NU580 Final Exam

NU580 Final Exam

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Purdue University Global

NU580 FNP II – Primary Care of Children and Adolescents’ Health

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Date

NU580 Final Exam

1. What is the next step for a 30-month-old toilet-trained girl with daytime enuresis, dysuria, low-grade fever, and a negative dipstick urinalysis?

Answer: The next step is to send the urine to the laboratory for culture.

Even when leukocyte esterase and nitrite tests are negative, a urinary tract infection (UTI) cannot be completely ruled out in young children with symptoms such as dysuria, fever, and daytime enuresis. A urine culture remains the gold standard for diagnosis.

Correct Answer: d. Send the urine to the lab for culture.

2. How should a child with dysuria, frequency, fever, and a urine culture showing 50,000–100,000 colonies of E. coli be treated?

Answer: The child should be treated with antibiotics for a urinary tract infection (UTI).

A colony count between 50,000 and 100,000 CFU/mL of E. coli in a symptomatic child is considered clinically significant and warrants treatment.

Correct Answer: d. Treat with antibiotics for urinary tract infection.

3. How should a school-aged child with dysuria, foul-smelling urine, and a positive dipstick for leukocyte esterase and nitrites be treated?

Answer: The recommended treatment is trimethoprim-sulfamethoxazole (TMP-SMX) twice daily for 3–5 days while awaiting culture results.

Positive leukocyte esterase and nitrite findings strongly suggest a UTI, and treatment should not be delayed in symptomatic children.

Correct Answer: b. Prescribe trimethoprim-sulfamethoxazole (TMP) twice daily for 3 to 5 days.

4. What should parents be told after their child with nephrotic syndrome responds well to steroid therapy?

Answer: Parents should be informed that steroids are commonly used again if relapses occur.

Nephrotic syndrome frequently follows a relapsing-remitting course. Most children respond well to corticosteroids during subsequent episodes.

Correct Answer: b. “Steroids will be used when relapses occur.”

5. What is the appropriate treatment when a child with nephrotic syndrome improves from 3+ to 1+ proteinuria?

Answer: Continue steroid therapy and salt restrictions until the urine is negative for protein.

Treatment should not be discontinued prematurely, as persistent proteinuria indicates ongoing disease activity.

Correct Answer: b. Continue with steroids and salt restrictions until the urine is negative for protein.

6. How should a child with post-streptococcal glomerulonephritis presenting with edema, hypertension, and tea-colored urine be managed?

Answer: The child should be referred to a pediatric nephrologist for hospitalization.

Features such as periorbital edema, hypertension, hematuria, and dyspnea indicate acute glomerulonephritis requiring specialist management.

Correct Answer: d. Refer the child to a pediatric nephrologist for hospitalization.

7. What should be done when a unilateral, smooth, firm abdominal mass is palpated in a 2-year-old child?

Answer: The child should be referred immediately to an oncologist.

A unilateral abdominal mass that does not cross the midline is highly suggestive of Wilms tumor and requires urgent evaluation.

Correct Answer: d. Refer the child to an oncologist immediately.

8. How is a retractile testis in a 6-month-old infant managed?

Answer: The infant should be referred to a pediatric urologist or surgeon for possible orchiopexy.

Persistent undescended or retractile testes beyond early infancy warrant specialist evaluation to prevent future complications.

Correct Answer: b. Refer the infant to a pediatric urologist or surgeon for possible orchiopexy.

9. What should be done for a 9-month-old infant with scrotal swelling, fussiness, and a tender, difficult-to-reduce scrotal mass?

Answer: The infant requires immediate referral to a pediatric surgeon.

These findings suggest an incarcerated inguinal hernia, which is a surgical emergency.

Correct Answer: b. Refer immediately to a pediatric surgeon.

10. What should parents know about using probiotics for infant colic?

Answer: Parents should be told that there is no conclusive evidence supporting probiotics for the treatment of infant colic.

Although some studies suggest possible benefits, current evidence remains insufficient to recommend routine use.

Correct Answer: d. There is no conclusive evidence about using probiotics to treat colic.

11. What is the next step for a premature toddler with poor weight gain and refusal of solid foods despite a normal barium swallow?

Answer: A video fluoroscopy swallowing study should be considered next.

This study evaluates swallowing mechanics and can identify aspiration or feeding dysfunction not detected on a standard barium swallow.

Correct Answer: d. Video fluoroscopy swallowing study.

12. How should a toddler with mild to moderate dehydration from vomiting and diarrhea be managed?

Answer: The child should receive oral rehydration solution (ORS) with follow-up in 24 hours.

Signs of mild dehydration can usually be managed effectively at home with ORS unless the child is unable to tolerate fluids.

Correct Answer: d. Oral rehydration solution with follow-up in 24 hours.

