ped exam fnp questions fully solved &
updated
A well 12-year-old child recently arrived from South Africa presents for a school
physical. She received BCG immunization shortly after birth and is up to date
with required immunizations. A PPD is placed and read at 48 hours. Likely
findings include which of the following? - ANSWER- Positive PPD, child requires
a follow-up chest X-ray
The BCG, or bacilli Calmette-Guérin, is a vaccine for TB. Many foreign-born
persons have been vaccinated with the BCG vaccine, especially in countries
where there is a high incidence of TB. It is likely that this child will have a positive
PPD test. It is not possible to determine in this case, however, if the child has
active TB without a chest X-ray.
What behavior in a 2-year-old would be considered worrisome? - ANSWER-
Unable to walk downstairs holding a rail:
The nurse practitioner should always be aware of typical expected growth and
development parameters. At two years of age, normal expected gross motor skills
include having the ability to walk up and down stairs without difficulty. The child
should be evaluated further for other delays in gross motor, fine motor, or
language/social skills.
Baby Sabrina presents for her 6 month well child check-up. At 40 weeks gestation
her documented birth weight was 6 lbs 6 oz, and length of 20 inches. Currently
her weight is 10 lbs, 4 oz and length is 24 inches. The nurse practitioner
concludes the following: - ANSWER- The infant is failing to meet expected gains
in both weight and length.:
Infants age 0-3 months gain approximately 1.4 inches in height per month. Baby
Sabrina would be expected to have achieved 24 inches in height by 3 months of
age. At 5-6 months of age, infants have usually doubled their birth weight.
,During a sports physical for an 18-year-old male high school student, which
finding would require further follow-up? - ANSWER- Tanner stage of 4:
Typically, males age 13-18 will have developed to Tanner stage 5. An 18-year-old
male that is in Tanner stage 4 should be evaluated for further growth and
development deficits. Scoliosis of the spine of 10-15 degrees is generally not
considered to be a problem unless the patient expressed concern or discomfort.
A 7-year-old male child is brought to the clinic by his parents for evaluation. The
child has no significant PMH. Approximately seven days ago he developed a cold
and since then has had a persistent cough and fever. His older sister was also ill
with cold symptoms at the same time. The NP performs a physical exam and
notes that the child has mild tachypnea, with crackles in both bases and a pulse
oximeter of 90%. His temperature is 100.8 °F. There are no wheezes auscultated.
The NP suspects that the child has which of the following? - ANSWER- Viral
pneumonia: The child presents clinically with pneumonia. Viral pneumonia
generally has a gradual onset with less acute symptoms and a low-grade fever. It
is usually preceded by an upper respiratory infection. Wheezes are not present in
children with pneumonia.
" 7-year-old male child is brought to the clinic by his parents for evaluation. The
child has no significant PMH. Approximately seven days ago he developed a cold
and since then has had a persistent cough and fever. His older sister was also ill
with cold symptoms at the same time. The NP performs a physical exam and
notes that the child has mild tachypnea, with crackles in both bases and a pulse
oximeter of 90%. His temperature is 100.8 °F. There are no wheezes auscultated."
What does the FNP expect to find on auscultation of the lungs? - ANSWER-
Crackles in a portion of a lung field, no wheezing:
The absence of wheezing is a positive predictor for children with pneumonia.
" 7-year-old male child is brought to the clinic by his parents for evaluation. The
child has no significant PMH. Approximately seven days ago he developed a cold
and since then has had a persistent cough and fever. His older sister was also ill
with cold symptoms at the same time. The NP performs a physical exam and
notes that the child has mild tachypnea, with crackles in both bases and a pulse
oximeter of 90%. His temperature is 100.8 °F.
There are no wheezes auscultated what will the FNP have as part of the plan of
care? - ANSWER- CXR now, supportive care at home; call in one day or if any
worsening of symptoms; return to office in 2 days for follow-up evaluation
,All children with a diagnosis of pneumonia should be carefully monitored. The
child has a classic viral pneumonia presentation, which tends to be less severe
and can be cared for at home.
