NRNP 6541-17-Primary Care of Adult & Child Final Exam

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Glyburide belongs to the following class of drugs:

	A.	Biguanides
	B.	Sulfonylureas
	C.	Thiazolidinediones
	D.	Diuretics

Leukocytes are differentiated into subtypes, which are:

	A.	Lymphocytes, granulocytes, monocytes
	B.	Albumin, globulin, and fibrinogen
	C.	RBCs, monocytes, and lymphocytes
	D.	Platelets, RBCs, and granulocytes

Approximately __________ of breast milk is water.

	A.	20%
	B.	40%
	C.	70%
	D.	90%

An important educational tip to give a parent of a child with a respiratory tract infection is:

	A.	Signs and symptoms of respiratory distress.
	B.	What to expect in the child’s symptoms and what to do if they worsen.
	C.	Infection control information.
	D.	A and B
	E.	A, B, and C

In a formula-fed infant with uncomplicated recurrent regurgitation, the following intervention may reduce over-regurgitation and vomiting.

	A.	Feeding water between each feeding
	B.	Thinning the formula
	C.	Thickening the formula
	D.	Feeding the baby in a supine position

Preventive measures for anal fissures are:

	A.	Avoiding constipation
	B.	Encouraging regular toileting habits
	C.	Avoiding the use of laxatives and/or enemas
	D.	A and B
	E.	A, B, and C

In a case of appendicitis, the imaging study which has been shown to be the most accurate for diagnosis is:

	A.	Conventional radiograph
	B.	Ultrasound
	C.	CT scan
	D.	MRI

Deformities are defects that result from:

	A.	Genetic processes
	B.	Developmental processes
	C.	An external process, causing an abnormal shape to a body part or organ
	D.	An external process, causing an abnormal positioning of a body part or organ
	E.	C and D

In treating a hordeolum, you tell your patient to:

	A.	Apply a steroid ointment that you prescribe four times a day.
	B.	Apply warm moist compresses to the affected eye three to four times a day.
	C.	Squeeze it in front of the mirror to encourage it to drain.
	D.	B and C
	E.	None of the above

Bands are:

	A.	The primary defense against infection and mediating stress.
	B.	Immature neutrophils put out by the bone marrow.
	C.	Primary components of the immune system.
	D.	Associated with antigen-antibody response.

The most common infecting organism(s) for acute otitis media is/are:

	A.	S. pneumoniae
	B.	Haemophillus influenzae
	C.	Moraxella catarrhalis
	D.	All of the above

Hodgkin lymphoma:

	A.	Typically originates in a cervical node
	B.	Leads to very painful lymph node enlargement
	C.	Commonly involves the bone marrow
	D.	A and C

To reduce the risk of mercury poisoning, recommendations for fish consumption for pregnant women and children include(s):

	A.	Eat albacore tuna no more than three times a week
	B.	Eat 8-12 ounces of fish per week for women
	C.	Choose fish lower in mercury
	D.	B and C
	E.	A, B, and C

In an infant, severe hydration is characterized by _____ weight loss.

	A.	5 %
	B.	10%
	C.	12%
	D.	15%

All of the following are types of diagnostic genetic testing, except:

	A.	Amniocentesis
	B.	Karyotype
	C.	FISH (fluorescence in situ hybridization)
	D.	Chromosomal microarray

Most pediatric neurologists will consider gradually withdrawing anticonvulsant activity after:

	A.	6 months without a seizure
	B.	1 year or longer without a seizure
	C.	2 years or longer without a seizure
	D.	10 years without a seizure

In pregnant women of the following cultures, referral is important for testing of Tay-Sachs disease.

	A.	African American
	B.	Asian
	C.	Mediterranean
	D.	Ashkenazi Jewish and French-Canadian

In a child with depression, a diagnosis of major depressive disorder is made if:

	A.	The child has more than one suicide attempt.
	B.	There have been at least 2 weeks of depressed mood or loss of interest and at least four symptoms of depression.
	C.	The symptoms cause considerable distress and impairment in social and academic functioning and are not caused by bereavement.
	D.	B and C
	E.	A, B, and C

The Vaccines for Children (VFC) program provides free vaccines to children under the age of 19 years who are:

	A.	Medicaid-eligible
	B.	Native American
	C.	Alaska native
	D.	All of the above

In a child with malabsorption syndrome, it is common to have:

	A.	A voracious appetite
	B.	Premature puberty
	C.	Pale formed stools
	D.	None of the above

In a child with repeated episodes of otitis externa, he/she should be instructed to:

