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NURS 612 Shadow Health All Modules Cases Instructor
Keys 2024 Version/100% Correct(For instructors only)
On your patient schedule see a diagnosis of plagiocephaly on your patient schedule. You vaguely recall learning something about this in Nurs 612 so you check UpToDate and are able to explain the etiology of this head growth disturbance is to the parents of this 4-month-old : A. Your child's head appears small. His head size is 2 SD below the mean, this can result abnormal brain development from a genetic or teratogenic exposure B. Your child's head appears flat. This form of craniostenosis can result from premature fusion of lambdoidal or coronal skull sutures and often results in brain injury. C. Your child's head appears large. His head size is 2 SD above the mean, this can result from hydrocephalus while skull sutures are open. D. Your child's head appears flat. This form of craniostenosis can result from premature fusion of lambdoidal or coronal skull sutures and is often only cosmetic and can be treated with a s - --------- ANSWER --------D. Your child's head appears flat. This form of craniostenosis can result from premature fusion of lambdoidal or coronal skull sutures and is often only cosmetic and can be treated with a special helmet. During a 1-week-old male well child check the head circumference is 3 S.D. (standard deviations) below the predicted mean. What risk factors increases the risk of this finding? A. Positioning infant on their back B. Prenatal Zika virus exposure C. Hydrocephaly D. Subdural hematoma or tumor - ---------ANSWER --------B. Prenatal Zika virus exposure You are seeing a 6-month-old today for follow-up after a febrile seizure yesterday. On exam you expect to find:
A. the anterior fontanel closed. B. the posterior fontanel closed C. sleepiness from a post-ictal state D. nuchal rigidity - ---------ANSWER --------B. the posterior fontanel closed You are examining a 22-month-old today for follow-up after a with a new sudden onset of jerking movements while febrile earlier today. Which of the following is not typical of this type seizure? A. Positive family history B. Age onset between 3 months and 5 years C. Seizure lasting more than 15 minutes D. Most likely to occur with a rapid rise in body temperature - ---------ANSWER --------C. Seizure lasting more than 15 minutes A 15-year-old with a diagnosis of epilepsy had a seizure in your office lasting 12 minutes requiring rectal diazepam (Valium). He is stable in a postictal state. His parents express concern as his last seizure was 2 years ago and he wanted to be weaned off his phenytoin (Dilantin).Which of the following may have contributed to this seizure? A. Experimentation with alcohol consumption which lowers seizure threshold. B. Recent growth spurt resulting in decreased kg/mg dosage C. Adolescent may be challenging diagnosis and non-compliant with phenytoin regimen D. All choices are correct - ---------ANSWER --------D. All choices are correct What question in an adolescent's history is the MOST important to ask concerning new onset of headaches? A. Alcohol use B. Caffeine use C. History of headache most severe when arising from sleep D. Positive family history for headaches - ---------ANSWER --------C. History of headache most severe when arising from sleep A 17-year-old arrives for evaluation of a headache. He states it is worse in the morning and does not respond to ibuprofen. His caffeine intake has not changed, he has no known head trauma. On exam you
You are examining a 4-month-old with a fever who suddenly stares blankly and her limbs start twitching. You time the episode which lasts 3 minutes. What are next steps? A. Administer IV antibiotic following obtaining lumbar puncture and blood culture B. Order a STAT EEG C. Lie child on their side and time the event, administer antipyretic D. Administer rectal valium - ---------ANSWER --------C. Lie child on their side and time the event, administer antipyretic Your are treating a 16-year-old female with chronic headaches. Effective management of headache in an adolescent patient includes which of the following A. Appropriate medication or other pain relieving intervention B. Explanation of the likely cause and expected course of the headache C. Elimination of headache triggers D. All answers are correct - ---------ANSWER --------D. All answers are correct Your 12-year-old male patient has a history of cord compression and anoxia at birth presents with spasticity and partial paralysis. His likely diagnosis is: A. erb's palsy B. brachial plexus palsy C. cerebral palsy D. muscular dystrophy - ---------ANSWER --------C. cerebral palsy A 3 year-old-femaie presents with loss of the use of her left arm since her forcep delivery birth. Which of the following is her most likely diagnosis? A. brachial plexus palsy B. cerebral palsy C. Bell's palsy D. none are likely diagnoses - ---------ANSWER --------A. brachial plexus palsy 9 - year-old Sarah presents with her normal-height parents who are concerned about her short stature. Physical exam is unremarkable except for height and weight are in the 3rd percentile, you note she is
