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Quiz Session - Attempts With Random Questions

PNCB CPNP-PC Exam Questions

Page 10 of 25

181.

Which of the statements regarding nonsuicidal self-injurious behaviors is CORRECT?

  • Selective serotonin reuptake inhibitors are used for pharmacologic treatment

  • Behavioral therapy is second-line treatment

  • The behaviors present as random acts that occur in an unpredictable manner

  • Psychotropic medications are not useful in the management of self-injurious behaviors

Correct answer: Selective serotonin reuptake inhibitors are used for pharmacologic treatment

Antidepressants (particularly SSRIs) are a first-line pharmacologic treatment to utilize after cognitive behavioral therapy for nonsuicidal self-injury (NSSI). Cognitive behavioral, dialectical, and family therapy is first-line treatment in NSSI. These behaviors typically present as idiosyncratic, repetitive acts that occur in a stereotypic manner. 

Psychotropic medications may be useful in the management of NSSI. Prompt referral to a mental health professional is necessary if symptoms of psychosis or suicide ideation are present.

182.

Which of the following is NOT an example of teratogen?

  • Diphenhydramine (Benadryl)

  • Thalidomide (Thalomid)

  • Tetracycline (Sumycin)

  • Cytomegalovirus (CMV)

Correct answer: Diphenhydramine (Benadryl)

A teratogen is an agent that causes malformation of an embryo. Teratogens may cause a birth defect in the child or may halt the pregnancy outright. Although teratogens have traditionally been considered as environmental toxins altering critical embryonic and fetal development, it now appears that genomic factors can have significant modifying effects to the teratogen.

Thalidomide is a notorious teratogen; however, exposures can also include viruses (CMV) and medications (tetracycline). Diphenhydramine (Benadryl) is generally considered safe to take during pregnancy.

183.

In an outpatient pediatric care setting, the nurse practitioner may find it difficult to utilize nursing research because:

  • The demands of providing primary care leave little time for research utilization

  • Procedures for utilizing research have not been well defined in the literature

  • Published research within professional journals is too difficult for practitioners to access

  • Outpatient care settings have little in common with settings used for most research

Correct answer: The demands of providing primary care leave little time for research utilization 

Time constraints can be a barrier to research utilization in any setting. However, in the primary care setting, the demands of providing care and thus having little time to devote to research is one of the main barriers that has led to inconsistent quality of preventative health care services affecting both children and families.

The other answer choices are not accurate.

184.

Which of the following is MOST likely to be indicated for an infant with Prader-Willi syndrome?

  • Increased calorie intake

  • Use of a gastrostomy tube

  • Implementation of a calorie restricted diet

  • Using a Prader-Willi specific growth chart for plotting weight and height

Correct answer: Increased calorie intake

Initally, the child with Prader-Willi syndrome is hypotonic and may demonstrate dysphagia and failure-to-thrive (FTT) as an infant. In addition, these infants often have poor feeding skills, a weak suck, tire easily, and do not always spontaneously demand feedings. Increased calorie feedings are often necessary to assist with weight gain.

By 3 to 4 years old, however, the child becomes hyperphagic, lacking the internal regulation responsible for satiety, and becomes at risk for overweight, obesity, and additional health problems. At this time, it may be necessary to implement calorie-restricted diets for weight control (decreased caloric intake), and encouragement of healthy eating habits and exercise are vitally important.

Prader-Willi growth charts do exist but are only for children over 1 year of age who are not receiving growth hormone therapy. For infants with Prader-Willi under 1 year of age or those receiving growth hormone therapy, normal growth charts are indicated. A gastrostomy tube should be avoided whenever possible but, when absolutely necessary, should be promptly removed when no longer indicated to minimize severe scarring.

185.

Your clinic has recently made the conversion to ICD-10-CM. Which of the following is TRUE?

  • ICD-10-CM codes greatly increase the amount of data that describes clinical conditions

  • ICD-10-CM will result in universal improvements in all medical practices

  • Implementation of ICD-10-CM is required by state laws that govern professional licensure

  • ICD-10-CM will result in simplification of the coding process for healthcare providers

Correct answer: ICD-10-CM codes greatly increase the amount of data that describes clinical conditions

Many disease diagnoses in the functional health domain are found in the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM); it is designed to represent the primary phenomena of concern to physicians. It is broad and mature in nature and represents physiologic problems extremely well but includes few labels for the behavioral, social, and developmental problems that NPs also manage.

Federal policy mandates implementation of this coding standard (not state laws). Although it significantly increases the amount of data to describe clinical conditions accurately, conversions are expensive, and it creates hardships to practitioners and institutions.

186.

