NU580 Final Exam

Name

Purdue University Globle

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

Prof. Name

Date

NU580 Final Exam

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

A. Start empiric treatment with trimethoprim-sulfamethoxazole.
B. Discuss behavioral strategies related to toilet training.
C. Reassure the parents that the symptoms are normal.
D. Send a urine specimen to the laboratory for culture.

Answer: D. Send a urine specimen to the laboratory for culture.

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

A. Observe the child without treatment.
B. Repeat the urine culture.
C. Increase oral fluid intake only.
D. Treat the child with antibiotics for a urinary tract infection (UTI).

Answer: D. Treat the child with antibiotics for a urinary tract infection (UTI).

3. What is the appropriate treatment for a school-aged child with dysuria, foul-smelling urine, and positive leukocyte esterase and nitrite results on a urine dipstick?

A. Prescribe nitrofurantoin for 10 days.
B. Prescribe trimethoprim-sulfamethoxazole (TMP-SMX) twice daily for 3–5 days.
C. Wait for the urine culture before initiating treatment.
D. Encourage increased fluid intake only.

Answer: B. Prescribe trimethoprim-sulfamethoxazole (TMP-SMX) twice daily for 3–5 days.

4. What should parents understand after their child with nephrotic syndrome responds well to corticosteroid therapy?

A. Corticosteroids should never be used again.
B. Corticosteroids may be used again if the child experiences a relapse.
C. Surgery is generally required.
D. The condition has been permanently cured.

Answer: B. Corticosteroids may be used again if the child experiences a relapse.

5. A child with nephrotic syndrome has improved from 3+ to 1+ proteinuria. What is the appropriate management?

A. Stop corticosteroid therapy immediately.
B. Continue corticosteroids and sodium restriction until the urine is negative for protein.
C. Initiate antibiotic therapy.
D. Restrict all fluid intake.

Answer: B. Continue corticosteroids and sodium restriction until the urine is negative for protein.

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

A. Prescribe oral antibiotics and schedule follow-up in one week.
B. Encourage increased oral fluid intake.
C. Manage the child as an outpatient with diuretics.
D. Refer the child to a pediatric nephrologist for hospitalization.

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

7. What is the appropriate action when a unilateral, smooth, firm abdominal mass is detected in a 2-year-old child?

A. Schedule routine follow-up in one month.
B. Begin empiric antibiotic therapy.
C. Recommend abdominal massage for comfort.
D. Refer the child to an oncologist immediately.

Answer: D. Refer the child to an oncologist immediately.

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

A. Observe the infant until puberty.
B. Refer the infant to a pediatric urologist or surgeon for evaluation and possible orchiopexy.
C. Begin testosterone therapy.
D. No treatment or follow-up is necessary.

Answer: B. Refer the infant to a pediatric urologist or surgeon for evaluation and possible orchiopexy.

9. What is the appropriate action for a 9-month-old infant with scrotal swelling, irritability, and a tender scrotal mass that is difficult to reduce?

A. Apply ice packs and observe.
B. Refer the infant immediately to a pediatric surgeon.
C. Prescribe oral antibiotics.
D. Schedule elective surgery several weeks later.

Answer: B. Refer the infant immediately to a pediatric surgeon.

10. What should parents know about probiotics for the treatment of infant colic?

A. Probiotics cure infant colic.
B. All infants should routinely receive probiotics.
C. Probiotics are FDA-approved specifically for infant colic.
D. There is insufficient conclusive evidence supporting probiotics as a treatment for colic.

Answer: D. There is insufficient conclusive evidence supporting probiotics as a treatment for colic.

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

A. Repeat the barium swallow study.
B. Refer the child for surgery.
C. Initiate tube feeding.
D. Perform a videofluoroscopic swallowing study.

Answer: D. Perform a videofluoroscopic swallowing study.

12. How should mild-to-moderate dehydration caused by vomiting and diarrhea be managed in a toddler?

A. Admit the child immediately for intravenous fluids.
B. Prescribe antibiotics.
C. Restrict oral intake.
**D. Provide oral rehydration solution (ORS) and arrange follow-up within 24 hours.

