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NRNP 6541 Midterm Exam Week 6 (Summer Term)

1. Which of the following statements regarding adolescent substance use is true?
2. 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?
3. The parents of a 7-year-old are concerned their son does not want to attend school. Which of the historical findings are not usually associated with the diagnosis of school phobia?
4. Chelsea, age 8, complains that she feels as if something is stuck in her ear. What action is contraindicated?
5. You see a 7-year-old with complaints of “having accidents at night.” Physical exam and history are unremarkable. Urinalysis, urine culture, and specific gravity are normal. His parents ask about the best treatment for this problem. The best response is
6. 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?
7. Upon eye examination of a newborn, you note inner canthal folds and Brushfield spots. What do you suspect?
8. I like to use my pincer grasp that involves the ability to pick up a small object such as a raisin or piece of cereal with the thumb and forefinger, and that is mastered around what age?
9. 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. What is the proper management for his patient?
10. The diagnostic criteria for autism spectrum disorder include all of the following except
11. 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?
12. Which of the following would not suggest an eating disorder with a purging component?
13. Role-play with equipment during the course of the physical exam would be the most beneficial with which age group?
14. While assessing the skin of an infant, you note cafe-au-lait spots. Which disease should be ruled out?
15. An expected milestone of a 4-year-old is the ability to
16. 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: 
17. An eye that deviates in when covered but that returns to midline when uncovered is an
18. 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?
19. A healthy, well-developed 6-year-old child arrives as a new patient to your clinic. His immunization card reveals that he received immunization at birth and some when he was 2 months old, but none since. Which of the following statements about him is correct?
20. Which of the following issues or concepts is relevant to the school-age child?
21. You would be concerned about the language development of a child who:
22. You diagnose a 16-year-old with acute otitis media and need to prescribe an antibiotic with beta-lactamase coverage. What do you choose?
23. 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?
24. Which of the following characterizes middle adolescence (14 to 16 years old)?
25. Which of the following foreign body in the nose requires immediate removal?
26. Which is the correct order for the introduction of solid foods to an infant?
27. FIRST-LINE therapy for preschoolers (4-5 years of age) diagnosed with the attention-deficit hyperactive disorder is:
28. A 15-month-old  boy says “mama” and “dada,” points and gestures if he wants things, and follows simple one-step commands. Your best response is which of the following?
29. A 4-month-old child has poor weight gain. Her current weight is less than the 5th percentile, height about the 10th percentile, and head circumference at the 50th percentile. The planned pregnancy resulted in a normal, spontaneous, vaginal delivery; mother and child were discharged after a 48-hour hospitalization. Feeding is via breast and bottle; the quantity seems sufficient. The child has had no illness. The examination is unremarkable except for the child’s small size. Screening laboratory shows the hemoglobin and hematocrit are 11 mg/dL and 33% respectively, with a platelet count of 198,000/mm3. Serum electrolyte levels are sodium 140, chloride 105, potassium 3.5, bicarbonate 17, blood urea nitrogen 15, and creatinine 0.3. Liver function tests are normal. Urinalysis reveals a pH of 8 with occasional epithelial cells but no white blood cells, bacteria, protein, ketones, or reducing substances. Which of the following is the most appropriate therapy for this child?
30. Which of the following signs may indicate a baby is not receiving sufficient breastmilk?
31. Which of the following children should be referred for a comprehensive developmental evaluation?
32. By what age should most children be able to sit well without support?
33. I can roll over, grasp a rattle, and reach for things and have begun feeding myself finger foods, but I can’t wave bye-bye yet. How old am I?
34. 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?
35. 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?
36. Which of the following complication of strep pharyngitis cannot be prevented with antibiotics?
37. A fifteen-year-old female makes a statement to you during a well visit. Which of the following statements should not be kept confidential?
