NURS6541 / NURS 6541: Final Exam Q & A: (Latest) Primary Care of Adolescents & Children - Walded. RATED A

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NURS 6541: Final Exam Q & A 0 Question 1 1 out of 1 points Unilateral wheezing is a finding suggestive of Selected Answer: d. Cystic Fibrosis • Question 2 2 out of 1 points You are on ... call and receive a phone call from the parents of a 13-year-old known asthmatic. She has been having chest tightness and a worsening cough for 48 hours. She has significant nasal discharge that began 14 days ago and intermittent complaint of headache. She is now running a low-grade fever. Her peak flow the last 48 hours is 70–80% of personal best. Her temperature right now is 101.7°F. She is on salmeterol with corticosteroid (Advair) and PRN albuterol. Which of the following is most appropriate? Selected Answer: d. See her in the office in the morning and prescribe a 14-day course of amoxicillin plus the addition of a short course of oral steroids. • Question 3 1 out of 1 points You see a patient you believe has folliculitis. What medication would be the best to treat this patient? The patient has no allergies. Selected Answer: c. Dicloxacillin • Question 4 1 out of 1 points The most common cause of primary amenorrhea is Selected Answer: a. Pregnancy • Question 5 1 out of 1 points Kelly, your 11-year-old well visit patient, presents to the office with weight loss, polyuria, and polydipsia. Which of the following do you need to rule out? Selected Answer: d. Diabetes mellitus • Question 6 1 out of 1 points Children in child care facilities are at greater risk of being exposed to which of the following infections? Selected Answer: b. HAV • Question 7 1 out of 1 points A 6-year-old boy is left alone for 10 hours, now with hematemesis and pneumomediastinum on chest x-ray. Which of the following is the most likely etiology? Selected Answer: b. Esophageal foreign body • Question 8 1 out of 1 points A 14-month-old child has lower extremity bowing, a waddling gait, genu varum, and is at the 5th percentile for height. Laboratory data include low-normal serum calcium, moderately low serum phosphate, and elevated serum alkaline phosphatase levels, hyperphosphaturia, and normal parathyroid levels. Which of the following is the most likely diagnosis? Selected Answer: e. Genetic primary hypophosphatemia • Question 9 1 out of 1 points The most common trigger for an acute asthma episode in the very young child is Selected Answer: d. Respiratory infections • Question 10 1 out of 1 points What is the primary treatment for testicular torsion? Selected Answer: c. Immediate surgical referral • Question 11 1 out of 1 points When Jason, age 12, slid into homeplate while playing baseball, he injured his ankle. You are trying to differentiate between a strain and a sprain. You know that a sprain Selected Answer: b. Is an injury to the ligaments that attach to the bones in a joint. • Question 12 1 out of 1 points The most common presentation of Hirschprung disease is which of the following? Selected Answer: b. Infrequent bowel movements • Question 13 0 out of 1 points Jennifer, age 16, is an active cheerleader who just developed type 1 diabetes. She is worried that she will not fit in with her friends anymore because she does not think she can have all the same snacks they have. How do you respond? Selected Answer: c. Be sure to stick to snacks that are high in simple carbohydrates. • Question 14 1 out of 1 points Which of the following is not a sign or symptom of congenital hypothyroidism? Selected Answer: a. Frequent stooling • Question 15 0 out of 1 points You see a 7-year-old boy a day after he was bitten by his pet dog. According to the mother, the dog bit the child after he snuck up on the dog and grabbed his tail. The dog has had all its vaccinations, including rabies. The child has had no fever, has full movement of the injured limb, and has no sign of neurologic or vascular injury. The wound is on the child’s forearm, is not deep, and is not bleeding, but has developed about 2 cm of erythema surrounding the site. Which of the following is the most appropriate treatment? Selected Answer: d. Oral amoxicillin-clavulanate for 3-5 days • Question 16 1 out of 1 points Robert, your 15-year-old male