You are seeing a 4-day-old infant for his first follow-up appointment post discharge. He was born to a first-time mother via spontaneous vaginal delivery after an uncomplicated pregnancy. Due to the mother testing positive for group B streptococcus (GBS) at 38 weeks, she was treated with one dose of penicillin during labor. The infant was observed in the hospital nursery for 48 hours without complications. He is breastfeeding well every 2 to 3 hours, and mom reports her milk is coming in, as she is engorged. The infant's weight today is down 6% from his birth weight. You hear a murmur upon auscultation but cannot tell if it is innocent or pathologic. His physical exam is otherwise normal.

What is the next BEST step in management?

  • Consult with a pediatric cardiologist

  • Obtain an electrocardiogram

  • Obtain a chest radiograph

  • As this is likely an innocent murmur, follow-up in 1 month

Correct answer: Consult with a pediatric cardiologist 

Referral for a newborn murmur to a pediatric cardiologist is recommended for patients with any other abnormal physical exam findings, a history of any conditions that increase the likelihood of structural heart disease, symptoms suggesting underlying cardiac disease, or in the case when any specific innocent murmur is in question by the primary care provider.

Electrocardiography and chest radiography rarely assist in the diagnosis of a heart murmur. Any murmur or cyanosis in the newborn should be carefully monitored and evaluated to detect cardiac abnormalities.

187.

In considering prescribing medications for children, which process within the body changes drugs into inactive, less active, or active compounds?

  • Biotransformation process

  • Elimination process

  • Absorption process

  • Drug distribution process

Correct answer: Biotransformation process

The dosage for pediatric patients has typically been determined by extrapolating from the adult dose and proportionately reducing the dose based on the child's weight and drug side effect profiles. This practice does not take into account, however, the developmental changes in pediatric metabolism, the drug's pharmacokinetics, adverse effects, and medication delivery form. 

A few fundamental principles are important to keep in mind when prescribing medications for children. Drug metabolism involves biotransformation processes that change drugs into active, inactive, less active, or active compounds in the body. Providers need to keep in mind the maturation level of the liver when prescribing drugs, as most drug metabolism occurs in the liver.

Elimination, absorption, and drug distribution are other key factors that need to be considered when prescribing medications for children.

188.

Both the American Academy of Pediatrics (AAP) and Bright Futures recommend blood pressure (BP) screenings at every well-child health visit beginning at what age?

  • 3 years old

  • 2 years old

  • 4 years old

  • 5 years old

Correct answer: 3 years old

Hypertension in infants and young children is most often secondary to another disease process, most commonly renal in origin. Increased rates of obesity can cause primary hypertension in older school-age children and adolescents; however, the GU system must be considered.

The AAP and the Bright Futures Practice Guidelines recommend routine blood pressure (BP) screening at every preventive health care visit beginning at 3 years old.

189.

Which statement regarding antihistamine use in the pediatric population is CORRECT?

  • Slow tapering after chronic use is indicated due to the risk of cholinergic rebound

  • Children younger than 6 years old should not be given decongestants

  • Ample pharmacokinetic data is available for children and adolescent use

  • Tolerance to any particular antihistamine is unlikely

Correct answer: Slow tapering after chronic use is indicated due to the risk of cholinergic rebound

After chronic use, antihistamines should be tapered down slowly due to the risk of cholinergic rebound.

Use of antihistamines can be effective for short-term relief (<4 months), but tolerance can develop and therefore the practitioner may need to rotate drugs. Children younger than 4 years old should not be given decongestants. 

There is limited pharmacokinetic data available for antihistamine use in the pediatric population.

190.

The single strongest predictor of quality of care for children in the United States is:

  • Lack of health care insurance

  • Race/ethnicity of the family

  • Family income

  • Family education

Correct answer: Lack of health care insurance

Lack of health care insurance is the single strongest predictor of quality of care for children in the United States, greater than the effects of race, ethnicity, family income, or education. Quality of care is measured by the timeliness and effectiveness of care, as well as the safety of the care delivered. Both quality and access are required to eliminate the impact of disparities in health.

191.

Which of the following is the MOST appropriate treatment option for a 5-year-old child with chickenpox and associated pruritic rash and fever?

  • Acetaminophen

  • Aspirin

  • Ibuprofen 

  • Varicella immune globulin

Correct answer: Acetaminophen

Chickenpox, caused by varicella-zoster virus (VZV), typically involves fever, rash, and muscle pain or "body aches," and is usually a benign infection in healthy children. Supportive care, which includes management of itching with antihistamines or oatmeal baths, acetaminophen for fever, and antistaphylococccal penicillin or cephalosporins for bacterial superinfections, is the treatment of choice in normal, healthy children.

Aspirin is contraindicated because of the possibility of Reye syndrome. The use of ibuprofen for fever is questionable because of a possible causal relationship with bacterial superinfections. Varicella immune globulin is not effective after the disease has progressed and is only indicated in immunocompromised patients in conjunction with acyclovir.

