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Quiz Session - Attempts With Random Questions

PNCB CPNP-PC Exam Questions

Page 4 of 25

61.

What is the MOST common complication of varicella?

  • Pyodermas

  • Idiopathic thrombocytopenia (ITP)

  • Pneumonia 

  • Encephalitis

Correct answer: Pyodermas 

Varicella is a very contagious but usually self-limited infection caused by the varicella-zoster virus. Since the introduction of the varicella vaccine, mild and atypical variants of the disease have become more common. 

Pyodermas (which literally means "pus in the skin"), or secondary skin bacterial infections from the classic rash that accompanies the virus, occur in about 5% of varicella cases. This complication can cause serious invasive disease from Streptococcus and Staphylococcus and sometimes superficial or life-threatening disease, such as impetigo and fasciitis.

ITP occurs in 1% to 2% of varicella cases. Pneumonia (for which smoking increases risk) and CNS complications, such as encephalitis, Reye syndrome and others, can also occur. 

62.

What are the four parameters included in the clinical dehydration scale (CDS), an assessment tool used to help determine pediatric management of dehydration? 

  • General appearance, eyes, moistness of mucous membranes, presence of tears

  • General appearance, capillary refill time, breathing, urine output

  • General appearance, eyes, capillary refill time, urine output

  • General appearance, moistness of mucous membranes, mental status, heart rate

Correct answer: General appearance, eyes, moistness of mucous membranes, presence of tears

Dehydration is overwhelmingly the result of an infectious process, most often viral, that causes diarrhea in many cases. Children are at an increased risk due to their higher surface area-to-volume ratios, higher rate of insensible loss, and in younger children, their inability to communicate or actively replace losses. 

A clinical dehydration scale (CDS) is a predictive tool regarding length of stay and need for intravenous (IV) fluids. The four parameters used for assessment are:

  • General appearance
  • Eyes (sunken or not)
  • Moistness of mucous membranes
  • Presence of tears

Capillary refill time (CRT), breathing, urine output, mental status, and heart rate are all signs and symptoms that are part of the clinical picture of the child's hydration status, but are not parameters used for the CDS predictive tool regarding management. 

63.

You are assessing a 3-year-old child and find several bruises along her upper arms and back in multiple stages of healing. When you question the mother, she reports that her daughter fell off the swings. You discover that when the mother works, she leaves the child with her boyfriend, whom she has been dating for 1 month. When you ask the child about the bruises, she looks away and does not answer. The child appears unkempt and is not dressed appropriately for the cold weather outside, wearing only a t-shirt and no coat. You suspect abuse and neglect.

What is the MOST appropriate course of action?

  • Call child protective services (CPS)

  • Ask the mother to leave the room and then ask the child about the bruises

  • Call the boyfriend and question him

  • Schedule a family meeting with all members of the child's household

Correct answer: Call child protective services (CPS)

You, as a healthcare provider, are legally obligated to report any suspicions of child abuse and/or neglect to CPS and/or law enforcement agencies. The Health Insurance Portability and Accountability Act (HIPAA) permits protected health information to be disclosed to CPS without the authorization of the legal guardian, but each state has their own laws regarding disclosure of health information to investigators. 

In addition, careful documentation of findings, and any statements made by a parent or caregiver or child (or both) are vital. It is important to act to protect the vulnerable child from potential additional abuse. 

The pediatric nurse practitioner or PCP should also question the child and schedule a family meeting, but these do not take precedence over calling CPS first and foremost.

64.

Transfusion reactions and Rh incompatibility are examples of which type of allergic reaction?

  • Type II

  • Type I

  • Type III

  • Type IV

Correct answer: Type II

There are four types of allergic reactions in which the union of antigen and antibody creates a cascade of biochemical reactions. Type II is defined as cytotoxicity reactions. An antigen causes the formation of IgM and IgG antibodies that bind to the target cell and ultimately destroy that cell. 

Examples of a type II allergic reaction include drug-induced hemolytic anemia, immune thrombocytopenia purpura where autoantibodies are directed against platelets, ABO incompatibility transfusion reactions, and hemolytic erythroblastosis fetalis. 

Type I is manifested as typical allergic symptoms to the extreme of anaphylactic reactions. 

Type III is immune complex reactions, such as serum sickness. 