A 6-month-old male is being seen with his caretaker for a barking cough which is
making the caretaker anxious. The baby seems to have mild respiratory distress
and the oximetry reads at 94%. The FNP sends the baby for - ANSWER- Steeple-
shaped appearance with narrowing in upper airway
Children with croup will usually present with a brassy bark sounding cough,
inspiratory stridor, and a steeple sign (or wineglass) appearance on a chest X-ray.
the most common organism responsible for otitis media is which of the
following? - ANSWER- Streptococcus pneumonia
Streptococcus pneumonia is the most common organism responsible for otitis
media. Amoxicillin
remains the first choice of treatment for otitis media with a suspected bacterial
etiology.
A 19-year-old mother brings her 2 1/2-month-old-boy to your clinic with a concern
that the baby has become less interested in his feedings over the past 2 or 3
days, taking in only about half the normal amount of formula before becoming
tired and falling asleep. His birth history is normal and he has normal
development and weight gain. His temperature is 100.2 °F (axillary) now. He has
no respiratory symptoms and your physical examination reveals no identifiable
source of fever. Which of the following questions/observations would be MOST
helpful in establishing a diagnosis? - ANSWER- "Is anyone else at home ill at this
time?"
The child's symptoms are consistent with the prodromal phase of a viral or
bacterial infection. Asking if there are sick contacts would provide the most
valuable information at this point in time.
Which of the following infants are susceptible to respiratory syncytial virus (RSV)
and bronchitis in the first year of life? - ANSWER- Very low birth weight infants
Although all infants are at risk for RSV, low birth weight infants, infants younger
than 6 months of age, premature infants, and infants with an underlying condition
such as heart or lung disease are at highest risk. By two years of age, almost all
children will have had RSV.
A 4-week-old infant presents to the office in mid-January with a one-week history
of nasal congestion and occasional cough. On the evening prior to this visit, she
, developed a temperature of 102 °F, refused to breast feed, had paroxysmal
coughing, and noisy, labored breathing. Patient is an ill-appearing infant who is
lethargic with tachypnea and intercostal retractions. She has a 4-year-old sibling
who is in day care and who recently had a "cold." Considering the clinical
presentation, what is the most likely cause of this infant's illness? - ANSWER-
RSV bronchiolitis
The child has many risk factors associated with RSV, including a sibling in day
care, along with the time of year. The child's clinical presentation is consistent
with RSV bronchiolitis.
A 9-year-old child's symptoms occur four times a week during the day and three
times during the night, with an FEV1 of 80%. What would be the severity
classification per the National Asthma Education and Prevention Program? -
ANSWER- Moderate persistent
The child's symptoms are consistent with the diagnosis of moderate persistent
asthma per the GINA (Global Initiative for Asthma) guidelines.
An 8-year-old male has mild persistent asthma. Appropriate daily medication
should include which of the following? - ANSWER- An inhaled low-dose
corticosteroid
A child with mild persistent asthma should be using the stepwise approach to
management. Per GINA guidelines, the child with mild persistent asthma should
be using an inhaled low-dose corticosteroid to control symptoms.
A 3-month-old female is brought to the office for a routine examination and
numerous bruises in varying stages are noted on the infant's back and legs. The
mother gets very upset when asked about the bruises and starts to cry. She
refuses to talk any more about the bruises or how this may have happened. A
necessary next step for this scenario is which of the following? - ANSWER-
Explain to the mother that bruises such as these are uncommon in a 4-month-old,
and further assessment, including a skeletal body scan, is required.
Any child with unexplained bruises (especially in children who are not yet
mobile) is required to have a full skeletal body scan.
According to the developmental theory of Erikson, if the needs of the infant are
met in a consistent manner, the infant will develop which of the following? -
ANSWER- TRUST
According to the developmental theorist, Erikson, it is essential for an infant's
needs to be met so they may develop trust in the world around them (Trust vs.
Mistrust stage).
