NR 661 Pediatrics 1 to 100

Question 1:

A 12-month-old is here today to receive the varicella immunization. A patient’s mother reports that her 12-month-old child was exposed to chickenpox about a week ago. The NP should recommend that he:

Correct Answer: be given the vaccine. (correct answer)
Explanation: The varicella vaccine can still be administered even if the child has been exposed to chickenpox. The vaccine may help in preventing or reducing the severity of the disease.

Question 2:

The term caput succedaneum refers to:

Correct Answer: scalp edema. (correct answer)
Explanation: Caput succedaneum is the swelling of the soft tissues of the scalp that occurs due to pressure on the head during delivery. It usually resolves on its own without treatment.

Question 3:

A 7-year-old boy who was previously unimmunized received his first tetanus, diphtheria, and acellular pertussis (TDaP), Hepatitis A, Hepatitis B, inactivated polio (IPV), measles, mumps, and rubella (MMR), and Varicella vaccinations one month ago. He returns today for his second series of immunizations. He should receive:

Correct Answer: Hepatitis B, TDaP, IPV, and MMR. (correct answer)
Explanation: The child should receive the second doses of Hepatitis B, TDaP, IPV, and MMR vaccines according to the vaccination schedule. Varicella can be administered later.

Question 4:

A 7-year-old male presents with encopresis. The NP might expect:

Correct Answer: constipation. (correct answer)
Explanation: Encopresis often occurs due to chronic constipation, where stool builds up in the colon, causing involuntary leakage.

Question 5:

An infant is diagnosed with diaper dermatitis. Satellite lesions are visible. This should be treated with a:

Correct Answer: topical antifungal agent. (correct answer)
Explanation: Satellite lesions in diaper dermatitis are indicative of a fungal infection, commonly treated with a topical antifungal cream.
Question 6:
When is a child first able to stand on one foot?
Correct Answer:
3 years.
(correct answer)
Explanation: Most children develop the ability to balance on one foot by the age of 3, which is a milestone in their motor development.
Question 7:
A patient has suspected scarlet fever. He likely has a sandpaper rash and:
Correct Answer:
a positive rapid Strept test.
(correct answer)
Explanation: Scarlet fever is commonly associated with Group A Streptococcus, and a positive rapid Strep test can confirm the diagnosis.
Question 8:
A 4-year-old female is brought into the clinic by her mother, who reports that she is constantly scratching “her private part.” The patient states that it itches. On exam, the vagina is red and irritated. How should the NP proceed?
Correct Answer:
Collect a vaginal swab of the external vagina for microscopic evaluation.
(correct answer)
Explanation: Collecting a vaginal swab allows for the identification of possible infections or irritants causing the symptoms.
Question 9:
What early finding may lead the provider to suspect renal artery stenosis in a 3-year-old male?
Correct Answer:
Increased blood pressure.
(correct answer)
Explanation: Renal artery stenosis can lead to hypertension in children, which may be an early indicator of this condition.
Question 10:
The chest circumference of a 12-month-old is:
Correct Answer:
equal to head circumference.
(correct answer)
Explanation: At 12 months of age, it is typical for a child’s chest circumference to be approximately equal to the head circumference, which is a normal growth milestone.
Question 11:
Which reflex would NOT be observed in a 1-month-old infant?
Correct Answer:
Parachute reflex.
(correct answer)
Explanation: The parachute reflex, which is a protective reflex, does not develop until about 8-9 months of age, so it would not be observed in a 1-month-old infant.
Question 12:
What is the earliest age that an average child would appropriately receive construction paper and a pair of scissors with rounded points?
Correct Answer:
4 years.
(correct answer)
Explanation: By the age of 4, children typically have developed the fine motor skills required to use scissors safely under supervision.
Question 13:
The pneumococcal immunization in infants has:
Correct Answer:
shifted the pathogenesis to fewer cases of S. pneumoniae.
(correct answer)
Explanation: The pneumococcal vaccine has been effective in reducing the incidence of infections caused by Streptococcus pneumoniae in infants.
Question 14:
Most hypertension in preadolescents and children is:
Correct Answer:
secondary hypertension.
(correct answer)
Explanation: In children, hypertension is often secondary to underlying conditions such as kidney disease, rather than primary (essential) hypertension.
Question 15:
According to the Tanner stages of development (Sexual Maturity Rating), breast development in Stage 5 in females includes the:
Correct Answer:
projection of the nipple only.
(correct answer)
Explanation: In Tanner Stage 5, the final stage of breast development, the breast reaches adult size and shape with the nipple projecting outwards.

Question 6:

When is a child first able to stand on one foot?

Correct Answer: 3 years. (correct answer)
Explanation: Most children develop the ability to balance on one foot by the age of 3, which is a milestone in their motor development.

Question 7:

A patient has suspected scarlet fever. He likely has a sandpaper rash and:

Correct Answer: a positive rapid Strept test. (correct answer)
Explanation: Scarlet fever is commonly associated with Group A Streptococcus, and a positive rapid Strep test can confirm the diagnosis.

Question 8:

A 4-year-old female is brought into the clinic by her mother, who reports that she is constantly scratching “her private part.” The patient states that it itches. On exam, the vagina is red and irritated. How should the NP proceed?

Correct Answer: Collect a vaginal swab of the external vagina for microscopic evaluation. (correct answer)
Explanation: Collecting a vaginal swab allows for the identification of possible infections or irritants causing the symptoms.

Question 9:

What early finding may lead the provider to suspect renal artery stenosis in a 3-year-old male?

Correct Answer: Increased blood pressure. (correct answer)
Explanation: Renal artery stenosis can lead to hypertension in children, which may be an early indicator of this condition.

Question 10:

The chest circumference of a 12-month-old is:

Correct Answer: equal to head circumference. (correct answer)
Explanation: At 12 months of age, it is typical for a child’s chest circumference to be approximately equal to the head circumference, which is a normal growth milestone.

Question 11:

Which reflex would NOT be observed in a 1-month-old infant?

Correct Answer: Parachute reflex. (correct answer)
Explanation: The parachute reflex, which is a protective reflex, does not develop until about 8-9 months of age, so it would not be observed in a 1-month-old infant.