13. What should be done for a 9-year-old with recurrent vomiting, headaches, abnormal eye movements, and mild ataxia?

Answer: The child should be referred to a pediatric gastroenterologist for further evaluation.

Neurological findings accompanying vomiting warrant additional investigation to exclude intracranial or other serious pathology.

Correct Answer: d. Refer to a pediatric gastroenterologist for further workup.

14. How should a child who swallowed a 6 mm metal bead found in the stomach be managed?

Answer: Parents should be instructed to monitor the child’s stools for passage of the object.

Small, smooth objects in asymptomatic children usually pass spontaneously without intervention.

Correct Answer: b. Have the parents watch for the object in the child’s stool.

15. What is the likely diagnosis in a child with abdominal pain that migrates to the right lower quadrant followed by fever?

Answer: The most likely diagnosis is appendicitis with perforation.

Pain relief after vomiting followed by increasing fever suggests perforation and requires urgent surgical assessment.

Correct Answer: a. Appendicitis with perforation.

16. What initial diagnostic workup is recommended for a school-age child with recurrent abdominal pain, headaches, and a normal physical examination?

Answer: The initial workup includes a CBC, ESR, amylase, lipase, urinalysis, and abdominal ultrasound.

These tests help rule out common organic causes while evaluating recurrent abdominal pain in children.

Correct Answer: a. CBC, ESR, amylase, lipase, UA, and abdominal ultrasound.

17. What is an important component of treatment for functional abdominal pain associated with stress and school anxiety?

Answer: Children and families should be taught about the brain-gut interaction that contributes to symptoms.

Understanding the relationship between stress and gastrointestinal symptoms helps reduce anxiety and improves symptom management.

Correct Answer: c. Teaching about the brain-gut interaction causing symptoms.

18. What is the next diagnostic step for a child with foul-smelling stools, abdominal distension, and failure to thrive after a failed lactose-free trial?

Answer: The child should undergo serologic testing for celiac disease.

Persistent gastrointestinal symptoms and poor growth are classic findings associated with celiac disease.

Correct Answer: b. Serologic testing for celiac disease.

19. What complication is commonly associated with Crohn disease in children?

Answer: Children with Crohn disease commonly develop intestinal obstruction due to scarring and strictures.

Chronic inflammation can lead to fibrosis, narrowing of the bowel, and obstructive symptoms.

Correct Answer: b. Intestinal obstruction with scarring and strictures.

20. How should poor weight gain in a 12-month-old infant with an otherwise normal examination be evaluated?

Answer: Obtain a detailed feeding history, stooling history, and a 3-day diet history.

Nutritional assessment is the first step when evaluating failure to thrive in infants.

Correct Answer: b. Feeding and stooling history and 3-day diet history.

21. What can help shorten the course of acute diarrhea in a well-hydrated 2-year-old child?

Answer: The pediatric nurse practitioner should recommend Lactobacillus (probiotics).

Some evidence suggests Lactobacillus may modestly reduce the duration of acute infectious diarrhea.

Correct Answer: b. Lactobacillus.

22. What condition is associated with a widely split second heart sound (S2) during expiration in a newborn?

Answer: A persistently wide split S2 is suggestive of an atrial septal defect (ASD).

This occurs because of increased blood flow through the right side of the heart.

Correct Answer: a. Atrial septal defect.

23. What type of murmur is a grade II vibratory midsystolic murmur that becomes louder when a child is supine?

Answer: This finding is characteristic of a Still’s murmur.

Still’s murmur is a common benign murmur in young children.

Correct Answer: c. Still’s murmur.

24. What should be done when a 6-month-old infant has a harsh grade IV/VI blowing murmur?

Answer: The infant should be referred to a pediatric cardiologist for further evaluation.

A loud murmur in infancy is considered pathologic until proven otherwise.

Correct Answer: d. Refer to a pediatric cardiologist for further evaluation.

25. What is the likely diagnosis in a 3-month-old infant with crackles, poor feeding, hepatomegaly, and a holosystolic murmur?

Answer: The most likely diagnosis is a ventricular septal defect (VSD).

A VSD commonly presents with signs of congestive heart failure during early infancy.

Correct Answer: d. Ventricular septal defect.

26. Which finding is expected in an infant with Trisomy 21 and a complete atrioventricular (AV) canal defect?

Answer: Oxygen desaturation is commonly seen in these infants.

AV canal defects are strongly associated with Down syndrome and may cause significant cardiopulmonary compromise.

Correct Answer: c. Oxygen desaturation.

27. How is blood pressure classified when a child consistently has systolic values between the 95th and 99th percentiles?

Answer: This blood pressure pattern is classified as Stage 1 Hypertension.

Persistent readings at these levels require further evaluation and management.

Correct Answer: c. Stage 1 hypertensive.