Tanner Stage 1, her endocrine work-up is normal except for a delayed bone age (8 years). The treatment for Sarah's suspected diagnosis: A. Reassurance, close observation, with anticipated growth acceleration B. Urgent endocrine referral for growth hormone, with anticipated growth acceleration C. Urgent endocrine referral for Turner syndrome D. Reassurance, close observation, with anticipated short stature - ---------ANSWER --------A. Reassurance, close observation, with anticipated growth acceleration 16 - year-old Michael presents with his 60-year-old father with a concern about delayed puberty, physical exam is remarkable for scant body hair, tall stature, mild gynecomastia and hypogonadism. The treatment for Michael's suspected diagnosis is: A. Reassurance, close observation, with anticipated catch up sexual maturity B. Endocrine referral for growth hormone, with anticipated catch up sexual maturity C. Endocrine referral for likely Klinefelter syndrome and consideration of testosterone therapy D. Endocrine referral for likely Klinefelter syndrome for consideration of growth hormone therapy - ------ ---ANSWER --------C. Endocrine referral for likely Klinefelter syndrome and consideration of testosterone therapy 15 - year-old Dana presents with her 60-year-old mother w a concern about delayed puberty with amenorrhea, physical exam is remarkable noting short stature, low set ears and hair line, cubitus valgus and web necked. The treatment for Dana's suspected diagnosis is: A. Reassurance, close observation, with anticipated catch up sexual maturity B. Endocrine referral for likely Turner's syndrome and consideration of estrogen, progesterone AND growth hormone therapy C. Endocrine referral for likely Turner's syndrome and consideration of estrogen, and progesterone hormone therapy D. Endocrine referral for growth hormone, with anticipated catch up sexual maturity - ---------ANSWER -- ------B. Endocrine referral for likely Turner's syndrome and consideration of estrogen, progesterone AND growth hormone therapy A 4-year-old girl presents with her mother with concerned about her breast development. Her family history is negative for endocrine disorders. Physical exam is unremarkable except for stage 1 breast development, no pubic with no signs of axillary or pubic hair. Her height and weight are above the 95th percentile. Which of the following BEST describes this child's physical findings?
A. Metformin prescription, urine dipsticks for urine glucose monitoring, healthy diet and exercise regimen B. Insulin prescription, home glucometer for blood glucose monitoring, healthy diet and exercise regimen C. Metformin prescription, home glucometer for blood glucose monitoring, healthy diet and exercise D. Insulin prescription, urine dipsticks for urine glucose monitoring, healthy diet and exercise - --------- ANSWER --------C. Metformin prescription, home glucometer for blood glucose monitoring, healthy diet and exercise A newborn JT in your care tests positive for PKU. His parents ask if switching his formula will improve his musty odor. They understand this disorder may impact his brain development and are requesting an MRI of his brain. As the FNP, you offer the following explanation of JT's PKU is due to: A. missing a hormone needed to synthesize important brain chemicals like norepinephrine, his new formula and supplements will help his brain development. This is monitored with PKU blood levels and not measurable with the MRI B. missing a hormone needed to synthesize important brain chemicals like melanin, his new formula and supplements will help his brain development. C. This is monitored with PKU blood levels and not measurable with the MRIRI missing a hormone needed to synthesize important brain chemicals, his new formula and supplements will help his brain development. This is monitored with an MRI. D. missing a hormone ne - ---------ANSWER --------A. missing a hormone needed to synthesize important brain chemicals like norepinephrine, his new formula and supplements will help his brain development. This is monitored with PKU blood levels and not measurable with the MRI A 7-year-old male has a recent history of viral infection and now presents with polyuria, polydipsia and a 1.5- kg weight loss. A dipstick UA is positive for glucose, and random plasma glucose is 350 mg/dL. Considering the likely diagnosis, what will included in the most appropriate plan of care? A. Metformin prescription, home glucometer for blood glucose monitoring, healthy diet and exercise regimen B. Insulin prescription (sq. infusion via pump or injection), home glucometer for blood glucose monitoring, healthy diet and exercise regimen C. Metformin prescription, urine dipsticks for urine glucose monitoring, healthy diet and exercise regimen