Question 12:

What is the earliest age that an average child would appropriately receive construction paper and a pair of scissors with rounded points?

Correct Answer: 4 years. (correct answer)
Explanation: By the age of 4, children typically have developed the fine motor skills required to use scissors safely under supervision.

Question 13:

The pneumococcal immunization in infants has:

Correct Answer: shifted the pathogenesis to fewer cases of S. pneumoniae. (correct answer)
Explanation: The pneumococcal vaccine has been effective in reducing the incidence of infections caused by Streptococcus pneumoniae in infants.

Question 14:

Most hypertension in preadolescents and children is:

Correct Answer: secondary hypertension. (correct answer)
Explanation: In children, hypertension is often secondary to underlying conditions such as kidney disease, rather than primary (essential) hypertension.

Question 15:

According to the Tanner stages of development (Sexual Maturity Rating), breast development in Stage 5 in females includes the:

Correct Answer: projection of the nipple only. (correct answer)
Explanation: In Tanner Stage 5, the final stage of breast development, the breast reaches adult size and shape with the nipple projecting outwards.

Question 16:

A child who is 15 months old is referred to as a(n):

Correct Answer: toddler. (correct answer)
Explanation: A child between the ages of 1 and 3 years is typically referred to as a toddler, a stage characterized by increased mobility and independence.

Question 17:

Pharmacologic treatment for children who have hypertension should be initiated for:

Correct Answer: diabetics with hypertension. (correct answer)
Explanation: Children with both diabetes and hypertension are at higher risk for cardiovascular complications, making pharmacologic treatment essential.

Question 18:

A 15-year-old male has worked this summer as a lifeguard at a local swimming pool. He complains of itching in the groin area. He is diagnosed with tinea cruris. The nurse practitioner is likely to identify:

Correct Answer: well-marginated half-moon macules on the inner thigh. (correct answer)
Explanation: Tinea cruris, also known as “jock itch,” presents with well-defined, scaly, red patches in the groin area, often in the shape of a half-moon.

Question 19:

A 2-month-old infant has an asymmetric Moro reflex. Which statement is true?

Correct Answer: The infant could have a birth injury. (correct answer)
Explanation: An asymmetric Moro reflex may indicate an underlying birth injury, such as a brachial plexus injury or clavicle fracture.

Question 20:

At what age should initial blood pressure screening take place?

Correct Answer: 3 years. (correct answer)
Explanation: Routine blood pressure screenings typically begin at the age of 3 years during well-child visits to detect any early signs of hypertension.

Question 21:

A 15-year-old female has been sexually active since she was 12 years old. She presents today with concerns of pregnancy. How should this be managed?

Correct Answer: Pregnancy test should be performed today. (correct answer)
Explanation: The first step in managing a sexually active adolescent with concerns about pregnancy is to perform a pregnancy test to confirm or rule out pregnancy.

Question 22:

A 7-year-old has a complaint of ear pain. If he has otitis externa, which complaint is most likely?

Correct Answer: He has tragal pain. (correct answer)
Explanation: Otitis externa, also known as “swimmer’s ear,” often presents with pain when the tragus (the small pointed part of the outer ear) is touched or manipulated.

Question 23:

Which of the following is an appropriate initial intervention for gastroesophageal reflux disease (GERD) in an 8-week-old?

Correct Answer: Small, frequent thickened feedings. (correct answer)
Explanation: For infants with GERD, small, frequent feedings with thickened formula or breast milk can help reduce reflux symptoms.

Question 24:

A 4-year-old is being examined today in the NP clinic. He appears shy and does not make eye contact with the examiner. The mother does not make eye contact with the examiner either. The patient lacks animation and does not smile. What likely possibility must be considered?

Correct Answer: Neglect is possible. (correct answer)
Explanation: The lack of eye contact and animation in both the child and mother may be a sign of neglect, and this possibility should be further explored.

Question 25:

How often should blood pressure be measured in a child who is 3 years old?

Correct Answer: It should be measured annually. (correct answer)
Explanation: Blood pressure should be measured annually in children starting at age 3 as part of routine health assessments to monitor for hypertension.

Question 26:

An 8-year-old has a painful limp. He reports that his knee hurts medially. On exam, he has pain with internal rotation of the hip. How should the NP manage this situation?

Correct Answer: The NP should order a hip X-ray, CBC, and ESR. (correct answer)
Explanation: Pain with internal rotation of the hip in a child with a limp suggests a possible hip pathology. A hip X-ray, CBC, and ESR are necessary to evaluate the cause, such as an infection or inflammation.

Question 27:

A 12-month-old was screened for iron deficiency anemia and found to be anemic. The nurse practitioner ordered oral iron. In 1 month, the child’s hemoglobin was reassessed. It increased greatly. Which answer might account for this?

Correct Answer: The bone marrow is responding appropriately. (correct answer)
Explanation: A significant increase in hemoglobin after starting iron therapy indicates that the bone marrow is responding well to the treatment, producing more red blood cells.

Question 28:

At what age would a baby first be expected to locate an object hidden from view?

Correct Answer: At 9 months of age. (correct answer)
Explanation: Object permanence, or the ability to locate an object hidden from view, typically develops around 9 months of age in infants.

Question 29:

A mother presents with her 1-month-old infant. She reports that he cries inconsolably every evening after his first evening feeding. She asks for help. What should be done?

Correct Answer: Provide education, parental reassurance, and encouragement. (correct answer)
Explanation: Inconsolable crying in an infant is often due to colic. Providing reassurance and education to the parents about this condition is the appropriate management.

Question 30:

The initial step in the management of encopresis is:

Correct Answer: client and family education. (correct answer)
Explanation: The first step in treating encopresis involves educating the child and family about the condition and its management, often including dietary and behavioral strategies.

Question 31:

A 3-year-old female had a fever of 102° F for the last 3 days. Today she woke up from a nap and is afebrile. She has a maculopapular rash. Which statement is true?

Correct Answer: The rash will blanch. (correct answer)
Explanation: A maculopapular rash that blanches is characteristic of roseola, a common viral infection in young children that typically follows a high fever.