28. What initial tests are recommended for a 12-year-old with persistent hypertension?

Answer: Initial testing should include renal function studies and plasma renin levels.

These tests help identify secondary causes of hypertension in children.

Correct Answer: c. Renal function and plasma renin tests.

29. What is the next step if an obese child’s blood pressure remains elevated despite successful weight reduction?

Answer: The child should be referred to a pediatric nephrologist or cardiologist.

Persistent hypertension despite lifestyle modifications warrants specialist evaluation.

Correct Answer: d. Referral to a nephrologist or cardiologist.

30. What should be done for a child with a repaired congenital heart defect who presents with fever and poor dental health?

Answer: The child should be admitted to the hospital with a pediatric cardiology consultation.

These findings raise concern for infective endocarditis.

Correct Answer: a. Admit to the hospital with a pediatric cardiology consult.

31. What is the earliest symptom of acute lower airway obstruction in children?

Answer: Wheezing is typically the initial manifestation of lower airway obstruction.

It occurs due to narrowing of the lower airways and turbulent airflow.

Correct Answer: d. Wheezing.

32. What is recommended for a child with nasal congestion and cloudy nasal discharge affecting sleep?

Answer: Saline nasal rinses are recommended.

Saline irrigation is safe and effective for relieving upper respiratory symptoms in young children.

Correct Answer: c. Saline rinses.

33. How should persistent rhinosinusitis with eyelid swelling and erythema be managed?

Answer: The child should be referred to a pediatric otolaryngologist immediately.

Periorbital involvement may indicate complications requiring specialist care.

Correct Answer: d. Referral to a pediatric otolaryngologist.

34. What is the appropriate action for a child with suspected epiglottitis presenting with stridor, drooling, and respiratory distress?

Answer: Arrange emergency transport to the hospital via EMS.

Children with suspected epiglottitis require urgent airway management.

Correct Answer: d. Transport the child to the hospital via emergency medical services.

35. Which medication is commonly used to facilitate airway clearance in children with cystic fibrosis?

Answer: Inhaled dornase alfa is used to thin airway secretions and improve pulmonary function.

Correct Answer: b. Inhaled dornase alfa.

36. What should be done when a 4-year-old has a visual acuity of 20/50 but had difficulty cooperating during testing?

Answer: The child’s vision should be retested in one month.

Repeating the examination helps determine whether the abnormal result was due to poor cooperation.

Correct Answer: d. Test the child’s vision in 1 month.

37. What should be done when an infant has an abnormal red reflex?

Answer: The infant should be referred to an ophthalmologist.

An abnormal red reflex may indicate cataracts, retinoblastoma, or other serious eye disorders.

Correct Answer: d. Refer the infant to an ophthalmologist.

38. What does the Hirschberg test evaluate?

Answer: The Hirschberg test evaluates ocular alignment.

It is commonly used to screen for strabismus in children.

Correct Answer: b. Ocular alignment.

39. What does a cloudy cornea after fluorescein staining indicate?

Answer: A cloudy appearance suggests corneal damage.

Fluorescein staining helps identify abrasions and other corneal injuries.

Correct Answer: c. There is damage to the cornea.

40. What treatment is commonly initiated for exotropia in a toddler?

Answer: Initial treatment often involves patching the unaffected eye for two hours daily.

Patching promotes use of the weaker eye and helps prevent amblyopia.

Correct Answer: d. Patching of the unaffected eye for 2 hours each day.

41. What is the recommended management for a 9-month-old infant with resolved retinopathy of prematurity (ROP)?

Answer: Infants with a history of retinopathy of prematurity should have a follow-up ophthalmologic examination at 12 months of age.

Continued surveillance is important because prematurity increases the risk of future visual problems.

Correct Answer: a. At 12 months of age.

42. What is the most likely diagnosis in a 1-week-old infant with eyelid swelling and thick purulent eye discharge?

Answer: The most likely diagnosis is Chlamydia trachomatis conjunctivitis.

This condition typically presents between 5 and 14 days of life with eyelid edema and purulent discharge.

Correct Answer: b. Chlamydia trachomatis conjunctivitis.

43. What should be done for a 5-day-old infant with conjunctivitis, corneal opacity, and serosanguinous discharge?

Answer: The infant should be admitted to the hospital immediately.

These findings are concerning for severe neonatal eye infection, including possible herpes simplex virus (HSV) infection, which requires urgent management.

Correct Answer: b. Admit the infant to the hospital immediately.

44. How should bacterial conjunctivitis in a preschool-aged child be treated?

Answer: Treatment includes topical antibiotic eye drops.

Bacterial conjunctivitis commonly presents with purulent discharge, matted eyelids, and conjunctival erythema.

Correct Answer: d. Prescribe topical antibiotic drops.

45. What is the appropriate management for a child with a glass fragment in the eye?

Answer: The child should be referred immediately to an ophthalmologist.