Type IV is delayed cell-mediated or delayed hypersensitivity reactions.

65.

A 17-year-old female was recently diagnosed with major depressive disorder (MDD). The girl's mother is taking too much responsibility for the distress of her daughter, subsequently “absorbing” all of her daughter's anxiety, and thus making the mother herself more prone to problems such as depression, substance abuse, or physical illness.

What is the MOST likely theory to explain this phenomenon?

  • Family systems theory

  • Human belief model

  • Evolutionary life history theory

  • Parent development theory

Correct answer: Family systems theory

Family systems theory is a theory of human behavior that views the family as an emotional unit, and uses systems thinking to describe the complex interactions in the unit. It is the nature of a family that its members are intensely connected emotionally. An individual's emotional dysfunction has a profound impact on the overall health of the family unit. This theory, originally described by Bowen in the 1960s, provides a framework to help PCPs understand how family dynamics influence adult and child behaviors. 

The PCP can aid families by helping them recognize triangulation and other signs of unhealthy self-differentiation and emotional fusion by helping families modify unhealthy behaviors, and by referring to mental health specialists when significant concerns and dysfunctions arise.

Human belief model is a theoretical construct that attempts to explain why people engage in healthier behavior. 

Evolutionary life history theories explain how the family environment affects family conflict and child development. These theories hold that behaviors are intrinsic, and that the genetic influences on behavior are largely driven by the biologic imperative to reproduce. 

Parent development theory asserts that the parenting role begins in childhood, evolving over time, and is influenced by personal experience, social norms, the health of the parent-child relationship, family dynamics, and the child's individual characteristics.

66.

You are assessing a 2-day-old male and observe a distended abdomen with hypoactive bowel sounds, and he has not yet passed a meconium stool. You order an x-ray of the newborn's abdomen, which reveals dilated loops of bowel. A biopsy determines the diagnosis of Hirschsprung disease.

Which of the following statements regarding Hirschsprung disease is CORRECT?

  • It involves an absence of ganglion cells in the bowel wall

  • It is often diffuse, though rare cases involve focal parts of the colon

  • It is common in children with achondroplasia

  • It results in a portion of the colon having no secretory function

Correct answer: It involves an absence of ganglion cells in the bowel wall 

Hirschsprung disease is an absence of ganglion cells in the bowel wall. It is the most common cause of neonatal colon obstruction and accounts for approximately 33% of all neonatal obstructions. It is not often diffuse, rather localized to a particular area of the bowel, most often in the rectosigmoid region, resulting in a portion of the colon having no motility. It is common in children with trisomy 21 (Down syndrome), and affects males four times more commonly than females.

Clinical findings include failure to pass meconium in the first 48 hours of life, failure to thrive, poor feeding, chronic constipation, vomiting, abdominal obstruction, diarrhea, explosive bowel movements, or flatus. The infant may also present with a distended abdomen with bilious vomiting. 

67.

A 15-year-old female with no known drug allergies has been diagnosed with chlamydia. What is the MOST appropriate treatment option? 

  • Azithromycin (Zithromax, Zmax) 1 g orally as a single dose

  • Ceftriaxone (Rocephin) 250 mg IM one time plus azithromycin (Zithromax, Zmax)1 g orally in a single dose

  • Benzathine penicillin G (Bicillin L-A) 2.4 million units IM in a single dose

  • Acyclovir (Zovirax) 400 mg orally TID for 7 to 10 days

Correct answer: Azithromycin (Zithromax, Zmax) 1 g orally as a single dose

Chlamydial genital infection is the most frequently reported bacterial sexually transmitted infection (STI). Azithromycin, 1 g orally in a single dose, is the first-line treatment for chlamydia. Doxycycline 100 mg orally bid for 7 days is another option. The diagnosis should be reported to the health department. All sex partners in the previous 60 days should be treated, and a test of cure is indicated only if the patient is pregnant.

Ceftriaxone is the treatment of choice for gonorrhea; a report sent to the state health department is indicated for this diagnosis, as well. Benzathine penicillin is generally used in the diagnosis of syphilis. Acyclovir is the indicated treatment for HSV (herpes simplex virus).

68.

Which of the following is a major manifestation of the revised Jones criteria used in the diagnosis of acute rheumatic fever (ARF)?