Question 32:

The age at which a child can first walk backwards is:

Correct Answer: 18 months. (correct answer)
Explanation: Most children develop the motor skills to walk backward around 18 months of age, marking an important milestone in their physical development.

Question 33:

A 6-week-old is suspected of having developmental dysplasia of the hip (DDH). What test would best assess for this?

Correct Answer: Barlow and Ortolani. (correct answer)
Explanation: The Barlow and Ortolani maneuvers are clinical tests used to diagnose developmental dysplasia of the hip in infants by checking for hip instability.

Question 34:

A 1-year-old patient’s mother reports allergy to gelatin. The mother describes the reaction as “lips swelling and breathing difficulties that necessitated a trip to the emergency department.” Which immunizations should be avoided?

Correct Answer: Varicella and MMR. (correct answer)
Explanation: Vaccines such as Varicella and MMR contain gelatin, which can trigger allergic reactions in individuals with gelatin allergies.

Question 35:

Which statement below is true of infants with developmental dysplasia of the hip?

Correct Answer: A palpable clunk is considered diagnostic. (correct answer)
Explanation: A palpable clunk felt during the Barlow or Ortolani maneuvers is indicative of a dislocated or dislocatable hip, confirming the diagnosis of DDH.

Question 36:

The nurse practitioner is examining a 3-month-old infant who has normal development. She has identified an alopecic area at the occiput. What should be done?

Correct Answer: Encourage the caregiver to change the infant’s head position. (correct answer)
Explanation: An alopecic area at the occiput is often due to positional alopecia, where the infant’s head rests in one position for prolonged periods. Encouraging the caregiver to change the infant’s head position regularly can help prevent this.

Question 37:

A young female has breast buds bilaterally. This represents Tanner Stage:

Correct Answer: II. (correct answer)
Explanation: Tanner Stage II is characterized by the appearance of breast buds, marking the beginning of breast development during puberty.

Question 38:

A male child has swelling in the upper left thigh below the inguinal ligament. He complains of cramping and intermittent lower abdominal pain. What should be included in the differential diagnosis?

Correct Answer: Femoral hernia. (correct answer)
Explanation: A femoral hernia may present with swelling below the inguinal ligament and can cause intermittent pain. It should be considered in the differential diagnosis.

Question 39:

Which suggestion below is the standard for treating iron deficiency anemia in infants and children?

Correct Answer: Iron supplementation in divided doses between meals with orange juice. (correct answer)
Explanation: Iron supplementation is best absorbed when taken between meals and with vitamin C (such as orange juice), which enhances iron absorption.

Question 40:

A sexually active adolescent male reports that he has dysuria. How should this be managed?

Correct Answer: Urethral/urine cultures should be collected and screening done for STDs. (correct answer)
Explanation: Dysuria in a sexually active adolescent male may be due to a sexually transmitted infection. Urethral and urine cultures should be obtained, and screening for STDs should be conducted.

Question 41:

A 9-year-old has been diagnosed with chickenpox. A drug that should be avoided in him is:

Correct Answer: aspirin. (correct answer)
Explanation: Aspirin should be avoided in children with viral infections like chickenpox due to the risk of Reye’s syndrome, a serious condition that can cause liver and brain damage.

Question 42:

A 4-year-old has been diagnosed with measles. The nurse practitioner identifies Koplik’s spots. These are:

Correct Answer: found on the inside of the cheek and are granular. (correct answer)
Explanation: Koplik’s spots are small, white lesions with a red base that appear inside the cheeks, typically before the rash in measles.

Question 43:

Which infant feeding behavior is least likely related to congenital heart disease (CHD)?

Correct Answer: Infants that burp frequently when feeding. (correct answer)
Explanation: Frequent burping is a normal feeding behavior and is not typically associated with congenital heart disease. Other signs, such as poor feeding or sweating during feeding, are more indicative of CHD.

Question 44:

A pregnant mother in her first trimester has a 5-year-old who has Fifth Disease. What implication does this have for the mother?

Correct Answer: There is a risk of fetal death if she becomes infected. (correct answer)
Explanation: Fifth Disease, caused by Parvovirus B19, can pose a risk to the fetus if the mother is infected during pregnancy, potentially leading to fetal death or complications.

Question 45:

A 12-year-old male with hip pain presents to the NP clinic. Hip pain has occurred with activity for the past 4-6 weeks, but his pain is worse and now involves the knee. There is no history of trauma. How should the workup be initiated?

Correct Answer: Perform Trendelenburg’s test in the office. (correct answer)
Explanation: Trendelenburg’s test can help assess for hip pathology, such as slipped capital femoral epiphysis (SCFE), which can cause referred pain to the knee.

Question 46:

When can a child with chickenpox return to daycare?

Correct Answer: After all lesions have crusted. (correct answer)
Explanation: A child with chickenpox is considered no longer contagious and can return to daycare once all the lesions have crusted over, typically about 5-7 days after the onset of the rash.

Question 47:

A 6-year-old being treated for community-acquired pneumonia (CAP) has been taking azithromycin in therapeutic doses for 72 hours. His temperature has gone from 102° F to 101° F. What should be done?

Correct Answer: Continue the same dose and monitor his status. (correct answer)
Explanation: A slight decrease in fever within 72 hours of starting antibiotics for pneumonia is expected. The current antibiotic regimen should be continued while monitoring the child’s condition.

Question 48:

A 6-month-old child comes into the clinic for immunizations. Which item below allows a delay in his getting immunizations today?

Correct Answer: Child has otitis media with a temperature of 103° F. (correct answer)
Explanation: Immunizations should be delayed if the child has a high fever (e.g., 103° F) associated with an illness such as otitis media, as the immune response might be compromised.

Question 49:

Many factors can contribute to the risk of congenital heart disease. Which maternal disease carries a higher risk of transposition of the great vessels (TGA), ventricular septal defect (VSD), and hypertrophic cardiomyopathy?

Correct Answer: Diabetes. (correct answer)
Explanation: Maternal diabetes is associated with an increased risk of congenital heart defects such as transposition of the great vessels, ventricular septal defect, and hypertrophic cardiomyopathy in the fetus.