192.

What is the MOST common tumor in childhood? 

  • Acquired melanocytic nevi

  • Wilms tumor

  • Osteosarcoma

  • Neuroblastoma

Correct answer: Acquired melanocytic nevi 

Nevi are a common finding in children. The two most common types are vascular nevi and pigmented nevi. 

Acquired melanocytic nevi, a type of pigmented nevi, are the most common tumor of childhood. They are caused by an overgrowth of pigment cells and are a type of lesion that contains nevus cells (a type of melanocyte). These acquired moles arise during early childhood and are a form of benign neoplasm, while congenital moles, or congenital nevi, are considered a minor malformation and may be at a higher risk for melanoma. Acquired melanocytic nevi are benign, light brown to dark brown to black, flat, or slightly raised, occurring anywhere on the body, especially on sun-exposed areas above the waist. 

The other answer choices are common malignant childhood tumors.

193.

Muscle weakness, ataxia, confusion, anorexia, tachycardia, and heart failure in infants are all considered signs of a deficiency of which of the following vitamins?

  • Thiamin (Vitamin B1)

  • Riboflavin (Vitamin B2)

  • Niacin (Vitamin B3)

  • Folate (Folacin)

Correct answer: Thiamin (Vitamin B1)

These are all indicative of a thiamin (vitamin B1) deficiency. The patient's caregiver(s) should be counseled on dietary sources to increase this vitamin in the child's diet, such as whole grains, brewer's yeast, legumes, seeds and nuts, fortified grain products, organ meats, and lean cuts of pork.

A riboflavin (vitamin B2) deficiency would manifest with oral-buccal cavity lesions, generalized seborrheic dermatitis, scrotal and vulval skin changes, normocytic anemia, and dimness of vision. 

Signs of niacin (vitamin B3) deficit are dermatitis, diarrhea, inflammation of mucous membranes, and indigestion. 

In severe cases of folate deficiency (vitamin B9), megaloblastic anemia is present. Other signs include glossitis, GI disturbances, increased risk of neural tube defects and growth retardation in infants of folate-deficient mothers.

194.

Which of the following statements is CORRECT about the management of post-traumatic stress disorder (PTSD) in the child?

  • Cognitive-behavioral approaches create an environment of safety and anticipatory planning with family

  • Beta-blockers may increase somatic symptoms of PTSD

  • SSRIs have no role in treating PTSD

  • Symptom patterns should cease with successful treatment, so consistent treatment is vital for the best long-term outcomes

Correct answer: Cognitive-behavioral approaches create an environment of safety and anticipatory planning with family

PTSD describes a characteristic set of symptoms that develops following actual or threatened exposure to a severe stressor or trauma. The trauma may result from a single event, or variable, multiple long-standing events, such as ongoing maltreatment. 

Crisis intervention is often indicated for the child, as well as for caregivers. The pediatric nurse practitioner should educate parents about trauma related to PTSD. Most pediatric psychiatrists do use medications, such as SSRIs and alpha-adrenergic agonists, in conjunction with psychodynamic or cognitive-behavioral approaches, to create an environment of safety and anticipatory planning.

Medication management is not well supported in children. Beta-blockers like propranolol may be effective at decreasing somatic symptoms, including racing heart rate and hyperpnea, associated with posttraumatic stress responses. Anxiety and depressive symptoms respond favorably to SSRIs. Symptom patterns do not cease; rather, they persist, even with successful treatment. Therefore, consistent follow-up assessment is important, and early intervention/management is associated with the best long-term outcomes.

195.

An 18-year-old male presents to your office with complaints of scrotal pain and dysuria. Upon physical examination, you note scrotal edema and erythema with urethral discharge. When the testes are elevated, the patient reports immediate pain relief. Additionally, the cremasteric reflex is present.

What is the MOST likely diagnosis?

  • Epididymitis

  • Testicular torsion

  • Hydrocele

  • Inguinal hernia

Correct answer: Epididymitis 

Epididymitis presents with acute scrotal pain, edema, and erythema. It is most commonly caused by N. gonorrhoeae or Chlamydia trachomatis in the sexually active adolescent, often with infection in the urethra or bladder. However, it can be caused by a viral, coliform bacterial, or tubercular infection; by chemical irritation; by anomalies of the GU tract; or by dysfunctional voiding. It is rare before puberty, but it occurs in younger boys from E. coli infection.

The epididymis is hard, indurated, enlarged, and tender. The cremasteric reflex is normal (not present in older adolescents), and Prehn sign can be elicited (pain relief with scrotal elevation). The urinalysis often shows pyuria.

In testicular torsion, Prehn sign is absent (pain increases with scrotal elevation), and urine is normal. A hydrocele usually presents with painless swelling, while an inguinal hernia presents with swelling most commonly found in the inguinal area, normal urine, and no urethral discharge.