	A.	Use well-fitting earplugs for swimming.
	B.	Use a blow dryer on a warm setting to dry the auditory canal.
	C.	Clean the auditory canal regularly.
	D.	A and B
	E.	A, B, and C

Radon is a gas that enters homes through:

	A.	Basement floors
	B.	Drains
	C.	Smoke
	D.	A and B
	E.	A, B, and C

In a patient with mitral valve prolapse, it is common to hear:

	A.	A friction rub with muffled heart sounds.
	B.	A loud S2
	C.	A variable murmur
	D.	A midsystolic click

Immune or idiopathic thrombocytopenic purpura is believed to be an autoimmune response in which circulating platelets are destroyed. The vast majority of cases:

	A.	Resolve within 6 months, even without treatment
	B.	Progress to leukemia
	C.	Are due to Von-Willebrand deficiency
	D.	Need chemotherapy as soon as it is diagnosed

Restless leg syndrome is a disorder that is characterized by:

	A.	Irritating sensations in the legs
	B.	An irresistible urge to move the legs
	C.	May occur with repetitive jerks of the legs
	D.	A and B
	E.	A, B, and C

The clinical findings in an individual with a corneal abrasion include:

	A.	Tearing
	B.	Sensation of a foreign body in the eye
	C.	Photophobia
	D.	All of the above

When describing a rash as confluent, it means:

	A.	It is arranged in a line
	B.	It is scattered, widely distributed
	C.	Is running together
	D.	Small, drop like

The first choice in antibiotic therapy for acute otitis media is:

	A.	Azithromycin 10 mg/kg on day 1, 5 mg/kg days 2-5
	B.	Amoxicillin 80-90 mg/kg divided twice a day
	C.	Cefedinir 14 mg/kg/day daily
	D.	Clarithromycin 15mg/kg/day divided twice a day

The following intervention, which has been shown to reduce the incidence of acute otitis media, should be recommended:

he following intervention, which has been shown to reduce the incidence of acute otitis media, should be recommended:

	A.	Exclusive breastfeeding until at least six months of age
	B.	Always feed infants when they are lying down
	C.	Encourage annual influenza vaccine
	D.	A and C

Alcohol-based hand rubs are ineffective against controlling the spread of:

	A.	Staphylococcus aureus
	B.	Clostridium difficile
	C.	Respiratory syncytial virus
	D.	S. pneumoniae

In an acutely ill and toxic-appearing child with an abrupt onset of fever, severe sore throat, dyspnea, inspiratory distress without stridor, and drooling, one should suspect:

	A.	Sinusitis
	B.	Epiglottitis
	C.	Croup
	D.	URI

Petechiae is:

	A.	A papule made of blood vessels
	B.	A bruise, purple to brown, macular, or popular, varied in size
	C.	A purple macular lesion, larger than 1 cm
	D.	Pinpoint, pink to purple macular lesions that do not blanch, 1 to 3 mm

When educating your teenage patient, Kathryn, about her facial acne, you encourage her to:

	A.	Wash her face twice a day with mild soap
	B.	Use a comedone extractor to extract the pustules
	C.	Encourage her to use oil-based face creams only in the morning and never at night.
	D.	A and B
	E.	A, B, and C

In a child with iron-deficiency anemia who is being treated appropriately with ferrous sulfate, hemoglobin should return to normal within:

	A.	1-2 weeks
	B.	4-6 weeks
	C.	3-4 months
	D.	6 months

A normal variation/common problem in children with dark skin is:

	A.	There are decreased areas of melanin in thicker-skinned areas, such as the knee or elbow.
	B.	Color alterations (jaundice, anemia, cyanosis) can be more difficult to assess.
	C.	Erythema is much easier to detect.
	D.	None of the above

In a child with a seizure disorders, factors that need to be considered in antiepileptic drug selection include:

	A.	Age
	B.	Gender
	C.	Ability to swallow
	D.	A and C
	E.	A, B, and C

In iron-deficiency anemia, the serum iron will be ___________, the TIBC will be _________, and the percent saturation will be ___________.