Answer: D. Provide oral rehydration solution (ORS) and arrange follow-up within 24 hours.

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

A. Prescribe antiemetics only.
B. Refer the child to a pediatric neurologist.
C. Observe the child for one week.
D. Refer the child to a pediatric gastroenterologist for further evaluation.

Answer: D. Refer the child to a pediatric gastroenterologist for further evaluation.

14. How should a child who swallowed a 6-mm metal bead that is located in the stomach be managed?

A. Arrange immediate endoscopic removal.
B. Instruct the parents to monitor the child’s stool for passage of the object.
C. Induce vomiting.
D. Begin laxative therapy.

Answer: B. Instruct the parents to monitor the child’s stool for passage of the object.

15. What is the most likely diagnosis when abdominal pain migrates to the right lower quadrant and is followed by fever?

A. Perforated appendicitis.
B. Gastroenteritis.
C. Constipation.
D. Mesenteric adenitis.

Answer: A. Perforated appendicitis.

16. What initial diagnostic evaluation is appropriate for a school-aged child with recurrent abdominal pain, headaches, and a normal physical examination?

A. CBC, ESR, amylase, lipase, urinalysis, and abdominal ultrasound.
B. CT scan only.
C. Colonoscopy.
D. Abdominal MRI.

Answer: A. CBC, ESR, amylase, lipase, urinalysis, and abdominal ultrasound.

17. What is an important component of managing functional abdominal pain associated with stress and school-related anxiety?

A. Long-term opioid therapy.
B. Surgical consultation.
C. Education about the brain-gut interaction that can contribute to symptoms.
D. Strict dietary restrictions.

Answer: C. Education about the brain-gut interaction that can contribute to symptoms.

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

A. Colonoscopy.
B. Serologic testing for celiac disease.
C. Stool culture.
D. Hydrogen breath testing.

Answer: B. Serologic testing for celiac disease.

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

A. Acute liver failure.
B. Intestinal obstruction caused by scarring and strictures.
C. Acute pancreatitis.
D. Nephrotic syndrome.

Answer: B. Intestinal obstruction caused by scarring and strictures.

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

A. Start appetite stimulants.
**B. Obtain feeding and stooling histories along with a 3-day dietary history.
**C. Order an MRI.
**D. Refer the infant immediately for surgery.

NU580 Final Exam

Answer: B. Obtain feeding and stooling histories along with a 3-day dietary history.

21. What intervention may help shorten the duration of acute diarrhea in a well-hydrated 2-year-old?

A. Loperamide
B. Lactobacillus probiotics
C. Oral antibiotics
D. Clear-liquid diet only

Answer: B. Lactobacillus probiotics.

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

A. Atrial septal defect (ASD)
B. Ventricular septal defect (VSD)
C. Patent ductus arteriosus (PDA)
D. Pulmonary stenosis

Answer: A. Atrial septal defect (ASD).

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

A. Venous hum
B. Pulmonary flow murmur
C. Still’s murmur
D. Aortic stenosis murmur

Answer: C. Still’s murmur.

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

A. Reassure the parents.
B. Repeat the examination in one year.
C. Begin antibiotic therapy.
D. Refer the infant to a pediatric cardiologist for further evaluation.

Answer: D. Refer the infant to a pediatric cardiologist for further evaluation.

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

A. Tetralogy of Fallot
B. Patent ductus arteriosus
C. Coarctation of the aorta
D. Ventricular septal defect (VSD)

Answer: D. Ventricular septal defect (VSD).

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

A. Bradycardia
B. Bounding peripheral pulses
C. Oxygen desaturation
D. Hyperactivity

Answer: C. Oxygen desaturation.

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

A. Elevated blood pressure
B. Prehypertension
C. Stage 1 hypertension
D. Stage 2 hypertension

Answer: C. Stage 1 hypertension.

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

A. Thyroid function tests and CBC
B. Liver function tests
C. Renal function studies and plasma renin levels
D. Lipid panel only

Answer: C. Renal function studies and plasma renin levels.

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

A. Continue observation only.
B. Begin a high-sodium diet.
C. Repeat the blood pressure measurement in one year.
D. Refer the child to a pediatric nephrologist or cardiologist.