D. Insulin prescription (sq. infusion via pump or injection), urine dipsticks for urine glucose monitoring, healthy diet and exercise regimen - ---------ANSWER --------B. Insulin prescription (sq. infusion via pump or injection), home glucometer for blood glucose monitoring, healthy diet and exercise regimen Reviewing the lab work for a 24-month-old with normal growth here for his Well Child Check, you note his CBC results: Hgb 11, Hct 33, MCV 78 with decreased serum Fe, increased Total Iron Binding Capacity and decreased Ferritin. Considering his most likely diagnosis are the most common presenting signs of in this age group? A. Splenic enlargement B. Pallor and fatigue C. Tachycardia and tachypnea D. Bruises, petechiae, and mucosal bleeding - ---------ANSWER --------B. Pallor and fatigue Understanding iron deficiency anemia often has a slow insidious onset, you develop screening protocols. This most common form of anemia is associated with different risks. Iron deficiency is associated with toddlers who continue to bottle feed milk (which unlike formula contains no iron) and which additional life periods? A. The first month of life B. The period when the child is most sedentary C. The preschool years D. Periods of rapid growth - ---------ANSWER --------D. Periods of rapid growth Reviewing the lab work for a 6-year-old vegetarian with normal growth here for his Well Child Check. You note his CBC results: Hgb 10, Hct 32, MCV 120 and a blood smear which reveals megaloblastic cells. Considering his most likely diagnosis what is the most appropriate next lab work to order? A. Serum Iron levels B. CBC C. Peripheral blood smear D. Serum Folate and B12 levels - ---------ANSWER --------D. Serum Folate and B12 levels You are consulting with a school nurse asking about 5-year-old African-American child with a sudden onset of a warm painful L knee. She notes his record reveals he takes a medication hydroxyurea. Considering his likely diagnosis, which of the following factors may have precipitated this event?
4 - year-old J.B. presents with edema of the face and lower extremities, his urine is frothy and positive for 4+ protein. Considering the most likely diagnosis the nurse practitioner explains to the family: A. J.B. likely has nephrotic syndrome this inflammatory problem is not likely to recur. Treatment will include oral steroids and daily weights to track fluid retention B. J.B. likely has nephrotic syndrome this may be a chronic problem. Treatment will include oral steroids and daily weights to track fluid retention C. J.B likely has nephritis this inflammatory problem is not likely to recur. Treatment will include oral steroids and daily weights to track fluid retention D. J.B likely has nephritis this may be a chronic problem. Treatment will include oral steroids and daily weights to track fluid retention - ---------ANSWER --------B. J.B. likely has nephrotic syndrome this may be a chronic problem. Treatment will include oral steroids and daily weights to track fluid retention Your front desk staff tells you there is a 15-year-old male presenting alone for a seeking treatment for a possible STI. As his primary care nurse practitioner what do you recommend? A. Inform the patient he must return with a guardian prior to treatment B. Explain to the patient you are mandated to inform his parents he is seeking treatment for a possible STI C. Explain to the patient he legally can consent to STI treatment, but if he uses her parent's insurance they will have access to his diagnosis from the explanation of benefits (EOB). D. Advise your front desk staff to accept her parent's insurance and schedule his appointment - --------- ANSWER --------C. Explain to the patient he legally can consent to STI treatment, but if he uses her parent's insurance they will have access to his diagnosis from the explanation of benefits (EOB). A 16-year-old male presents with dysuria requesting a urinalysis for his UTI. Considering the most likely diagnoses, what findings