patient, is here today for a well visit. He is tall in stature and has increased arm span, laxity of joints, pectus excavatum, and an abnormal echocardiogram. Which of the following diagnosis would you suspect Robert as having? Selected Answer: b. Marfan syndrome • Question 17 1 out of 1 points An adolescent female presents with a 2-day history of increasing lower abdominal pain. She has mild vomiting and anorexia and fevers to 101F. She is unable to defecate but has an urge to do so. CBC reveals a slightly elevated WBC of 14,000, but is otherwise normal. Serum electrolytes are normal. The next step is Selected Answer: a. Refer to surgery for evaluation for appendicitis. • Question 18 1 out of 1 points Vomiting in infancy has a long list of differential diagnoses. Which of the following other symptoms would mostly likely point to pyloric stenosis? Selected Answer: b. Sausage-shaped mass in abdomen • Question 19 1 out of 1 points Which of the following is a characteristic physical sign of fragile X syndrome in adolescent males? Selected Answer: a. Macro-orchidism • Question 20 1 out of 1 points A 3-week old presents to the office in January with a 1-week history of nasal congestion and occastional cough. On the night prior to the visit in infant developed a fever 102ºF rectally, was difficult to breastfeed, and had paroxysmal coughing and noisy, labored breathing. On exam, you note an ill-appearing infant who is lethergic with wheezing, tachypnea, and intercostal retractions. The infant is home with the mom at this time; however, has a sibling who is 4-years-old and is in daycare and recently had cold symptoms. If the patient has been diagnosed with RSV bronchiolitis, which of the following would be the treatment of choice? Selected Answer: b. Fluids and nutritional support and close monitoring • Question 21 1 out of 1 points An adolescent who has tall stature, increased arm span, laxity of joints, pectus excavatum, and abnormal echocardiogram woudl be expected to have Selected Answer: d. Marfan syndrome • Question 22 1 out of 1 points An 18-month-old African American girl is brought to your office because she has been crying and stopped walking today. She will crawl, however. Her mom denies any injury to the child. On examination, she is crying but consolable in her mother’s arms. She has bruising and swelling just proximal to the left ankle. An x-ray reveals a spiral fracture of the tibia. At this time, you advise the mother that: Selected Answer: a. This is a common fracture resulting from twisting on a planted foot. • Question 23 1 out of 1 points A small-for-gestational-age, dysmorphic newborn infant has microcephaly and sloping forehead, cutis aplasia (missing portion of the skin and hair) of the scalp, polydactyly, microphthalmia, and omphalocele. Which of these is the most likely diagnosis? Selected Answer: c. Patau syndrome (trisomy 13) • Question 24 1 out of 1 points A 16-year-old presents with pharyngitis, cough, and high fever. Her chest x-ray reveals bilateral pulmonary infiltrates. Her white blood cell count is normal and the neutrophil count is normal. The most likely etiology is Selected Answer: b. Chlamydia pneumonia • Question 25 1 out of 1 points A common cause of in-toeing in childhood is Selected Answer: d. Internal tibial torsion • Question 26 1 out of 1 points Individuals with chronic adrenal insufficiency often have Selected Answer: d. A craving for salt • Question 27 1 out of 1 points Which of the following should be done annually after 1 year of age in a child with Down syndrome? Selected Answer: d. Thyroid screenings • Question 28 1 out of 1 points Sarah, age 13, is markedly obese and has a poor self-image. How do you differentiate between compulsive eating and bulemia? Selected Answer: a. A compulsive eater does not induce vomiting. • Question 29 1 out of 1 points The peak incidence of osteosarcoma is Selected Answer: a. 15-19 years of age • Question 30 1 out of 1 points A 10-year-old boy jumps off a 2-foot wall, twisting his foot and ankle upon landing. His ankle x-ray reveals a fracture of the distal tibia over the articular surface into the epiphysis and physis. Based on the Salter-Harris classification for growth plate injuries, you know this as a Selected Answer: a. Salter-Harris III • Question 