Attempting to remove or manipulate an ocular foreign body can worsen the injury.

Correct Answer: a. Refer immediately to an ophthalmologist.

46. What should pediatric nurse practitioners consider when prescribing topical glucocorticoids?

Answer: They should prescribe brand-name preparations when consistent effects are necessary.

Potency and absorption can vary among formulations, making consistency important in certain clinical situations.

Correct Answer: c. Prescribe brand-name preparations for consistent effects.

47. How is hot tub folliculitis managed in adolescents?

Answer: Treatment typically includes topical keratolytics and topical antibiotics.

Hot tub folliculitis presents as erythematous papules centered around hair follicles, commonly caused by Pseudomonas aeruginosa.

Correct Answer: d. Prescribe topical keratolytic and topical antibiotics.

48. What is the treatment for candidal dermatitis in an infant with erythema in the neck and flexural folds after antibiotic therapy?

Answer: The appropriate treatment is topical nystatin cream applied several times daily.

Candida infections frequently occur in moist skin folds following antibiotic use.

Correct Answer: d. Topical nystatin cream applied several times daily.

49. How should a child with tinea corporis and scalp involvement be treated?

Answer: The child should receive oral griseofulvin for 2 to 4 weeks.

Scalp involvement (tinea capitis) requires systemic antifungal therapy because topical agents are generally ineffective.

Correct Answer: c. Prescribe oral griseofulvin for 2 to 4 weeks.

50. What is the recommended treatment for tinea versicolor?

Answer: Treatment consists of selenium sulfide 2.5% lotion applied twice weekly for 2 to 4 weeks.

This therapy helps reduce the overgrowth of Malassezia species responsible for the condition.

Correct Answer: a. Application of selenium sulfide 2.5% lotion twice weekly for 2 to 4 weeks.

51. Which test differentiates HSV-1 from HSV-2 in adolescents with oral vesicular lesions?

Answer: A viral culture can help distinguish between HSV-1 and HSV-2.

Identifying the viral subtype may assist with counseling and management.

Correct Answer: d. Viral culture.

52. How is herpes zoster managed in an otherwise healthy school-aged child?

Answer: Management includes Burrow solution and warm soothing baths for symptom relief.

Herpes zoster in healthy children is usually self-limited and often requires only supportive care.

Correct Answer: a. Order Burrow solution and warm soothing baths as comfort measures.

53. What physical findings are associated with pediculosis capitis?

Answer: Children typically present with scalp itching and excoriations, especially on the back of the head, along with live lice or nits near the scalp.

Correct Answer: c. Itching of the scalp, with skin excoriation on the back of the head.

54. How is scabies treated in a 9-month-old infant?

Answer: The recommended treatment is permethrin 5% cream applied to the face, neck, and body and washed off after 8–14 hours.

Household contacts should also be evaluated and treated if necessary.

Correct Answer: b. Permethrin 5% cream applied to face, neck, and body and rinsed off in 8 to 14 hours.

55. What acne distribution pattern is commonly seen on the cheeks and under the chin in adolescents?

Answer: This pattern is known as hormonal acne distribution.

Hormonal acne commonly affects the lower face and jawline.

Correct Answer: c. Hormonal.

56. What is the preferred treatment for mild inflammatory acne with papules and pustules?

Answer: Treatment typically includes topical erythromycin combined with benzoyl peroxide.

Combination therapy helps reduce bacterial resistance and improves treatment outcomes.

Correct Answer: c. Topical erythromycin with benzoyl peroxide.

57. How is seborrheic dermatitis in an adolescent managed?

Answer: The recommended treatment is daily application of ketoconazole 2% topical cream.

Seborrheic dermatitis commonly presents with greasy yellow scales on the face and scalp.

Correct Answer: a. Daily application of ketoconazole 2% topical cream.

58. What is the initial treatment for acute urticaria after strawberry ingestion?

Answer: The child should receive diphenhydramine 0.5–1 mg/kg every 4–6 hours.

Antihistamines are the first-line treatment when there are no signs of anaphylaxis.

Correct Answer: c. Diphenhydramine 0.5 to 1 mg/kg/dose every 4 to 6 hours.

59. How should Stevens-Johnson syndrome or toxic epidermal necrolysis be managed?

Answer: The child should be admitted to a pediatric intensive care unit (PICU) in consultation with a pediatric intensivist.

Extensive skin involvement and systemic symptoms require intensive supportive care.

Correct Answer: a. Consult with a pediatric intensivist for admission to a pediatric intensive care unit.

60. What is the appropriate management for pityriasis rosea?

Answer: Parents should be reassured that pityriasis rosea is a benign, self-limited condition.

The classic presentation includes a herald patch followed by a “Christmas tree” distribution rash.

Correct Answer: c. Reassure the child’s parents that the rash is benign and self-limited.