  • Subcutaneous nodules

  • Fever

  • Elevated acute-phase reactants

  • A positive throat culture

Correct answer: Subcutaneous nodules

The diagnosis of an initial attack of ARF is based on evidence of documented GAS pharyngeal infection, and the revised Jones criteria: findings of two major manifestations, or one major and two minor manifestations of ARF.

Major manifestations include:

  • Carditis
  • Polyarthritis
  • Chorea
  • Erythema marginatum
  • Subcutaneous nodules

Minor manifestations include:

  • Clinical fever, polyarthralgia
  • Laboratory elevated acute phase reactants (ESR or leukocyte count)

69.

What is the MOST common gastrointestinal (GI) emergency affecting neonates? 

  • Necrotizing enterocolitis (NEC)

  • Gastroenteritis

  • Gastroschisis

  • Hirschsprung disease

Correct answer: Necrotizing enterocolitis (NEC)

NEC is a condition prominently affecting premature infants, though it is also seen in full-term infants, particularly those with a history of birth asphyxia, congenital heart disease, and after rotavirus infections. The usual onset is in the first 2 weeks of life, but it can occur later in very low birthweight (VLBW) infants. It is characterized by varying degrees of mucosal or transmural intestinal necrosis.

Infants with immature colons that have become necrosed from trauma or injury are at especially high risk of developing this condition. NEC occurs in 1% to 5% of neonates in the neonatal intensive care unit (NICU), with the vast majority of these cases occurring in VLBW infants. The mortality rate is 10% to 30%; ileus and perforation are early complications.

Hirschsprung disease is an absence of ganglion cells in the bowel wall, resulting in a portion of the colon having no motility. It is the most common cause of neonatal obstruction of the colon. Gastroschisis is a protrusion of the intestinal contents through the abdomen, caused by a failure to close the lateral ventral folds of the developing abdominal wall in utero. Although it is a serious condition, it is not the most common GI emergency. Gastroenteritis is an intestinal infection that is generally not serious.

70.

The American Congress of Obstetricians and Gynecologists (ACOG) recommends that female adolescents have an initial reproductive health visit between:

  • 13 and 15 years old

  • 11 and 13 years old

  • 15 and 17 years old

  • 17 and 19 years old

Correct answer: 13 and 15 years old

ACOG recommends an initial reproductive health visit between 13 and 15 years old for young female adolescents to provide preventive care, anticipatory guidance, and screening. This visit includes discussions of normal menses and patterns, pregnancy prevention, and a pelvic exam only if concerns arise that indicate this exam is warranted.

71.

In the presence of an adrenal crisis in the pediatric patient, administration of intravenous (IV) dextrose and normal saline should be started immediately, in addition to:

  • Hydrocortisone succinate (Solu-Cortef)

  • Glucagon (GlucaGen)

  • Albumin (Albuminar)

  • Antibiotic therapy depending on culture results

Correct answer: Hydrocortisone succinate (Solu-Cortef)

Treatment of adrenal insufficiency includes hormone replacement and is best managed by a pediatric endocrinologist. An adrenal crisis, however, is a medical emergency and requires immediate administration of IV normal saline, dextrose, and stress doses of hydrocortisone succinate. 

IV stress doses of hydrocortisone succinate vary with age: 25 mg in children younger than 3 years old, 50 mg in children 3 to 12 years old, and 100 mg in children older than 12 years old, administered every 6 hours. Parents should be instructed regarding the need for stress doses of hydrocortisone succinate when their child has a febrile illness, surgery, or trauma. They should also be taught how to administer hydrocortisone succinate via intramuscular injection in case the child is vomiting or otherwise unable to swallow or retain oral medication. 

Antibiotic therapy may be warranted (to rule out sepsis) until the diagnosis is confirmed. The other answer choices are not indicated in the presence of an adrenal crisis.

72.

Which of the following countries has the HIGHEST incidence of Kawasaki Disease (KD), the second most common childhood vasculitis?

  • Japan

  • India

  • United Kingdom

  • United States 

Correct answer: Japan

KD is a medium-vessel vasculitis of childhood with a predilection for the coronary arteries. It presents as an acute febrile illness, and is the leading cause of acquired heart disease. It is the second most common childhood vasculitis, with a varying incidence from country to country. 