would you expect and course of treatment would you anticipate? A. Perform a GU exam noting lesions/drainage to guide explanation of STI most likely causing dysuria, tx prophylactically, send cultures and need safer sex practices and sex partner notification B. Obtain a urinalysis to guide explanation of STI most likely causing dysuria, tx prophylactically, send cultures and need safer sex practices and sex partner notification. C. Perform a GU exam noting lesions/drainage to guide explanation of STI most likely causing dysuria, await results from cultures to initiate treatment and need safer sex practices and sex partner notification D. Obtain a urinalysis to guide explanation of UTI most likely causing dysuria, tx prophylactically, send cultures. - ---------ANSWER --------A. Perform a GU exam noting lesions/drainage to guide explanation of
STI most likely causing dysuria, tx prophylactically, send cultures and need safer sex practices and sex partner notification While performing a testicular exam on a 4-week-old M.N. You are unable to locate and palpate the left testicle. Considering the most likely diagnosis the nurse practitioner explains to the family: A. M.N. has cryptorchidism, an undescended testicle. This is critical finding, he will need to be admitted for surgery immediately B. M.N. has a hydrocele, an excess fluid in the testicle. We will continue to monitor, but this will likely resolve over time. C. M.N. has testicular torsion, this twisting cuts of blood supply to the testicle. This is critical finding, he will need to be admitted for surgery immediately D. M.N. has cryptorchidism, an undescended testicle. We will consult urology and monitor this for the next few months and consider hormone treatment or surgery if it does not descend spontaneously - ----- ----ANSWER --------D. M.N. has cryptorchidism, an undescended testicle. We will consult urology and monitor this for the next few months and consider hormone treatment or surgery if it does not descend spontaneously The primary care nurse practitioner evaluates a 15-year-old male in distress with severe, sudden onset right scrotal pain. On exam his right testicle is exquisitely tender, and elevated from normal lie. Considering the likely diagnosis, how will the nurse practitioner manage this patient? A. Prescribe NSAID medication and collect a urinalysis B. Reassure the patient and his parent that he likely has a hydrocele and should resolve spontaneously with ice and rest C. If his urinalysis is negative arrange follow up with a urologist within 48 hours. D. Consult urology immediately for emergent imaging and surgery to return blood flow to the testicle - -- -------ANSWER --------D. Consult urology immediately for emergent imaging and surgery to return blood flow to the testicle A 7-year-old female has told her parent she has pain when she urinates. She has no hx of UTI and is afebrile and playing in the room. On exam she does not have CVA tenderness and her perineal exam is unremarkable without erythema or discharge. Urinalysis is positive for nitrites, bacteria and leukocytes. Considering likely causative organisms, which medication would be the NOT be appropriate to prescribe? A. Cefixime x 5 days B. Cefdinir x 5 days
D. M.N. likely has cystitis caused by E. coli which converts nitrates to nitrites, this is the most common UTI pathogen - ---------ANSWER --------D. M.N. likely has cystitis caused by E. coli which converts nitrates to nitrites, this is the most common UTI pathogen You diagnose erysipelas (Strep A) in a child who weighs 25 kg who is afebrile and taking po well. All the following medications would be effective in the treatment EXCEPT: A. Penicillin VK 30-50mg/kg/day divided bid x 10 days B. Penicillin G benzathine 600,000 units IM q day C. Trimethoprim-sulfamethoxazole 8-12mg/kg/day divided bid D. Amoxicillin 80-90mg/kg/day divided bid x 10 days - ---------ANSWER --------C. Trimethoprim- sulfamethoxazole 8-12mg/kg/day divided bid JC,16-year-old female presents with a 2 cm dark brown pigmented lesion on the left shoulder with an irregular border and uneven pigmentation. Considering her most likely diagnosis, what is the most appropriate counsel for JC and her parents? A. This lesion has characteristics of benign nevi, this is a pigmented lesion which requires ongoing assessment, if changes occur we should consider biopsy B. This lesion has characteristics of café au lait patch, this is a pigmented lesion which requires ongoing assessment, if more than 7 are noted there is concern for neurofibromatosis. C. This lesion has characteristics of melanoma, this is a pigmented lesion which requires immediate biopsy