Answer: D. Refer the child to a pediatric nephrologist or cardiologist.

30. What should be done when a child with a repaired congenital heart defect develops fever and has poor dental health?

A. Admit the child to the hospital and obtain a pediatric cardiology consultation.
B. Prescribe oral antibiotics and discharge the child.
C. Schedule a dental appointment only.
D. Reassure the parents.

Answer: A. Admit the child to the hospital and obtain a pediatric cardiology consultation.

NU580 Final Exam

31. Which is an early symptom of acute lower airway obstruction in children?

A. Cyanosis
B. Retractions
C. Stridor
D. Wheezing

Answer: D. Wheezing.

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

A. Oral antibiotics
B. Nasal decongestants
C. Saline nasal rinses
D. Oral corticosteroids

Answer: C. Saline nasal rinses.

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

A. Continue supportive care at home.
B. Prescribe antihistamines.
C. Observe for 72 hours.
D. Refer the child immediately to a pediatric otolaryngologist.

Answer: D. Refer the child immediately to a pediatric otolaryngologist.

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

A. Examine the throat with a tongue depressor.
B. Obtain a throat culture.
C. Prescribe oral antibiotics.
**D. Arrange emergency transport to the hospital through EMS.

Answer: D. Arrange emergency transport to the hospital through EMS.

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

A. Albuterol tablets
B. Inhaled dornase alfa
C. Oral prednisone
D. Montelukast

Answer: B. Inhaled dornase alfa.

NU580 Final Exam

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

A. Refer immediately to an ophthalmologist.
B. Prescribe corrective lenses.
C. Patch one eye.
**D. Repeat the vision screening in one month.

Answer: D. Repeat the vision screening in one month.

37. What is the appropriate action when an infant has an abnormal red reflex?

A. Recheck it at the next well-child visit.
B. Prescribe antibiotic eye drops.
C. Initiate vision therapy.
**D. Refer the infant to an ophthalmologist.

Answer: D. Refer the infant to an ophthalmologist.

38. What does the Hirschberg test evaluate?

A. Visual acuity
B. Ocular alignment
C. Color vision
D. Peripheral vision

Answer: B. Ocular alignment.

39. What does corneal clouding or an abnormal corneal appearance after fluorescein staining indicate?

A. A normal finding
B. Increased tear production
C. Corneal damage
D. Retinal detachment

Answer: C. Corneal damage.

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

A. Immediate surgery
B. Corrective eyeglasses only
C. Topical antibiotic ointment
**D. Patch the unaffected eye for 2 hours each day.

Answer: D. Patch the unaffected eye for 2 hours each day.

41. What is the recommended follow-up for a 9-month-old infant whose retinopathy of prematurity (ROP) has resolved?

A. Schedule a follow-up ophthalmologic examination at 12 months of age.
B. No additional follow-up is necessary.
C. Refer for immediate eye surgery.
D. Begin corrective lens therapy.

Answer: A. Schedule a follow-up ophthalmologic examination 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?

A. Gonococcal conjunctivitis
B. Chlamydia trachomatis conjunctivitis
C. Allergic conjunctivitis
D. Viral conjunctivitis

Answer: B. Chlamydia trachomatis conjunctivitis.

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

A. Prescribe topical antibiotic drops and discharge the infant.
B. Admit the infant to the hospital immediately.
C. Schedule follow-up in 48 hours.
D. Observe without treatment.

Answer: B. Admit the infant to the hospital immediately.

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

A. Oral antihistamines
B. Artificial tears only
C. Warm compresses only
**D. Prescribe topical antibiotic eye drops.

Answer: D. Prescribe topical antibiotic eye drops.

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

A. Refer the child immediately to an ophthalmologist.
B. Irrigate the eye and remove the fragment in the office.
C. Apply an eye patch and observe.
D. Prescribe topical antibiotics only.

Answer: A. Refer the child immediately to an ophthalmologist.

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

A. Generic preparations are always identical to brand-name products.
B. Topical glucocorticoids have no differences in potency.
C. Brand-name preparations may be selected when consistent effects are necessary.
D. The strongest available steroid should be used for every skin condition.