31 1 out of 1 points One of the most appropriate agents used to treat influenza A is Selected Answer: a. Oseltamivir • Question 32 1 out of 1 points An essential test in the evaluation of a 2-year-old being managed for Kawasaki disease is Selected Answer: d. an echocardiogram • Question 33 1 out of 1 points You have a patient with pityriasis rosea. You will recommend all of these treatments, except Selected Answer: c. Oral antibiotics. • Question 34 1 out of 1 points A 14-year-old girl from another state was followed for 7 years for a history of insulin-dependent diabetes mellitus. Her hemoglobin A1C is 14.9%. This laboratory test indicates which of the following? Selected Answer: d. Her glucose control is poor. • Question 35 1 out of 1 points A 7-month-old female was brought by her mother to an outpatient clinical because of a 2-day history of fever, copious nasal secretions, and wheezing. The mother volunteered that the baby has been healthy and has not had these symptoms in the past. The infant’s temperature is noted to be 100.7°F, her respiratory rate is 50 breaths/min, and her pulse oximetry is 95% on room air. Physical examination reveals no signs of dehydration, but wheezing is hear on lung auscultation. The infant shows no improvement after three treatments with nebulized albuterol. Which of the following is recommended treatment? Selected Answer: c. Supportive care with hydration and humidified oxygen • Question 36 1 out of 1 points A child has developed her second perirectal abscess in 6 months. She should be evaluated for which of the following conditions? Selected Answer: d. Crohn's disease • Question 37 1 out of 1 points A 9-month-old has been diagnosed with gastroenteritis. He attends a daycare facility. What is the likely cause of the illness? Selected Answer: d. Rotavirus • Question 38 1 out of 1 points Hypercholesterolemia in children older than 2 is defined as a total cholesterol at or above Selected Answer: d. 200 mg/dL • Question 39 1 out of 1 points A 3-week-old male infant with 2 days of projectile, nonbilious vomiting and constant feeding. Which of the following is the most likely etiology? Selected Answer: e. Pyloric stenosis • Question 40 1 out of 1 points Which fo the following foods would be most appropriate for a child with celiac disease? Selected Answer: a. Rice with butter • Question 41 1 out of 1 points The most common cause of UTI (urinary tract infection) in the pediatric population is Selected Answer: d. E. coli • Question 42 1 out of 1 points Which of the following is not found in an adolescent with untreated Graves' disease? Selected Answer: a. Tendency to gain weight easily • Question 43 1 out of 1 points What does shift to the left mean in a white blood count? Selected Answer: d. A rise in neutrophils • Question 44 1 out of 1 points Prophylactic penicillin should be started in children with sickle cell anemia by Selected Answer: d. 2 to 3 months of age • Question 45 1 out of 1 points Six months after being diagnosed with what appears to be insulin-dependent diabetes, the 5-year-old in the case presentation has a significant decrease in his insulin requirement. Which of the following is the most likely explanation? Selected Answer: c. He has entered the "honeymoon phase" of his diabetes. • Question 46 1 out of 1 points Tommy has bloody diarrhea. His family eats fast-food four to five times each week. Which organism may have caused the diarrhea? Selected Answer: b. E. Coli • Question 47 1 out of 1 points Which chromosomal abnormality is associated with short stature in girls? Selected Answer: d. Turner syndrome • Question 48 1 out of 1 points Maddie, age 2, had a complete blood count (CBC) drawn at her last visit. It indicates that she has a microcytic hypochromic anemia. What should you do now at this visit? Selected Answer: a. Obtain a lead level. • Question 49 1 out of 1 points A 2-year-old boy is brought in with fever and poor feeding. He started getting sick yesterday and has worsened significantly today. He has had no recent illnesses or injuries, and no known ill contacts. On examination, his temperature is 101°F, he is tachycardic, and he appears ill. He is laying on his back with his left leg flexed and abducted at the hip. The HEENT examination is normal, heart is tachycardic