and excision D. This lesion has characteristics of melanoma, this is a vascular lesion which requires immediate biopsy and excision - ---------ANSWER --------C. This lesion has characteristics of melanoma, this is a pigmented lesion which requires immediate biopsy and excision 3 - week-old PK presents with a new onset of an expanding raspberry colored raised lesion lateral to his left eye. Considering his most likely diagnosis, what is the most appropriate counsel for PK and his parents? A. This lesion has characteristics of a hemangioma, this is a pigmented lesion which may grow over time, considering its location let's consult dermatology as steroids, betablockers or laser treatment may be indicated B. This lesion has characteristics of a hemangioma, this is a vascular lesion which may grow over time, considering its location let's consult dermatology as steroids, betablockers or laser treatment may be indicated
C. This lesion has characteristics of a salmon patch , this is a vascular lesion which will likely resolve over time we will monitor it for changes and consult dermatology if not improving. D. This lesion has characteristics of a salmon patch , this is a pigmented lesion which will - --------- ANSWER --------B. This lesion has characteristics of a hemangioma, this is a vascular lesion which may grow over time, considering its location let's consult dermatology as steroids, betablockers or laser treatment may be indicated Reviewing lesion pathophysiology you understand that vascular nevi are malformations of blood vessels near the skin surface. Which of the following lesions is NOT a type of vascular nevi: A. Salmon Patch B. Hemangioma C. Port-wine stain D. Blue nevi - ---------ANSWER --------D. Blue nevi 12 - year-old ST presents with a complaint of a possible "spider bite" on exam you note a tender 3 cm fluctuant area of erythema. As his primary care nurse practitioner how will you manage this condition? A. Incise the lesion and then await culture results to determine antibiotic treatment B. Incise and drain the fluctuant lesion and initiate oral antibiotic therapy with Group A strep coverage C. Incise and drain the fluctuant lesion and initiate oral antibiotic therapy with both staph aureus and Group A strep coverage D. Initiate oral antibiotic therapy with staph aureus and Group A strep coverage, if not improving consider incising the lesion - ---------ANSWER --------C. Incise and drain the fluctuant lesion and initiate oral antibiotic therapy with both staph aureus and Group A strep coverage During a well-child examination of an infant, the primary care nurse practitioner counts 8 light brown flat lesions on the infant's trunk. What potential concern is associated with this finding? A. Turner's syndrome B. Neurofibromatosis C. Sturge-Weber syndrome D. Hypothyroidism - ---------ANSWER --------B. Neurofibromatosis At her 2-week follow-up you note 8-month-old TL's otitis media has resolved following a course of Amoxil. On exam you also note bright red papules in a diaper distribution with areas of confluence in the
Your patient's mother expresses concern her daughter may have ADHD. All of the following are symptoms of ADHD EXCEPT A. Trouble organizing school work B. Talking excessively C. Onset of symptoms after age 7 years D. Easily distracted from tasks - ---------ANSWER --------C. Onset of symptoms after age 7 years After ruling out sleep apnea, hypothyroidism and anemia, you diagnose 14-year-old S.H. with mild depression. Which of the following interventions is NOT a recommended treatment for depression: A. Regular exercise and sleep regimen B. SSRI and sunlight exposure C. Distraction with increased screen time D. Cognitive Behavioral Therapy - ---------ANSWER --------C. Distraction with increased screen time Which of the following tools would you choose to screen your patient for autism? A. MCHAT B. Conners C. PHQ- 9 D. HEADDSS - ---------ANSWER --------A. MCHAT A 4-month-old is consolable but is fussy with a history of intermittent low grade fever. An appropriate antipyretic measures would be: A. ibuprofen 10mg/kg q6-8 PRN B. acetaminophen 15mg/kg q 6-8 PRN C. acetylsalicylic acid 20mg/kg D. cool sponge baths - ---------ANSWER --------B. acetaminophen 15mg/kg q 6-8 PRN
