NSG6435 Week 5 Assignment 4 Midterm Exam / NSG 6435 Week 5 Midterm Exam -Family Health – Pediatrics- South University
Question 1.
The incidence of congenital heart defects is estimated to be ________ of all live births.
20%
10%
5%
1%

Question 2
Breastmilk can be safely stored in a freezer below 0 degrees Fahrenheit for how long?
Three months
Six months
One year
Two years
Question 3
Which foreign body needs immediate removal from a five-year-old boy’s nose?
Bean
Bead
Stone
Battery
Question 4
The most useful diagnostic test in delayed puberty is _____________________.
complete thyroid panel
X-Ray of the left wrist and hand
X-Ray of the right wrist and hand
X-Ray of the spinal column
Question 5
An average vision of a two-year-old child is approximately:
20/150
20/400
20/70
20/30
Question 6
A five-year-old female presents for a follow-up emergency room visit with a diagnosis of bronchitis. You would expect which treatment to have been prescribed?
Oral steroids
Azithromycin
Increase rest and fluid
Albuterol
Question 7
An adolescent with a chronic asthma cough notes that symptoms are usually worse _____________.
only with exertion
only during the daytime
only at night
at night and with exertion
Question 8
An average adolescent female usually experiences her biggest growth spurt at approximately what age?
Ten and half years
Eleven and half years
Twelve and half years
Thirteen and half years
Question 9
If an adolescent has a bone age of 10 but is actually 13 years of age, this patient has ______.
an increased risk of fracture in the next three years
an increased risk of osteoporosis as an adult
a higher potential for bone growth
a lower potential for bone growth
Question 10
Gardasil results in greater antibody responses for females who are administered the three-dose series between what ages?
Six to twenty-six years of age
Prior to eleven years of age
Nine to fifteen years of age
Nine to twenty-six years of age
Question 11
An eight-year old has chronic intermittent nasal congestion. All but which of the following would support allergic rhinitis?
Red swollen turbinates
Darkened areas below eyes
Increased basophils on complete blood count (CB
Itchy, watery eyes
Question 12
A fifteen-month old failed treatment with amoxicillin for an otitis media. At his two-week recheck, his tympanic membrane remained red with distorted landmarks and he persisted with nasal discharge that is thick and yellowish. The best action for the nursing practitioner should be to prescribe:
A ten-day-course of augmentin
A three-week-course of a cephalexin
A higher dose amoxicillin
Ceftriaxone and an antihistamine
Question 13
An infant should be able to say his or her first word by:
four to five months
eight to nine months
twelve to fifteen months
twenty four to twenty six months
Question 14
The latter part of adolescence includes the ability to develop ________ and _______ means to be a part of society.
strong attachments; sexuality
career; marriage
critical thinking; basic life skills
moral; intellectual means
Question 15
A fourteen-year-old adolescent presents with fatigue, endocarditis, pulmonary hypertension, arrhythmias, and congestive heart failure. You suspect he may have ____________.
ASD
pulmonary valve stenosis
aortic valve stenosis
a ventricular septal defect (VSD)
Question 16
A four-year-old male patient presents with his mother with a school referral regarding red eyes. Which questions would not assist in establishing a list of differential diagnoses?
Unilateral vs. bilateral presentation
Type of drainage
Vision status
History of a bacterial infection one month ago
Question 17
______________ adolescents should be screened for sexually transmitted diseases.
Males
Females
All
Sexually active
Question 18
An infant should no longer have a head lag when pulled from the supine to sitting position at what age?
Two months
Four months
Six months
Nine months
Question 19
____________ should be given as a supplement in the management of delayed puberty.
Vitamins B1 and B12
Vitamins D and E
Vitamin A and Calcium
Calcium and Vitamin D
Question 20
Parents or guardians of adolescents should ___________________.
not be included in the adolescent’s health care
receive health guidance information at least twice during adolescence
encourage reasonable use of alcohol and tobacco by the adolescent
encourage early sexual activity by providing condoms to the adolescent
Question 21
How does cultural sensitivity impact the care of infants in the primary care setting?
Health-care providers may possess cultural biases that can impact care.
Cultural sensitivities do not exist in health care.
Cultural sensitivity only impacts the parents of infants.
Cultural sensitivity increases access to timely health-care services for infants.
Question 22
The most typical chest radiographic finding consistent with the diagnosis of asthma is ______________.
normal chest film
diffuse airway edema
right upper-lobe infiltrate
hyperinflation
Question 23
A 10 yo has a single painful ulcerated lesion on an erythematous base on the inner buccal mucosa. The most likely diagnosis and treatment would be: 
 herpes simplex stomatitis–oral acyclovir
 herpangina–viscous xylocaine
 apthous ulcer–triamcinalone in orabase
Hand, foot, mouth syndrome–antibiotic mouthwash
Question 24
 
