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NURS 6541 Midterm Exam 5 – Question and Answers

1. Medicaid provides health insurance coverage to
2. A differential diagnosis for child abuse would include all of the following except.
3. Which of the following injuries is most likely to be caused by abuse of a toddler?
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. The first sign of the onset of female puberty is usually:
6. 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
7. Which of the following statements about bullying is true?
8. The mother of a 5-year-old informs you that her daughter cheats when playing board games. What is the best response?
9. Which of the following conditions requires urgent inpatient admission?
10. All of the following are consistent with peritonsillar abscess except:
11. 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?
12. You are performing an examination of a 3-year-old who is new to your office. Which finding requires immediate further evaluation?
13. A child’s head circumference is routinely measured on each well visit until what age?
14. Which of the following children has abnormal language development? 
15. Please interpret the following labs for an adolescent. The adolescent has a history of obesity and acanthosis nigricans.
16. Which of the following issues or concepts is relevant to the school-age child?
17. The diagnostic criteria for autism spectrum disorder include all of the following except
18. Conductive hearing loss can be caused by
19. The most common substance used in middle school is
20. The results of the hemoglobin A1c test are LESS reliable in children with which of the following conditions? (Hint: select two)
21. 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?
22. Mark is in the exam room. You are concerned he may have epiglottitis. In what position do these patients prefer to sit?
23. 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:
24. Which of the following characterizes middle adolescence (14 to 16 years old)?
25. 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?
26. A 14-year old has ataxia. He is brought to the local emergency department, where he appears euphoric, emotionally labile, and a bit disoriented. He has nystagmus and hypersalivation. Many notice his abusive language. Which of the following agents is most likely responsible for his condition?
27. 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?
28. A fifteen-year-old female makes a statement to you during a well visit. Which of the following statements should not be kept confidential?
29. Most children can independently get dressed by themselves by age:
30. 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?
31. 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.
32. 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?
33. Chelsea, age 8, complains that she feels as if something is stuck in her ear. What action is contraindicated?
34. Which of the following substances is associated with pupillary constriction?
35. Which of the following children should be referred for a comprehensive developmental evaluation?
36. John is diagnosed with allergic conjunctivitis. What type of discharge do you expect to see upon exam?
37. You diagnose a 16-year-old with acute otitis media and need to prescribe an antibiotic with beta-lactamase coverage. What do you choose?
38. A new mom calls the NP on 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?
39. Which of the following represents normal sequencing of development in a toddler?
40. By what age should most children be able to sit well without support?
41. A common feature of 2-year-old behavior is:
42. 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
43. Flourescein staining of the eye is used to detect a
44. Blood pressure should be measured at well-child visits starting at age:
45. Sarah, 7 years old, is in the office today. All of the following are acceptable management options for allergic rhinitis, except
46. 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?
47. At what age would a child be expected to remember a string of numbers and repeat them backwards?
48. During a domestic health assessment, the CDC recommends screening every refugee child for which of the following diseases?
49. Which of the following signs may indicate a baby is not receiving sufficient breastmilk?
50. Which-of the following eye findings would be considered an ophthalmic emergency?
51. Which of the following statements regarding adolescent substance use is true?
52. Which of the following vaccines is routinely recommended at 4 months of age?
53. The nurse practitioner role was initially established to
54. 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. TM is normal. Mark should be instructed to do which of the following?
55. 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?
56. Early reflexive responses that are not related to survival include all but:
57. You would be concerned about the language development of a child who:
58. The appropriate lab tests in the assessment of cervical adenitis include all of the following except:
59. A 4-month-old presents with both eyes turning inward. What is this called? (NURS 6541 Midterm Exam)
60. 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?
61. You see a 13-year-old who reports she is learning some basic geometry (areas, volume etc.).
62. The ability to successfully master these concepts occurs during which Piaget developmental stage? 
63. 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?
64. 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?
65. Which of the following is a true contraindication of vaccinating a child?
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:  (NURS 6541 Midterm Exam)
67. 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?
68. 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?
69. Which is the correct order for introduction of solid foods to an infant?
70. Which of the following foreign body in the nose requires immediate removal?
71. A Mantoux test in a child with no risk factors is considered positive with a reaction of:
72. 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? (NURS 6541 Midterm Exam)
73. 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?
74. 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: 
75. All of the following may predispose a patient to thrush except: 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?
76. 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:
77. Which of the following screenings should adolescents have done annually?
78. 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? (NURS 6541 Midterm Exam)
79. 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?
80. 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:
81. 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:
82. A 2-year-old child weighs 34 lb. What type of car seat should the child use?
83. Which of the following is a priority nurse practitioner role to help children and adolescents to have healthy sexual development?
84. Epiglottitis has decreased due to which immunization?
85. Role-play with equipment during the course of the physical exam would be the most beneficial with which age group?
86. A 2-day-old newbornwith conjunctivitis is likely due to
87. 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
88. Which of the following would not suggest an eating disorder with a purging component?
89. 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?
90. 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? (NURS 6541 Midterm Exam)
91. You see a 5-month-old who is fussy, has interrupted sleep, and is drooling. You-note large lower lateral incisor bulges. You recommend:
92. The most likely weight of a 1-year-old whose birth weight was 6-1/2 pounds would be:
93. Head and chest circumferences should be equal at:
94. 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?
95. FIRST-LINE therapy for preschoolers (4-5 years of age) diagnosed with attention-deficit hyperactive disorder is:
96. 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
97. A 3-year-old (37 months) refuses to have bowel movements on the toilet. He is bladder trained. He goes and hides and squats when having bowel movements. Positive encouragement and praise is not working. You advise:
98. A typically developing 8-year-old girl will have which of the following genital development? (NURS 6541 Midterm Exam)
99. Which of the following are important considerations when screening child refugees for tuberculosis? SELECT TWO (2)
100. 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
101. 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