As an NP running the student health clinic a 17-year-old J.T. has been referred to you after he "jokingly" made a statement to his teacher that he was going to kill himself. Your surveillance and his PHQ9 score are consistent with depression. Your initial action would be to: A. Report your findings to the school administrator B. Ensure his safety and notify his parents C. Refer JT to a counselor and teen support group D. Contact 911 for immediate transport to the Emergency Department. - ---------ANSWER --------B. Ensure his safety and notify his parents As the primary care NP you have concerns of autism for your 7-year-old patient. Which of the following are diagnostic criteria for autism spectrum disorder? A. Fascination with light or movement B. Tolerance of flexibility with routines C. Abnormal eye movements or body language D. Difficulty in social conversation skills - ---------ANSWER --------D. Difficulty in social conversation skills Suspecting your 5-year-old patient may have ADHD, the following screening scores supports your concern. Choose the tool and your best intervention: A. MCHAT, counsel about behavior modification MCHAT, prescribe methylphenidate B. MCHAT, prescribe methylphenidate C. Conners scale, prescribe methylphenidate. D. Conners scale, counsel about behavior modification - ---------ANSWER --------D. Conners scale, counsel about behavior modification The American Academy of Pediatrics recommends using a screening tool for adolescent depression like the modified PHQ-9. The age and frequency for recommended routine screening is: A. Annual screening 13yrs-18yrs Only screen if presenting symptoms warrant B. Annual screening 15yrs-18yrs C. Annual screening 11yrs-18yrs D. Only screen if presenting symptoms warrant - ---------ANSWER --------C. Annual screening 11yrs-18yrs
_____ is any organism capable of supporting the nutritional and physical growth requirements of another organism - ------CORRECT ANSWER -----host ______ is bacteria that inhabits exposed surfaces of the body - ------CORRECT ANSWER -----microflora _______ is the presence and multiplication of a living organism on or within a host that does NOT cause harm - ------CORRECT ANSWER -----colonization _______ is the disease state brought about by the interaction of an organism living within a host that causes harm to the host - ------CORRECT ANSWER -----infectious disease ____ is the disease inducing potential of a microbe/organism - ------CORRECT ANSWER -----virulence _____ are microorganisms so virulent that they are rarely found in the absence of disease - ------ CORRECT ANSWER -----pathogens _____ is a free-living organism that obtains growth from dead or decaying organic material, rarely affect humans - ------CORRECT ANSWER -----saprophytes ______ are microorganisms that are capable of producing an infectious disease when the health/immunity of the host have been severely weakened by illness, malnutrition, or medical therapy - ------CORRECT ANSWER -----opportunistic pathogens _____ is a relationship between microorganism and host in which both organisms benefit e.g. bacteria in the gut producing Vit. K - ------CORRECT ANSWER -----mutualism ____ is a relationship between microorganism and host in which the colonizing organism acquires its needs from the host, but without causing harm to the host - ------CORRECT ANSWER -----commensalism _____ is a relationship between a microorganism and host in which the microorganism acquires its need at the expense of the host, only the infecting organism benefits - ------CORRECT ANSWER -----parasitism
_____ are protein particles that are able to transmit infection, lack a demonstrable genome, and are resistant to antibiotics due to their lack of repro/metabolic functions - ------CORRECT ANSWER -----prions Two examples of diseases transmitted via prions are: - ------CORRECT ANSWER ------Creutzfeldt Jacob disease
- Kuru Prion-based diseases are typically ______ progressing, and result in non-inflammatory neuronal degeneration resulting in dementia, ataxia, and death - ------CORRECT ANSWER -----slow _______ are the smallest obligate intracellular pathogens, have no organized cellular structure, and can be composed of either DNA or RNA, but never both - ------CORRECT ANSWER -----Viruses Viruses are composed of two parts: the _____ and _______, and require what to replicate? - ------ CORRECT ANSWER ------capsid (protein coat)
- nucleic acid core (genome, either DNA or RNA) They require a host cell in which to replicate, replication cannot occur outside of a living cell ____ are bacteria that lack an organized nucleus - ------CORRECT ANSWER -----prokaryotes _____ are microorganisms that possess a membrane nucleus such as fungi - ------CORRECT ANSWER ----- eukaryotes ______ are a type of fungi that are yeast at one temperature and molds at another - ------CORRECT ANSWER -----dimorphic fungi Examples of dimorphic fungi: - ------CORRECT ANSWER ------blastomycosis
- histoplasmosis
- coccidiodomycosis _____ are long filaments utilized by molds - ------CORRECT ANSWER -----hyphae