A 9 month old is noted to have a bifid uvula. This would increase his risk of developing which disorder? 
 otitis media
 retropharyngeal abscess
 sinusitis
dental malocclusion
 
Question 25
 
All of the following may predispose a patient to thrush except: 
 age
 steroid therapy
 antibiotics
poor oral hygiene
Question 26
 
Patients with sinusitis should be instructed not to participate in what activity? 
 swimming/ diving
 boxing/ wrestling
 weight lifting
cross country running
Question 27
 
What complication of sinusitis are adolescent males more prone to? 
 intracranial abscess
 potts puffy tumor
 orbital cellulitis
dental infection
 
Question 28
 
Acceptable management options for allergic rhinitis include all of the following except: 
 oral cetirizine
 oral montelukast
 nasal beclomethsone
nasal neosynephrine
Question 29
 
A 7 yo has experienced recurrent nose bleeds in the past 2 months. What finding on the physical exam would suggest an underlying medical cause for the epistaxis? 
 wheezing
 grade II murmur
 petechiae
tonsil hypertrophy
Question 30
 
A 2 yo male with a history of chronic serous OM is noted to have a pearly white opacity in the upper outer quadrant of his TM. He currently has no symptoms and appears to be ok. The most likely diagnosis and appropriate managment would be: 
 tympanosclerosis; no treatment is necessary
 persistent perforation; prescribe topical antibiotic drops
 foreign body; perform an ear wash for removal
cholesteatoma; refer to otolaryngology
Question 31
A 15 mo failed treatment with amoxicillin for OM. At his 2 week re-check his TM remained red with distorted landmarks and he persisted with nasal congestion, poor sleep, and fever. The next best step would be to treat with:
 a 10 day course of augmentin
 a 3 week course of cephalosporin
 a higher dose of amoxicillin and topical abx
ceftriaxone and an antihistamine
 
 
 
 
 
 
 
 
Question 32
All but which one of the following patients are at an increased risk of developing otitis media? 
 2 yo with cleft palate repair at 1 year of age
 15 mo with down syndrome
 9 mo with lactose intolerance
3 yo with IgA immune deficiency
Question 33
Patients with otitis externa should be instructed to do which one of the following:
 keep ear dry until symptoms improve
 limit swimming for the remainder of summer
 wear ear plugs at all times with swimming
use alcohol drops before swimming each day
Question 34
A 10 yo has marked ear pain, not wanting anyone to touch his ear. The canal is edematous and exudate is present. TM is normal. How should this be managed? 
 topical fluoroquinolone
 oral steroids and topical neomycin
 oral amoxicillin and topical anesthetic
oral amoxicillin and topical steroid
Question 35
A 16 yo was hit in the eye 1 day ago and now has ecchymoses on the upper and lower lids with 5/10 eye pain. All but which of the following would be appropriate to obtain at this time: 
 visual acuity
 intraocular pressure
 CT scan
fluorescein stain
Question 36
The greatest risk in a patient with a hyphema is which of the following? 
 glaucoma
 infection
 rebleed 
cataracts
Question 37
Corneal abrasions can be managed with topical application of which of the following:
 anesthetic for pain control
 steroids to prevent adhesions
 antibiotics to prevent infection
atropine to prevent ciliary spasm
Question 38
Trauma to the eye increases the risk of developing all but which one of the following?
 strabismus
 glaucoma
 cataracts
hyphema
Question 39
Fluorescein staining of the eye is used to detect a: 
 keratitis
 foreign body
 corneal abrasion
hyphema
Question 40
Prematurity increases the risk of developing which one of the following? 
 nystagmus
 astigmatism
 myopia
glaucoma
Question 41
 