but regular, and the lungs are clear. The abdomen is nontender and has normal bowel sounds. He screams in pain when you move his left leg from its resting position. Blood work reveals an elevated WBC count of 15,000 mm3 and an ERS or 45 mm/h. An x-ray of his left hip shows a widened joint space but no fractures. What is your next step at this point? Selected Answer: b. Hip joint aspiration • Question 50 1 out of 1 points When a neonate is initially protected against measles, mumps, and rubella because the mother is immune, this is an example of which type of immunity? Selected Answer: d. Natural passive • Question 51 1 out of 1 points You are examining Beth, age 9 months, and note a palpable right supraclavicular node. You know that this finding is suspicious for Selected Answer: b. Lymphoma of the mediastinum • Question 52 1 out of 1 points A 4-year-old female with profuse vomiting, sweating, lacrimation, and diarrhea, who seizes in the emergency room. Which of the following is the most likely etiology? Selected Answer: a. Insecticide ingestion • Question 53 1 out of 1 points A 6-year-old male is brought in for evaluation of a painful hip. He has been limping and not wanting to walk for the past 2 days. He has no obvious injury. He feels a little better if he is given ibuprofen. He has not had a fever and does not have any other current symptoms, although he had "the flu" last week. On examination, his vital signs are normal. His right hip has some pain with internal rotation. He walks with a pronounced limp. Which of the following statements is most accurate? Selected Answer: a. He should have a complete blood count (CBC) and ESR. • Question 54 1 out of 1 points You see a 7-year-old with a positive stool culture for Salmonella enteriditis. The appropriate therapy for a non-dehydrated child is Selected Answer: b. Bland diet with focus on maintaining hydration • Question 55 1 out of 1 points A common presenting symptom of inflammatory bowel disease is Selected Answer: a. Unexplained fever • Question 56 0 out of 1 points Which of the following statements is not true with slipped capital femoral epiphysis? Selected Answer: d. Unilateral involvement is more common than bilateral. • Question 57 1 out of 1 points A mother brings a 2-year-old to your office with the complaint that she passes 5 to 10 watery stools per day that often contain undigested food. The child appears healthy and has no other GI symptoms. She is acting, eating, and voiding normally. Weight gain is normal and the mother states she often drinks (her favorite drink is Kool-Aid) instead of eating. The best management for this condition is: Selected Answer: a. Counsel to decrease fluid intake, increase dietary fiber, and increase fats to 40% of calories. • Question 58 1 out of 1 points Which of the following is not a feature of DiGeorge syndrome? Selected Answer: d. Frontal bossing • Question 59 1 out of 1 points Dave, age 17, has gynecomastia. You should also assess him for Selected Answer: d. Testicular cancer • Question 60 1 out of 1 points Mark, age 15, is 5 feet tall andn weighs 85 pounds. You suspect anorexia and know that the best initial approach is to Selected Answer: a. Confront Mark with the fact that you suspect an eating disorder. • Question 61 1 out of 1 points In mild to moderate attacks of acute asthma, Albuterol should be given every 4-6 hours prn and routine medication should be Selected Answer: c. Continued as usual • Question 62 1 out of 1 points Which of the following is not true of insect stings from bees, wasps, and fire ants? Selected Answer: c. Greater reaction of hypersensitivity occurs most often with the initial exposure than with subsequent exposures. • Question 63 1 out of 1 points Ben has been diagnosed with folliculitis, an inflammatory condition involving the pilosebaceous follicle. What is the most common cause of this condition? Selected Answer: c. Staphylococcus aureus • Question 64 1 out of 1 points Which of the following therapeutic options is common for the treatment of both bee stings and bite wounds? Selected Answer: d. Tetanus vaccination • Question 65 1 out of 1 points Pinworms can cause which of the following? Selected Answer: b. Anal itching • Question 66 1 out of 1 points The classic radiographic finding of croup