Japan has the highest incidence of 264.8 per 100,000 in 2012 in children from 0 to 4 years. This is a 10- to 20-fold increase of incidence in Japan, as compared to the United States and United Kingdom. Children of Asian/Pacific Islander descent have the highest rate of hospitalization in the United States, pointing to the role genetics play in the disease.

73.

What are the "three Cs" of measles in a pediatric patient?

  • Cough, coryza, conjunctivitis

  • "Co"plik spots, C. difficile, calcemia

  • Color (red), cough, cold

  • Cough, café-au-lait spots, cleft lip

Correct answer: Cough, coryza, conjunctivitis

The prodromal period marks the first sign of the illness and lasts 4 to 5 days. It consists of URI symptoms including a cough, runny nose due to inflammation of the nasal membranes (coryza), and conjunctivitis (the "three C's" of measles). 

In addition, low to moderate fever and Koplik spots (an enanthem found on the oral mucosa opposite the lower molars that are small bluish-white spots on an erythematous background) are common during this phase of the illness as well. A maculopapular rash first appearing behind the ears and on the forehead, moving progressively downward to engulf the entire body, generally appears on the third or fourth day of the illness, and lasts about 1 week.

The other answer choices are not indicative of measles.

74.

In managing a child with sickle cell anemia (SCA), which of the following is standard of care for stroke prevention with an abnormal transcranial Doppler ultrasound?

  • Initiate transfusion programs

  • Begin hydroxyurea

  • Folic acid supplementation

  • Volume replacement therapy to prevent circulatory collapse

Correct answer: Initiate transfusion programs

Annual stroke prevention screening of major intracranial vessels with a transcranial Doppler ultrasound evaluation is planned for 2- to 16-year-old children or as long as their bone windows allow meaningful waveforms to be evaluated. A reading of greater than 200 cm/sec time-averaged mean maximal velocity indicates a high risk for stroke and is an indication to start transfusion programs to maintain hemoglobin S levels less than 30%.

In children with severe SCA, hydroxyurea is used to reduce the number of painful crises and incidences of acute chest syndrome (a leading cause of death in adolescents with SCA). 

Folic acid supplementation is typically given to adults to prevent folate deficiency due to hemolysis. It is not recommended for children unless a folic acid deficiency is suspected and should be individualized for each patient. 

Volume replacement is used in the case of infections (and subsequent dehydration) in a child with SCA.

75.

You practice in a rural pediatric outpatient clinic, where a majority of your patients use well water, not city water, for drinking. You are asked by a patient's mother how often and when the well's water should be tested.

What is the MOST appropriate response?

  • Well water does not need to be tested for vitamin D before recommending supplementation

  • Well water should be tested monthly for pathogenic microorganisms

  • Well water should be tested yearly for lead levels, even if the child's lead screen is normal

  • Well water should be tested if there is a gastrointestinal illness in the home

Correct answer: Well water does not need to be tested for vitamin D before recommending supplementation

Assessment of environmental health hazards, including the source of the family's drinking water (well, city or bottled), should be integrated into health visits of both well and ill children. If the family drinks only well water, vitamin D supplementation is indicated, as well water does not have vitamin D.

Well water should be tested annually, not monthly, for bacteria, especially coliform bacteria. More frequent lead level testing of well water may be indicated if the child has an abnormal lead screen. Otherwise, annual lead testing in well water is not necessary. Well water should be considered a possible source of infection and tested only if there are frequent, recurring, or multiple GI illnesses in the home.

76.

Which of the following aspects of pediatric pharmacokinetics compared with adults is CORRECT?

  • Dosing intervals are often shorter in children than in adults

  • Children have lower metabolic capacity than adults

  • Children have less efficient renal elimination of drugs than adults

  • Children have relatively more adipose tissue than adults

Correct answer: Dosing intervals are often shorter in children than in adults

The maturing child is physiologically dynamic and factors such as size, age, renal function, and maturation/development/genetics of body systems compared to adults can lead to specific pharmacokinetic differences that can affect any given drug effect and dosing decision. 

Children have higher metabolic capacity and drugs must be given at shorter intervals. They tend to have more efficient renal elimination and will excrete drugs faster than adults. The lower content of adipose tissue in children also contributes to quicker absorption of drugs; therefore, the younger the child, the more the absorption may vary.