A 3 month old has a mild asymmetrical corneal light reflex on physical exam. What is the next appropriate step? 
 observe and reevaluate at the next well check
 refer immediately to ophthalmology
 begin atropine drops or eye patching
protect eyes from sunlight
Question 42
 
Which of the following may cause microcephaly? 
 Hypocalcemia
 Craniosynostosis
 Skull fracture
Seizure disorder
Question 43
What finding may accompany macrocephaly?
 Pulsating anterior fontanel
 Sunken fontanel
 Premature closure of suture lines
Widened suture lines
Question 44
 
Obtaining a CT of the head would be indicated in which of these conditions? 
 Macrocephaly
 Cephalohematoma
 Craniosynostosis
Caput succedaneum
Question 45
 
Which one of the following conditions increases the risk of developing hydrocephalus? 
 Bilateral cephalohematomas
 Craniosynostosis
 Prematurity
Familial macrocephaly
Question 46
 
A conjunctivitis appearing in a 2 day old newborn is likely due to: 
 chemical irritation from eye drops
 group B streptocuccus
 chlamydia
gonorrhea
Question 47
 
Confirming the diagnosis of chlamydia conjunctivitis in a newborn would best be done by obtaining which one of the following? 
 cervical swab of the mother
 urine PCR from the mother
 culture of the eye discharge
culture of the conjunctival scrapings
Question 48
 
Which one of the following eye findings would be considered an ophthalmic emergency?
 unilateral vesicular lesions on the upper eyelid of a 3 week old
 presence of chemosis in a 5 yo with bilateral upper eyelid edema
 cobblestone-like appearance along the inner aspect of the upper eyelid in a 15 yo
bilateral redness along the eyelid margins with tiny ulcerated areas in a 16 yo
Question 49
 
 
The most appropriate management of a 5 yo with a firm, nontender nodule in the mid-upper eyelid for 3 weeks would be: 
 cool compresses
 topical ophthalmic ointment
 oral antibiotics
oral steroids
Question 50
 
Daily eyelid cleansing with diluted baby shampoo and a cotton tipped applicator would be appropriate in the treatment of which one of the following conditions? 
 Dacryostenosis
 Chalzion
 Hordeolum
Blepharitis
Question 51
 
A 3 year old has an edematous, mildly erythematous right upper eyelid for one day with a fever of 103. An important eye assessment would be: 
 ocular mobility
 conjunctival inflammation
 pupillary reaction
optic disk papilledema
Question 52
 
Concurrent otitis media and conjunctivitis is likely due to which organism? 
 streptococcus pneumoniae
 haemophilus influenza
 moraxella catarrhalis
staphylococcus aureus
 
Question 53
A 16 yo girl makes the following statements to you during her health visit. Which of the following pieces of information should not be kept confidential?
 I have been sexually active with three of my boyfriends
 I sometimes smoke marijuana
 I want to get pregnant
Sometimes I feel like ending my life
Question 54
In performing a physical examination on a nine month old infant, which of the following developmental fears would not be appropriate for you to consider? 
 Stranger anxiety
 Pain
 Separation from parents
Bodily harm
Question 55
When performing a physical examination on a toddler, which of the following body parts would you examine last: 
 Heart and lungs
 abdomen and genitals
 Ears and throat
Hips and extremities
Question 56
Role play with equipment during the course of a physical examination would be most beneficial with which of the following age groups: 
 Toddlers
 Preschoolers
 Young school-age children
Older school-age children
Question 57
Providing reassurance of “normalcy” during the course of an examination would be most important for: 
 Preschool children
 Young school-age children
 Older school-age children
Adolescents
Question 58
Which of the following would not elevate the pulse of a child: 
 Fever
 Anemia
 Hypothyroidism
Exercise
 
Question 59
The PNP recognizes which of the following signs as indicators that baby is not receiving sufficient breastmilk?
 Sleepiness, jaundice, decreased urine and stool
 Diarrhea, nausea, and vomiting
 Bulging fontanel and irritability
Sleeplessness and excitability
Question 60
Blood pressure should be measured at WCC beginning at age: 
 2
 3
 4
5
Question 61
 