	A.	Increased, increased, increased
	B.	Decreased, decreased, decreased
	C.	Increased, decreased, increased
	D.	Decreased, increased, decreased

In a child with chest pain that is musculoskeletal in origin, the following is/are differential diagnoses:

	A.	Tietze syndrome
	B.	Muscle strain
	C.	Slipping-rib syndrome.
	D.	B and C
	E.	A, B, and C

In children, aspirin is typically contraindicated due to the possibility of:

	A.	Bleeding disorders.
	B.	Agatha syndrome.
	C.	Aspirin allergy
	D.	Reye syndrome

In an individual with bipolar disorder, the medication(s) of choice are:

	A.	Antidepressants
	B.	Mood stabilizers
	C.	Atypical antipsychotics
	D.	B and C
	E.	A, B, and C

The following is an iron-rich food:

	A.	Apricots
	B.	Eggs
	C.	Carrots
	D.	Peanut butter

he following is a gram-positive bacterium:

	A.	Staphylococcus aureus
	B.	Escherichia coli
	C.	Pseudomonas aeruginosa
	D.	Mycoplasma

The following is/are mild traumatic brain injury (concussion) symptoms:

	A.	Confusion
	B.	Emotional irritability
	C.	Dizziness.
	D.	A and C
	E.	A, B, and C

A genuine encounter moment (GEM) is:

	A.	When you pause for 20 seconds to let a child show you something.
	B.	A mutually agreed-upon time that is set apart for 100% attention and love, focused attention, or direct involvement.
	C.	The attendance at a parent-teacher meeting.
	D.	A special time to talk to pre-adolescents about going through puberty.

Mariana comes into your office because she is concerned about her breastmilk. Her baby is 3 ½ weeks old. She tells you that she is exclusively breastfeeding and just when she was “getting the hang of it”, the baby does not seem as satisfied as he was before. She says he is continuing to have 6-8 wet diapers daily and several yellowish cottage-cheese like stools, but suddenly, he is wanting to breastfeed more often and seems very hungry. She is worried that her breastmilk “is not enough anymore”. On exam, the baby’s weight is appropriate, and his exam is unremarkable. You tell Mariana:

	A.	You are correct. The baby must not be getting enough from your milk and it may be time to start supplementing with formula.
	B.	You are doing a great job with your breastfeeding. This is a typical time for a growth spurt (about 3-4 weeks of age). You may need to increase your feedings and feed “on demand” for a few days but that is totally normal.
	C.	That is definitely concerning. You may need to add baby cereal for a few days.
	D.	I wouldn’t worry too much about it. Just let the baby cry and stay on your current schedule. He is doing just fine.

Cerumen in the ear can be removed:

	A.	Mechanically
	B.	By gentle irrigation
	C.	By using a cerumenolytic
	D.	Any of the above

Celiac disease is an immune-mediated systemic disorder characterized by dietary exposure to:

	A.	Lactose
	B.	Eggs
	C.	Citrus fruit
	D.	Wheat gluten

Sources of lead poisoning in children is/are:

	A.	Dust and chips from old deteriorating paint on interior surfaces.
	B.	From soil where children play outside.
	C.	Lead leached into water from lead pipes
	D.	From food cooked in old pottery.
	E.	All of the above

In pernicious anemia, the erythrocytes are:

	A.	Microcytic
	B.	Normocytic
	C.	Macrocytic
	D.	None of the above

The American Cancer Society, ACOG, and the USPTF all recommend that pap tests should begin at age ______ and occur every _____ year(s) afterward.

	A.	Of first sexual encounter; 3
	B.	18; 2-3
	C.	21; 3
	D.	21; 1

In complicated pyelonephritis in a child the child should immediately be:

	A.	Placed on PO antibiotics
	B.	Given IM antibiotics
	C.	Treated as an inpatient with IV antibiotics
	D.	Told to hydrate and to return the next day for follow up

Separation anxiety is a normal developmental phenomenon from about _________ through ___________.

	A.	Birth to 3 months
	B.	3 months to 8 months
	C.	7 months through the preschool years
	D.	3 years to 5 years

Attention Deficit Disorder (ADD) is characterized by:

	A.	Disobedience
	B.	Inattention and impulsiveness
	C.	Aggressive behavior
	D.	Willful defiance

To reduce the risk of carbon monoxide poisoning, families should be warned against using the following in unventilated areas:

	A.	Charcoal grills
	B.	Gas stoves
	C.	Kerosene space heaters
	D.	A and B
	E.	A, B, and C

In the following type(s) of headache(s), vomiting may be present:

	A.	Pediatric migraine headache
	B.	Infrequent episodic tension headache
	C.	Chronic tension headaches
	D.	All of the above

n the developmental stages of self-perception, the first stage is:

	A.	Emergence of self
	B.	Refining of self
	C.	Development of body image
	D.	Development of life story

More NRNP 6541 Final Exam questions

An example of a selective serotonin reuptake inhibitor (SSRI) is:

	A.	Lithium
	B.	Risperidone
	C.	Carbamazepine
	D.	Fluoxetine

John had testing done for Hepatitis B. His serologic markers came back, and you are reviewing them with him. The lab report says: HBsAg -; Anti HBs +; IgM Anti-HBc -; and Total Anti-HBc -. Based on these results, you inform John that he:

	A.	Is immune from vaccination
	B.	Has an acute infection
	C.	Has past infection and is recovered and immune
	D.	Is susceptible as he has never been infected

In a child with peptic ulcer disease (PUD), the procedure of choice for detecting the problem is,

	A.	Colonoscopy
	B.	Esophagogastroduodenoscopy
	C.	Abdominal X-ray
	D.	Chest X-ray

In an infant or child older than 3 months, the following is a criterion for hospital admission with pneumonia.

	A.	Grunting, dyspnea, or apnea
	B.	Hypoxemia with oxygen less than 90%F
	C.	Toxic appearance
	D.	All of the above

Minimum criteria for treating PID in sexually active adolescents with pelvic or lower abdominal pain and no other cause for illness identified include one or more of various criteria. These include:

	A.	Cervical motion tenderness
	B.	Decreased ESR
	C.	Cervical exudates
	D.	A and C
	E.	A, B, and C

The rash that is characteristic with erythema infectiosum:

	A.	Resembles slapped cheeks
	B.	Is on the hands, feet, and mouth
	C.	Is a strawberry tongue
	D.	Are bluish spots on the buccal mucosa

The recommended water intake for a child is approximately:

	A.	1 ounce/kg/day
	B.	8 ounces daily
	C.	32 ounces daily
	D.	As much as the child will drink

All of the following are proton pump inhibitors that can be used to treat gastroesophageal reflux disease except:

	A.	Famotidine
	B.	Omeprazole
	C.	Lansoprazole
	D.	Esomeprazole

Children younger than 2 years old with the first UTI should have ______________ as soon as the urine is sterile or when the prescribed antibiotic has been completed.

	A.	A renal and bladder ultrasound
	B.	A nuclear voiding cystourethrogram
	C.	A CT scan
	D.	A repeat urine culture

Colostrum:

	A.	Meets all nutritional needs of a normal term newborn in the first few days of life.
	B.	Is the first milk produced by the mother and although it is healthy for the baby, there is typically not enough produced to meet the nutritional needs of a normal term newborn in the first few days of life.
	C.	Is produced during the pregnancy but as soon as the baby is delivered, the milk changes to transitional milk.
	D.	Has more calories than the mature milk.

Cow’s Milk Allergy (CMA):

	A.	Typically develops in the neonatal period, peaks in infancy, and tends to remit during childhood.
	B.	Typically develops in the neonatal period and stays with an individual throughout his/her lifetime.
	C.	Does not develop until the child starts cow’s milk at age 12 months.
	D.	Typically gets worse throughout an individual’s life.

The central nervous system (CNS) consists of the:

	A.	Brain
	B.	Spinal cord
	C.	Afferent nerves
	D.	A and B
	E.	A, B, and C

As a provider, when taking a sexual history from an adolescent, it is most effective to:

	A.	Reassure the client that asking sexual questions is a normal part of clinical practice.
	B.	Use slang so that the adolescent feels more comfortable talking to you.
	C.	Use closed-ended questions to make it more comfortable for them to answer.
	D.	Lead away from questions related to sexual orientation as they may not be ready to discuss this at this age.

In a case of testicular torsion, the child should be:

	A.	Referred to a urologist and seen within a week.
	B.	Given conscious sedation and the provider should try to untwist the spermatic cord.
	C.	Be sent immediately to a urologic surgeon, as there is a 6-hour window following a testicular torsion before significant damage may occur.
	D.	Be followed daily until it resolves itself.

The diagnostic criteria for irritable bowel syndrome are known as IBS _________________ diagnostic criteria.

	A.	Rome III
	B.	Abdominal syndrome
	C.	Manifred
	D.	Mark IV

A hydrocele is:

	A.	A common congenital abnormality in which the urethral meatus is located anywhere from the proximal glans to the perineum on the ventral surface of the penis.
	B.	A condition when the testicle cannot be palpated in the scrotal sac.
	C.	A collection of serous fluid in the scrotal sac.
	D.	A benign, painless cyst on the head of the epididymis.

