
45. A 5yearold child who had a repair for transposition of the great arteries shortly after birth is growing normally and has been asymptomatic since the surgery. The primary care nurse practitioner notes mild shortness of breath with exertion and, upon questioning, learns that the child has recently complained of dizziness. What will the nurse practitioner do? A. Order an echocardiogram and chest radiograph. B. Perform pulmonary function testing. C. Reassure the parent that these symptoms are common. D. Refer the child to the cardiologist immediately. Correct
46. The primary care pediatric nurse practitioner is performing a well child

examination on a school age child who had complete repair of a tetralogy of Fallot defect in infancy. What is important in this child’s health maintenance regime? A. Cardiology clearance for sports participation Correct B. Restriction of physical activity to avoid pulmonary complications C. Subacute bacterial endocarditis prophylaxis precautions D. Teaching about management of hyper cyanotic episodes

47. The primary care pediatric nurse practitioner is performing a sports physical on an adolescent whose history reveals mild aortic stenosis. What will the nurse practitioner recommend? A. Avoidance of all sports to prevent sudden death B. Clearance for any sports since this is mild C. Evaluation by a cardiologist prior to participation Correct D. Low intensity sports, such as golf or bowling
48. During a routine well child exam on a 5yearold child, the primary care pediatric nurse practitioner auscultates a grade II/VI, harsh, late systolic ejection murmur at the upper left sternal border that transmits to both lung fields. The child has normal growth and development. What will the nurse practitioner suspect? A. Aortic stenosis B. Patent ductus arteriosus C. Pulmonic stenosis Correct D. Tricuspid atresia
49. A 5yearold child has an elevated blood pressure during a well child exam. The primary care pediatric nurse practitioner notes mottling and pallor of the child’s feet and lower legs and auscultates a systolic ejection murmur in the left infraclavicular region radiating to the child’s back. The nurse practitioner will suspect which condition? A. Aortic stenosis B. Coarctation of the aorta Correct

D. Send the child to the emergency department for fluids and IV insulin.

13. The primary care pediatric nurse practitioner is performing a well child examination on a 12yearold child who was diagnosed with type 1 diabetes at age 9. The child had a lipid screen at age 10 with an LDL cholesterol <100 mg/dL. What will the nurse practitioner recommend as part of ongoing management for this child? A. Annual lipid profile evaluation B. Annual screening for microalbuminuria C. Comprehensive ophthalmologic exam Correct D. Hypothyroidism screening every 5 years
14. A 16yearold adolescent female whose BMI is at the 90th percentile reports irregular periods. The primary care pediatric nurse practitioner notes widespread acne on her face and back and an abnormal distribution of facial hair. The nurse practitioner will evaluate her further based on a suspicion of which diagnosis? A. Dyslipidemia B. Hypothyroidism C. Nonalcoholic steatohepatitis D. Polycystic ovary syndrome Correct
15. The primary care pediatric nurse practitioner notes a musty odor when examining a newborn at a 2week checkup. What will the nurse practitioner suspect? A. Galactosemia B. Glucose6phosphatase deficiency C. Phenylketonuria Correct D. Urea cycle disorder
16. An initial key part of management of a child suspected of having an inborn error of metabolism is A. consulting a metabolic specialist. Correct B. obtaining a complete family history.

C. ordering metabolic screening tests. D. referring the family to a dietician.

15. The primary care pediatric nurse practitioner prescribes metformin for a 15yearold adolescent newly diagnosed with type 2 diabetes. What will the nurse practitioner include when teaching the adolescent about this drug? A. That insulin therapy will be necessary in the future B. The importance of checking blood glucose 3 or 4 times daily Correct C. To consume a diet with foods that are high in vitamin B D. To use a stool softener to prevent gastrointestinal side effects
16. A 13yearold Native American female has a BMI at the 90th percentile for age. The primary care pediatric nurse practitioner notes the presence of a hyperpigmented velvetlike rash in skin folds. The child denies polydipsia, polyphagia, and polyuria. The nurse practitioner will A. counsel the child to lose weight to prevent type 2 diabetes. B. diagnose type 2 diabetes if the child has a random glucose of 180 mg/dL. C. order a fasting blood sample for a metabolic screen for type 2 diabetes. Correct D. refer the child to a pediatric endocrinologist.
17. A 7yearold female has recently developed pubic and axillary hair without breast development. Her bone age is consistent with her chronological age, and a pediatric endocrinologist has diagnosed idiopathic premature adrenarche. The primary care pediatric nurse practitioner will monitor this child for which condition? A. Adrenal tumor B. Congenital adrenal hyperplasia C. Polycystic ovary syndrome Correct D. Type 1 diabetes mellitus