Answer: C. Brand-name preparations may be selected when consistent effects are necessary.

47. How should hot-tub folliculitis in an adolescent be managed?

A. Oral acyclovir
B. Oral griseofulvin
C. Systemic corticosteroids
**D. Prescribe topical keratolytic agents and topical antibiotics.

Answer: D. Prescribe topical keratolytic agents and topical antibiotics.

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

A. Hydrocortisone cream
B. Bacitracin ointment
C. Mupirocin ointment
**D. Apply topical nystatin cream several times daily.

Answer: D. Apply topical nystatin cream several times daily.

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

A. Topical clotrimazole only
B. Selenium sulfide shampoo alone
**C. Oral griseofulvin for 2–4 weeks
**D. Topical hydrocortisone cream

Answer: C. Oral griseofulvin for 2–4 weeks.

50. What is the recommended treatment for tinea versicolor?

A. Apply selenium sulfide 2.5% lotion twice weekly for 2–4 weeks.
B. Oral amoxicillin
C. Topical mupirocin
**D. Oral prednisone

Answer: A. Apply selenium sulfide 2.5% lotion twice weekly for 2–4 weeks.

51. Which test can differentiate HSV-1 from HSV-2 in an adolescent with oral vesicular lesions?

A. Complete blood count (CBC)
B. Gram stain
**C. Potassium hydroxide (KOH) preparation
**D. Viral culture

Answer: D. Viral culture.

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

A. Use Burow solution and warm soothing baths for symptomatic relief.
B. Administer intravenous acyclovir.
C. Prescribe oral antibiotics.
D. Administer high-dose corticosteroids.

Answer: A. Use Burow solution and warm soothing baths for symptomatic relief.

53. Which physical findings are commonly associated with pediculosis capitis?

A. Vesicular lesions on the scalp
B. Thick yellow scales over the scalp
**C. Scalp itching with excoriations, particularly on the back of the head
**D. Diffuse hair loss without itching

Answer: C. Scalp itching with excoriations, particularly on the back of the head.

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

A. Topical hydrocortisone cream
**B. Apply permethrin 5% cream to the face, neck, and body and wash it off after 8–14 hours.
**C. Oral fluconazole
**D. Topical mupirocin

Answer: B. Apply permethrin 5% cream to the face, neck, and body and wash it off after 8–14 hours.

55. Which acne distribution pattern is commonly associated with the cheeks and area beneath the chin in adolescents?

A. Comedonal acne
B. Nodulocystic acne
**C. Hormonal acne distribution
**D. Neonatal acne

Answer: C. Hormonal acne distribution.

56. What is a commonly recommended treatment for mild inflammatory acne characterized by papules and pustules?

A. Oral isotretinoin
B. Topical tretinoin alone
**C. Topical erythromycin combined with benzoyl peroxide
**D. Oral prednisone

Answer: C. Topical erythromycin combined with benzoyl peroxide.

57. How is seborrheic dermatitis in an adolescent commonly managed?

A. Apply ketoconazole 2% topical cream daily.
B. Oral terbinafine
C. Oral cephalexin
D. Topical mupirocin

Answer: A. Apply ketoconazole 2% topical cream daily.

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

A. Intramuscular epinephrine for every patient
B. Oral corticosteroids only
**C. Diphenhydramine 0.5–1 mg/kg/dose every 4–6 hours
D. Topical hydrocortisone cream

Answer: C. Diphenhydramine 0.5–1 mg/kg/dose every 4–6 hours.

59. How should Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) be managed?

A. Consult a pediatric intensivist for admission to the pediatric intensive care unit (PICU).
B. Treat with topical antibiotics and discharge the patient.
C. Prescribe oral antihistamines.
D. Manage the condition with outpatient follow-up only.

Answer: A. Consult a pediatric intensivist for admission to the pediatric intensive care unit (PICU).

60. What is the appropriate management for pityriasis rosea?

A. Prescribe oral antibiotics.
B. Begin systemic corticosteroid therapy.
**C. Reassure the child and parents that the rash is generally benign and self-limited.
D. Refer the child immediately to a dermatologist.

Answer: C. Reassure the child and parents that the rash is generally benign and self-limited.