Question 50:

A healthy 7-year-old child is diagnosed with atypical pneumonia. He is febrile but not in distress. What is the preferred treatment for him?

Correct Answer: Azithromycin. (correct answer)
Explanation: Azithromycin is the preferred treatment for atypical pneumonia in children, particularly if Mycoplasma pneumoniae is suspected.

Question 51:

An otherwise healthy two-year-old presents with a heart rate that varies with inspiration and expiration. Which statement is true?

Correct Answer: This is a normal exam. (correct answer)
Explanation: A heart rate that varies with respiration (sinus arrhythmia) is a normal finding in children and is not indicative of any underlying pathology.

Question 52:

A 3-day-old full-term infant has a bilirubin level of 16 mg/dL. How should this be managed?

Correct Answer: Order phototherapy for the infant. (correct answer)
Explanation: A bilirubin level of 16 mg/dL in a 3-day-old infant is high and requires phototherapy to reduce the risk of bilirubin encephalopathy.

Question 53:

The nurse practitioner sees a child who reports fatigue and presents with purpura on his lower extremities. His temperature is normal. The differential includes:

Correct Answer: acute leukemia. (correct answer)
Explanation: Fatigue and purpura with normal temperature could be signs of acute leukemia, which should be included in the differential diagnosis.

Question 54:

A 6-year-old complains that his legs hurt. His mother states that he has complained for the past 2 weeks, and she thought it was from “playing outside too much.” When asked to identify the painful areas, the child points to the midshaft of the femurs. He grimaces slightly when asked to walk. What is the most important initial intervention?

Correct Answer: Complete blood count. (correct answer)
Explanation: Persistent leg pain in a child warrants a complete blood count to rule out serious conditions such as leukemia or bone infections.

Question 55:

MMR immunization is safe in children:

Correct Answer: who are allergic to eggs. (correct answer)
Explanation: The MMR vaccine can be safely administered to children with egg allergies, as the amount of egg protein in the vaccine is minimal and does not typically cause allergic reactions.

Question 56:

Correct Answer: Acute lymphocytic leukemia (ALL). (correct answer)
Explanation: Persistent bone pain, especially in the long bones like the femur, may be an early sign of acute lymphocytic leukemia (ALL), which should be considered in the differential diagnosis.

Question 57:

Medications considered first line to treat attention deficit disorder and attention deficit hyperactivity disorder are Schedule:

Correct Answer: II. (correct answer)
Explanation: Medications like stimulants (e.g., methylphenidate, amphetamines) used to treat ADHD are classified as Schedule II drugs due to their potential for abuse and dependence.

Question 58:

A 2-year-old with sickle cell anemia (SCA) should receive which immunizations?

Correct Answer: All routine childhood immunizations at the usual time. (correct answer)
Explanation: Children with sickle cell anemia should receive all routine immunizations according to the standard immunization schedule to protect against infections.

Question 59:

A 6-month-old male has a palpable cystic mass in his scrotum. His mother states that sometimes the size of his scrotum varies. What should the nurse practitioner do next?

Correct Answer: Referral to urology if this has not resolved in 6 more months. (correct answer)
Explanation: A cystic mass in the scrotum that varies in size could be a hydrocele. If it persists beyond 1 year of age, referral to a urologist is appropriate for further evaluation.

Question 60:

An 18-month-old child is diagnosed with bronchiolitis. His respiratory rate is 28 breaths per minute. Which choice below is most appropriate for patient management?

Correct Answer: Antipyretics. (correct answer)
Explanation: Bronchiolitis in a young child is typically managed supportively with antipyretics for fever and close monitoring of respiratory status. The respiratory rate of 28 is within the normal range for this age.

Question 61:

A 6-week-old infant is found to have positive Barlow and Ortolani maneuvers. What test should the NP order to assess and confirm developmental dysplasia of the hip (DDH)?

Correct Answer: Ultrasound of the hip. (correct answer)
Explanation: An ultrasound of the hip is the imaging modality of choice for assessing developmental dysplasia of the hip (DDH) in infants, especially if the Barlow and Ortolani tests are positive.

Question 62:

Children with Legg-Calve-Perthes disease should:

Correct Answer: avoid weight bearing on the affected extremity. (correct answer)
Explanation: Children with Legg-Calve-Perthes disease, a condition affecting the hip joint, should avoid weight bearing on the affected side to prevent further damage to the femoral head.

Question 63:

A 3-day-old infant weighed 8 pounds at birth. Today he weighs 7.5 pounds. How should this be managed?

Correct Answer: Continue feeding every 2-4 hours. (correct answer)
Explanation: It is normal for newborns to lose up to 10% of their birth weight in the first few days. The recommendation is to continue regular feedings every 2-4 hours to promote weight gain.

Question 64:

The term that describes the urethral opening on the ventral surface of the penis is:

Correct Answer: hypospadias. (correct answer)
Explanation: Hypospadias is a congenital condition where the urethral opening is located on the underside (ventral surface) of the penis instead of the tip.

Question 65:

A mother of a 4-week-old infant visits your office. She states that her baby is vomiting after feeding and then cries as if he is hungry again. What should the nurse practitioner assess?

Correct Answer: His abdomen for an olive-shaped mass. (correct answer)
Explanation: The symptoms described are suggestive of pyloric stenosis, a condition that typically presents with projectile vomiting and an olive-shaped mass in the abdomen.

Question 66:

A 14-year-old male patient has an acute, painless groin swelling. Which tool would yield the most information to identify the etiology of the swelling?

Correct Answer: Ultrasound of the scrotum. (correct answer)
Explanation: An ultrasound of the scrotum is the best diagnostic tool to evaluate painless groin swelling and can help identify conditions such as hydrocele, varicocele, or inguinal hernia.

Question 67:

A side effect of DTaP that should be reported is:

Correct Answer: nonstop crying (3 hours or more) within 48 hours of receiving the immunization. (correct answer)
Explanation: Nonstop crying for 3 hours or more after the DTaP vaccine may indicate a severe reaction, such as encephalopathy, and should be reported to a healthcare provider.