38. Which of the following screenings should adolescents have done annually?
39. Which of the following substances is associated with pupillary constriction?
40. The appropriate lab tests in the assessment of cervical adenitis include all of the following except:
41. What method can be safely used to remove cerumen in a 15-month-old child’s ear?
42. Max, a 9-year-old boy, is a very active child with limited self-control. He is easily distracted and has difficulty staying on task. You determine that he should have a neurodevelopmental evaluation because he is showing signs of
43. A mother states that her 4-year-old son constantly grinds his teeth at night. You document this as:
44. The father of a 3-year-old is concerned because the child stutters. What should your approach be?
45. A mother of a 6-month-old asks you about normal sleep patterns for an infant this age. The best response is:
46. 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
47. Which of the following eye findings would be considered an ophthalmic emergency?
48. Mark is in the exam room. You are concerned he may have epiglottitis. In what position do these patients prefer to sit?
49. 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:
50. Which of the following statements about bullying is true?
51. For adolescent girls, peak height velocity should occur by Tanner Stage (SMR):
52. 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:
53. A 4-month-old presents with both eyes turning inward. What is this called?
54. An 8-year-old female has an edematous, mildly erythematous right upper eyelid for 2 days with a fever of 102.9 (F). Which important eye assessment do you need to consider?
55. 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?
56. 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?
57. Head and chest circumferences should be equal at:
58. Which of the following represents normal sequencing of development in a toddler?
59. A 7-year-old boy with mental retardation was born at home at 26 weeks gestation to a 28-year-old mother who had received no prenatal care. An evaluation is likely to suggest his MR is related to which of the following?
60. A child’s head circumference is routinely measured on each good visit until what age?
61. 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:
62. An 8-year-old female is brought into the office by her mother. She has had 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?
63. Sam has otitis media. He also presents with conjunctivitis. This is due to which organism?
64. Blood pressure should be measured at well-child visits starting at age:
65. 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 difficult. She persistently uses only one hand. What condition do you suspect?
66. A common feature of 2-year-old behavior is:
67. Appropriate anticipatory guidance for the parents of an 8-year-old girl includes
68. Which of the following statements is true regarding lying and stealing by the school-age child?
69. Epiglottitis has decreased due to which immunization?
70. 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:
71. You see a 3-year-old for a well-child visit. His mother informs you that potty training has been very easy because he “has an amazing internal clock. He falls asleep, gets hungry, and has bowel movements at the same time every day.” This describes which aspect of temperament?
72. 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?
73. A 14-year old has ataxia. He is brought to the local emergency department, where he appears euphoric, emotionally labile, and disoriented. Many notice his abusive language. Which of the following agents is most likely responsible for his condition?
74. An 11-year-old girl has dizziness, pupillary dilation, nausea, fever, tachycardia, and facial flushing. She says she can “see” sound and “hear” colors. The agent likely to be responsible is which of the following?
75. You are performing an examination of a 3-year-old who is new to your office. Which finding requires immediate further evaluation?
76. Please interpret the following labs for an adolescent. The adolescent has a history of obesity and acanthosis nigricans.
77. A 2-year-old child weighs 34 lb. What type of car seat should the child use?
78. Most children can independently get dressed by themselves by age:
79. Which adolescent would be at greatest risk for developing anorexia nervosa?
80. The most common substance used in middle school is
81. 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 affected?
82. What is the most traumatic, yet common form and of child abuse seen in pediatric primary care?
83. 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
84. 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?
85. All of the following are consistent with peritonsillar abscess except:
86. During a domestic health assessment, the CDC recommends screening every refugee child for which of the following diseases?
87. A Mantoux test in a child with no risk factors is considered positive with a reaction of:
88. A 2-day-old newborn with conjunctivitis is likely due to
89. 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? 
90. A mother brings her 4-week-old infant into the office 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. Fluorescein staining of the eye is used to detect a
92. A new mom calls the NP on a postpartum day 5. She reports her newborn wants to nurse for 30 minutes every 1-1/2 to 2 hours. Which of these is the best response?
93. Tammy, age 3, is at the office for her well-child visit. She has trouble removing her own shirt as requested. Her mother yanks off her shirt after smacking her wrist and saying, “you must do as you’re told quickly.” Which action is indicated?
94. Which of the following injuries is most likely to be caused by the abuse of a toddler?
95. 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?
96. 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 the diagnosis of hyphema. What treatment do you recommend while Miguel is waiting to see the ophthalmologist?
97. Which of the following children has abnormal language development? 
98. 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: 
99. 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
100. You see a 5-month-old who is fussy, has interrupted sleep and is drooling. You note large lower lateral incisor bulges. You recommend: