PNCB CPNP-PC Exam Questions

Correct answer: Intense, conscious anger 

The school-age child is most likely to exhibit conscious, intense anger in regards to the stressor of his parent's recent divorce. As a part of the process of developing relationships with others, school-age children refine their ability to identify, label, and manage their feelings. However, their experiences are limited, and their cognitive abilities are still expanding. They need help in labeling and processing complex emotions such as sadness, depression, worry, and envy. They also need help to manage those and other feelings consciously and in acceptable ways. Coping abilities are significantly affected by the availability of social supports from caregivers.

The younger child is more likely to accept the situation, but have frequent and varied emotional reactions to the divorce as they process through it. The ability to see the positive aspects is not likely to occur until much later in development.

Correct answer: A 10-month-old infant currently on antibiotic therapy for an ear infection

According to the AAP (American Academy of Pediatrics), the most recent guidelines for the treatment of febrile seizures state an LP should be considered in infants younger than 12 months old who are inadequately vaccinated against H. influenzae or Streptococcus pneumoniae, or those who may also have been using an antibiotic prior to seizure onset, and/or in those who have signs of meningeal irritation (suspicion of intracranial infection). Other diagnostic studies include:

• Blood glucose in all children
• CBC, calcium, electrolytes, and urinalysis are optional but frequently included
• EEG if neurologic signs are present or seizure was atypical
• MRI for complex febrile seizure features or if any doubt exists about the diagnosis

Other higher risk groups include patients with focal or prolonged seizures, toxic-appearing, or abnormal physical examinations. Regardless of vaccination status, older patients are able to participate in a complete physical exam to aid the pediatric practitioner in determining whether meningitis is a consideration. Most ordinary febrile seizures are treated symptomatically with antipyretics. Up to 5% of neurologically healthy infants and young children will experience at least one simple febrile seizure, and they are slightly more common in males. 

Correct answer: Prolonged course

In children, the illness B. pertussis generally follows a three-stage pattern:

• Catarrhal stage: 1-2 weeks with nonspecific complaints and manifestations of the common cold including low-grade fever, mild but worsening cough, coryza, sneezing. This is the most contagious stage.
• Paroxysmal stage: 2-4 weeks with absent or minimal fever, persistent paroxysmal cough ending with an inspiratory whoop, worse at night, with vomiting, cyanosis, sweating, and exhaustion present (especially after coughing)
• Convalescent phase: 3 weeks to 6 months; paroxysms become less frequent and less distressing, although the cough may become louder.

Pertussis (whooping cough) is mainly a clinical diagnosis, but a prolonged course of cough along with leukocytosis (not leukopenia) with a marked lymphocytosis supports the diagnosis. Pertussis is known as the "100-day cough" in China. 

Polymerase chain reaction (PCR) is the primary diagnostic test used in most commercial and state laboratories for confirmation. Chest x-rays are most often normal or have nonspecific findings, and a majority of cases occur in children younger than 5 years old.

Correct answer: Provide services to families who care for children with developmental disabilities

The practitioner can, and should, refer families to the Office of Developmental Disabilities for case management, but only this office (not the nurse practitioner) can provide services to these families. Each state manages its own program, and providers need to check with their individual states for a list of provided services, and to learn whether particular services are funded.

The other answer choices are ways the nurse practitioner can advocate for these children and their families.

Correct answer: HIV infection

Breast milk, with very few exceptions, is indicated for all infants. Although rare, contraindications to breastfeeding occur in some unique situations, and include:

• maternal HIV-positive infection
• illegal drug use (maternal use of cocaine, phencyclidine [PCP], and cannabis)
• Classic galactosemia in the infant
• maternal diagnosis of human T-cell lymphotropic virus type I or II
• maternal diagnosis of untreated brucellosis
• maternal diagnosis of cancer and treatment
• herpetic lesions on the mother's nipples, areolas, or breast (expressed breastmilk can be fed to the infant)

Untreated tuberculosis is considered a contraindication to breastfeeding, but if the mother has received over 2 weeks of therapy, she may resume breastfeeding. Hepatitis B and C are not transmitted via breast milk and are, therefore, not contraindicated. However, if the mother's nipples are cracked and/or bleeding, caution should be advised and breastfeeding temporarily be stopped until the nipples are fully healed.

Correct answer: Children in rural areas are more likely to be diagnosed with ADHD and less likely to receive behavioral therapy

ADHD is one of the most commonly diagnosed disorders in childhood, and symptoms can profoundly affect the behavior of individuals across many settings in their lives. ADHD prevalence increases with the child's age and affects approximately 9-15% in school-age children. It is more frequent in males than in females, and females tend to have more problems with inattention. 

The National Survey of Children's Health reports a 6.1% overall prevalence of ADHD in children 2 to 17 years of age in the United States. This study also showed that children in rural areas are more likely to be diagnosed and less likely to receive behavioral therapy for their ADHD. 

ADHD has been identified as one of the most neglected and misunderstood psychiatric conditions in Europe. Although ADHD is estimated to affect approximately 1 in 20 children and adolescents across Europe, very few people received an appropriate diagnosis due to the lack of public awareness and widespread social stigma, as well as the lack of appropriate community support and resources.

Correct answer: Anorexia 

The 5-year mortality rate for anorexia is 15% to 20%, and the majority of these deaths are caused by electrolyte imbalance, malnutrition, and suicide. Due to the complexity of eating disorders, specialty care is needed; however, PCPs play a critical role through detection and early intervention, case coordination, and monitoring for complications.

Complications of anorexia include:

• death, usually secondary to cardiac arrhythmia, hypokalemia, congestive heart failure, or suicide
• chronic altered metabolism
• alcohol and drug addictions
• osteoporosis
• GI disturbances including ulcers and motility disorders
• fertility problems
• gynecologic problems related to prolonged menstrual irregularities
• growth retardation
• dehydration

Correct answer: 2 years of age

The eruption of primary teeth typically begins with the lower central incisors and ends with the maxillary second molars. The sequence and timing of eruption for each tooth are similar for boys and girls. Although there is some age variability in timing, the eruption sequence is important to document. 

In most children, the 20 primary teeth are fully erupted by age 2 years.  

Correct answer: 12 months old

Vision is close to fully developed at 12 months of age. Eye growth, however, is not completed until 10 to 13 years old.

Correct answer: Conflict can lead to barriers to productivity within the organization

Conflict is a natural outcome of working with others and is unavoidable, particularly when there are significant differences in complex organizational systems, and when difficult decisions are required. It is not necessarily good or bad. Unresolved conflict, however, can generate poor health outcomes and can lead to barriers between colleagues and teams, as well as for organizational growth and productivity. 

Practitioners with creative conflict negotiation skills will be better able to resolve tensions that arise than those who avoid or "give in" to conflict.

Correct answer: Sexually active individuals

The causative organism responsible for meningitis spreads via respiratory tract secretions (large droplets) or contact with saliva (kissing). Asymptomatic carriers are the most common source of transmission, as 10% of the population at any given time is a carrier. 

Those at high risk for contracting meningococcal infection who should get vaccinated include:

• All adolescents
• Unvaccinated or partially vaccinated college freshmen living in dormitories
• Military recruits
• Those with HIV
• Those with functional or anatomic asplenia
• Those with persistent complement deficiencies (e.g., SLE)
• Travelers to hyperendemic or epidemic countries
• Those exposed during a community outbreak attributable to a vaccine serogroup

Sexually active individuals are at risk for sexually transmittable diseases, such as HPV (genital warts), and should receive HPV vaccine.

Correct answer: Accountability for each patient outcome is shared 

As a team, each member should be held accountable for every patient outcome. It is vital to clarify the roles and responsibilities of each team member to better define what each member brings to the practice and to better learn from one another. The leader does not necessarily need to have the greatest skill set. The team members should not be autonomous in their particular areas of practice and should work together, teaching and learning from one another.

Correct answer: Monogenetic disorders

Monogenetic disorders (also referred to as single gene disorders) occur when the mutation affects a single gene. The mutation may be present on one or both chromosomes and is most often classified as dominant, recessive, or X-linked. Examples include sickle cell, thalassemia, neurofibromatosis, hemophilia, Duchene muscular dystrophy, cystic fibrosis, fragile X syndrome, PCKD, Marfan syndrome, and Tay-Sachs disease.

Chromosome disorders occur with changes in the number or structure of an entire chromosome (e.g., Down syndrome is caused by an extra copy of chromosome 21). 

Multifactorial disorders result from a combination of genetic and environmental factors (e.g., neural tube defects). 

Mitochondrial disorders are caused by mutations in mitochondrial DNA (nonchromosomal DNA) and are typically progressive disorders affecting the brain and muscles. They are characterized by exclusively maternal (matrilinear) transmission. 

Correct answer: Vitamin B12

Vitamin B12 is essential for neurologic function, adequate red blood cell formation, and DNA synthesis. A vitamin B12 deficiency has been associated with megaloblastic anemia, sore tongue, weakness, and neurological deficits. These neurologic symptoms are often associated with the build-up of homocysteine, due to the failure of precursor B-12 dependent conversion enzymes. Because of the associated neurologic manifestations that can occur, prompt diagnosis of vitamin B12 deficiency is imperative.

Vitamin B1 (thiamin) deficiency is exhibited by muscle weakness, ataxia, confusion, anorexia, tachycardia, and heart failure in infants. 

Signs of Vitamin B2 (riboflavin) deficiency are oral-buccal cavity lesions, generalized seborrheic dermatitis, scrotal and vulval skin changes, normocytic anemia, and dimness of vision. 

Vitamin B6 (pyridoxine) deficiency manifests as dermatitis, anemia, convulsions, neurologic symptoms, and abdominal distress in infants. It may also be seen in combination with other B-complex vitamin deficiencies.

Correct answer: Mycoplasma pneumonia

The most common causes of community-acquired bacterial pneumonia in school-aged children are M. pneumonia, C. pneumonia, S. pneumonia, and M. tuberculosis. M. pneumonia has a slow onset. A persistent cough, malaise, and headache are clinically present, and symptoms are generally accompanied by a high fever (>102.2 F).

H. influenza can cause community-acquired pneumonia in school-aged children but is less common.  C. trachomatis typically causes pneumonia in a 1- to 3-month-old child, and viral pneumonia, such as RSV, is the most common cause of pneumonia in children younger than 2 years of age.

Correct answer: Vitamin D

Human milk has more than adequate amounts of vitamins A, C, E, K, B1, B2, and B6. Although low levels of iron are found in human milk, iron absorption is highly efficient, with 49% of the available iron absorbed, in contrast to 4% from formula. A full-term infant who is exclusively breastfed for 4 to 6 months is not at risk for iron deficiency anemia with iron supplement (1 mg/kg/day) beginning at age 4 months. However, the level of vitamin D in breast milk may not be adequate for breastfed infants.

The American Academy of Pediatrics (AAP) recommends a vitamin D supplement of 400 IU/day, beginning shortly after birth for all infants (including those exclusively breastfed). It is also recommended that the nursing mother takes vitamin D supplements to ensure adequate concentrations in breast milk. Small amounts of direct, unprotected exposure to sunlight is a more effective way than diet for the body to get vitamin D and provides other benefits to the infant. 

Zinc is readily available in human milk and has an absorption rate of 41% versus 31% from cow's milk protein formulas and 14% from soy formulas. 

Correct answer: Storing patient data at multiple sites 

Some practices that threaten patient privacy include storing records in files that are not password protected, leaving computers unattended, storing data at multiple sites, and sharing passwords.

All of the other answer choices are safeguards to protect patient privacy.

Correct answer: This is a benign, self-limited disease with spontaneous resolution in 6 to 12 weeks

Pityriasis rosea (meaning rose-colored flaking) is a common, mild and benign, self-limited rash of unknown origin, although it is thought to be caused by human herpesvirus 6 or 7 (HHV-6 or HHV-7). It is not, therefore, related to a streptococcal infection. It is minimally contagious and occurs most commonly in the fall, early winter, and spring in temperate climates. 

Fifty percent of all cases of pityriasis rosea occur before 20 years old, most commonly in adolescence, and the disease has no gender predilection. It generally resolves spontaneously in 6 to 12 weeks. Oral erythromycin at 250 mg four times daily for 2 weeks may hasten the resolution of the eruption, and antihistamines may be helpful for itching. Minimal sun exposure can help lesions resolve more quickly (make sure to prevent sunburn). Topical steroids do not change the lesions, nor will they hasten recovery (oral steroids can exacerbate symptoms). 

Correct answer: No treatment is required

Erythema toxicum is a common, benign rash in neonates characterized by firm, yellow-white 1- to 2-mm papules or pustules with a surrounding erythematous flare. These lesions are often spread over the entire body in clusters and develop at 24 to 48 hours of life. The origin is unknown with an incidence of up to 50% (higher incidence in term than in preterm newborns). No treatment is required, and the course is brief and transient. 

The other answer choices do not pertain to erythema toxicum, but are various treatments for other, more serious neonatal complications.

Correct answer: Self-awareness

Self-awareness is the understanding of one's own values, beliefs, and bias. Health care providers are encouraged to examine the social and historical context in which they were raised and educated in an effort to gain insight into how that context helped create their values, beliefs, and biases. Exploration of how they are privileged and reflection on how their position can enhance or inhibit optimal health care outcomes is necessary, and is considered the cornerstone of becoming a culturally competent practitioner.

Engagement represents thoughtful consideration, active involvement, and reflection, all occurring together. Examples include empathy, connectivity, and high-quality relationships.

Application denotes moving beyond cultural knowledge toward action, such as intervention. 

Communication with patients of different cultures is essential, as well. When it is successful, there is a synchrony of energies between client and provider, as well as a feeling of connection.