Question 68:

A young child has an audible murmur. The nurse practitioner describes it as a grade 4 murmur. How should this be managed?

Correct Answer: The child should be referred to cardiology. (correct answer)
Explanation: A grade 4 murmur is significant and should be evaluated by a cardiologist to rule out any underlying heart defects or conditions.

Question 69:

Head circumference should be measured until a child has attained:

Correct Answer: 36 months of age. (correct answer)
Explanation: Head circumference is routinely measured until 36 months of age to monitor brain and skull growth and identify any potential abnormalities.

Question 70:

A child has 8-10 medium brown café au lait spots > 1 cm in diameter. The differential diagnosis should include:

Correct Answer: neurofibromatosis. (correct answer)
Explanation: Multiple café au lait spots larger than 1 cm are a hallmark of neurofibromatosis, a genetic disorder that causes tumors to form on nerve tissue.

Question 71:

A child with a sandpaper-textured rash probably has:

Correct Answer: Strept infection. (correct answer)
Explanation: A sandpaper-textured rash is characteristic of scarlet fever, which is caused by a Group A Streptococcus infection.

Question 72:

A definitive diagnosis of sickle cell anemia can be made:

Correct Answer: by a hemoglobin electrophoresis. (correct answer)
Explanation: Hemoglobin electrophoresis is the definitive test for diagnosing sickle cell anemia by identifying the presence of abnormal hemoglobin S.

Question 73:

Which statement below best characterizes scoliosis in an adolescent?

Correct Answer: There can be unequal rib prominences or shoulder heights. (correct answer)
Explanation: Scoliosis often presents with physical asymmetries such as unequal rib prominences or shoulder heights, which can be observed during a physical exam.

Question 74:

A child’s resting heart rate is expected to be between 60 and 100 beats per minute once he reaches:

Correct Answer: 10 years of age. (correct answer)
Explanation: By the age of 10, a child’s resting heart rate typically falls within the adult range of 60-100 beats per minute.

Question 75:

What is the earliest age that an average child would be able to copy a triangle, know his colors, and count on his fingers?

Correct Answer: 5 years. (correct answer)
Explanation: By age 5, children generally develop the fine motor skills needed to copy geometric shapes like a triangle and have the cognitive ability to recognize colors and count on their fingers.

Question 76:

A pregnant patient is concerned because her 12-month-old needs an MMR immunization. What should the NP advise this patient?

Correct Answer: MMR immunization presents no risk to the child’s mother. Immunize now. (correct answer)
Explanation: The MMR vaccine is a live attenuated vaccine that is safe for the child to receive, even if the mother is pregnant. There is no risk to the mother from the child being immunized.

Question 77:

The most common cause of pneumonia in an otherwise healthy 3-year-old child is:

Correct Answer: a viral infection. (correct answer)
Explanation: Viral infections are the most common cause of pneumonia in young children, especially those under 5 years of age.

Question 78:

An adolescent male has had a sudden onset of severe scrotal pain following a kick in the groin earlier in the day during a soccer game. How should this be managed?

Correct Answer: He should be referred to the emergency department. (correct answer)
Explanation: Severe scrotal pain following trauma could indicate testicular torsion, which is a surgical emergency. Immediate referral to the emergency department is required.

Question 79:

Cranial nerve II could be evaluated in a young infant by assessing:

Correct Answer: squinting response to bright light. (correct answer)
Explanation: Cranial nerve II (the optic nerve) can be assessed in infants by observing their response to bright light, such as squinting or blinking.

Question 80:

A 9-year-old female has presented to your clinic because of a rash on the left, upper area of her anterior trunk. She is embarrassed and very reticent to lift her blouse because her nipple will be exposed. How should the NP proceed?

Correct Answer: Examine all other areas of the trunk, then ask the child to lift her blouse. (correct answer)
Explanation: It’s important to maintain the child’s comfort and dignity during the examination by first examining other areas and then gently asking her to expose the affected area.

Question 81:

A 6-year-old has been diagnosed with Lyme disease. Which drug should be used to treat him?

Correct Answer: Amoxicillin. (correct answer)
Explanation: Amoxicillin is the preferred antibiotic for treating Lyme disease in children under 8 years old to avoid the potential side effects of doxycycline.

Question 82:

What is the usual recommendation about administering MMR and varicella immunizations?

Correct Answer: They should be given on the same day or at least one month apart. (correct answer)
Explanation: MMR and varicella vaccines can either be administered on the same day or separated by at least one month to ensure proper immune response.

Question 83:

A mother reports that her child is not allergic to chickens but is allergic to ducks and duck feathers. The child is 4 years old today. Which immunizations should he receive?

Correct Answer: None are contraindicated. (correct answer)
Explanation: Duck allergies do not contraindicate any standard childhood vaccinations, so the child should receive all routine immunizations as scheduled.

Question 84:

The test of choice to confirm and assess developmental dysplasia of the hip (DDH) in a 3-month-old is:

Correct Answer: ultrasound of the hip. (correct answer)
Explanation: Ultrasound is the preferred imaging technique for diagnosing developmental dysplasia of the hip in infants, particularly under 6 months of age.

Question 85:

What advice should be given to a parent who has a child with Fifth Disease?

Correct Answer: A parent may experience joint aches and pains. (correct answer)
Explanation: Fifth Disease, caused by Parvovirus B19, can cause joint pain in adults who are exposed to the virus, so parents should be informed of this possible symptom.

Question 86:

Which of the following is true about metatarsus adductus?

Correct Answer: Mild flexible metatarsus usually spontaneously corrects. (correct answer)
Explanation: Mild flexible metatarsus adductus, a common foot deformity in infants, often resolves on its own without intervention.

Question 87:

Which patient below is most likely to experience stranger anxiety during a physical exam?

Correct Answer: A 12-month-old female. (correct answer)
Explanation: Stranger anxiety typically peaks around 12 months of age, making this the age group most likely to exhibit distress during interactions with unfamiliar individuals.