If molluscum contagiosum is left untreated, it:

	A.	Can progress to skin cancer
	B.	Will usually disappear within 6 months to 2 years
	C.	Will overtake the entire body
	D.	Will cause sepsis

The method of hearing screening used for universal newborn screening is:

	A.	Audiometry
	B.	Auditory brainstem response
	C.	Whisper test
	D.	Evoked otoacoustic emission testing

A finding which is very often observed in patients with hyperthyroidism is:

	A.	Narrow pulse pressure
	B.	Overweight for height
	C.	Goiter
	D.	All of the above

Amenorrhea means:

	A.	Painful periods
	B.	Heavy menstrual bleeding
	C.	Lack of menstruation
	D.	Constant menstruation

Oral antibiotics that may be used for the treatment of acne include,

	A.	Clindamycin
	B.	Doxycycline
	C.	Minocycline
	D.	B and C
	E.	A, B, and C

Cow’s milk protein intolerance (CMPI):

	A.	Tends to get worse throughout one’s lifetime
	B.	Only happens in males
	C.	Usually resolves by 1 to 3 years old
	D.	Only affects individuals if they drink whole milk

In a child with Tetralogy of Fallot, the following is typically present:

	A.	Pulmonary valve stenosis
	B.	Right ventricular hypertrophy
	C.	VSD
	D.	An aorta that overrides the ventricular septum
	E.	All of the above

Cranial nerve I is difficult to assess in children and is not functional until the infant is 5 to 7 months old. CN I is:

	A.	Olfactory
	B.	Oculomotor
	C.	Facial
	D.	Auditory

If a child ingests a foreign body and it is found to be lodged in the esophagus, the method of choice for removal is:

	A.	Surgery
	B.	Endoscopy
	C.	Suction
	D.	Induction of vomiting

In a child with sickle cell anemia, the fundamental aspect(s) of disease management is/are:

	A.	Hydration
	B.	Illness prevention
	C.	Pain management
	D.	A and B
	E.	A, B, and C

The definition of a bulla is:

	A.	A vesicle larger than 1 cm
	B.	A palpable lesion with definite borders filled with liquid or semisolid material
	C.	A solid, raised, flat-topped lesion with distinct borders that is greater than 1 cm
	D.	A raised lesion filled with pus

Eosinophilic esophagitis is only able to be accurately diagnosed by:

	A.	Blood testing
	B.	Urine testing
	C.	Endoscopy and biopsy
	D.	Colonoscopy

All children with Type 1 Diabetes Mellitus should be started on __________ at diagnosis.

	A.	Aspirin
	B.	Metformin
	C.	Insulin
	D.	B and C

Bell Palsy is:

	A.	A sudden, acute unilateral paralysis or weakening of any facet of the facial nerve without sensory loss.
	B.	A sudden, acute unilateral paralysis or weakening of any facet of the facial nerve with sensory loss.
	C.	A sudden, acute bilateral paralysis or weakening of any facet of the facial nerve without sensory loss.
	D.	A weakening of the facial nerve that precedes a transient ischemic attack (TIA).

A phobia is:

	A.	The occurrence of various avoidance responses to particular stimuli.
	B.	A state of apprehension in response to a threatening situation.
	C.	A persistent, extreme, and irrational fear triggered by the presence or anticipation of the presence of a specific person, object, or situation.
	D.	A type of separation anxiety.

Two HPV vaccines are currently licensed for use in the United States. They are:

	A.	Gardasil 1 and Gardasil 2
	B.	Gardasil and Wartaid
	C.	Gardasil and Viracil
	D.	Gardasil and Cervarix

Hepatitis A vaccine is given:

	A.	As a one-time shot.
	B.	At 6 months, one year, and five years
	C.	As a two-dose series
	D.	Orally

Nonsuppurative late complication(s) of GABHS include(s):

	A.	Rheumatic fever
	B.	Acute glomerulonephritis
	C.	Poststreptococcal reactive arthritis
	D.	All of the above

Pelvic pain that occurs at the time of ovulation (typically midway between periods) is called:

	A.	Cyclical menstrual pain
	B.	Midcycle cramps
	C.	Pelvic polyp syndrome
	D.	Mittelschmerz

Labial adhesions:

	A.	Must be opened with surgery as soon as they are discovered.
	B.	Typically resolve spontaneously
	C.	Should not be operated on until the child is one year old.
	D.	Do not occur in children

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NRNP 6541-17-Primary Care of Adult & Child Final Exam

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