196.

You are assessing a one-day-old newborn female for primitive reflexes. Upon eliciting the Moro reflex, the infant responds asymmetrically, indicating:

  • Paralysis or fractured clavicle

  • Brainstem problem

  • Spinal cord lesion(s)

  • CNS disease or severely depressed infant

Correct answer: Paralysis or fractured clavicle

When the Moro is elicited (presenting loud noise or allowing the infant's head to drop slightly), the infant should respond symmetrically with a "startle," in which both arms abduct and fingers first extend, then flex, then both arms adduct (come back together toward each other to midline). If the arms respond asymmetrically, paralysis or fractured clavicle is possible, and further assessment/diagnostic testing is indicated. The absence of a response indicates severe brainstem problem.

Spinal cord lesions should be ruled out in the presence of an asymmetrical response to trunk incurvation (Galant reflex). CNS disease or a severely depressed infant is likely in the case of an absent rooting reflex; however, do make sure the infant is awake and alert when eliciting the rooting reflex as a sleeping infant may not respond.

197.

Of the following clinical manifestations, which is NOT considered to be a mild allergic reaction to foods in the pediatric patient?

  • Mild laryngeal edema/mild asthma

  • Localized cutaneous erythema/urticaria

  • Angioedema

  • Rhinoconjunctivitis

Correct answer: Mild laryngeal edema/mild asthma

Redness of the skin and/or rash, either localized or generalized, facial swelling, and runny or congested nose with red eyes are all clinical features of a mild allergic reaction to food. In addition, gastrointestinal symptoms are generally caused by mild reactions to offending food(s). 

However, any degree of laryngeal edema or asthma is a more severe clinical manifestation of food intolerance, which may require more immediate treatment.

Height and weight should be monitored closely in children with food allergies, because food elimination and use of alternative foods may compromise nutrition and affect growth.

198.

Which of the following population groups has the HIGHEST incidence of Henoch-Schonlein Purpura (HSP), the most common vasculitis of children?

  • Caucasians

  • African Americans

  • Hispanics

  • Asian Americans

Correct answer: Caucasians 

HSP is the most common vasculitis of children and is a leukoclastic vasculitis of the small vessels. For the majority of children, the prognosis is excellent. HSP can occur anytime from infancy (as early as 6 months old) to adulthood, with Caucasians having the highest incidence and African Americans the lowest incidence.

HSP is seen slightly more in males than in females and occurs more frequently in the fall and winter months, pointing to an environmental trigger, including viral infection. While an upper respiratory infection often precedes HSP, a clear association between an infectous agent and HSP has not been found.  

199.

A 7-year-old female presents to clinic with a rash on her hands, wrists, armpits, forearms, and genitalia. She complains that the rash itches severely, especially at night, but she does not have a history of fever. Her younger sibling has a similar rash. The physical examination reveals assorted vesicles, pustules, and papular lesions, concentrated on the webs of her fingers, sides of her hands, and folds in the axillae.

What condition does this child MOST likely have?

  • Scabies

  • Impetigo

  • Pediculosis

  • Tinea corporis

Correct answer: Scabies

Scabies is caused by the mite, Sarcoptes scabiei, a human parasite that burrows into the skin and causes intense itching. Scabies is highly infectious, and is spread through close contact and sharing of linens or clothing. Sensitization, causing intense itching, occurs approximately 3 weeks after infestation. 

Characteristic lesions include curving S-shaped burrows, especially on the webs of fingers and sides of hands, folds of wrists and armpits, forearms, elbows, belt line, buttocks, genitalia, or proximal half of foot and heel. 

Diagnostic studies include a microscopic exam of scrapings from an unscratched burrow in saline or mineral oil or the burrow ink test. Management involves 5% cream permethrin for affected individuals and others who have been exposed to the patient, as well as washing linens and clothing in hot water and vacuuming the home.

200.

Which of the following genetic syndromes is NOT an indication for initiating growth hormone therapy?

  • Klinefelter syndrome

  • Noonan syndrome

  • Prader-Willi syndrome

  • Turner syndrome

Correct answer: Klinefelter syndrome

FDA-approved indications for growth hormone therapy include:

  • Growth hormone deficiency (GHD), congenital or acquired
  • Growth failure caused by chronic renal failure
  • Acondroplasia
  • Turner syndrome
  • Prader-Willi syndrome
  • Intrauterine growth retardation with failure to catch up by 2 years old
  • Noonan syndrome
  • Down Syndrome
  • SHOX-containing gene deficiency (short-stature homeobox-gene)
  • Idiopathic short stature
  • Unexplained short stature with poor height prognosis, among others

Growth hormone dosing is based on a child's body weight and is generally given in daily subcutaneous injections.

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