Question 88:

A contraindication to giving MMR vaccination is:

Correct Answer: encephalopathy within 7 days after immunization. (correct answer)
Explanation: A history of encephalopathy within 7 days after a previous dose of MMR is a contraindication to receiving the vaccine, due to the risk of serious neurological complications.

Question 89:

A 6-week-old male infant is brought to the nurse practitioner because of vomiting. The mother describes vomiting after feeding and feeling a “knot” in his abdomen, especially after he vomits. The child appears adequately nourished. What is the likely etiology?

Correct Answer: Pyloric stenosis. (correct answer)
Explanation: Pyloric stenosis is characterized by projectile vomiting and a palpable “olive-shaped” mass in the abdomen, typically presenting in infants between 2 to 8 weeks old.

Question 90:

Children with an inguinal hernia:

Correct Answer: have a history of an intermittent bulge in the groin. (correct answer)
Explanation: An inguinal hernia in children often presents as an intermittent bulge in the groin, which may be more noticeable during crying or straining.

Question 91:

A 6-year-old is brought to your clinic because of behavior problems at school. DSM V criteria are used to diagnose attention deficit disorder (ADD). Which finding is likely present?

Correct Answer: Inattention. (correct answer)
Explanation: Inattention is a core symptom of attention deficit disorder (ADD), which can lead to difficulties in school performance and behavior.

Question 92:

The Sexual Maturity Rating (Tanner Staging) in boys includes 5 stages. Characteristics indicative of Stage 1 would include:

Correct Answer: the absence of pubic hair; same size and proportion penis, testes, and scrotum as in childhood. (correct answer)
Explanation: Tanner Stage 1 represents the prepubertal stage, where there are no signs of sexual maturation, and the genitalia are of childhood size.

Question 93:

Clubfoot:

Correct Answer: involves the foot and lower extremity. (correct answer)
Explanation: Clubfoot, or congenital talipes equinovarus, is a deformity that affects the foot and lower leg, causing the foot to be twisted inward and downward.

Question 94:

The nurse practitioner identifies satellite lesions in a 6-month-old infant. These are:

Correct Answer: indicative of candidal infection. (correct answer)
Explanation: Satellite lesions around the main area of a rash are characteristic of a candidal (yeast) infection, particularly in the diaper area.

Question 95:

According to the Tanner stages of development (Sexual Maturity Rating), breast development in Stage 3 in females includes the:

Correct Answer: enlargement and elevation of breast and areola with no separation of their contours. (correct answer)
Explanation: Tanner Stage 3 in females is marked by further enlargement of the breasts and areola, with no distinct separation between them.

Question 96:

Which choice below is a risk factor for sudden infant death syndrome (SIDS)?

Correct Answer: Low birth weight. (correct answer)
Explanation: Low birth weight is a significant risk factor for sudden infant death syndrome (SIDS), along with other factors such as prematurity and prenatal exposure to smoking.

Question 97:

An adolescent takes isotretinoin for nodulocystic acne. She is on oral contraceptives. Both were prescribed by the dermatologist. The adolescent presents to your clinic with a sinus infection. Her temperature is 99.5° F and her blood pressure is 160/100 mmHg. How should this be managed?

Correct Answer: Call the dermatologist to report the elevated BP. (correct answer)
Explanation: Isotretinoin can cause serious side effects, including elevated blood pressure. The prescribing dermatologist should be informed immediately to adjust the treatment plan.

Question 98:

What Tanner stage corresponds to an average 8-year-old male?

Correct Answer: Stage 1. (correct answer)
Explanation: At 8 years old, most boys are in Tanner Stage 1, which is the prepubertal stage with no signs of secondary sexual development.

Question 99:

Which of the following increases the risk of cryptorchidism?

Correct Answer: Premature birth. (correct answer)
Explanation: Premature birth is a risk factor for cryptorchidism, a condition where one or both testicles fail to descend into the scrotum.

Question 100:

According to the Tanner stages of development (Sexual Maturity Rating), breast development in Stage 4 in females includes the:

Correct Answer: projection of areola and nipple to form a secondary mound above the level of the breast. (correct answer)
Explanation: In Tanner Stage 4, the areola and nipple project above the level of the breast, forming a secondary mound, indicating further maturation.

Question 101:

Correct Answer: be given the vaccine. (correct answer)
Explanation: Administering the varicella vaccine after exposure may prevent or reduce the severity of chickenpox.

Question 102:

A 2-month-old infant has an asymmetric Moro reflex. Which statement is true?

Correct Answer: The infant could have a birth injury. (correct answer)
Explanation: An asymmetric Moro reflex may indicate a birth injury, such as a clavicle fracture or brachial plexus injury.

Question 103:

The initial step in the management of encopresis is:

Correct Answer: client and family education. (correct answer)
Explanation: Educating the child and family about encopresis and its management is the first step in treatment, often involving dietary and behavioral changes.

Question 104:

A child has 8-10 medium brown café au lait spots > 1 cm in diameter. The differential diagnosis should include:

Correct Answer: neurofibromatosis. (correct answer)
Explanation: Multiple café au lait spots larger than 1 cm are suggestive of neurofibromatosis, a genetic disorder that causes tumors to form on nerve tissue.

Question 105:

Which patient below is most likely to experience stranger anxiety during a physical exam?

Correct Answer: A 12-month-old female. (correct answer)
Explanation: Stranger anxiety peaks around 12 months of age, making infants in this age group more likely to exhibit distress during encounters with unfamiliar individuals.

Question 106:

Correct Answer: well-marginated half-moon macules on the inner thigh. (correct answer)
Explanation: Tinea cruris, commonly known as jock itch, presents with well-defined, scaly, red patches in the groin area.

Question 107:

The chest circumference of a 12-month-old is:

Correct Answer: equal to head circumference. (correct answer)
Explanation: At 12 months of age, a child’s chest circumference is typically equal to their head circumference, reflecting normal growth and development.

Question 108:

A 3-year-old female had a fever of 102° F for the last 3 days. Today she woke up from a nap and is afebrile. She has a maculopapular rash. Which statement is true?

Correct Answer: The rash will blanch. (correct answer)
Explanation: A blanching maculopapular rash is characteristic of roseola, a common viral infection in young children that follows a high fever.