77.

A 4-year-old female presents to the clinic with her mother for concerns about perirectal and vaginal pruritus (excessive itching). You diagnose the child with pinworms, and the diagnosis is confirmed with a positive scotch tape test that was sent home with mom. 

You treat the patient with albendazole x2 weeks. Mom informs you that her older daughter is also exhibiting similar symptoms after recently attending a birthday party sleepover. You advise the mom to inform the parents of the girls at the sleepover, so they can be seen by their family physicians for treatment.

Who else should be treated?

  • The entire family of the original case

  • The original patient and her sister only

  • The parents only of the original case

  • The siblings of the party members

Correct answer: The entire family of the original case 

Treatment of all family members is vital to ensure complete eradication. Eggs can be aerosolized and pass easily among family members or people living in close contact with one another.

78.

In a child with an initial diagnosis of type 1 diabetes mellitus (T1DM), which of the following conditions is MOST likely to occur concomitantly?

  • Thyroiditis 

  • Polycystic ovary syndrome (PCOS)

  • Addison's disease

  • Precocious puberty

Correct answer: Thyroiditis 

The provider should always screen for concomitant associated autoimmune conditions. About 25% of children with T1DM have thyroid autoantibodies present at the time of diagnosis, which is predictive of thyroid dysfunction. Hypothyroidism is more common, although hyperthyroidism (Graves' disease) may also be present. Currently, the American Diabetes Association (ADA) recommends screening children with TIDM annually for autoimmune thyroid disease by obtaining a TSH level.

Celiac disease also occurs more frequently in children with diabetes (1% to 6%) compared to children without, although it's not nearly as common as thyroid dysfunction. Addison's disease is found in less than 1% of patients with type 1 diabetes, and there is little correlation between precocious puberty and PCOS, and type 1 diabetes.

79.

You are seeing a 17-year-old female who cut her leg on a metal fence while playing outside with her friends. Upon assessment, she has a puncture wound that is approximately 2 cm deep and 4 cm in diameter, with dirt in and around the wound. You clean, debride, then suture the wound. She reports she is up-to-date on her vaccinations and remembers getting her tetanus booster when she was 11 years old.

Which of the following statements is CORRECT?

  • In addition to wound care, she should receive Td or Tdap today

  • Since she is up-to-date on her immunizations, she needs only wound care today

  • In addition to wound care, she should receive Td or Tdap and Tetanus immune globulin (TIG) within 3 days

  • In addition to wound care, she should receive oral antibiotics for 10-14 days, but does not need a Td or Tdap since she is up-to-date on her tetanus vaccines

Correct answer: In addition to wound care, she should receive Td or Tdap today 

This patient has a wound that is considered high-risk for developing tetanus, and it has been > 5 years since last tetanus toxoid dose. Therefore, in addition to wound care, she should receive a tetanus vaccine prior to leaving her appointment. Tetanus-prone wounds include those contaminated with dirt, feces, or saliva, puncture wounds, avulsions, and wounds acquired as a consequence of missiles, burns, crushing, or frostbite.

TIG would be required in addition to a tetanus vaccine for individuals with tetanus-prone wounds who are under-vaccinated or whose vaccination status is unknown. For minor, clean wounds, tetanus vaccine would be indicated only if the last dose was >10 years ago. Metronidazole (Flagyl) is the antibiotic of choice in treating tetanus, but it is not necessary here, as the patient is not exhibiting signs of tetanus, and is presenting with a recent wound.

80.

A 23-month-old child weighing 23 pounds should be placed in which type of safety restraint when riding in a car?

  • A rear-facing convertible car seat in the back seat

  • A rear-facing booster seat in the back seat

  • A forward-facing convertible car seat in the back seat

  • A forward-facing booster seat in the back seat

Correct answer: A rear-facing convertible car seat in the back seat

Infants and toddlers younger than 2 years old should be in the rear-facing position in an infant car seat (if the height and weight requirements are still met) or a convertible car seat. Once the child is 2 years old, the convertible car seat may be placed in the forward-facing position.

A booster seat is for older children and should never be placed rear-facing. A safety restraint should always be in the back seat (never in the front seat), and one should always follow the height and weight requirement specific to that seat.

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