A wide pulse pressure that results from a high systolic blood pressure is usually not due to which of the following: 
 Fever
 Exercise
 Excitement
A patent ductus arteriosus
Question 62
 
Head and chest circumferences should be equal at: 
 6 months
 1 year
 2 years
3 years
Question 63
 
The anterior fontanel usually closes by: 
 2 months
 6 months
 18 months
24 months
Question 64
 
Diffuse edema of the soft tissue of the scalp which usually crosses suture lines in the newborn is: 
 Bossing
 Caput seccedaneum
 Cephalohematoma
Macrocephaly
Question 65
An infant should no longer have head lag when pulled from the supine to sitting position at what age? 
 2 months
 4 months
 6 months
9 months
Question 66
“Boggy” nasal mucous membranes with serous drainage upon examination usually suggests: 
 Sinusitis
 Polyps
 URI
Allergic rhinitis
Question 67
A white instead of red reflex upon eye examination of a 1 yo child would suggest: 
 An accommodative error
 Retinoblastoma
 Papilledema
Retinal detachment
Question 68
A cobblestone appearance of the palpebral conjunctiva usually indicates: 
 Bacterial infection
 Chemical irritation
 Viral infection
Severe allergy
Question 69
An eye that deviates in when covered but returns to midline when uncovered is an: 
 Esophoria
 Exophoria
 Esotropia
Exotropia
Question 70
Pain produced by manipulation of the auricle or pressure on the tragus suggests: 
 Acute otitis media
 Otitis externa
 Otitis media with effusion
Mastoiditis
Question 71
 
A hypernasal voice and snoring in a child is suggestive of: 
 Polyps of the larynx
 Nasopharyngeal tumor
 Hypertrophied adenoids
Cleft palate
Question 72
Physiological splitting of the second heart sound during inspiration in a child: 
 is normal
 should be evaluated with an EKG
 Suggests ASD
Should be referred to a cardiologist
Question 73
Which of the following is not characteristic of innocent heart murmurs in children?
 Systolic in timing
 Varies in loudness with positioning
 Usually transmitted to the neck
Usually loudest at lower left sternal border or at second or third intercostal space
Question 74
A grade II musical or vibratory murmur heard best at the lower left sternal border that changes with positioning is suggestive of a: 
 Pulmonary ejection murmur
 Ventricular septal defect
 Venous hum
Vibratory or Still’s murmur
Question 75
 
Wheezing in a child may not be found in which of the following conditions: 
 Asthma
 Bronchiolitis
 Pleural friction rub
Cystic fibrosis
Question 76
Gynecomastia in a male may not be a finding in which of the following: 
 Normal pubertal development
 Steroid usage
 Hyperthyroidism
Testicular tumor
Question 77
Which of the following would usually not be considered a sign of a pituitary tumor in an adolescent female? 
 Dysfunctional uterine bleeding
 Galactorrhea
 Loss of peripheral vision
Increase in headaches
Question 78
Which of the following is not a specific examination test for a dislocated hip?
 Barlow’s test
 Ortolani’s test
 Trendelenburg test
Gower’s test
Question 79
In addition to the knee, which of the following should be examined in a child complaining of knee pain? 
 Foot
 Ankle
 Hip
Spine
Question 80
Which of the following infant reflexes should not disappear by 6 months of age? 
 Moro
 rooting
 tonic neck
plantar grasp
Question 81
Spasticity in an infant may be an early sign of: 
 Neurofibromatosis
 Hydrocephalus
 Cerebral palsy
Muscular dystrophy
Question 82
A shift to the left is present when which of the following are elevated? 
 Neutrophils
 Bands or stabs
 Lymphocytes
Eosinophils
Question 83
 
Which of the following is usually elevated with viral infections? 
 Neutrophils
 Eosinophils
 Lymphocytes
Basophils
Question 84
Decreased platelets may not be found in which of the following:
 Leukemia
 Anemia
 Idiopathic thrombocytopenic purpura
Medication usage (e.g. ampicillin, cephalothin)
Question 85
 
Which of the following does not suggest a urinary tract infection? 
 Increased protein
 Increased WBCs
 Increased RBCs
Increased nitrites