Question 109:

Correct Answer: Perform Trendelenburg’s test in the office. (correct answer)
Explanation: Trendelenburg’s test is used to assess hip stability and can help diagnose conditions like slipped capital femoral epiphysis, which may cause referred knee pain.

Question 110:

A 15-year-old female has been sexually active since she was 12 years old. She presents today with concerns of pregnancy. How should this be managed?

Correct Answer: Pregnancy test should be performed today. (correct answer)
Explanation: The first step in managing a sexually active adolescent with concerns about pregnancy is to perform a pregnancy test to confirm or rule out pregnancy.

Question 111:

A 7-year-old male presents with encopresis. The NP might expect:

Correct Answer: constipation. (correct answer)
Explanation: Encopresis often occurs due to chronic constipation, where stool builds up in the colon, causing involuntary leakage.

Question 112:

A mother of a 4-week-old infant visits your office. She states that her baby is vomiting after feeding and then cries as if he is hungry again. What should the nurse practitioner assess?

Correct Answer: His abdomen for an olive-shaped mass. (correct answer)
Explanation: These symptoms are suggestive of pyloric stenosis, which presents with projectile vomiting and a palpable olive-shaped mass in the abdomen.

Question 113:

A young female has breast buds bilaterally. This represents Tanner Stage:

Correct Answer: II. (correct answer)
Explanation: Tanner Stage II is characterized by the appearance of breast buds, marking the beginning of breast development during puberty.

Question 114:

A 14-year-old male patient has an acute, painless groin swelling. Which tool would yield the most information to identify the etiology of the swelling?

Correct Answer: Ultrasound of the scrotum. (correct answer)
Explanation: An ultrasound of the scrotum is the best diagnostic tool to evaluate painless groin swelling and can help identify conditions such as hydrocele, varicocele, or inguinal hernia.

Question 115:

A 9-year-old has been diagnosed with chickenpox. A drug that should be avoided in him is:

Correct Answer: aspirin. (correct answer)
Explanation: Aspirin should be avoided in children with viral infections like chickenpox due to the risk of Reye’s syndrome, a serious condition that can cause liver and brain damage.

Question 116:

A 3-day-old full-term infant has a bilirubin level of 16 mg/dL. How should this be managed?

Correct Answer: Order phototherapy for the infant. (correct answer)
Explanation: A bilirubin level of 16 mg/dL in a 3-day-old infant is high and requires phototherapy to reduce the risk of bilirubin encephalopathy.

Question 117:

Correct Answer: Pyloric stenosis. (correct answer)
Explanation: Pyloric stenosis is characterized by projectile vomiting and a palpable “olive-shaped” mass in the abdomen, typically presenting in infants between 2 to 8 weeks old.

Question 118:

An infant is diagnosed with diaper dermatitis. Satellite lesions are visible. This should be treated with a:

Correct Answer: topical antifungal agent. (correct answer)
Explanation: Satellite lesions in diaper dermatitis are indicative of a fungal infection, commonly treated with a topical antifungal cream.

Question 119:

A 6-month-old male has a palpable cystic mass in his scrotum. His mother states that sometimes the size of his scrotum varies. What should the nurse practitioner do next?

Correct Answer: Referral to urology if this has not resolved in 6 more months. (correct answer)
Explanation: A cystic mass in the scrotum that varies in size could be a hydrocele. If it persists beyond 1 year of age, referral to a urologist is appropriate for further evaluation.

Question 120:

Correct Answer: Hepatitis B, TDaP, IPV, and MMR. (correct answer)
Explanation: The child should receive the second doses of Hepatitis B, TDaP, IPV, and MMR vaccines according to the vaccination schedule. Varicella can be administered later.

Question 121:

A healthy 7-year-old child is diagnosed with atypical pneumonia. He is febrile but not in distress. What is the preferred treatment for him?

Correct Answer: Azithromycin. (correct answer)
Explanation: Azithromycin is the preferred treatment for atypical pneumonia in children, particularly if Mycoplasma pneumoniae is suspected.

Question 122:

A 2-year-old with sickle cell anemia (SCA) should receive which immunizations?

Correct Answer: All routine childhood immunizations at the usual time. (correct answer)
Explanation: Children with sickle cell anemia should receive all routine immunizations according to the standard immunization schedule to protect against infections.

Question 123:

The term that describes the urethral opening on the ventral surface of the penis is:

Correct Answer: hypospadias. (correct answer)
Explanation: Hypospadias is a congenital condition where the urethral opening is located on the underside (ventral surface) of the penis instead of the tip.

Question 124:

A child has 8-10 medium brown café au lait spots > 1 cm in diameter. The differential diagnosis should include:

Correct Answer: neurofibromatosis. (correct answer)
Explanation: Multiple café au lait spots larger than 1 cm are a hallmark of neurofibromatosis, a genetic disorder that causes tumors to form on nerve tissue.

Question 125:

Correct Answer: Collect a vaginal swab of the external vagina for microscopic evaluation. (correct answer)
Explanation: Collecting a vaginal swab allows for the identification of possible infections or irritants causing the symptoms.

Question 126:

What is the earliest age that an average child would be able to copy a triangle, know his colors, and count on his fingers?

Correct Answer: 5 years. (correct answer)
Explanation: By age 5, children generally develop the fine motor skills needed to copy geometric shapes like a triangle and have the cognitive ability to recognize colors and count on their fingers.

Question 127:

The pneumococcal immunization in infants has:

Correct Answer: shifted the pathogenesis to fewer cases of S. pneumoniae. (correct answer)
Explanation: The pneumococcal vaccine has been effective in reducing the incidence of infections caused by Streptococcus pneumoniae in infants.

Question 128:

According to the Tanner stages of development (Sexual Maturity Rating), breast development in Stage 3 in females includes the:

Correct Answer: enlargement and elevation of breast and areola with no separation of their contours. (correct answer)
Explanation: Tanner Stage 3 in females is marked by further enlargement of the breasts and areola, with no distinct separation between them.