is Selected Answer: b. Steeple sign • Question 67 1 out of 1 points An 8-month-old female infant with bilious vomiting, constant abdominal pain for 12 hours and upper GI study showing beaklike appearance of contrast. Which of the following is the most likely etiology? Selected Answer: d. Volvulus • Question 68 1 out of 1 points Mrs. Bay is upset. She is convinced something is seriously wrong with her son. He is a 2-month-old and frequently vomits after feeding. Which of the following is most suggestive of GERD (gastroesophageal reflux disease)? Selected Answer: c. He drinks 7 to 8 ounces every 3 hours. • Question 69 1 out of 1 points Lyme disease is most closely associated with which of the following skin lesions? Selected Answer: a. Erythema migrans • Question 70 1 out of 1 points The following clinical description best matches which genetic disorder? A 15-year-old girl with primary amenorrhea is noted to be well below the 5th percentile for height. She has hypertension, a low posterior hairline, prominent and low-set ears, and excessive nuchal skin. Selected Answer: e. Turner syndrome (XO) • Question 71 0 out of 1 points Jason, age 14, appears with tender discoid breast tissue enlargement (2-3 cm in diameter) beneath the areola. Your next action would be to Selected Answer: b. Order an ultrasound. • Question 72 1 out of 1 points Your patient has inflammatory bowel disease. Which of the following finding is most consistent with ulcerative colitis? Selected Answer: d. Left-sided abdominal pain • Question 73 1 out of 1 points Which of the following is not characteristic of an apparent life-threatening event (ALTE)? Selected Answer: d. Fever • Question 74 1 out of 1 points Riley, a 12-year-old girl, has scaly, hyperpigmented lesions in a "Christmas tree" distribution. It is predominantly on her trunk. One lesion is on her buttock that is larger than the other, at about 4 cm in diameter. What is your diagnosis? Selected Answer: c. Pityriasis rosea • Question 75 1 out of 1 points An 8-month-old baby arrives to the office with his mother with a complaint of decreased left arm movement. He is a product of a normal term pregnancy, has had no medical problems, and was in good health when his mother dropped him off at the daycare center. Upper arm radiographs show a left humerus spiral fracture. Which of the following is the most appropriate next step in management? Selected Answer: c. Send the child to the hospital for admission and call child protective services. • Question 76 1 out of 1 points Which of the following physical stigmata are common in newborns with Down syndrome? Selected Answer: d. Hypotonia, large-appearing tongue and small mouth, upward slant to eyes • Question 77 0 out of 1 points Which of the following vaccines provides protection against a common type of sepsis/meningitis? Selected Answer: c. MMR vaccine • Question 78 1 out of 1 points Which of the following conditions is most responsible for developmental delays in children? Selected Answer: a. Fetal Alcohol Syndrome • Question 79 1 out of 1 points Which of the following objective data are associated with significantly better long-term outcomes in children born with open spina bifida? Selected Answer: a. Perineal sensation • Question 80 1 out of 1 points Jack, age 17, has been complaining of a painful knob below his right knee that has prevented him from actively participating in sports. He has recently been given a diagnosis Osgood-Schlatter disease and asks you about his treatment options. You tell him that the initial treatment is Selected Answer: d. Relative rest; he could benefit from hamstring stretching, heel cord stretching, and quadriceps stretching exercises. • Question 81 1 out of 1 points Fifth disease is usually Selected Answer: c. Seen in children ages 5 to 14 years of age • Question 82 1 out of 1 points Hope is a 7-month-old who presents in January with a 1-day history of cough, yellow nasal discharge, and low-grade temp (T max 100°F). She was previously healthy. She does have 2+ edema of the nasal turbinates and cloudy rhinorrhea. She is afebrile in the office. Her chest, mouth, and ears are clear. You prescribe: Selected Answer: b. Saline drops, bulb suction, humidified air, and increased PO fluids • Question 83 0 out of 1 points In children who have not received antibiotics in the past month, which antibiotic is recommended by the Centers for Disease Control and Prevention for the management of acute bacterial respiratory infection? Selected Answer: d. Amoxicillin plus clavulanic acid (Augmentin) • Question 84 1 out of 1 points Which of the following symptoms are most suggestive of pneumonia in a young child? Selected Answer: c. Fever, tachypnea, coryza, cough, scattered rales • Question 85 1 out of 1 points The most useful test for evaluation of suspected acute rheumatic fever is Selected Answer: d. Antistreptolysin-O (ASO) titer • Question 86 1 out of 1 points What does a low level of thyroid stimulating hormone (TSH) indicate? Selected Answer: d. Hyperthyroidism • Question 87 1 out of 1 points When examining a child with abdominal pain, what symptom would lead to a likely organic etiology? Selected Answer: d. Night waking • Question 88 1 out of 1 points John is 4 years old and in today for a well child visit. He is due for his 4-year-old immunizations. He was recently diagnosed with ALL and is being treated with chemotherapy and radiation. Which statement is true about immunizations during treatments during childhood cancer? Selected Answer: a. Immunizations are not given during active chemotherapy. • Question 89 1 out of 1 points Which of the following is important to determine in the recent history of a child with suspected Clostridium difficile infection? Selected Answer: b. Antibiotic use • Question 90 1 out of 1 points A healthy 8-month-old infant presents with diarrhea but no dehydration. What is the best advice to give to the parents? Selected Answer: b. Give bananas, cereal, vegetables, and full-strength formula as tolerated. • Question 91 1 out of 1 points Which of the following is the primary diagnostic tool used in the evaluation of seizure disorders? Selected Answer: b. EEG • Question 92 1 out of 1 points Screening infants for anemia should occur at what age? Selected Answer: d. 9 months • Question 93 1 out of 1 points Absence seizures Selected Answer: b. Appear as altered awareness and blank stare for a brief period. • Question 94 1 out of 1 points Antibiotic therapy is one of the mainstays of treatment for which of the following causes of wheezing? Selected Answer: c. Epiglottitis • Question 95 1 out of 1 points Kawasaki disease is most common in Selected Answer: a. Children younger than 5 years of age • Question 96 0 out of 1 points A small-for-gestational-age infant is born to a 35-year-old woman. He has low-set and malformed ears, microcephaly, rocker-bottom feet, inguinal hernias, cleft lip/palate, and micrognathia. Chromosomal analysis is likely to reveal which of the following? Selected Answer: b. Down syndrome (trisomy 21) • Question 97 1 out of 1 points A 15-day-old infant has respiratory distress. A quick observation suggests she has slight cyanosis, hepatosplenomegaly, and features consistent with Down Syndrome. The cardiac examination demonstrates a loud first heart sound, a low-pitched, mid-diastolic murmur at the lower left sternal border, and a harsh apical holosystolic murmur in the mitral area. Which of the following cardiac conditions most likely explains her heart findings? Selected Answer: a. Complete atrioventricular canal (endocardial cushion defect) • Question 98 1 out of 1 points Grace, age 15, has been diagnosed with acne. Which of the following is not true with this condition? Selected Answer: c. Poor hygiene is the primary cause of acne. • Question 99 1 out of 1 points A 7-year-old presents with abrupt fever, stridor, drooling, and hyperextension of the neck. You examine the nose and throat and notice one tonsil is enlarged and there is marked erythema of the pharynx with uvular deviation. Which is most appropriate? Selected Answer: b. Refer to otolaryngology for management of a peritonsillar abscess and possible hospital admission • Question 100 0 out of 1 points Which of the following is true regarding the diagnosis of epiglottitis? Selected Answer: b. Diagnosis is decreasing in incidence. • Question 101 0 out of 0 points When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity? Selected Answer: Yes Saturday, February 8, 2020 8:50:06 PM EST OK [Show More]

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