Question 129:

A child with a sandpaper-textured rash probably has:

Correct Answer: Strept infection. (correct answer)
Explanation: A sandpaper-textured rash is characteristic of scarlet fever, which is caused by a Group A Streptococcus infection.

Question 130:

Which statement below is true of infants with developmental dysplasia of the hip?

Correct Answer: A palpable clunk is considered diagnostic. (correct answer)
Explanation: A palpable clunk felt during the Barlow or Ortolani maneuvers is indicative of a dislocated or dislocatable hip, confirming the diagnosis of DDH.

Question 131:

Which reflex would NOT be observed in a 1-month old infant?

Correct Answer: Parachute reflex. (correct answer)
Explanation: The parachute reflex, a protective reflex when an infant is turned face down, typically develops later around 8-9 months, so it would not be observed in a 1-month-old infant.

Question 132:

At what age should initial blood pressure screening take place?

Correct Answer: 3 years. (correct answer)
Explanation: Routine blood pressure screenings typically begin at the age of 3 years during well-child visits to detect any early signs of hypertension.

Question 133:

How often should blood pressure be measured in a child who is 3 years old?

Correct Answer: It should be measured annually. (correct answer)
Explanation: Blood pressure should be measured annually in children starting at age 3 as part of routine health assessments to monitor for hypertension.

Question 134:

Correct Answer: Continue the same dose and monitor his status. (correct answer)
Explanation: A slight decrease in fever within 72 hours of starting antibiotics for pneumonia is expected. The current antibiotic regimen should be continued while monitoring the child’s condition.

Question 135:

A child with a sandpaper-textured rash probably has:

Correct Answer: Strept infection. (correct answer)
Explanation: A sandpaper-textured rash is characteristic of scarlet fever, which is caused by a Group A Streptococcus infection.

Question 136:

Correct Answer: Hepatitis B, TDaP, IPV, and MMR. (correct answer)
Explanation: The child should receive the second doses of Hepatitis B, TDaP, IPV, and MMR vaccines according to the vaccination schedule. Varicella can be administered later.

Question 137:

Correct Answer: well-marginated half-moon macules on the inner thigh. (correct answer)
Explanation: Tinea cruris, commonly known as jock itch, presents with well-defined, scaly, red patches in the groin area.

Question 138:

What early finding may lead the provider to suspect renal artery stenosis in a 3-year-old male?

Correct Answer: Increased blood pressure. (correct answer)
Explanation: Renal artery stenosis can lead to hypertension in children, which may be an early indicator of this condition.

Question 139:

The pneumococcal immunization in infants has:

Correct Answer: shifted the pathogenesis to fewer cases of S. pneumoniae. (correct answer)
Explanation: The pneumococcal vaccine has been effective in reducing the incidence of infections caused by Streptococcus pneumoniae in infants.

Question 140:

Correct Answer: The bone marrow is responding appropriately. (correct answer)
Explanation: A significant increase in hemoglobin after starting iron therapy indicates that the bone marrow is responding well to the treatment, producing more red blood cells.

Question 141:

Correct Answer: be given the vaccine. (correct answer)
Explanation: Administering the varicella vaccine after exposure may prevent or reduce the severity of chickenpox.

Question 142:

At what age would a baby first be expected to locate an object hidden from view?

Correct Answer: At 9 months of age. (correct answer)
Explanation: Object permanence, or the ability to locate an object hidden from view, typically develops around 9 months of age in infants.

Question 143:

Which reflex would NOT be observed in a 1-month old infant?

Correct Answer: Parachute reflex. (correct answer)
Explanation: The parachute reflex, a protective reflex when an infant is turned face down, typically develops later around 8-9 months, so it would not be observed in a 1-month-old infant.

Question 144:

A sexually active adolescent male reports that he has dysuria. How should this be managed?

Correct Answer: Urethral/urine cultures should be collected and screening done for STDs. (correct answer)
Explanation: Dysuria in a sexually active adolescent male may be due to a sexually transmitted infection. Urethral and urine cultures should be obtained, and screening for STDs should be conducted.

Question 145:

A young child has an audible murmur. The nurse practitioner describes it as a grade 4 murmur. How should this be managed?

Correct Answer: The child should be referred to cardiology. (correct answer)
Explanation: A grade 4 murmur is significant and should be evaluated by a cardiologist to rule out any underlying heart defects or conditions.

Question 146:

A child with a sandpaper-textured rash probably has:

Correct Answer: Strept infection. (correct answer)
Explanation: A sandpaper-textured rash is characteristic of scarlet fever, which is caused by a Group A Streptococcus infection.

Question 147:

Which statement below is true of infants with developmental dysplasia of the hip?

Correct Answer: A palpable clunk is considered diagnostic. (correct answer)
Explanation: A palpable clunk felt during the Barlow or Ortolani maneuvers is indicative of a dislocated or dislocatable hip, confirming the diagnosis of DDH.

Question 148:

A side effect of DTaP that should be reported is:

Correct Answer: nonstop crying (3 hours or more) within 48 hours of receiving the immunization. (correct answer)
Explanation: Nonstop crying for 3 hours or more after the DTaP vaccine may indicate a severe reaction, such as encephalopathy, and should be reported to a healthcare provider.

Question 149:

A 3-day-old full-term infant has a bilirubin level of 16 mg/dL. How should this be managed?

Correct Answer: Order phototherapy for the infant. (correct answer)
Explanation: A bilirubin level of 16 mg/dL in a 3-day-old infant is high and requires phototherapy to reduce the risk of bilirubin encephalopathy.

Question 150:

A 7-year-old has a complaint of ear pain. If he has otitis externa, which complaint is most likely?

Correct Answer: He has tragal pain. (correct answer)
Explanation: Otitis externa, also known as “swimmer’s ear,” often presents with pain when the tragus (the small pointed part of the outer ear) is touched or manipulated.

Question 151:

A 4-year-old has been diagnosed with measles. The nurse practitioner identifies Koplik’s spots. These are:

Correct Answer: found on the inside of the cheek and are granular. (correct answer)
Explanation: Koplik’s spots are small, white lesions with a red base that appear inside the cheeks, typically before the rash in measles.